Operative surgery . on the kidney in no uncertain manner. Normally tiielower limit of the pleura corresponds to a line extending between the lowerborders of the twelfth dorsal vertebra and the eleventh rib. The twelfth ribmay be absent, or so rudimentary as to escai)e notice, therefore the eleventhmay be mistaken for it, with obvious outcome in extended operative pro-cedure directed to the supposed twelfth rib. When this rib is rudimentarythe jileura descends as low as when of normal length. JfelsoHie has pointed out the fact that when the twelfth rib extendsbeyond the outer border of the erec
Operative surgery . on the kidney in no uncertain manner. Normally tiielower limit of the pleura corresponds to a line extending between the lowerborders of the twelfth dorsal vertebra and the eleventh rib. The twelfth ribmay be absent, or so rudimentary as to escai)e notice, therefore the eleventhmay be mistaken for it, with obvious outcome in extended operative pro-cedure directed to the supposed twelfth rib. When this rib is rudimentarythe jileura descends as low as when of normal length. JfelsoHie has pointed out the fact that when the twelfth rib extendsbeyond the outer border of the erector spinge muscle an incision reaching tothe angle of the crossing does not endanger the pleura except when the mus-cle is cut into or pulled aside, thus changing, perhaps needlessly, the normalrelations of the parts. However, in the absence of this rib, or its failure tocross the muscle, the trusty angle is not present, but instead a deceptive oneis formed higher up by the eleventh instead of the twelfth rib. IfCfl. Fig. 1033.—The surgical anatomy of the left kidney, transverse section, a. Externaloblique muscle, b. Internal oblique muscle, c. Transversalis muscle, d. Fasciati-ansversalis and peritonanun. e. Anterior, middle, and posterior of lumbar fascia. If this fallacy be not determined by previous counting of the ribs, fromabove downward, the pleural cavity is almost certain to be invaded. But lat-erally, on the left the pleura extends to within an inch and a half of thecostal margin; on the right to within two inches. Nephropexy.—Nephropexy (nephrorrhaphy) is an operation directed tothe fixation of a troublesome movable or floating kidney. The former con-dition is quite common and usually acquired; the latter is rare and congeni-tal. The right kidney is mobile much more frequently than the left; bothmay be similarly affected together, the left rarely alone. 826 OPERATIVE SURGERY. lite Operation.—Place tlie patient with the sound side resting on a hardpillow so as t
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