Showing papers in "Archives of Surgery in 1941"

Studies on prostatic cancer: ii. the effects of castration on advanced carcinoma of the prostate gland

Abstract: The thesis of this work may be briefly summarized In many instances a malignant prostatic tumor is an overgrowth of adult epithelial cells All known types of adult prostatic epithelium undergo atrophy when androgenic hormones are greatly reduced in amount or inactivated In this paper evidence is presented that significant improvement often occurs in the clinical condition of patients with far advanced cancer of the prostate after they have been subjected to castration Conversely, the symptoms are aggravated when androgens are injected We believe that this work provides a new concept of prostatic carcinoma The evidence that prostatic carcinoma is often composed of an adult type of epithelium derives from a study of such tissue with respect to the phosphatase which manifests optimum activity atpH5 An important advance in the technic of investigation of the prostate gland was made by Kutscher and Wolbergs,1who found that

Chemosurgery: a microscopically controlled method of cancer excision

Abstract: Foreword to Article by Dr. Mohs This paper presents a method for the treatment of carcinoma which is localized to an accessible region of the body. It does not give the answer as to the cause of cancer, nor does it eliminate surgical intervention or radium or roentgen therapy in the treatment of the disease. The method is the result of eight years of work in the laboratory and four years of clinical experience, during which time well over 600 cases have been observed and the results of treatment carefully analyzed. The escharotic agent may be one of several, and the base may be one of many. Over two hundred different bases were studied, and many were suitable. The combination used may be varied, with equally good results. In the last analysis it is the method of control rather than the chemical agent itself that promises an advantage. The advantage

Results of removal of acoustic tumors by the unilateral approach

Abstract: If any neurologic surgeon were asked to name the most difficult tumor to extirpate, his answer would doubtless be "the acoustic tumor." Until recent years the surgical removal of this type of growth appeared to be almost impossible. In 1917 no less an authority than Cushing1wrote: "I doubt very much, unless some more perfected method is devised, whether one of these tumors can with safety be totally enucleated." He was content with removal of the interior of the tumor, by which life could be prolonged, although recurrence was inevitable. Nor could there be any question of the wisdom of his course, for the mortality following total removal at that time was nearly 100 per cent. Successful complete removals of tumors of this type by all of the world's brain surgeons at that time could be counted on the fingers of one hand. It seemed incredible that a perfectly

Regional lymphatic metastases of carcinoma of the stomach

Abstract: The low incidence of five year cures after partial gastric resection for carcinoma of the stomach is discouraging. However, it is easily explained by the insidiousness of the disease in its early stages; by the time the symptoms become sufficiently alarming to make the patient seek medical aid, the condition is often inoperable. The elimination of certain factors to be discussed later should increase the number of five year cures. This study, similar to one we made of the regional lymphatic metastases of carcinoma of the rectum1and colon,2is based on the dissection and examination of all the regional lymph nodes in 53 cases of carcinoma of the stomach. Fifty-one of the patients had previous partial to subtotal gastric resection, and 2 came to autopsy. The lymph nodes were dissected from each specimen after they had been visualized (fig. 1) by clearing by the Gilchrist and David

Primary torsion and infarction of the appendices epiploicae

Abstract: Among the many acute intra-abdominal conditions which produce clinical problems, primary lesions of the appendices epiploicae are relatively rare. Because of this, the clinician or surgeon often does not consider lesions of these structures in the differential diagnosis of intra-abdominal disease. Consequently the clinical diagnosis of primary torsion, infarction or inflammation of the appendices epiploicae has, according to the literature on this subject, never been made. One must admit, however, that recognition of disease of these structures is very important from the standpoint of offering the patient an accurate prognosis. There are many variations from the typical picture, and often the clinical and laboratory findings are not sufficiently significant to be of any help in diagnosis. Our object in conducting this review was to discover, if possible, any facts that could add to our diagnostic acumen when confronted with the aforementioned conditions. In 1936, Fiske 1 was able to collect

Metastasis of primary carcinoma of the breast: with special reference to spleen, adrenal glands and ovaries

Abstract: The literature on the sites of metastasis of primary carcinomas of the breast consists of amazingly few specific contributions. Of course, all leading textbooks and comprehensive studies of tumors in general and of cancers of the breast in particular refer to the various locations of the metastatic deposits, but they either mention only the lymph nodes, lungs, liver and bones or refer to old, apparently out of date studies on this subject. Thus, Ewing 1 in 1940, in regard to sites of metastasis, cited Gross's 2 work on carcinoma of the breast, a study published in 1888, when as a rule only macroscopic evidence of metastasis was available. There are reports of a few instances of what were thought to be unusual sites of metastasis, or one may find rarely a series of cases of carcinoma of the breast with metastases. Most often, however, either the latter are clinical reports

Actual growth of young cartilage transplants in rabbits: experimental studies

Abstract: In the field of plastic and reconstructive surgery the transplantation of cartilage has assumed a role of increasing importance. During the past seventy-five years many reports have appeared in the literature describing the experimental and clinical results of the use of cartilage grafts, but the conclusions presented have often been contradictory. At present the evidence for survival of autografts of cartilage is admitted readily, but similar proof for the viability of isotransplants1is not so conclusive. Observations as to whether cartilage grafts were living or dead have depended on the gross and microscopic appearance of apparently viable cartilage cells at the time of removal of the graft. It has been assumed that if a transplant of very young cartilage remains viable in all probability it will resume its regular rate of growth. A demonstrable increase in size of the graft, correlated with the macroscopic and microscopic appearance, would present

Naevus unius lateris

Abstract: One of the most interesting and certainly the most unusual of the varieties of nevi is the so-called neuropathic papilloma, or naevus unius lateris. It is a papillary or verrucous congenital tumor having a unilateral or nearly unilateral distribution in linear streaks or bands following the long axis of the limbs or extending transversely around the trunk. This unique disease is so striking that it is readily recognized as a distinct clinicopathologic entity. Only 4 cases have been observed among 40,000 patients with tumors studied at the Memorial Hospital, an incidence of 0.01 per cent. To these have been added 156 cases from the literature, thus affording 160 cases for analysis. SYNONYMS The term naevus unius lateris was originated by von Baerensprung in 1863. Theories as to etiology, variations in appearance of the reported lesions and attempts to create names embodying both descriptive and pathogenetic elements have led to the

Papilloma of the choroid plexus

Abstract: Papilloma of the choroid plexus is a rare tumor; no single author's published experience encompasses more than 12 instances. For this reason alone it seems justifiable to collect the isolated reports, since the frequency of diagnosis and surgical treatment of tumors of the brain is ever increasing and since there are few persons with a neurosurgical or neuropathologic experience extending over a period of five years who have not had contact with at least 1 papilloma. This paper represents a collection of the 80 odd published case reports of papilloma of the choroid plexus, together with some emphasis on incidence, sites of origin, inferences as to growth characteristics, pathologic picture—with emphasis on the known seeding characteristic—and summarized surgical experience. INCIDENCE Cushing's series of 2,023 tumors of the brain contained 12 papillomas of the choroid plexus; Elsberg's series of 878 contained 2; Tooth's series of 258 contained 3, and Peers's series

A comparison of the effects of heat and those of cold in the prevention and treatment of shock

Abstract: There has been a revival of interest in recent years in the reactions of living matter to changes in temperature. From the therapeutic point of view the effects of fever therapy in the treatment of infections, of low temperatures in the retardation of growth of cancer 1 and of cooling parts with deficient circulation in the prevention of gangrene 2 have been studied. In addition to determining the effects of different temperatures on the local tissues in which the circulation was inadequate, Allen 2b found that constriction of the circulation of the thigh is more apt to be accompanied with shock if the local temperature is high than if it is low. Because of the variability in individual responses to various means of producing shock, such as trauma and the removal of blood, it is extremely difficult to compare the effects of various therapeutic agents. In other words, the variation

Appendix vermiformis duplex

Abstract: The appendix is such a common surgical specimen that one hardly anticipates the possibility of its duplication. However, although it is a very rare anomaly, the so-called double appendix does occur, and it offers a number of interesting points for consideration. The first question which naturally arises is: What is an appendix, and what are the criteria by which one may identify the organ and separate it from other types of protrusions from the cecum? Cave, in an extensive summary of the knowledge of the comparative anatomy of this region, concluded, contrary to common belief, that a true vermiform appendix identical to that met with in man is found only in gibbons and anthropoid apes, although, peculiarly enough, monotremes and some marsupials possess a strikingly similar structure. Aside from its gross form and position, histologically the appendix is identified and distinguished from the cecum by the amount and arrangement of

The sympathetic nervous system in neurogenic and renal hypertension: experimental correlation and clinical consideration

Abstract: The development in the last eight years of various surgical technics directed toward alleviation of essential, or idiopathic, hypertension has renewed interest in the role of the sympathetic nervous system and its splanchnic divisions in regulation of blood pressure and their possible etiologic role in clinical hypertension. These surgical technics have been chiefly directed toward sympathetic denervation of the splanchnic area. It is difficult to evaluate the therapeutic effect of these procedures and even more difficult to estimate whether the improvements reported are related to an elimination of etiologic factors or to a direct effect produced by denervation of large vascular beds. The experiments to be considered in this study deal with an attempt to reexamine the role of the sympathetic nervous system and its splanchnic divisions in regulation of blood pressure. The possible role of the sympathetic system in the production of chronic neurogenic hypertension in man is also

Carcinoma of the large intestine: review of four hundred and sixteen autopsy records

Abstract: Many papers are to be found in the literature dealing with problems of malignant tumor of the colon. A vast amount of material has accumulated on all phases of the subject, especially in the hospital records pertaining to mortality, morbidity and treatment. It occurred to me that it would be interesting to take a group of cases in which autopsy had been performed for study of the nature of the lesion at the time, making an effort to analyze some of the difficulties that hedge about clinical recognition of the disorder. All of the patients reported on in this review came to necropsy in the department of pathology at the University of Minnesota between January 1910 and July 1937 because of carcinoma of the large bowel. That this material represents a fair sample of the general population is attested by the fact that in 1927 it was found that 19

Squamous cell carcinoma arising in a chronic osteomyelitic sinus tract with metastasis

Abstract: Carcinoma arising in a chronic osteomyelitic sinus tract has been reported sporadically for more than a hundred years and with somewhat greater frequency within the last decade. Nevertheless, the increasing incidence of chronic osteomyelitis that may be expected as a consequence of the war justifies directing attention to a complication that is by no means generally appreciated. This consideration and the fact that there are few reports of metastasis from carcinoma of an osteomyelitic sinus tract have prompted us to submit 2 cases and to review the literature. The first case of this type of carcinoma appears to have been reported by Hawkins, 1 of London, England, in 1835, under the title "Cases of Warty Tumors in Cicatrices." Dittrich 2 in 1847 recorded the next case, in which the tibia was involved. Thigh amputation was performed, and the diagnosis of carcinoma was confirmed by Rokitansky. Between 1851 and 1891 the

Early rising and ambulatory activity after operation: a means of preventing complications

Abstract: Since January 1938 we have performed 383 appendectomies at St. Joseph's Mercy Hospital, Detroit. Thirteen of these appendectomies were done in cases in which the appendix was ruptured and there was spreading or generalized peritonitis, and the patients were not considered suitable for the early ambulatory treatment about to be described. The diagnoses in the remaining 370 cases were as follows: chronic appendicitis, 108 cases; mild appendicitis, 153 cases; acute appendicitis, 69 cases, and empyema or gangrene of the appendix without rupture, 40 cases (tables 1 and 2). RESULTS WITH THE REGIMEN IN THREE HUNDRED AND SEVENTY CASES IN WHICH APPENDECTOMY WAS PERFORMED In this series of 370 cases the average period of confinement to bed after operation was one and a half days and the average period of hospitalization after operation two and three-tenths days (tables 1 and 2). In 2 cases Meckel's diverticulum was also removed through the

Spinothalamic tractotomy in the medulla oblongata: an operation for the relief of intractable neuralgias of the occiput, neck and shoulder

Abstract: Not infrequently the neurosurgeon is confronted by a case of intractable pain distributed so high over the shoulder and neck that it cannot be interrupted by cordotomy, no matter how high the spinothalamic tract is sectioned in the cervical portion of the spine. Pain of this type is most often due to neuralgia arising in an amputation stump of the upper part of the arm or shoulder or caused by avulsion or carcinomatous infiltration of the brachial plexus or to one of the rare unexplained neuralgias which may follow an operative incision or a penetrating wound of the neck or upper part of the back. As is well known, such conditions have been most difficult to relieve, even with extensive resection of the posterior cervical sensory roots and the consequent sacrifice of a useful arm. It has been observed clinically in patients with thrombosis of the posterior inferior cerebellar artery

Venous thrombosis: early diagnosis with the aid of phlebography and abortive treatment with heparin

Abstract: Since Jorpes1by his work at Karolinska Institutet in Stockholm in 1935 defined the chemical nature of heparin and made this physiologic anticoagulant of Howell available in a pure form, he and his co-workers, as well as other Swedish investigators, have been trying to determine the clinical serviceability of this preparation. Their efforts have been successful. Their results and those of the group in Toronto, Canada, working on the same problem have been summarized in two monographs, by Jorpes2and Mason.3 One of the most important questions was whether heparin could be used in treating thromboembolic disease. Some valuable work on this problem has been done independently by Crafoord4and Crafoord and Jorpes5in Stockholm and by Murray and Best in Toronto. In several studies, based on 500 cases, Crafoord has shown that in no instance has postoperative thrombosis appeared in patients who have been

Inguinal ectopia of the ovary and fallopian tube: review of the literature and report of the case of an infant

Abstract: The occurrence in our service of a case of inguinal ectopia of the ovary and fallopian tube prompted us to make a survey of the literature. We have examined the reports to date to determine the incidence of this condition and the outstanding views as to its mechanism of development. In our review of the literature we found several excellent summaries and compilations of cases. Among them, the reports of Andrews 1 in 1905 and 1906, those of Heineck 2 in 1912 and 1927 and that of Watson 3 in 1923 (revised in 1938) are excellent and complete analyses of reported cases. We decided to bring the compilation to the present, listing the aforementioned data as well as those reported since their publication. We have, however, attempted to restrict our list to cases of inguinal ectopia of the ovary and fallopian tube in an effort to distinguish the condition from

Resection of the liver for hepatoma

Abstract: Primary cancer of the liver in the absence of cirrhosis is unusual, and most reports on the subject are from autopsy observations. Hepatoma in an otherwise normal liver may originate in the parenchymatous liver cells or in the intrahepatic bile ducts. This tumor may grow slowly for years before it spreads through hepatic vessels or metastasizes widely. The symptoms usually are mild indigestion or disturbance caused by the size and weight of the tumor, but massive intra-abdominal hemorrhage has occurred. Few surgeons have reported on resectable hepatoma. In the literature I have been able to find 29 cases, in 7 of which the tumor originated in the right lobe. Of the 23 patients who survived operation, there was no later report of 3, and 8 died of recurrence. A primary hepatoma may be encapsulated and appear benign; it may grow very slowly; it may have areas of cystic degeneration, or

Congenital duodenal obstruction

Abstract: Acute intestinal obstruction is always such a serious illness that it demands prompt recognition and treatment to prevent a fatal termination. This is just as true when it occurs in infants as when it occurs in adults, with the further consideration that infants, being inarticulate, often are subjected to delay in diagnosis, and this results in their contributing more than their share to the high mortality rate. When one is reminded that the first successful operation for the cure of duodenal obstruction in an infant was reported as recently as 1916,1 there seems some justification for the past failures of those responsible for the medical care of infants to recognize the condition. That the point in pediatrics has been reached where the disease, whether acquired or congenital, is more promptly recognized is attested by the increasing number of cases reported. There has been an unjustifiable tendency to consider gastric and

Nerves in the vertebral canal: their relation to the sympathetic innervation of the upper extremities

Abstract: According to current accounts of the nerves in the vertebral canal, based mainly on the work of von Luschka (1850) 1 and Rudinger (1863), 2 a recurrent or meningeal nerve arises from the communicating ramus of every spinal nerve and enters the vertebral canal through the corresponding intervertebral foramen. Within the vertebral canal these nerves bifurcate, sending a short division cephalad and another caudad. These divisions constitute a longitudinal strand of nerve fibers, the sinuvertebral nerve, located in the lateral region of the floor of the canal. Branches arising from the sinuvertebral nerve convey fibers to the meninges, to the blood vessels within the canal and to the membranes enveloping the spinal nerve roots. Certain clinical observations reported by Simpson, Brown and Adson (1930), 3 White (1933), 4 Telford (1934) 5 and others support the assumption that in certain cases some sympathetic fibers in the upper extremity remain functionally intact

Experiences with intramedullary tractotomy: i. relief of facial pain and summary of operative results

Abstract: It has long been known from the study of pathologic conditions affecting the brain stem that there are an anatomic separation and a physiologic dissociation of the fibers of the trigeminal nerve immediately on their entry into the brain stem. The fibers conducting the modalities of pain and temperature turn downward and in company with the nucleus of the spinal tract of the fifth nerve run throughout the length of the medulla oblongata and into the upper cervical portion of the cord. During their course, they emerge from under cover of the restiform body and take a superficial position on the lateral surface of the medulla. In this situation they form a distinct elevation on the surface of the medulla—the tuberculum cinereum. In the closed portion of the medulla the tuberculum cinereum lies below the restiform body and above the olivary eminence. The fibers mediating touch sensation, on the other

Changes in the liver associated with hyperthyroidism: with a study of plasma prothrombin levels in the immediate postoperative period

Abstract: During the past nine years considerable interest has been aroused concerning the state of the liver in patients with hyperthyroidism, and excellent studies of the morphologic and physiologic changes in this organ associated with increased activity of the thyroid gland have been reported. Despite the evidence of such a possible relation, however, many patients with hyperthyroidism are treated without regard for hepatic function so far as the type of diet is concerned. Attention has been focused on a high caloric intake, with disregard of the carbohydrate-fat ratio and the vitamin requirements. ANATOMIC CHANGES Cameron and Karunaratne 1 have summarized the development of knowledge concerning the hepatic changes accompanying hyperthyroidism, and Boyce and McFetridge 2 have reviewed the significant clinical and pathologic contributions which have been made to this subject in recent years. In 1932, Weller, 3 in studying the morphologic changes in the livers of 48 patients who died with

Visualization of the pulmonary artery during its embolic obstruction

Abstract: The purpose of this study was to work out a simple method of visualizing the pulmonary artery in the dog as Robb and Steinberg have done in man1and then to study the vascular bed after the administration of drugs and after the production of embolism. In a previous publication2the effect of embolism on the coronary circulation has been reported. In this paper we wish to report our observations on the effect of pulmonary embolism on the pulmonary vascular bed of the dog. Two hundred and sixty-three films were obtained of 48 dogs. The pulmonary vascular tree was first studied by injection of a barium sulfate suspension into the pulmonary conus distal to its ligature. Various angles were employed, and finally the right anterior and left anterior oblique positions were selected (fig. 1). The anteroposterior view shows that only the left pulmonary artery is filled adequately. In

Congenital lumbosacral defect

Abstract: The causation and the anatomy of lumbosacral defect have not been well studied, and the assumption is generally made that nothing can be done about the condition. Many of the unfortunate persons with this deformity are of normal mentality. At least 2 persons described in the medical literature, while apparently completely lacking a sacrum, have' gone through two pregnancies each. An understanding of their difficulty should be of interest. The literature on this anomaly lists 41 cases. Since they have been adequately reviewed in recent years, we merely cite the reviews, 1 together with a few isolated cases, and contribute a case that came to our attention at the Children's Hospital in Galveston. REPORT OF CASES Case 1. —A bright looking 9 year old boy was admitted to the orthopedic service by one of us (N. D.) in November 1940 (fig. 1). He was able to sit up and drag

Cranial chordomas: a clinical and pathologic study

Abstract: The term chordoma refers to a neoplasm arising from embryonic rests of the chorda dorsalis or notochord, which in its development more or less reproduces the structure of the primitive notochord. Chordomas arise in the craniospinal axis in certain definite locations, the selection of which can be explained on an embryologic basis. While they rarely metastasize, the clinical course is characterized by slow expansile enlargement with destruction of adjacent bone and compression of neural structures and by recurrences after operation. EMBRYOLOGY The embryology of the chorda dorsalis has been reviewed by others1and will be given briefly here. The notochord forms the primitive axial skeleton of all vertebrates, and in certain lower forms, such as the Amphioxus, it forms the sole axial skeleton. The structure is formed primarily by the proliferation of cells from the anterior end of the primitive streak. While some writers consider the chorda to be

Hydatid disease (hydatidosis): pathology and treatment

Abstract: Foreword to Article by Dr. Arce Nearly forty years have passed since the day in 1903 when Dr. Jose Arce received his first formal honor, the gold medal awarded by the Medical School of the University of Buenos Aires to its best student. The surgical world is well aware how thoroughly the promise of those early years has been fulfilled. Dr. Arce's distinguished achievements as surgeon, teacher, university administrator, author, editor and both provincial and national deputy have been recognized by many medical societies, universities and national governments of both hemispheres. For more than twenty years he has occupied the important chair of professor of surgery at his alma mater. In accordance with the desire of the editors of theArchives of Surgeryto place before their readers the most authoritative surgical thought of the day, the Chairman of the Editorial Board requested Dr. Arce to contribute to the pages

Renal blood flow and sympathectomy in hypertension

Abstract: The importance of the kidneys in the pathogenesis of arterial hypertension has been widely recognized since the demonstration by Goldblatt and his co-workers1that lasting hypertension can be produced experimentally by partial constriction of one main renal artery. Page has obtained similar hypertension by compression of the renal parenchyma in the scar of cellophane or silk perinephritis.2Although several cases of hypertension in human beings have been described in which the condition arose as the apparent result of partial obstruction of renal circulation or as the result of perinephritis, neither abnormality of the large renal vessels nor diffuse perinephritis is commonly present. Lesions of the small renal arterioles, however, are evident even in the early stages of the disease.3It has therefore been suggested that hypertension may ordinarily arise as the result of spasm and sclerosis of the renal arterioles, functional equivalents of the application of myriads

Malignant renal neoplasms in children review of twenty-six cases

Abstract: The Wilms tumor is the most common malignant growth affecting the kidneys of infants and children. It is estimated that tumors of the kidney comprise approximately 25 per cent of all malignant tumors occurring in childhod. In 1828, Gairdner 1 reported the first case of sarcoma of the kidney in an infant. Eberth 2 in 1872 first described this type of tumor and suggested that it is derived from remnants of the wolffian body. In 1875 Cohnheim 3 and in 1886 Ribbert 4 stated that the tumor has its beginning in aberrant germ plasma from the primitive segments. Weigert 5 in 1876 stated the belief that the tumor is a congenital adenocarcinoma of the kidney, probably derived from misplaced cell rests. Osler 6 in 1879 described 2 cases of striated myosarcoma of the kidney, but he offered no theory as to the origin of the growths. Brosin 7 in 1884

Studies on experimental hypertension: xv. experimental observations on hypertension associated with unilateral renal disease; effect of occlusion of the ureter on experimental hypertension due to unilateral renal ischemia

Abstract: In the earliest studies on experimental hypertension due to renal ischemia 1 it was shown that constriction of the main artery of only one kidney in a dog or a monkey is sufficient to cause elevation of the blood pressure. It was also shown in these and in later studies 2 that this elevation does not usually persist indefinitely unless the other kidney is removed or unless the main artery of the other kidney is also constricted. In most dogs with unilateral renal ischemia the blood pressure returns to the preoperative level in six weeks or less, but in some the hypertension may persist at a high level for many months. The return of the blood pressure to normal obviously may be due ( a ) to the development of considerable accessory circulation to the ischemic kidney or ( b ) to the compensating, neutralizing or inhibiting effect of the contralateral normal kidney. The