Identifier: textbookofoperat1903koch (find matches)
Title: Text-book of operative surgery
Year: 1903 (1900s)
Authors: Kocher, Theodor, 1841-1917 Stiles, Harold J
Subjects: Surgery, Operative Surgery
Publisher: London : Adam and Charles Black
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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been opened it is to be accurately sutured. Com-plete primary union should result within forty-eight hours. N. REGION OF THE LOIN 111. Nephrotomy (Fig. 83). Nephrotomy is performed in cases of floatingkidney in order to moor it to skin and fascia, to open the pelvis of the kidney and therenal calyces in cases of hydro- and pyonephrosis, for nephrolithiasis, and for neoplasms.A very important indication for nephrotomy has been recently introduced, namely, forthe relief of tension. Thanks to mistaken diagnosis, Reginald Harrison, first in 1878,and again in 1896, established the fact that in acute nephritis with increased tensionand induration of the kidney an incision into it was followed not only by disappearanceof the pain, and of the blood and albumen in the urine, but also that the condition ofthe other kidney was much improved by the diminution of the functional demands madeupon it. Korteweg has quite recently stated that any engorgement of the kidney, such,, REGION OF THE LOIN 79
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Fig. S3.—(a) and (b) Nephrotomy. (<_■) Ligature of the sciatic and internal pudic arteries : exposure ofthe great sciatic, small sciatic, and pudic nerves, (d) Ligature of the gluteal artery andexposure of the superior gluteal nerve. for instance, as may occur from increased pressure in the ureter and renal pelvis, maylead to a sort of strangulation as the result of venous congestion. This may causeanuria, and, on account of the sympathetic connection of the two kidneys, the second OPERATIVE SURGERY kidney may also be threatened with engorgement. Pain in the loin, high remittingfever, diminution in the quantity of urine, and slight anaemic symptoms, are thedefinite signs which, according to Korteweg, demand an incision for the relief oftension, whereas in cases of chronic nephritis, pain and haemorrhage are indicationsfor the same procedure. Israel, Guyon, Albarran, and Braak have also madecontributions to this important question. Nephrotomy can be performed from behind or from

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