- Email: [email protected]
An apparent recovery from multiple sarcomata
New
SERIES VOL.III,
No.2
Progress
in Surgery
American Journd
of Surgery
207
and not the uterus shoutd be suspended, even if a tota proIapse of the uterus shouId be coexisting. Technique: The uterus is puIIed upwards and outward; transverse incision 2 cm. to 3 cm. long in the vesicouterine fold; separation of bladder downward beyond the vagina1 fornix. A suture armed with needles at both ends is now inserted through each half of the vagina1 vauIt to right and to Ieft. Each end is carried forward through (I) the viscera1 peritoneum (2) the parieta1 peritoneum, (3) the externa1 obIique muscIe, (4) the abdomina1 fascia, and (5) the skin. The ends are then secureIy tied over a smaI1 gauze pad, so that the anterior vagina1 vauIt is in broad and firm contact with the abdomina1 waI1. The vesicouterine pouch is closed. The abdomina1 wal1 is sutured in four Iayers. The duration of the operation is twenty minutes. It does not matter whether the suture enters the Iumen of the vagina or onIy penetrates the vagina1 waI1. The suture shouId be nonabsorbabIe and is removed on the fourteenth day, after a fibrous scar has formed in the suture cana1. The foIIowing objections may be made to this procedure: (I) The vagina is forced directIy upward to the anterior abdomina1 waI1; it separates the bIadder in two and prevents distention and IiIIing in the median Iine. The disadvantage is transitory. About 25 per cent of the patients compIain of ischuria or strangury foIIowing the operation. The symptoms invariabIy disappear within a few days spontaneousIy and, after application of a permanent catheter, immediateIy. Thereafter the capacity of the bIadder is not Iessened, because the IateraI parts expand. Permanent diffIcuIties have never been seen. (2) The vagina is Iixed. This might interfere with (a) cohabitation, or (b) Iabor. The former does not occur. Labor after ventrofixation of the vagina has not been seen, as only patients beyond the chiIdbearing period were subjected to the operation. Labor complications may be prevented by steriIization or confining the procedure to women past the chiIdbearing period. FraenkeI’s operation has been performed many times during the Iast ten years without a singIe recurrence.
deVeIoped a myeIosarcoma of the tibia near the site of a chronic OsteomyeIitis that had been operated upon twice and which, in turn, appears to have deveIoped from a trauma. A few months after amputation of the thigh there appeared a subcutaneous metastasis above the umbiIicus and recurrence in the femur and soft parts of the stump, which increased greatly in size. Both of these conditions progressed steadiIy during treatment by injections of CoIey’s IIuid and metastatic growths appeared in many parts of the body incIuding the right cIavicIe, the scaIp and crania1 bones. Under a further course of treatment by Coley’s mixed toxins, increasing to 17 minims every day, there was progressive and compIete disappearance of a11 the masses. The metastasis above the umbiIicus, which had attained the size of a Iemon, yieIded to injections directly into it. Fifteen months after the amputation, the man was discharged in good heaIth and apparently compIeteIy recovered, and he had gained about 40 pounds in weight. Sections from the tibia and from the supraumbiIica1 metastasis were diagnosed myeIosarcoma by Ewing TayIor, and the diagnosis was concurred in by James Ewing and Ernest Codman.
S. L., and PALMER, L. A., New York. An apparent recovery from muItipIe sarcomata. Mil. Surgeon, JuIy, 1927, Ixi, 42.
In fractures of the maIar-zygomatic compound, the author suggests that a smaI1 incision be made in the tempora1 region, and a heavy bIunt eIevator be passed down aIong the fascia1 planes to beneath the region of the fracture.
CHRISTIAN,
The authors record what appears to be a remarkabIe case. A man aged thirty-one years
BIRD, CLARENCE E., Boston. Sarcoma compIieating Paget’s disease of the bone. Report of nine cases, five with pathoIogic verification. Arch. Surg., June, 1927, xiv, I 187. The incidence of sarcoma in Paget’s disease, so far as it is represented among hospitaI patients in this country, is approximateIy one case in ten, a suffrcientIy high percentage to excite surprise in view of the age of these patients and the fact that bone sarcoma is considered to be a disease of youth. In eIderIy peopIe afKcted with sarcoma of bone roentgenograms of the entire skeIeton shouId aIways be made, for it is probabIe that the coexistence of the osteitis deformans of Paget is frequentIy overIooked. GILLIES, H. D. et a1. Fractures of the malarzygomatic compound: with a description of a new x-ray position. Brit. J. Surg., ApriI, 1927, xiv, No. 56, 65 I.
SERIES VOL.III,
No.2
Progress
in Surgery
American Journd
of Surgery
207
and not the uterus shoutd be suspended, even if a tota proIapse of the uterus shouId be coexisting. Technique: The uterus is puIIed upwards and outward; transverse incision 2 cm. to 3 cm. long in the vesicouterine fold; separation of bladder downward beyond the vagina1 fornix. A suture armed with needles at both ends is now inserted through each half of the vagina1 vauIt to right and to Ieft. Each end is carried forward through (I) the viscera1 peritoneum (2) the parieta1 peritoneum, (3) the externa1 obIique muscIe, (4) the abdomina1 fascia, and (5) the skin. The ends are then secureIy tied over a smaI1 gauze pad, so that the anterior vagina1 vauIt is in broad and firm contact with the abdomina1 waI1. The vesicouterine pouch is closed. The abdomina1 wal1 is sutured in four Iayers. The duration of the operation is twenty minutes. It does not matter whether the suture enters the Iumen of the vagina or onIy penetrates the vagina1 waI1. The suture shouId be nonabsorbabIe and is removed on the fourteenth day, after a fibrous scar has formed in the suture cana1. The foIIowing objections may be made to this procedure: (I) The vagina is forced directIy upward to the anterior abdomina1 waI1; it separates the bIadder in two and prevents distention and IiIIing in the median Iine. The disadvantage is transitory. About 25 per cent of the patients compIain of ischuria or strangury foIIowing the operation. The symptoms invariabIy disappear within a few days spontaneousIy and, after application of a permanent catheter, immediateIy. Thereafter the capacity of the bIadder is not Iessened, because the IateraI parts expand. Permanent diffIcuIties have never been seen. (2) The vagina is Iixed. This might interfere with (a) cohabitation, or (b) Iabor. The former does not occur. Labor after ventrofixation of the vagina has not been seen, as only patients beyond the chiIdbearing period were subjected to the operation. Labor complications may be prevented by steriIization or confining the procedure to women past the chiIdbearing period. FraenkeI’s operation has been performed many times during the Iast ten years without a singIe recurrence.
deVeIoped a myeIosarcoma of the tibia near the site of a chronic OsteomyeIitis that had been operated upon twice and which, in turn, appears to have deveIoped from a trauma. A few months after amputation of the thigh there appeared a subcutaneous metastasis above the umbiIicus and recurrence in the femur and soft parts of the stump, which increased greatly in size. Both of these conditions progressed steadiIy during treatment by injections of CoIey’s IIuid and metastatic growths appeared in many parts of the body incIuding the right cIavicIe, the scaIp and crania1 bones. Under a further course of treatment by Coley’s mixed toxins, increasing to 17 minims every day, there was progressive and compIete disappearance of a11 the masses. The metastasis above the umbiIicus, which had attained the size of a Iemon, yieIded to injections directly into it. Fifteen months after the amputation, the man was discharged in good heaIth and apparently compIeteIy recovered, and he had gained about 40 pounds in weight. Sections from the tibia and from the supraumbiIica1 metastasis were diagnosed myeIosarcoma by Ewing TayIor, and the diagnosis was concurred in by James Ewing and Ernest Codman.
S. L., and PALMER, L. A., New York. An apparent recovery from muItipIe sarcomata. Mil. Surgeon, JuIy, 1927, Ixi, 42.
In fractures of the maIar-zygomatic compound, the author suggests that a smaI1 incision be made in the tempora1 region, and a heavy bIunt eIevator be passed down aIong the fascia1 planes to beneath the region of the fracture.
CHRISTIAN,
The authors record what appears to be a remarkabIe case. A man aged thirty-one years
BIRD, CLARENCE E., Boston. Sarcoma compIieating Paget’s disease of the bone. Report of nine cases, five with pathoIogic verification. Arch. Surg., June, 1927, xiv, I 187. The incidence of sarcoma in Paget’s disease, so far as it is represented among hospitaI patients in this country, is approximateIy one case in ten, a suffrcientIy high percentage to excite surprise in view of the age of these patients and the fact that bone sarcoma is considered to be a disease of youth. In eIderIy peopIe afKcted with sarcoma of bone roentgenograms of the entire skeIeton shouId aIways be made, for it is probabIe that the coexistence of the osteitis deformans of Paget is frequentIy overIooked. GILLIES, H. D. et a1. Fractures of the malarzygomatic compound: with a description of a new x-ray position. Brit. J. Surg., ApriI, 1927, xiv, No. 56, 65 I.