A.M.A. Archives Surgery

Caroli, Jacques

doi: 10.1001/archsurg.1953.01260030412001pmid: 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 DETERMINATION of the sulfobromophthalein appearance-time in bile is not a laboratory procedure but a simple clinical method. Its measurement is made by the combination of duodenal intubation with the usual intravenous injection of sulfobromophthalein (150 mg. per square meter). For this purpose, the biliary fluid is simply collected by siphonage into tubes containing a few drops of 10% sodium hydroxide solution; these tubes are shaken every minute until a reddish-violet color develops. In order that the test be reliable (a) the output of biliary juice must be sufficient (about 1 cc. per minute as an average), and (b) it must contain a detectable amount of bile. Moreover, the biliary flow can be stimulated by intraduodenal instillation of procaine hydrochloride or magnesium sulfate. In normal subjects the sulfobromophthalein appearance time ranges between 5 and 15 minutes. This test is of significant value in uncommon cases of subtotal and yet latent common

Starr, Kenneth W.

doi: 10.1001/archsurg.1953.01260030413002pmid: 13039701

Abstract IN 1938, Lahey suggested that gallstone surgery had evolved through the three stages of cholecystostomy, cholecystectomy, and choledochotomy. Now possibly it has entered a fourth stage, that of dealing with residual problems. External biliary drainage after choledochotomy by means of an indwelling tube (or T-tube) has had a wide vogue. In a recent study, however, I drew attention to the fact that tubal drainage is not always certain drainage and that obstructive jaundice and biliary peritonitis may still occur. Furthermore, the technical problem of an irremovable T-tube, or the fluid and electrolyte imbalance associated with excessive loss of bile may tax the most expert. The results of a five-year study in 160 cases of drainage of the common bile duct were presented before the Mayo Foundation on Oct. 3, 1952. It indicated that external biliary drainage had occasionally failed to prevent recurrence of obstructive jaundice or to ameliorate with certainty References 1. Millbourn, E.: On the Excretory Ducts of the Pancreas in Man, with Special Reference to Their Relations to Each Other, to the Common Bile Duct and to the Duodenum , Acta anat. 9:1-34, 1950.Crossref 2. Littler, T. R., and Ellis, G. R.: Gall-Stones: A Clinical Survey , Brit. M. J. 1:842-844 ( (April 19) ) 1952.Crossref 3. Womack, N. A.: The Origin of Cholecystitis , Surg., Gynec. & Obst. 79:441-444 ( (Oct.) ) 1944.

Bell, H. Glenn

doi: 10.1001/archsurg.1953.01260030414003pmid: 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 MELANOSARCOMA is a dread disease. Once the diagnosis has really been made, the percentage of cure is very small. Whether the actual number in the lay public is increasing or whether this just appears to be the case because we are seeing more of them at the University Medical Center is hard to determine. It does seem to me, however, that we are seeing more young people with this type of lesion. In addition, there appear to be more people who have noticed a growth or change in a pigmented lesion following repeated exposure to the sun and, perhaps, to the irritation of sand on the beach. The over-all rage to get a good sun tan has definitely, I am certain, played a part. Just recently we have seen three people who had had no other trauma to their lesion except repeated severe sunburn, and perhaps some irritation of the lesion while lying on the beach.

PACKARD, GEORGE B.

doi: 10.1001/archsurg.1953.01260030416004pmid: 13039702

Abstract THIS IS my first opportunity to express to you my deep appreciation of the honor of serving as your presiding officer. I feel very humble when I look over the names of the distinguished surgeons who have gone before me in the presidency of this fine and illustrious surgical organization. It is the duty of a president to deliver an address. This one will be short, and its brevity may be its greatest asset, for you will not all accept the ideas in it—ideas which have concerned me for a long time. I want to say something about time—it seems more important to me now than it did years ago. May I quote from a recent sea novel, part of a letter from a doctor to his son? Remember this if you can—there is nothing, nothing more precious than time. You probably feel you have a measureless supply of it, References 1. Wouk, H.: The Caine Mutiny , Garden City, N. Y., Doubleday & Company, 1951. 2. Gregg, A.: Can Excellence be Learned? J. A. Am. M. Coll. 19:105 ( (March) ) 1944. 3. Stalnaker, J. M.: Study of Applicants for Admission to United States Medical Colleges. Class Entering in 1950-1951 , J. M. Educ. 26:1 ( (Jan.) ) 1951. 4. Markee, J. E.; Harris, J. S., and Davison, W. C.: Programs to Provide More Physicians , J. M. Educ. 26:437 ( (Nov.) ) 1951. 5. Hutchings, R. M.: Education for Freedom , Harper's Magazine ( (Oct.) ) 1941.

MAYO, CHARLES W.;FERGESON, JAMES O.

doi: 10.1001/archsurg.1953.01260030421005pmid: 13039703

Abstract ALL MEN interested in medical pathology seem to believe that there is a hereditary factor present in the individual susceptibility to disease. Particularly does this belief apply to the occurrence of pathologic processes of unknown cause. When the etiology of any one of the idiopathic conditions is finally understood, all physicians may be quite amazed that the simplicity of that etiology remained so long undiscovered. We feel that all physicians should always be alert to the possibility of occurrence of significant results of presently available common laboratory examinations which might point toward the solution of etiologic problems, even though the tests now seem to apply to entirely different aspects of the disease in question. With these ideas in mind, we have chosen five pathologic entities of obscure etiology. They are duodenal ulcer, malignant neoplasms of the gastrointestinal tract, chronic ulcerative colitis, chronic cholecystitis with cholelithiasis, and pulmonary embolism proved at References 1. Morgan, W. T. J.: Occurrence and Nature of Human Blood-Group Substances , Brit. M. Bull. 2:165-168 ( (Oct.) ) 1944. 2. Boyd, W. C.: Use of Blood Groups in Human Classification , Science n. s. 112:187-196 ( (Aug. 18) ) 1950.Crossref 3. Best, C. H., and Taylor, N. B.: The Physiological Basis of Medical Practice , Ed. 4, Baltimore, Williams & Wilkins Company, 1945. 4. Foord, A. B.: Significance of Results Obtained in Blood Grouping Tests , Ann. West. Med. & Surg. 4:478-483 ( (Sept.) ) 1950. 5. Alexander, W.: An Inquiry into the Distribution of the Blood Groups in Patients Suffering from "Malignant Disease," Brit. J. Exper. 2:66-69 ( (April) ) 1921. 6. Hooper, I.: Origins and Distributions of Blood Groups , Irish J. M. Sc. , pp. 382-388, (Aug.) 1950. 7. Pautienis, K., Medicina , Kaunas 18:1-12 ( (Jan.) ) 1937. 8. Potter, E. L.: The Rh Factor in Obstetrics , M. Clin. North America 28:254-266 ( (Jan.) ) 1944. 9. Yannet, H.: Importance of the Rh Factor in Mental Deficiency: Preliminary Report , Bull. New York Acad. Med. 20:512-514 ( (Sept.) ) 1944. 10. Mitra, P. N.: The Influence of Blood Group in Certain Pathological States , Indian J. M. Research 20:995-1004 ( (April) ) 1933. 11. Pautienis, K., Medicina , Kaunas 18:1-12 ( (Jan.) ) 1937. 12. Pautienis, K.: Kraujo grupes ir ju sasyjis su kaikuriomis ligomis, Medicina , Kaunas 18:1-12 ( (Jan.) ) 1937. 13. Tagliaferro, E.: Gruppi sanguigni e carcinoma , Minerva Med. 1:219-220 ( (March 4) ) 1937. 14. Lessa, A., and Alarcão, J.: Contribuição para o estudo das incidências dos tipos do sistema clássico ABO, sobre os estados mórbidos, Hema, Ser. 2, No. 1, pp. 1-32q, 1949. 15. Ugelli, L.: Distribuzione dei gruppi sanguigni negli individui portatori di ulcére gastroduodenali , Policlinico (sez. prat.) 43:1591-1594 ( (Sept. 7) ) 1936.

PATTON, ROBERT J.

doi: 10.1001/archsurg.1953.01260030425006pmid: 13039704

Abstract DIVERTICULOSIS of the colon is an irreversible structural change that occurs in approximately 5% of persons beyond middle age. Symptoms are absent or inconsequential unless some degree of inflammation supervenes; this constitutes diverticulitis and occurs in an estimated 10% of diverticulosis cases.1 In the great majority of these cases diet and medication constitute adequate treatment, but complications requiring surgery occur in approximately 1 in every 10 cases of diverticulitis. Such complications are perforation, abscess, fistula formation, obstruction, hemorrhage, and inability to differentiate between diverticulitis and cancer. The current surgical trend is not toward new procedures in the treatment of these complications, for the fundamental operations have been long established. But modern bowel surgery has been rendered less hazardous by the development of poorly absorbed sulfonamides and antibiotics so that a more radical approach to the problem may decrease the over-all morbidity of the disease without an unreasonable mortality rate. References 1. Smithwick, R. H.: Experiences with the Surgical Management of Diverticulitis of the Sigmoid , Ann. Surg. 115:969, 1942.Crossref 2. Gramse, A. E.; Dockerty, M. B., and Waugh, J. M.: False Diverticula of the Appendix , S. Clin. North America 29:1189, 1949. 3. Wilson, R. R.: Diverticula of the Appendix and Certain Factors in Their Development , Brit. J. Surg. 38:65, 1950.Crossref 4. Lauridsen, J., and Ross, F. P.: Acute Diverticulitis of the Cecum , A. M. A. Arch. Surg. '64:320, 1952.Crossref 5. Bosworth, B. M., and Laundan, F. L.: Solitary Diverticulum of the Ascending Colon , Surgery 29:523, 1951. 6. Albright, H. L., and Leonard, F. C.: Management of Diverticulitis Coli , Am. J. Surg. 82:674, 1951.Crossref 7. Pemberton, J. deJ.; Black, B. M., and Maino, C. R.: Progress in the Surgical Management of Diverticulitis of the Sigmoid Colon , Surg., Gynec. & Obst. 85:523, 1947. 8. Neal, J. W.: Diverticulitis of the Colon and Its Surgical Management , Surgery 30:606, 1951. 9. Woodruff, M. F. A.: Spontaneous Perforation of the Large Bowel , Ann. Surg. 135:221, 1952. 10. Bacon, H. E.: Anus, Rectum, Sigmoid Colon: Diagnosis and Treatment , Ed. 3, Philadelphia, J. B. Lippincott Company, 1949. 11. Albers, J. H., and Smith, L. L.: A Comparison of Cecostomy and Transverse Colostomy in Complete Colon Obstruction , Surg., Gynec. & Obst. 95:410, 1952. 12. Boyden, A. M.: The Surgical Treatment of Diverticulitis of the Colon , Ann. Surg. 132:94, 1950.

WALTERS, WALTMAN;KELLY, ANTHONY H.

doi: 10.1001/archsurg.1953.01260030432007pmid: 13039705

Abstract ON PREVIOUS occasions one of us (Walters) has presented studies of 165 patients with stricture of the common and hepatic duct operated on from 1924 to 1947 inclusive.1 The present study is based on 100 patients on whom 113 operations were performed from 1948 through 1951. In this group were 11 patients on whom one of us (Walters) had previously operated for stricture.2 The operative mortality rate was 7.1%. Since a thorough study of the cases prior to 1949 was presented at one of the meetings of a surgical association at that time and subsequently, in this presentation we shall confine our discussion principally to our recent study of patients operated on from 1948 through 1951. and shall reserve until another occasion a detailed comparison of the different groups of cases. In Table 1 are recorded the different types of surgical procedures used, the number of cases in References 1. Walters, W., and Lewis, E. B.: Strictures of the Common and Hepatic Bile Ducts with a Report of 98 Cases , in Lahey, F. H.: Frank Howard Lahey Birthday Volume, June First, Nineteen Hundred Forty , Springfield, Ill., Charles C Thomas, Publisher, 1940, pp. 443-457. 2. Walters, W.: Physiologic Studies in Cases of Stricture of the Common Bile Duct , Ann. Surg. 130:448-454 ( (Sept.) ) 1949.Crossref 3. Walters, W., and Phillips, S. K.: Physiologic Aspects of Repaired Stricture of the Extrahepatic Bile Ducts: Report of 165 Cases , Proc. Staff Meet., Mayo Clin. 24:12-16 ( (Jan. 5) ) 1949 4. Stricture of the Bile Ducts , in Christopher, F.: A Textbook of Surgery , Ed. 5, Philadelphia, W. B. Saunders Company, 1949, pp. 1152-1161. 5. Walters, W., and Marvin, C. P.: Complete Stricture of the Extrahepatic Bile Ducts: External Hepaticostomy Followed by Spontaneous Hepatoduodenal Fistula , Arch. Surg. 57:18-23 ( (July) ) 1948.Crossref 6. Walters, W., and Cameron, J. M.: Studies of Biliary Strictures and Their Surgical Treatment in 184 Patients , Proc. Staff Meet., Mayo Clin. 25:150-156 ( (March 29) ) 1950. 7. Walters, W.: Symposium on Abdominal Surgery: Strictures of the Common and Hepatic Bile Ducts and Their Treatment , S. Clin. North America 30:987-1000 ( (Aug.) ) 1950. 8. A drop or two of bile frequently will indicate the location of the duct when an impending fistulous tract to the duodenum is trying to develop.

CHILDS, SAMUEL B.;PREVEDEL, ARTHUR E.

doi: 10.1001/archsurg.1953.01260030438008pmid: 13039706

Abstract WE ARE reporting from the Surgical Service of the University of Colorado School of Medicine 100 consecutive cases of exploration of the common bile duct in an effort to determine the positive incidence of choledocholithiasis, and the relation between jaundice and choledocholithiasis; and to determine whether choledocholithiasis develops as a new condition following previous cholecystectomy. In 290 cholecystectomies, choledochotomy was performed 100 times, or 34%. In no instance in this series—as proved by the necessity for reexploration—was there failure to explore a duct which was obstructed by calculus. In three instances, reexploration of the duct was required to correct obstruction which had not been relieved at the initial operation. Our error, then, has not been attributable to our criteria for exploring the common duct, but rather to our failure to make sure of removing all obstructing calculi which were present (Table 1). If there is doubt that a patent duct

SNYDER, HOWARD E.;SNYDER, CECIL D.;BUNCH, LEITHA D.

doi: 10.1001/archsurg.1953.01260030441009pmid: 13039707

Abstract THE ENZYME cholinesterase is a protein of liver origin. The concentration of cholinesterase appearing in the blood serum at any one time is a reflection of the rate of formation of the enzyme by the liver. The value of the determination of the cholinesterase activity of the blood serum as an index of liver function in various pathological states has been reported by many. Our preliminary observations on its value as a liver function test in surgical patients have been previously reported.1 This report is concerned with studies conducted on an additional 49 patients, all of whom underwent surgery on the biliary tract. In these patients serum cholinesterase levels were determined on one or more preoperative days, immediately before and immediately after the surgery performed, and on the 1st, 2d, 3d, 4th, 5th, 7th, and 10th postoperative days. Hemoglobin levels were determined simultaneously. Laboratory determinations of serum cholinesterase activity, hemoglobin content, and all other blood References 1. Snyder, H. E.; Snyder, C. D., and Bunch, L. D.: Serum Cholinesterase Levels in Surgical Patients , Am. Surg. 17:959-981 ( (Oct.) ) 1951.

ROBINSON, DAVID W.

doi: 10.1001/archsurg.1953.01260030449010pmid: 13039708

Abstract THE LOWLY plantar wart, although a very small lesion, may cause great disability. Most plantar warts respond well to simple forms of treatment, but a multiplicity of methods of therapy indicates no single better mode. Electrocoagulation,1 chemicals,2 freezing,3 podophyllin,4 and irradiation5 have all produced some good results. Claims of "cures" as high as 95% are made for various treatments, but little is written about the poor results of specific types of therapy. Surgical excision has few advocates because of the resultant painful scars and calluses. Many persons are insensitive to radiotherapy,6 and the many poor results of such repeated or overenthusiastic treatment are seen by every service for reconstructive surgery.7 In general, repeated treatments have caused deep fibrosis, which is the fundamental pathologic cause of intractable ulceration with its attendant pain. Crippling orthopedic imbalances of years' standing attest the pain and psychological disturbances References 1. Karp, F. L.: Electrosurgical Removal of Plantar Warts (Loop Treatment) , Arch. Dermat. & Syph. 53:496-497 ( (May) ) 1946. 2. Blank, H.: Treatment of Plantar Warts , Arch. Dermat. & Syph. 56:459-461 ( (Oct.) ) 1947. 3. Montgomery, A. H., and Montgomery, R. M.: Mosaic Type of Plantar Wart: Its Characteristics and Treatment , Arch. Dermat. & Syph. 57:397-399 ( (March) ) 1948. 4. Wright, W. L.: Plantar Wart Therapy , U. S. Nav. M. Bull. 49:707-709 ( (July-Aug.) ) 1949. 5. Kurtin, A., and Yontef, R.: Podophyllum Therapy for Plantar Warts , Arch. Dermat. & Syph. 57:395-396 ( (March) ) 1948. 6. Tobias, N.: The Plantar Wart , Mississippi Valley M. J. 70:206-209 ( (Nov.) ) 1948. 7. McLaughlin, C. R.: Plantar Warts: A Plea for Rational Treatment , Lancet 1:168-169 ( (Jan. 31) ) 1948. 8. McIndoe, A. H.; Forbes, R., and Windeyer, B. W.: Symposium: Radiation Necrosis , Brit. J. Radiol. 20:269-278 ( (July) ) 1947. 9. Blair, V. P.; Brown, J. B., and Byars, L. T.: Plantar Warts, Flaps, and Grafts , J. A. M. A. 108:24-27 ( (Jan. 2) ) 1937. 10. Dickson, J. A.: Surgical Treatment of Intractable Plantar Warts , J. Bone & Joint Surg. 30-A:757-760 ( (July) ) 1948. 11. Greeley, P. W.: Plastic Repair of Radiation Ulcers of the Sole , U. S. Nav. M. Bull. 45:827-830 ( (Nov.) ) 1945. 12. Pangman, W. J., and Gurdin, M.: Treatment of Complicated Plantar Lesions , Plast. & Reconstruct. Surg. 5:516-519 ( (June) ) 1950. 13. Shaw, M. H.: Treatment of Chronic Ulceration After Irradiation of Plantar Wart , Brit. M. J. 1:11 ( (Jan. 3) ) 1948. 14. Ghormley, R. K., and Lipscomb, P. R.: The Use of Untubed Pedicle Grafts in the Repair of Deep Defects of Foot and Ankle: Technique and Results , J. Bone & Joint Surg. 26:483-488 ( (July) ) 1944. 15. Haggart, G. E.: The Conservative and Surgical Treatment of Plantar Warts , S. Clin. North America 14:1211-1218 ( (Oct.) ) 1934.