- Email: [email protected]
The localization and extraction of foreign bodies
NEW
SERIES VOL. X, No.
I
Editorials
ence in deaIing with bone tumors. He must get a carefuI history of the case with especia1 reference to antecedent Iocal trauma. He must study the Iocation of the tumor, its consistence, the coIor and texture of the overIying skin, and the presence of IocaI or genera1 temperature. In addition in a very considerabIe number of cases a biopsy wiI1 be necessary before one can make a correct diagnosis. The biopsy shouId be performed by the man who is uItimateIy to have charge of the treatment. He must be famiIiar with both the macroscopica appearance of the tumor and the histoIogica1 structure of the
THE LOCALIZATION
T
‘59
different varieties of bone tumors and inffammatory Iesions of bone. In addition, he wiI1 naturaIIy have had a Iarge experience in the interpretation of roentgenograms of bone tumors. The surgeon must be abIe to correIate a11 these different and vaIuabIe aids to diagnosis, and must weigh the evidence carefuIIy before he can advise the best method of treatment. In short, it requires the cooperation of the surgeon, the pathoIogist and the roentgenoIogist to make a correct diagnosis of bone sarcoma especiaIIy in the earIy stages of the disease. WILLIAM B. COLEY.
AND EXTRACTION
HERE are some extremeIy simpIe and easiIy accompIished methods for the IocaIization and extraction The basic principIes of foreign bodies. are as oId as mathematics and were appIied in radioIogy within three months of Roentgen’s first pubIication. Buguet and Gascard had the distinction of the first pubIished appIication of trianguIation to the radioIogicaI estimation of the position and depth of an opaque foreign substance in the human body. Sir James Mackenzie-Davidson devised the crossed thread method of visuaIizing and simpIifying the trianguIation method which found such wide use during the WorId War. The “nearest method, the “harpoon” method, point” method, the method of the “paraIIax” “rotation of the part through ninety and numerous other devices degrees,” were popuIarized by the miIIions of opportunities offered during the great conflict. EspeciaIIy in the French and German armies remova of projectiIes and other foreign bodies under fluoroscopic contro1 was the favorite method of extraction where the surgeon found diffIcuIty in Iocating the offending substance with the aid of the marks put on the part by the radioIogist during the ffuoroscopic IocaIi-
American Journal of Surgery
OF FOREIGN BODIES
zation. In the United States army these methods were wideIy taught but our participation in the conffict was not of Iong enough duration to aIIow the deveIopment of anything Iike an estabIished method or technic. It was not at a11 generaIIy reaIized, except by the American physicians who actuaIIy served in the forward battIe area, that foreign body IocaIization couId be satisfactoriIy performed by the aid of the Auoroscope, without any radiographic assistance, in a11 but a very smaI1 proportion of cases, or that radioIogic aid when needed during the extraction of such projectiIes was immediateIy avaiIabIe by the use of the fluoroscope, either in the x-ray department or by portabIe x-ray apparatus and bonnet Auoroscopes used in the operating room. Because of the reIativeIy short apprenticeship of most American physicians in war surgery and the considerabIe Iapse of time since the cIose of hostiIities, it seems to be a fact that in the average hospital in the United States the ffuoroscope is not being sufflcientIy or properIy used as an aid in finding and removing such foreign bodies as are encountered in peace times. Instead of rapid, economica fluoroscopic IocaIization, there is a rever-
160
American
Journal
of Surgery
EditoriaIs
sion to the oIder and more expensive method of stereoscopic fiIms or fiIms in two directions. And for the extraction of the offending particIes one seIdom sees use made of ffuoroscopic aid. As a matter of nationa preparedness against mihtary contingencies, as we11 as in the interests of economy of time and materiaIs, one shouId urge the more genera1 adoption of the war proved methods of ffuoroscopic aid in the operating room. The removal of SuperficiaIIy Iodged needles, naiIs and other foreign bodies commonIy encountered in civi1 Iife is often seen as a tedious, Iong drawn out operation trying the patience of both surgeon and patient because x-ray fiIms are made and posted in the operating room, and in good Iight a persistent effort is made to seize what appears to be an easiIy accessibIe solid substance; whereas under fluoroscopic guidance it is usuaIIy possibIe to remove the offender promptIy, with a minimum of traumatism through dissection of soft tissues. For the more deepIy Iodged projectiIes or other foreign bodies it is possibIe to improvise an operating set up in the x-ray department, but it seems more Iogical to set up a portabIe x-ray equipment in the surgical operating room where the surgeon
O<.T<,e~.m, ,930
can work under good Iight and with ever\faciIity at hand for emergencies, with the radiologist Iending his aid through the help of a Auoroscopic bonnett, such as the Dessane bonnett with which many of us became famiIiar during the war. Nor is this method of x-ray assistance to the surgeon confined to foreign hod>surgery; it is aIso appIicabIe to the Iocahzation of puImonary abscess and for guidance of the surgeon to the abscess during operative intervention. Sometimes a mechanica device Iike the Hirtz compass may be used to advantage, for it may be steriIized and taken into the operation for use as often as the surgeon needs. In operations for renal caIcuIi it is sometimes needfu1 to empIoy the fluoroscope at the tabIe side to guide the surgeon. The United States Army X-Ray ManuaI prepared under the supervision of the Surgeon General’s of&e during the World War, the Surgeon GeneraI’s History of the WorId War, and various surgical monographs and systems contain descriptions of the methods aIready referred to, but it has seemed to the writer that it is profitabIe and opportune to call attention to the somewhat neglected field for their use in civi1 practice. JAMES T. CASE.
Subscribers to THE A-RICAN JOURNAL OF SURGERY visiting ?$ew York City are invited tn mrJte the ofice of the publishers (Paul B. Hoeber, Inc., 76 Fifth Avenue, New York) their heuJ rters. Mail, packages or bundles may be addressed in our care. Hotel reservations will gladly r made for those advising us in advance: @ndly notify us in detail as to requirements and prices. List of operations in New York hospitals it file in our o&e daily. I
I
GIOVANNI
BATTISTA
MORGAGNI
[ 1682-17711
The Amn~m N. S.
Journal
ofSurgery
Vol.x, October. 1930
SERIES VOL. X, No.
I
Editorials
ence in deaIing with bone tumors. He must get a carefuI history of the case with especia1 reference to antecedent Iocal trauma. He must study the Iocation of the tumor, its consistence, the coIor and texture of the overIying skin, and the presence of IocaI or genera1 temperature. In addition in a very considerabIe number of cases a biopsy wiI1 be necessary before one can make a correct diagnosis. The biopsy shouId be performed by the man who is uItimateIy to have charge of the treatment. He must be famiIiar with both the macroscopica appearance of the tumor and the histoIogica1 structure of the
THE LOCALIZATION
T
‘59
different varieties of bone tumors and inffammatory Iesions of bone. In addition, he wiI1 naturaIIy have had a Iarge experience in the interpretation of roentgenograms of bone tumors. The surgeon must be abIe to correIate a11 these different and vaIuabIe aids to diagnosis, and must weigh the evidence carefuIIy before he can advise the best method of treatment. In short, it requires the cooperation of the surgeon, the pathoIogist and the roentgenoIogist to make a correct diagnosis of bone sarcoma especiaIIy in the earIy stages of the disease. WILLIAM B. COLEY.
AND EXTRACTION
HERE are some extremeIy simpIe and easiIy accompIished methods for the IocaIization and extraction The basic principIes of foreign bodies. are as oId as mathematics and were appIied in radioIogy within three months of Roentgen’s first pubIication. Buguet and Gascard had the distinction of the first pubIished appIication of trianguIation to the radioIogicaI estimation of the position and depth of an opaque foreign substance in the human body. Sir James Mackenzie-Davidson devised the crossed thread method of visuaIizing and simpIifying the trianguIation method which found such wide use during the WorId War. The “nearest method, the “harpoon” method, point” method, the method of the “paraIIax” “rotation of the part through ninety and numerous other devices degrees,” were popuIarized by the miIIions of opportunities offered during the great conflict. EspeciaIIy in the French and German armies remova of projectiIes and other foreign bodies under fluoroscopic contro1 was the favorite method of extraction where the surgeon found diffIcuIty in Iocating the offending substance with the aid of the marks put on the part by the radioIogist during the ffuoroscopic IocaIi-
American Journal of Surgery
OF FOREIGN BODIES
zation. In the United States army these methods were wideIy taught but our participation in the conffict was not of Iong enough duration to aIIow the deveIopment of anything Iike an estabIished method or technic. It was not at a11 generaIIy reaIized, except by the American physicians who actuaIIy served in the forward battIe area, that foreign body IocaIization couId be satisfactoriIy performed by the aid of the Auoroscope, without any radiographic assistance, in a11 but a very smaI1 proportion of cases, or that radioIogic aid when needed during the extraction of such projectiIes was immediateIy avaiIabIe by the use of the fluoroscope, either in the x-ray department or by portabIe x-ray apparatus and bonnet Auoroscopes used in the operating room. Because of the reIativeIy short apprenticeship of most American physicians in war surgery and the considerabIe Iapse of time since the cIose of hostiIities, it seems to be a fact that in the average hospital in the United States the ffuoroscope is not being sufflcientIy or properIy used as an aid in finding and removing such foreign bodies as are encountered in peace times. Instead of rapid, economica fluoroscopic IocaIization, there is a rever-
160
American
Journal
of Surgery
EditoriaIs
sion to the oIder and more expensive method of stereoscopic fiIms or fiIms in two directions. And for the extraction of the offending particIes one seIdom sees use made of ffuoroscopic aid. As a matter of nationa preparedness against mihtary contingencies, as we11 as in the interests of economy of time and materiaIs, one shouId urge the more genera1 adoption of the war proved methods of ffuoroscopic aid in the operating room. The removal of SuperficiaIIy Iodged needles, naiIs and other foreign bodies commonIy encountered in civi1 Iife is often seen as a tedious, Iong drawn out operation trying the patience of both surgeon and patient because x-ray fiIms are made and posted in the operating room, and in good Iight a persistent effort is made to seize what appears to be an easiIy accessibIe solid substance; whereas under fluoroscopic guidance it is usuaIIy possibIe to remove the offender promptIy, with a minimum of traumatism through dissection of soft tissues. For the more deepIy Iodged projectiIes or other foreign bodies it is possibIe to improvise an operating set up in the x-ray department, but it seems more Iogical to set up a portabIe x-ray equipment in the surgical operating room where the surgeon
O<.T<,e~.m, ,930
can work under good Iight and with ever\faciIity at hand for emergencies, with the radiologist Iending his aid through the help of a Auoroscopic bonnett, such as the Dessane bonnett with which many of us became famiIiar during the war. Nor is this method of x-ray assistance to the surgeon confined to foreign hod>surgery; it is aIso appIicabIe to the Iocahzation of puImonary abscess and for guidance of the surgeon to the abscess during operative intervention. Sometimes a mechanica device Iike the Hirtz compass may be used to advantage, for it may be steriIized and taken into the operation for use as often as the surgeon needs. In operations for renal caIcuIi it is sometimes needfu1 to empIoy the fluoroscope at the tabIe side to guide the surgeon. The United States Army X-Ray ManuaI prepared under the supervision of the Surgeon General’s of&e during the World War, the Surgeon GeneraI’s History of the WorId War, and various surgical monographs and systems contain descriptions of the methods aIready referred to, but it has seemed to the writer that it is profitabIe and opportune to call attention to the somewhat neglected field for their use in civi1 practice. JAMES T. CASE.
Subscribers to THE A-RICAN JOURNAL OF SURGERY visiting ?$ew York City are invited tn mrJte the ofice of the publishers (Paul B. Hoeber, Inc., 76 Fifth Avenue, New York) their heuJ rters. Mail, packages or bundles may be addressed in our care. Hotel reservations will gladly r made for those advising us in advance: @ndly notify us in detail as to requirements and prices. List of operations in New York hospitals it file in our o&e daily. I
I
GIOVANNI
BATTISTA
MORGAGNI
[ 1682-17711
The Amn~m N. S.
Journal
ofSurgery
Vol.x, October. 1930