New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

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Denk and De Takats have obtained satisfactory results from the use of intravenous doses of papaverine in acute embolic occlusion. By relieving vessel spasm they claim to receive as good results with this harmless pro- cedure as may be expected from performing an embolectomy. However, it is advised that the injections should be made immediately upon the diagnosis of pulmonary or peripheral embolism. In advanced cases where the injections of the papaverine have not improved the circulation, embolectomy, of course, becomes imperative. Disorders of the gastro-intestinal tract continue to present difficulties. Of the four drugs commonly used for intestinal distention, pituitrin, physostigmin, peristaltin CCibal, and acetylcholine, Gerthin and Bargen, from a series of observations, found that pituitrin alone was a marked stimulant. They con- sidered it the only drug of this group likely to prove effective regularly in augmenting the peristalsis of the atonic or paralyzed bowel. Pituitrin acted in three to five minutes and had gradually diminishing effects for three quarters to one and one half hours. Experiments performed by Blalock in an effort to find the factors respon- sible for the rapidly developing signs and symptoms of ruptured peptic ulcer indicate that the various gastro-intestinal juices, especially bile, when free in the abdominal cavity, produced a marked drop in blood pressure. He believes that cc dilatation of the many intra-abdominal blood vessels causes the primary fall in blood pressure which is followed by the secondary decrease in cardiac output. Priestly and McCormack, advised serum therapy in addition to ordinary treatment for generalized peritonitis secondary to ruptured appendix: a dis- tinctly lower mortality rate was found in those cases where it was used as compared to a control series in which serum was not given. Weinberg has prepared three sera, one a polyvalent antiserum for the anaerobes most com- monly found in these cases, another a colon bacillus anti-serum, and finally a so-called complimentary serum to combat other invaders, i. e. streptococcus, staphylococcus and related organisms. Best and Hicken have rendered an interesting account on visualization of the biliary tract by injections of radio-opaque fluids into the common duct during operations ..... a method they called immediate cholangiographyn. They injected a contrast medium, usually about an ounce, into the gall-bladder, cystic duct, or common bile duct and immediately took X-rays. They felt these studies were important in visualizing the duct system and in demonstrating over-looked stones. When the duct system was injected post-operatively thru catheters or fistulas they found a surprising number of cases of spasm of the ducts. They also found that glyceryl trinitrate, magnesium sulphate, atropine, cream, and olive oil had very evident therapeutic value in these cases of spastic dysynergia. Rothman, Meranza and Meranza, during the past year have been studying blood phosphatase and its relationship to jaundice. After observing a large number of cases of obstructive and non-obstructive jaundice they have con- cluded that a value greater than 10 units suggests obstruction. They found this test to be of greater value than any other in the differentiation of these two types of jaundice. Without doubt the most fascinating of the recent developments in neuro- surgery is that of the surgical approach to the treatment of intractable pain and essential hypertension. Adson, in l934, relieved an otherwise incurable fronto- One hundred seventy-four

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BY WILLIAM RUBIN to emerge from their experimental stage into one of general, unanimous approval. The major development in surgery during 1933 had been in the field of the endocrine system. Hollman and Railsback added to the number of cases of hyperinsulinism already treated successfully by surgery, their own case of partial resection of the pancreas. Adenomata of the islands of Langerhans has been found not to be a rare condition. The change in secondary sexual characteristics with virilism, hirsutism, amenorrhea and abnormal deposits of fat in adrenal cortical tumors, basophilic adenomata of the pituitary tCushing's Syndromel, and, that peculiar ovarian tumor, arrhenoblastoma, no longer presents the hopeless prognosis of former years. The large group of disturbances due to endocrine deficiencies such as myxedema, diabetes mellitus, parathyroid tetany and Addison's disease may all become amenable to surgical treatment. Already much work has been done along these lines of hetero-glandular and homoglandular transplantation. Difficulties which are gradually being overcome are: ill surrounding the transplant With a suitable nutrient medium: C23 providing adequate circulation for each cell: C39 preventing pressure necrosis of the tender grafts by surround- ing tissue. To prevent the last, the loose areolar tissue of the axilla or groin is selected as a bed for the transplant. ln order to help the gland to adapt itself to its new environment, it is first grown in a culture medium of beef embryo juice and serum saline, next in the serum from the donor finally in the serum from the recipient and then heparinized plasma for one month before trans- planting. We may very Well ask, Are We on the threshold of the door to the fountain of youth? Much interest has been aroused in the field of thoracic surgery, especially by the increasingly frequent and successful removal of a lobe or even of an entire lung. Advances in technic have been rapid so that the mortality in several clinics has been reduced to less than fifteen per cent. Carr has con- tributed an important improvement to the operative procedure. He has devised a small automatic hilum clamp by which strong ligation tension may be applied. This appears to have marked advantage in safety over the previous methods of ligature or suture of the contents of the hilar stump. The clamp is left on for fifteen days and is then removed through a small intercostal incision. I-lilum occlusion is complete, so that resection of the diseased lobe may be carried out immediately after application of the clamp. Excision of an entire lung is now practiced in selected cases of bronchioqenic carcinoma. Lobec- tomy is gradually winning the approval of Graham, Lillienthal, Coryllos, and others, in selected cases of bronchiectasis and lung abscess. An extremely interesting approach to coronary disease of the heart has been undertaken by C. S. Beck. By means of a pedicle graft to the heart from the pectoralis major he was able experimentally, and then in one patient, to develop a collateral circulation to this vital organ. Further reports on other patients subjected to this operation are yet to be published. One hundred seventy three

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temporal migriane by a combination of surgical procedures designed to diminish the angiospasm and desensitize the meningeal vessels. Instant and complete relief followed periarterial sympathectomy of the common carotid artery and removal of the superior cervical sympathetic ganglion along with six centimeters of the cervical sympathetic trunk. In 1935 Adson used a technic whereby the splanchnic nerves are sectioned and the first and second lumbar ganglia, together with a portion of the suprarenal gland, are excised. He claims that a modified high kidney incision gives excellent exposure. He believes this operation is superior to, and less formidable than a bilateral and ventral rhizotomy of the thoracic and lumbar roots from the sixth thoracic to the second lumbar segment, inclusive. Promptly following operation the systolic blood pressure is capable of dropping from 270mm. of mercury or more, to lOOmm. Improvement in clinical symptoms is more manifest than the actual drop in blood pressure. Retinal hemorrhage, spasm, and papilledema will often disappear following sympathectomy. Cardiac and renal functions also improve. Flothow and Swift reported a review of 100 cases in which sympathetic ganglionectomy was performed for various purposes. In scleroderma only some of the symptoms were ameliorated. In Raynaud's disease better results were obtained when only the lower extremities were involved. The question of operability or degree of vasospasm in thrombo-angitis obliterans was simpli- fied by the diagnostic injection of sympathetic nerves or by spinal anesthesia. Crile performed denervation of the suprarenals in over three hundred cases of various sympathetic disorders. Over 9O'k of those having neuro- cir- culatory asthenia, hyperthyroidism or peptic ulcer were cured or greatly im- proved. Selected cases of diabetes, epilepsy, and early hypertension also showing promising results, Crile's latest exploits have been localized about the celiac ganglion and aortic plexus. Whether young or old patients are concerned, Crile's treatment of essential and malignant hypertension by means of a bilateral excision of the celiac ganglion and denervation of the aortic plexus affords promise of permanent relief. Craig suggests section of the presacral nerves in cases of uncontrollable bladder pain or dysfunction, severe dysmenorrhea, or I-Iirschsprung's disease. Leriche and Fontaine advocate novocain infiltration of the lumbar sympa- thetic nerves for the treatment of post-operative femoral phlebitis. Pearl and Shapiro found that instances of abnormal sweating as to color, odor or chemi- cal composition calls for surgical intervention. Sympathetic ganglionectomy at the proper level will produce a total inhibition of sweating in the desired regions. They claim that the accompanying rise in peripheral vasoconstriction gives no uncomfortable symptoms. Levine has furnished us with evidence to show that the vagus in man is not the constrictor nerve of the bronchial mus- culature, and that impulses for bronchial constriction must therefore be con- tained in the sympathetic fibres. With this in mind he attempted to interrupt this sympathetic reflex mechanism in bronchial asthma. In 23 cases of intract- able bronchial asthma treated by injection of the communicating rami complete relief was obtained in 75W, with varying degrees of improvement in the re- mainder. The management of brain abscess is still in a state of confusion. Many surgeons are in doubt when to drain an abscess, and are uncertain as to the procedures to use. A similar disagreement exists in the treatment of head injuries. Temple Fay regularly presents data, to support the treatment of One hundred seventy five