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AUTOMATIC RETRACTOR FOR ABDOMINAL SURGERY
692 Ahlstrom (1931), in trying to explain the occurrence of carcinoma with chorionepithelioma in the male in the absence of a teratoma, has suggested that local differentiation is the cause. Mathieu (1939) recognises that some cases of chorionepithelioma are paradoxical and would place them in the irreconcilable group, and that is where this case undoubtedly belongs. to
I wish to thank Sir Frederick Menzies for permission publish this case. REFERENCES
Soresi, A. L. (1936) Amer. J. Cancer, 28, 483. Ahlström, C. G. (1931) Acta path. microbiol. scand. 8, 213. Mathieu, A. (1939) Surg. Gynec. Obstet. 68, 181.
A NEW WAY TO DETERMINE BLEEDING-
TIME
BY H. A. E.
v.
DISHOEK, M.D.
AND
JONGKEES, M.D. (From the oto-rhino-laryngological departments of Universities of Amsterdam and Utrecht)
REFERENCES
L. B. W.
the
THE usual method of determining the bleeding-time is that described by Duke (1912), who makes a stab wound in the finger-tip or in the ear lobe after careful cleaning. The blood flowing from the wound is sucked away with tissue-paper every 15-30 sec., without the wound being touched. To obtain more accurate results, Spitz (1923) has suggested making a wound of fixed depth in the ear lobe with a Francke’s blood lancet and rubbing the lobe firmly before measuring the bleeding-time. In this way a maximal quantity of blood will flow from the ear lobe. Even then, as Fonio (1928) and others admit, the determination of the bleeding-time is inaccurate. This is due to the fact that the thickness of the skin differs in different places and in different people, with the result that the resistance to the blood-flow varies. Moreover, this resistance is enhanced by the edges of the wound adhering together, and the direction of the stab wound influences the direction in which the skin splits and the relative direction of the vessels. These factors may hinder haemorrhage so much that a small punctured wound may show no increased bleeding-time in hoemophilia, although an operation would be fatal, because tension and adhesion of the skin play no part in an open wound, only the contraction of the vessels and the formation of thrombus being of importance. For these reasons we have developed a method which imitates as nearly as possible the circumstances of an open wound. First, the ear lobe is made hyperasmic by rubbing. Next, it is pressed against a thin steel plate-e.g., a razor blade-with a circular opening 4 mm. in diameter. A small part of the lobe is protruded through this opening and cut off with a Thus an open wound is obtained, in which razor. many capillaries have been cut. The wound should preferably not be made on the edge of the lobe. The blood is sucked up every half-minute with a separate portion of filter paper without the wound being touched, and the number of drops on the paper indicates the bleeding-time in half-minutes. The force with which the ear lobe is pressed against the steel plate can be made constant by fastening a steel spring to the plate and fixing the lobe in between. This method is not very painful, probably owing to the pressure; at any rate it is much less painful than a
puncture.
To find out whether with this method sufficiently consistent results can be obtained, we have determined the bleeding-time of 85 people, each twice with an interval of four hours. The difference between the two records was only in a few cases more than a minute. The average bleeding-time estimated by this method in 450 tests was 3 min. 25 sec. By Duke’s method an average bleeding-time of only 2 min. 30 sec. was obtained. The increased time obtained by our method is important in scientific investigations because the The longer the margin of error is thus reduced. bleeding-time, the more accurately the difference between two groups of observations can be shown. To summarise, this method produces consistent results, is not painful, and leads to a longer bleedingtime, haemorrhage not being hindered by the edges of the wound adhering together and by tension of the In this way some cases of ha3morrha.gie tissues. diathesis can be detected which could not be discovered by previous methods. Duke, J. (1912) J. Amer. med. Ass. 15, 1125. Fonio, A. (1928) Bethe’s Handbuch der normalen und pathologischen Physiologie, Berlin, vol. vi, 377. Spitz, S. (1923) Klin. Wschr. 13, 584.
New Inventions AUTOMATIC RETRACTOR FOR ABDOMINAL SURGERY
THE retractor and stand here illustrated is for use in deep pelvic and other abdominal operations and has been made for me by Powells Ltd., Bombay. The use of this retractor, which holds the tissues firmly and exposes to view a large field of operation,
dispenses with the services of a third surgical assistant, who would otherwise to required to hold a retractor. Since this apparatus is not placed between the patient’s legs, it does not interfere with the arrangement of sterilised towels and with the passage of instruments into the rectum or into the vagina; nor does it cause pressure on the genitalia. F. R.
PARAKH,
M.D.
Manc., F.C.P.S. Bombay.
Parsi General Hospital, Bombay.
"... Studying medicine is probably the worst nervous strain you can put any man through. It’s like having a wife who is pregnant all the time and never delivered; only when the time for the delivery comes, as in a nightmare, it turns out to be you, and not your wife, who have to be delivered."—AUGUSTA TucKEB in "Miss Susie Slagle’s," London, 1940.
I wish to thank Sir Frederick Menzies for permission publish this case. REFERENCES
Soresi, A. L. (1936) Amer. J. Cancer, 28, 483. Ahlström, C. G. (1931) Acta path. microbiol. scand. 8, 213. Mathieu, A. (1939) Surg. Gynec. Obstet. 68, 181.
A NEW WAY TO DETERMINE BLEEDING-
TIME
BY H. A. E.
v.
DISHOEK, M.D.
AND
JONGKEES, M.D. (From the oto-rhino-laryngological departments of Universities of Amsterdam and Utrecht)
REFERENCES
L. B. W.
the
THE usual method of determining the bleeding-time is that described by Duke (1912), who makes a stab wound in the finger-tip or in the ear lobe after careful cleaning. The blood flowing from the wound is sucked away with tissue-paper every 15-30 sec., without the wound being touched. To obtain more accurate results, Spitz (1923) has suggested making a wound of fixed depth in the ear lobe with a Francke’s blood lancet and rubbing the lobe firmly before measuring the bleeding-time. In this way a maximal quantity of blood will flow from the ear lobe. Even then, as Fonio (1928) and others admit, the determination of the bleeding-time is inaccurate. This is due to the fact that the thickness of the skin differs in different places and in different people, with the result that the resistance to the blood-flow varies. Moreover, this resistance is enhanced by the edges of the wound adhering together, and the direction of the stab wound influences the direction in which the skin splits and the relative direction of the vessels. These factors may hinder haemorrhage so much that a small punctured wound may show no increased bleeding-time in hoemophilia, although an operation would be fatal, because tension and adhesion of the skin play no part in an open wound, only the contraction of the vessels and the formation of thrombus being of importance. For these reasons we have developed a method which imitates as nearly as possible the circumstances of an open wound. First, the ear lobe is made hyperasmic by rubbing. Next, it is pressed against a thin steel plate-e.g., a razor blade-with a circular opening 4 mm. in diameter. A small part of the lobe is protruded through this opening and cut off with a Thus an open wound is obtained, in which razor. many capillaries have been cut. The wound should preferably not be made on the edge of the lobe. The blood is sucked up every half-minute with a separate portion of filter paper without the wound being touched, and the number of drops on the paper indicates the bleeding-time in half-minutes. The force with which the ear lobe is pressed against the steel plate can be made constant by fastening a steel spring to the plate and fixing the lobe in between. This method is not very painful, probably owing to the pressure; at any rate it is much less painful than a
puncture.
To find out whether with this method sufficiently consistent results can be obtained, we have determined the bleeding-time of 85 people, each twice with an interval of four hours. The difference between the two records was only in a few cases more than a minute. The average bleeding-time estimated by this method in 450 tests was 3 min. 25 sec. By Duke’s method an average bleeding-time of only 2 min. 30 sec. was obtained. The increased time obtained by our method is important in scientific investigations because the The longer the margin of error is thus reduced. bleeding-time, the more accurately the difference between two groups of observations can be shown. To summarise, this method produces consistent results, is not painful, and leads to a longer bleedingtime, haemorrhage not being hindered by the edges of the wound adhering together and by tension of the In this way some cases of ha3morrha.gie tissues. diathesis can be detected which could not be discovered by previous methods. Duke, J. (1912) J. Amer. med. Ass. 15, 1125. Fonio, A. (1928) Bethe’s Handbuch der normalen und pathologischen Physiologie, Berlin, vol. vi, 377. Spitz, S. (1923) Klin. Wschr. 13, 584.
New Inventions AUTOMATIC RETRACTOR FOR ABDOMINAL SURGERY
THE retractor and stand here illustrated is for use in deep pelvic and other abdominal operations and has been made for me by Powells Ltd., Bombay. The use of this retractor, which holds the tissues firmly and exposes to view a large field of operation,
dispenses with the services of a third surgical assistant, who would otherwise to required to hold a retractor. Since this apparatus is not placed between the patient’s legs, it does not interfere with the arrangement of sterilised towels and with the passage of instruments into the rectum or into the vagina; nor does it cause pressure on the genitalia. F. R.
PARAKH,
M.D.
Manc., F.C.P.S. Bombay.
Parsi General Hospital, Bombay.
"... Studying medicine is probably the worst nervous strain you can put any man through. It’s like having a wife who is pregnant all the time and never delivered; only when the time for the delivery comes, as in a nightmare, it turns out to be you, and not your wife, who have to be delivered."—AUGUSTA TucKEB in "Miss Susie Slagle’s," London, 1940.