Bandages for movable kidney arc of two kinds: simple bandages and appa ratus with some special kidney pad. Simple bandages act by supporting the whole abdominal contents, thus helping to fix the movable kidneys by pressing the intestines upon them. This result can be obtained either by simple band ages or by corsets. The as sociation of enteroptosis is necessary for bandages to afford any relief. When movable kidney exists without concom itant enteroptosis, no form of bandage does any good.
All kidney are useless, for they cannot fix or sustain a movable kidney, and may exercise an injurious pressure on the kidney or vermiform appendix, or both. is indicated in all cases in which a simple bandage or cor set does not give relief. Edebohls (Med ical Record, May 4, 1901).
-Nephro pexy or Nephrorrhaphy.—By this term is meant the operation for fixation of a movable kidney. The operation was first performed in 1381 by Hahn, of Berlin, who operated upon two cases of movable kidney in April of that year.
Before the introduction of nephropexy, nephrectomy was performed for the re lief of movable kidney; but at present it would only be considered justifiable in case of some severe complication, such as strangulation or suppuration.
Out of 374 operative cases of movable kidney but 7 deaths occurred within four months of the operation. In 4 in stances only could death be attributed to the operation. As regards relief of symptoms, the results were successful in 78 cases out of 100 in which intra parenchymatous sutures were employed. Nervous symptoms were, however, less often relieved than painful ones, 14 out of 100 being partially relieved, while 36 out of 100 received no benefit in this particular. With respect to pain, ne phrorrhaphy was suceessful in SS eases out of 100. Albarran (Gaz. Med. de Paris, Sept. 14, 21, '95).
An incision in Petit's triangle between the posterior margin of the oblique and latissimus dorsi muscles involves only cutting down on the anterior margin of the quadratus lumborum through the an terior and posterior folds of the aponeu rosis of the transversalis, to reach the adipose capsule of the kidney. The adi pose and fibrous capsules of the kidney are then removed, and the organ is fixed in its proper place by means of tampons of gauze, with which the entire lower part of the wound is filled, though no sutures are used. In from six to eight days the kidney is firmly fixed in its place. Of course, the tampons prevent the wound from healing by primary union, but this is also the case Nv th other methods, in which the oozing of urine will prevent primary union. The connective tissue formed around the kid ney does not compress it, and its func tions are not compromised. 'Permanent recovery occurred in the eleven cases so treated. D. Biondi (La Riforma Med.,
July 10, 1900).
The following method of fixation for loose kidneys recommended: A flap of capsule, including the larger part of the mesial surface of the kidney, is incised with a scalpel and the flap of capsule then stripped up from the parenchyma, but remaining attached to the convex border of the kidney. The flap of cap sule is drawn through a slit in the psoas muscle of the quadratus. This brings the parenchyma also in contact with the psoas or quadratus fascia, where it forms a firm connective-tissue attach ment. The operation avoids the neces sity of passing sutures through the renal parenchyma. R. T. Morris (Med. Record, Feb. 23, 1901).
New method of anchoring the kidney. The incision extends from the lower rib to near the crest of the ilium, a hand's breadth to the right of the spinous proc esses of the vertebre. The fatty cap sule is reached just anterior to the outer border of the quadratus lumborum, and is opened and a large part of it trimmed away. The kidney is pushed into place by a cylindrical pad placed under the abdomen. When the kidney is well ex posed, an incision is made through the proper capsule from one process below the upper pole to a point two centimetres above the lower pole. This incision is plated vertically on the posterior surface near the convex border. The capsule is stripped loose from the kidney substance from a distance of three-fourths inch an teriorly and posteriorly to the incision of the capsule. From the upper and lower extremities of the vertical incision a perpendicular incision three-fourths inch long is made th•ongh the capsule, this giving two flaps of capsule three fourths of an inch wide by about two and one-half inches long. Next a strip the thickness of one's little finger of the other border of the quadratus lumborum musele is split off from the remainder of the muscle, the fibres being separated by the handle of the scalpel. This separa tion extends from the muscular attach- ' ment to the twelfth rib downward for two and one-half inches, or the slit in the muscle is made as long as the length of the capsular flaps before described. Next, an artery forceps is pa--ea through the slit in the muscle, made to grasp the free border of the posterior flap of the kidney capsule,and then withdrawn. bringing the flap of the kidney through the slit in the muscle. The two capsular flaps are next brought together over the bundle of muscular fibres thus isolated from the border of the quadratus hun borum, and stitched together with a run ning suture of fine ehromated catgut, the needle being allowed to penetrate the muscular bundle at two or three places. The lumbar wound is next closed by tier sutures of catgut, the skin wound being closed with horsehair. B. G. Davis (Amer. Medicine, Jan. 11. 1902).