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Hydrops of the gallbladder in an infant
236
American J . . . . .
[ of
Surgery
Progressin Surgery
the common duct CriIe cIoses it. The function of the biIe with its high alkaIinity, when its pressure is maintained at a normaI degree, is to maintain the alkaIinity of the Iiver ceIIs. FauIty drainage may produce a welI instead of a stream. Too much fluid may accumulate before its escapes, with immediate resuhant functional disturbance and the more remote resuIt of adhesions, which in turn interfere with liver function and consequently with general organic function. This drainage is met or IargeIy eliminated by employing gravity drainage through Morrison's pouch. CriIe has found that the introduction of heat within the abdomen causes an immediate rise, not onIy in the~ temperature of the Iiver, but aIso, synchronousIy, in the temperature of the brain. The application of heat to the Iiver shouId in Iarge part counteract the effect of operations upon the liver and biIe ducts. CriIe has been applying heat to the Iiver by means of diathermy. One pIate of the diathermy apparatus is placed on the lower chest on one side and the other is brought opposite the dome of the liver. The current can thus be continuaIIy applied during the operation and the temperature of the Iiver and the abdominal viscera can be maintained at or above the normal throughout the operation regardIess of the exposure of the intestines; moreover, the appIication of the diathermy current during the immediate postoperative hours is of great aid in carrying the patient through that critical period. H Y D R O P S OF T H E G A L L B L A D D E R IN A N INFANT.
Henry MiIch, New York. Annals of Surgery, September, 1926. Hydrops of the gaIIbIadder in young subjects, and especiaIIy in chiIdren, is rare. MiIch reports an instance in an infant 16 months old, in which the diagnosis was made before operation, a n d in which the condition deveIoped during an encephalitis. No stone or actual obstruction in the ducts was found at operation or postmortem. INTUSSUSCEPTION AND ITS T~EATMENT ~Y HYDROSTATIC PRESSURE: BASED ON AN ANALYSIS OF IO0 CONSECUTIVE CASES SO
TREATED. P. L. HipsIey, Sydney. The Medical Journal of Australia, August 14, 1925. Whether pIain warm water or saline solution is used does not matter much. The height of the head of the coIumn must not exceed three feet
OCTOBER, I926
six inches and in the majority of cases it did not exceed three feet. An ordinary glass douche is quite suitabIe, but a graduated vesseI enables one to watch the progress of the saIine soIution more cIoseIy, as it runs very sIowIy after portion of the intussusception has been reduced. The injection is given through a No. IS.rubber catheter which is passed into the boweI for seven and ~ half or ten centimeters (three or four inches) and then the buttocks are pinched closely round it to prevent any escape of the saIine soIution. It is important not to use vaseIine or other lubricant on the catheter, as they make the buttocks so sIippery that it is difficuIt to hoId the catheter in. The fluid runs in quickIy at first, then more slowIy as the intussusception is 'being reduced and then after a short cessation it may run sIowIy on again, as the fluid passes into the smaII bowel and graduaIIy distends it. If the pressure is kept up it may pass right up into the jejunum. In the whoIe series of one hundred and five patients there were seventy males and thirtyfive femaIes. Out of one hundred consecutive intussusceptions sixty-two were reduced by hydrostatic pressure. In forty-four of these an operation was performed and amongst these cases there were ten in which the duration of the intussusception was over twenty-four hours, three over forty-eight hours and one over three days. The average duration in these cases was over sixteen hours. In eighteen out of the sixty-two cases a smaII incision was made to confirm the diagnosis of reduction. In two of these the duration was over three days, the average being over seventeen hours. In only thirty-eight out of the hundred cases was there a faiIure to reduce the intussuscep, tion and in these the average duration was 25.8 hours, that is after excluding the case in which the duration was three weeks. Hipsley did not incIude in this series any case in which he could not feeI a tumor before treatment. C O N J U G A L U L C E R S OF T H E P Y L O R U S A N D T H E
STOMACH. (Les ulc~res conug~s du pylore et du corps de l'estomac.) X. DeIore, P. Mallet-Guy et P. Ducroux, Lyon. La Presse M~dicale, August 7, 1926. In the statistics of the Mayo clinic, muhipIe ulcers occur in about 6 per cent of aII the
American J . . . . .
[ of
Surgery
Progressin Surgery
the common duct CriIe cIoses it. The function of the biIe with its high alkaIinity, when its pressure is maintained at a normaI degree, is to maintain the alkaIinity of the Iiver ceIIs. FauIty drainage may produce a welI instead of a stream. Too much fluid may accumulate before its escapes, with immediate resuhant functional disturbance and the more remote resuIt of adhesions, which in turn interfere with liver function and consequently with general organic function. This drainage is met or IargeIy eliminated by employing gravity drainage through Morrison's pouch. CriIe has found that the introduction of heat within the abdomen causes an immediate rise, not onIy in the~ temperature of the Iiver, but aIso, synchronousIy, in the temperature of the brain. The application of heat to the Iiver shouId in Iarge part counteract the effect of operations upon the liver and biIe ducts. CriIe has been applying heat to the Iiver by means of diathermy. One pIate of the diathermy apparatus is placed on the lower chest on one side and the other is brought opposite the dome of the liver. The current can thus be continuaIIy applied during the operation and the temperature of the Iiver and the abdominal viscera can be maintained at or above the normal throughout the operation regardIess of the exposure of the intestines; moreover, the appIication of the diathermy current during the immediate postoperative hours is of great aid in carrying the patient through that critical period. H Y D R O P S OF T H E G A L L B L A D D E R IN A N INFANT.
Henry MiIch, New York. Annals of Surgery, September, 1926. Hydrops of the gaIIbIadder in young subjects, and especiaIIy in chiIdren, is rare. MiIch reports an instance in an infant 16 months old, in which the diagnosis was made before operation, a n d in which the condition deveIoped during an encephalitis. No stone or actual obstruction in the ducts was found at operation or postmortem. INTUSSUSCEPTION AND ITS T~EATMENT ~Y HYDROSTATIC PRESSURE: BASED ON AN ANALYSIS OF IO0 CONSECUTIVE CASES SO
TREATED. P. L. HipsIey, Sydney. The Medical Journal of Australia, August 14, 1925. Whether pIain warm water or saline solution is used does not matter much. The height of the head of the coIumn must not exceed three feet
OCTOBER, I926
six inches and in the majority of cases it did not exceed three feet. An ordinary glass douche is quite suitabIe, but a graduated vesseI enables one to watch the progress of the saIine soIution more cIoseIy, as it runs very sIowIy after portion of the intussusception has been reduced. The injection is given through a No. IS.rubber catheter which is passed into the boweI for seven and ~ half or ten centimeters (three or four inches) and then the buttocks are pinched closely round it to prevent any escape of the saIine soIution. It is important not to use vaseIine or other lubricant on the catheter, as they make the buttocks so sIippery that it is difficuIt to hoId the catheter in. The fluid runs in quickIy at first, then more slowIy as the intussusception is 'being reduced and then after a short cessation it may run sIowIy on again, as the fluid passes into the smaII bowel and graduaIIy distends it. If the pressure is kept up it may pass right up into the jejunum. In the whoIe series of one hundred and five patients there were seventy males and thirtyfive femaIes. Out of one hundred consecutive intussusceptions sixty-two were reduced by hydrostatic pressure. In forty-four of these an operation was performed and amongst these cases there were ten in which the duration of the intussusception was over twenty-four hours, three over forty-eight hours and one over three days. The average duration in these cases was over sixteen hours. In eighteen out of the sixty-two cases a smaII incision was made to confirm the diagnosis of reduction. In two of these the duration was over three days, the average being over seventeen hours. In only thirty-eight out of the hundred cases was there a faiIure to reduce the intussuscep, tion and in these the average duration was 25.8 hours, that is after excluding the case in which the duration was three weeks. Hipsley did not incIude in this series any case in which he could not feeI a tumor before treatment. C O N J U G A L U L C E R S OF T H E P Y L O R U S A N D T H E
STOMACH. (Les ulc~res conug~s du pylore et du corps de l'estomac.) X. DeIore, P. Mallet-Guy et P. Ducroux, Lyon. La Presse M~dicale, August 7, 1926. In the statistics of the Mayo clinic, muhipIe ulcers occur in about 6 per cent of aII the