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The McCarthy punch
Section
NEW SERIESVOL. III, No. I
THE
MCCARTHY
C. TRAVERS
STEPITA,
of Genito-Urinary
PUNCH M.D.
This new instrument of Dr. Joseph F. McCarthy is a prostatic punch or median bar excisor that permits these manipulations under the guidance of the eye, and renders the operative field easiIy visibIe at a11 times. The McCarthy punch consists of a Iarge caIiber beaked sheath with an obturator, used for introduction and remova of the sheath, which when introduced, obIiterates the fenestra in which the median bar or prostatic Iobe is engaged. The bIade, or sharp circuIar tube plunger is worked with a p&to1 grip handIe. This tube is detachabIe from the sheath by a bayonet joint, and the handIe and cutting blade are easiIy removabIe. The McCarthy visua1 system is utilized, and it is to be noted that the light and Iens do not move aIong with the cutting bIade, but remain stationary. An irrigating attachment, which keeps the visua1 fIeId cIear with a continuous flow, is provided with the cutting part. After biting out an intrusion, the bIade and pisto1 grip are removed, the sheath remaining in situ, and the teIescope together with an eIectrode and continuous irrigation system are introduced. In the cIear fieId, the bIeeding can be Iocated and diathermized. This coId punch with its accurate appIication under the guidance of the eye wiI1 remove Iarge pieces of tissue Ieaving a cIean incised area which heaIs quickIy without the annoyance of deIayed bIeeding or the higher incidence of febriIe reactions which one may find when the cautery bIade is empIoyed. (No discussion)
PRESENTATION
OF
SPECIMENS
BILATERAL HYDRONEPHROSIS HYDROURETER CAUSED PHIMOSIS C. TRAVERS
STEPITA,
WITH BY
M.D.
S. G., aged one month, admitted to the PostGraduate HospitaI as a feeding case, ApriI I, 1926. FamiIy history: IrreIevant. Past history: Birth at 9 months. Labor norma1. Except for constipation, the past history was negative. Fed entireIy from mother’s miIk, every two to three hours. Appetite poor. Present iIIness: The baby had been sick since
Surgery
American Journal of Surgery
33
birth. Never took feedings weI1. Had been constipated, so mother had been giving one dram of castor oil daiIy. Had an umbiIica1 hernia. The chief compIaints were vomiting, faiIure to gain in weight, and constipation since birth. No urinary disturbances noted. PhysicaI examination: Genera1 appearance that of a thin, premature baby of four pounds, coId, sick and rather cyanotic. Respiration normaI. With the exception of some abdominal distention, physica examination negative. Temporary improvement in condition under medica care, but condition graduaIIy worse as severe cough deveIoped. Died ApriI 8, 1926. Post-mortem findings: Body is that of a poorIy nourished and emaciated maIe infant of one month. Abdomen considerabIy distended. Scrotum edematous and giving the appearance of a doubIe hydroceIe. Both kidneys show marked feta1 IobuIation and are mottIed purpIish-red, especiaIIy in their Iower portions. The right renal vein appears to be bIocked with cIotted blood. On section, both kidneys show a marked hydronephrosis, peIvis of each kidney being wideIy diIated with considerabIe thinning of the kidney substance, more marked in the Ieft than in the right, the former being 4 to 7 mm. in thickness and the Iatter 8 to IO mm. Both ureters are wideIy distended, with thinning of their waIIs, and very tortuous in their course. The bIadder is moderateIy distended to the size of an EngIish waInut. The waIIs somewhat thickened, but the rugae are not marked. There is very marked phimosis, so that the praeputium cannot be retracted. The testes are very smaI1 and undescended, each Iying in the abdomina1 ring. Each shows a sIight hydrocele. Each scrota1 sac is distended with fluid to about the size of a pigeon’s egg. Microscopic: the kidney peIvis shows some fibrous thickening of the subepitheIia1 tissue. The deeper portion .of the stroma is edematous and thickIy infiItrated with extravasated red ceIIs. In the meduIIa the tubuIes are generaIIy we11 preserved. Some of them are quite wideIy diIated. The intertubuIar vessels are deeply congested. In the cortex the convoIuted tubuIes are distended and contain inspissated aIbumin, and rareIy a hyaIine cast. In many tubuIes the epitheIium is we11 preserved, but in some of the ceIIs appears ragged, and shows some disintegrated nuclei. The gIomeruIar tufts are deepIy congested and in some of the gIomeruIi the
NEW SERIESVOL. III, No. I
THE
MCCARTHY
C. TRAVERS
STEPITA,
of Genito-Urinary
PUNCH M.D.
This new instrument of Dr. Joseph F. McCarthy is a prostatic punch or median bar excisor that permits these manipulations under the guidance of the eye, and renders the operative field easiIy visibIe at a11 times. The McCarthy punch consists of a Iarge caIiber beaked sheath with an obturator, used for introduction and remova of the sheath, which when introduced, obIiterates the fenestra in which the median bar or prostatic Iobe is engaged. The bIade, or sharp circuIar tube plunger is worked with a p&to1 grip handIe. This tube is detachabIe from the sheath by a bayonet joint, and the handIe and cutting blade are easiIy removabIe. The McCarthy visua1 system is utilized, and it is to be noted that the light and Iens do not move aIong with the cutting bIade, but remain stationary. An irrigating attachment, which keeps the visua1 fIeId cIear with a continuous flow, is provided with the cutting part. After biting out an intrusion, the bIade and pisto1 grip are removed, the sheath remaining in situ, and the teIescope together with an eIectrode and continuous irrigation system are introduced. In the cIear fieId, the bIeeding can be Iocated and diathermized. This coId punch with its accurate appIication under the guidance of the eye wiI1 remove Iarge pieces of tissue Ieaving a cIean incised area which heaIs quickIy without the annoyance of deIayed bIeeding or the higher incidence of febriIe reactions which one may find when the cautery bIade is empIoyed. (No discussion)
PRESENTATION
OF
SPECIMENS
BILATERAL HYDRONEPHROSIS HYDROURETER CAUSED PHIMOSIS C. TRAVERS
STEPITA,
WITH BY
M.D.
S. G., aged one month, admitted to the PostGraduate HospitaI as a feeding case, ApriI I, 1926. FamiIy history: IrreIevant. Past history: Birth at 9 months. Labor norma1. Except for constipation, the past history was negative. Fed entireIy from mother’s miIk, every two to three hours. Appetite poor. Present iIIness: The baby had been sick since
Surgery
American Journal of Surgery
33
birth. Never took feedings weI1. Had been constipated, so mother had been giving one dram of castor oil daiIy. Had an umbiIica1 hernia. The chief compIaints were vomiting, faiIure to gain in weight, and constipation since birth. No urinary disturbances noted. PhysicaI examination: Genera1 appearance that of a thin, premature baby of four pounds, coId, sick and rather cyanotic. Respiration normaI. With the exception of some abdominal distention, physica examination negative. Temporary improvement in condition under medica care, but condition graduaIIy worse as severe cough deveIoped. Died ApriI 8, 1926. Post-mortem findings: Body is that of a poorIy nourished and emaciated maIe infant of one month. Abdomen considerabIy distended. Scrotum edematous and giving the appearance of a doubIe hydroceIe. Both kidneys show marked feta1 IobuIation and are mottIed purpIish-red, especiaIIy in their Iower portions. The right renal vein appears to be bIocked with cIotted blood. On section, both kidneys show a marked hydronephrosis, peIvis of each kidney being wideIy diIated with considerabIe thinning of the kidney substance, more marked in the Ieft than in the right, the former being 4 to 7 mm. in thickness and the Iatter 8 to IO mm. Both ureters are wideIy distended, with thinning of their waIIs, and very tortuous in their course. The bIadder is moderateIy distended to the size of an EngIish waInut. The waIIs somewhat thickened, but the rugae are not marked. There is very marked phimosis, so that the praeputium cannot be retracted. The testes are very smaI1 and undescended, each Iying in the abdomina1 ring. Each shows a sIight hydrocele. Each scrota1 sac is distended with fluid to about the size of a pigeon’s egg. Microscopic: the kidney peIvis shows some fibrous thickening of the subepitheIia1 tissue. The deeper portion .of the stroma is edematous and thickIy infiItrated with extravasated red ceIIs. In the meduIIa the tubuIes are generaIIy we11 preserved. Some of them are quite wideIy diIated. The intertubuIar vessels are deeply congested. In the cortex the convoIuted tubuIes are distended and contain inspissated aIbumin, and rareIy a hyaIine cast. In many tubuIes the epitheIium is we11 preserved, but in some of the ceIIs appears ragged, and shows some disintegrated nuclei. The gIomeruIar tufts are deepIy congested and in some of the gIomeruIi the