Archives of Surgery

SMITH, FREDERICK GOETHE

doi: 10.1001/archsurg.1946.01230060614001pmid: 20279410

Abstract THYROID tissue develops fairly frequently in ovarian dermoids (table 1), although it is usually no more than a microscopic portion of the tumor. There is, however, a rare type of ovarian tumor, known as struma ovarii, in which thyroid tissue is a major constituent.1 Some of these ovarian goiters are obvious teratomas, containing besides thyroid such tissues as skin, teeth, brain and intestinal epithelium. Others consist entirely of thyroid or of thyroid in association with a cystoma. Boettlin in 1889 was the first to note the presence of thyroid tissue in an ovarian dermoid. Wilms, Merttens and Kroemer published reports of similar cases. Then Gottschalk in 1899 described an ovarian tumor composed entirely of thyroid-like tissue. Thyroid tissue in the midst of a dermoid was not remarkable, but an ovarian tumor composed entirely of thyroid seemed improbable. Gottschalk concluded, despite its structural similarity to thyroid, that the tumor was References 1. The term struma ovarii is often loosely applied to any ovarian teratoma containing thyroid tissue; only the tumors in which there has been considerable unilateral development of thyroid tissue should be so designated. 2. It is to be noted that Ulesko-Stroganowa's case of "metastasis" of pure struma from one ovary to the other is not included. It is apparent from my tabulation that bilateral teratomas are not rare, and without other evidence of metastasis such an explanation is extremely unlikely. 3. Adolf, S.: Arch. f. Gynaek. 108:657, 1918.Crossref 4. Aisenstadt, I.: Ueber Struma ovarii coloides, Inaug. Dissert., Giessen, O. Kindt, 1913. 5. Anspach, B. M.: Univ. Pennsylvania M. Bull. 16:337, 1903. 6. Aschkanasy, K.: Monatschr. f. Geburtsh. u. Gynäk. 103:203, 1936. 7. Bauer, E.: Ztschr. f. Geburtsh. u. Gynäk. 75:617, 1914. 8. Bell, R. H.: J. Obst. & Gynaec. Brit. Emp. 8:92, 1905. 9. Blackwell, W. J.; Dockerty, M. B.; Masson, J. C., and Mussey, R. D.: Am. J. Obst. & Gynec. 51:151, 1946. 10. Boettlin, R.: Virchows Arch. f. path. Anat. 115:493, 1889. 11. Bolt, W.: Canad. M. A. J. 47:250, 1923. 12. Boxer, S.: Zentralbl. f. Gynäk. 35:31, 1911. 13. Brandenburg, O.: Deutsches Arch. f. klin. Med. 179:421, 1936. 14. Brown, A. L., and Shoor, M.: Am. J. Surg. 55:173, 1942. 15. Bua, C.: Ann. di ostet. 44:521, 1922. 16. Büll, A.: Ueber Struma ovarii, Inaug. Dissert., Stettin, Fischer & Schmidt, 1919. 17. Cabot, R. C.: Differential Diagnosis , Philadelphia, W. B. Saunders Company, 1924, vol. 2, p. 655. 18. Cantor, P. J., and Kogut, B.: Am. J. Cancer 28:760, 1936. 19. Castano, C. A.: Rev. Asoc. méd. argent. 53:131, 1939 20. Bol. Soc. de obst. y ginec. de Buenos Aires 19:316, 1940. 21. Cleland, J. B.: Australasian M. Gaz. 29:235, 1910. 22. Cohn, S., and Kushner, J. I.: Am. J. Obst. & Gynec. 47:421, 1944. 23. Davison, R. A.; Zollinger, R. W., and Curtis, G. M.: J. Lab. & Clin. Med. 27: 643, 1942. 24. Dingels, H.: Ueber das anatomische und klinische Verhalten der Struma thyreoidea ovarii, Inaug. Dissert., Bonn, H. Trapp, 1912. 25. Eerland, L. D.: Nederl. tijdschr. v. verlosk. en gynaec. 39:137, 1936. 26. Emge, L. A.: Am. J. Obst. & Gynec. 40:738, 1940. 27. Eversmann, J.: Arch. f. Gynaek. 76:101, 1905.Crossref 28. Fahmy, E. C.: Edinburgh M. J. 43:177, 1936. 29. Fiebach: Beitr. z. path. Anat. u. z. allg. Path. 51:648, 1911. 30. Frank, R. T.: Am. J. Obst. 60:433, 1909. 31. Frankel, J. M., and Lederer, M.: Am. J. Obst. & Gynec. 16:367, 1928. 32. Frankl: Zentralbl. f. Gynäk. 36:1761, 1912. 33. Frankl, O., in Liepmann, W. G.: Kurzgefasstes Handbuch der gesammten Frauenheilkunde, Gynaekologie und Geburtshilfe für den praktischen Arzt , Leipzig, 1914, vol. 2, p. 222 34. Zentralbl. f. Gynäk. 48:766, 1924 35. 55:21, 1931 36. 58:2706, 1934. 37. Funke, A.: Beitr. z. Geburtsh. u. Gynaek. 3:101, 1900. 38. Gargano, C.: Arch. ed. atti d. Soc. ital. di chir. 34:731, 1928. 39. Gemmell, J. E.: Proc. Roy. Soc. Med. (Sect. Obst.) 4:285, 1911. 40. Giannettasio, N.: Riforma med. 30:38 and 68, 1914. 41. Glockner, A.: Zentralbl. f. Gynäk. 27:790, 1903. 42. Gottschalk, S.: Arch. f. Gynaek. 59:676, 1899 43. Berl. klin. Wchnschr. 39:607, 1902. 44. Graham, A.: Ann. Surg. 82:30, 1925. 45. Gusberg, S. B., and Danforth, D. N.: Am. J. Obst. & Gynec. 48:537, 1944. 46. Haggag, H.: Virchows Arch. f. path. Anat. 264:686, 1927. 47. Heinsen, H. A.: Virchows Arch. f. path. Anat. 284:234, 1932. 48. Hundley, J. M., Jr.: Am. J. Obst. & Gynec. 40:749, 1940. 49. Hunt, R.: Am. J. Physiol. 63:257, 1923. 50. Kafka, V.: Arch. f. Gynaek. 114:587, 1921.Crossref 51. Katsurada, F.: Beitr. z. path. Anat. u. z. allg. Path. 30:179, 1901. 52. Kaufmann, E.: Pathology , translated by S. P. Reimann, Philadelphia, P. Blakiston's Son & Co., 1929. 53. King, E. S. J., and Norris, J. H.: J. Coll. Surgeons, Australasia 3:373, 1931. 54. Kleine, H. O.: Arch. f. Gynaek. 158:62, 1934.Crossref 55. Koerner, J.: Monatschr. f. Geburtsh. u. Gynaek. 68:264, 1925. 56. Koucky, J. D.: Ann. Surg. 81:821, 1925.Crossref 57. Kovacs, F.: Arch. f. Gynaek. 122:766, 1924Crossref 58. Klin. Wchnschr. 3:126, 1924. 59. Kraus, E. J.: Virchows Arch. f. path. Anat. 218:107, 1914.Crossref 60. Kretschmar, K.: Verhandl. d. deutsch. Gesellsch. f. Gynäk. 9:459, 1901 61. Centralbl. f. Gynäk. 25:729, 1901 62. Monatschr. f. Geburtsh. u. Gynäk. 19:389, 1904. 63. Kroemer, P.: Arch. f. Gynaek. 57:322, 1899Crossref 64. Veit, J.: Handbuch der Gynäkologie , ed. 2, Wiesbaden, J. F. Bergmann, 1908, vol. 4, p. 269. 65. Lanz: Cor.-Bl. f. schweiz. Aerzte 32:553, 1902. 66. Lecene, P.: Ann. de gynéc. et d'obst. 1:14, 1904. 67. Lindquist and Forselius: Monatschr. f. Geburtsh. u. Gynäk. 41:495, 1915. 68. Lochrane, C. D.: Proc. Roy. Soc. Med. 26:1427, 1933. 69. Lyday, R. O.: Am. J. Surg. 25:89, 1934.Crossref 70. Macleod, D. H.: Proc. Roy. Soc. Med. 25:1386, 1932. 71. Manasse, T.: Ztschr. f. Geburtsh. u. Gynäk. 89:638, 1926. 72. Masson, J. C., and Mueller, S. C.: Surg., Gynec. & Obst. 56:931, 1933. 73. Matthews, N. L.; Curtis, G. M., and Brode, W. R.: Indust. & Engin. Chem. (Indust. Ed.) 10:612, 1938. 74. Maxwell, R. D.: Proc. Roy. Soc. Med. 4:217, 1911. 75. Mayer, A., in Halban, J., and Seitz, L.: Biologie und Pathologie des Weibes , Berlin, Urban & Schwarzenberg, 1926, vol. 5, pt. 2, pp. 861-863. 76. Meigs, J. V.: Tumors of the Female Pelvic Organs , New York, The Macmillan Company, 1934. 77. Merttens, J.: Ztschr. f. Geburtsh. u. Gynäk. 36:287, 1897. 78. Meyer, R.: Virchows Arch. f. path. Anat. 173:538, 1903 79. Zentralbl. f. Gynäk. 27:736, 1903. 80. Möller: Monatschr. f. Geburtsh. u. Gynaek. 41:497, 1915. 81. Moench, G. L.: Ztschr. f. Geburtsh. u. Gynaek. 77:301, 1915 82. Surg., Gynec. & Obst. 49:150, 1929. 83. Mohr: Monatschr. f. Geburtsh. u. Gynaek. 36:366, 1912. 84. Momigliano, E.: Riv. ital. di ginec. 3:457, 1924. 85. Moraes Barros, N.; de Godoy, P., and Delascio, D.: Obst. y ginec. latino-am. 2:114, 1944. 86. Morgen, M.: Virchows Arch. f. path. Anat. 249:217, 1924. 87. Murray, N. A.; Dockerty, M. B., and Pemberton, J. de J.: Am. J. Obst. & Gynec. 44:134, 1942. 88. Neu, M.: Monatschr. f. Geburtsh. u. Gynaek. 34:251, 1911. 89. Neumann, H. O.: Arch. f. Gynaek. 163:600, 1937. 90. Nicholson, G. W.: Guy's Hosp. Rep. 87:391, 1937. 91. Norris, C. C.: Am. J. Obst. 60:985, 1909. 92. Oppenheimer, J. M.: Quart. Rev. Biol. 15:1, 1940. 93. Outerbridge, G. W.: Am. J. Obst. 68:1032, 1913. 94. Parodi, A.: Pathologica 14:529, 1922. 95. Pick, L.: Deutsche Med.-Ztg. 35:412, 1902 96. Berl. klin. Wchnschr. 39:442 and 618, 1902. 97. Piltz, W.: Ztschr. f. Geburtsh. u. Gynäk. 67:377, 1910. 98. Plauchu and Gaudon: Lyon méd. 132:1009, 1923. 99. Plaut, A.: Klin. Wchnschr. 10:1803, 1931Crossref 100. Am. J. Obst. & Gynec. 25:351, 1933. 101. Polano, O.: München. med. Wchnschr. 1:45, 1904 102. Ztschr. f. Geburtsh. u. Gynäk. 51:1, 1904. 103. Poli, G.: Ann. di ostet. 32:230, 1910. 104. Pollosson, A., and Violet: Lyon méd. 105:769, 1905. 105. Proescher, F., and Roddy, J. A.: Am. J. Obst. 61:619, 1910. 106. Ribbert: Deutsche med. Wchnschr. 31:1819, 1905. 107. Riebel, F. A., and Riebel, J. A.: Ohio State M. J. 23:304, 1927. 108. Ries, E.: Surg., Gynec. & Obst. 18:262, 1914. 109. Rohdenburg, G. L.: J. Lab. & Clin. Med. 12:211, 1926. 110. Rothe, H.: Monatschr. f. Geburtsh. u. Gynaek. 19:799, 1904. 111. Ruiz, F. R.: Rev. Soc. argent. de biol. 3:139, 1927. 112. Saidl, J.: Casop. lék. česk. 76:1653, 1937. 113. Sailer, S.: Am. J. Clin. Path. 13:271, 1943. 114. Salter, W. T.: The Endocrine Function of Iodine , Cambridge, Mass., Harvard University Press, 1940. 115. Sanders, R. L.: Am. J. Surg. 28:831, 1935.Crossref 116. Saxer, F.: Beitr. z. path. Anat. u. z. allg. Path. 31:452, 1902. 117. Schauta: Zentralbl. f. Gynäk. 35:898, 1911. 118. Schickele, G.: Beitr. z. Geburtsh. u. Gynäk. 16:130, 1911. 119. Schipper, G. F.: Beitrag zur Kasuistik der Struma ovarii, Inaug. Dissert., Bonn, E. Eisele, 1907. 120. Shapiro, P. F.: Ann. Surg. 92:1031, 1930.Crossref 121. Shaw, E. H.: Brit. J. Surg. 13:580, 1926.Crossref 122. Shaw, W.: J. Obst. & Gynaec. Brit. Emp. 39:13 and 234, 1932. 123. Sitzler, O.: Ueber Struma ovarii, Inaug. Dissert., Heidelberg, J. Hörning, 1913. 124. Spencer, H. R.: Proc. Roy. Soc. Med. 26:1438, 1933. 125. Swanton, J. H.: Brit. Gynaec. J. 22:244, 1906-1907. 126. Thaler, H.: Zentralbl. f. Gynäk. 47:1786, 1923. 127. Trapl, J.: Bratisl. lékar. listy 15:576, 1935. 128. Trettenero, M.: Riv. ital. di ginec. 12:184, 1931. 129. Tribedi, B. P., and De, S. N.: Calcutta M. J. 41:31, 1944. 130. Ulesko-Stroganowa, K.: Monatschr. f. Geburtsh. u. Gynaek. 22:503, 1905. 131. Vagedes: Deutsche med. Wchnschr. 30:1595, 1904 132. Monatschr. f. Geburtsh. u. Gynaek. 20:1301, 1904. 133. Walthard, M.: Ztschr. f. Geburtsh. u. Gynäk. 50:567, 1903. 134. Werth, G.: Zentralbl. f. Gynäk. 52:2944, 1928. 135. Wilms, M.: Deutsches Arch. f. klin. Med. 55:289, 1895 136. Beitr. z. path. Anat. u. z. allg. Path. 19:367, 1896. 137. Witherspoon, J. T.: Am. J. Obst. & Gynec. 24:240, 1932. 138. Wood, F. C.: Proc. New York Path. Soc. 9:51, 1909. 139. Wynne, H. M. N.; McCartney, J. S., and McClendon, J. F.: Am. J. Obst. & Gynec. 39:263, 1940.

STEVENS, G. ARNOLD

doi: 10.1001/archsurg.1946.01230060638002pmid: 20279411

Abstract TUMORS obstructing the common and hepatic bile ducts include primary neoplasms of the ducts and of the ampulla and carcinoma of the pancreas secondarily involving the common duct. Benign adenomas, polyps and congenital cysts may involve the ducts; however, carcinoma is relatively more frequent, and of this group carcinoma of the ampulla of Vater is perhaps the commonest.1 All these primary lesions are extremely rare. Kelznack found two instances in four thousand, five hundred and seventy-eight routine postmortem examinations, and McGlinn found five in nine thousand. Of twenty-two thousand operations on the biliary tract at the Mayo Clinic, only forty-one were for carcinoma of the bile ducts.2 The lesion occurs more frequently among men, and in about half of the cases it is associated with stones in the gallbladder or in the bile ducts. Primary carcinoma most frequently occurs at the junction of the cystic and common ducts References 1. Cole, W. H., and Elman, R.: Textbook of General Surgery , New York, D. Appleton-Century Company, Inc., 1939, p. 598. 2. Walters, W., in Christopher, F.: Textbook of Surgery , Philadelphia, W. B. Saunders Company, 1936, pp. 1334 and 1338. 3. Clagett, O. T.; Counseller, V. S., and Waugh, J. M.: Proc. Staff Meet., Mayo Clin. 21:5-10, 1946. 4. Waugh, J. M.; Dixon, C. F.; Clagett, O. T.; Bollman, J. L.; Sprague, R. G., and Comfort, M. W.: Proc. Staff Meet., Mayo Clin. 21:25-46, 1946. 5. Cole, W.: Surg., Gynec. & Obst. 82:104-105, 1946.

ELMAN, ROBERT;RIEDEL, HARRY

doi: 10.1001/archsurg.1946.01230060646003pmid: N/A

Abstract DESPITE the large number of studies on hemorrhage, there is little exact information in regard to the phenomenon of hemodilution, this term being used to describe a decrease in the red cell concentration in the blood, as measured by the hematocrit reading, by the erythrocyte count or by the concentration of hemoglobin. While most observers agree that hemodilution (i.e., anemia) ordinarily follows severe hemorrhage, it is generally believed to occur only after the lapse of time. For example, in two textbooks on hematology the hemodilution following a severe hemorrhage is described as follows: "The red cell count, hemoglobin, and volume of packed red cells, at first misleadingly high as the result of vasoconstriction and of liberation of corpuscles from storehouses such as the spleen, decrease and may continue to fall for several days even though hemorrhage has ceased."1 "There will be little or no deviation from normal if an References 1. Wintrobe, M. M.: Clinical Hematology , Philadelphia, Lea & Febiger, 1942, p. 391. 2. Fowler, W. M.: Hematology , New York, Paul B. Hoeber, Inc., 1945, p. 160. 3. Vierordt, K. von V.: Arch. physiol. de heilk. 13:274, 1854. 4. Elman, R.; Weiner, D. O., and Cole, W. H.: Proc. Soc. Exper. Biol. & Med. 32:793, 1935. 5. Adolph, E. F.; Gerbasi, M. J., and Lepore, M. J.: Am. J. Physiol. 104:502, 1933. 6. Bourne, W.; Bruger, M., and Dreyer, N. B.: Surg., Gynec. & Obst. 51:356, 1930. 7. Essex, H. E., and others: Proc. Soc. Exper. Biol. & Med. 35:154, 1936. 8. Hirota, K.: J. Biochem. 9:87, 1928. 9. Boyd, E. M., and Stevenson, J. W.: J. Biol. Chem. 122:147, 1937. 10. Ikeda, T.: Taiwan Igakkai Zasshi 41:322, 1932. 11. Fine, J.; Fischmann, J., and Frank, H. A.: Surgery 12:1, 1942. 12. Price, P. B.; Hanlon, C. R.; Longmire, W. P., and Metcalf, W.: Bull. Johns Hopkins Hosp. 69:327, 1941. 13. Magladery, J. W.; Solandt, D. Y., and Best, C. H.: Brit. M. J. 2:248, 1940. 14. Chevallier, A., and Trabouyer, L.: Compt. rend. Soc. de biol. 107: 1129, 1931. 15. Beard, J. W.; Wilson, H.; Weinstein, B. M., and Blalock, A.: J. Clin. Investigation 11:291, 1932. 16. Brown, G. L.; Miles, J. A. R.; Vaughan, J. M., and Whitby, L. E. H.: Brit. M. J. 1:99, 1942. 17. Zweifach, B. W.; Hershey, S. G.; Rovenstine, E. A.; Lee, R. E., and Chambers, R.: Surgery 18:49, 1945. 18. Weston, R. E.; Janota, M.; Levinson, S. O., and Necheles, H.: Am. J. Physiol. 138:450, 1943. 19. Calvin, D. B.: J. Lab. & Clin. Med. 26:1144, 1941. 20. Elman, R., and Davey, H. W.: Proc. Soc. Exper. Biol. & Med. 56:14, 1944. 21. Perera, G. A., and Berliner, R. W.: J. Clin. Investigation 22:25, 1944. 22. Ebert, R. V.; Stead, E. A., and Gibson, J. G.: Arch. internat. de med. 68:1578, 1941. 23. Walsh, R. J., and Sewell, A. K.: M. J. Australia 1:73, 1946. 24. Wallace, J., and Sharpey-Schafer, E. P.: Lancet 2:393, 1941.Crossref 25. Tonkes, E.: Zentralbl. f. Gynäk. 56:2003, 1932. 26. Elman, R.; Lischer, C. E., and Wolff, H.: Am. J. Physiol. 138:569, 1943.

CIESLAK, ARTHUR K.;STOUT, ARTHUR PURDY

doi: 10.1001/archsurg.1946.01230060657004pmid: 20279413

Abstract THE CAUSE of painful and traumatic neuromas is not clearly understood. The investigation reported in this paper has been undertaken with the hope of determining whether or not the various methods of dealing with the divided nerve ends influence their occurrence or prevention. The records of the Laboratory of Surgical Pathology have been examined for proved cases, and these as well as amputations of major extremities in the Presbyterian Hospital from 1932 to 1945 were reviewed. Only records with adequate follow-up were used. DEFINITION After section, the distal end of the nerve may enlarge and simulate a tumor. These enlargements, called neuromas, are not true neoplasms. The nodule is made up of granulation tissue through which many strands of regenerated or proliferated axons with Schwann sheaths pass. These are arranged in interlacing bundles running in all directions. It is believed that the granulation tissue preceding neuroma formation arises from the References 1. Stoney, R. A.: Forty Years' Experience with Nerve Suture , Irish J. M. Sc. , (March) 1944, pp. 85-92. 2. Coleman, C. C.: Peripheral Nerve Surgery: Diagnostic Considerations , J. Neurosurg. 1:123-132 ( (March) ) 1944.Crossref 3. Spurling, R. G.: Symposium on War Surgery: Use of Tantalum Wire and Foil in Repair , S. Clin. North America 23:1491-1504 ( (Dec.) ) 1943 4. Nerve Surgery: Technical Considerations , J. Neurosurg. 1:133-138 ( (March) ) 1944.Crossref 5. Gurdjian, E. S., and Smathers, H. M.: Peripheral Nerve Injury in Fractures and Dislocations of Long Bones , J. Neurosurg. 2:202-219 ( (May) ) 1945.Crossref 6. Weiss, P.: Sutureless Reunion of Severed Nerves with Elastic Cuffs of Tantalum , J. Neurosurg. 1:219-225 ( (May) ) 1944Crossref 7. Technology of Nerve Regeneration , Weiss J. Neurosurg. 1:400-450 ( (Nov.) ) 1944.Crossref 8. Davis, L., and Hiller, F.: Regeneration in End to End Suture, Grafts, and Gunshot Injuries , Tr. Am. Neurol. A. 70:178-179, 1944. 9. Smith, B. C.: Amputation Through Lower Third of Leg for Diabetic and Arteriosclerotic Gangrene , Arch. Surg. 27:267-295 ( (Aug.) ) 1933.Crossref 10. White, J. C.: Pain After Amputation (Especially Due to Neuroma and Phantom Limb) and Its Treatment , J. A. M. A. 124:1030-1035 ( (April 8) ) 1944.Crossref 11. Boldrey, E.: Amputation Neuroma in Nerves Implanted in Bone , Ann. Surg. 118:1052-1057 ( (Dec.) ) 1943.Crossref 12. Livingston, K. E.: Phantom Limb Syndrome: Discussion of Role of Major Peripheral Nerve Neuromas , J. Neurosurg. 2:251-255 ( (May) ) 1945.Crossref 13. Bate, J. T.: Method of Treating Nerve Ends in Amputation Stumps , Am. J. Surg. 64:373-374 ( (June) ) 1944.Crossref 14. Herrmann, L. G., and Gibbs, E. W.: Phantom Limb Pain: Relation to Treatment of Large Nerves at Time of Amputation , Am. J. Surg. 67:168-180 ( (Feb.) ) 1945.Crossref 15. Poth, E. J., and Fernandez, E. B.: Prevention of Neuroma Formation by Encasement of the Severed Nerve End in Rigid Tubes , Proc. Soc. Exper. Biol. & Med. 56:7-8 ( (May) ) 1944. 16. Poth, E. J.; Fernandez, E. B., and Drager, G. A.: Prevention of Formation of End-Bulb Neuromata , Proc. Soc. Exper. Biol. & Med. 60:200-207 ( (Nov.) ) 1945.

DONALD, DAN C.;MEADOWS, BURTON T.;SILBERMANN, S. J.

doi: 10.1001/archsurg.1946.01230060663005pmid: 20279414

Abstract OUR BELIEF is that the future success in the diagnosis of internal biliary fistula lies not in roentgenologic examination exclusively but more in evaluation of the pathologic antecedents that accompany the biliary fistula. With more emphasis placed on clinical study of cases of biliary disease, a greater number of biliary fistulas will be recognized earlier, thus minimizing future complications, and with more attention to the preoperative care the present mortality rate following operations on internal biliary fistulas will be reduced. Spontaneous internal biliary fistulas are infrequent. The majority result from infections and calculi in the gallbladder or are caused by a perforative ulcer or a malignant growth of the stomach or bowel. According to the literature, in only 108 cases have internal biliary fistulas been recognized preoperatively, and all have been diagnosed by roentgenologic examination. Of this number, including our case, in only 12 cases has diagnosis been made by References 1. Courvousier, L. G.: Casuistisch-statistische Beiträge zur Pathologie und Chirurgie der Gallenwege , Leipzig, F. C. W. Vogel, 1890, pp. 83-114. 2. Roth, cited by Courvousier.1 3. Dean, G. O.: Internal Biliary Fistulas , Surgery 5:857-864 ( (June) ) 1939. 4. Puestow, C. B.: Spontaneous Internal Biliary Fistula , Ann. Surg. 115: 1043-1054 ( (June) ) 1942.Crossref 5. Pataro, F. A.: La diarrea como síntoma de presunción diagnóstica de las fistulas biliares internas , Semana méd. 2:524-535 ( (Sept. 2) ) 1943. 6. Garland, L. H., and Brown, J. M.: Roentgen Diagnosis of Spontaneous Internal Biliary Fistulae, Especially Those Involving the Common Bile Duct , Radiology 38:154-159 ( (Feb.) ) 1942. 7. Murchison, C.: A Clinical Lecture on Diseases of the Liver, Jaundice and Abdominal Dropsy , edited by T. L. Brunton, London, Longmans, Green & Co., 1885, p. 569. 8. Stevenson, C. A., and Sherwood, M. W.: The Roentgen Diagnosis of Cholecystocolic Fistula , Radiology 35:616-621 ( (Nov.) ) 1940. 9. Bengolea, A. J., and Velasco Suárez, C.: Las fistulas bilares internas; contribucion a su estudio , Rev. med.-quir. de pat. fem. 7:125, 1936. 10. Rigler, L. G.; Borman, C. N., and Noble, J. F.: Gallstone Obstruction: Pathogenesis and Roentgen Manifestations , J. A. M. A. 117:1753-1759 ( (Nov. 22) ) 1941.Crossref 11. Eliason, E. L., and Stevens, L. W.: Spontaneous Internal Biliary Fistula , Am. J. Surg. 51:387-392 ( (Feb.) ) 1941.Crossref 12. Judd, E. S., and Burden, V. G.: Internal Biliary Fistula , Ann. Surg. 81: 305-312 ( (Jan.) ) 1925.Crossref

HODGEN, JOHN T.;FRANTZ, CHARLES H.

doi: 10.1001/archsurg.1946.01230060675006pmid: 20279415

Abstract ARREST of epiphysiodiaphysial growth, or epiphyseodesis, was originally described by Phemister1 in January 1933, having been proposed as a method of obtaining equalization of leg length in growing children. This procedure involves the removal of a block of bone 3 cm. in length and 1.5 cm. in width from across the epiphysial line. This block is about 0.5 cm. deep. After removal of the block of bone the epiphysial line is curetted for a distance of 2 to 5 cm. lateralward and about 10 to 15 mm. in depth. It is the experience of Hatcher that stripping of the periphery of the epiphysial line is sufficient and that deep curettement is unnecessary. The block of bone is then turned end on end and reinserted, so that a bony bridge covers the epiphysial line (fig. 1B). There have naturally arisen modifications of the original technic. Philip Wilson2 went References 1. Phemister, D. B.: Operative Treatment of Longitudinal Growth of Bones in the Treatment of Deformities , J. Bone & Joint Surg. 15:1 ( (Jan.) ) 1933. 2. Wilson, P. D., and Thompson, T. C.: A Clinical Consideration of the Methods of Equalizing Leg Length , Ann. Surg. 110:992 ( (Dec.) ) 1939. 3. White, J. W., and Stubbins, S. G., Jr.: Growth Arrests for Equalizing Leg Lengths , J. A. M. A. 126:1146 ( (Dec. 30) ) 1944. 4. White, J. W.: A Practical Graphic Method of Recording Leg Length Discrepancy , South. Med. J. 33:946 ( (Sept.) ) 1940. 5. White, J. W., and Warner, W. P., Jr.: Experiences with Metaphyseal Growth Arrests , South. Med. J. 31:411 ( (April) ) 1933. 6. Haas, S. L.: Retardation of Bone Growth by a Wire Loop , J. Bone & Joint Surg. 28:25 ( (Jan.) ) 1945. 7. Blount, W. P.: Personal communication to the authors. 8. Baldwin, B. T.: Physical Growth of Children from Birth to Maturity , in Studies in Child Welfare , Iowa City, University of Iowa, 1921, vol. 1, no. 1. 9. Gill, G. G.: The Cause of Discrepancy in Length of the Limbs Following Tuberculosis of the Hip in Children: Arrest of Growth from Premature Closure of the Epiphyseal Cartilages About the Knee , J. Bone & Joint Surg. 26:272 ( (April) ) 1944 10. A Simple Roentgenographic Method for the Measurement of Bone Length: A Modification of Milliwee's Method of Slit Scanography , Gill J. Bone & Joint Surg. 27:767 ( (Oct.) ) 1944. 11. Gill, G. G., and Abbott, L. C.: Practical Method of Predicting Growth of the Femur and Tibia in the Child , Arch. Surg. 45:286 ( (Aug.) ) 1942. 12. Straub, L. R.; Thompson, T. C., and Wilson, P. D.: The Result of Epiphyseodesis and Femoral Shortening in Relation to Equalization of Limb Length , J. Bone & Joint Surg. 27:254 ( (April) ) 1945. 13. Todd, T. N.: Atlas of Skeletal Maturation (Hand) , St. Louis, C. V. Mosby Company, 1937.

ROCHE, MAURICE B.;BRYAN, CHARLES S.

doi: 10.1001/archsurg.1946.01230060686007pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract ALONG accelerated tempo in investigations of syndromes of the lower part of the back during recent years, prespondylolisthesis and spondylolisthesis have been uncovered as relatively frequent findings. With reference to the defect in the neural arch, there has been speculation as to whether it has resulted from an intrauterine disturbance sufficient to fracture or to impede circulation to the isthmic portion, with the resultant defect of a pseudarthrosis, or whether there has been a developmental failure of bony fusion of the two separate ossification centers of this portion of the neural arch. We are prone to support the latter view and feel that other congenital anomalies of this isthmic portion may be present in addition. We seek to demonstrate some of these in the following presentation. The defect in the neural arch referred to as spondylolysis or spondyloschisis involves the isthmic portion, or pars interarticularis, situated between the superior and

KOZOLL, DONALD D.;HOFFMAN, WILLIAM S.;MEYER, KARL A.;GARVIN, THELMA

doi: 10.1001/archsurg.1946.01230060694008pmid: N/A

Abstract IN A RECENTLY reported study from this laboratory,1 it was shown that positive nitrogen balances could be consistently obtained in surgical patients with protein deficiency by the parenteral administration of amino acids as the only source of nitrogen. However, this method was not successful as a practical program for restoration of the large losses of nitrogen incurred in the protracted deficiency of protein of such patients. With nitrogen losses estimated to be on the order of 480 Gm., the average positive nitrogen balance of 4 Gm. that was obtained would require one hundred and twenty days of continuous intravenous treatment for complete restitution of protein stores. Such management was obviously impractical if not impossible. The time required could be reduced, it was true, if parenteral injections were supplemented with blood transfusions and with normal oral alimentation. The need for high intakes of protein or protein digests in patients with References 1. Kozoll, D. D.; Hoffman, W. S., and Meyer, K. A.: Nitrogen Balance Studies on Surgical Patients Receiving Amino Acids , Arch. Surg. 51:59 ( (July-Aug.) ) 1945.Crossref 2. Co Tui; Wright, A. M.; Mulholland, J. H.; Carabba, V.; Barcham, I., and Vinci, V. J.: Studies on Surgical Convalescence: I. Sources of Nitrogen Loss Postgastrectomy and Effect of High Amino Acids and High Caloric Intake on Convalescence , Ann. Surg. 120:99, 1944.Crossref 3. Elman, R.: The Oral Use of the Amino Acids of Hydrolyzed Casein (Amigen) in Surgical Patients , Am. J. Digest. Dis. 10:48, 1943.Crossref 4. Lund, C. C., and Levenson, S. M.: Protein in Surgery , J. A. M. A. 128:95 ( (May 12) ) 1945.Crossref 5. Furnished by Frederick Stearns & Company, Detroit. 6. Hoffman, W. S., and Osgood, B.: The Photoelectric Microdetermination of Nitrogenous Constituents of Blood and Urine by Direct Nesslerization , J. Lab. & Clin. Med. 25:856, 1940. 7. Peters, J. P., and Van Slyke, D. D.: Quantitative Clinical Chemistry , Baltimore, Williams and Wilkins Company, 1932, vol. 2, p. 78. 8. Gregerson, M. I.: A Practical Method for the Determination of Blood Volume with the Dye T-1824 , J. Lab. & Clin. Med. 29:1266, 1944. 9. Campbell, W. R., and Hanna, M. I.: The Albumins, Globulins, and Fibrinogen of Serum and Plasma , J. Biol. Chem. 119:15, 1937. 10. Chatfield, C., and Adams, G.: The Proximate Composition of American Food Materials, Circular no. 549, United States Department of Agriculture, 1940. 11. Allison, J. B., and Anderson, J. A.: The Relation Between Absorbed Nitrogen, Nitrogen Balance and Biological Value of Proteins in Adult Dogs , J. Nutrition 29:413, 1945. 12. Abbott, W. E., and Mellors, R. C.: Total Circulating Plasma Proteins in Surgical Patients with Dehydration and Malnutrition , Arch. Surg. 46:277( (Feb.) ) 1943. 13. Epstein, A. A.: Concerning the Causation of Edema in Chronic Parenchymatous Nephritis: Method for Its Alleviation , Am. J. M. Sc. 154:638, 1917. 14. Turner, D. F.: Selection of Protein Containing Foods to Meet Protein Requirements , J. A. M. A. 128:590 ( (June 23) ) 1945. 15. Jones, D. B.: Factors for Converting Percentages of Nitrogen in Foods and Feeds into Percentages of Protein, Circular no. 183, United States Department of Agriculture, 1931.

LYONS, ALBERT S.;GARLOCK, JOHN H.

doi: 10.1001/archsurg.1946.01230060713009pmid: 20279418

Abstract IN 1932, Crohn, Ginzburg and Oppenheimer1 first described the clinicopathologic entity which was called "terminal ileitis." Since then, many instances of the same pathologic process in all parts of the ileum and jejunum have caused modification of the term to "regional enteritis." Of the numerous cases reported, however, in only a few has the disease been limited to the jejunum. Harris, Bell and Brunn2 first described a case with the lesion wholly in the jejunum. Brown and Donald3 included in their 178 cases of regional enteritis 5 instances of primary jejunal lesions. W. R. Johnson4 reported a case with multiple diseased segments which were all confined to a few feet of jejunum and for which resection with end to side anastomosis was performed. H. N. Brewster5 also described an instance of localized obstructing jejunitis in a small section of bowel treated by resection and anastomosis. References 1. Crohn, B. B.; Ginzburg, L., and Oppenheimer, G. D.: Regional Ileitis: Pathologic and Clinical Entity , J. A. M. A. 99:1323 ( (Oct. 15) ) 1932.Crossref 2. Harris, F. I.; Bell, G. H., and Brunn, H.: Chronic Cicatrizing Enteritis: Regional Ileitis (Crohn) New Surgical Entity , Surg., Gynec. & Obst. 57:637 ( (Nov.) ) 1933. 3. Brown, P. W., and Donald, C. J.: Prognosis of Regional Enteritis , Am. J. Digest. Dis. 9:87 ( (March) ) 1942. 4. Johnson, W. R.: Chronic, Non-Specific Jejunitis with Unusual Features , Gastroenterology 1:347 ( (April) ) 1943. 5. Brewster, H. N., cited by Crohn, B. B., in discussion on Johnson.4 6. Garlock, J. H., and Ginzburg, L.: Regional Ileitis , Ann. Surg. 116:906 ( (Dec.) ) 1942.