The operation is not dangerous, pro vided a completely aseptic ligature is used. Blacque and A. Guinard (Ann. Mal. de l'Or., Nov., '96).
Traumatic aneurism of the ulnar artery in the palm cured by tying the ulnar artery above the wrist. William Robertson (Brit. Med. Jour., Dec. 4, '97).
Two cases of traumatic aneurism of the radial artery, treated by excision of the sac. Recovery. Elevation of the limb, combined with pressure on the sac. will sometimes effect a cure, but at best it is tedious in its application and un certain in its results. Simple ligation of the vessel above and below the sac is more likely to prove successful. Ex cision effectually cures the disease. and is easily performed if the sac be of small size. Non-removal of the tourniquet, until the dressing and bandaging of the wound are completed, is a valuable detail. J. E. Platt (Med. Chronicle, Dec.. '97).
Cirsoid Aneurism.
As compared to the forms of aneurism already described, this variety is very rarely met with. It should be classed with tumors, being, in reality, an arterial an,gionia.
Varieties. — Where a single vessel is involved, it is usually called an arterial rarix: when a number of vessels are included in the mass, it is termed cirsoid aneurism; and, when the surrounding veins and capillaries are also dilated, the name aneurism by anastomosis is applied to the irregular mass thus formed.
Symptoms. — Although cirsoid aneu risms may be met with in any part of the body, their site of predilection is the head especially, and more particularly the temporo-parietal region. The hands come next in the order of frequency. A cirsoid aneurism appears as an irregu larly-shaped, bluish, and flattened mass of dilated blood-vessels, twisted inextri cably together, from which project am pullue, or bags. The skin over this is extremely thin, soft, and doughy to the touch, and is in imminent danger of rupture. Manual examination shows that it is connected with the arterial system, synchronous pulsation with the heart be ing evident. Its temperature is generally higher than that of the surface of the body, owing to the increased rapidity of the circulation through the tortuous an eurismal channels. It is easily emptied
by pressure, but immediately fills as soon as released. A distinct thrill may gener ally be heard over it, which can be traced along its branches. It does not give rise to pain unless a nerve is involved in the absorptive process which cirsoid aneu risms give rise to in the surrounding structures. To this process is due the grooves found in bone underlying them and the thinness of the skin covering them.
Diagnosis. — When the discoloration and the general outline of the growth present does not at once establish its identity, a true aneurism may be simu lated. True aneurism, however, is usu ally found upon an artery of considerable size, such as the carotid, the tracheal, and the popliteal, and does not yield so readily to pressure. The bosselated out line of cirsoid is replaced by a regular globular mass. The peculiar doughy sen sation communicated to the hand during palpation is peculiar to cirsoid growths. Again, these are habitually situated in the extremities where medium or small arteries are to be found.
Pathology.—Cirsoid aneurisms usually occur as the result of traumatism. This is thought to give rise to paralysis of the vasomotor nerves supplying the region affected, and thus allowing the blood vessels to be dilated. It has been known to start from a nevus, and it has been traced to an arteritis. In the majority of cases, however, its origin cannot be ascertained. As already stated, it be longs more properly to true tumors, and should be termed, according to Tillmann, "angionia arteriate raccmosa." Cirsoid aneurisms believed to be due to arteritis, which weakens the vessel walls and allows their dilatation. Ar teritis explains all eases of eirsoid aneu rism following an injury; those follow ing !nevi can be explained by a congeni tal defect of nutrition of the walls of the vessels. J. L. Reverdin (Rev. Mad. de la Suisse, Feb. 20, 'OS).