ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716352

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

摘要:

SummaryUntil recently, visceral pain has been a subject without precise basis, which we are reduced to study directly on the sick man.In spite of the ease which anesthetic infiltrations offer us, these do not have the accuracy of surgical sections in which we cut only one nerve path in each operative time, thus allowing for a better understanding of the phenomena.When a visceral disease is accompanied by acute pain, we do not feel visceral pain only but miscellaneous painful sensations.We must distinguish three different kinds of pain which can be felt at the same moment, but which have very different properties.1. Pains of the parietal serous membrane :They are of cerebro-spinal origin and are very acutely felt.They are due to the irritating contacts which the viscera may develop with the peritoneum, whether through their distension (mecanical stimulus) or by way of lymphangitis (chemical stimulus).They are not affected by the infiltration of the splanchnic nerve.2. The pain proper to the splanchnic organs :It is a fact and it is well perceived at the site of the diseased organ. It is apt to make itself felt even in the absence of all irritation of the parietal peritoneum, but it can only respond to special irritations, the so-calledadequate irritations(i.e. distension, spasm, ischemia, inflammation). It is a dull, imprecise, confuse pain and is relieved by the infiltration of the splanchnie nerve.3. The radiated pains :They are frequently felt in ill-defined areas, varying from one moment to another. They are annoying and hard to bear. They are usually present in acute attacks but can exist on their own.When involving the bile-ducts, these radiated pains offer the picture of a real phrenic neuritis. This is best explained by the connections which exist between the nerve endings supplying the peritoneum under the diaphragm and the endings of the phrenic nerve which also takes part in the innervation of the same area of the peritoneum.From the therapeutic point of view, two types of anesthetic infiltrations have been tried. I have used them in several sorts of biliary colics.1. Intradermal infiltrations of Lemaire(Louvain 1926) :It is given in the cutaneous area where the referred pain is perceived. It abolishes the cutaneous hyperesthesia which adds its own sufferings to the visceral pain, the latter persisting entirely with its character of deep, vague, imprecise pain. It does not modify the pain of peritoneal origin or that due to the phrenic neuritis.2. Infiltration of the right Splanchnic Nerve :It reaches at the same time the splanchnic nerve, the sympathetic chain and the right phrenic nerve which runs at 3 to 4 cm. from the point of infiltration.In fact, it abolishes the visceral pain and the phrenic neuritis, but leaves the pain due to the peritoneal irritation.3. Infiltration of the 12th right intercostal nerve :This has never been described before. I had noticed that every patient suffering from a painful or functional disorder of the bile-ducts had a spot sensitive to finger pressure. This point is exactly located under the inferior border of the 12th right rib where it crosses the external border of the lumbar muscular mass (fig. 4).I have noticed the existence of that painful spot with such regularity that I am now in the habit of considering this fact as a revealing sign of biliary disease.Since 1941, I have systematically practised infiltrations of that painful point and have noticed that if the needle penetrated exactly under the lower edge of the 12th rib, good results were regularly obtained. Pain of peritoneal origin and phrenic neuritis is instantly abolished. The visceral-algy does not appear to be influenced at that precise moment. But on the following day, we notice disappearance of functional disorders and at the same time, gradual disappearance of the visceral sensibility. All this happens as if this anesthesia blocked certain centripetal paths of reflexes whose answer, whether motor, vaso-motor or secretory, unfavorously modified the functions of the gall-bladder and the bile-ducts. Once this vicious circle is broken, the disorders completely disappear.So convinced am I of this fact, that when events do not seem to bear it out, I believe that the diagnosis must be revised and that we must investigate the possibilities of an anatomical lesion (blocking gall-stones or tumour).

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716353

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

摘要:

Summary1°The etiology of chronic pericarditis or Pick’s disease is still undetermined. We are rarely able to trace it to tuberculosis or another definite infection.2. During this clinical condition we find a vena cava superior syndrom with or without a thoracic collateral circulation; the frequent absence of the latter is due to the development, inside the thorax, of an anastomotic circulation through the azygos.3°Most of the patients, present a sharp duplicating of the second sound at the auscultation. This duplicating happens before the opening of the auriculo-ventricular valves. It probably is a consequence of a diastolic relaxing which becomes difficult and noisy because of calcifications.4°The electrocardiogram is characterized by a QHS complex of low voltage and by marked alterations of the T wave which is small, isoelectric, negative or diphasic. An auricular fibrillation appears usually during the illness.5°To detect the calcifications by X rays exploration, it is necessary to use very hard rays and to examine the patients in the different oblique positions.6°The circulatory symptoms of this disease are easy to understand if we remember that the heart by these patients has a very bad diastolic filling.7°There is no medical treatment; the only rational therapeutic is a pericardiolysis limited to the anterior part of the left ventricle.

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716354

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716355

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

摘要:

SummaryCultures of gonococci from women’s genital secretion. By M. Millet, J. Gaudy, R. Denolin-Reubens and J. Brenez. (Brussels.)The Carpenter’s method was used.125 suspected women were examined.Direct examination was positive in 31 cases. Of the 94 remaining, 43 yielded a positive culture from cervical or urethral secretions, or from both.Of 60 treated patients whose smear was repeatedly negative, 21 still gave a positive culture.

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716356

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716357

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

摘要:

SummaryA case is reported of acromegaly, occuring in a 38 years old woman. Three years after the onset of the first signs, the patient developed a severe diabetes. The pituitary tumor was irradiated. Two months later, the patient suddenly was struck by a syndrome characteristic of cavernous sinus compression : this accident was interpreted as the result of an acute hemorrhage in the pituitary adenoma. Regression of the neurological symptoms was followed by complete disappearance of the diabetes (controled by blood sugar tolerance tests). The significance of this pathological experiment is examined in the light of recent knowledge concerning the influence of the pituitary in experimental diabetes.

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716358

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

摘要:

SummaryTwo cases of meningococcemia aro reported. The first one was complicated with meningitis and large areas of ischaemic necrosis of the skin of both shoulders, upper parts of the arms and back. These cutaneous lesions were livid in their central parts and hemorrhagie at their periphery. Later on, they underwent a dry necrosis, forming hard, black eschars which ulcerated in the following days. Pneumonia also occured in the course of the disease. The patient recovered but epidermic grafts were required to heal up the wounds. She was treated with sulfathiazol and later on with penicillin when pneumonia occured.The second was a typical case of very acute meningococcemia with circulatory collaps, suggesting Waterhouse-Friderichsen syndrom. The patient was quite well 18 hours later. Large doses of sulfathiazol, penicillin and desoxy-corticosterone acetate were administered.

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716359

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor

ISSN:1784-3286    

DOI:10.1080/17843286.1946.11716360

出版商:Taylor&Francis    

年代:1946

数据来源: Taylor