MKDIcBR=TouLof Douglas, each about the size of a tangerine and attached to the back of the uterus. They were moderately tender. This finding was confirmed on vaginal examination. The white cells numbered 15,000 per c.mm., of which 77% were polymorphs. A radiograph of the pelvis showed the presence of a cluster of teeth in front of the sacrum and a little to the left of the midline. producing the twist by constricting the area of attachment of the hydrosalpinx. The dermoid cyst of the left ovary had not taken part in the torsion of the left tube and did not seem to have had anything to do with its production.A study of the recorded cases of torsion of the Fallopian tube reveals that in the majority of cases the tube is the seat of disease, although a normal tube may undergo this complication. The commonest lesion is a hydrosalpinx, and this fact is well shown in the figures quoted above from Anspach's paper. A hydrosalpinx satisfies the conditions required-for torsion of an organ-namely, a freely mobile tumour attached to a more or less fixed base by a pedicle. A pyosalpinx, on the other hand, is much less likely to undergo torsion because of surrounding adhesions which limit its mobility.The clinical picture of torsion of the tube resembles that of torsion of an ovarian cyst, for which it has often been mistaken, but differs in that the symptoms are much less severe, and also in that shock is not a feature of the condition.I wish to thank Mr. John Scholefield, under whose care the patient was admitted, for guidance and for permission to publish this case.
Leiomyosarcoma of the StomachLeiomyosarcoma is one of the rarest tumours of the stomach, comprising only 10% of all gastric sarcomas. Ewing (1940) estimated that 1% of malignant tumours of the stomach were sarcomatous. At the Mayo Clinic in one year, however, of 298 malignant lesions of the stomach 3.3 % were sarcomas (Counseller et al., 1946). Edwards and Wright (1933) thought the condition more common than the number of reported cases indicated.
CASE REPORTThe patient was a Bantu woman aged 21. She had four years' history of attacks of severe epigastric pain, which was unrelated to meals but worse before her periods. For the last six months she had continuous pain and frequent vomiting, the vomitus being pale and never coffee-ground in appearance. Her appetite was good, but she had lost a great deal of weight and was becoming progressively weaker. Her diet was predominantly carbohydrate, and her home conditions were poor.On examination she was cachectic and too weak to stand. The temperature was 100°F. (37.80 C.) and pulse 120. In the abdomen a hard, tender mass was felt occupying the costal angle; there was a second mass under the left costal margin which appeared to be connected with the liver. Both masses were felt only on deep inspiration. There were no other physical signs.The patient stopped vomiting on the day of admission. She exhibited a remittent temperature which frequently reached 1020 F. (38.90 C.). A chest radiograph showed clear lung fields bu...
