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To Bouque belongs the credit having reintroduced among others the method cauterization either alone or together with immediate union the edges for rightly says that Les fistules vesico-vaginales dans leur grande variete repondent pas a une seule indication, a seul moyens therapeutiques connus mais que tous sont appeles a rendre, dans certain nombre cas, des services a l'exclusion des autres que tous par consequent meritent d'etre etudies Let now consider cauterization as a means for the cure urinary fistulas. Its object cause the formation a more or less deep eschar at the edges the wound, or in its neighborhood, and close the orifice the granulation and cicatrization which occur when the slough cast off. Various caustics maybe used the red-hot iron, thegalvano-cautery, nitrate silver, acid nitrate mercury Ehrmann, Cousot, creosote Emmert, sulphuric acid Soupart, Du Moulin, van Wetter, Deneffe, de Lorge and others, chromic acid Deneffe, the juice euphorbia Soupart, caustic potash Deneffe, van Wetter, chlorine water, Vienna paste and others. They may applied either from the vagina the genital mucous membrane in the neighborhood the fistula, or from thesis assistance writing the vesical surface, or finally the fistulous tract itself.
Cauterization the neighborhood the fistula from the vagina was first practised Ohelius.
He cauterized with nitrate silver in substance a broad tract the vaginal mucous membrane around the fistula, and about half an inch from its edges. The method was especially favored Soupart, Du Moulin, van Wetter and Deneffe in Belgium and Soupart modified converting the simple perifistular cauterization into a perifistular centripital cauterization, making each successive application nearer and nearer the fistula, yet without touching its edges. He used sulphuric acid as well as the actual cautery and the galvanocautery. A second cauterization undertaken as soon as the eschar caused the one cast off and the wound cicatrized. An older method was the so-called intermediary or intra-fistular one of Desault, how to write thesis which consisted cauterizing the inner surface the fistulous canal.
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The actual cautery, and lunar-caustic in holders from which it could projected, were especially used.
Dupuytren, Lallemand, Simon, Soupart, and others have cured cases in this way. Sometimes the vesical mucous membrane near the fistulous opening was help on college essay cauterized at the same time.
Dupuytren and Velpeau described instruments carrying a piece lunar caustic bent a right angle, which could projected and used cauterize the vesical mucous membrane for a certain distance This procedure has been improved upon Soupart, Deneffe and Bouque, that someone write my dissertation an intra-vesical cauterization may conducted as follows in a hollow sound shaped like a uterine sound, but thicker, a mandril, which a small sponge soaked in chromic acid or a piece lunar caustic may attached.
The fistula then fixed the left index finger in the vagina, and the bladder being empty the sound passed to the neighborhood the fistula through the urethra, the caustic holder projected, and with the help the finger in the vagina, swept over a vesical surface surrounding the fistula and some inch distant from The cauterizations per vaginam and per vesicam are not always concentric, and the uneven cicatrization leads a more rapid reduction the These three methods cauterization may used singly or combined, urethro-vaginal, vesico-vaginal, and vesico-uterine fistula? applicable not only small fistula?, but those also which measure inches in diameter Nelaton, Passamonti. It may urged as an objection the cauterization method that the cicatrices causes in the neighborhood the fistula diminish the chances a subsequent cutting operation but this has not been found the case.
It must conceded, however, that severe intra-fistular cauterization may occasionally cause enlargement the fistula. Cauterization has been recommended for a number fistula? in which a blood operation contra-indicated namely those situated high iti the anterior vaginal vault, and those in which the peritoneum liable be wounded, though peritonitis from the latter cause hardly feared now that use systematic antiseptic precautions.
It has also been recommended for vesicouterine fistula?, as prevent union the lips the and sterility, though buy top writing service a thesis online the process itself liable cause atresia. It was not thought for uretero-uterine and uretero vaginal fistulas, account the danger closing the ureter, with subsequent uraemia. As the most suitable time and method for cauterization, there considerable difference opinion. Some authorities, as Nelaton, Verneuil, Trelat, West, Sims, Schuppert, would wait six twelve months, give time for as great as possible amount cicatrization the original wound others, like Velthem, Baker Brown, and especially Nottingham, with Bozeman, Wright, Warner, etc. recommend cauterization as soon as possible. Nottingham relates that found only small fistula? in a woman months after confinement but that months later, probably in consequence coitus, they were times larger than before. The length of time required for cure this method in favor early cauterization according Bouque, when done less than month after the injury was.
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