OTHER FORMS OF HEPATIC TUMOR.— Cavernous angioma are common, but produce no symptoms during life. They occur as small, reddish bodies, and con sist of dilated blood-vessels. They have produced large tumors in children occa sionally.
Adenomata observed: I. Post-mortem, in subjects affected with atrophic cir rhosis or rarer disease. 2. In subjects presenting a cirrhosis of extremely-rapid progress, persistent icterus and enlarge ment of the liver being added to the ordi nary symptoms. 3. In cases the symp toms of which do not resemble those of cirrhosis, but of neoplasm. Darier (Bull. de la Soc. Anat., No. 12, '92).
Case of Laennee's atrophic cirrhosis of rapid development accompanied with icterus and associated with adenoma of the liver, occurring in a male. There was extensive cedema and ascites. The spleen was enlarged and diffluent, the kidneys enlarged and congested. Dufournier (Bull. de la Soc. Anat., No. 21, '92).
Case of tubular adenoma of the liver in a man aged 60 years. Death occurred from rupture of the liver. Vanni vista Clinica e Terap., Apr., '93).
In man the liver is, perhaps, the most frequent seat of angicanata. Adami (Montreal Med. Jour., July, '94).
Treatment.—As cancer of the liver is invariably fatal, nothing can be done beyond allaying the pain, relieving the gastric disturbance, removing ascitic fluids if excessive, etc.
Liver-han-norrhage is amenable to press ure applied directly upon the bleeding surface, in that regard resembling the kidney. L. McLane Tiffany (Amer. Jour. Med. Sci., June, 'SS).
In animals one-third of the liver may be removed without causing death. Ceccherelli (Wiener med. Presse, May 26, '89).
Large portions of the liver can be re moved without undue disturbance of the function of that organ; the escape of bile into the peritoneal cavity is not a usual phenomenon after such an operation, and it may be generally prevented either by searing the raw surface of the liver, by ligation, or by securing the stump in the abdominal wound, and even if the bile does enter the peritoneal cavity the re sult is not necessarily fatal; hmmorrhage need not be greatly feared, as vessels can often be tied separately or en masse, cut through by the cautery, or controlled by pressure; resection or amputation is best done either by enucleation, by the cau tery, or with the knife or scissors,—pref erably, perhaps, in the order named; the mortality thus far has only been about 10 per cent. W. W. Keen (Boston Med.
and Surg. Jour.. Apr. 28, '92).
Removal of the liver in the frog does not involve an immediately fatal tissue, as in the case in mammals. Roger (La Sem. Med., June 15, '92).
Case of successful removal of an ade noma connected by a thick pedicle with the lower surface of the liver. Von Bergmann (Brit. Med. Jour., May 27, '93).
Portions of the liver removed by opera tion speedily replaced and parts renewed perform their function normally; sur geon justified in removing, when neces sary, even large portions. Von Berg mann (Archly f. klin. Chin, B. 46, II. 2, '95).
In operations on the liver ligature of the mass of the liver, slowly and firmly drawn tight, closes the lumen of the vessels and thus prevents hmmorrhage. After chloroform the peritoneum is opened and the lobe of the liver drawn out through the wound. A row of liga tures is then made through the liver with a blunt needle and a double silk thread, the entire length of the piece to be re moved. The needle is passed through the substance of the liver several times, a few centimetres apart. The nearest threads in the different holes are tied to gether. When these ligatures are drawn tight, the piece to be reseeted in front or back of them is removed. Compresses of gauze should be applied to control Inemorrhage of the parenchyma. After ablation the hepatic stump is sutured to the end of the abdominal wound, or the great omentum can be sutured to the cut surface of the liver, or the stump can be put back into the abdominal cavity and the walls closed with a suture in three stages, after dressing with collodion gauze.