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Related post: contracted until ii had not the thickness of the little finger, but Buy Meloxicam this
was deemed spasmodic contraction, and it was expected to disappear
s|)ontaiieously. 'I'he intestine was leplaced in the abdotinnal cavity
and the abdominal wound was closed. 'V\w operation lasted an hour.
The patient had three stools during the next few houis, and at the end
of four days she was pionounced cured.
The calculus had the form and volume of a small egg; it weighed
fourteen grammes and had forty-two inillimetreH in its greateHt, twenty-
six and twenty-eight inillimetreH in Meloxicam Buy the two other diameters. ItH color
was yellowish-white and brownish in places. It was composed of a
central region of pure cholcHterin and of stratified layers of calcareous
salts and hard fa'cal matter.
Thiriar believes that this was a biliaiy calcMJus which had escaped
from the gall-l)ladder into the intestine, and, as the patient had never
had colic or jaundice, and as so large a calculus could not have trav-
ersed the common bile duct, he maintains that adhesions must have
been produced between the gall bladder and intestine, and that the
calculus ulcerated its way through the walls and fell into the intes-
tine.
Cam[)enon at the same time reported a similar case (ihid.). but with
not so fortunate a result. The obstruction was found a little below the
duodenum, a calculus inclosed in a pocket formed in the same way as
in Thiriar's case. The intestine was opened as in the other case, but
the stone had to be extracted and the pocket did not retract ; it re-
mained flabby and gaping. The wound was sutured in Meloxicam 7.5 Tablets the same man-
ner as in the preceding case. On the third day the patient died of
peritonitis.
At the auto])sy the intestinal sutures were found to be in good con-
dition. It was established that the seat of the calculus was forty
centimetres below the duodenum. The duodenum communicated by
a large perforation with the gall-bladder, or rather with a cavity cor-
responding to the latter, which was bounded above by the inferior sur-
face of the liver, in front by the colon, below by the duodenum, and
behind by the remains of the gall-bladder. One of the adhesions
which formed the wall of this cavity had broken and permitted the
escape of faecal matter into the peritoneal cavity. This rupture may
have been caused by traction during the operation, or by the peristaltic
movements of the intestine.
Enterorrhaphy. — M. Chaput {ibid.), after objecting to the various
forms of enterorrhaphy, proposes the following:
A primary row of muco-mucous sutures is inserted in the posterior
demi-circumference of the intestine. A longitudinal slit three centi-
metres long is then made in each of the two ends, either upon the con-
vex surface or midway between this and the mesenteric insertion. The
two triangular portions thus obtained on each side are trimmed by cut-
ting off their apexes. The muco-mucous suture is then continued
around the entire circumference of the intestine and to the ends of the
slits. This row of sutures is then re-enforced by two rows of peritoneal
sutures.
Eesection of the Pubic Bone in Suprapubic Cystotomy. — Heyden-
reich {ibid.) relates a case in which the vesical tumor was inaccessible
by the ordinary operation of suprapubic cystotomy, although Peterson's
rectal bag was employed. He resected the superior part of the sym-
physis for a distance of four centimetres, and the operation was then
easily completed. Unhappily, the patient died of pyelonephritis, which
had existed for some time. The resection of the pubic bone did not
seem to aggravate the operation, but rather abridged its duration by
the facility it afforded. It should be performed only in exceptional
cases, however, where access to the bladder is difficult.
Tuberculosis of the Testicle. — Roux (ibid.) believes in radical extir-
pation of the tubercular focus in these cases before the organism is
infected. To remove the testicle alone is insufficient. • It is necessary
to sacrifice the vas deferens and the seminal vesicle, which are almost
alwavs simultaneouslv attacked. His method is to first remove the
July IS, 189J.J
MISCELLANY.
81
testicle, isolate the vas deferens as lii^li as possible in the infruinal
canal, tlien place the patient in the dorso-luiiibar posture and pene-
trate t]irou


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Ultimo accesso:Sunday, 24 November 2013, 07:27  (2185 giorni 3 ore)


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