The problem of renal lithiasis in an orthopedic hospital

As will be noticed, cases 5 and 8 although presenting the typical symptoms of renal colic, did not show any stone either by X-ray or cystoscopy; but the urine was positive for red cells. It is possible that the stone or stones were radio-transparent or had escaped the notice of the patient. In the consideration of the etiologic factors concerning the frequency of the formation of renal calculus in bedridden patients, several factors are believed to come into play: 1. Posture predisposes to stasis, so that some of the urine is retained in the renal calyces. It is well known that stasis favors the formation of stone2. Toxemia. In our cases toxemia arising from chronic suppuration might give rise to some calcium plaques of Randall which might well serve as the nidus of a stone in the renal papilla3. Disturbance in the calcium and phosphorus metabolism without hyperparathyroidism. The orthopedic surgeon in quite aware of the increased demineralization of bones following injury and immobilization. This is shown by X-ray studies of the affected limbs, as well as studies of the calcium and phosphorus content of the urine which is usually increased4. A fourth factor is the inadequate nursing service. The lack of personnel to help bedridden patients change their positions was badly felt. Some of the patients had to forego drinking a sufficient amount of water because there was no one to supply them with it. The withholding of urination on account of insufficient help was also a strong factorThe factor of infection in the urinary tract probably was not an important factor in our cases. (Discussion)

Safeguards in nupercaine spinal anesthesia (a preliminary report of 108 consecutive cases operated in the North General Hospital during the last 18 months)

1. One hundred eight cases of different types of abdominal operations performed under spinal nupercaine anesthesia are presented2. The details of the technique and the safeguards are discussed fully. The safety of the patients depended mainly on the knowledge of the anesthetist about the physiology of spinal anesthesia, the complications to be avoided, should they occur, and they could be remedied3. From a practical standpoint, the paper is presented for the benefit of surgeons in the provinces who cannot avail of the services of a trained anesthetist. The complications have to be guarded against, so that remedial measures can at one be taken--lowering of the blood pressure and the signs of respiratory depression. Watching the patient during the first 10 minutes after the injection of the anesthetic is invaluable in the prevention of accidents which can very well mean death. Two cases are cited to prove this point4. Artificial respiration should be given at once and continued until automatic breathing is reestablished5. There was no mortality from anesthesia in this series. (Summary)

Sparganosis in Filipinos: with a review of reported cases in the Philippines

An additional case of sparganosis in the Philippines is presented, with a brief review of the pathogenesis and a resume of the other cases so far reported in this country. (Summary)