Vol. 60, 1909 - University of North Carolina at Chapel Hill

Ill
THE CHARLOTTE MEDICAL JODRNA].
'
moved, and the veilical peritoneum, togeth- a calculus no time should be lost with coner
with the posterior sheath, is closed first, servative methods, but the ureter exposed
Efficient drainage may be secured through by abdominal incision, opened longitudithe
upper end of the lateral wound before nally, and the calculus gently expressed,
the peritoneum and vnnsversalis fascia are A sound is then introduced to detect any
brought together. \\ h:ii the inner end is other calculi or strictures and the ureteral
reached the rectus is suiu -ed at the fibrous wound closed by a few fine silk sutures. It
intersection where the St'tuie holds well, is better not to imbed it or fix it in the sur-
The anterior sheath is ma le to overlap a rounding tissues, since kinks and cicatricial
little, and the fibres of the external and in- induration may result. If the ureter is obternal
oblique and transversalis muscles are structed low down it may be exposed
gently approximated. The skin is closed through the vagina or by perineal or periby
celluloid thread or Meckel's clips. sacral, incision, though the latter is not to
be recommended. If the calculus is sit-
Treatmenl ol Ulcerative Colitis.-Dunn ^ated near the bladder cystotomy is indiin
the Medical Lancet reports that m the cated. In cases of injuries of the ureter
Berkshire Asylum, Wallingford, they have garlv operation is necessary, although the
for some years past been so convinced of diagnosis is often uncertain. The retrothe
superiority of the treatment of ulcera- peritoneal route should be selected so as to
five colitis by creosote and ol. morrhuse avoid urinary infiltration. In gynecological
that it is now exclusively made use of. He operations if the meter is injured the
has no hesitation in saying that it relieves wound should be closed at once by two fine
the symptoms more quickly and shortens silk sutures, or if torn across, the sutures
the course of the disease more effectually are preferably to be applied in an oblique
than u.se other, and there has been less mor- circular rather than a transverse direction,
tality since adopting this method. The '
Anastomosis may give rise to obstruction
dose used is as follows: Creosot., W iii; ol.
j^ t^e urinary flow, and it is better to j
morrh., 3i, is given three times daily on the i„vaginate the proximal end into the vesi- /
first day of the disease, castor oil having ^al end of the ureter. From 3 to 5 cm. of ij
been previously administered. This is in- the ureter can be resected, this being com- 5
crea.sed by 3i daily until on the fourth day pensated for by the descent of the kidney. {:
the patient is taking creosot., "^xiii: ol. Suture of the divided ureter low down near 1,
morrh., 3ss. This is continued until the the bladder is technically impracticable \
termination of the disorder. and is commonly replaced by intraperito- '_
Eczema in InIants.-Menddssonl Munch,
Med. Woch.) states that, according Finkel-
"eal implantation of the ureteral stump into .:
the bladder. Apart from injury, implan- ',
stein, the eczema of infants is due to disturb- Nation is also indicated m cases of prolapse, '
tumors of the bladder, ectopia ,'
vesicse, etc.
ed assimilation of the salts in milk; its
treatment therefore is not local, but must
^^ contraindicated for technical reasons it .|
consist of dietetic measures. The best diet ^^^ ^e replaced by (I extirpation of the ) j!
ispoorin salt but rich in proteid andfat,
co^'^^esponding kidney, if the other is
j
and is prepared by removing the salts of liealty; (2) anastomosis of both ureters; I
milk washing the casein in water and then '^^ nephrostomy or implantation into the <
abdominal wall; (4) implantation into the "I
mixing it with diluted whey. Mendelsson
obtained very good results with Finkelstein's "'testme; and (5 '
artificial replacement of
)
diet, the eczematous conditions disappearing of the ureter by tubes. In regard to these !
more quickly and surely than with the older procedures Garre remarks that anastomosis '
local treatment. The loss of weight noted °^ "'l^'^h ureters is very difficult and fail- j
on this diet should not .stop its use, as it is ^^^ ^^o^l*^^ imperil both kidneys and cause caused bv the rapid loss of water with the
\
'ieath. In intestinal implantation of the ;
ureter, to avoid the risk of pyelonephritis, j
removal of salts in the tissues. The diet,
however, .should be tried only in such chil- ^^^ ureter has been implanted into an ex- )
drenwhocan bear fat well; such infants are eluded segment of the sigmoid,
usually large for their age, have a pasty „ . . , , , „ * r„ t-aoLv
, ,,
„.•„ J . T .
Pepsin IS undoubtedly one of the most valuable
Skin and are prone to manifest not only ec- digestive agents of our Materia Medica, provided a
zema but other phenomena of "exudative good article is used. Robinson's Lime Juice and
diathesis." They stand the withdrawal of I'epsin, (see page xvi this number) we can recorasalt
very well if it is not
me"^l as po.ssessing
continued
merit of high order.
too long
after the curative effect upon the eczema "^^^ ^^'^^ '^'''' '''"^ manufacturers of this palatable
has
been noted. preparation u.se the purest and best Pepsia, and
that every lot made by them is carefully tested, be-
Ureleral Surgery.—Garre ( Deutsche fore offering for sale, is a guarantee to tire physic-
Med. Wochensch) believes that in cases in ian that he will certainly obtain the socd results he
which the ureter is completely blocked by expects from Pepsin.