Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

317/440 (page 299)

29& tumours of the ovaries and uterus, and without symptoma of inflammation j the process consisting in friction of the- peritoneal surfaces, abrasion of tlie epithelium, and subsequent adhesion of the abraded surfaces, so that the presence of the adhesions does not always indicate previous inflammatory changes. It would perhaps seem strange, on the above hypothesis explaining the origin of the symptoms of incarceration, that these symptoms are not more frequently observed. This would certainly happen often, if there were not other causes to prevent the danger of frequently occurring complete or long persistent occlusion or narrowing of the renal vein. These causes receive additional support from the fortunate circum- stance, that the renal artery and vein are not equally long,, owing to the difference between the course of the aorta and vena cava inferior, so that spiral twisting of both vessels in their whole extent (like that for instance in the umbilical cord) is here rendered impossible. We must further remember that the part of the right renal artery between the aorta and the right border of the vena cava inferior, and the part oE the left renal vein between the vena cava and the left border of the aorta (see Fig. 2) are very firmly fixed by connective tissue to the main trunks, i.e. to the vertebral column, and are therefore protected against kinks in part of their course, though a comparatively small part. But it is just here that a series of small veins from the capsule of the kidney, and on the left side from the suprarenal body open, and these effect a collateral cir- culation easily and quickly, if the circulation in the renal veins becomes obstructed. This end is favoured by the double renal vein found especially on the right side, the frequency of which was pointed out even by Biolan and Sailer (119). It must also be remembered that if the renal vein is kinked or twisted, the renal artery, although provided with very thick walls and a large calibre, will be narrowed at the same time, so that the diminished supply of blood will slightly alleviate the excessive engorgement of the renal vein. Finally, however, quiet horizontal decubitus, and a return of the kidney to its normal position will very often i^elieve