Percentage Of Good Results Research Articles

Preanesthetic sedation and analgesia for intraocular operations done with local anesthesia.

THE VALUE of individualized preanesthetic medication to produce effective sedation and analgesia for eye surgery is well recognized. This is particularly true of intraocular surgery done with local anesthesia. It is difficult to exaggerate the importance of good anesthesia and akinesia, and to obtain them careful attention to the details of the preanesthetic preparation of the patient is essential. Although the need for this is well known, many surgeons fail to give it the attention it deserves. Thus many operations are made more hazardous and eyes are needlessly damaged. With the improved anesthesia and operative technique now generally practiced. it becomes increasingly difficult to decrease appreciably the number of mishaps in operations, such as those for cataract extraction. However, any measure that will improve our percentage of good results by even a fraction of 1% seems worthy of consideration. Hartmann¹has recently emphasized the importance of careful psychologic preparation

CONGENITAL ABSENCE OF THE VAGINA

The surgical treatment of congenital absence of the vagina constitutes a most interesting chapter in gynecology. Like the treatment of other anomalies, it has gone through many changes, with successes and failures, and ultimately a method of correction evolves which becomes simple, easy of execution and attended by low mortality and morbidity rates, and which produces a high percentage of good results. There always will be some poor results and even failures in the management of any congenital anomaly by virtue of the defective quality of the tissues with which the surgeon must work. In this communication I wish to report a group of 76 cases of congenital absence of the vagina, to describe a surgical procedure which I think is adequate and to disclose the results. The patients were seen and treated during the decade ending Dec. 31, 1946. Eight more have been treated during the present year but

Technic of high subtrochanteric osteotomy

T HE increasing use of osteotomy in both old and fresh fractures of the neck of the femur makes it necessary to perfect a better method of performing this important procedure. The technic of the operation is usually dismissed with the statement that a high osteotomy was performed, foIIowed by inward d;spIacement of the shaft of the femur. Through a study of the factors causing several poor results as well as the observation of two particuIarIy successful cases (resulting from accidental variations in the usua1 method of performing the operation), an improved technic has now been evolved. It is hoped that further application and study of this method wiI1 make it more useful in both old and fresh fractures of the neck of the femur. Recent communication with thirty leading fracture men as we11 as a study of the literature prove that we must again take stock of intracapsular hip fractures. We all agree that pinning has been a wonderfuI advance. Leaving out those cases, irretrievable by any method, the percentage of good results as reported varies from 40 to 80 per cent depending on the Iength of time followed. CIinics located in rural areas had better results (Mayo Clinic 75 per cent) than big city charity hospitals. Vigorous old farm folk do better than ill fed sIum derelicts. There is aIso still a wide divergence of opinion as to the best methods of pinning. By any method of interna fixation the usual causes of bad resuIts are we11 known. (I) Inadequate reduction and pinning; (2) degenerated bony structure which in the aged wiII not support internal fixation; (3) Iate aseptic necrosis (or fragmentation) of the head of the femur; (4) degenerative arthritis with or without bony union and (5) too earIy weightflearing on a bad mechanica line subject to shearing force. Whatever the cause, a11 surgeons queried had seen a lot of bad results in cases of intracapsular fracture of the neck of the femur. PracticaIIy all stated they used some form of reconstruction operation, usually the CoIonna or Brackett types, at least in the younger or more vigorous subjects, reserving osteotomy for the oIder group. This personal survey as well as the Iiterature of the past few years shows an increasing number of the leading surgeons oI England and America using osteotomy for ail oId hip fractures with bad resuIts whether due to mal-union, non-union or degenerative arthritis. Frank Dickson,l Leadbetter,” Wallace Cole,” Kellogg Speed,4 J. S. Speed (Memphis),” George Bennett,6 Hermann, Barney Owen,x McMurrayi2 of EngIand, Reich!’ and Magnuson10 are a few who now are using osteotomy as the treatment of choice in old ununited cases. CoIe and Murphy” have used this method instead of primary pinning while McMurray uses it excIusiveIy in both fresh and old intracapsular fractures. A few, though not the majority, report the use of pins to hold the fragments after osteotomy. High osteotomy is more popular because of the greater chance of bony union in the original fracture, and because internal fixation of the fragments is almost obligatory with the Schanz or low osteotomy. It is generally conceded that the well known reconstruction operations of the hip were great contributions. DiagrammaticaIIy, all can be made to look simple and efficient. In actual practice, others as well as myself have found it necessary to use these procedures only in selected cases because of conditions present at the site of fracture or because of the condition of the patient. Such procedures as the bone-peg operation or the Brackett, Whitman, or Colonna reconstructions are all formidable as to risk and difficult of execution. J. S. Speed stated that only about 60 per cent fairly good results are obtained by these large procedures even in selected cases and that 25 per cent 01 the favorable resuIts are Iater vitiated by degenerative arthritis causing painful and rcstricted hip movement. Against the net 45 per cent satisfactory results from reconstruction operations used only on good risks, most men report about 80 per cent good results with osteotomy used on al1 types of patients and bony union was achieved in more than half of them. The only procedure showing comparable results is the rareIy indicated bone-peg operation.

Studies on the blocking antibody in serum of ragweed-treated patients: II. Its relation to clinical results

The blocking antibody response has been studied in thirty-four cases of ragweed pollinosis treated with ragweed antigen. The results seem to warrant the following conclusions: 1. 1. Ragweed antigen injections definitely produce specific blocking antibody titer in ragweed-sensitive patients. 2. 2. Although high blocking antibody titers are to be found most frequently in patients who have received high total dosages of ragweed antigen, in the present study, 53 per cent of those who received high dosages did not develop high titers of blocking antibody. 3. 3. Fifty per cent of the patients treated with ragweed antigen during previous years developed high blocking antibody titers. 4. 4. Clinical results apparently do not depend upon high blocking antibody titers. The percentage of good results was identical in the patients who had low titers and in those who had high titers.

Sanatorium Treatment of Tuberculosis

The primary function of a sanatorium is the one fundamental and first in the activities of any hospital, namely, care of the sick, and in this instance, the attempt to obtain an arrest and cure of tuberculosis. Whether an arrest of the disease will occur depends on many factors, such as age, sex, race, occupation, and complications, but particularly on the stage of the disease. In spite of the repeated emphasis of the fact that the chances for recovery and a good prognosis in pulmonary tuberculosis depend on the extent and degree of lung involvement at the start of treatment, the number of patients that begin treatment with far advanced disease is tremendously high. At the present time, 75 to 85 per cent of the admissions to the sanatoria and tuberculosis hospitals of this country are in a far advanced stage. Our experience has indicated that treatment of a sanatorium group of patients with 85 per cent showing minimal or moderately advanced lesions (minimal 35—40%, moderately advanced 45—50%), will result at the time of discharge with 85 per cent in a condition graded from improved to arrested and close to 50 per cent in the latter category. Thus the efficacy of sanatorium treatment depends in a great measure on the early diagnosis and reference of the patients. All health efforts to find, isolate and treat pulmonary tuberculosis in an early stage are not only justified but necessary. It is especially the general practitioner who should seriously accept the slogan Find and treat tuberculosis early, for he is the individual who often makes the first contact with the patient. Proper recommendations by him at that time will frequently determine the eventual outcome of the disease. Follow-up studies of discharged cases have indicated that the permanency of a satisfactory physical condition (with a stationary or retrogressive lesion, negative sputum, slight or no symptoms, and return to work or normal environment) depends directly on the stage of the disease with the best results in the minimal group and the highest unsatisfactory percentage (with progression of the lesion, positive sputum, symptoms, need o! hospitalization, or failure to return to normal environment) in the far advanced stage Moreover, the importance and necessity o! uninterrupted sanatorium care until the condition becomes arrested has been further evidenced by the follow-up observations that: (1) The closer the physical status on discharge approaches a condition of complete arrest, the greater the probability of continuation of a satisfactory condition after hospitalization; (2) the percentage of good results is less for those patients who leave the institution against advice; and (3) arrested cases form a majority of those patients, who after discharge are able to return to a gainful occupation or are in condition to work. The next great function of the sanatorium is its service as an educational medium for the patients. In the teaching of new health habits and demonstration of proper modes of living, the sanatorium instructs patients not only how to care for their own health. but how to live with and protect others. The patients receive both didactic and practical instruction. The didactic training is covered by lectures, the content of which is briefly outlined as follows: The functions of the sanatorium (i.e., for treatment, removal of positive cases and education of patients) are explained. Items in a book of rules and regulations given each patient are discussed with constant emphasis on the need of the patients' cooperation to get the best results of sanatorium treatment. This booklet contains not only rules of conduct and sanatorium regulations, but items of a general nature and ( their influence on tuberculosis, such as rest. fresh air, heliotherapy, food, tobacco, etc, and instructions and suggestions for the patients in relation to these factors. | The manner of spread of tuberculosis is explained and the many methods responsible such as coughing, sneezing, spitting, kissing contamination of utensils, body discharges etc., are expounded upon. The viability of th? tubercle bacillus in sputum droplets and dust j particles, under conditions of drying and

ITALY

<h3>Congress of Orthopedics</h3> The twenty-third Congresso nazionale di ortopedia was held at Bologna, under the chairmanship of Professor Putti. A number of foreign surgeons were in attendance. In his address, Professor Putti brought out that the work of the congress would be based on observations in more than 4,000 cases of congenital dislocation of the hip, all of which had been reexamined radiologically at least three years after operation. He pointed out that the incidence of this abnormality amounts to about 2 per thousand of population. The chief speaker was Professor Annovazzi of Milan, who based his conclusions on 1,610 cases. In the children treated under 2 years of age, the percentage of good results was 82 per cent; in children under 5 and more than 2 years of age, 66 per cent, while in children more than 5 years old the percentage of favorable results diminished gradually. These statistics