Portions of liver-tissue of considerable size may be safely removed by previ ously rendering anmrnic the part which it is intended to remove. For the sup port of the ligatures, living tissue from the same animal, preferably the fascia and peritonemn from the abdominal wall, is best suited. The intraperitoneal or the intraparietal method is preferable to the external method. Carl Beck (Jour. Amer. Med. Assoc, April 26, 19021.
Hydatid Cyst of the Liver Symptoms.—Small cysts cause no symptoms; they may be discovered at the autopsy. Cysts may reach consider able size without causing inconvenience and be discovered as a tumor-like en largement accidentally. The liver en larges irregularly and in time the cyst causes disturbance by pressing- on some neighboring organ or part, interfering with its function. If in the dome of the liver it may displace the heart or lungs. It may press on the bile-passages, jaundice resulting; or on the portal vein, causing ascites. If it presses on the vena cava it causes cedema of the legs. If superficial, the cyst may fluctuate to palpation, or, if tense, it may be felt as a hard solid mass. ITydatid thrill is sometimes obtained by placing one hand lightly on the cyst and tapping it gently \vith the fingers of the other hand. The thrill has been ascribed to the sudden impact of the daughter-cysts against each other and against the wall of the cyst; but thrill is sometimes obtained in cysts which contain only clear fluid.
Rupture of the cyst may occur. If it takes place into any of the serous cavi ties inflammation results. The pleura suffers most frequently; perforation of the lung often follows, with pneumonia and the expectoration of cysts and book lets. More often pus, blood, and bile pigment are coughed up, such as °CULTS in gangrene or abscess of the lung sec ondary to liver-abscess.
,The cyst may rupture into the stom ach, as proved by the vomiting of cysts and hooklets; or into the intestine, with the appearance of these bodies in the fmces, as would occur also if rupture takes place into the bile-passages. Rupt ure may occur into the pelvis of the right kidney followed by the presence of the hooklets and cysts in the urine.
Case of hydatid disease of the liver, 11 th perforation of one of the cysts into the stomach. Karmilow (Laitopisj Chin
kago obschtschestw a, No. 3, '92).
IIooklets are frequently absent from hydatid tumors. James Watson (Lancet, 1/ec. 3, '92).
Case of cyst in the liver containing 10 quarts of liquid. Microscope showed no traces of echinoeoccus and no bile-salts or pigment. There was no epithelial lining of the cyst. Boyer (Amer. Jour. Med. Sei., May, '93).
Cases of hydatid cysts in which cyst opened through gall-bladder. Brjucha now (Bolnit. Gaz. Botkina, No. 2, '95); Medwedjewa (Bolnit. Gaz. Botkina, No. 2, '95).
Case of hydatid cysts in which cyst opened into bladder. Henczynski (Miinch. med. Woeh., Mar. 26, '95).
Case of ileus due to hydatid cyst of the liver. Reichold (Miinch. med. Woch., Apr. 27, '97).
Apart from such accidents, the symp toms may consist only of trifling dis comfort in the hepatic region.
Rupture of the cyst is often followed by severe urticaria; it has been attrib uted to a toxic material in the fluid. It may also follow aspiration of the cyst.
Diagnosis.—This is rarely possible be fore the cyst has attained considerable dimensions; then the irregular enlarge ment of the liver for a long period, with the preservation of health, indicates hy datid disease. It may be necessary to aspirate the cyst, and, if hooklets are found in the fluid, the diagnosis is con firmed. A fluctuating tumor in the epi gastrium is suggestive; it may give fremitus and be within easy reach of the aspirator-needle. Abscess of the liver is differentiated by the absence of symp toms of suppuration. It will not be possible to distinguish a suppurating hy datid cyst unless the hooklets be found in the fluid. Cancer has been closely simulated by suppurating cyst. The clinical history usually serves to differ entiate it. Dilated gall-bladder and hy dronephrosis have been mistaken for hyclatid cyst. A more common error is the mistaking of a cyst of the dome of the liver for right pleural effusion. Subd iaphragmatic abscess, and purulent pleurisy secondary to rupture of a cyst are conditions difficult or impossible to distinguish unless the booklets arc found in the fluid.