In unmistakable cases operation is indicated, the trap-door exposure being the best, the inner end of the fifth and sixth ribs being elevated. Irrigation and drainage will be necessary. It is encouraging to know that 11 of the 40 cases above mentioned have recovered.
CARDIOLYSIS.
Cardiolysis refers to the operative release of the heart from adhesions which have formed between it and the pericardium or the chest wall. When with every contraction the heart itself is subjected to the strain of an adhesion the work proves excessive and it will finally succumb. It has been suggested by Delorme, Peterson, and Simon to either temporarily resect the chest wall, open the pericardium and break down or divide the adhesions, or else to resect those bony portions of the chest wall, i. e., the sternum, cartilages, or ribs, which are so inflexible as not to yield, not removing the bands but making them harmless.[25]
[25] Those interested in the modern surgery of the heart and lungs should consult Rickett’s recent work on this subject.
THE ARTERIES.
There are few parts of the body which adhere more closely to the normal standard than do the larger arteries. Even here malformations and congenital defects are met with. In calculating the chances of a given procedure the surgeon should consider the condition of the venous and lymphatic systems before deciding to operate on a portion of the arterial system. This is particularly true when ligating the femoral artery for elephantiasis of the leg.
Thrombosis and embolism have already been considered in the chapter on the Blood. Nevertheless it may be well to remind the student at this point that thrombus means a blood clot, while thrombosis refers to the process of its formation; that embolus means something which has passed into the blood current of an artery and plugged it, the obstruction usually being a fragment of clot or tissue, though it may be a droplet of fat or a bubble of air. Emboli, like thrombi, may be sterile, and in this respect innocent, or it may be composed of material loaded with septic, tuberculous, or cancerous germs.
Fig. 137
Fig. 138