A MIRROR OF HOSPITAL PRACTICE, CASES OF MYCETOMA. By G. D. McReddie, M.
D.r
Civil Surgeon, Pcrtabgarh. I.?Case of Mycetoma of the hand. Mussamat
Doolaree, aged 30, presented
herself at the the 1st January 1880. She stated that 3 years ago a swelling began on the dorsal aspect of the little finger of the left hand. It slowly increased up to May last, when, however, it took an active growth. When admitted an oval tumour, 2 inches in its longest diameter, was seen on the hand, involving the ring and little fingers, which were displaced forwards and inwards, and were widely separated from the other fingers by the intervening tumour: the palm and dorsum of the hand were also involved ; upwards the growth did not extend beyond the heads of the metacarpal bones of the ring and little fingers. The rest of the hand was not affected. A suppurating ulcer, the result of an escharotic 11 inches in diameter, was seen on the inner margin of the hand : no sinuses existed. As excision presented the only hope of cure, the patient was at once put under chloroform and an incision made into the tumour. It was found to be a mycetoma. The ring and little fingers and their metacarpal bones had become a white glairy-looking mass of tissue. All structures had participated in the degeneration, except part of the ring metacarpal bone. All diseased parts were excised and the surface of the wound touched with a strong solution of Chloride of zinc. Antiseptic dressings were applied ; Esmarch's bandage was used.
Pertabgarh Dispensary
on
A microscopic examination showed the degenerated tissue to be composed of minute cells, agglomerated in masses and free, and without nuclei. No striation existed : nothing like fungoid growth could be seen. Spicuhe of the metacarpal bones in the diseased mass exhibited only small remains of original bony structure ; the bone cells were in course of absorption, having bright vacuoles in the interstices. The wound granulated rapidly, and the patient was discharged on the 8th February 1880. II.?Case of Mycetoma of the foot. Rughbur, aged 30, Thakur, on admission into the Pertabgarh Dispensary on the 5th February stated that 8 months previously a slight swelling appeared on the inner side of the left heel : it had gradually increased, attended with pain on exertion. On admission he presented a hard mass, size of an orange, projecting from the outer side of the heel : the whole ankle was swollen, the heel all round was riddled with sinuses, he could not rest his foot on the ground or walk without pain. The disease was diagnosed to be mycetoma, complicated with sarcoma. Excision of the diseased structures was the only measure feasible. Every bone of the tarsus, except a part of the astragalus, had undergone degeneration ; and the skin of the foot was extensively diseased. The whole foot was therefore removed with the ends of the tibia and fibula?the latter procedure was necessary, as sound skin to cover the stump was not otherwise available. Every portion of the diseased mass was removed and a good stump obtained. Esmarch's bandage was usedr hence the operation was bloodless. Antiseptic dressings were applied. The sarcoma was found not to be a distinct growth from the mycetoma, the latter merged into sarcomatous structure.
appearances of the mycetoma were the described in Case No. 1. No fungoid growth could be seen. The sarcoma showed fine fibres with non-nucleated cells in the inter-fibrillar spaces. The patient made a good recovery, and was discharged on the 20th March 1880. He returned to the Dispensary on the 19th April with a small recurrent fibro-sarcomatous tumour in the stump. This tumour was excised and the wound touched with nitric acid. The microscopic appearances of the recurrent growth were fine fibril he interlaced and wavy with non-nucleated cells and granular in meshes. The
same
microscopic
as
Pertabgarh,
12111
May
1880.
D.r
Civil Surgeon, Pcrtabgarh. I.?Case of Mycetoma of the hand. Mussamat
Doolaree, aged 30, presented
herself at the the 1st January 1880. She stated that 3 years ago a swelling began on the dorsal aspect of the little finger of the left hand. It slowly increased up to May last, when, however, it took an active growth. When admitted an oval tumour, 2 inches in its longest diameter, was seen on the hand, involving the ring and little fingers, which were displaced forwards and inwards, and were widely separated from the other fingers by the intervening tumour: the palm and dorsum of the hand were also involved ; upwards the growth did not extend beyond the heads of the metacarpal bones of the ring and little fingers. The rest of the hand was not affected. A suppurating ulcer, the result of an escharotic 11 inches in diameter, was seen on the inner margin of the hand : no sinuses existed. As excision presented the only hope of cure, the patient was at once put under chloroform and an incision made into the tumour. It was found to be a mycetoma. The ring and little fingers and their metacarpal bones had become a white glairy-looking mass of tissue. All structures had participated in the degeneration, except part of the ring metacarpal bone. All diseased parts were excised and the surface of the wound touched with a strong solution of Chloride of zinc. Antiseptic dressings were applied ; Esmarch's bandage was used.
Pertabgarh Dispensary
on
A microscopic examination showed the degenerated tissue to be composed of minute cells, agglomerated in masses and free, and without nuclei. No striation existed : nothing like fungoid growth could be seen. Spicuhe of the metacarpal bones in the diseased mass exhibited only small remains of original bony structure ; the bone cells were in course of absorption, having bright vacuoles in the interstices. The wound granulated rapidly, and the patient was discharged on the 8th February 1880. II.?Case of Mycetoma of the foot. Rughbur, aged 30, Thakur, on admission into the Pertabgarh Dispensary on the 5th February stated that 8 months previously a slight swelling appeared on the inner side of the left heel : it had gradually increased, attended with pain on exertion. On admission he presented a hard mass, size of an orange, projecting from the outer side of the heel : the whole ankle was swollen, the heel all round was riddled with sinuses, he could not rest his foot on the ground or walk without pain. The disease was diagnosed to be mycetoma, complicated with sarcoma. Excision of the diseased structures was the only measure feasible. Every bone of the tarsus, except a part of the astragalus, had undergone degeneration ; and the skin of the foot was extensively diseased. The whole foot was therefore removed with the ends of the tibia and fibula?the latter procedure was necessary, as sound skin to cover the stump was not otherwise available. Every portion of the diseased mass was removed and a good stump obtained. Esmarch's bandage was usedr hence the operation was bloodless. Antiseptic dressings were applied. The sarcoma was found not to be a distinct growth from the mycetoma, the latter merged into sarcomatous structure.
appearances of the mycetoma were the described in Case No. 1. No fungoid growth could be seen. The sarcoma showed fine fibres with non-nucleated cells in the inter-fibrillar spaces. The patient made a good recovery, and was discharged on the 20th March 1880. He returned to the Dispensary on the 19th April with a small recurrent fibro-sarcomatous tumour in the stump. This tumour was excised and the wound touched with nitric acid. The microscopic appearances of the recurrent growth were fine fibril he interlaced and wavy with non-nucleated cells and granular in meshes. The
same
microscopic
as
Pertabgarh,
12111
May
1880.
