A.M.A. Archives Surgery

Lindskog, Gustaf E.

doi: 10.1001/archsurg.1952.01260020645001pmid: 12984966

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 THE PAST decade has witnessed rather definite changes in the content of thoracic surgery. An ever-increasing employment of antibiotic drugs in the management of acute respiratory tract infections has decreased sharply the incidence of pneumonia, postpneumonic empyema, and pulmonary abscess, at least as seen in general hospital practice. The latter two diseases at one time furnished a considerable fraction of thoracic surgical case material, especially in the winter months, but are now reduced to a minor role. Despite this and other results of chemotherapy, the field of thoracic surgery continues to expand. Almost every year brings its new surgical procedure or new therapeutic concepts. By way of illustration one has only to recall the enormous progress made in the area of cardiovascular surgery since the first successful ligation of a patent ductus arteriosus was performed in 1938. One development in thoracic surgery which has contributed in a minor way to

KLEITSCH, WILLIAM P.

doi: 10.1001/archsurg.1952.01260020647002pmid: 12984967

Abstract HYPERTROPHY of the pyloric sphincter as a source of symptoms in the adult is an uncommon but by no means rare condition. Recent extensive reviews of the literature have brought the subject up-to-date.1 Unfortunately, however, in most instances the condition has been described as more or less of a medical curiosity, and diagnosis has been insufficiently stressed. Indeed, Bockus2 has said, "A positive preoperative diagnosis of pyloric muscle hypertrophy in adults is not possible." It is my opinion, to the contrary, that this condition is associated with sufficient constant roentgenographic features to be diagnosable by the radiologist or the gastroenterologist. An increased awareness of this disease, together with an appreciation of its diagnostic criteria, will bring surgical relief to a number of patients now treated medically for vague abdominal and epigastric symptoms. In this series of four cases the patient was usually referred to the surgeon as having References 1. McCann, J. C., and Dean, M. A.: Hypertrophy of Pyloric Muscle in Adult , Surg., Gynec. & Obst. 90:535-542, 1950. 2. North, J. P., and Johnson, J. H.: Pyloric Hypertrophy in the Adult , Ann. Surg. 131:316-329, 1950. 3. Bockus, H. L.: Pyloric Muscle Hypertrophy in Adults, in Gastro-Enterology, Vol. I: The Esophagus and Stomach: Examination of the Patient, and Diagnosis and Treatment of Disorders of the Esophagus and Stomach, Including Duodenal Ulcer , Philadelphia, W. B. Saunders Company, 1943, pp. 759-761. 4. McClure, C. C.: Hypertrophy of the Pyloric Muscle in Adults , Surg., Gynec. & Obst. 52:945-952, 1931. 5. Donovan, E. J.: Congenital Hypertrophic Pyloric Stenosis , Ann. Surg. 124:708-715. 1946. 6. Fowler, L. H., and Hanson, W. A.: Gastrojejunal Ulcer Following Gastro-Enterostomy Performed 24 Years Before for Pyloric Stenosis of Infancy , Minnesota Med. 23:602, 1940. 7. Horwitz, A.; Alvarez, W. C., and Ascanio, H.: The Normal Thickness of the Pyloric Muscle and the Influence on It of Ulcer, Gastro-Enterostomy and Carcinoma , Ann. Surg. 89:521-528. 1929. 8. Wollstein, M.: Healing of Hypertrophic Pyloric Stenosis After Fredet-Rammstedt Operation , Am. J. Dis. Child. 23:511-517, 1922.

KLEITSCH, WILLIAM P.

doi: 10.1001/archsurg.1952.01260020657003pmid: 12984968

Abstract AN ESOPHAGEAL hiatus hernia is frequently asymptomatic or unsuspected until it is discovered accidentally when roentgenograms of the gastrointestinal tract are made because of other pathology.1 Not uncommonly, however, such hernias do produce symptoms. It is important to note that these symptoms, although mild and intermittent, form a definite symptom complex if truly caused by hiatus hernia. This symptom complex consists of substernal or epigastric pain, acid eructations, and, most characteristically, aggravation of the pain precipitated by maneuvers which increase intra-abdominal pressure.2 Because of the fact that many esophageal hiatus hernias are asymptomatic and many of those that are symptomatic are only mildly so, there has been a controversy as to what should be done about them. Errors in diagnosis are frequent, and the significance of hiatus hernia is often overlooked. Frequently the dilemma is solved (?) by the physician by prescribing medical treatment consisting of a bland References 1. (a) Bowden, L., and Miller, C. J.: Massive Hematemesis from Hiatus Hernia: Report of 4 Cases with Discussion of Etiology , A. M. A. Arch. Surg. 63:143-146 ( (Aug.) ) 1951.Crossref 2. (b) Brick, I. B., and Amory, H. I.: Incidence of Hiatus Hernia in Patients Without Symptoms , Arch. Surg. 60:1045-1050 ( (June) ) 1950.Crossref 3. (a) Richards, G. G., and Crockett, K. A.: Hiatus Hernia , Arch. Surg. 58:411-418 ( (April) ) 1949.Crossref 4. (b) Rossien, A. X.; Reuling, J. R., and Stanton, A.: A Study of Hiatus Hernia , Am. J. Digest. Dis. 17:69-76 ( (March) ) 1950.Crossref 5. (c) Simmons, E. E.; Long, R. S.; Hunt, H. B., and Moore, R. C.: Hiatus Hernia: Analysis of 25 Cases , Arch. Int. Med. 86:253-265 ( (Aug.) ) 1950.Crossref 6. (a) Pickhardt, O. C.; Rafsky, H. A., and Ghiselin, F. H.: Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310-315 ( (Feb. 4) ) 1950.Crossref 7. Clerf, L. H.; Shallow, T. A.; Putney, F. J., and Fry, K. E.: Esophageal Hiatal Hernia , J. A. M. A. 143:169-172 ( (May 13) ) 1950.Crossref 8. Surgical Forum: Esophageal Hiatus Hernia , Arch. Surg. 60:633-634 ( (March) ) 1950.Crossref 9. Simmons, Long, and Hunt.2c Surgical Forum.5 10. Sweet, R. H.: Esophageal Hiatus Hernia of the Diaphragm: The Anatomical Characteristics, Technic of Repair, and Results of Treatment in 111 Consecutive Cases , Ann. Surg. 135: 1-13 ( (Jan.) ) 1952.Crossref 11. lerf, Shallow, Putney, and Fry.4 Richards and Crockett.2a

LASSEN, H. KRIEGER

doi: 10.1001/archsurg.1952.01260020665004pmid: 12984969

Abstract DURING recent years two new methods have been developed for treatment of perforated gastric or duodenal ulcers: primary subtotal gastrectomy and conservative therapy without surgical intervention. The marked fall in the mortality figures for gastric resection which has occurred during recent years has induced some surgeons to employ this procedure in certain of their patients with perforated ulcer. Owing to the effect of antibiotics, blood transfusions, and adequate parenteral administration of fluids combined with continuous suction through an indwelling stomach tube, conservative therapy without surgical intervention has been successfully used in treating the same disorder. I have had no experience with the latter method of treatment, but through a follow-up study of our patients at Central Hospital I am able to give an opinion on the use of primary gastrectomy, for which reason I publish the following report. The series presented consists of all the patients who were treated for References 1. Alsted, G.: Studies on the Changing Incidence of Peptic Ulcer of the Stomach and Duodenum , Copenhagen, Ejnar Munksgaards Forlag, 1939. 2. Abrahamsen, H.: Hospitalstid. 68:367, 1925. 3. Tovee, E. B.: A. M. A. Arch. Surg. 63:408, 1951.Crossref 4. Morville, P.: Hospitalstid. 73:315, 1930. 5. Kühnel, P.: Hospitalstid. 73:849, 1930. 6. Sørensen, B.: Ugesk. læger 113:991, 1951. 7. Luer, C. A.: Surgery 27:360, 1950.

ROMANUS, RAGNAR

doi: 10.1001/archsurg.1952.01260020674005pmid: 12984970

Abstract AFTER the publication of an article by Collins entitled, "Endometriosis of the Vermiform Appendix: Review of Literature, with Addition of Nine New Instances, One of Which Caused Severe Melena," which appeared in the A. M. A. Archives,1 it now seems opportune to report five of my own cases. They had other types of clinical findings than those reported by Collins, though the endometrial tissue had the same unusual location. In 1932 to 1933, operations for endometriosis of the appendix were carried out in four cases, at the Maria Hospital, headed at that time by Prof. E. Key. In 1935 I made a short report to the Swedish Surgical Association of these and 31 other cases collected from the literature. Most of the latter are included in Collins' review, but reference to his footnotes shows that he failed to mention 11 cases. These 11 cases, my four, and another one References 1. Collins, D. C.: Endometriosis of the Vermiform Appendix , A. M. A. Arch. Surg. 63:617-.622, 1951.Crossref 2. Horn, J.: Om endometrioser , Nord. med. tidskr. 1:71-76, 1929.

EZE, W. C.

doi: 10.1001/archsurg.1952.01260020676006pmid: 12984971

Abstract THE HEPATIC artery contributes about 20% of hepatic blood flow, while the portal vein carries the remaining 80%. There is some collateral supply, but under normal conditions this is negligible. Reciprocal variations in the amount of blood carried by either the hepatic artery or the portal vein occur, and Soskin and co-workers1 have observed that this reciprocal variation could be as low as 10% or as high as 90% in either vessel. Some interesting observations have been made when the liver is supplied by either one of these vessels, the other being tied. Ligation of the portal vein, as in Eck fistula, results in parenchymal fibrosis and considerable reduction in the size of the liver. The dogs, however, do not die, and there is little or no alteration in hepatic function.2 Ligation of all the branches of the hepatic artery is followed in about 100% of cases by References 1. Soskin, S.; Essex, H. E.; Herrick, J. F., and Mann. F. C.: The Mechanism of Regulation of the Blood Sugar by the Liver , Am. J. Physiol. 124:558, 1938. 2. Mann, F. C., and Bollman, J. L.: Liver Function Tests , Arch. Path. & Lab. Med 1:681, 1926. 3. (a) Haberer, H.: Experimentelle Unterbindung der Leberarterie , Arch. klin. Chir 78:557, 1905. 4. (b) Harrison, G. A.: Chemical Methods in Clinical Medicine: Their Application and Interpretation with the Technique of the Simple Tests , Ed. 2, London, J. & A. Churchill, Ltd., 1937. 5. (c) Huggins, C., and Post, J.: Experimental Subtotal Ligation of the Arteries Supplying the Liver , Arch. Surg. 35:1165, 1937. 6. (d) Narath, A.: Über Entstehung der anämischen Lebernekrose nach Unterbindung der Arteria hepatica und ihre Verhütung durch arterio-portale Anastomose , Deutsche Ztschr. Chir. 135:375, 1916. 7. (a) Fraser, D.; Rappaport, A. M.; Vuylsteke, C. A., and Colwell, A. R.: The Effects of the Ligation of the Hepatic Artery in the Dog , Surgery 30:624, 1951. 8. (b) Grindlay, J. H.; Mann, F. C., and Bollman, J. L.: Effect of Occlusion of the Arterial Blood Supply to the Normal Liver: Experimental Study , A. M. A. Arch. Surg. 62:806, 1951. 9. (c) Markowitz, J.; Rappaport, A. M., and Scott, A. C.: The Function of the Hepatic Artery in the Dog , Am. J. Digest. Dis. 16:344, 1949 10. (d) Prevention of Liver Necrosis Following Ligation of the Hepatic Artery , Proc. Soc. Exper. Biol. & Med. 70:305, 1949. 11. (e) Markowitz, J., and Rappaport, A. M.: The Hepatic Artery , Physiol. Rev. 31:188, 1951. 12. (f) Tanturi, C.; Swigart, L. L., and Canepa, J. F.: Prevention of Death from Experimental Ligation of the Liver (Hepatic Proper) Branches of the Hepatic Artery , Surg., Gynec. & Obst. 91:680, 1950. 13. Ellis, J. C.; and Dragstedt, L. R.: Liver Autolysis in Vivo , Arch. Surg. 20:8, 1930. 14. Graham, R. R., and Cannell, D.: Accidental Ligation of the Hepatic Artery: Report of One Case, with Review of Cases in Literature , Brit. J. Surg. 20:566, 1933. 15. MacLennan, J. D., and MacFarlane, R. G.: Toxin Antitoxin Studies of Gas-Gangrene in Man , Lancet 249:301, 1945. 16. Bollman, J. L.: The Influence of Diet on the Production of Ascites , Arch. Path. 6:162, 1928. 17. (a) Benedict, S. R.: The Detection and Estimation of Glucose in Urine , J. A. M. A. 57:1193, 1911. 18. (b) Esbach, H.: Urine Protein , in Hawk, P. B.; Oser, B. R., and Summerson, W. H.: Practical Physiological Chemistry , Philadelphia, The Blakiston Company, 1947, p. 868. 19. (c) Malloy, H. T., and Evelyn, K. A.: The Determination of Bilirubin with the Photoelectric Colorimeter , J. Biol. Chem. 119:481, 1937. 20. (d) Nelson, N.: A Photometric Adaptation of the Somogyi Method for the Determination of Glucose , J. Biol. Chem. 153:375, 1944. 21. (e) Somogyi, M.: A New Reagent for the Determination of Sugars , J. Biol. Chem. 160:61, 1945. 22. (f) Rosenthal, S. M., and White, E. C.: Clinical Application of the Bromsulphalein Test for Hepatic Function , J. A. M. A. 84:1112, 1925. 23. (g) Schiff, L.: The Differential Diagnosis of Jaundice . Chicago, The Year Book Publishers, Inc., 1946. 24. Hoffman, W. S.: Subcutaneous Versus Intramuscular Administration of Penicillin , J. Lab. & Clin. Med. 31:1165, 1946. 25. Ungar, J.: Penicillin in Tissue Exudates After Injection , Lancet 1:56, 1950.

TELOH, H. A.

doi: 10.1001/archsurg.1952.01260020685007pmid: 12984972

Abstract CARCINOMA and lymphoma of the tonsil are more easily recognized than cured, and the ease with which a diagnosis of cancer in this area may be made is offset by the poor prognosis and poor results achieved in therapy. Although the average practitioner may have the opportunity to see only isolated examples of this condition during a lifetime of practice, its relative frequency is high when compared with the incidence of other cancers of the pharynx. The present report is concerned with evaluation of a series of 162 patients with cancers of the tonsil seen in the outpatient clinic or admitted to the Pondville Hospital (Massachusetts Department of Public Health) from 1927 to 1945 inclusive. This hospital is a state institution for the treatment of malignant disease. INCIDENCE During the period encompassed by this report there were seen 162 patients with malignant tumors in the region of the tonsil. This References 1. Martin, H. E., and Sugarbaker, E. L.: Cancer of the Tonsil , Am. J. Surg. 52:155-196 ( (April) ) 1941.Crossref 2. Schall, L. A.: Carcinoma of the Tonsil: Statistical Study of 230 Cases , New England J. Med. 211:997-1000 ( (Nov. 29) ) 1934.Crossref 3. Mattick, W. L.: The Diagnosis and Treatment of Cancer of the Tonsil , Radiology 35:268-273 ( (Sept.) ) 1940.Crossref 4. Despons, J.: Cancer de l'amygdale , Rev. de laryiig. 49:305 ( (May 15) ) 5. 339 (May 31) 1928. 6. Nathanson, E. A.: Cancer of the Tonsils , Arch. Clin. Cancer Res. 3:181, 1927-1928. 7. Burnam, C. F.: Diagnosis and Treatment of Malignant Tonsil Conditions , Surg., Gynec. & Obst. 55:633-639 ( (Nov.) ) 1932. 8. Berven, E. G. E.: Radiation Therapy of Malignant Tumors of the Tonsil, in Pack, G. T., and Livingston, E. M.: Treatment of Cancer and Allied Diseases, New York, Paul B. Hoeber, Inc. 9. Coutard, H.: Roentgen Therapy of Epitheliomas of the Tonsillar Region. Hypopharynx and Larynx from 1920 to 1926 , Am. J. Roentgenol. 28:313-331 ( (Sept.) ) 1932. 10. Mathey-Cornat, R.: Le traitement du cancer de l'amygdale par les radiations: Résultats éloignés , J. radiol. et électrol. 26:173-174. 1944-1945.

BAKER, ROGER;GORDON, ROBERT;HUFFER, JOHN;MILLER, GEORGE H.

doi: 10.1001/archsurg.1952.01260020694008pmid: 12984973

Abstract ON THE basis of existing evidence the cause for failure of renal transplantation is due to the host developing antibodies in response to the foreign protein of the graft. This immune process is not only a natural phenomenon but also a valuable protective biological reaction. The present paper is concerned with methods of modifying or depressing this renal antigen-antibody response by use of nitrogen mustard (methyl bis [β-chloroethyl] amine hydrochloride), cortisone, and splenectomy. Philips, Hopkins, and Freeman,1 and others2 have demonstrated that nitrogen mustard will suppress development of antibodies. Germuth and co-workers3 have shown that cortisone is effective for states of hypersensitivity. Rich and co-workers4 have indicated also that cortisone inhibits antigen-antibody reactions. Persky and Jacob,5 however, failed to note any increased survival of renal transplantation in the cortisone-treated dog. The role of the spleen in the development of antibodies has been explored. After intravenous References 1. Philips, F. S.; Hopkins, F. H., and Freeman, M. L. H.: J. Immunol. 55:289, 1947. 2. Janeway, C. A.; Schwab, L.; Moll, F. C.; Hall, T.; Brean, H.; Kirk, M., and Hawn, C. Z.: J. Exper. Med. 91:505, 1950.Crossref 3. Bukantz, S. C.; Dammin, G. J.; Wilson, K. S.; Johnson, M. C., and Alexander, H. L.: Proc. Soc. Exper. Biol. & Med. 72:21, 1949. 4. Germuth, F. G.; Nedzel, G. A.; Ottinger, B., and Oyama: Proc. Soc. Exper. Biol. & Med. 76:177, 1951. 5. Rich, A. R.; Bennett, I. L.; Cochran, T. H.; Griffith, P. C., and McGood, D. C., Bull. Johns Hopkins Hosp. 88:189, 1951. 6. Persky, L., and Jacob, S., Proc. Soc. Exper. Biol. & Med. 77:66, 1951. 7. Harris, T. N.; Rhoads, J., and Stokes, J., Jr.: J. Immunol. 58:27, 1948. 8. Wolfe, H. R.; Norton, S.; Springer, E.; Goodman, M., and Herrick, C. A.: J. Immunol. 64:179, 1950. 9. The cortisone (Cortone) was supplied through Dr. Elmer Alpert, of Merck & Company, Inc. 10. Williamson, C. S.: J. Urol. 16:231, 1926. 11. Ibuka, K.: Am. J. Med. Sc. 171:420, 1926. 12. Marpurgo, B.: Arch. ital. de biol. 78:108, 1927.

REINHOLD, JOHN G.;VON FRIJTAG DRABBE, A. J.;NEWTON, MICHAEL;THOMAS, JOHN

doi: 10.1001/archsurg.1952.01260020698009pmid: 12984974

Abstract THE USE of polyvinylpyrrolidone (PVP)1 and of dextran2 has been proposed for increasing the volume of plasma after hemorrhage and for the treatment of shock. Earlier experience with acacia used for this purpose indicated that it impaired liver function.3 In addition, the use of acacia depressed the formation of plasma protein,4 possibly because of its action on the liver. Although dextran and polyvinylpyrrolidone have been used extensively in foreign clinics, there is little specific information concerning possible ill effects on the liver function of man. Bohmansson and co-workers have made some studies of dextran, using for this purpose bile pigment, hippuric acid, and phosphatase determinations. We have extended these studies by means of other liver function tests, including several generally considered to be more sensitive than those used by these workers, and. in addition, have made similar studies of polyvinylpyrrolidone. METHOD The patients studied were those References 1. Hecht, G., and Weese, H.: A New Plasma Substitute , München. med. Wchnschr. 90: 11-15, 1943. 2. Schultz, E.: Blood Transfusion and Blood Substitutes in War , Deutsche med Wchnschr. 67:779-784, 1941.Crossref 3. Flannery, M. M., and Menkin, A.: Polyvinylpyrrolidone , New York, General Aniline and Film Corp., 1951. 4. Grönwall, A., and Ingelman, B.: Untersuchungen über Dextran und sein Verhalten bei parenteraler Zufuhr, I ., Acta physiol. scandinav. 7:97-107, 1944Crossref 5. Untersuchungen über Dextran und sein Verhalten bei parenteraler Zufuhr, II ., Grönwall Acta physiol. scandinav. 9:1-27, 1945.Crossref 6. Ingelman, B.: Investigations on Dextran and Its Application as a Plasma Substitute , Upsala läkaref. förh. 54:107-122, 1949. 7. Bohmansson, G.; Rosenkvist, H.; Thorsen, G., and Wilander, O.: Clinical Experiences with Dextran as a Plasma Substitute , Acta chir. scandinav. 94:149-167, 1946. 8. Lundy, J. S.; Gray, H. K., and Craig, W. M.: Dextran in Supportive Therapy with Comments on Periston and Gelatins , Arch. Surg. 61:55-61, 1950.Crossref 9. Hall, W. K.; Gibson, R. B., and Weed, L. A.: Studies on the Intravenous Injection of Colloids: II. Effects of Gum Acacia on Certain Functions of the Liver with a Note on Its Effects on the Production of Immune Bodies , J. Lab. & Clin. Med. 26:330-339, 1940. 10. Jackson, R. L., and Frayser, L.: The Effect of Acacia on the Blood , J. Pharmacol. & Exper. Therap. 65:440-452, 1939. 11. Nine patients received 1 liter of a preparation of polyvinylpyrrolidone manufactured in Germany and bottled by the Schenley Laboratories, Inc. The intrinsic viscosity of the material was 0.245, the average molecular weight approximately 30,000. The remainder of the patients received polyvinylpyrrolidone manufactured by the General Aniline and Film Corporation. The average molecular weight of this material was 33,000; the K value was 33. Both preparations contained 3.5% of polyvinylpyrrolidone in 0.85% sodium chloride solution. Dextran was supplied by the Commercial Solvents Corporation. It was given as a 5.9% solution. The results of a typical analysis were as follows: viscosity 3.18 centipoises; no precipitation at 45% methyl alcohol; 88% precipitation at 58% methyl alcohol, and 12% precipitation at 80% methyl alcohol. 12. Malloy, H. T., and Evelyn, K. A.: The Determination of Bilirubin with the Photoelectric Colorimeter , J. Biol. Chem. 119:481-490, 1937. 13. Ducci, H., and Watson, C. J.: The Determination of the Serum Bilirubin with Special Reference to the Prompt-Reacting and the Chloroform-Soluble Types , J. Lab. & Clin. Med. 30:293-300, 1945. 14. Reinhold, J. G., and Hutchinson, C.: To be published. 15. Maclagan, N. F.: Thymol Turbidity Test: A New Indicator of Liver Dysfunction , Nature, London 154:670-671, 1944. 16. Kunkel, H. G.; Ahrens, E. H., Jr., and Eisenmenger, W. J.: Application of Turbidimetric Methods for Estimation of Gamma Globulin and Total Lipid to the Study of Patients with Liver Disease , Gastroenterology 11:499-507, 1948. 17. de la Huerga, J., and Popper, H.: Standardized Reagent for Thymol Turbidity Test , J. Lab. & Clin. Med. 34:877-880, 1949. 18. Hanger, F. M.: Serological Differentiation of Obstructive from Hepatogenous Jaundice by Flocculation of Cephalin-Cholesterol Emulsions , J. Clin. Invest. 18:261-269, 1939. 19. Neefe, J. R., and Reinhold, J. G.: Photosensitivity as a Cause of Falsely Positive Cephalin-Cholesterol Flocculation Tests , Science 100:83-85, 1944. 20. von Frijtag Drabbe, C. A. J., and Reinhold, J. G.: Determination of Polyvinylpyrrolidone in Body Fluids by Means of a Turbidity Producing Reaction with Phenol, to be published. 21. Weichselbaum, T. E.: An Accurate and Rapid Method for the Determination of Proteins in Small Amounts of Blood Serum and Plasma , Am. J. Clin. Path. 10:40-49, 1946. 22. Majoor, C. L. H.: The Possibility of Detecting Individual Proteins in Blood Serum by Differentiation of Solubility Curves in Concentrated Sodium Sulfate Solutions: Comparison of Solubility Curves with Results of Electrophoresis Experiments , J. Biol. Chem. 169:583-594, 1947. 23. Watson, C. J.; Schwartz, S.; Sborov, V., and Bertie, E.: Studies of Urobilinogen: A Simple Method for the Quantitative Recording of the Ehrlich Reaction as Carried out with Urine and Feces , Am. J. Clin. Path. 14:605-615, 1944. 24. Watson, C. J., and Schwartz, S.: A Method of Separating Small Quantities of the Coproporphyrin Isomers I and III , Proc. Soc. Exper. Biol. & Med. 44:7-10, 1940. 25. Bonsnes, R. W., and Taussky, H. H.: On the Colorimetric Determination of Creatinine by the Jaffe Reaction , J. Biol. Chem. 158:581-591, 1945. 26. Zamchek, N.; Chalmers, T. C., and Davidson, C. S.: Pathologic and Functional Changes in the Liver Following Upper Abdominal Operations , Am. J. Med. 7:409, 1949.Crossref 27. Neefe, J. R.; Kurtz, C. H.; Smith, H. D.; Reynolds, H. M.; Gambescia, J. M., and Reinhold, J. G.: Technique Book of the Hospital of the University of Pennsylvania , Philadelphia, University of Pennsylvania Press, 1951. 28. Neefe, J. R., and Reinhold, J. G.: Laboratory Aids in the Diagnosis and Management of Infectious (Epidemic) Hepatitis , Gastroenterology 7:393-413, 1946 29. Studies of Responses of Certain Hepatic Tests in Diseases of the Liver and Biliary Tract , Neefe Gastroenterology 9:656-671, 1947. 30. Fisher, R. A.: Statistical Methods for Research Workers , Ed. 6, London, Oliver and Boyd, Ltd., 1936.

HOWE, CHESTER W.;PORELL, WILLIAM J.

doi: 10.1001/archsurg.1952.01260020706010pmid: 12984975

Abstract A STANDARD routine for studying the effects of various surgical procedures upon the acidity of the gastric contents of ulcer patients has been used in this clinic for several years. Previous reports1 have dealt with gastric acidity under fasting (basal) conditions and in response to neurogenic and chemical stimuli in normal persons and in ulcer patients. Secretory responses have been studied before and after gastric resections of various extent, alone and combined with sympathectomy or vagotomy. The clinical and laboratory results following removal of approximately 50% of the stomach combined with vagotomy indicate that of all the combinations studied, the best protection against the development of gastrojejunal ulceration is afforded by this operation. Similar investigations on dogs have been carried out simultaneously with the clinical studies. Previous papers from the experimental laboratory discussed the assessment of gastric secretory responses in general,2 the effects of 50% gastrectomy combined with References 1. (a) Smithwick, R. H., and Kneisel, J. J.: The Effect of Resection of the Sympathetic and Parasympathetic Innervation of the Stomach upon Gastric Acidity , Rev. Gastroenterol. 17:439, 1950. 2. (b) Farmer, D. A.; Howe, C. W.; Porell, W. J., and Smithwick, R. H.: The Effect of Various Surgical Procedures upon the Acidity of the Gastric Contents of Ulcer Patients , Ann. Surg. 134:319, 1951.Crossref 3. Howe, C. W.; Porell, W. J., and Ware, P. F.: Assessment of Gastric Secretory Responses in Relation to Peptic Ulcer: Method of Study and Control Data on 39 Normal Dogs , A. M. A. Arch. Surg. 63:234, 1951.Crossref 4. Effects of Sympathectomy Alone and Combined with Gastrectomy on Gastric Secretory Responses: Experimental Study on Esophageal-Fistula Dogs, with Normal Stomachs , Howe A. M. A. Arch. Surg. 64:238, 1952.Crossref 5. Ware, P. F., and Howe, C. W.: Experimental Esophageal and Pharyngocervical Fistula , A. M. A. Arch. Surg. 63:229, 1951.Crossref 6. Farmer and associates.1b Howe and associates.2 7. Several changes in the study routine have recently been made as a result of experience to date. Samples during the 1-hour basal and broth periods are now collected in three 20-minute aliquots. The insulin period has been shortened to two hours, during which four half-hour aliquots are collected. Representative samples from each period are used for pepsin determinations. The histamine test has been omitted. All tests are run on the same day. 8. Smithwick, R. H.: Total Gastrectomy with Particular Reference to Closed (Aseptic) Esophagojejunostomy , New England J. Med. 237:39, 1947.Crossref 9. Porell, W. J., and Howe, C. W.: Assessment of Gastric Acidity and Pepsin in Relation to Peptic Ulcer: I. Acidity of Gastric Contents , Boston M. Quart. 2:73, 1951. 10. Visick, A. H.: Measured Radical Gastrectomy: Review of 505 Operations for Peptic Ulcer , Lancet 1:505, 1948.Crossref