TREATMENT. — Kelly has seen great improvement follow gradual dilatation by graduated hollow bougies in cases of stricture. Ureterotomy and division of the valve or, in case of stricture, closing the opening after the Heinecke-Mikulicz method of suturing the pylorus has been successful in relieving these conditions in a number of cases. Resection and anastomosis or suturing the ureter into the lower part of the infundibulum is sometimes necessary.
General Surgery of the Kidneys.
When operative procedures are about to be performed on the kidney, the fact that it is occasionally the seat of alies should be borne in mind. It may occupy an abnormal position; under such circumstances it will usually be found below and nearer the middle line than usual. It may even be found as low as within the pelvic cavity. Irregu larities of size and shape may also be found, due to abnormal or arrested de velopment.
Sometimes the extremities fuse, form ing "horseshoe kidney" or one kidney may be wanting, in which case the other is apt to be of unusual size. A number of cases of congenital occlusion of the ureter have been reported in which it was, of course, impossible for the kidney to fulfill its function.
Nephrotomy.
Nephrotomy is an incision into the kidney, but the term is now generally limited to incisions for the evacuation of cystic or purulent collections of fluid.
INDICATIONS.—It may be indicated in simple cysts, hydronephrosis, hydatid cysts, pyonephrosis, suppurative nephri tis, and tuberculosis of the kidney.
In all of these conditions pus and blood will be found in the urine. The amount of blood is generally small and the cells are abnormal; the pus, if measured, is apt to vary in amount. Renal cells and the characteristic epithelium of the pelvis of the kidney will also probably be found. In all chronic inflammatory conditions casts and albumin are present in the urine. Elevation of temperature, with or without chills, loss of appetite, hectic, suppression of urine, and uraemia may also exist. There will be more or less pain and tenderness over the region of the kidney and in pyelonephritis and pyonephrosis there may be consider able swelling, redness, and cedema. The symptoms of pyonephrosis are those of hydronephrosis plus those of suppura tion.