Satisfactory End Result Research Articles

CARTILAGE AND IVORY: INDICATIONS AND CONTRAINDICATIONS FOR THEIR USE AS NASAL SUPPORT

In previous papers dealing with the use of ivory implants in rhinoplasty I stressed the importance of the morphologic and chemical structures of this substance with reference to its tolerance by human tissues.1To my knowledge these were the first communications in the medical literature pertaining to the use of ivory in reconstructive surgery. During the eight years that have elapsed since the publication of these communications, I have continued to use ivory implants in selected cases, giving preference to cartilage grafts in most instances. Reports on this subject which have appeared in the medical literature in the last few years are far from uniform. Satisfactory end-results are claimed by a number of reliable observers,2while others point to the difficulties met with in shaping the implant or to infection following its introduction. The mere fact that ivory is not an autoplastic material seems to a

Plastic surgery and the specialists

Because of its extensive development plastic surgery has become an indispensable surgical unit in the general hospital. The relationship of this surgery to other specialities must be based on its definite indications. The manifold problems involved in the prevention and treatment of deformities caused by automobile and industrial accidents as well as by burns can be properly handled only by those thoroughly familiar with plastic surgery procedures. The successful reconstruction of highly hypertrophic and atrophic prolapsed breasts is at present assured by the method of subcutaneous transposition of the gland with mastopexy. Plastic repair in otorhinolaryngology as a rule should not be attempted by nose and throat specialists, and the association of plastic surgery with the laryngological service in a general hospital should be avoided. The end-results in rhinoplasties are uniformly successful if this surgery is performed aseptically and with proper skill. Intricacies of plastic repair in the paraorbital region are due to the different types of skin grafts required in a relatively limited area, and the great functional importance of the eyelids. Cicatricial contractions around the eyelids are the most common indications for this surgery. Cleft lip and cleft palate, repaired at an early age, should in the majority of cases be followed by a satisfactory end-result. A variety of skin conditions such as nevi, hemangiomas, lymphangiomas, large hairy moles, extensive pigmentation and scars can be successfully eradicated by plastic procedures, followed, if necessary, by the application of physical agents such as x-ray and radium. A great economic waste will thus be avoided.

THE ELECTROSURGICAL METHOD OF CLOSED INTRAPLEURAL PNEUMOLYSIS IN ARTIFICIAL PNEUMOTHORAX

It is generally admitted that artificial pneumothorax is not only the most widely applicable method of collapsing the lung in the treatment of pulmonary tuberculosis but also the most valuable. Unfortunately, pleuritic adhesions are almost invariably present in cases in which the patients require pneumothorax treatment and constitute the greatest obstacle to a satisfactory end-result. As a result of experience in the treatment of approximately 1,400 patients with pulmonary tuberculosis with artificial pneumothorax during the past eighteen years, my co-workers and I are convinced of the importance of establishing a type of pneumothorax which within a few months will give the diseased lung sufficient functional rest, collapse or compression to render it no longer a source of tuberculotoxemia or tubercle bacilli-laden sputum. The importance of a satisfactory collapse of the lung is strikingly shown in the accompanying table. A careful review of the clinical records and stereoroentgenograms in 245 cases

Radium Radiation from a General Utility Standpoint

The introduction of radium into general therapeutic use has been accomplished by much discussion and also considerable unjustifiable criticism. In the light of past achievements, however, we are in duty bound to review our work with radium and continue in its scientific application, secure in the knowledge that in certain phases of cancer it has demonstrated therapeutic results as yet unequalled by any other medical or surgical measure known. Outside of the comparatively few institutions where radium is supplied in the form of emanation, the bulk of independent radium therapy is carried on by means of elemental radium in the various glass and metallic containers with which we are all acquainted. With the advent of the aerial mail service, even the remotely located radiologist can have placed at his disposal, upon telegraphic request, a suitable quantity of radon or radium emanation of exact measurement and known content. This service is invaluable to those who have not the facilities of an emanation apparatus. According to the experience of the writer, the field where the best results have been obtained from radon implants or seeds is the oral cavity, particularly the tongue. In no other location has this form of therapy seemed to us so surely the best, unless it be in such nodules or tumor masses of the rectum, vagina or cervix uteri as will not react so as to injure seriously a functionating mucous membrane. In early cancerous lesions of the tongue, our experience with radon seeds has been gratifying. In the bladder, prostate and rectum, we have not been so fortunate. In the majority of malignancies, we have noted that outside of a very few favorable cases where a metallic needle imbedded for a limited time gave the desired result, we accomplish a great deal more with much less pain and discomfort to the patient by the screened applicator method. Similarly, our use of the metallic needles imbedded in tongue or throat lesions have given way, either to the radon seeds or to screened topical application. In tissues which are hyperplastic and free from adjacent sensitive structures, as, for example, polypi or small fibroids of the cervix uteri, judicious employment of metallic needles will yield more satisfactory end-results than any other method of eradication. On the other hand, in cancerous nodules elsewhere located, the response with needles has not measured up to what should theoretically be expected from such treatment. Many of us at one time advocated the use of needles imbedded in the various cancer nodules of the breast. We have, in our Clinic, discontinued this procedure for several reasons, the chief one being the severe reaction and sloughing, with a long, tedious healing period which sorely tries the patience of both the operator and his charge. When we have reverted to the older technic of screened external applications, we have secured equally good end-results with no such serious sequelæ.

GANGRENE OF TOES IN AN INFANT, DUE TO SCALD

The case reported herewith is of interest first, because of the etiology, and, secondly, because of the satisfactory end result of conservative treatment. REPORT OF CASE History. —An infant, 5 days old, was seen in consultation for gangrene of the toes of the left foot which had resulted from a scald during delivery. The mother had been advised to sit over a pan of hot water to hasten parturition. While doing so a foot presented and was scalded. Fig. 1.—Clinical record. Examination. —The left foot showed a scald of the second and third degree extending up above the ankle on the anterior surface. Gangrene extended to Chopart's line. The infant appeared otherwise normal and was not prostrated. Fig. 2.—Appearance of the foot at entrance to hospital five days after scald.