The present status of the surgery of systematic goitre : illustrative cases / William Seaman Bainbridge, A.M., Sc.D., M.D.

  • Bainbridge, William Seaman, 1870-1947
Date:
[1914?]
Catalogue details

Licence: In copyright

Credit: The present status of the surgery of systematic goitre : illustrative cases / William Seaman Bainbridge, A.M., Sc.D., M.D. Source: Wellcome Collection.

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    Weinlechner, tetany has been known to follow upon the ligation of the two superior thyroid arteries. Fig. VII.—Case III. Immediately after operation. Wound sutured, ready for dressing. Bilateral ligation of the inferior thyroid ar¬ teries, with resection of the right sympathetic nerve, was performed by Patel and Leriche, in the case of a woman twenty-six years of age. The large goitre diminished in size, but soon increased again, and six weeks later the right half of the thyroid was extirpated. The patient rapidly succumbed to cachexia, within three weeks of the operation, and at autopsy a thymus gland the size of a walnut was found, although clinically the case was not one of thymus death. The mortality of vascular ligation, both single and double, in the worst types of the disease, in Mayo’s experience fully equalled or exceeded the mortality of thyroidectomy. According to Mayo, the method of ligation now has an accredited position in the treatment of systemic goitre. He states that patients seen in the early stages are sometimes wonderfully improved by the simple operation of double liga¬ tion. In mild cases, or when the patient is operated upon at an early date, ligation of the blood and lymph vessels is recommended by him in the treatment of hyperthyroidism. This in¬ tervention serves to prevent the production as well as the outpouring of the secretion, and a complete cure frequently follows. The same is adopted by a number of operators in the very grave cases, which are thereby essen¬ tially improved, so that the larger lobe with the isthmus can be removed later under more favor¬ able conditions. The general health is often greatly benefited by the ligation, and the pa¬ tients gain in weight. SELECTION OF OPERATIVE METHOD. The unilateral type of systemic goitre always affords favorable prospects for operative inter¬ ference. In a general way, after the patient has been prepared by improving the general con¬ dition, three-fifths of the goitre may be re¬ moved. Kocher, in a recent contribution, emphasizes that operative procedures are not only permis¬ sible, but positively indicated in all goitre cases where an increased function of the thyroid gland can be demonstrated by clinical observa¬ tion and examination of the blood. Two or three of the main arteries may be tied, first on one side, then on both sides. In case the result is not sufficient, a portion of the goitre may be extirpated in the third session. One-half of the gland or the more considerably enlarged lateral lobe, may be removed, practically always with the certainty that not too much has been ablated, and without risking the onset of symp- Fig. VITI.—Case III. A. left lobe of thyroid. B. growth from isthmus—mediastinal goitre. toms due to loss of thyroid function. Vascular ligation and partial thyroidectomy have been combined in such a way that uni-