A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology — John Shaqi
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
Death is not one of the usual results of this affection, but a recent
surgical writer (Keppler[4]) has called attention to cases where
long-continued dyspeptic symptoms, with constant pain and the chagrin
and melancholy due to inability to work, have been followed by death
from exhaustion, and nothing except a movable kidney has been found at
the autopsy.
[Footnote 4: _Arch. für Klin. Chirurg._, 1879.]
There can be no doubt that in many cases the symptoms are more severe
than might be supposed from the ordinary descriptions, and are very
unfairly characterized as hysterical. On the other hand, many cases are
attended with but the mildest form of the symptoms just described, and
the patients, ignorant of any tumor either from its discomfort or from
having felt it, live in health and comfort for many years.
DIAGNOSIS.--The diagnosis of this condition, if the physician keeps in
mind the possibility of its occurrence, is usually not difficult. In
many cases a tumor has been felt by the patient which when called to
the attention of the physician is recognized by its shape. In some
cases in thin persons the form of the kidney, even to its hilus with
the strongly-beating artery, can be made out. It glides easily from
between the fingers, and can be moved more or less remotely from its
normal position, to which, however, it returns without difficulty,
especially when the patient assumes the recumbent position. The
excursions are of course limited to a certain length of radius, of
which the origin of the renal vessels is the centre, and seldom go much
beyond the median line toward the side opposite to that on which the
movable organ belongs.
The usual statement of text-books, that a depression or lessened
resistance is to be felt in the loins of the side from which the kidney
is absent, and a diminution of the normal dulness, which returns again
when the organ is replaced, rests, as regards the majority of cases,
rather upon theoretical considerations than on actual observation. The
thickness of the lumbar muscles, upon which the kidney rests, is such
that the dulness on percussion is not capable of much change. In most
persons the outer limit of dulness in this region is not that of the
outer edge of the kidney, but of the extensor dorsi communis. Palpation
and percussion therefore in the renal region are not likely to be of
much value in diagnosis, although an occasional case appears to justify
the ordinary statement. The hand-and-knee position described above
would be more likely than any other to show an existing depression.
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