Group Of Similar Cases Research Articles

ЧАСТОТА ГОСПИТАЛЬНЫХ ОСЛОЖНЕНИЙ И ГОДОВЫЕ ИСХОДЫ У ПАЦИЕНТОВ ПОСЛЕ АКШ В ЗАВИСИМОСТИ ОТ ПЕРЕНЕСЕННОЙ COVID-19

Introduction. Despite the decrease in activity and the trend towards the end of the pandemic of a new coronovirus infection (NCI), the burden of NCI remains a serious problem of modern healthcare. Since the beginning of the NCI pandemic, evidence has been obtained that the long-term consequences of COVID-19 infection for patients with cardiovascular pathology will be characterized by an unfavorable prognosis. The ability to predict complications in the early and late postoperative period after CABG for patients after CCI is an important tool to influence the prognosis. Materials and methods. We examined 60 patients with various forms of coronary artery disease who were selected for CABG. The first group consisted of 30 patients who had previously undergone NCI. The second group consisted of 30 persons without NCI in history. The groups were comparable in terms of gender (21 men (70%) in the first group and 25 (83.3%) men in the second, p=0.2) and age (mean age 64.4±1.1 years in the first group and 63.3±1.04 in the second, p=0.46). In all patients, except for standard laboratory and instrumental diagnostic methods, Echo-KG parameters, EuroScore and Syntax index, the frequency of concomitant diseases and postoperative complications were evaluated. Statistical analysis was carried out using the Microsoft Excel 2017 program, the calculation of the significance of differences (p) was carried out using the Fisher test. Results: Most patients of both groups had AH (29 each (96.6%), p=0.4), CHF was observed in 7 (23.3%) persons of the first group and 6 (20%) of the second (p=0, 47). The Syntax SCORE index was initially statistically significantly higher in patients of the first group than in the second - 25.55 ps 21.62 (p=0.03). DM was somewhat more common in patients of the first group than in the second (15 (50% ps 9 (30%, p=0.13). 0.87 hours, p = 0.008. In 5 (16.6%) patients of the first group, the postoperative period was complicated by major bleeding, in the second group, this complication had 2 (6.6%) patients p = 0.28. In most patients of both groups in the postoperative period, hydrothorax was diagnosed (25 (83.3% of persons of the first group and 24 (80%) of the second, p = 0.4), four patients of the first group (13.3%) had hydropericardium, in the second group of similar cases not noted, p=0.04).Atrial fibrillation was observed in more patients of the first group than the second - 11 (36.6%) ps 6 (20%), p=0.19.12 months after the surgical treatment An analysis of late complications of surgery was carried out.There were no differences between the groups in the frequency of newly emerging angina pectoris (5 patients in each group (16.6%)). Clinical CHF was more often observed in patients of the first group — 16 (53.3%) than in the second — 11 (36.6%) p=0.19. Atrial fibrillation was more common in patients of the first group — 4 (13.3%) ps 2 (6.6%) (p=0.67). The high frequency of detection of oncological diseases in patients after undergoing NCI is cause for concern - 5 (16.6%); in patients of the second group, oncological diseases were not diagnosed (p=0.05). Conclusion: Thus, patients with NCI were more likely to have diabetes, bleeding in the perioperative period, they had a longer duration of EC. The late postoperative period for this group of patients was characterized by a higher incidence of cardiac arrhythmias, a higher incidence of CHF, and a rather high (compared with the group after CABG without a history of NCI) incidence of newly diagnosed oncological diseases. The data obtained indicate a higher risk of late perioperative complications after CABG in patients after CCI, which emphasizes the need for more detailed preparation of this category of patients and the development of individual follow-up follow-up programs, as well as more in-depth oncological screening.

516: The effect of pravastatin administration on fetal and utero-placental blood hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction

To study the impact of pravastatin (20 mg/d) administration on the fetal growth and feto-utero-placental hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction (FGR). The study group comprised of pregnancies complicated by severe early-onset FGR (EFW below the 3rd percentile and GA< 33+0 weeks) that were admitted in the Maternal Fetal Medicine Unit (MFMU) Pravastatin (20 mg/d, orally) was added to their treatment at the time of admission, as part of an ongoing prospective study. Fetal growth was assessed once weekly. Measurement of the amniotic fluid volume and Doppler studies of the umbilical artery (UmA), middle cerebral artery (MCA), uterine artery (UtA) and ductus venosus (DV) were performed twice per week. The primary aim was to study the evolution of the pulsatility index (PI) of the above parameters on serial ultrasound evaluations. Furthermore, we compared the interval from admission to delivery between the study group and a similar group of cases that were admitted in the MFMU before the initiation of the pravastatin study. The historic control group was matched for gestational age, UtA Doppler and estimated fetal weight at the time of admission. Overall, eleven pregnancies were included in this ongoing study, of which 8 were singleton and 3 were twin. The mean gestational age at admission was 27.4 (± 2.9) weeks and 30.9 (± 2.7) weeks at delivery. The mean UtA-PI improved significantly between days 0 and 14 (84.9 vs. 76.1 percentile respectively, P=0.05). There was no improvement in fetal Doppler studies but, the admission-to-delivery interval was significantly higher in pregnancies treated by pravastatin compared to the historic controls (25.7 vs. 6.7 days, P=.01). In these preliminary data, pravastatin administration in cases with severe early-onset FGR was associated with an improvement both of the mean UtA-PI as well as of the pregnancy prolongation interval compared to the controls.

Death by Drama and Other Medieval Urban Legends by Jody Enders (review)

MLRy 99.1, 2004 187 religious struggles of the day (Sabine Lardon). The final section consists mostly of essays on pamphlets written in the turbulent years of the late sixteenth or early se? venteenth centuries, and covers debates not only on religious issues, but also on the question of the powers and status of the monarchy. Overall this volume contains a wealth of scholarship, which the dedicatee can feel proud to have inspired. University of Birmingham Leslie C. Brook Death by Drama and Other Medieval Urban Legends. By Jody Enders. Chicago and London: University of Chicago Press. 2002. xxx + 432 pp. ? 24.50; $35. ISBN 0-226-20787-0 In 1549 in the town of Tournai a remarkable event occurred. During the performance ofa play dramatizing the story of Judith and Holofernes, just before the climax, when Judith decapitates the drunken Holofernes, the two principal actors were replaced by two criminals, who had been instructed to carry out the execution of Holofernes for real. The one was promised execution rather than an even more painful death; the other was promised freedom. But could this really have happened? Is it not merely a tall story? This is just one of several such incidents recorded (mostly) in the annals of late medieval French theatre history,which are the subject of Jody Enders's latest book. For Enders, whether such events really took place or not is of secondary importance. They are medieval versions of what are now often called urban legends, i.e. they may well be fictional, but they probably contain an element of truth and a moral lesson of value. After an introduction which discusses the nature of the urban legend, with emphasis on modern examples, Enders devotes a chapter to each of fourteen cases, or groups of similar cases, where drama and reality become confused. The fourteen chapters take up 200 pages, followed by 100 pages of documents, notes, bibliography, and index. The Judith and Holofernes example is probably the most bloody, but the others are all intriguing and sometimes amusing: a wealthy merchant marries the actress playing the role of Saint Catherine; a widow wishes to take under her wing the beautiful young man who played the title role in the mystery play of Saint Barbara?but the actor prefers the protection of a priest; two priests almost die on the cross playing the roles of Jesus and Judas; a stagehand is killed by a canon; an actor screams with genuine fear at the sight of the tortures his character is due to undergo; ete. Most of these anecdotes are well known to historians ofmedieval drama. But Enders considers that they are worthy of much closer attention than they have been accorded in the past. In each case, she analyses the documents which record the stories, playing inventively with the inconsistencies between the sources, and studies the historical, social, and dramatic background to each event. She does examine the potential truthfulness of the stories, but this is not of the essence. What interests Enders is how it came about that such stories were remembered and recorded, and what light they cast on the people and the society that produced them. This book does not tell us anything new about medieval drama, but that is not its intention. What it does is provide material of interest to a whole range of other disciplines?social anthropology, psychology, religiosity,folklore, medieval and modern mentalities, ete.?from which diverse fields Enders frequently quotes modern theoreticians. These provide an academic framework for her own fascinating discus? sions of this somewhat unusual material, inspired, it would appear, by a disturbing personal experience. Many sections of this essay are deliberately fanciful and some? what self-indulgent. But there is no doubt that Enders has written an attractive and 188 Reviews unusual book which tells us a lot about the importance of storytelling, whether true or false, forthe understanding ofthe human psyche, whatever the period. Edinburgh Graham Runnalls Pre-histoires II: langues etrangereset troubleseconomiques au xvf siecle. By Terence Cave. (Cahiers d'Humanisme et Renaissance, 61: Les seuils de la modernite, 5) Geneva: Droz. 2001. 212 pp. ?36.76; SwF 54.30. ISBN 2-600-00627...

Gore, Gibson, and Goldsmith: The Evolution of Internet Metaphors in Law and Commentary

This paper addresses the evolution of metaphors for the Internet and shows how they have constrained and determined the development of cyberlaw. Within the law, metaphors mold the framework of discourse, determining the scope of appropriate questions about and answers to various social and legal problems. Courts and commentators employ metaphors as heuristics to generate hypotheses about the application of law to novel, unexplored domains. Metaphors structure the way lawyers conceptualize legal events, as they infiltrate, consciously and unconsciously, legal discourse. Under the classic formalist view of common law analogy as syllogism, analogical reasoning from precedent begins with the establishment of a rule behind a case or group of similar cases. Judges then apply the rule fairly mechanically to the case at hand to yield a result that is understood through the background of precedent. In contrast to figurative literary metaphors, highly structured analogical, metaphorical mappings may be used to make persuasive, logical arguments. Like all metaphors, however, legal metaphors possess a paradoxical quality, embodied in the constant tension between the legal metaphor's literal incongruence and metaphorical congruence with reality. Metaphors whose metaphorical congruence with reality is perceived as dominant, such as the marketplace of ideas metaphor in First Amendment jurisprudence and the bundle of sticks metaphor in Takings clause jurisprudence, will continue to have analogical value and will be perpetuated through judicial opinion and scholarly commentary. Conversely, legal metaphors erceived as having greater literal incongruence with reality, such as the slavery metaphor of African Americans as chattels, will lose their value and be discarded. While metaphors aid humans in comprehending abstract concepts and legal doctrines, they also may limit human understanding by selectively highlighting various aspects of an issue while suppressing and marginalizing others. Unreflective use of metaphors can lead lawyers to take for granted the realities that metaphors enable. A bad metaphor can also simply lead to bad decision making. For example, Cass Sunstein argues that the marketplace of ideas metaphor has turned the right to free expression into a degraded form of commerce. This paper seeks to explore the evolution of metaphorical inferences as applied to the Internet within legal commentary and judicial opinions. Three metaphors in particular will be examined: the information superhighway, cyberspace, and the Internet as real space. Given the Internet's ongoing evolution as an unstable and ever-changing technology, courts and commentators have faced perpetual difficulty in mapping metaphors to it. Changing social constructions of the Internet as necessitated by its evolving underlying technological architecture have supported, or conversely eroded, a particular metaphor's literal congruence with reality. The purpose of this paper to make transparent the different conceptions of the Internet courts and commentators are sub silentio employing, and the various sociological, technological, and ideological conceptions of the world that support them.

舌病変に対するＫＴＰレーザー治療の臨床評価 ＣＯ２レーザー治療群との比較

Seventeen cases of tongue lesions treated with a KTP laser were retrospectively assessed. Out of these, the effectiveness of treatment on eight leukoplakias and five squamous cell carcinomas, which were resected with output power of 10 watts, was compared with those in a group of similar cases that had been treated with a CO2 laser.It was easy to cut the tongue lesions in both groups. Forty percent of squamous cell carcinoma patients in both groups had bleeding from the tongue during the operation. Consequently, silk-suturing was performed. No cases of leukoplakia of the tongue in either group resulted in bleeding during the operation. In both types of lesions, the postoperative bleeding was mostly confined to the group treated with the KTP laser. Furthermore, postoperative pain tended to continue longer in the KTP laser group, compared with the CO2 laser group.The period necessary for wound healing was shorter in the KTP laser group, for both types of lesions. Postoperative functional disturbance of the tongue was slight in both groups.(J. Jpn. Soc. Laser Dent. 12: 10-15, 2001 Reprint requests to Dr. ISHII)

Judicial Bookshelf

Judicial Bookshelf D. Grier Stephenson, Jr. Systematic study ofthe Supreme Court began little more than a century ago as history, law, and political science emerged as professional academic disciplines. The result has been an ex­ panding variety of approaches and methodologies designed to explain both the what and the why of the Court’s decisions. Judicial scholarship continues to explore the contributions of individual Justices, and through them the effects ofthe Bench and the rest ofthe political system on each other. Animated by twentieth-century empiricism, one category ofCourt scholarship is thejudicial process itself—that is, the business, procedure, and impact of courts. It may depict one or more elements ofthat process as illustratedby a series ofcases, or virtually all elements ofthe process as illustrated by a single case. The latter type is commonly referred to as a “case study” as it portrays judges as actors on the political and legal stage. Applied to the Supreme Court, case stud­ ies have become a major part of the literature only since the late 1950s. In the first edition of one undergraduate textbook on American con­ stitutional law published in 1954, the several hundred entries of “suggested readings” in­ cluded barely a single one that could fairly be labeled a case study.1 When one of the first collections ofarticle-lengthjudicial case stud­ ies was published in 1963, the co-editors de­ voted part of the introductory chapter both to a defense of the value of the case study as a tool in understanding “constitutional politics” and to a description ofwhat a properly designed case study should encompass. [T]he case must be reconstructed in all its complexity, background, color, conflict, strategic dilemmas, and rami­ fications. The real parties to disputes and how their disputes arose; the struggles in private and public arenas JUDICIAL BOOKSHELF 139 that preceded the transfer of the dis­ pute to the courts;... the strategic and doctrinal battles during the litigation process; the way in whichpolitical and private forces affect the litigation as it progresses through the courts;... the impact ofpublic opinion upon theju­ diciary in its consideration of cases and its scope of decision; the re­ sponse of the parties, government, and the public to the judicial rulings ...; the compliance, noncompliance, or modification of judicial rulings by elected and appointed officials;... — these and a host of other questions must be explored in order to achieve a sophisticated understanding of what the role ofthe courts is in contempo­ rary America.2 Once novel,judicial case studies have become commonplace. The expectation now is that they treat “all levels of courts and all kinds of law as integral parts of the politics ofpolicy mak­ ing.”3 Studies of a single constitutional case or group of similar cases are intellectually useful in at least three ways. First, they are descrip­ tive. As analytical narratives, case studies pic­ ture all or part ofthe judicial process at work, from the origins of a controversy to its resolu­ tion, including its impact on the larger politi­ cal system and on future litigation.4 Second, case studies are efficient. Since it is not feasible for every case to be examined in great detail, readers makejudgments about re­ ality from a much smaller number of close-up encounters, inferring the whole from the part. A single case study illustrates how thejudicial process can work; a series of case studies al­ lows conclusions fairly to be drawn about how the judicial process ordinarily does work. Third, case studies are demonstrative. They may lay bare important, but sometimes overlooked, ingredients in constitutional inter­ pretation. One ofthese is the Court’s own case selection process: deciding what to decide; another might be the role of self-interest, of timing, or even of chance. Moreover, because ofthe particular issues that litigationmaypose, the case study can be a window on complex cultural and intellectual forces that ordinarily seem far removed from a courtroom but which may lend the litigation its significance as well as its notoriety. Five recently published vol­ umes reflect the enduring utility of case stud­ ies and suggest that this genre of Court litera­ ture continues to thrive. Jay Stewart’s Most Humble Servants5 is a meticulous...

The Value of the Double-Track Sign as a Differentiating Factor between Pylorospasm and Hypertrophic Pyloric Stenosis in Infants

The development of vomiting in the infant after the immediate neonatal period frequently requires radiographic investigation of the underlying cause. The classical case of hypertrophic pyloric stenosis presents little problem, but an infant with a severe and prolonged pylorospasm may be difficult to differentiate from one with hypertrophic pyloric stenosis. In this communication, a group of proved cases of hypertrophic pyloric stenosis is compared with a similar group of cases of pylorospasm to determine identifying features of each. The main roentgenographic signs of hypertrophic pyloric stenosis are the string (Fig. 1), the shoulder (Figs. 1 and 2), the beak (Figs. 1 and 3), and the tit (Figs. 1 and 4). With the string sign an area of constant narrowing appears to be rigid and free of peristaltic activity in the prepyloric region and pylorus. This is due to the restriction of distensibility by the hyper-trophied muscle of the pylorus. The narrowed channel presents a curve upward and slightly to the left...

Infantile cortical hyperostosis.

Infantile cortical hyperostosis was first described and named by Caffey and Silverman in 1945.4Smyth, Potter, and Silverman12described a similar group of cases in a separate and independent report the next year. These reports stimulated a great deal of interest in the disease, and by 1952 there were over 100 case reports in the literature. It soon became apparent that infantile cortical hyperostosis, rarely recognized before its description in 1945, was now diagnosed and reported with increasing frequency. Yet, although the number of cases of infantile cortical hyperostosis seems to be increasing, and in spite of the fact that the disease is recognized in pediatric practice so commonly that only cases of unusual interest are now being published, our experience of having observed 11 cases in 2 generations of one family reveals that much is still to be learned about this interesting entity. Clinical Picture The

METHODS USED IN TREATMENT OF DIARRHEA WITH POTASSIUM AND SODIUM SALTS

The actual procedures used in the treatment of 153 cases of diarrhea with potassium chloride in addition to the other established therapeutic methods are described. The mortality was 6% and study of the fatal cases indicated that a large proportion of these cases apparently died from nutritional injury developing before the onset of the diarrhea or from injury as a result of dehydration developing before treatment was started. The serum bicarbonate returns to normal somewhat more slowly than when larger doses of sodium bicarbonate (or lactate) are given. However, the absence of alkalosis, the infrequency of low serum calcium and the infrequency of the "postacidotic state" suggest that slow restoration of the concentration of serum bicarbonate may be advantageous. In no instance was low concentration of potassium in serum encountered. On the other hand serum potassium remained normal or slightly high during recovery. In no instance were symptoms referable to potassium intoxication encountered and in no instance was death associated with high concentration of potassium in serum. The method of treatment is safe and produces results as good as have been obtained in any similar group of cases. The method is relatively simple to carry out and is equally applicable to diarrhea of the newborn and that of older infants.

Hot baths in the treatment of earlyinfantile paralysis

I MMERSION in warm water during the early phases of infantile paralysis ha.s beeil used for some time and has been described by different authors for relief of soreness and muscle tightness, ~-~ but this approach has never been widely applied. Our results obtained so far with this method seem to us to justify the re-emphasis of this simple procedure. We would like to do this with all the reserve necessarily needed for the recommendation of any treatment approach in infantile paralysis at the present time. The symptoms in this disease vary widely; spontaneous recoveries are frequent. The possible value of any treatment form can be determined only by the comparison of large groups of similar cases treated in different ways and uniformly recorded. We are lacking in sufficient numbers and necessary controls to draw valid conclusions; but we feel that the number of our patients is large enough to derive a clinical impression of the value of the treatment approach we are reporting. We have treated all patients with infantile paralysis with Kenny packs in the 1941, 1942, and 1943 outbreaks. It was our impression that muscle soreness and stiffness responded more quickly in a large percentage of patients than with previously employed methods. Each year, however, a number of patients were observed in whom pain and stiffness remained in spite of long periods of packing. In November, 1943, we decided to treat several patients, who remained tender and very stiff in spite of prolonged packs, with frequent daily immersions in hot water. We observed a definite spurt in loosening up and decreased pain. Gradually we prescribed this treatment to an everincreasing number of patients. After January, 1944, hot baths became the treatment of choice and packs were prescribed only for those patients who for one reason or another could not be put into the pool; for instance, because of the patient having to wear a plaster boot, or because of incontinence. Until Sept. 1, ]945, we bare treated 307 patients. The technique we are using is as follows: Patients are put into water of ;/ temperature of 104 ~ F. '[he water is shMlow so that the patient can lie flat with his head only very slightly raised on a headrest (Pi~. 1). Gentle, free m<)tion is lint restricted but no exercises of any kind are given. The lifting is done either on light canvas stretchers or by two to four persons according to the patient's height, leaving the patient's body straight to prevent pull on tender muscles (]?ig. 2). Immersions are started as soon as the patient has been admitted--usually from an isolation hospital. For pa-

EXPERIENCES WITH ENDAURAL SURGERY: PRELIMINARY REPORT

In his paper on the Endaural, Antauricular Surgical Approach to the Temporal Bone, Lempert 1 concluded: A careful comparative study of the postoperative course, the convalescence, the period of healing and the ultimate end results obtained in the 1,780 consecutive cases in which operation was performed by me through the endaural, antauricular surgical approach... more than justifies my abandonment of the postauricular approach to the temporal bone. With a view to investigating this method of approach, we employed the endaural route in operating on a small number of patients who entered the otolaryngological service of the Massachusetts Memorial Hospitals from January to July 1940, and compared the postoperative course and results with those in a similar group of cases in which operation was performed by the postaural approach. It is not our purpose in this paper to discuss the anatomic and surgical details of the method (for a discussion of these

EXUDATIVE CHRONIC DISCOID AND LICHENOID DERMATITIS (SULZBERGER AND GARBE)

In 1937 Sulzberger and Garbe 1 described a group of cases of what they designated exudative discoid and lichenoid chronic The authors referred to similar cases that had been described before with a variety of different diagnoses and also credited Rosen 2 with being the first to express the opinion that these cases may be examples of a distinctive dermatosis. Since Sulzberger and Garbe's publication, a number of cases with the diagnosis of exudative discoid and lichenoid chronic dermatosis have been presented before dermatologic societies, 3 and a similar group of cases was studied by Cannon. 4 The latter author, however, referred to the condition in his cases as allergic dermatitis simulating lymphoblastoma. The characteristic features of the disease as it appeared in Sulzberger and Garbe's cases may be described as follows: Chronic discoid and lichenoid dermatitis appears during the fourth or fifth decade of life andthus far has been observed only in Jewish males. There were 2 women and 1 gentile in the group as reported by Cannon. The dermatitis is chronic and remittent and is associated with intense and intractable itching.

Mesonephroma of the ovary

A satisfactory classification of ovarian tumors has not yet been established, although much has been accomplished recently by correlating the clinical and pathologic features of these neoplasms. In reviewing over 350 true neoplasms of the ovary, a group of 6 has been separated on the basis of their pathologic characteristics. Schiller has recently described a similar group of cases and believes them to be derived from mesonephric tissue. It is the purpose of this paper to describe the clinical and pathologic characteristics of these tumors and to discuss their histogenesis.

Statistical studies on puerperal infection: II. An analysis of 545 cases of puerperal infection (including a comparison between them and a similar group of cases with normal puerperia)

Statistical studies on puerperal infection: II. An analysis of 545 cases of puerperal infection (including a comparison between them and a similar group of cases with normal puerperia)

Trauma and compensation in gynecology and obstetrics

cent, have since died. Nine died in the first year following delivery, six in the second, three in the third, five in the fourth, three in the sixth, two in the seventh, one in the eighth, and one in the ninth year, Adding to these the 17 deaths which occurred in the hospital this gives a total of 48 in the 240 cases over a ten-year period, a mortality of 20 per cent. How this figure compares with the mortality in a similar group of cases in which pregnancy and labor had not been a factor I do not know. This information is necessary in order to form a true estimate of the risk which pregnancy imposes on the woman with heart disease. A 20 per cent mortality over a period of ten years does not seem high for the type of case with which we are dealing. It would be indeed interesting if further statistical study were to show that the care and attention given in our clinics to the pregnant patient with heart disease more than offset the strain of pregnancy and labor. But now we are getting into the realm of speculation and had better stop.

LXIII.—PYODERMIA GANGRENOSUM

The term pyodermia gangrenosum signifies a suppurative destructive process of the skin. In recent literature, a definite relationship between certain well defined ulcerative lesions of the skin and infections of long duration elsewhere in the body has been noted. The study and observation of such a case prompt us to report our findings. Our patient, a woman, showed a widespread progressive ulceration of the skin. She also suffered from a prolonged infection of the gallbladder and marked pyuria. It was evident that the lesions of the skin were directly dependent on these conditions. Accompanying an exacerbation of either condition there was a marked recrudescence of the ulcers. The apparently parallel relationship between an underlying infection and certain types of cutaneous lesions is the unusual feature of the condition. The recognition of this fact moved Brunsting, Goeckerman and O'Leary 1 to report a group of similar cases. They

THE PLASMA PROTEIN IN POSTURAL ALBUMINURIA

The peculiar albuminuria that becomes manifest in certain persons if they assume the upright position, and disappears if they assume the recumbent position, has been the subject of considerable interest and study. It is generally spoken of as orthotic, orthostatic or postural albuminuria. Moxon, 1 in 1878, gave the earliest description of the condition and called attention to the fact that the albuminuria was apparently unassociated with other evidence of renal disease. He distinguished an adolescent albuminuria with a fairly permanent showing of albumin in the urine, and a remittent type in which the albumin completely disappeared from the urine when the subject was recumbent and disappeared after assumption of the erect posture. Pavy, 2 in 1885, reported a group of similar cases. Stirling 3 first emphasized the importance of posture and its definite connection with the appearance and disappearance of the albumin in the urin. Heubner 4 suggested the

THE TABETIC BLADDER FROM THE STANDPOINT OF THE UROLOGIST

During the last few years, there have appeared a number of excellent contributions dealing with the secondary changes in the lower urinary tract resulting from the more obscure types of central nervous disease. The careful considerations of Plaggemeyer 1 and others 2 in the management of the urinary conditions resulting from spinal injury have prompted us to undertake a more detailed study of a somewhat similar group of cases. We refer to the diagnostic and prognostic problems associated with the so-called bladder. The primary consideration in this class of cases is the earliest possible recognition of any urinary changes which may occur in syphilitic involvement of the nervous system prior to the development of obvious tabetic or ataxic symptoms. The major problem, however, involves an accurate diagnosis is those cases in which the specific tabetic process has become apparently dormant, while the urinary abnormality persists or gradually increases in