. Radium . e rectum occurs highabove the vesicles as pointed out by Geraghty, and normally can justbe reached with the tip of the finger. The superficial lymph nodes arepalpated as is also the penis, for carcinoma. Any swellmg of the legs is noted. i i -j r The amount of residual urine is measured as also the kidney tunc-tion Cystoscopv is done. It is not practicable to radiograph the wholebody for metastases to the bones. As metastasis most often attacksthe lumbar spine and pelvis, one roentgenogram is taken showing bothof these This roentgenogram may also be used to exclude stone of theprost
. Radium . e rectum occurs highabove the vesicles as pointed out by Geraghty, and normally can justbe reached with the tip of the finger. The superficial lymph nodes arepalpated as is also the penis, for carcinoma. Any swellmg of the legs is noted. i i -j r The amount of residual urine is measured as also the kidney tunc-tion Cystoscopv is done. It is not practicable to radiograph the wholebody for metastases to the bones. As metastasis most often attacksthe lumbar spine and pelvis, one roentgenogram is taken showing bothof these This roentgenogram may also be used to exclude stone of theprostate the one condition which most simulates carcinoma. I have onone occasion used a long needle inserted through the perineum into theprostate (novocaine anaesthesia) to make the differential diagnosis be-tween stone and carcinoma. We found that the needle very distinctlygrated upon the prostatic stone. Of the 145 cases of prostatic carcino-ma seen at the Memorial Hospital, I have never come across a stone m. ^ 1.—Punch used for suprapubic removal ofcarcinomatous prostatic base. the prostate. And in all of these the prostatic region had been eitherradiographed or needled. Pathological Examination We have developed at the hospital* a needle wdiich has provedto be of value in the diagnosis of doubtful cases. This needle has asmall cutting screw at the point with which prostatic tissue is obtainedThe needle is inserted through the perineum (novocaine anesthesia)into the prostate, a finger in the rectum guiding it. We have used thisneedle 33 times, in 16 of which prostatic tissue was obtained, 9 of theseproving to be carcinoma. It should only be used in cases in wdiich thediagnosis is in doubt. Technique of Radium Application. I. Prostate needle. The technique first used at the MemorialHospital in October, 1915, is still with us the most efficient and leastpainful method of destroying carcinoma of the prostate. A steel needle10 to 15 centimeters long of No. 18 gauge is used, 5
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