924 Dr. Ewing’s results suggest that exercise definitely between only a few lymph and chyle vessels would benefited and decreased the incidence of pain. That suffice to produce back pressure effects in the former. the general attitude towards the menstrual period as The points against a purely mechanical cause are natural function should be a very important part two : first, that the lymphangiectases presented a a girl’s training was one of the conclusions reached centrifugal spread. and8econdly,thatthe circumference from the Medical Women’s Federation inquiry, and of the leg remained normal and apparently withstood Dr. Ewing confirms this when she says that psycho- the hypothetical back pressure for 20 years. logical factors such as self-discipline play a part in the treatment of dysmenorrhoea. a
URINARY CALCULI. LITIIIASIS was the subject discussed by a number of French urologists lately gathered at Vittel.1 Prof. M. Loeper in an introductory paper on the causes of oxaluria and oxalate calculi pointed out that there are three possible sources from which oxalates may be derived : they may be taken with the food, they may result from fermentation in the intestinal canal, In any or they may be derived from the tissues. study of oxaluria the liver is of first importance since the condition often indicates disturbance of carbohydrate metabolism. That this is so is proved said Prof. Loeper by the fact that oxaluria is very commonly found in diabetics. In treatment attention must be paid to all these possible sources and the diet should exclude substances rich in oxalates, like rhubarb and haricot beans. Meat, he thinks, should be cut down-not so much because it is a protein as because it contains a large amount of sugar and from Exercise should be sugar may be derived oxalates. encouraged, and steps should be taken to ensure the complete oxidation of carbohydrates. Foremost among the remedies that help oxidation is insulin, and Loeper suggests that it may usefully be given in small doses even in non-diabetic cases. At the same time an attempt should be made to diminish the tendency towards precipitation in the kidney. Since precipitation of calcium oxalate is likely to. occur in alkaline urine it is important to avoid giving alkalis in large doses and it is often useful to exhibit such drugs Prof. F. Legeu, speaking as acid sodium phosphate. on the indications for surgical intervention in cases of lithiasis, said that operation was desirable where calculus was associated with enlargement of the kidney, where stone was impacted in the ureter If stones were or where there was pyonephrosis. bilateral, operation was required for such symptoms as pain or marked hoematuria. When a stone on one side had reached the ureter intervention was always necessary. In the less common case of a stone in a solitary kidney or in a horseshoe kidney, much would depend on whether the stone could be dealt with by pyelotomy or required nephrotomy. With a horseshoe kidney pyelotomy or partial nephrectomy was usually needed, the choice being made according to the effect of the calculus on the surrounding kidney. Prof. Merklen devoted his address to the treatment of lithiasis in children. After the fourth year of life, he said, two different classes of calculus were found, either uric acid and oxalate calculi or phosphatic calculi. A striking fact was that lithiasis was commoner in boys than girls. Very often there was a family history of stone and many patients showed signs of gastro-intestinal
LYMPHANGIECTASIS AND CHYLORRHŒA. ISOLATED and circumscribed lymphangiomata are a rare form of naevus which it is difficult to treat. Their aetiology is uncertain, but it presumably resembles that of the vascular types of naevus so Both varieties tend to common in the infant. grow with the child and on reaching a certain size to remain stationary, after which they usually persist indefinitely. The differences between lymphangioma and lymphangiectasis are not sufficiently emphasised and a case just reported by Ningof Frankfurt should not be neglected. The patient, a woman of 34, was admitted to hospital in 1909 for a grouped vesicular condition on the internal aspect of the right thigh. She said it had been present since she was 11, and that regularly every fortnight a variable quantity (up to a litre) of white fluid had been freely discharged from the small blisters. This assertion was substantiated at the time, when it was found that a milky fluid could be collected at the approximate rate of 10 c.cm. in eight hours. She was again admitted in 1913 when it was further noted that the urine was often white-less so after a discharge from the vesicles in the thigh. Biochemical and microscopical examination proved this liquid to be chyle, and its quantity and appearance could be in some Thus after a meal rich measure controlled by diet. in fats and cream it would be milky and opalescent, while if fats were withheld it would become clear, In the course of a surgical attempt or nearly so. to relieve the condition, it was found necessary to tie two large lymph vessels which discharged their contents freely into the depths of the wound. At her third admission in 1931 there was a further increase in the number of vesicles and a considerable swelling, observed for three years, of the right leg. Lymphatic and chylous discharge is still present but not in such quantity as formerly, and soon ceases on elevation of the limb. Palpation of the two groups of vesicles elicits the sensation of fine crepitation. They are of two defined types, small vesicles and sac-like structures. Histologically, there is a general dilatation of the lymphatic system in the affected area, with cyst-formation on the surface. The description should thus be multiple lymphangiectasis with cyst formation and recurrent chylorrhcea. TheI aetiology as Ning says, is difficult. Most authors favour a purely mechanical cause leading to back: pressure, but anatomical proof, even at autopsy, is wanting or inconclusive. In the case here cited Ning assumes a congenital error of communication between the lymph vessels of the right thigh and the: chyle effluents from the mesentery of the same disturbance. side. In support of this theory is the fact that the vesicles immediately below Poupart’s ligament con. THE Semon lecture will this year be delivered by tained chyle from the earliest date of origin of theB Nlr. Douglas Harmer at 5 P.M. on Thursday, Nov. 5th, symptoms. According to Kaufmann the main chyleB at the house of the Royal Society of Medicine, vessel empties itself into the left lumbar lymphatic’ 1, Wimpole-street, W. His subject will be the Relative trunk in 70 per cent. of all cases examined, but this; Value of Radiotherapy in the Treatment of Cancers finding does not invalidate Ning’s view, for a junctiorl of the Upper Air Passages. .
Woch., Sept., 1931.