My recent ureteral work / by Howard A. Kelly.

  • Howard Atwood Kelly
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: My recent ureteral work / by Howard A. Kelly. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    from the pelvis of each kidney coming for- ward over and crossing obliquely the psoas muscle, and passing over the common iliac arteries immediately above the bifurcation, to enter the pelvis close to the inner side of the internal iliac artery. The ovarian veins [V] and arteries [A] are seen crossing in front of the ureters on the psoas. The entrance of the left vein into the left renal is especially well shown. Fig. 4.—The position at which the ureters are to be located on the pelvic brim. The sigmoid flexures, SS, with the lax meso sig- moid, is pulled over to the right, and the fol- lowing structures are evident, though faintly outlined, through the peritonEeum, at the pel- vic brim on the left. Ps. is the psoas muscle, Ar the external iliac artery, and Ur. the ureter, and Ov v the ovarian vessels crossing the brim into the pelvis, Ov is the left ovary, and U the uterus, R the rectum, and B. the bladder. Fig. 5.—The right ureter, U, is here ex- posed by an incision in the peritonieum at the brim of the pelvis. Here the sigmoid flexure is held well over to the left, while the caput coli is drawn to the right. P locates the promontory of the sacrum. Fig. 6.-The right ureter shown in Fig. 5, brought forward from the cellular tissue on a needle, showing its position and rela- tion more distinctly. Fig. 7.—A sketch from nature of the rela- tions of the ureters to the vessels at the pelvic brim. Fig. 8. -The right half of the pelvis. In this case drawn from nature the ovarian ves- sets were simply picked up above the brim of the pelvis as if for ligation. I he ureter was found grasped with the vessels, showing the danger of ligating the ureter in this position. O. v, ovarian vessels. Ur, ureter. P, sacral promontory. T, Fallopian tube. O, ovary. U, uterus. S, symphysis. Fig. 9.—The left ureter is exposed by draw- ing the sigmoid flexure lo the right, and in- cising the peritonaeum over the common iliac artery just above the bifurcation. Fig. 10.—The meso-sigmoid is here drawn to the left, showing the impossibility of expos- ing the left ureter, which is covered by it in this position, without cutting the sigmoid vessels. Fig. 11.—Diagram made directly from sub- ject, looking into pelvis from below, to show the relations of the left ureter to the iliac ves- sels, ovarian vessels and uterine artery. Fig. 12.—Same subject as Fig. 11, looking into pelvis from side showing same relations. Fig. 13.—Same subject as Figs. 11 and 12, looking into pelvis from above. Fig. 14.—The landmarks for locating the ureters at the brim of the pelvis through the skin. Straight line indicates the promontory of the sacrum. X X the position of the ureters. Fig. 15.—'The course of the ureters indi- cated on the skin of the abdomen. '1 he ab- domen has been opened and the line of the ureters projected on the skin by direct exam- ination and measurement. The abdomen is then held closed by the hand above, while the subject is photographed. The left kidney is lower than the right. Fig. 16.—Catheterization of the left ureter. Some thirty minims of urine has been col- lected in the minim glass, the time during which the urine is flowing is carefully noted. Fig. 17.—Both ureters catheterized simul- taneously. Fig. 18.—Ureteral catheters. pIG> ,g _Case containing ureteral instru- ments. Two catheters and two bougies for dilating strictures, as well as two glasses measuring minims and cubic centimeters.