Nonoperative Procedures Research Articles

OPERATIVE OR NONOPERATIVE PROCEDURES FOR UTERINE FIBROIDS

To the Editor:— Reference is made to the article Operative Vs. Nonoperative Procedures for Uterine Fibroids, by Robert T. Frank (J. A. M. A. 140 :1001-1008 [July 23] 1949). In this article Dr. Frank advocates supravaginal hysterectomy in the treatment of fibromyomas of the uterus, mainly because he never has seen carcinoma arising in the stump. This doctrine is too dangerous to be left uncontradicted. In the material of our comparatively small hospital in the last two years we have treated forty-three histologically proved carcinomas of the cervix, seven of which arose in cervices left after supravaginal hysterectomy. While this material may not be statistically significant, it shows that the remaining cervical stump represents a definite danger to life, and this danger should be weighed carefully against the local discomfort encountered in a certain percentage of patients who have undergone complete hysterectomy.

SIMPLE PROCEDURE FOR RELIEF OF ENTROPION

The reluctance patients have for operative procedures, especially when the promise for relief is meager, has prompted me to report a simple procedure for an annoying condition known as entropion. Operation does not give satisfactory results, and often the disfigurement is disturbing to the patient. That a correction must be made of the disturbance every ophthalmologist knows. Besides the annoying symptoms which accompany it, there are the serious complications which may attend it, especially epiphora, erosion of the cornea and ulcers, with their consequences, which may prove fatal to the eye. Recently I had a patient, an elderly man, who had severe conjunctivitis followed by entropion. All recognized nonoperative procedures were carried out but were of no avail. Operation was refused. I finally conceived the idea of having a spectacle frame made with a small attachment to the lower rim so adapted that slight pressure was exerted on the lower

Non-operative procedures for the relief of lumbo-sciatica

Non-operative procedures for the relief of lumbo-sciatica

Non-operative procedures in urology

T HE remarkabIe stride which has been made in the deveIopment of cystoscopic technique within the last two decades, the better understanding of underlying pathoIogy made possibIe by the introduction of urography, have tended to conservatism in the management of uroIogica1 conditions to a degree never known before. CauIk in his presidentia1 address before the American UroIogicaI Association Iaid emphasis on the fact that “in spite of surgica1 preparedness and surgica1 efficiency, the striking tendency of uroIogy today is conservatism. Science has reduced uroIogica1 surgery in the Iast quarter of a century to a striking degree in spite of the fact that it has given faciIities for its advancement . . . Many of the operations have been either restricted or erased from our surgica1 caIendar.” However true the above may be, a word of warning is in order against overinduIgence in conservative manipulations in various obstructed, infected or neopIastic Iesions of the urinary tract. A Iine must be drawn sharpIy between what constitutes an operative Iesion or a condition where cystoscopie measures have a reasonabIe chance to succeed. This entaiIs a carefu1 study of the case and a correct diagnosis. Too much temporizing with true surgica1 conditions is the one great danger so commonIy seen and which must be avoided. I shaI1 endeavor brieffy to enumerate the various conditions in the urinary tract which may be corrected by the empIoyment of minor surgica1 procedures in as much as they entail cystoscopic manipuIation, touching upon indications and, as much as the space wiI1 permit, on technique. I. Urethral stones frequentIy become Iodged either in the anterior or posterior YORK

Fractures from an Operative Viewpoint

ALTHOUGH the operative treatment of fractures was made possible by Lister's demonstration that incision did not necessarily mean infection, it was not until 1894, when Sir Arbuthnot Lane began his pioneer work, that the procedure was considered seriously. Since then the literature has contained many discussions of the subject, and it would seem as though there is little left to be said. Two noteworthy and painstaking investigations have been made in the effort to evaluate the open and closed methods of treatment: one by the Committee on Treatment of Simple Fractures appointed by the British Medical Association and submitted in 1912 (10), and one by the committee appointed by the American Surgical Association and submitted in 1915 (3). A discussion of the subject should not be attempted without mentioning the chief conclusions reached by these two careful and discriminating committees. The British report was, briefly, as follows: 1. The results of non-operative and operative treatment in children are practically the same: 90.5 per cent good function in the non-operative cases, and 93.6 per cent in the operative. 2. There is a progressive depreciation of the functional results from non-operative treatment as the age of the patients advances, that is to say, the older the patient the worse the result. 3. At nearly all ages, operative treatment produces a higher percentage of good results than non-operative. 4. Although the functional result may be good and the anatomic result indifferent, the most certain way to obtain a good functional result is to secure a good anatomic result. 5. A method which does not definitely promise a good anatomic result should not be chosen. 6. In order to secure the most satisfactory results from operative treatment, it should be resorted to as soon after the accident as possible, and not following the failure of the non-operative measures. 7. The operative treatment of fractures requires special skill and experience and such facilities and surroundings as will insure asepsis. 8. The mortality rate directly due to the operative treatment of simple fractures is so low that it can not be used as an argument against operative treatment. Finally, for surgeons and practitioners who are unable to avail themselves of the operative treatment, the non-operative procedures will remain for some time safer and more serviceable. The foregoing conclusions were backed by a careful report filled with figures and percentages. It is clear that the Committee was convinced that the operative treatment of simple fractures gave better functional and anatomic results than the non-operative, but it is also clear that the members felt the promiscuous use of this method by those not properly trained or experienced or in poorly equipped hospitals was dangerous.