장음표시 사용
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it strihes the nerve the patient ili laetis ain hootin down thele alon the line of his forme palns. The operator ill perceivea sensation asci the needle ad passe fro musci into rubber tubins in peculia elastic resistance. I the nervecis no struc theneedle ili strike the nec of the femur. The operator must thenparti withdra the needi and stari in me direction. Usuali hewil find that his needle has been passe to far mediatly Patientsearch musti maderuntii the nerve localed by nomenns Blways a simple matter particulari in stout patients. The solution to the amount indicated is deposited in his resion In thin subjecisci se the esse amount an in stout patient an for repente injections the large amount is sed Lusuali try to inject 5 cc. of the solutiondirecti into the substance of the nerve and the remainde in iis immediate vicinity.
Aster the injectio has been ad the patientishouldie kept inhed a da o two. Recent or mit cases are usuali cured by one injection Severe cases hould e reinjected after a week Severe. long-standin cases, particulari thos complicate by coliosis may require a many a Mur orisve injections. The interval betweenthe reatments houldie a wee o two. I the injectio is made into the nervem cur is certain USuallytherars injectio produces a marked improvement. In rare instanceSthe conditio seem tote aggravate but his passes o within alaw days There have been no complications o unplensant sequellcte, an sociar a Ianow there have been no recurrenceS.
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212 THE REATMEN OF VERTIGOTHE REATMEN OF VERTIGO
Professoris Clinica Medicine Manchester University Hon Physician Manchester Roya Infirmary
AETER a dissertation o the natur os vertigo, as SSOcialed
ith aura disease the author continueS: The reaiment of vertis the result of a non-Suppurative lesion in the labyrint demand attention a durins an attach b. bet een the attac as a preventive measure During the attac thepatient is putri be&with the head stishil raised hol-water botilesare putrio the eel, and calomel, gr.v. administered AS a preventive meas e between the attacks the patientishouldie warne to avoidsudde turnins movement of the ead undue exertion, and the watchin o quickl passing objecis a experienced by lookins ut of the windo hiis travellin in an expres train. Sometime evensaetin a movin pictures may incite an attach. Constipation houldbe prevented, and obacco and alcohol used only in moderation Themost efficacious drus are iodides bromides, Strychnine, and quinine.
In an particular cas it is dissiculi to an hic of these is likelyriobe mos successiat, thous in hos with a neuroti temperament Ithin bromides are indicated. Whilst strychnin is perhaps the ostbeneficiat in debilitated individuals On the whole ho ever, I belleve that quinin in mali doses,ith or,ithout romides illis found tot the mos valvable drus in ardin offittack of vertis of this class. A useful prescription is:
In vertis unassocialed with aura diseas the author says that in Some cases of vertis combined with migrain considerable benefit may be derived by takin pil quininae gr.l. twicem day, combinedwith a die restricte in animal ood an strict instructions to the patient to eat Sparinsly.
The Lances, London, Dec. 6, 192q. p. ll9l
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Chies of the Surgical Depariment of the municipat Maria-Hospital
Mariani and Rin Misch. 2. Methods whichiim at curing the diseas radicatly by extirpationo the enlarge bundies of veins: eithe by one long oris severat
3. Method seekinsu achieve the fame resulti producing throm bosis of the eins. The thrombosis may be produced eitheris localinjections ori sillin the entire enlarued vel system it the liquid hic is to brin about the thromboSiS.whic of these method is tot used in an particular caseaeSultSfirs an foremos hom the natur of that caselut also in part romthe preference of the surgeon forine methodi the other Moreoverthe Various method may be happii combine withiach other. In the Maria Hospita at Helsinsfors. 288 patienis ere reate forVarice or complications. In 33 cases an operation a made. In these cases at the bove mentione method excepi in Disch sspirat cui ere applied where varicos veinchad collected in clearly defined aggregations and belonge to the area of the great saphenous
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vein the method selected consisted in extractionis themaid veinsin Bahcoch s metho an in cultins ut the enlarsed veins Babcoch smethodus as follows the great Saphenous vetiis exposedit the potnt where it end in the femorat vel aster hicli it is ligatured a close to the junctio a possibi and opened Through his openins a flexibie meta found is inserte in the periphera par of the ein themaidsound bein atine end litte&with a large bali and at the othe witha mali ball. Is his special instrument is wantins then an oesophasUSsound ma be sed, S a done by me, to ne en o whicli thesmal ball. an to the ther the large ne is screwed with the smalibal in front the ound is pushed inside the vel like a catheter in theurethra, and as a ule it is possibi to pusti in the ound so a that itcan e seen an felici a Subculaneous vel in the lower par of theles This vetiis exposed by a cui and is peripherali ligatured, after
leve of the tubercle of the tibia. Marianis method a described by R. C. Ohman in insta Laharesaltsh Hana 19l3ὶ Last ea in
Similar cases, used injections producing thrombosis, Wit a Solution
thrombophlebitis the treaiment was stoppedintii the inflammation hadbeen remove by est in bed and applicationis compresses. In phlebitis e mostly used lea lotion, an for ound boracic lotio orphysiological solutions os common sal tosether illi ho mater dress-inss. In individua cases Flachers fluid ' rendere good service. Equipped in this way it mistitie supposed that we were fully armedia the reaiment of varicos velns, butinfortunatet this is no thecase Pliave so armo dealt with an incalculabie danser,hicli threat-
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bosis and embolism Let me sive an eXample of this A,ouns omani flourishin health calle upo me last priniso the reaiment oflars mell-define an uncomplicate varicoSe einS. The case was exceedinst wel adapte for a Babcock operation tu extirpation. O m proposa that he hould undergo an operation, he replied that he had hesitate for a lon time hecause he had tostae bestfriend win to a loo clo after the fame operation. I reassuredhe by saying that strict rest in bed after the operation disposes of this anser. The operation was carried out an healin completed
quite Septicatly when the patient on the 5 h da after theoperatio sol ut of ed. he fel down ead. The post mortemsho ed that a par of the thrombus hic had forme in the en of the great saphenous had broken way and had been dashed into the
Amon the 33 operations hicli ere carried out in the Maria Hospitat, observe an other case of thrombosis an embolism. This as a oman of 56 who had been subjecte to an operationo the Mariani method for a varicose ound in thecies. Feve in the post-operationa period was absent, butin the h da after theoperatio phlebitis occurred in the hollow of the knee. O the 7 hda abdominatisains ere recorde and o the l0 h da sangrene in the oot hicli ad to e amputate later Later on there also appeared embolism in the mesenteria vesset an in both arms, allos hicli resulted in the deat of the patient whicli occurred 30 daysafter therars operation. ,ould like to ad that ali large series of these operation are attendedi equali strihin missortune. Thus B. G. Noble reporis that in 17 sections of the . saphena there occurre one case o pulmonar embolism illi fata result. Other statistics by Ieannet indicate that in .qq varix extirpations there occurre 20 asepti andra suppuratin thrombi, 3 cases of embolismo the lun an of pyemia. In vlew of such incalculabi cataStrophies oneris compelle to ook around for es danserous method ostreaiment. Evencis the saphen is ligature clos to the femora and the patient allo e to emat in hed for weeks one cannot be quite sure of him. illi entiret aseptic thrombosis the clot of blood hardly
stratifled soli thrombi,hicli adhere firmi and in good time to the
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wal of the ein. In the Maria Hospita investigations in his directio mere carried outi m assistant Dr. UIDes. The related in the sest place to the thrombi,hic form after quinin injections
injections are exceedinsi simple o mahe. The patient sit on theedue of the bed illi leus hansin down and the doctor ahes his
place opposite the patient Aster an application os lodine the injectionis made with an ordinary morphia Syringe provide&with a fine potnt. Aster makin sure by exertin sentie suetion, that the needle is in the interior of the vel one-quarte to ne hal c. . of the solutionis injected. Da litile of the solutio mahes it way into the wal of the ei or the par surroundinxit, thimis notither is than beneficiat This hould e alme at in particular is the varicos veinsare large The puncture is the closed um it cotton wool steepedi collodium About 8 cm. hiulier a resti injectio is made, etc. Geneomer seldom exceed a dos of . . at ne sitiins. At thepoints of injectio thrombosis ahes place hic may be atherpainsul in the rs days. A wee later the method canci necessary
wit this method of reaiment the question, of OurSe nriwSwhether these thrombi are no jus as anserous a those hichfor after a ligatur of the eins. The reat road throus the Saphenou is ope wide. I seems to me that theoretica doubis inthi respectiust yielesto practica experience. Geneorier state that the intravenous injections o quinin are innumerable and that hehimself has carried out q.000 of them ithout emboli consequenceS. In the Maria Hospital 26 patient underwent his reaimen and more than 500 injections were carrie out without an accident. Dr. UIDess investigations concerning the actionis quinine n the
to a there is no coagulatio at all. A microscopi examinationshows that the roli formation is stopped. - f the time os coagulationis determine helare an after the injectionis quinine, it is found that it is reduce 2-2l minutes, .e. 25 30 M. B way o com parison Lwould mention that non of the many asenis,hic promote coagulation and were tried by Dr. Eloino in the Maria Hospital in
Bnother connectio possesse so pomeris a coagulative proper
althous the were used in heau doses. Furthermore in dissectionso quinine-thrombicit is found that the adhere stronsi to the walis of the esset whic are permeated by a bloody selatinous mass. Itappears therefore that quinine exeris a genera actio on the consul
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ation proces an a loca action the wali of the vesself, e.i is particulari sultable for creatins rapid fir an salaly-adherinuthrombi These facta must a state be confirmedi further investi
B way o completion I ould further mentio that we sed in 2 cases the method os, after the ligatur of the saphenous ein to filithe entire superficiat varicos system of vein with a solution os lodine. in this case Preses solution The result must be describesas splendid. The dra back of the method are: reser solution is patented and practicali impossibi to obtain and bove ali the ligatur of the saphenous entatis the sua ris of embolism hichus incalculabie. Possibi the thrombosis of the ein might rst e produce by quinin injectio and Some time later the vascula system filled with
Preor solution. The surgical reaimentis varices leaves bellind excellent functionalresulis although smali osten harmiess, relapse Aremo infrequent. Itis nevertheles our ut to investigate further an above alicio attemptrio obviat the incalculabie danseris embolism. f, should further succeed in curin the aliment,ithout operation and without lensth sta in the hospital this to wouldie a great advance.
The writer emphasietes that the operative therapyis varicos veinsyields ood resulis buth that the danseris embolism is an incalcul- able factor hic has hitherio proved impossibi to eliminate. At the Maria Hospital Helsinsfors a series of patient have been trealed illi intravenous injections o quinine. Investigations have proved that his substanc has a two-fold effect in soria that it reduces thetime o coagulatio of the bloo tora muchireater extent than Anyother known substance and further irritates the wal of the vel so Strongi a to produce thrombi that hecome firmi attache to the wal of the veSSel.
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218 THE REATMENT OF VARICOSE VEINSTHE REAT MENT OF VARICOS VEINS BYINTRAVARICOS INIECTIONS OF QUININE
LE TRAITEMEN DES VARICES PAR LES INIECTIONS INTRAVARIQUEUSES DE QUININE)
DR ALEXANDRE MATHIELI MARSEILLES
THE reaimentis varicos Vein by loca intravenous injections, a question which was received by Sicard who in l920 injecteda solutionis carbonate of sodium, has been o late the subjecto severa communication resardin ne 'herapeutic sentS. Doctor Geneorier, in October last, advised the use of neutra hydrochloride os quinine, hii Monipellier an Lacrois, of Alsiers, extolled bi-iodide os mercury. Finalty last November. Si res aras anci Lermoverat the Medicat
CongreSS eulosised Sodium Salicylate. we thought it os interest o form an independent opinioni thevalue of ach of these druss and we propos to sive a Series of caseobservations for each of them successively.we besan wit quinine hydrochloride, illi Six Cases unde obser vatio a the present time. Al our patient had varicos vein with complicationS: CZem or
we reate them it loca intravenous injections of the solutiono neutra hydrochlorate o quinine recommendedi Geneorier.
we have to than Pros. Reynes for allowin us to take Some obSer vations in his hospital ards an also Pros Gauioux an Doctor igne, ho were hin enousticio entrusi Some of thei patient to S. Casea S... iusseppe. 65 years old entered the Hospital de la Conceptionon December for reaiment of varicos ulcer of the right les.
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He had been sufferin Dom varicos vein for at least 0,ears. and had atready had severa ulcer o both less. On his admission hewas seen to have two ulcerS, ne the Size of A two hillin piecein the right inne malleolus, the other, the siet os a doliar, o the inner of the fame eq. p to the 6 h o December, the wound were dressed with someno Oil and with stripsis Viso plaster. The lim, a placed in an elevated position, but the patient, ather ebl minded. did not remat in that position. The ulcers up to that date, leansed flowl and were alway Sup
O the 16 h December. we injected the quinin solution long the tractis the right interna saphenous Vein firs at iis origin o the dorsum of the oot then histier up encirclins the ulcers, finalty every
stistit tendernes to pressure at the potnts of injection. The ulcer hadbeen resse on the fame da af the injections ith stripsis Viso plaster. The patient reste in ed. wo aYs later o the 18 h of December the ulcer were Mundinealeci. The varicos veinsin thetreate fide ere, in the pristit position les voluminous thanuhose of the other Side. The patient est the hospital immediately. ithout waitin forinsecon series of injections. Case II. G Charies. 9 ear old cook entere the hospital on thel 6 h o December for rupture of varicos veitis in the est calf. Has suffere fro varicos vein since 900 an has atready had ulcers. On his admission me noticed o the est calf,in iis inne Side, Bn ulcer the surtace of hicli assimpled. and whichiled Enormous windins varicose Veins covered the inne fide of the est lower extrem- ity. The emorrhase a stoppe with a lishil compressive
O the 8 h o December e made an intravenous injection fquinine. very three o four inche we injected I to l2 c.c. four Solution in to the dilate paris Doni the dorsum of the oo tot incentimetres rom the end of the Aphenous Vein. In the histi the einous issue ver distende caused, he theneedle was ahen ut a listi flow of blood into the subculaneous
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observabie o the tractis the Saphenous ein, at the oints of injection.
cember it ecam necessar to rene injections in paris hich
Sesments of the saphenous ein, and we considered the patient curedon the 16 h of Ianua . it indurate segments o the tractis the Saphenou Vein, correspondin to a many ligatures hicli prevenith vein rom filiins up when chansing rom the recumbent to theupristit position.
The injectio was notiainful, and the patient Was notis ali disturbed There as a listi flow of hlood in three places formin a