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1902. The middle and lowest fibroids were enu- Coreg 10 Mg cleated through a median incision, shelling out very readily. The upper tumor was removed by an elliptical incision, Order Coreg which included the sur- rounding scar tissue. The wound was closed by sutures of silkworm gut, deeply placed so as to obliterate all spaces. The closed incision made a continuous linear wound, placed between the left labia majus and minus. The wound healed per primam, and the patient was discharged Septem- ber 10th. Eighteen months later there had been no recurrence of the growths. The pathologist, Dr. Ralph Morse, reported the tumors to be fibromata mollia. Although the number Coreg Er of cases reported is too small to serve as a basis for the establishment of hard and fast conclusions, still an analysis of them may be of interest. It will be seen that from the standpoint of aetiology, Coreg 18.75 Mg the age and social condition of the patient are of importance. In the majority of the cases cited, the tumors ap- peared from the thirty-fifth to the fifty-second year in women who were married and had borne children. Veit, in discussing the setiology of fibromata of the vulva, lays considerable stress upon the irritation of the tissues due to coition, and the facts in the cases reported bear out his observations. Veit also Coreg Cr 10 Mg states that Is Coreg A Beta Blocker in many cases the initial condition is one of elephantiasis, the connective tissue elements and muscle cells sub- sequently taking on more active growth, and the tumor resulting from this cell proliferation. The fact that wide lymphatic spaces, sometimes suffi- ciently extensive to be classed as cysts, are occa- sionally found in vulval fibromata forms the basis of this assertion. Fibromata may develop from the fascial structures, from the round ligaments, Cheap Coreg or from other connective tissue elements in this region. The left labium majus was most often the seat of development in the cases which I have reported, and the labia minora were less frequent- ly involved. The tumors were pedunculated in 50 per cent, of the cases. In but one case, that of Kirchoflf, were multiple growths reported. The diagnosis of fibromata of the vulva should not be difficult. Small growths may be differen- tiated from elephantiasis by the fact that the fibroid is sharply outlined and more or less mov- able under the skin. Elephantiasis vulvas is a condition of diffuse thickenina: due to inflamma- tion and hypertrophy of the lymphatic channels. Cysts of Bartholin's glands are thin walled, globular shaped structures, and give the peculiar movable fluctuating feel characteristic of reten- tion cysts. It is especially important to recog- nize carcinoma of the vulva, which is also a rare condition. Carcinoma is characterized by rapid- ity of growth, early infiltration of the surround- Coreg Generic Name ing tissue, tendency to early ulceration, and in- volvement of the neighboring lymphatics. Pain, a prominent S3'mptom in carcinoma, is absent in these fibroid growths. Lipomata of the vulva are rather more common than fibromata. They are Coreg Cr 40 Mg usually larger, softer, and are perhaps oftener pedunculated. From a clinical standpoint their differentiation is unimportant. Inguinal hernia descending into the labial structures may pro- duce a mass resembling a new growth. It is to be differentiated by the history of the patient, by the possible presence of distensile expansion on coughing, by the percussion note if the hernial sac contains gut, and by its possible reducibility. The diagnosis between hernia and new growth may Coreg 2.125 Mg be difficult as in a case reported by Coreg Cr 80 Mg Tuttle, in which incision for fibroid revealed a structure resembling a hernial sac. Careful investigation showed it to be Coreg Cr 20 Mg a cystic fibroma, having its origin in the tissues Generic Coreg Cr of the round ligament. The impor- tance of recognizing a hernia in this location is apparent. The diagnosis between fibroma molle Coreg Cr Generic and sarcoma-, can usually be made only by the microscope, and in at least two of the cases stud- ied even the microscope failed to make a satis- factory Coreg 80 Mg distinction. The border line between the two conditions is exceedingly shadowy. The only treatment of fibromata of the vulva is surgical. Benign growths of the vulva are no menace to the life of the individual ; but as malig- Coreg 20 Mg nant tumors and especially sarcomata in their early stages often simulate innocent growths, prompt removal of any neoplasm is indicated. Mesoblastic growths are easily enucleated. If a capsule is present it should be removed. Pe- dunculated growths are best dealt with by mak- ing an elliptical incision around the base of the mass, and ligating the pedicle with catgut. Haem- orrhage is usually slight, but should be thorough- ly controlled, especially in those tumors originat- Coreg Cr 40 ing in the inguinal canal. Sutures should be deeply passed to close dead spaces. In every case the material removed should be submitted to the pathologist, and Coreg Cr 20 if the tissue is found to be malig- nant, radical measures should be instituted. The Coreg 40 Mg employment of the microscope in diagnosticating these conditions ' cannot be too strongly urged.

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