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Illustrazione di un caso di doppio frenico bilaterale
132
TUBERCLE
out. Microscopic examination, as in the first case, showed characteristic tuberculous lesions over most of the breast tissue, many of these being caseous. Tubercle bacilli were demonstrable in stained sections of the organ. PARODI,, E. and CAL~/I, F. Linfoangoite tubercolare della mammella nell' rome. Riv. di I'atol. e Clin. della Tubercolosi, 1933, 7, 709. A record of four cases of tuberculous lymphangitis of the breast in young men whose exact age is not stated. The condition was unilateral in three and bilateral in one. There did not appear to be auy relation between the severity of the puhnonary lesion and the extent of the infiltration of the mammary region, but a specific pleuro-pulmonary lesion was present in all eases. The prognosis was good. Treatment consisted iu residence in a sanatorium and tuberculin therapy, wi~h the result that the mammary infiltration subsided with a maximum period of three months.
PHRENICECTOMY. MAZZETTI, M. Di un rare tncidente operatorio helle exeresi del frentco sinistro: la lacerazione del dotto toracico. Ospedale Maggiore, 1933, 2 t , 417. The writer records the case of a man, aged 37, in whom the thoracic duct was injured during avulsion of the lett phrenic nerve for pulmonary tuberculosis. A copious discharge of lymph took place and the patient lost about 5 kg., but on the sixth day after phrenieectomy when all efforts to check the discharge had failed and the patient's condition had become very serious the duct was sutured and rapid recovery took place. ZANNELLI, C. Illustrazionc di un ease di doppm frenieo bilaterale. L o f t s centre la Tubercolosi, 1933, ~, 979. The writer records the case of a woman, aged 28, suffering from bilateral pulmonary tuberculosis, in whom right phrenicectomy was performed. The operation was followed by paralysis of
[December, 1934
the diaphragm, which lasted only two months, after which the muscle resumed its function, and it was not until after a second operation on the same side when an accessory phrenie nerve was discovered that a permanent paralysis of the diaphragm was effected. The second operation on the right side was suggested during phrenicectomy on the left side (performed shortly after the first operation on the right side) when two branches of the nerve were found, both contained in the fascia of the scalcnus anticus. The temporary paralysis of the diaphragm was probably caused by the injury to the main trunk of the phrenie nerve resulting from avulsion of one of its roots. LUNDE, S. Har frcnikoeksairesen sore selvetendig operasjon red kavcrner i lungens kraniale felt nogen betydning ? Tidsskr. f. d. NorsT~'e Laegeforening~ 1933, 53, 1268. Has phrenic avulsion any effect on the lung with cavities in the field of operation ? The answer to Otis question provided by the extensive literature of the subject is most ambiguous. At o n e extreme there are t h e optimists who claim success in 80 per cent. of their cases. At the other extreme are those who rate their successes at nil. Lundc is inclined to join the latter group after a systematic study of 73 patients, on whom phrenic avulsion was performed at the Glittre Sanatorium in Norway in the period 1928-32. Cavities in the field of operation were demonstrable by the X.rays in 66 of these patients, 61 of whom belonged to the third stage of the disease (TurbanGerhardt). On discharge, 43 of these 73 patients showed some general ira9 provement, but there was little change in the number of positive sputa. The proportion of patients showing general improvement on discharge was lower in the phrenie avulsion group than among the other patients in the third stage of the disease. Lunde succeeded in tracing 50 patients from one to four years after discharge. Only four of them were then perfectly fit for work, without cough, sputum-free and sputum-nega-
TUBERCLE
out. Microscopic examination, as in the first case, showed characteristic tuberculous lesions over most of the breast tissue, many of these being caseous. Tubercle bacilli were demonstrable in stained sections of the organ. PARODI,, E. and CAL~/I, F. Linfoangoite tubercolare della mammella nell' rome. Riv. di I'atol. e Clin. della Tubercolosi, 1933, 7, 709. A record of four cases of tuberculous lymphangitis of the breast in young men whose exact age is not stated. The condition was unilateral in three and bilateral in one. There did not appear to be auy relation between the severity of the puhnonary lesion and the extent of the infiltration of the mammary region, but a specific pleuro-pulmonary lesion was present in all eases. The prognosis was good. Treatment consisted iu residence in a sanatorium and tuberculin therapy, wi~h the result that the mammary infiltration subsided with a maximum period of three months.
PHRENICECTOMY. MAZZETTI, M. Di un rare tncidente operatorio helle exeresi del frentco sinistro: la lacerazione del dotto toracico. Ospedale Maggiore, 1933, 2 t , 417. The writer records the case of a man, aged 37, in whom the thoracic duct was injured during avulsion of the lett phrenic nerve for pulmonary tuberculosis. A copious discharge of lymph took place and the patient lost about 5 kg., but on the sixth day after phrenieectomy when all efforts to check the discharge had failed and the patient's condition had become very serious the duct was sutured and rapid recovery took place. ZANNELLI, C. Illustrazionc di un ease di doppm frenieo bilaterale. L o f t s centre la Tubercolosi, 1933, ~, 979. The writer records the case of a woman, aged 28, suffering from bilateral pulmonary tuberculosis, in whom right phrenicectomy was performed. The operation was followed by paralysis of
[December, 1934
the diaphragm, which lasted only two months, after which the muscle resumed its function, and it was not until after a second operation on the same side when an accessory phrenie nerve was discovered that a permanent paralysis of the diaphragm was effected. The second operation on the right side was suggested during phrenicectomy on the left side (performed shortly after the first operation on the right side) when two branches of the nerve were found, both contained in the fascia of the scalcnus anticus. The temporary paralysis of the diaphragm was probably caused by the injury to the main trunk of the phrenie nerve resulting from avulsion of one of its roots. LUNDE, S. Har frcnikoeksairesen sore selvetendig operasjon red kavcrner i lungens kraniale felt nogen betydning ? Tidsskr. f. d. NorsT~'e Laegeforening~ 1933, 53, 1268. Has phrenic avulsion any effect on the lung with cavities in the field of operation ? The answer to Otis question provided by the extensive literature of the subject is most ambiguous. At o n e extreme there are t h e optimists who claim success in 80 per cent. of their cases. At the other extreme are those who rate their successes at nil. Lundc is inclined to join the latter group after a systematic study of 73 patients, on whom phrenic avulsion was performed at the Glittre Sanatorium in Norway in the period 1928-32. Cavities in the field of operation were demonstrable by the X.rays in 66 of these patients, 61 of whom belonged to the third stage of the disease (TurbanGerhardt). On discharge, 43 of these 73 patients showed some general ira9 provement, but there was little change in the number of positive sputa. The proportion of patients showing general improvement on discharge was lower in the phrenie avulsion group than among the other patients in the third stage of the disease. Lunde succeeded in tracing 50 patients from one to four years after discharge. Only four of them were then perfectly fit for work, without cough, sputum-free and sputum-nega-