1919 Journal of the American Medical Association  
PHILADELPHIA On a number of occasions in the past I have reported in the pages of The Journal and in the Therapeutic Gazette cases of aortic aneurysm treated by the introduction of gold-platinum wire and electrolysis. The previously reported cases combined with the three herewith presented, make a total of thirty. THE ESSENTIAL POINTS FOR SUCCESS There are several points essential to the success of this method, and a number of others which, when understood clearly, show why it cannot always
more » ... t cannot always succeed: 1. The aneurysm must be sacculated, not fusiform, and if it be of the dissecting sacculated type it is the most favorable for good results. It is not only useless but dangerous for obvious reasons to operate on a fusiform aneurysm. 2. Although it is not at all necessary for the aneurysm to have eroded the chest wall so as to protrude, it must be close enough to the chest wall anteriorly or posteriorly to permit the insulated needle to enter the sac. 3. The wire must be of gold and platinum so that it will coil properly in the sac. A gold-copper wire is useless because the copper is eaten out so rapidly by electrolytic action that the procedure cannot be com¬ pleted. Fig. 1 (Case 1).-Aneurysmal growth, 10 inches in width and inches from below upward. 4. Great care must be taken that the skin over the sac is protected from electrolytic action by having the external part of the needle well insulated as well as the shank. 5. Depending on the size of the sac, the amount of wire varies, but it is usually from 15 to 20 feet. 6. The time during which the current is allowed to pass is usually about forty-five minutes, and the cur¬ rent strength must be turned on and off very gradually. 7. If the street current is used, great care must be taken that the proper reducing apparatus is employed, and also that the table on which the patient lies is insulated with rubber pads and that the operator and his assistant wear rubber-soled shoes. The facts that stand in the way of complete success are that in a large proportion of cases the entire aortic wall is diseased, the area operated on being chiefly in Fig. 2 (Case 1).-The crosses show the points at which the wiring was introduced into the aneurysm. trouble. Solidifying the contents of the sac is well so far as it goes, but other parts of the aortic wall give way later. In many cases the entire arterial system is diseased, and the only patient I have seen who did not get relief from pain before the operation was finished died suddenly sometime later and the necropsy revealed a second sacculated aneurysm just above the diaphragm which had ruptured. THE PROGNOSIS The prognosis, therefore, depends largely on the general state of the vessels. If this is good and the aneurysm seems to have resulted chiefly from injury, the prognosis is better than if the general vascular state is bad. Syphilis is manifestly an active factor. When the growth is very large, and particularly if its pressure has already begun to cause pulmonary edema or pleural effusion, the procedure is, of course, a for¬ lorn hope. The value of the procedure lies in the following facts : 1. The extraordinary decrease in pain, which, as already stated, usually takes place soon after the cur¬ rent begins to pass. Whether this easement of pain is due to decrease in the tension in the sac with its associated diminution of pressure on adjacent tissues or whether it is due in whole or in part to a sedative effect of the current, I am unable to state; but I am inclined to the former view. This relief from pain, which has previously required large amounts of morphin, justifies the operation even if life is not greatly prolonged. 2. Arrest of the progress of the growth, at least in the direction in which it threatens to rupture. I have reported a number of cases in patients in whom blood
doi:10.1001/jama.1919.02610510003002 fatcat:xtuz5mvpqrb5rhx3uvkgcbhbcy