Granuloma inguinale. Clinical observation, vaccine treatment and allergic reactions

I I0

AmericanJ . . . . . 1 of Surgery

Progressin Surgery

organisms, often in symbiosis with other bacteria. Among such infections Vincent mentions: Ludwig's angina (which he says was described by GensouI six years before Ludwig) ; gangrenous appendicitis and other para-intestinaI phIegmons; puImonary gangrene; certain cases of puerperal metro-peritonitis, certain perivesieaI infections, prostatitis, periprostatitis, and certain fetid urinary abscesses, etc. TREATMENT

OF

VARICES

BY

SCLEROSING

INJECTIONS. (Le Traitement des Varices par les Injections ScI~rosantes.) J. A. Sicard and L. Gaugier. Presse M~dicaIe, June 2, 1926.

Sicard has been practising this method of treating varicose veins since 1917. It is essentiaIIy an ambulatory procedure and does awa.y with the mutilating effects of the extensive operations previously advocated. The treatment consists in the injections of various drugs directly into the veins with the object of causing an obliteration of the dilated portion. Some authors beIieve this is brought about as a result of a reflex spasm of tile muscuIature but Sicard is of the opinion that following the chemical irritation caused by the injected fluid a fiat parietaI thrombosis is formed which Ieads to obliteration of the vein. The chemicaI is injected with the patient in the sitting or standing position though it may aIso be undertaken with the patient prone. The veins of the Ieg are injected first and two or even three veins at a distance of 5-6 cm. may be injected at once. The fluid is injected with a smalI caliber needle directly into the diIated portion. The needIe is Ieft in situ for several minutes and immediateIy upon withdrawing the site of the puncture is compressed with the finger to prevent escape of the fluid into the perivascular tissues. Within five minutes the patient is permitted to Ieave. Injections may be repeated after the subsidence of the reaction folIowing the first injection. Some pain is compIained of. This may be due either to faulty technique, resuIting in perivascuIar infiItration, or may be due to a cramp of the vessel following the injection. The author has experimented with various agents and believes that chemicalIy pure sodium salicyIate is the most desirabIe. This is used in 20 per cent, 30 per cent, and 40 per cent strengths depending on the toIerance of the patient. The initial dose consists of 2 cc. of a 2o per cent solution. This is gradually increased until as much as 5 cc. of a 4o per cent solution are given. The author warns against the use of smalI amounts of weak solution because instead of bringing about a thrombosis

AUGUST, I926

of the lumen, it resuIts in a sclerosis of the vein wail. There is no danger of iII-effects, such as emboIus, because t h e essentiaI pathological process is n o t a phIebitis but a chemicaI reaction with the formation of a firm parietaI thrombus. However, there are certain cases in which the author advises against the application of the method. Plethoric individuaIs or those suffering from hypertension, cardionephritics, and those who have previously undergone a phIebitis of the deep veins of the Ieg are not good subjects. FIBROSIS OF VARICES. (Fibrose Curative des Varices). G. Delater. Presse M~dicaIe, June 2, 1926.

CURATIVE

In certain cases, the saIicyIate of soda injections recommended by Sicard in the treatment of varicose veins seem to be without effect after the first severaI injections. In such cases, Delater advocates the substitution of quinine for the salicylate. He proceeds in the following manner. The patient is first injected with 2 cc. of a 2o per cent soIution of sodium salicylate. If this proves inefficacious the patient is treated with 2 cc. of a 3o per cent and 4 cc. of a 4o per cent solution. If the resuIts are satisfactory, the treatment is continued. Otherwise, the author repiaces the salicyIate by the foIIowing solution; quinine hydrochIoride o.45, urethane o.23; distiIIed water 3.o. At the first injection o.5-I cc. of this soIution is injected. At subsequent treatments the quantity may be increased until the patient is getting 3--4 cc. In the experience of Delater, this soIution is oceasionaIIy successfuI where sodium salicyIate faiIs. Sometimes after the use of quinine, the saIicylate may become more efficacious. GRANULOMA INGUINALE. CLINICAL OBSERVATION, VACCINE TREATMENT AND ALLERGIC

t~EACTIONS. Max Goldzieher and SamueI M. Peck, New York. Archives of Dermatology and Syphilology, July, 1926. Seven cases of granuIoma venereum were studied. The diagnosis was made by the characteristic cIinicaI appearance; demonstration of bacillus venerogranuIomatis in smear, section and culture; compIement fixation and aIIergic skin reactions. The best therapeutic resuIts were obtained by the combined use of bacillus venerogranulomatis vaccine, with tartar emetic. THE R6LE OF A SPECIFIC BACTERIUM IN THE

PROnUCTIONOF URINARYCALCULI.Benjamin H. Hager and Thomas Magayh, Rochester, Minn. International Journal of Medicine and Surgery, June, I926. The authors believe that proteus ammonix after invading the bIadder can, under favorable