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Vol.. III, No. .+
Progress
TARNOWSKY, GEORGE, Chicago. Primary echinococcus cyst of the kidney. 5’. Clinics N. America, June, 1027, vii, 783.
Because of the rarity of echinococcus cysts of the kidney, the diagnosis wiII be in doubt unIess the mother cyst ruptures into the peIvis of the kidney and daughter cysts are expeIIed in the urine, or if-which is extremeIy rarebimanua1 paIpation of a kidnev tumor gives the eXaminer the cIassica1 ” thriIi” produced by the rubbing together of daughter cysts. The bIood picture and serodiagnostic tests wiI1 be of the greatest assistance. EosinophiIia is present in 80 per cent of echinococcus cyst cases, the percentage of eosinophiIes varying between 7 and 40 per cent. Unfortunately, eosinophiIia is absent in cases where the cyst is dead, degenerated, or suppurative. It is frequentIy absent when the cyst has ruptured into the kidney pelvis, because in such cases the cyst content is eIiminated with the urine without causing accentuated anaphyIactic phenomena. The compIement-fixation test of BordetGengou is positive in g3 per cent of echinococcus cases. The intraderma1 reaction of Casoni is positive in go per cent of a11 cases. Puncture of a suspected echinococcus cyst of the kidney is a dangerous procedure. Not onIy may the escape of the Iiquid content into the perinephric tissues give rise to severe anaphyIattic shock, but daughter cysts may aIso escape and proIiferate de novo in the retroperitonea1 tissues. MarsupiaIization of the cyst or nephrectomy, if rupture into the kidney peIvis has occurred and the other kidney is normaI, are the operations of choice. O’CONNOR, VINCENT J., Chicago. disIocation of the kidney. S. America, June, 1927, vii, 743.
Traumatic Cfinics N.
Traumatic Ioosening of the kidney may be gradua1, but it is more often due to a sudden rupture of its fascia1 and peritonea1 coverings. PerirenaI and periuretera1 hemorrhage occurs, and the resuItant organization about these areas may resuIt in scIerotic attachments which compress or anguIate the ureter or renaI peIvis. If Iow-grade infection supervenes in these areas of estravasation the subsequent density of these cicatrices wiI1 be increased, and as contraction occurs there wiI1 be a gradua1 compression of kidney, peIvis, or ureter. If the
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Surgery
American
Journal
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409
kidney is not dispIaced and the trauma affects onIy the perirena1 tissue a subsequent perirenal scIerosis may result. DANHIEZ, IP., Lille. Large renaI infarcts. (Les grands infarctus rhaux.) J. d’Urol., June, 1927, xxiii, 48 1. The author reviews the whoIe of the discoverabIe Iiterature on the subject of total infarct of the kidney. There have been apparentIy no more than 40 cases reported in the Iiterature. The notion of tota infarct of the kidney invoIves necessariIy the concept of compIete and sudden occIusion of either renaI artery or vein. Though the renaI vesseIs are anatomicahy terminaf in nature, functionaIIy there may deveIop a rather sizeable coIIatera1 circulation through the Iumbar, the capsuIar and the uretera vesseIs. The infarcts may arrse as a resuIt either of thrombosis or of emboIus of the renaI vesseIs. The diagnosis has onIy seIdom been made before operation. The symptoms, however, are fairiy characteristic. Sudden onset of pain, oIiguria, albuminuria and hematuria are the symptoms that shouId suggest the presence of a renaI infarct of Iarge dimensions. The onIy treatment is immediate nephrectomy. HELLSTR~M, JOHN, Gcteborg. Contribution to the knowIedge of the etioIogy of hydronephrosis. Acta Cbir. Scandinav., JuIy 28, 1927, Ixii, 167. The author relates two cases of hydronephrosis where the pelvic diIatation was probabIy caused by the obIique course through the peIvic waI1 of the upper end of the ureter, probabIy of congenita1 origin, and a third case where spastic conditions at the ureteropeIvic junction had probabIy occasioned the hydronephrosis. JOSEPH, E., BerIin. Lithotripsy under visuaI direction. (Litbotripsie unter Leitunp des Auges.) Wien. klin. Wcbnscbr., Aug. 4, 1927, IXXiV, 1314. Josephs describes a steriIisabIe Iithotrite combined with a cystoscopic Iens which permits of the crushing of foreign bodies under the guidance of the eye. In considering the indications for the use of his instrument, Joseph observes that Iarge vesica1 caIcuIi are to be removed by cystotomy. OnIy in the case of pure phosphatic stones of unusua1 size is the