Showing papers in "American Journal of Surgery in 1933"

Segmental peridural spinal anesthesia

Abstract: T HE method of anesthesia which will now be described and which was worked out by me has been in use for three years with increasing success. It is intended to produce, as a resuh of a single injection which does not involve the subarachnoid spuce, a compIete, suffrcientIy long and deep anesthesia in any part of the body to enable any surgical intervention to be carried out. By this method the advantages of IocaI anesthesia with its freedom from risk are combined with those of subarachnoid spinal anesthesia with its powerful and satisfactory action. BriefIy described it is a procedure which makes it possibIe to obtain in the upper parts of the body just as exceIIent resuIts as may be had in the region of the sacrococcygea1 plexus after sacra1 extradura1 anesthesia has been performed.

A biological, bacteriological and clinical study of larval or maggot therapy in the treatment of acute and chronic pyogenic infections

Abstract: 1. 1. A single egg can be sterilized and a sterile larva and fly grown from it. 2. 2. Working with a mass of eggs, sterilization would appear to be much more dificult, apparently because of points of contact between two or more eggs. 3. 3. Using a single bottle from a series on which a brood had been grown, bacteriological study showed 10 per cent of 100 broods to be sterile. 4. 4. When “composite” cultures were made at intervals during the growth of the larva, the incidence of contamination increased as time went on, with 100 per cent contamination found by this type of cuhuring, after forty hours. 5. 5. The degree of bacterial contamination decreased as the technique of egg sterilization improved. 6. 6. The tota number of kinds of organisms in any one brood of maggots was found to be very small. 7. 7. Among these, pathogenic forms were few and occurred rarely. 8. 8. The iodine treatment of contaminated partly grown maggots was shown bacteriologically to be efficient in 40 per cent of broods.

The use of sclerosing solutions in the treatment of cysts and fistulae

Abstract: We have reported here cases of gliomatous cysts (astrocytomatous type), cervical fistulae and pilonidal sinuses in which a modification of Carnoy's solution used as a sclerosing agent has either greatly assisted in making an operation more complete, as in the cases of gliomatous cysts, or has been able to cure the condition without radical surgery, as in the cases of cervical fistulae and pilonidal sinuses.

Papilloma of the gall bladder

Abstract: B ENIGN tumors of the gaII bIadder were considered rare unti1 MacCarty described choIecystitis catarrhaIis papiIIomatosa in rgr o; he was the first in this country to describe the condition. About the time of his report, choIecystectomy began to be recognized more and more as the best procedure in treating many cases of disease of the gaI1 bIadder. With this change in surgica1 procedure, more thorough examination of the interior of the gaI1 bIadder couId be carried out, and papiIIomas began to be seen more frequentIy by the surgica1 pathoIogist. This increasing incidence of recognition of the condition is evident in the papers of Irwin and MacCarty, C. H. Mayo, Keene, M8IIe, AbeII, and MacCarty. My study was of a group of 500 gaI1 bIadders, surgicaIIy removed at The Mayo Clinic between 1923 and rg2g which proved to contain one papiIIoma or more. These gaI1 bIadders were taken consecutiveIy as they appeared in the course of a11 operations on the gaI1 bIadder. SpeciaI attention was given to the reIationship of papiIIoma t.o maIignancy, and to other diseases of the gaII bIadder. The corresponding cIinica1 histories were reviewed. The incidence by age of patients was found to be as foIIows: ten to twenty years, 0.4 per cent; twenty to thirty years, 6.2 per cent; thirty to forty years, 2g per cent; forty to fifty years, 30.8 per cent; fifty to sixty years, 27.6 per cent, and sixty to seventy years, 6 per cent. Of the patients from whom the gaII bIadders were derived, 68.4 per cent were femaIes. From these figures the high incidence of papiIIomas among patients of the comparativeIy earIy age group of thirty to forty years wiI1 be noted. PapiIIomas rareIy occur before the third decade of Iife. Records of post-mortem examinations made at the cIinic from 1922 to 1930 in cases in which death was from other causes than disease of the gaI1 bIadder discIose that onIy 3 cases of papiIIoma of the gaI1 bIadder were found among patients who were Iess than thirty years of age. These three patients were, respectiveIy, twentytwo, twenty-four and twenty-six years of age. Mentzer, in his study of 633 consecutive postmortem examinations, found onIy one patient Iess than thirty years of age who had papiIIomatous choIecystitis. AI1 the sections studied microscopicahy gave evidence of inflammation, either in an acute, subacute, or chronic form, but by far the greatest number were exampIes of so-caIIed chronic catarrha1 choIecystitis, as is shown by infiItration of the submucosa by smaI1 round ceIIs. EtioIogicaIIy I think two factors present themseIves in the formation of papiIIomas: in one group infection pIays the important part; in a second group, infection and metaboIic disturbances work together. By far the Iarger number of cases wiI1 faI1 in the Iatter group. In the cases of true inffammation, the gross appearance is that of papiIIary projections from the mucous membrane of the gaI1 bladder; the coIor of the papilloma resembIes that of the mucous membrane. The pedicIe is of about the same size as the growth (Fig. I). The growth, therefore, does not break off easiIy, but, as wiI1 appear, papiIIomas of the type next to be described do break off. MicroscopicaIIy, the papiIIomas appear as projections with many branches, with very Iittle stroma,

Effect of roentgen rays on bone growth and bone regeneration

Abstract: D URING the fn-st year after the discovery of the x-rays, it was observed that this form of energy produced profound changes in Iiving matter. In 1903 Perthes found that the growth of one wing of a chicken was greatIy diminished if this wing onIy were exposed to the inffuence of roentgen rays when the chicken was one day oId. Since the appearance of Perthes’ report, numerous investigators have recorded their observations concerning the influence of the roentgen ray on the growth of bones in anima1 experiments and aIso from the therapeutic use of the roentgen ray. From a carefu1 review of a11 the avaiIabIe Iiterature it seemed that there was as yet a sufhcient Iack of cIearness concerning the amount of irradiation necessary to inhibit the growth of bone, the quantity of the effect produced, the duration of the inff uence, and the coincident histoIogica1 changes, to justify the repetition of many of the experiments previousIy performed. The possibiIity of inhibiting or stimuIating regeneration of bone has afso been investigated by experiments upon animaIs and by observations upon patients with bone defects due to trauma or other disease. From previous studies it seems as if it were definiteIy determined that extraordinariIy Iarge doses of irradiation have IittIe or no effect on the capacity of a bone to [regenerate new bone. There is a conflict of opinions concerning the stimuIating effect of the roentgen ray on new bone formation, but it wouId seem as if the maximum stimuIating effect which had been observed is not sufficient to be of importance. * From the Department of Surgery, VanderbiIt University. t Deceased.

Epiphrenal diverticulum of the esophagus with case report

Abstract: Thirty-one reported cases of true epiphrenal diverticulum are analyzed. The etiological considerations of this condition are discussed. A typical asymptomatic case is reported.

Extreme cardiac decompensation following traumatic arteriovenous fistula of the left subclavian vessels

Abstract: 1. 1. In a previously healthy woman, an arteriovenous fistula in the first portion of the left subclavian vessels was diagnosed forty-eight hours after the inff iction of a stab wound beneath the left clavicle. 2. 2. Locally, during the healing of the wound a thrill and bruit became marked and widespread. There was no complaint of severe pain, but the patient was much disturbed by the noise of the bruit and by a sensation of oppression in the chest. There was no tumor. 3. 3. Peripherally there were no varicosities, neither was there any edema of the extremity. The pulse in the involved side was weaker and the blood pressure was lower than on the sound side. 4. 4. Centrally and systemically she developed, within six weeks of the receipt of the injury, every discomfort which could we11 take place from a decompensated heart: pleura1 and peritonea effusions, enlargement of the liver, edema of the lower extremities, cough, dyspnea, dilated heart, low blood pressure and weakened pulse. 5. 5. Following ligation of the subclavian artery in its first and third portions; and the subclavian, interna jugular, and left innominate veins, and excision of the included sections of these vessels together with the fistula, the signs of broken compensation have disappeared, the quality of the pulse has improved, and the blood pressure has risen to a more norma level. The patient has been able to resume her household duties and is steadily improving. The heart, though wellcompensating, has sustained damage which will probably be permanent.

Original articleRenocolic fistulae

Abstract: Renocolic fistulae are always secondary to long-standing suppurative lesions of the kidney which as a rule are associated with either a chronic perinephritis or a perinephric abscess. In a third of the reported cases renal calculus was associated with this lesion, while in only 2 of the 34 was the primary lesion tuberculous in origin. In no instance was there any primary pathological process in the large bowel. In only 2 instances did the report claim that the fistula was between the renal pelvis and bowel. In all others the fistula was from a calyx, passing through the kidney substance into the bowel. A study of the anatomical relations of the reflection of the peritoneum from the posterior abdominal wall will give some idea as to why and where renocolic fistulae occur.

Wounds of the heart and a discussion of the causes of death

Abstract: 1. 1. The important causes of death from heart wounds which we should remember are: “Herz tamponade” Hemorrhage Foreign bodies Secondary infection. 2. 2. Aspiration of the pericardium may relieve the patient from “Herz tamponade” temporarily until the operation can be performed, and occasionally aspiration alone may save life. 3. 3. Foreign bodies may do little harm and should not be removed in most instances. 4. 4. Extreme care should be used to eliminate infection, which often follows in the pleural cavity, and takes many lives after apparently successful suture. 5. 5. The operative approach to the heart when the pleura has not been injured should be with great care to avoid opening the pleura. On the other hand when the pleura has been wounded the approach should be through the pleural cavity. 6. 6. Electrocardiographic studies were given which showed the effect of the coronary obstruction.

Vascular obstruction of the ureter in juveniles

Abstract: Seven proved cases and one probable instance of vascular ureteral obstruction in juveniles are reported. Loin pain is a frequent symptom. When infection with pyuria exists, “chronic pyelitis” is the usual diagnosis. When infection is slight or absent, the clinical diagnosis, based on urinalysis, is likely to be chronic interstitial nephritis. The existent nephritis is regularly of the toxic variety in the unobstructed organ and of the compression or back-pressure type in the obstructed kidney. This nephritis may be expected to disappear following removal or adequate treatment of the seriously diseased mate. Only by complete urological examination with urography can the diagnosis accurately be made preoperatively. Conservative surgery, chiefly vessel resection or ureteroplasty, is urged; nephrectomy is demanded with far-advanced renal destruction, infection or calculus disease. By specific example these cases serve to emphasize the great importance and necessity of the employment of modern urological methods in the diagnosis and treatment of persistent urinary tract disease in young patients.

Bladder tumor: Observations on one hundred and fifty cases☆

Abstract: 1. 1. One hundred and fifty cases of tumor of the bladder have been studied as to age, symptomatology, type of tumor, treatment and end result. 2. 2. Thirty-seven autopsies have been analyzed as to type and grade of cancer, presence and distribution of metastases, and existence of other pathological conditions.

Complete & permanent removal of toe nail in onychogryposis & subungual osteoma

Abstract: A plastic operation for complete and permanent removal of the toe nail is described. This operation is offered for cases of onychogryposis, subungual osteoma, and any deformity of the toe nail where complete removal of the nail is indicated.

End results in the treatment of cancer of the breast by radical surgery combined with preoperative and postoperative irradiation

Abstract: M UCH that is being written today concerning mammary cancer contains fauIty phiIosophy upon the subject. When the radica1 amputation was devised in 1888 by HaIsted and WiIIy Meyer independentIy, a new era began in the treatment of cancer of the breast. The radica1 operation had been carefuIIy pIanned and it was proposed in the reasonabIe hope that in a certain percentage of cases, a compIete eradication of the IocaI disease couId be assured, with a possibIe permanent cure. Today, this operation stiI1 remains the most effective weapon in the hands of the surgeon, and the advent of irradiation furnishes an additiona usefu1 therapeutic adjunct. But the stage of the disease which was seen thirty-five years ago by the surgeons of that time was much more advanced than the earIier phases that are encountered in the surgica1 cIinics of this country today. Moreover, as we are Iearning more about the disease, we are appreciating the futiIity of applying the radica1 surgica1 procedure in more advanced stages, with wide extension or metastasis far beyond the reach of surgery. We beiieve that these more advanced forms shouId be handIed by paIIiative surgery, combined with irradiation. In this conviction, we are not in accord with Lewis and Rienhoff who fee1 that radica1 surgery shouId be done even in the advanced phases of mammary cancer. RadicaI amputation combined with the usefu1 adjuncts of preoperative and postoperative irradiation, is the best method in hand