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AMERICAN JOURNAL OF DIGESTIVE DISEASES AND NUTRITION
His home was in Mississippi until July, 1929, when he moved North. He had the usual childhood diseases, nothing else, and no operations. He never had malaria nor any dysentery. The r e f e r r i n g physician states that he has used anti-amebic t r e a tm e n t (emetine) and also some of the arsenic preparations. Rectal irrigations were used over a long period. Examination: Abdomen negative. Inspection and palpation of the perianal region and anus were negative. Proctoscopy showed an edematous and redundant mucosa, containing many tiny ulcerations. The rectum contained some bloody mucus. Sigmoidoscopy at six inches showed a normal mucosa. On April 20, 1935, warm stage examination showed nothing but red cells. Treatment: He was started on Alpha Naphco liquid 15 gtts every hour in hot water, ten doses daily, and Alpha Naphco capsules two before each meal. May 1st. There has been no improvement. May 4th. Patient states that he is feeling a little better. Mucosa looks a little better. May 13th. Not so good. There was free blood in the rectum. May 15th. Mucosa a little better. May 22nd. A little better. May 27th. No improvement. To discontinue pasteurized milk.
May 31st. Increase Alpha Naphco capsules to three, four times a day. June 20th. Has not passed any blood for two weeks. June 27th. Some blood flakes in the rectum. J u l y 2nd. More blood in the rectum, but he is feeling fine. He is leaving the city for three weeks on a vacation. I gave him enough Alpha Naphco liquid and capsules to last during this period. J u l y 23rd. Returned from his vacation feeling fine. July 30th. Mucosa is boggy but he passes no blood. August 6th. Mucosa looks fine. August 13th. Proctoscopy shows everything to be normal. Dismissed. Th e e x p e r i e n c e s of o t h e r s would i n d i c a t e t h a t respiratory infections are the greatest contributing cause of r e c u r r e n c e s in ch r o n i c u l c e r a t i v e colitis. W i t h t h i s in m i n d p a t i e n t s should be v e r y c a r e f u l not to c o n t r a c t colds. T h e i r r e s i s t a n c e should be kept up to p a r by e a t i n g a b u n d a n t l y of wholesome foods, and t a k i n g cod l i v e r oil, d u r i n g the w i n t e r m o n t h s especially. While diet does not a p p a r e n t l y play a v e r y g r e a t role in t h e t r e a t m e n t of t h e disease, still I t h i n k it is w i s e to r e f r a i n f r o m a s k i n g a sick colon to handle t h e r esi d u e f r o m the l eaf y g r e e n vegetables.
I
ABSTRACTS CLINICAL MEDICINE F. R. BERNHARDT.
What is the Significance of the Invading of Stomach Contents into the Bile Ducts Following Anastomosis Especially Cholecocho-duodenostomies? Archly. f. Kiln. Chirur., Vol. 180, Sept. 21, 1934. An exhaustive report is given of 22 cases where anastomosis was performed between the bile ducts and the adjacent organs with careful follow-up histories, roentgen examination included. This surgical procedure being recently undertaken more frequently, evolves the so-important question of ascending infection from the stomach or bowels. The answer is not uniformly affirmative. The Author collected, however, a certain number of cases where such infection has not occurred. It must be cited, however, that passing of duodenal content into the bile ducts is not always harmless and often is followed by damaging effects upon the mucosa of the bile ducts. The prevalence of acids are often playing a decisive role in that for instance in cases of decreased HC1 secretion the administration of HC1 and pepsin may counteract ascending infections with comparative certainty. Entrance of the barium meal into the bile. ducts was visualized in one case where the hepaticus was anastomosed to the stomach. In three cases of
cholecystogastrostomies it penetrated cnce, in six cases of cholecystoduodenostomies it invaded twice and in 15 cases of choledocho-duodenostomies it gained access eight times into the bile ducts. In the latter cases concommitent attacks of cholangitic processes were observed. Possibly a dilatation of the smallest ducts was responsible for such complications. It is noteworthy that where barium did not invade the bile ducts cholangitis also was absent. Untoward results are often due to faulty technic such as too narrow anastomosis. In these cases a stenosis may be responsible for the complaints which are similar to those of common duct stones. Sometimes the retroduodenal portion of the common duct shows stasis and thus may give rise to secondary ascending infections. To overcome this, it is advisable to perform the anastomosis at the lowest point of the choledochus, an advantage resulting in diminished traction upon the duodenum. Such operations ought to be considered as major surgical measures. Although often life saving they are not always harmless. Consequently indications must be taken very judiciously. Complete stenosis of the common duct with a functionless gall bladder is one of such indications. Other processes obstructing the flow of bile within the papilla also belong here. Another large group consists of lesions involving the
pancreas, i.e. induration of the head, tumors, widespread adhesions obstructing thus a satisfactory flow of bile, etc. In such instances the choledochoduodenostomies are especially the operation of choice. Incidents are mentioned where the post-operative course remained satisfactory 18 years after such operation. In most of cases complete obliteration of the common duct was found. The gall bladder had been removed previously because of stones. Anastomosis was performed between the duodenum and the common duct resulting in stormy post-operative courses, manifested by severe cholangitis. In these cases the barium swiftly invaded the smaller bile ducts and almost invariably a shadow was seen in the retro-duodenal portion of the comraon duct. Choledocho-duodenostomies should be performed in the appropriate cases with a most meticulous technic. Because of the possible complications, however, the indications for such procedures must be cautiously weighed. M. E. Gabor, Milwaukee. II. KALK.
Hereditary Factors in Lesions of the Gastro-intestinal Canal. Deut. Med. Woch., No. 39, Sept. 20, 1934. A short and interesting survey is given about inheriting anomalies, constitutional types and finally diseases of
ABSTRACTS the gastro-intestinal tract. To ulcer disease is devoted a great deal of attention. "Ulcer Families" are described where the occurrence of ulcers could be traced to the second or third generation with almost identical complications such as hemorrhage and perforation. The contention that such stomachs are all afflicted with a lowered resistance, a socalled "Minderwertigkeit" is still a muted question. Malignancies of the stomach may also be inherited revealing sometimes identical predilection of invaded areas. Gastritis also may be found as revealing hereditary tendencies, manifested by achylias and pernicious anemias. The haemolytic jaundice described by the French as Familial Cholemias and by the Germans as Constitutional Hyper-bilirubinemia is well known. With regard to Cholecystopathias one can say that the stronger the hereditary tendency the sooner we may expect stone formation, inflammations or other derangements of the bile ducts. M. E. Gabor, Milwaukee.
BODMAN, FRANK, M.D. The Psychologic Background of Colitis. Amer. Jour. Med. Se., pp. 535, Oct., 1935. The writer states that the bacterial cause of ulcerative colitis has not been convincingly proven and it has been overlooked that it constitutes a terminal stage in a colon which has been the seat of disorganizing dysfunction. Ulcerative colitis is incurable as gross organic changes have taken place in the mucosa of the bowel, in the myocardium and in the elastic tissue of the arteries. Prevention of these terminal stages can be attained if the functional disorder is recognized in good time and as partly an expression of an emotional state. The Author predicates that colonic dysfunction begins during breastfed infancy. The baby upon defecation experiences discomfort, cries for his mother or nurse; a call for help or attention and another conditioned reflex in infancy may be established by the emptying of the bowel when the child is f r i g h t e n e d - - b y being handled by strangers or examined by physicians in a children's ward. The next psychologic factor in the development of bowel function is that invoked in the training of the infant to a regular reflex. This is the first demand made by society--through the mother or nurse on the infant. If the response to the reflex is prompt and satisfactory it receives encouragement - - t h a t if it fails to respond displeasure may be exhibited by its guardian. It has discovered a new channel for exercising power. Twelve cases are described which illustrate the various stages and degrees of functional and organic disorders of the colon. The family and personal histories of these cases are
meticulously dealt with and the psychogenic factors emphasized both in the development and management of the disorder. Allen Jones, Buffalo.
ROSEDALE, R. S. Jejunal Diverticulosis. S. G. and 0., Vol. 61, No. 2, pp. 223-228, Aug., 1935. Multiple jejunal diverticulosis is a rare condition; the Author has been able to find 71 recorded cases to date. J e ju nal diverticula are classified as congenital, or acquired. The congenital diverticula are made up of all the layers of the intestinal wall, while the acquired ones contain only a fraction of the layers of the intestinal wall. The etiology of these diverticula is obscure. Increased intra-intestinal tension, embryologic incoordination, and weakness of the intestinal wall at the point of entry of the vessels are probably important factors in their formation. Butler has concluded from some experimental work that sclreosis of the terminal branches of the superior mesenteric artery and the resultant formation of "traction pockets" is also an important etiological factor in the formation of these diverticula. Complications of jejunal diverticulosis do not occur frequently. They may contain enteroliths and cause partial intestinal obstruction, or they may become inflamed and cause vague abdominal pain. The Author reports three cases in detail. Seven figures and a bibliography accompany the article. Nelson M. Percy, Chicago. BLOOMFIELD, ARTHUR L., M.D.
The Mechanism of Decrease of Gastric Secretion With Advancing Years. Amer. Jour. Med. Sc., p. 325, Sept., 1935. Bloomfield and Keefer, in 1928, were the first to demonstrate the steady drop in acidity which takes place with advancing years. Polland and Bloomfield confirmed this finding through histamin tests on essentially normal people. Vanzant and her colleagues showed that men have a more highly acid gastric juice than women. This work established: 1. There is a marked fall in the average gastric acidity of men with advancing years and the curve is a straight line. 2. The average gastric acidity of young women is distinctly lower than that of young men, but the fall with advancing years is very Might. 3. The average volume of secretion both men and of women falls markedly with advancing years and the curve is a straight line. It was found that there was not a gradual fall in all people because even in the older age periods a number of
73 individuals are found who preserve a maximal secretion. The rapidly increasing incidence of anacidity with advancing years also seems out of accord with gradual drop in secretion of the whole population. The writer says it was very difficult to accomplish followup studies over a period of 5 or more years, therefore, they had only 6 cases so examined. Many observations showed the amount of variation by tests at brief intervals to be slight. Rather slight differences in secretion volume and acidity were revealed in these cases though there was a lessening tendency. One must look elsewhere then, for the explanation of the general fact that gastric secretion decreases with advancing years. The answer lies in certain cases in which there is a very rapid deterioration of secretion. The Author cites 2 case abstracts of instances of this sort. One was the case of a 33 year old teamster with a penetrating type of lesser curvature gastric ulcer in 1927. His acidity was n o r m a l - - h e was re-examined in 1934 and no free HC1 was found nor was the ulcer demonstrated by Roentgen ray. He had taken alcohol freely and returned with anorexia and had vomited for a year. The second case was one of a penetrating ulcer with pyloric obstruction first seen in 1929. The patient was 57 years old. Histamine test showed free HC1 88--, total 98, height volume period 41 c.c. The ulcer was excised and gastroenterostomy was done. It showed a benign gastric ulcer. Histamine test, September 9, 1933, showed free HC1 0 and total 12; volume 17 c.c. Discussion: The observations show there is no uniform steady decline of gastric secretion in all people with advancing years. The level of secretion remains essentially unchanged; t h e r e . may be a slight increase or a rapid failure may occur and lead to anacidity. Allen Jones, Buffalo.
NUTRITION BAUMGARTNER, L.
Pituitary Basophilism and Hypertension. Yale Jour of Biology and Medicine, Vol. 7, p. 327, 1935. Since Cushing's description of the clinical phenomena associated with basophilic adenoma of the pituitary, another approach to the study of the relation of the pituitary to clinical hypertensive disease has offered itself. Baumgartner selected 13 cases of hypertension in young individuals in whom arteriosclerotic and nephritic complications were minimal, and no other complicating disease was present. Detailed clinical study including blood chemistry, X-rays of sella and skeleton, visual field determinations and basal metabolism, was made, and the results compared with the data for the 23 cases of pituitary basophilism now in the litera-
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AMERICAN JOURNAL OF DIGESTIVE DISEASES AND NUTRITION
ture. The f e a t u r e s c h a r a c t e r i s t i c of p i t u i t a r y basophilism occurred in relat i v e l y few of the hypertensives, but the method of selection would eliminate those with advanced signs of basophilism. (a) Obesity occurred in the m a j o r i t y and the typical distribution of f a t to t r u n k and face with m a r k e d s p a r i n g of the extremities was recognized in 4 of the 13. In 5 cases the sudden increase in weight comparable with Cushing's description had occurred. (b) Skin and hirsutism. In none of the hypertensives did the c h a r a c t e r i s t i c purplish striae occur. Polytrichosis was noted in 3 of the 8 women. (c) Sexual dystrophies did not occur, except for m e n s t r u a l i r r e g u l a r i t i e s in 2 women. (d) Osteoporosis was lacking although it was a decided f e a t u r e in some cases of basophilic adenoma. (e) E r y t h r o c y t o s i s with counts exceeding 5,000,000 occurred in 8 of the 13 cases. (f) Pathologic e x a m i n a t i o n in 2 hypertensives revealed a small basophilic adenoma of the a n t e r i o r lobe, associated with infiltrations of the post e r i o r lobe with basophilic cells in one case and a normal gland in the other. H o w a r d F. Root, Brookline, Mass.
SPIES, TOM D. The Medical Treatment of Early Pellagra. J. A. M. A., 105:1028, Sept. 28, 1935. The two main theories of the cause of p e l l a g r a a r e : F i r s t , t h a t p e l l a g r a is caused by a bacterium. The second t h e o r y , i s t h a t it is caused by the lack of a specific chemical substance p r e s e n t in food. N e i t h e r of these theories has e x p e r i m e n t a l proof. The m o r t a l i t y rate in p e l l a g r a is high. The t r e a t m e n t of the moderately severe case of p e l l a g r a should be generally known. The diet should be well balanced and contain 4000 calories. The p a t i e n t should have a d e q u a t e rest. In addition good b r e w e r ' s yeast, w h e a t g e r m or liver e x t r a c t should be given in large doses. A n y of these agents are
best given in doses of f r o m 10 to 20 g r a m s in a glass of iced milk or iced e g g n o g e v e r y three or f o u r hours f o r a total of 75 to 100 g r a m s daily. P a r e n t e r a l injections of l i v e r e x t r a c t are v e r y effective coupled with b r e w e r ' s y e a s t or wheat g e r m given by mouth. The patient should be watched and guarded against relapses. F r a n c i s D. Murphy, Milwaukee. DRAKE, E. H., HAWKES, R. WARREN, MORTIMER.
S., AND
A n Epidemic of Trichinosis in Maine. J. A. M. A., 105:1340, Oct. 26, 1935. The A u t h o r s discuss the first recorded epidemic of trichinosis in Maine and possibly the l a r g e s t epidemic to be reported in the U n i t e d States. Infection resulted f r o m the e a t i n g of improperly cooked homemade pork sausages. The infected m e a t and the s t r i a t e d muscles of two f a t a l cases showed the trichinellae. Of seventy-one individuals known to have eaten the sausage, fiftysix revealed signs of infection. Twentysix persons ill with probable trichinosis were given skin tests, t w e n t y - f o u r of these were positive. The technique of the i n t r a d e r m a l test for trichinosis is discussed. F r a n c i s D. Murphy, Milwaukee. RALLI, ELAINE P., AND WATERHOUSE, ALICE.
Studies on the Effect of the Administration of C a r o t e n e and Vitamin A in Patients with Diabetes Mellitus. II. The Effect of a Cod Liver Oil Concentrate on the Blood Carote~e and Cholesterol. The Diabetic Clinics of the Third (New York University) Medical Division, Bellevue Hospital, and the Department of Medicine, Universify and Bellevue Hospital Medical College, New York University. Jour. of The Amer. Diet. Assoc., pp. 110-114. A previous study showed t h a t when a group of diabetic and non-diabetic patients were fed carotene t h a t there
WANGENSTEEN
was a g r e a t e r increase in the blood carotene in the diabetic p a t i e n t t h a n in t h a t of the non-diabetic. Because of this fact a study was made on the effect of a cod l i v e r oil concentrate on the blood carotene and cholesterol in twenty-seven diabetic patients. The ages of these patients v a r i e d f r o m 22 to 68 y e a r s ; 14 of which were over 45 years of age. Six of these f o u r t e e n had a severe case of diabetes and eight mild diabetes. Of the cases u n d e r 45 years of age, ten were severe diabetic and t h r e e mild. A f t e r a controlled period d u r i n g which time observations were made on blood carotene and cholesterol, the patients were given cod liver oil in the f o r m of a concentrate. F a s t ing samples of blood w e r e t a k e n at intervals and blood carotene and cholesterol were determined f r o m these samples. The results of this e x p e r i m e n t shows that : The blood carotene increased in seven cases, fell in seven, and showed no change in t h i r t e e n cases. An increase in blood cholesterol was a s s o c i a t e d with an increase in blood carotene in twelve patients. In f o u r t e e n cases the blood cholesterol changes were in the same direction as the blood carotene changes. There seems to be no constant relationship between d u r a t i o n or severity of diabetes and the h e i g h t of the blood carotene. The reaction of the p a t i e n t to the concentrate was p r a c t i c a l l y the same in the v a r i o u s groups. T h e r e were no complaints a t t r i b u t e d to the high blood carotene. These results indicate t h a t the effect of the concentrate on the blood carotene is much less t h a n the effect of carotene in oil. It is the opinion of the writers, t h a t since there is a definite increase in blood carotene in diabetic patients following the a d m i n i s t r a t i o n of carotene per se, it m i g h t be wiser to use Vitamin A as such in these patients until the clinical significance of an increase in blood carotene has been established. Clifford J. Barborka, Chicago.
DUODENAL
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ABSTRACTS
ROENTGENOLOGY K I R K L I N , B . R . , AND B L A K E , T H O M A S W .
Cholecystie Disease. A Comparison of the Clinical With the Cholecystographis Data Concerning 500 Patients Not Operated On. J. A. M. A., 105:1416, Nov. 2, 1935. Cholecystography checked by subsequent surgery and pathologic examination has been proven to be a reliable test. There has been some doubt expressed regarding the reliability of cholecystography in non-operated cases. A series of five hundred such patients examined clinically and cholecystographically but not operated on is here reviewed. The results of this study showed agreement between the clinical impression and cholecystographic findings in 90.8 per cent of these cases. The results of this study would tend to prove that even in non-operated cases cholecystography is both useful and reliable. Cholecystography should be employed as an aid to the clinical examination. The two examinations can be employed profitably together. Francis D. Murphy, Milwaukee.
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successful procedure. The patients who are not cured by cholecystectomy present a very difficult problem. Errors in diagnosis, poor selection of cases, residues of cholecystic disease, cholangeitis, hepatitis, and pancreatitis, stricture formation in the extrahepatic bile passages and post operative colic constitute the basis for poor results. Careful diagnosis of the presence of gall bladder disease is important. Careful history, physical examination and cholecystography is stressed in making an exact diagnosis. Residual cholan-
geitis, pancreatitis and hepatitis, in some cases at least, account for poor results after cholecystectomy. Stricture of the common bile duct after cholecystectomy is a rare cause of complaint. Colic after choleeystectomy may be explained by stone in the common duct, stricture formation, residual pancreatitis, eholangeitis or hepatitis and in a few cases a spasm of the sphincter of Oddi with transient "physiologic" obstruction. Francis D. Murphy, Milwaukee.
Dr. Raymond Leaves Rockefeller Institute To Head Searle Research
THERAPEUTICS CLERF, L. ~. Foreign Bodies in the Stomach Removed by Peroral Endoscopy. S. G. and 0., Vol. 61, No. 2, pp. 210213, Aug., 1935. The Author reports a series of 849 cases of radio-opaque foreign bodies in the stomach and intestinal tract admitted to the Bronchoscopic Clinic of the Jefferson Hospital during a 10 year period ending in January, 1934. Of those, 818 passed spontaneously, 12 were removed by laparotomy, one by peranal endoscopy, and 18 were removed from the stomach by peroral gastroscopy. Among the objects which passed spontaneously were open safety pins, common pins, and a variety of sharp, pointed, and irregular foreign bodies. The Author, aided by a roentgenologist familiar with the technical phase of double plane roentgenoscopy, removed twelve foreign bodies by peroral gastroscopy. He recommends that method when removal is decided upon. In questionable cases the opinion of a competent roentgenologist should be secured to determine if the object can leave the stomach, and also if it will be able to traverse the angulations of the intestinal canal, particularly the duodenojejunal junction.. Nelson M. Percy, Chicago. W E I R , J A M E S F . , AND S N E L L , ALBERT M .
Symptoms That Persist A f t e r Cholecystectomy, Their Nature and Probable Significance. J. A. M. A., 105:1093, Oct. 5, 1935. Cholecystectomy well performed on proper indications is an extraordinarily
DR.
ALBERT
U
RAYMOND
ANNOUNCEMENT Announcement has just been made by G. D. Searle & Co., Chicago, of the appointment of Dr. Albert L. Raymond as Director of their Research Laboratories. To take this Sear]e appointment, Dr. Raymond resigns from the Rockefeller Institute of Medical Research, with which he has been connected for the past nine years, the last seven of which he was an associate of Dr. Levene. F o r two years he was National Research fellow, working on problems connected with the biological mechanism of carbohydrate degradation. Dr. Raymond is a Californian and gained his Ph.D. at the California Institute of Technology, Pasadena, in 1925. Afterwards he spent three years part-time teaching at California Institute of Technology and at the University of California. He is a member of the American Chemical Society and the American Society of Biological Chemists. Says Dr. R a y m o n d : " I know of no field offering g r e a t e r facilities for the p r a c t i c a l application of biochemical research t h a n the laboratory of a p h a r m a c e u t i c a l house. H e r e we come in firut hand contact with the problems of t h a t w o r k i n g scientist, the p r a c t i c i n g physician, a n d this is a g r e a t incentive to provide him with better chemical instruments with which to fight disease." (Adv.)
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AMERICAN JOURNAL OF DIGESTIVE DISEASES AND NUTRITION
HOLMES, WM. H.
that it is composed of liquefied liver the difficulties of either type of surgical tissue and red blood cells in various drainage. Two patients treated by the stages of disintegration, and that it Author as well as some reported by does not contain cells of leucocytic others were cured by medical treatment origin in uncomplicated cases. The in- alone. He believes that surgical treatadequacy of drainage is due in part to ment should be reserved for cases comthe fact that the amoebae are present plicated by secondary bacterial infecin greatest numbers in the wall of the tions and for other complications, such cavity and continue enlarging the size as rupture of the abscess into the of the abscess. Aspiration if not un- pleural or peritoneal cavities. J. Duffy Hancock, Louisville. successful may frequently cause dissemination, and open operation has a rather high mortality rate. Further, ABDOMINAL SURGERY contrary to the usual view these abscesses are often multiple increasing J. SENEQUE AND MILHIET. Su~'gical Treatment of Redundant Colon, in Particular the Precedure in one Stage, with Exteriorized End-to-end Closure. (Traitement Chirurgical du Dolichocolon, en Particulier Dans le Procedure en un Temps, Avec Suture TerminoTerminale Exteriorisee). Jour. de Chir., No. 2, pp. 188-201, Aug., 1935. In this article the Authors give a general review of the subject of redundant colon, the different operative proN all forms of dyspepsia other than those arising from cedures already made use of, and degastric ulcer or cancer, Vichy Celestins is of distinct scribe their own technique which they have employed since 1931 in the treatservice. Being easily assimilated, the water promotes ment of five patients with five cures. Constipation, painful crises, a~rogastric secretion and tends to normalize the function of colon, and volvulus, are the indication the gastric glandular apparatus. In gastric neuroses and for operation. However, operative precedure need scarcely be employed in the milder forms of organic disease of the stomach, the the treatment of constipation as an stomach is soon physiologically improved, digestion acisolated symptom. The attacks of abdominal pain and a~rocolon have the celerated, fermentation neutralized, and pain and nausea same causes which are especially of alleviated. mechanical origin, thus by this fact rendering useful surgical intervention. These causes are (1) chronic volvulus and (2) kinking of the intestine; when the patient presents only attacks of Vichy Celestins is the property of pain without meteorism medical therathe French Republic, under whose peutics suffices, in general, to either supervision the water is bottled. The medical profession and all conalleviate or to cure the condition for sumers are protected by a guaranthe lesions of a colitis suffice to explain tee of the French Government as to the symptoms; but when the painful the water's authenticity and purity. crises are accompanied by colicky distension, the treatment is more delicate. If the symptoms persist for a long time it may be an indication for resection of the long (redundant) loop in order to remedy the possible twisting I or kinking of the loop. In the cases of intestinal obstruction the resection will be practised either '.~r ~r~, during or after the attack, acording to ~ the case. ~:j?~j For acute volvulus it is possible, by means of the present technique of the Authors, to resect the twisted loop if it is not sphacelated. When the operative procedure is limited to an untwisting of the loop it will be indicated, NATER after the attack, to resect it in order to prevent a recurrence. The Authors mention the operative procedures already utilized: resection Write for booklet on Therapeutic Value of Vichy with Medical Bibliography of the rectal valves; dilatation of the anus; section of the first and second lumbar ramicommunicantes; ablation of
Medical Treatment of Amoebic Infevtions of the Liver. S. G. and 0., 61:521-522, Oct., 1935. The hepatic complications of intestinal amoebiasis include acute hepatitis and abscess. The treatment of the former is entirely medical and of the latter, abscess, is almost always surgical. The Author offers good reasons why this should also, in most instances, be treated medically. An amoebic abscess is quite different from a pyogenic abscess in that it results from the lytic action of ferments liberatdd by amoebae,
• of distinct service
in digestive
diseases
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ABSTRACTS
77
the r i g h t and left lumbar sympathetic g a n g l i a ; colopexy; the methods m a k i n g use of ileo-sigmoidectomy and ileorectostomy, with or without exclusion of the r e d u n d a n t loop of colon; sigmoido-sigmoidostomy; all methods inf e r i o r to segmental colectomy, the method of choice p r e s e n t i n g the minim u m of risks. P r e p a r a t i o n for operation lasts 7 days. F i r s t day: p u r g a t i o n with castor oil, and each day following, a gentle laxative. The food taken d u r i n g this period will be easy to digest and of a type which leaves but little residue. Plenty of liquid in order t h a t the patient does not become dehydrated. T e c h n i q u e : The Authors describe the nmst f r e q u e n t type of case, resection of the r e d u n d a n t loop of sigmoide. 1st. Left-side M a c B u r n e y Incision. 2nd. E x p l o r a t i o n : to remove comB I L E S A L T S stimulate the l i v e r cells to f o r m pletely f r o m the abdominal cavity the more bile salts a n d o t h e r secretions, and these of e x e b u r a n t pelvic loop. course will keep the cholesterol which is formed in more a b u n d a n c e d u r i n g periods of t e m p e r a 3rd. P l a c i n g of a supple clamp on the ture and in s t a r v a t i o n more in solution. mobile side of the loop, and a Kocher forceps on the other side, the two in~( O t h e r Plessner Products )4 s t r u m e n t s 4 cms. apart. Careful preTAUROCOL COMP. TABLETS "" (with digestive ferments) °" ventive hemostasis. VERA PERLES of Sandalwood Section of the intestine by scalpel Compound. close to (or n e a r l y level with) the Kocher forceps. Clinical Record Forms for the asking. Samples and information on request. 4th. End-to-end anastomosis, " m a r g i n - t o - m a r g i n " or "border-to-border" of T h e P a u l P l e s s n e r Co. Robineau, the sutures being carried Detroit - J.D. S-36 Mivhigan f r o m left to right, and using c a t g u t 00 or linen thread, and a needle at each end. The Authors describe in details the posterior and a n t e r i o r musculo-serous and muco-mucous whipstitches. The Tilden Company has just 5th. Careful closure of the mesocolic issued a Warning in the Drug breach. 6th. E x t e r i o r i z a t i o n of the anastoTrade News which circulates to manufacturers, wholesalers and mosis. Two c a t g u t stitches are passed retailers that any infringement to unite the p a r i e t a l p e r i t o n e u m of the angles of the wound with the intestine of their Trade Mark DANISH at a distance of about 4 cms. f r o m the OINTMENT will be prosecuted. anastomosis at either end, to the level The Tilden Company has used of the colic longitudinal band, if posthe name since 1924 and put up sible. Two large gauze packs are slipthe formula, approved by authori- ped between the two lips of the incision ties. It is intended that physi- and the intestine. I f possible, re-encians shall get true DANISH force the anastomosis by a p p l y i n g to it OINTMENT when they write pre- a layer of omentum. 7th. Dressing applied on the intesscriptions for it since this is a most thoroughly effective and tine, vaseline compresses or oily tulle, harmless ointment in the treat- in order t h a t the intestine and the ment of Scabies, Itch and Ache sutures do not adhere to it. P o s t o p e r a t i v e cure. Liquid diet for Rosacea based on the original 6 days; subcutaneous saline. Keep formula. patient constipated for 8 days. P u r g a Any interested p a r t i e s are tion the 10th day. Gauze packs reurged to report to The Tilden moved the 6th day.
K e e p i n g the U p p e r Biliary Tree Free From Stasis
TAUROCOL
Bile Salts Tablets
NOTICE!
Company, New Lebanon, N. Y. or St. Louis, Mo., any infringement by otbers of the Trade Mark DANISH OINTMENT and such information will be acknowledged suitably. Write for Reprint J. A. M. A., March 4, 1933. Adv
Operative and cases: Case I.
late
results
o.f five
Anastomosis enters within the abdominal cavity at the end of 8 days. P a r i e t a l suppuration cleared up on the 15th day. Case II. Small stercoral fistula cleared up on the 15th day. Cicatrization on the 30th day. Case III. P a t i e n t 62 years of age. Loosening of the sutures over the an-
t,
at,nent
PEPTIC ULCER hyperchlorhydria, heartburn and other conditions where the neutralization of gastric HC1 is desirable, TRI-CALSATE has been found to be a powerful neutralizer--yet does not produce a harmful alkalosis. it is in effect a "buffered neutral antacid" that eliminates the disadvantages of the alkaline antacids. As no carbon dioxide is evolved during the r e a c t i o n in the stomach, the distress from gastric distention and belching is eliminated. Tri-Calsate is non-toxic and nonirritating. The probability of gastro-intestinal irritation is remote . . . the kidneys are unharmed. Patients like it because it is palatable and easy to take. TRY Avoid the TRI-CAI_SATE Available Vicious Circle ~n p r e s c r i p tion at your ~ ~ pharmacy or direct in 4 oz. a n d 16 oz. bottles. Use the coupon or write us for of Alkali t r i a I supply and l i t e r a Neutralization ture.
TRI.CilLSflTE
78
AMERICAN JOURNAL OF DIGESTIVE DISEASES AND NUTRITION
terior semi-circumsference. Fistula closed in a second stage. Treatment required 45 days. Cases IV and V. Ideal operative results, Late results. The three last cases are too recent to draw useful conclusions, The first case was done 3 years ago, and the second, 2 years ago. Both of these patients are very satisfied, less constipated, no f u r t h e r painful crises or swellings, the signs of intestinal intoxication have disappeared, Advantages of this technique. Superior to the classic colotomy in one
stage, which by a possible loosening of the sutures may result in an acute peritonitis. Superior also to the colectomy in several stages, a sure but complex method requiring prolonged hospitalization and necessitating furthermore the making of an artificial anus, the cure of which is sometimes dangerous. As one is able to gather from the detailed observations of the Authors, the technique recommended by them has the advantages of the two classic procedures without their inconveniences. The technique is simple, the operative results rapid and sure, and the possible
C H E C K P U T R E F A C T I O N with
Detoxification of the bowel contents with Karicin is effective in relieving the symptoms of intestinal toxemia, mucous colitis and putrefaction. Not a laxative m Not an antiseptic. DOSE: The average dose of Karicin is a tablespoonful three times a day, taken in water or milk at least one hour before or one hour after meals. Write for clinical sample and literature.
THE
W M .
S.
M E R R E L L
CINCINNATI, U.S.A.
C O M P A N Y
rupture of the anastomosis does not expose the patient to any vital danger. Pierre Smith, Thomas Farmer, Montreal.
STANTON, E. MAcD. Acute Appendicitis. A Study of the Correlation Between the Time of Operation, the Pathology and the Mortality. S. G. and 0., Vol. LIX, No. 5, pp. 738-744, Nov., 1934. A f t e r having reviewed some recent publications on appendicitis, and after having analyzed and re-analyzed his own, as well as the reported cases of appendicitis during the last twenty-six years, the Author has shaped two functional truths which he believes can be confirmed by any surgeon of experience. The first is that the operative mortality of acute appendicitis bears a definite relationship to the duration of the inflammatory process prior to operation. The mortality increases with the duration of the process up to the fourth and fifth days, which are about the same, after which it falls in a curve almost the mirror image of its rise. The ideal solution of t h a t problem would be to have all patients come to operation during the first twenty-four hours of the attack, but as long as human nature and human judgment remain what they are surgeons will continue to be called upon to treat a considerable number of late cases of appendicitis. The second basic point is that the mortality is inseparably associated with a corresponding sequence of changes in the inflammatory process itself. During the first day the peritoneal reaction is one of engorgement with little exudate. During the second day there is engorgement and leukocytic infiltration with roughening of the peritoneum. Experience has shown that at this stage the perito.neum is still able to take care of whatever infection there may be after the appendix is removed. During the third day the exudate is distinctly purulent, fibrin is abundant and organization has begun. By the fourth and fifth days the process of organization is well advanced so that the process is somewhat encapsulated. At this stage it is usually multitocular and not drainable; later a single cavity results. As the age of the process increases now, the extent of the peritoneal process diminishes and the mortality rate falls. In the Author's experience the Ochsner treatment during the high mortality period of the disease has been safe, and technically easy and satisfactory in every way, but it has been morally very difficult not to operate upon most patients as soon as referred. In retrospection the Author believes that he cannot see how he might have materially reduced his mortality rate by employing the Oehsner treatment in a larger number of cases. N. M. Percy, Chicago.