Icterus Gravis and Cirrhosis of the Liver

Abstract

BRTsHNm 1385MEDICAL JOUxN& tion I would use the anterior vaginal wall approach and would cut through that band. A further operation was not done in this case because the woman had secondaries from a carcinoma of the larynx.The other failure was in a case of moderate cystocele in which mobilization was again done through the Millin II approach. This woman has not yet had the cystocele repaired, but I feel confident that, when it is, the stress will be finally relieved. In this connexion Mulvany (1951) states: "The writer used to confine the suprapubic route to those cases of stress incontinence requiring also an abdominal operation and the vaginal one for those in need of repair, but these excellent results have prompted its employment also in the early to moderate prolapse, especially if there is a likelihood of future child-bearing, as in most cases it is the stress incontinence and not the prolapse which is the most prominent and troublesome feature." I cannot agree with this, and my results show that support from below is as important as mobilization.Latterly, therefore, nearly all my cases have been done through an anterior vaginal wall incision, whether prolapse was present or not. The procedure when this approach is used consists of: (1) dissection of urethra and bladder-neck; (2) rupture of pudendal diaphragm by index finger or blunt scissors on either side of urethra; (3) pushing the bladder off the back of the symphysis pubis; (4) removal of redundant vaginal mucosa, if any; (5) re-uniting vaginal mucosa and pa'ra-urethral tissues. This operation now constitutes part of any prolapse operation when stress incontinence is present.Many of my cases, but not all, had had several previous operations for prolapse and stress incontinence. One case had also had an Aldridge sling operation by another surgeon, but had not been improved. During operation on that case (suprapubic approach) no evidence could be found of the fascial sling inserted one year before. An immediate postoperative urinary infection tended to obscure the successful result, but one important point made by the patient (and since asked of other patients) was that she could now feel urine passing through the urethra. When the urinary infection was overcome the incontinence was completely relieved. ConclusionsIt would be wrong of me to make statistical deductions with so few cases. But my experience, gained in the study of many other procedures besides the present series, leads me to the following conclusions.1. That cases of stress incontinence require careful radiographic and cystoscopic investigation, apart from clinical neurological examination, before operations are performed. There is nothing new in this, as has been repeatedly pointed out by Millin (1950) and WinsburyWhite (1948). Measured cystography has shown that there is often a slight increase in descent of the bladderneck after mobilization, although the stress is cured.2. That Mulvany has introduced a new aetiological concept and an operation which has formed part of many sling proc...

Liver Function Tests in Survivors of Haemolytic Disease of The Newborn

“…Gerrard (1952), however, in a study of 226 cases of icterus gravis neonatorum, followed for more than five years, found little support for this hypothesis. His investigations included clinical examination, thymol turbidity tests and estimations of serum albumin and globulin.…”