Elliott C. Cutler

The use of sclerosing solutions in the treatment of cysts and fistulae

Abstract We have reported here cases of gliomatous cysts (astrocytomatous type), cervical fistulae and pilonidal sinuses in which a modification of Carnoys solution used as a sclerosing agent has either greatly assisted in making an operation more complete, as in the cases of gliomatous cysts, or has been able to cure the condition without radical surgery, as in the cases of cervical fistulae and pilonidal sinuses.

Localization of Pain Following Faradic Stimulation of the Common Bile Duct

Conclusions The sites of pain following faradic stimulation of the common duct are not restricted to the anterior abdominal wall as found following electrical excitation of the stomach and duodenum. 2 The location of the pain coincided more closely with the level of the electrode in relation to the cerebro-spinal segment involved. Pain was referred to the back in those who described such radiation preoperatively. The epigastric distress at times seemed to coincide with peristaltic contractions of the pylorus.

Management of cerebral trauma

Abstract 1. 1. We have reviewed a series of 396 consecutive cases of craniocerebral injury admitted to the Peter Bent Brigham Hospital during the years 1913 to 1939 inclusive, of which 44.41 per cent were mildly injured, 37.88 per cent moderately injured, and 22.73 per cent severely injured. 2. 2. The gross mortality for the entire series was 11.87 per cent; for the mild cases, 1.2 per cent; for the moderately injured cases, 2.6 per cent; and for the severely injured cases, 51.9 per cent. The mortality for all cases has decreased from 26.98 per cent in 1913 to 1921 inclusive, to 7.92 per cent in 1931 to 1939 inclusive, but in the severely injured cases has remained constant. 3. 3. The incidence of operative intervention has been reduced from 52.38 per cent to 13.75 per cent from the former period (1913 to 1921) to the latter period (1931 to 1939). 4. 4. Mild dehydration therapy has been employed with steadily increasing frequency. From 1931 to 1939 inclusive 42 per cent of patients had some limitation of fluid intake and 31.67 per cent received large doses of magnesium sulfate orally or rectally. 5. 5. Diagnostic lumbar puncture has been utilized more and more frequently, up to 75 per cent of all cases from 1931 to 1939 inclusive; therapeutic lumbar puncture has been abandoned. 6. 6. A general plan of treatment as used by us at present is described.

Atlas of Surgical Operations

Atlas of surgical operations , Atlas of surgical operations , کتابخانه دیجیتال جندی شاپور اهواز

The Education of the Surgeon

I AM highly sensible of the great honor done me tonight by the Boston Surgical Society through this presentation of the Henry Jacob Bigelow Gold Medal. As one who has attended the presentation of t...

Effect of Total Thyroidectomy on Response to Injection of Adrenalin

Since Elliots work in 1907, the increased sensitivity to adrenalin in vessels deprived of sympathetic innervation has been well known. Clinical observations on patients following total removal of the thyroid have suggested a close dependency of adrenalin efficiency on the presence of thyroid hormone. The injection of adrenalin in patients deprived of thyroid secretion seemed to produce less vasoconstriction. This diminished action of adrenalin was very striking in limbs rendered especially sensitive to adrenalin by sympathectomy. To test the accuracy of these observations the following experiments were performed on dogs: Dogs were trained to stand quietly in a light overhead harness. Skin temperature curves were made at the same time of each fore leg by means of thermocouples attached to the skin. A number of such skin temperature curves under standard conditions revealed no difference between the fore legs. Being thus assured of a proper control, the sympathetic fibers supplying the left leg were destroyed by the removal of the stellate and each adjoining ganglion above and below. After allowing adequate time for the degeneration of the post-ganglionic fibers, determinations by the thermocouples revealed the customary 4° to 5° difference in temperature between the 2 legs. Skin temperature curves were now taken simultaneously on the 2 forelegs following an intravenous injection of a 1-20,000 solution of adrenalin chloride. The injections caused consistently a much greater and more prolonged fall in temperature on the operated side. When a number of similar curves were accumulated under identical standard conditions, the dogs were subjected to total thyroidectomy. After recovery and during the next 8 months temperature changes in both fore legs were again recorded following adrenalin injection. The post-thyroidectomy curves showed a great loss in the sensitivity of the sympathectomized vessels to adrenalin. In the dogs deprived of thyroid secretion the former prompt pressor response and resulting abrupt and prolonged fall of temperature on the operated side was almost entirely abolished. The curves for the intact limb were but little changed by total thyroidectomy. These experiments served to confirm our clinical impressions of the direct relationship between the thyroid hormone and the effectiveness of circulating adrenalin.

Skin Temperature Changes After Total Thyroidectomy

As a part of the careful study of patients submitted to the operation of total thyroidectomy for heart disease, we have conducted skin temperature observations before and after the operative procedure. We have utilized the method of Gibbon and Landis. 1 This method has been shown to produce adequate vasomotor dilatation and is far simpler than the other methods of injection of foreign proteins, the induction of a general or spinal anesthetic, or the blocking of sympathetic ganglia or peripheral nerves with novocaine or alcohol. The operative procedure on all patients was done under local anesthesia, thereby eliminating the variability of blood flow studies as seen after a general anesthesia (Herrick et al. 2 ). The skin temperature determinations were all done in a small room, free from air currents, and having a constant temperature of 68–72°F. and humidity between 40 and 50%. This gives constant findings as shown by Talbot. 3 The patients in all cases were in bed in a semi-Fowler position and the points of election of skin temperature were the tibial tubercle, anterior ankle, and great and small toes of both lower extremities. According to Morton and Scott, 4 there is a maximum vasodilatation response for normal vessels that has been designated the “normal vasodilatation level”. The lower limit of this maximum level for the surface temperature of the great toe whose vasoconstrictors have been released by general or spinal anesthesia (and the water-bath technique of Gibbon 1 ) is 31.5°C. at a room temperature of 20°C. (69°F.). Studies of the skin temperature were made on 13 patients before operation and the vasodilator response determined. In these same patients postoperative studies were carried out at varying intervals, as from the fourth postoperative day to about 7 weeks later when the patient was in clinical myxedema, and again after thyroid therapy. The results of these studies in a typical case of angina pectoris are shown in Fig. 1.