. A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . he has seen exacerbations or disasters follow whichhe believes would have been prevented by nephrectomy. It is unnecessary to say more than a word regardingpartial nephrectomy and nephrotomy in this former is a more dangerous surgical procedure thancomplete nephrectomy. In case of a tuberculous kid-ney, with pus escaping into its pelvis, a sudden occlu-sion of the ureter may call for immediate nephrotomy,but the expectation of getting any progressive b
. A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . he has seen exacerbations or disasters follow whichhe believes would have been prevented by nephrectomy. It is unnecessary to say more than a word regardingpartial nephrectomy and nephrotomy in this former is a more dangerous surgical procedure thancomplete nephrectomy. In case of a tuberculous kid-ney, with pus escaping into its pelvis, a sudden occlu-sion of the ureter may call for immediate nephrotomy,but the expectation of getting any progressive benefit 351 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. for such a case by lumbar drainage is apt to be falla-cious. The details of the operation of nephrectomy will bedealt with in the article. In tlie present place it isonly pertinent to add that, in general, antesthesia with ni-trous gas and ether is to be preferred. Wliateverthe site and shape of incision selected, the kidney andanv desired portion of its ureter should be removed extra-pentcineally. Both the ilio-hypogastric and ilici-inguiual. Fig. 3070.—Anterior T-indsion; E.\traperitoaeal taken two years after the operation and fifteen yearsafter an operation for appendicitis. (Writers case.) nerves shoidd be spared severance. The costo-iliacoblique incision offers the simplest access to the kid-ney,—less stripping of parietal peritoneum being re-quired,—but the patients posture is here one wliich some-times involves an undesirable amoimt of pressure on kidney; and besides, if mneh of the ureter isfound diseased and its removal is practised, the necessaryextension downward of this incision severs the internaloblique and transversalis muscles more or less trans-versely. Mainly for these reasons the writer prefers tomaintain the patient in the dorsal position and to em-ploy an antero-lateial incision wliich conforms to thecostal margin, and by means of
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