. Surgery, its principles and practice . er pole alone seemed involved. An ex-amination after the operation showed the lower pole to contain threenodules potential of later trouble, if a resection had been done. Thelocalization in one pole may be explained by the observation publishedin 1899 by Zondeck, that the lower pole often receives a separate arterialsupply from the aorta. With the involvement of the capsule and perirenal tissues, perinephri- 230 SURGERY OF KIDNEY, URETER, AND SUPRARENAL GLAND. tis of caseating or suppurating form often follows. In cases of long stand-ing the perinephrit
. Surgery, its principles and practice . er pole alone seemed involved. An ex-amination after the operation showed the lower pole to contain threenodules potential of later trouble, if a resection had been done. Thelocalization in one pole may be explained by the observation publishedin 1899 by Zondeck, that the lower pole often receives a separate arterialsupply from the aorta. With the involvement of the capsule and perirenal tissues, perinephri- 230 SURGERY OF KIDNEY, URETER, AND SUPRARENAL GLAND. tis of caseating or suppurating form often follows. In cases of long stand-ing the perinephritis assumes the sclerosing form. Chronic sinuses withpurulent or uropurulent discharges often result from the invasion of theretrorenal connective-tissue planes. Israel descril^es a rarer form of tuberculous ulceration of the apices ofthe papillae, the pelvic mucosa and ureter remaining intact. In thesecases profuse hematuria is likely to occur before there is any markedenlargement of the gland. In every advanced renal tuberculosis the \. Fig, 124.—Tuberculosis of Kidney showing the Descending Process of the Infection (Lower). The pelvis and upper part of ureter contain many tuberculous ulcers which gradually become less, entirely disappearing in the lower portion of the ureter. ureter is involved. The process is most marked in the upper segmentin the primary form and appears as small tuberculous nodules and ulcera-tions (Fig. 124). The ureter may be greatly thickened and stenotic,thereby causing renal retention. The bladder wall about the ureteralorifice in most cases shows a tuberculous cystitis. Symptoms.—How long tuberculosis may remain latent in the kidneycannot be determined. Until a caseating focus breaks into the pelvisor until tension in the capsule gives rise to pain or tumor, there may be PLATE III.
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