JAMA

O'Conor, Vincent J.

doi: 10.1001/jama.1956.02970300001001pmid: 13366727

• Serious injuries to the ureter have often resulted during trauma, such as stab and gunshot wounds, to the abdominal or pelvic organs, but they also occur occasionally during surgical procedures on neighboring structures, diagnostic procedures such as cystoscopy, and therapeutic procedures such as irradiation. Preoperative urographic study is important in planning the operative attack on certain abdominal, pelvic, and retroperitoneal [ill]paces. Preoperative introduction of ureteral catheters should be utilized more frequently to facilitate identification of the ureters during difficult dissections. The unintended inclusion of a ureter in a ligature must be corrected promptly; the release of such a ligature is more readily accomplished by teamwork between the surgeon and the urologist. The possibility that a ureter has been injured should always be considered whenever oliguria or anuria is observed during the first eight hours after any surgical operation in the vicinity of the ureters. If evidence of injury or ligation is found, prompt repair, with provision for tissue drainage, is imperative.

Talbot, Herbert S.

doi: 10.1001/jama.1956.02970300003002pmid: 13366728

• The structural changes that follow retention of urine in a paralyzed bladder must be prevented by adequate drainage from the beginning. With a catheter in place, the bladder regains its ability to fill and empty by reflex action with a certain regularity. It can be conditioned by the method of tidal drainage within a period of 6 to 12 weeks. Mean while a program of high fluid intake, acidulation of the urine, and muscular exercise is carried out to prevent lithiasis. The catheter can then be removed, and the observance of a certain program of fluid intake and other habits enable many patients to maintain an adequate urinary capacity, to empty the bladder completely, and to get along without wearing any apparatus.

Cooper, Irving S.

doi: 10.1001/jama.1956.02970300005003pmid: 13366729

• The first decision for the neurosurgeon after an injury to the spinal cord is whether any immediate neurosurgical maneuver is indicated. Neurological and roentgenographic examination determine whether fracture-dislocations need to be reduced, whether traction or laminectomy are necessary, and whether post-traumatic fragments of bone, intraspinal hematomas, or herniated intervertebral disks require attention. In many cases early laminectomy is actuatly the conservative course of action. Later problems for the neurosurgeon, from three months to several years after the injury, concern especially the intractable pain and spasticity that generally accompany paraplegia. Various procedures, including chordotomy, offer reasonable hope of relief of pain; alleviation of spasticity may be afforded by peripheral neurectomy, subarachnoid alcohol block, rhizotomy, or subtotal spinal chordectomy.

Covalt, Donald A.

doi: 10.1001/jama.1956.02970300008004pmid: 13366730

• The end-result in rehabilitating the paraplegic patient is preparing him for a job, or at least preparing him for further vocational training that will result in a job. Total rehabilitation requires the cooperative services of the neurosurgeon, urologist, orthopedic surgeon, and physiatrist. The series of activities presented, which follow definitive care, are directed to the paraplegic patient's adjustment to walking and daily living.

Buckwalter, Joseph A.; Wohlwend, E. Bruce; Colter, Donald C.; Tidrick, Robert T.; Knowler, Lloyd A.

doi: 10.1001/jama.1956.02970300010005pmid: 13366731

• The existence of an association between certain diseases and the ABO blood groups was investigated by studying the blood-type frequencies of 158 patients with pernicious anemia, 908 with gastric carcinoma, 1,839 with peptic ulcer, 866 with carcinoma of the breast, 395 with carcinoma of the lungs, 256 with carcinoma of the colon and rectum, 456 with leukemia, 327 with congenital anomalies, and 184 with ulcerative colitis, and comparing them with the blood-type frequencies observed in blood donors. The strongest association found concerned peptic ulcer; statistically significant associations also were found for gastric carcinoma and pernicious anemia. Patients with pernicious anemia were distributed between groups A and O in the ratio 1:0.78, while the control patients exhibited the ratio 1:1.10. So great a difference in a sample of this size would have been found as an accident of sampling less than 5 times in 100, and is therefore accepted as significant. The incidence of gastric carcinoma was also greatest in persons with blood type A; that of peptic ulcer was greatest in persons with blood type O. The data suggested, but did not suffice to prove, an association of blood group with pulmonary and mammary carcinoma. No evidence was found of association with carcinoma of the colon and rectum, leukemia, ulcerative colitis, or congenital anomalies.

Buckwalter, Joseph A.; Wohlwend, E. Bruce; Colter, Donald C.; Tidrick, Robert T.; Knowler, Lloyd A.

doi: 10.1001/jama.1956.02970300015006pmid: 13366732

• The incidence of the four blood types O, A, B, and AB was studied in 1,301 patients with duodenal ulcer, 469 with gastric ulcer, and 69 patients with both gastric and duodenal ulcers. The three distributions so obtained were compared with the distribution found in a reference of 8,767 people without ulcers. Type O was more frequent among the ulcer patients than in the reference group, and calculations of probability showed that the association between type O and peptic ulcer was statistically significant. It was shown not to be secondary to any influences of sex, age, rhesus blood type, or occupation. Among a group of 529 patients who had histamine tests, however, the frequency of type O was significantly greater among those who reacted with an increase of free hydrochloric acid than among those in whom no increase of acid occurred.

Blakemore, William S.; Lehr, Herndon B.; Roberts, Brooke

doi: 10.1001/jama.1956.02970300020007pmid: 13366733

• An arterial homograft bank was established to supply freeze-dried segments of human arteries for use in surgery. Analysis of the results from the first 100 preparations used shows that 36 were used in repairing aneurysms of the abdominal aorta and 24 in relieving arteriosclerotic obstruction in peripheral arteries, with results considered good in 24 and 20 cases respectively. Uniformly good results were obtained in 13 cases of obstruction of the terminal portion of the aorta and 11 cases of coarctation. Mortality was high in ruptured, but low in unruptured, aneurysms of the abdominal aorta. The preparation of materials for the arterial homograft bank can be undertaken by large community hospitals without additional highly trained personnel.

Kile, Roy L.

doi: 10.1001/jama.1956.02970300022008pmid: 13366734

• The distribution of warts was studied in an orphanage where 58 children lived during the winter months. Warts were found in 15. The warts in some instances had been present when the child arrived; in other instances they appeared some time after the child's arrival. There were cases of spontaneous disappearance and subsequent recurrence. The distribution of the lesions on different parts of the body did not afford clues as to the method of dissemination, and the time relations of their appearance were not clear. Four out of 18 adults resident in a seminary cottage reported warts; again it was difficult to interpret the data because information as to the time relations and the distribution among other residents was incomplete. Much work on the transmissibility of these lesions must be done before standard hygienic measures can be established. Better knowledge of this virus infection is very desirable because these lesions are so common. They affected at least 20% of the residents in the seminary cottage and more than 25% of the children in the orphanage.

Franz, Warren L.; Sands, G. Winthrop; Heyl, Henry L.

doi: 10.1001/jama.1956.02970300024009pmid: 13366735

• The incidence and course of common colds were followed in 89 medical students and nurses who volunteered in a study of the efficacy of naringin, a bioflavonoid extracted from grapefruit peel and used in remedies for colds. One group of 22 subjects received 333 mg. of naringin and 65 mg. of ascorbic acid three times daily for three months; a second group received naringin only, another ascorbic acid only, and the fourth a placebo. These substances were administered in capsules as nearly alike as possible. Symptoms of colds were systematically recorded, and the levels of ascorbic acid in the blood were determined periodically. The average level of ascorbic acid in 22 men who were to receive ascorbic acid by mouth was initially 0.96 mg. per 100 cc. of blood; after 12 weeks of taking only ascorbic acid the average for this group was 1.41 mg. per 100 cc. of blood. In all groups and at all stages, the blood ascorbic acid levels for males were significantly lower than those for females. There was no evidence that the naringin affected the ascorbic acid level of the blood, prevented colds, or cured them.

Tebrock, Harry E.; Arminio, Joseph J.; Johnston, John H.

doi: 10.1001/jama.1956.02970300027010pmid: 13366736

• The evaluation of any drug used to treat the comcon cold must necessarily be based on clinical observations. Bioflavonoids and ascorbic acid, singly and in combination, were evaluated in a study on almost 2,000 persons as to their efficacy, not by symptom alleviation but as to whether it would shorten the course of illness. The overwhelming impression gained from the study presented is the singular lack of effect in altering the course of the common cold by either the bioflavonoid or the ascorbic acid.