Piecemeal Removal Research Articles

Surgery of tumours in the thoracic portion of the trachea.

We have operated on nine patients suffering from benign or malignant tumours in the thoracic portion of the trachea. The main clinical symptom was difficulty in breathing, accompanied in the majority of cases by attacks of asphyxia, cough with mucous phlegm, and haemoptysis. The following operations were performed: circular resection of the trachea with end-to-end anastomosis, thoracic tracheotomy with enucleation of the tumour, fenestral resection with auto-alloplasty of the ensuing defect, piecemeal removal of the tumour through the lumen of the trachea, and intrathoracic tracheotomy with biopsy of the tumour. All patients were discharged after the operation. When giving an anaesthetic during an operation on the thoracic portion of the trachea it is expedient to introduce a tube into the left main bronchus from the right pleural cavity and to exclude the right lung from ventilation. These measures ensure convenience of manipulation of the trachea, unhampered by the presence of a tube. End-to-end anastomosis is the best way to restore the thoracic portion of the trachea after circular resection. The problem of replacing large fenestral defects of the trachea can be solved by auto-alloplasty with thick Marlex, preliminarily overgrown with connective tissue.

Amyloid deposition localized to the lower respiratory tract

A case of diffuse submucosal deposition of amyloid material in the trachea and bronchi is reported. Although rare, this condition should be considered in the differential diagnosis of stenosing lesions of the lower part of the respiratory tract. This is the first reported case of amyloidosis in the lower part of the respiratory tract in which several parameters of pulmonary function were tested. Piecemeal removal of the obstructing nodular masses by bronchoscopic biopsy is the only successful means of relieving the airway obstruction that may develop in patients with this disease.

Surgical avulsion of the nail; a modified technique.

Surgical avulsion of the nail is a not uncommon therapeutic necessity. The nail is usually removed by traction after it has been bluntly separated from its bed. The infected nail is friable, and often difficult to remove. It crushes easily under the pressure of the hemostat, and adequate traction may be impossible to obtain. Piecemeal removal, then, is necessary, which increases the possibility that infected spicules will be left behind to reinfect the new nail. Profuse bleeding may occur after this procedure. It is common knowledge that a fingernail will loosen and separate cleanly after injury severe enough to produce a large subungual hematoma. The hematoma acts as a blunt dissector, and, thus efficiently separates the nail from the bed. In an effort to duplicate this natural process, a subungual injection of water was attempted. Enough pressure to separate the nail was difficult to obtain, and fluid escaped backwards

RESECTION OF THE TRACHEA

TRACHEAL obstruction by a primary tumor is customarily treated by endoscopic methods, namely, piecemeal removal of tissue projecting from the wall of the trachea, diathermic cautery of the base of the tumor and dilation. Such procedures have sufficed to relieve many patients of their symptoms for months. Because a fairly large proportion of primary tumors in the trachea are cylindromas, which invade little beyond the trachea and grow slowly, control of the tumor may be possible for several years. Obviously, however, a more nearly ideal treatment would conform to the accepted principle of surgery in neoplastic disease: complete excision of the tumor, the tumor-bearing region and a surrounding margin of normal tissue. The rareness of tumors of the trachea has, on the one hand, provided little incentive to develop a method of radical surgical treatment, and, on the other hand, the hazards which come to mind in the contemplation of a possible

MENINGIOMAS ARISING FROM THE TUBERCULUM SELLAE

An equally large tumor, to judge by the weight of the fragments that were preserved, was successfully removed three months later from the next case. This tumor also had failed to give neighborhood symptoms beyond those of the syndrome under discussion, though the adiposity and scanty menstruation suggested a nearly hypophysial involvement. Case12.— Failing vision for eighteen months advancing to near blindness. Primary optic atrophy. Bitemporal hemianopsia advancing to unilateral blindness. Normal sella. Correct preoperative diagnosis. Operation. Total piecemeal removal of a 16 Gm. tumor. Recovery with marked improvement in vision in the left eye, stationary after two years. July 8, 1926 : Admission of Mrs. Rose B., 37 years of age, with the sole complaint of loss of vision ; referred by Dr. George de Schweinitz through Dr. Otto Lowy of Newark, N. J. History .—Until December, 1924 , the patient had never consulted a doctor. At about that time she