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

4.i8 THE CHARLOTTE MKDICAI, JOURNAL.
Locomotor Ataxia and Paralysfs Jn the nev may be assumed if catheterization of
Light of the Newer Syphilis Rcscarcl^.-
^j^^ ^^^^^^ ^^-^^ ^^ ^^^^^ ^^^^, retention of se-
LessertBerl.klniWochenschr) states that
^.^gjiQ^y i„ ^^^ ^^^^^^ p-gj^.j^ Repeated
Wassermann's syphihs reaction is positive
ngors in the course of a febrile pvelonein
paralysis m lOU per cent, of the cases and
pj^^j^jg p^j^j ^^ ^1^^ presence of abscesses in
in ataxia locomotor m .0 per cent, of the
the cortical portion. .-Vcute and subacute
cases examined Both diseases must be
pyelonephritis demand nephrotomy, if perlookedupon
astheresultof syphilis, but in
^fstent and general septic symptoms point
none of them IS the real process a syphihtic
^^ abscess formation in the parenchyma,
one. It is Ihe result ot nerve degeneration
^,^ bilateral disease nephrotomy may be recaused
by meningitis syphi it.ca, which -^^^^ ^^ ^^^.^ ^j^j^^ .pi^^ u,iiiateral hemmay
still be present or not. flie meningitis
atogenous form of cortical al)scess, such as
luetica may be compared with the media
occurs after furunculosis or angina, as w?ll
infiltration in aneurysm of the aorta This^^jjg
sequels (paranephritis), must be
explains why auiiluetic treatmem does not
^^^^^^^ j^,, ^^,i^. ^g^^^t to nephrotomy and
benefit the disease. Healthy persons, who
j^cision of the abscess. Nephrectomy is
have suffered from syphilis before, show the
indicated in chronic supuralive processes
reaction in 50 per cent of paralysis. It is
j,, the kidnev accompanied by sclerosis of
possible, according to Lesser's experience,
the ureter (empyema of the renal pelvis,
to make the reaction disappear by specific
p^^^jg,,^ nephrolithiasis), provided the
treatment Healthy persons showing the
functional capacity of the other kidney is
reaction should therefore undergo antisyphsatisfactory
ilitic treatment for a considerable time.
This is the prophylaxis for paralysis and Incomplete Ligature o! Arteries in the
ataxia locnmotica. Treatnient of Aneurism.—Doyen ' Munch.
The Treatment ol Purulent Non Tuber- Med. Wochensch. ) says the operation sagculous
Disease of the Renal Pelvis.— gested consists in encircling the artery
(Munch, med. Wochensch) says that while above the aneurismal sac with a silken
certain forms of acute and chronic pyelitis ligature, which is tightened only sufficientcan
occasionally be cured by medical and ly that the pulsations below are barely perdietetic
treatment, local and surgical meas- ceptible. In cases of aneurism of the abures
are of chief importance. In acute domiiial arteries, subclavian or carotid,
febrile pyelitis catheterization of the ureter nothing further is done, but in aneurisms of
is indicated both for the removal of retain- the main artery of a limb incomplete ligaed
inflammatory products as well as for ture is followed by longitudinal resection
irrigation of the renal pelvis. Chronic of the sac and restoration of the normal
pyelitis should be treated by irrigation of lumen by a doucle longitudinal suture. He
the renal pelvis or instillations. The best reported a case of aneurism of the popliteal
results are obtained in infections due to the artery in which normal conditions were
bacterium coli and gonococcus, while the thus restored over a section of 11 cm,
local treatment is of less value in staphy- Owing to subsequent obliteration of the
lococcus, streptococcus or proteus in fee- popliteal vein with considerable edema of
tions. In cases in which tuberculosis is the limb, he resorted to the following prosuspected
and in pyelonephritis irrigation cedure: The entire external jugular vein
of the renal pelvis is contraindicated, and WdS removed from a sheep and placed in an
this also applies to infective hydronephro- isotonic saline solution. The tibioperoneal
sis. If repealed evacuation of accumn- veins of the patient were then exposed and
lated secretions in the renal pelvis with the one of them found permeable. An incision
uretral catheter and the use of local medi- was next made in the popliteal region and
cation has proved ineffective, and the the proximal end of the politeal vein found
febrile condition or other severe general in Hunter's canal. At each end of the exphenomena
persist, nephrotomy should be tirpated vein of the sheep three sutures were
undertaken. This operation should also inserted; the exposed tibiopereneal vein
be considered as a primary procedure in was then transversely divided, invaginated
cases of acute and chronic pyelitis in which into the sheep's vein, and the latter sutured
uretral catheterization cannot be carried to the external coat of the tibioperoneal. .A
out, as well as in infective hydronephrosis long curved forceps was inserted into the
and pyonephrosis, or it may be replaced by femoral wound and made to perforate the
nephrectomy in the latter two conditions, tissues of the politeal space down to the tib-
Fistula of the renal pelvis, or severe inju- ial wound, the sheep's vein drawn through,
ries of the renal substance after nephroto- and its proximal end sutured i;ito a longimy,
revnires secondary nephrectomy. He tudinal incision in the popliteal vein. The
further stated that in acute febrile cases of implanted segment had a length of 25 cm.
infection of the upper urinary passages an The wound was drained and complete resinvolvement
of the parenchyma of the kid- toration of the circulation took place.