Cosmetic result in a case of marked scoliosis

NPN

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Lo.

Buchman- _

5

results. If, on the other hand, the fetus is premature, or is mature, but dead, the vagina1 cesarean section shouId be performed. The indications for vaginal cesarean section are \‘ery Iimited; but in properIy selected cases the advantages which it offers are unsurpassed by any other method.

pared softs parts and where a rapid painIess deIivery is essential, one has the choice of either abdomina1 or vagina1 section. The decision shouId depend entirely on the condition and age of the fetus. If the fetus is mature and alive, abdominal cesarean section is the method of choice and gives more satisfactory

COSMETIC RESULT IN A CASE OF MARKED SCOLIOSIS WITH

ROTATION

OF THE

RIBS TREATED BY CONVEX AND RIB RESECTION*

JOSEPH BUCHMAN, BROOKLYN,

A

M.D.,

NEW

FRAME,

SPINE

FIJSION

F.A.C.S.

YORK

GIRL fourteen years oId was admitted to the HospitaI for Joint Diseases on IS, 1928, with the compIaint August of deformity of the back of two years’ duration. Examination showed a very marked right

dorso-lumbar scoliosis with marked rotation of the ribs to the right, and a collapse of the trunk, as shown in Figure 3. After being kept on a convex frame for several months, the patient \vas operated upon hy Dr. Samuel

FIG. I. Anteroposterior

FIG. 2. Anteroposterior roentgenogram of spine eight months after spine fusion. Note improvement in curvature. The beef bone grnft is beginning to be absorbed. There is considerxble bony cnllus formation.

* Presented

before

roentgenogram operation.

Section

of spine

of Orthopedic

before

Surgery,

New York

Academy

of Medicin<,,

October

10, IQZC).

FIG. 3. FIG. 4. FIG. 3. 4 FIG. 3. Appearance of back before operation. Note sagging and shifting of trunk to right and marked rotation and prominence of ribs on right side. FIG. 4. Appearance of back after spine fusion and rib resection. FIG. 3. Appearance of back when apparent shortening of right Iower Iimb is compensated by an inch lift of right shoe.

FIG. 6:Tracing

of back at IeveI of the tenth dorsx1 vertebra before and atter rib resection improvement in deformity.

to show

X,-U

SFHII.S

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Hueper-MyxogIobuIosis

I;leinberg, who performed a spine fusion from the fifth dorsal to the second Iumbar vertebra, an d inserted a beef bone graft on the concave side of the curve. \vas replaced

Ten

on a convex

days

Iater

the patient

frame and on Febru-

arh- I, 1929, the child was discharged a plaster

wearing

of Paris jacket.

She was readmitted to the service of Dr. Kleinberg, at the Hospital for Joint Diseases on August 20, 1929, for the correction of the deformity

due

Examination back

to

the

at that

\vas markedIy

rotation time

of

the

showed

improved,

that

ribs.

that the

ated area was stiff, that the patient’s was considerably improved, and that

the oper-

posture she was

of Appendix

American J~~rnaiU[~urpery1083

severa

inches taIIer than on the previous admission. It was aIso noted that there was an apparent shortening of the right lower Iimb of I inch. On August 23, Igzg, a rib resection, as advocated by Dr. Armitage Whitman, was performed by me. I removed about two and a half to three and a haIf inches of the sixth to the eIeventh ribs incIusive. Eleven days later the patient was pIaced on a convex frame and four weeks thereafter she was discharged, markedIy improved in appearance and in genera1 condition. This case was presented to demonstrate the cosmetic resuIt obtainahIe by means of the convex frame treatment, spine fusion and rib resection.

+EB+ MYXOGLOBULOSIS W.

OF THE APPENDIX*

C. HUEPER, CHICAGO,

ETENTION cysts of the appendix with mucous content were first described by Fraenkel in 1901 and appear in the Iiterature under various names as hydrops of appendix, coIIoid or pseudomucinous cyst, myxoceIe, mucyst, pseudomyxoma, coceIe, mutinous etc. They are rather rare, if a correct conclusion can be drawn from the number of cases reported. Weaver’ coIIected 168 cases in 1928 from the Iiterature. An uncommon variety of this condition is the myxogIobuIosis (Hansemann2) or the fish egg appendix (Morrison3). Weaver found onIy 8 cases recorded of this type which number Hudacsek4 couId increase to tweIve in 1929. The condition is characterized by the presence of globoid bodies of mutinous character in the cystic content resembling in their gross appearance fish eggs. These baI1.s vary considerabIy in size and may reach one centimeter in diameter. They contain occasionalIy caIcifications. They represent inspissated baIIs of mucoid materia1 around minute masses of necrotic materia1 and are composed

R

* Submitted

M.D.

ILL.

of mucin and pseudomucin sometimes arranged in concentric Iayers. The lumen of the appendix is more or Iess distended and Iined by a straight, sometimes stratified Iayer of cyIindrica1 mucus-producing ceIIs of goblet ceI1 type. With the increasing pressure of the mucous content degenerative changes of the epitheIia1 ceIIs may occur, resuIting in a self-Iimitation of the process. The submucosa is fibrous and contains no or very IittIe Iymphoid tissue. A mutinous imbibition of the submucosa is sometimes observed. The muscuIaris is usuaIIy thinned, but aIso hypertrophy may be seen (Hudacsek4). Stenosis of the Iumen at the ceca1 OS with continuation of the mucus production by the mucosa and with absence of an infection is regarded as the causative mechanism of this condition. The stenosis may be due to a constrictive scar formation from a preceding appendicitis (Aschoffb), or due to anguIation, torsion, compression by adhesions, invagination into the cecum, foreign bodies or parasites in the lumen of the appendix. The clinical symptoms

for pubhcation

December

30, 1929.