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A method of removing a bead from a bronchus
74
American
Journalof Surgery
Progress
incisors, attaching ofttimes in a deep fissure formed by the maxiIIary bones, and ending in a tuft of tissue Iingual to the gingiva1 border of the gums. Upon raising the upper Iip the frenum wiI1 be seen to spread out in fan-shape, Iosing the ends of its fibers in the Iip. Under gentIe stimuIation the space between the incisors is to be partiaIIy closed. When two-thirds cIosed, the frenum shouId be removed surgicaIIy. This operation is performed by anesthetizing the tissues, and with sharp bistoury, cutting down to the bone on each dista1 margin of the frenum and around the tuft of tissue on the IinguaI surface, thus enucleating the stricture. Then with sharp smaI1 currette the whoIe is peeIed out from IinguaI to IabiaI and from deep down in the fissure. With sharp knife or scissors it is then cut off about 5 mm. above the gingival border. A few sutures may be inserted, but rareIy is this necessary. Teeth shouId now be moved into contact with each other, and retained there unti1 fibers from each adjoining waI1 have united, and tissues have become fixed in their new environment. JESBERG, SIMON. A method of removing a bead from a bronchus. Laryngoscope, Dec., I 926, xxxvi. Smooth, round or ova1 foreign bodies in a bronchus tend to descend as far as possible, diIating the air tubes and permitting a partia1 coIIapse of the Iumen above the body. Such a body, if hard and smooth, is aImost impossibIe to engage with any usua1 grasping instrument, and if impacted there is insuffIcient room between it and the waIIs of the bronchus to permit the passing of an instrument around it. Even the slightest pressure pushes the foreign body deeper and impacts it more tightIy. In the case of a foreign body containing a hole, e. g., a bead, the sides of the hoIe can be used as a grasping surface. If, however, the hole is smaI1, it is diffIcuIt to pass into it a probe or grasping forceps suffIcientIy strong to be safe. The device here described consists of a stee1 styIet or probe, the dista1 end of which contains an eye through which a thin rubber band can be threaded. The probe with the stretched rubber band is made just smaI1 enough to pass through the hoIe in the bead. When this is accompIished the tension on the rubber band is reIeased and the expansion of the rubber band Iocks the bead on the styIet.
in Surgery CHAPMAN, T. L. LocaI anesthesia in toxic goiter. Minnesota Med., Dec., 1926, ix. Chapman makes use of inMtration onIy, proceeding carefuIIy and quickIy through the front pIanes unti1 the surface of the gIand is exposed, then infiItrating the Ioose connective tissue at the side and behind the Iobes, seizing and raising them so that any necessary advancement of the edematized fieId can be easiIy made without pain. This can be done with a short needIe without the sIightest danger of injury to important adjacent structures. In his whoIe series no such injury has occurred, and anesthesia was entireIy satisfactory. The soIution used is 0.5 per cent procaine, in norma1 saIt soIution. In two years, more than three hundred goiters, mostIy of the exophthaImic type, were operated upon by this method, with no reason to fee1 that it faiIed in any instance in satisfactory anesthetic effect or in giving the greatest possibIe lack in undesirabIe after-effect to the patients. With regard to time consumed in getting to the actua1 remova of the gIand at operation, it is quite as rapid as with other methods, and there is the additiona advantage that the infiItration edema produced makes for easy separation of anatomica planes with the greatest precision and minimum of bIeeding. In the severe and questionabIe cases IocaI anesthesia wiI1 show frequentIy so decisive a gain over any other type of anesthesia that a distinct advantage over a11 other methods may be read in the mortaIity and morbidity records. By this mode of management, some extreme cases can be brought to surgery that by any other method are impossibIe and not to be considered. On the surgeon’s side can be credited these vaIues: The anatomica reIationships with IocaI anesthesia are accurate and undisturbed, the edematization of the tissues making their dissection and separation quick and easy; the engorgement of the veins, so notabIe in nitrous oxide and ethyIene anesthesia, is not seen. The contro1 of bIood Ioss is very accurate, and the advantage of a shortened operating time is thus secured. If doubt regarding hemostasis is felt, the patient can be caIIed upon to cough or hoId the breath, before cIosure of the deep field, to test the accuracy of the Iigations. Test of phonation can be voIuntariIy empIoyed by the patient during the operative maneuvers, if
American
Journalof Surgery
Progress
incisors, attaching ofttimes in a deep fissure formed by the maxiIIary bones, and ending in a tuft of tissue Iingual to the gingiva1 border of the gums. Upon raising the upper Iip the frenum wiI1 be seen to spread out in fan-shape, Iosing the ends of its fibers in the Iip. Under gentIe stimuIation the space between the incisors is to be partiaIIy closed. When two-thirds cIosed, the frenum shouId be removed surgicaIIy. This operation is performed by anesthetizing the tissues, and with sharp bistoury, cutting down to the bone on each dista1 margin of the frenum and around the tuft of tissue on the IinguaI surface, thus enucleating the stricture. Then with sharp smaI1 currette the whoIe is peeIed out from IinguaI to IabiaI and from deep down in the fissure. With sharp knife or scissors it is then cut off about 5 mm. above the gingival border. A few sutures may be inserted, but rareIy is this necessary. Teeth shouId now be moved into contact with each other, and retained there unti1 fibers from each adjoining waI1 have united, and tissues have become fixed in their new environment. JESBERG, SIMON. A method of removing a bead from a bronchus. Laryngoscope, Dec., I 926, xxxvi. Smooth, round or ova1 foreign bodies in a bronchus tend to descend as far as possible, diIating the air tubes and permitting a partia1 coIIapse of the Iumen above the body. Such a body, if hard and smooth, is aImost impossibIe to engage with any usua1 grasping instrument, and if impacted there is insuffIcient room between it and the waIIs of the bronchus to permit the passing of an instrument around it. Even the slightest pressure pushes the foreign body deeper and impacts it more tightIy. In the case of a foreign body containing a hole, e. g., a bead, the sides of the hoIe can be used as a grasping surface. If, however, the hole is smaI1, it is diffIcuIt to pass into it a probe or grasping forceps suffIcientIy strong to be safe. The device here described consists of a stee1 styIet or probe, the dista1 end of which contains an eye through which a thin rubber band can be threaded. The probe with the stretched rubber band is made just smaI1 enough to pass through the hoIe in the bead. When this is accompIished the tension on the rubber band is reIeased and the expansion of the rubber band Iocks the bead on the styIet.
in Surgery CHAPMAN, T. L. LocaI anesthesia in toxic goiter. Minnesota Med., Dec., 1926, ix. Chapman makes use of inMtration onIy, proceeding carefuIIy and quickIy through the front pIanes unti1 the surface of the gIand is exposed, then infiItrating the Ioose connective tissue at the side and behind the Iobes, seizing and raising them so that any necessary advancement of the edematized fieId can be easiIy made without pain. This can be done with a short needIe without the sIightest danger of injury to important adjacent structures. In his whoIe series no such injury has occurred, and anesthesia was entireIy satisfactory. The soIution used is 0.5 per cent procaine, in norma1 saIt soIution. In two years, more than three hundred goiters, mostIy of the exophthaImic type, were operated upon by this method, with no reason to fee1 that it faiIed in any instance in satisfactory anesthetic effect or in giving the greatest possibIe lack in undesirabIe after-effect to the patients. With regard to time consumed in getting to the actua1 remova of the gIand at operation, it is quite as rapid as with other methods, and there is the additiona advantage that the infiItration edema produced makes for easy separation of anatomica planes with the greatest precision and minimum of bIeeding. In the severe and questionabIe cases IocaI anesthesia wiI1 show frequentIy so decisive a gain over any other type of anesthesia that a distinct advantage over a11 other methods may be read in the mortaIity and morbidity records. By this mode of management, some extreme cases can be brought to surgery that by any other method are impossibIe and not to be considered. On the surgeon’s side can be credited these vaIues: The anatomica reIationships with IocaI anesthesia are accurate and undisturbed, the edematization of the tissues making their dissection and separation quick and easy; the engorgement of the veins, so notabIe in nitrous oxide and ethyIene anesthesia, is not seen. The contro1 of bIood Ioss is very accurate, and the advantage of a shortened operating time is thus secured. If doubt regarding hemostasis is felt, the patient can be caIIed upon to cough or hoId the breath, before cIosure of the deep field, to test the accuracy of the Iigations. Test of phonation can be voIuntariIy empIoyed by the patient during the operative maneuvers, if