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Francis Villar

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FRANCIS VILLAR (Bordeaux) said that early diagnosis of pancreatic tumors is difficult, but becomes somewhat easier as the neoplasm increases. A zone of dulness bounded above by the stomach resonance and below by the colic is the principal physi cal sign ; insufflation of the stomach augments the superior reso nant zone and diminishes the dull zone. In some rare cases the tumor passes between the liver and stomach and is not covered by the superior resonant zone. Other symptoms confirm the diagnosis, e.g., diarrhcea, vomiting of fatty material, glycosu ria, etc.

The treatment of pancreatic tumors varies as they are solid or cystic. In cysts, the ideal treatment is extirpation ; but it is not always practicable, and marsupialization must be adopted. This has given good results. In solid tumors the treatment may be radical or palliative. Experience shows that (1 ) serious trau matisms of the pancreas recover readily. (2) Extirpation of the tail and part of the body of the organ is not a very serious opera tion ; a very limited tumor of the head may be removed.

Palliative treatment consists in overcoming biliary retention and intestinal occlusion by means of cholecystotomy, choledochos tomy, cholecystenterostomy, etc., and by gastro-enterostomy. Villar has made a pancreatico-intestinal fistula in a case where the gland juice was retained by compression of Wirsung's canal. Proceedings of the XIII International Congress of Medicine; Revue de Chirurgie, September, Istoo.

IL Ectokelostomy. By DR. JUNIUS VITRAC (France). When operating for strangulated hernia, it is often necessary to drain the peritoneum, but this drainage interferes with the radical cure of the hernia. Such being the the surgeon occasionally discards drainage when its use might avert evil. The author has devised a means of drainage which does not interfere with the closure of the hernial opening, and to his procedure, " for the lovers of neologisms," he has given the rather " expensive" name ectokelostomy, which, being interpreted, meaneth displacement and drainage of the sac.

The operation, whether for femoral or inguinal hernia, is performed as follows : Step One. Expose the sac, open, empty, and separate it from its'surroundings, very much as in the Macewen operation.

Step Two. Guided at first by the anterior wall of the sac, pass the finger upward and separate the peritoneum from the anterior belly wall. When the separation of peritoneum has been carried out sufficiently, cut through the belly wall on to the tip of the finger. Pass a forceps through the abdominal wound down to and through the hernial opening. With the forceps seize the distal end of the hernial sac and pull it up so that its end pro trudes through the abdominal wound. Sew the sac to the skin with one or two provisional sutures.

Step Three. Close the hernial opening completely. (Radi cal cure of the hernia.) Step Four. Through the displaced sac introduce drainage tubes into the peritoneal cavity. Excise all excess of sac.

When there is no further occasion for drainage, close the mouth of the sac with a few stitches and permit it to retract through the abdominal wall, which is now closed. Revue de Chirurgie, January, 19o1.

sac, drainage, treatment, hernial and zone