1892 Annals of Surgery  
OF NEW YOKE. SURGEON TO T1IE OUT-TATIKNT DEPARTMENT, NEW YORK HOSPITAL. CHARLES A. POWERS. across with forceps, and the same instrument would very quickly have divided the ramus. Considerable time was spent in isolating the lingual nerve. In a word, I feel that the portion of jaw which was the scat of the tumor should have been removed with adjacent tissues in the shortest possible space of time. I find no record of similar operation on a child of this age. EDITORIAL ARTICLES. AKND ON THE
more » ... . AKND ON THE METHODS AND RESULTS OF EXCISION OF RECTAL CARCINOMA.1 In an extensive, thorough and clear work. A. compares the various methods which have been employed in dealing with rectal cancer, details at length the histories of 35 cases operated upon by Kochcr, and analyzes 230 additional operations, which he gathers from litera¬ ture. The communication is of such interest that it deserves careful study. It is of such length, however, that but few of its features can be noted here. Of interest is it to know that so long ago as 1874, Kocher published an account of an operation devised by himself for removal of cancerous rectum, which consisted in a posterior incision with excision of the coccyx. This he called the "Long posterior incision," and he ascribed to it the advantages which render the now popular operation of Kraskc so useful, viz : Extirpation of the cancer is done with greater case, certainty and completeness than by the older operations from below, and the bleeding is much more easily controlled. So we must see that the Kraske operation brings to that of Kochcr extension of the principle of posterior incision, and conse¬ quent ability to remove tumors which have a very high seat. A. ascribes all credit to Kraskc's procedure. He emphasizes with vigor, however, that in the great majority of cases of cancer of the rectum the long incision of Kochcr will suffice. Of the modifi¬ cation made by Hochencgg, Hcnzfeld, Heineke and Levy it is not necessary to speak in detail, the principle is that of Kocher, extended and emphasised by Kraske. Of the entire number of cases the peritoneum was wounded in 69, and of these only 9 (13 per cent.), died from peritonitis. 'C. Arnd (Berne.) Deutsche ZeUshriJlfm Otirurgie, Bd. xxxii, Hit., 1 and 2. 374 EDITORIAL ARTICLES. Without doubt these wounds should be closed by suture, and at the earliest (possible moment. Kraske reports several accidents which followed this open treatment. In three of his cases the circular intestinal suture gave way, the proximal end of the intestine slipped back into the peritoneal cavity, and fecal infection occasioned a fatal peritonitis. In nine of Kocher's cases was the peritoneum opened, and death occurred in each of the cases in which its suture was omitted.
doi:10.1097/00000658-189201000-00014 pmid:17859766 fatcat:wohunkiqujeelfjpcpezyvfzay