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A T-tube inserter
,NEW
INSTRUMENTS
4
A T/TUBE INSERTER IRVING WILLS, M.D., Attending,
P.A.C.S.
Santa Barbara Cottage HospitaI and Santa Barbara Hospital SANTA
BARBARA,
L
ONG ago the r-tube proved its efficiency as a means of suppIying a particuIar type of drainage in such
CALIFORNIA
The technique is simpIe. The instrument is Ioaded by the nurse or assistant, using a smaI1 amount of steriIe Iubricating jeIIy
FIG.
Iocations as the common biIe duct and the smaI1 bowe1 and many surgeons today find diffrcuhy in getting aIong without it. However, the use of this spIendid aid has never been very universa1. It is our beIief that one of the main reasons for this negIect has been the technica difhcuIty often attendant upon insertion of the r-tube into the viscus. FrequentIy, too, the time eIement is an important factor and the surgeon handIing a desperate case wiI1 choose a simple catheter, which can be easiIy inserted, instead of the r-tube which he might greatIy prefer. To overcome these diffrcuhies I devised a r-tube inserter which has handIed the probIem so satisfactoriIy that I wouId Iike to pass it aIong. The instrument consists of two meta tubes, one sliding within the other, the caliber of the inner one being of a size to just admit the Iong Ieg of the r-tube. The outer tube is large enough to hoId the foIded short arms of the T. 37’5
FIG.
2.
NEW SERIES VOL.XxX1,
No. z
WilIs-T-Tube
to keep the rubber from binding aIong the sides of the tube. A purse-string is put into the waII of the viscus and an opening made. The wall of the viscus is steadied with two AIIis forceps and the end of the By instrument appIied to the opening.
REFERENCES
Inserter
American
Journal
of Surgery
377
cIosing the instrument the T-tube enters the viscus accurately, its two arms opening out in opposite directions due to the spring of the rubber. The purse string is drawn up and tied and theinstrument removed by simply sIiding it back off the Iong Ieg.
OF
DR.
HARRIS”
REFERENCES ALVAREZ W. C. How earIy do physicians diagnose cancer in themseIves. Histories of 41 cases. J. A. M. A., 97: 77-83 (JuIy II) 1931. ASHHURST, A. P. C., and KLOPP, J. W. Carcinoma of stomach. Arch. of Surg., 27: 320-344, 1933, BALFOUR, D. C., and HARGIS, E. H. Cancer of the stomach. Am. J. M. SC., 173: 773, 1927. BASTIANELLI, R. Carcinoma perigastroduodenaIe. Am. J. Surg., 93: 301-316 (Jan.) rg3r. BASTIANELLI, RAFFAALE. Report of International Cancer Conference. Brit. M. J., 2: 169 (JuIy 28) 1028. BENA& E. Pseudocancerous type of gastric syphilis. Arch. ital. di dermat., sif. 5: I8o-198, Ig2g-Ig3o. BENNETT, T. I. Early diagnosis of carcinoma of stomach. Practitioner, 130: 141-150 (Feb.) 1933. BERGER, W. Cancer of the stomach: present states of earIy diagnosis. Wien. klin. Wcbnscbr, 44: 33; 71; 108 (Jan.) 1931. BLOODGOOD,J. C. UItimate results and actua1 functiona1 resuIts after different types of operation after intervaIs of five years or more. Am. J. Surg., gz: 574-596 (Oct.) 1930. BRINDLEY, P., and WOLFE, P. S. Cancer and peptic uIcer. Tex. St. J. M., 26: 51o-512 (Nov.) 1930. BROOKS, BARNEY. Persona1 communication. BULCHMAN, P. I. EarIy diagnosis of cancer of stomach; its reccurrence and metastases. Klin. med., (Nos. 23-24) 10: 1008-1014, 1932. BURKE, M. 0. Cancer and peptic uIcer. Vu. Med. Monthly, 59: 150-153 (June) 1932. CABOT. Carcinoma of stomach. New Engl. J. Med., 202: 881-882 (May) 1930. CARSON. Report. of InternationaI Cancer Conference. Brit. M. J., 2: 169 (Jury 28) 1928. CARRO, S. Diffculties in diagnosis of cancer in cardiac region. Clin. y. lab., 23: 542-748 (Sept.) 1933. CERF, M. Importance of earIy diagnosis of cancer of stomach. Brux. med., IO: 761-766 (May II) 1930. C. T. CHAMPION DE CRESPIGNY. Cancer and peptic uIcer. M. J. Australia, I : 549-55 I (ApriI 26) 1930. CHANEY. R. H. Cancer and oeotic uIcer. J. M. A. Ga.. Ig: ;22-232 (June) 1936. ’ COE, F. 0. Lenitis pIastica. Southern M. J., 24: 477-482 (June) 193 I. DAVIDSON, L. V. PoIypus; cancerous degeneration, Klin. j. saratov. Univ., 6: I 13-120 (Sept.) 1928. DEMEL, R. SymptomatoIogy and earIy diagnosis of cancer of stomach. Wien. klin. Wcbnscbr., 44: r115-1116, 1931.
DEMEL, R. Cancer and peptic ulcer. Wein. med. Wchnscbr., 82: 178-182 (Feb. 6) 1932. DENNING, E. J. Cancer and peptic uIcer. New Eng. Med. J., 202: 164-165 (Jan.) rg3o. DODD, E. C. Report of InternationaI Cancer Conference. &it. Med. J., 2: 169 (JuIy 28) 1928. DODD, E. C., and ROBERTSON, J. D. Lactic acid and carcinoma of stomach. Lancet, I : I 7 I-I 74 (Jan. 25) rg30. DKJ~LIZY,G. S. Cancer and peptic uIcer. S. Clin. North America, I I : 683-684 (June) I g3 I. DWYER. M. F.. BLACKFORD.J. M.. and TURNER, 1~1.C. Gastric Cancer. J. A. hf. A., b3: 145&1454. EINHORN, MAX. Carcinoma of the Iower esophagus and upper f$ of the stomach. J. A. M. A. 93: 1279-1282. (Oct. 26) 1929. ERICKSON, B. Case of carcinoma of stomach with marked disturbance of carbohydrate metabolism. Svenska ltik.-tideing, 27: 729-745 (June 6) 1930. EUSTERMAN, G. B., and BUEERMAN, W. H. Cancer of stomach. Present status of diagnosis and prognosis. J. A. M. A., 88: 295, 1927. EUSTERMAN, G. B. Obscure gastric Iesions; diagnostic significance of tests for occuIt blood. Proc. Staf Meet. Mayo Clinic, 5: 160 (June I I) 1930. EUSTERMAN, G. B. Significance of anaIysis of gastric contents in diagnosis of carcinoma of the stomach. M. Clin. Nortb America, 14: 557-563 (Nov.) 1930. FEIGHEL, M. DificuIties of early diagnosis of cancer of stomach. Strasbourg mid., 89: 405 (Aug. 5) rg2g; 1929; 416 (Aug. 20) 1929. FIHE, C. C. Cancer of the stomach. h/ledicaI aspect. J. Med., 12: 356362 (Sept.) 1931. FINNEY, J. M. T., SR. Personal communication. FITTS, J. B. Cancer of the stomach in Southern negro; $0 cases. Soutb. M. J., 24: I IO-III (Feb.) 1931. FRANK, L. Statistics, diagnosis, and treatment of cancer of stomach. Klin. Wcbnscbr, 6: 700 1927. FRIEDENWALD, J., and MORRISON, T. H. CIinicaI observations on so-caIIed Ieather bottle stomach. Tr. A. Am. Physicians, 46: 327-339. Am. J. M. SC., 182: 847-858. FRY. H. J. B. Reoort of InternationaI Cancer Confer‘ence. Brit. M: J., 2: 169 (JuIy 28) 1928. GATEWOOD. Prognosis in cancer of stomach treated by resection. Surg. Gyn. & Obs., 56: 442-444 1933. GRAHAM, R. R. Cancer of stomach. Canad. M. A. J., 18: 25, 1928. HARTFALL, S. J. Anemia of gastric carcinoma. Lancet, I: 74-76 (Jan. 14) 1933. [Concluded on p. 3951.
* Continued from p. 236.
INSTRUMENTS
4
A T/TUBE INSERTER IRVING WILLS, M.D., Attending,
P.A.C.S.
Santa Barbara Cottage HospitaI and Santa Barbara Hospital SANTA
BARBARA,
L
ONG ago the r-tube proved its efficiency as a means of suppIying a particuIar type of drainage in such
CALIFORNIA
The technique is simpIe. The instrument is Ioaded by the nurse or assistant, using a smaI1 amount of steriIe Iubricating jeIIy
FIG.
Iocations as the common biIe duct and the smaI1 bowe1 and many surgeons today find diffrcuhy in getting aIong without it. However, the use of this spIendid aid has never been very universa1. It is our beIief that one of the main reasons for this negIect has been the technica difhcuIty often attendant upon insertion of the r-tube into the viscus. FrequentIy, too, the time eIement is an important factor and the surgeon handIing a desperate case wiI1 choose a simple catheter, which can be easiIy inserted, instead of the r-tube which he might greatIy prefer. To overcome these diffrcuhies I devised a r-tube inserter which has handIed the probIem so satisfactoriIy that I wouId Iike to pass it aIong. The instrument consists of two meta tubes, one sliding within the other, the caliber of the inner one being of a size to just admit the Iong Ieg of the r-tube. The outer tube is large enough to hoId the foIded short arms of the T. 37’5
FIG.
2.
NEW SERIES VOL.XxX1,
No. z
WilIs-T-Tube
to keep the rubber from binding aIong the sides of the tube. A purse-string is put into the waII of the viscus and an opening made. The wall of the viscus is steadied with two AIIis forceps and the end of the By instrument appIied to the opening.
REFERENCES
Inserter
American
Journal
of Surgery
377
cIosing the instrument the T-tube enters the viscus accurately, its two arms opening out in opposite directions due to the spring of the rubber. The purse string is drawn up and tied and theinstrument removed by simply sIiding it back off the Iong Ieg.
OF
DR.
HARRIS”
REFERENCES ALVAREZ W. C. How earIy do physicians diagnose cancer in themseIves. Histories of 41 cases. J. A. M. A., 97: 77-83 (JuIy II) 1931. ASHHURST, A. P. C., and KLOPP, J. W. Carcinoma of stomach. Arch. of Surg., 27: 320-344, 1933, BALFOUR, D. C., and HARGIS, E. H. Cancer of the stomach. Am. J. M. SC., 173: 773, 1927. BASTIANELLI, R. Carcinoma perigastroduodenaIe. Am. J. Surg., 93: 301-316 (Jan.) rg3r. BASTIANELLI, RAFFAALE. Report of International Cancer Conference. Brit. M. J., 2: 169 (JuIy 28) 1028. BENA& E. Pseudocancerous type of gastric syphilis. Arch. ital. di dermat., sif. 5: I8o-198, Ig2g-Ig3o. BENNETT, T. I. Early diagnosis of carcinoma of stomach. Practitioner, 130: 141-150 (Feb.) 1933. BERGER, W. Cancer of the stomach: present states of earIy diagnosis. Wien. klin. Wcbnscbr, 44: 33; 71; 108 (Jan.) 1931. BLOODGOOD,J. C. UItimate results and actua1 functiona1 resuIts after different types of operation after intervaIs of five years or more. Am. J. Surg., gz: 574-596 (Oct.) 1930. BRINDLEY, P., and WOLFE, P. S. Cancer and peptic uIcer. Tex. St. J. M., 26: 51o-512 (Nov.) 1930. BROOKS, BARNEY. Persona1 communication. BULCHMAN, P. I. EarIy diagnosis of cancer of stomach; its reccurrence and metastases. Klin. med., (Nos. 23-24) 10: 1008-1014, 1932. BURKE, M. 0. Cancer and peptic uIcer. Vu. Med. Monthly, 59: 150-153 (June) 1932. CABOT. Carcinoma of stomach. New Engl. J. Med., 202: 881-882 (May) 1930. CARSON. Report. of InternationaI Cancer Conference. Brit. M. J., 2: 169 (Jury 28) 1928. CARRO, S. Diffculties in diagnosis of cancer in cardiac region. Clin. y. lab., 23: 542-748 (Sept.) 1933. CERF, M. Importance of earIy diagnosis of cancer of stomach. Brux. med., IO: 761-766 (May II) 1930. C. T. CHAMPION DE CRESPIGNY. Cancer and peptic uIcer. M. J. Australia, I : 549-55 I (ApriI 26) 1930. CHANEY. R. H. Cancer and oeotic uIcer. J. M. A. Ga.. Ig: ;22-232 (June) 1936. ’ COE, F. 0. Lenitis pIastica. Southern M. J., 24: 477-482 (June) 193 I. DAVIDSON, L. V. PoIypus; cancerous degeneration, Klin. j. saratov. Univ., 6: I 13-120 (Sept.) 1928. DEMEL, R. SymptomatoIogy and earIy diagnosis of cancer of stomach. Wien. klin. Wcbnscbr., 44: r115-1116, 1931.
DEMEL, R. Cancer and peptic ulcer. Wein. med. Wchnscbr., 82: 178-182 (Feb. 6) 1932. DENNING, E. J. Cancer and peptic uIcer. New Eng. Med. J., 202: 164-165 (Jan.) rg3o. DODD, E. C. Report of InternationaI Cancer Conference. &it. Med. J., 2: 169 (JuIy 28) 1928. DODD, E. C., and ROBERTSON, J. D. Lactic acid and carcinoma of stomach. Lancet, I : I 7 I-I 74 (Jan. 25) rg30. DKJ~LIZY,G. S. Cancer and peptic uIcer. S. Clin. North America, I I : 683-684 (June) I g3 I. DWYER. M. F.. BLACKFORD.J. M.. and TURNER, 1~1.C. Gastric Cancer. J. A. hf. A., b3: 145&1454. EINHORN, MAX. Carcinoma of the Iower esophagus and upper f$ of the stomach. J. A. M. A. 93: 1279-1282. (Oct. 26) 1929. ERICKSON, B. Case of carcinoma of stomach with marked disturbance of carbohydrate metabolism. Svenska ltik.-tideing, 27: 729-745 (June 6) 1930. EUSTERMAN, G. B., and BUEERMAN, W. H. Cancer of stomach. Present status of diagnosis and prognosis. J. A. M. A., 88: 295, 1927. EUSTERMAN, G. B. Obscure gastric Iesions; diagnostic significance of tests for occuIt blood. Proc. Staf Meet. Mayo Clinic, 5: 160 (June I I) 1930. EUSTERMAN, G. B. Significance of anaIysis of gastric contents in diagnosis of carcinoma of the stomach. M. Clin. Nortb America, 14: 557-563 (Nov.) 1930. FEIGHEL, M. DificuIties of early diagnosis of cancer of stomach. Strasbourg mid., 89: 405 (Aug. 5) rg2g; 1929; 416 (Aug. 20) 1929. FIHE, C. C. Cancer of the stomach. h/ledicaI aspect. J. Med., 12: 356362 (Sept.) 1931. FINNEY, J. M. T., SR. Personal communication. FITTS, J. B. Cancer of the stomach in Southern negro; $0 cases. Soutb. M. J., 24: I IO-III (Feb.) 1931. FRANK, L. Statistics, diagnosis, and treatment of cancer of stomach. Klin. Wcbnscbr, 6: 700 1927. FRIEDENWALD, J., and MORRISON, T. H. CIinicaI observations on so-caIIed Ieather bottle stomach. Tr. A. Am. Physicians, 46: 327-339. Am. J. M. SC., 182: 847-858. FRY. H. J. B. Reoort of InternationaI Cancer Confer‘ence. Brit. M: J., 2: 169 (JuIy 28) 1928. GATEWOOD. Prognosis in cancer of stomach treated by resection. Surg. Gyn. & Obs., 56: 442-444 1933. GRAHAM, R. R. Cancer of stomach. Canad. M. A. J., 18: 25, 1928. HARTFALL, S. J. Anemia of gastric carcinoma. Lancet, I: 74-76 (Jan. 14) 1933. [Concluded on p. 3951.
* Continued from p. 236.