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Related post: was to be removed, all manipulations of it should be made with
as little force and violence as possible. Special care should be
exercised in securing the pedicle. The artery might be ligated
separately, or, if a mass ligature was used, it should be an elastic
one.
Dr. Arthur T. Cabot, of Boston, discussed the question of
stone in the ureter. Impaction of calculi within the ureter
might be caused by irregularities in their contour. Impaction
might be so firm as to cause serioug injury to the ureter, the
kidney, or both, or the stone might be dislodged by the press-
ure of the urine from behind. The pain caused by a stone in
the ureter was a most important consideration, not only on ac-
count of its subjective influence, but also on account of its in-
fluence in determining a diagnosis. Thickening of the wall of
the ureter was one of the conditions that might attend the pres-
ence of a calculus. The state of affairs being assured, it would
next be of importance to find out the exact location of the
offending body, and this was usually very difficult except in the
lowermost portiim of the ureter, where it could be palpated
thrc;:gh the vagina or rectum. Palpation through the abdomen
in vpi-y thin people would sometimes enable one to iocite it as
high as the brim of the pelvis or even higher. In other cases
the location must he determined by an abdominal incision. The
treatment of this condition was Calan Sr 240 Mg considered as preventive, non-
operative, and operative. Operative procedures would be influ-
enced by the question of the presence of stone in only one or in
both kidneys, and it must be remembei-ed that if there were a
stone in one there often was a stone in the other also. If an
operation was decided upon, it was very desirable that it should
be performed without opening the peritonajum. The incision
which should he made in the loin to reach the ureter followed
an irregular line and was described. This incision would enable
one to reach all but the lower three or four inches of the ureter.
An anterior incision was not practicable for the removal of the
calculus, though it might be useful in locating it. The posterior
incision obviated the division ot the peritonaeum. The ureter
having been reached and incised, and the stone removed, the
wound could either be closed with fine silk or allowed to remain
open and heal by granulation. The latter method was believed
to be preferable.
Dr. Edward L. Keyes, of New York, discussed tlie question
of stone in the bladder, and that of what special indications
should govern a choice of operation as between litluitoniy and Calan Sr 120 Mg
lithotrity. He remarked that the three modern procedures, litho-
lapaxy, cystoscopy, and prostatectomy, had changeil the Calan Sr 180 Mg course
of the treatment of stone in the bladder. The size of the stone
did not now affect the treatment, so far as the result was con-
cerned, or perhaps it would be more correct to say that the
smaller stones were better treated with the lithotrite, the larger
ones with the knife. Lithotomy, in some respects, required
more skill than lithotrity, and yet it was not always easy to
314
FROCKh-JJfXaS OF .•^OCIIiTIES.
|N. Y. Med. Jouu.,
grasp mill crush a small stono without doing injury to the tis-
sues of the bliukler. The ajje of the patient was not now ii
matter of such consideration as formerly. Crushing could be
performed u[)on persons of all ages, Calan Sr 240 and it should be preferred
as an operative procedure in all cases prior to the period of
puberty. For persons in middle life the perineal section was
frequently the preferable operation, especially if stricture of the
urethra or cystitis was present. For cases in which the stone
was sacculated the suprapubic operation was to be preferred.
For old men with enlarged prostate the suprapubic operation
was to be preferred, and the prostate might be operated upon
:at the same time.
Dr. L. B. Bangs, of New York, discussed the indications for
choosing between sii])rMpubio lithotomy and lithotrity.
Fibroid Disease of the Heart.— Dr. A. L. Loomis, of New
Y'ork, read a paper on this subject. Heart failure with pneu-
monia, resulting fatally, was frequently attributable to fibrosis.
Changes in the coronary arteries, or anything which caused
■changes in the parenchyma of the heart, might precede fibrosis.
Some of the causes that induced fibrosis were toxic changes in
the blood, mechanical interference with nutrition, and trauma-
tisms of various kinds. The most important causes were those
that interfered with cell nutrition and lowered the vital force.
Toxic causes acted primarily upon the cardiac walls. The diag-
nosis of fibrosis of the heart could sometimes be made during
life, and even in the early stages of the disease. The disease
should be carefully distinguished from valvular disease. Irregu-
larity of the heart's action was likely to occur early in the dis-
ease and to be permanent. The heart's action was feeble and
intermittent, and palpitation was frequently complained of.
Unusual efforts of all kinds would cause difficulty. Precordial
anguish followed at a later stage of the disease. If the diagno-
sis was made early, the development of the disease might be
prevented, or its progress delayed. The treatment would con-

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Ostatni dostęp:czwartek, 28 listopad 2013, 04:16  (1393 dni 7 godz.)