Archives of Surgery

RICHARDSON, WILLIAM R.

doi: 10.1001/archsurg.1961.01300110003001pmid: 13741310

Abstract Cancer ranks second only to accidents as a cause of death in children. It is now the leading cause of death from disease in children of ages 3 to 14 years. The years of potential salvage provide a better measure of general importance than the 1% contribution to malignant disease of all ages. "Management" properly implies that all phases of total care are the concern of the surgeon, and "recent advances" may conveniently be presented under 4 headings: research and education, prevention, diagnosis, and treatment. Research and Education Cancer in children is a major concern for an increasing number of physicians and institutions, and this has inevitably accelerated progress in management and understanding. Rupert Willis' recent book title, Borderlands of Embryology and Pathology, recognizes the fundamental biologic significance of growth research in the young.1 No tumor of the adult ordinarily grows as rapidly as does the normal embryo. Nowhere References 1. Willis, R.: The Borderland of Embryology and Pathology , Baltimore, Williams and Wilkins Company, 1958. 2. Winship, T.: Carcinoma of The Thyroid in Children , Pediatrics 18:459, 1956. 3. DiGeorge, A. M., and Paschkis, K. E.: Some Aspects of Tumors of the Endocrine Glands , Pediat. Clin. N. Amer. 6:583, 1959. 4. Dukes, C. E.: Cancer Control in Familial Polyposis of the Colon , Dis. Colon Rectum 1:413, 1958.Crossref 5. Smith, W. G.: Multiple Polyposis, Gardner's Syndrome and Desmoid Tumors , Dis. Colon Rectum 1:323, 1958.Crossref 6. Swenson, O.: Follow-Up on 200 Patients Treated for Hirschsprung's Disease During A 10-Year Period , Ann. Surg. 146:706, 1957.Crossref 7. Hiatt, R. B.: A Further Description of the Pathologic Physiology of Congenital Megacolon and the Results of Surgical Treatment , Pediatrics 21:825, 1958. 8. Hubbard, T. B., Jr.: Familial Polyposis of the Colon: The Fate of the Retained Rectum After Colectomy in Children , Amer. Surg. 23: 577, 1957. 9. Kiviranta, U. K.: Corrosion Carcinoma of the Esophagus , Acta Otolaryng. 42:89, 1952.Crossref 10. West, J. P., and Van Schoonhoven, P. V.: Cancer of the Lung Developing in a Congenital Cyst , Surgery 42:1071, 1957. 11. Bergmann, M., and Charnas, R. M.: Tracheobronchial Rests in the Esophagus , J. Thor. Surg. 35:97, 1958. 12. Schlosser, R. J.; Kanar, E. A., and Harkins, H. N.: I. The Surgical Significance of Marjolin's Ulcer , Surgery 39:645, 1956. 13. Cannon, B.; Murray, J. E., and Randolph, J. G.: Malignant Irradiation for Benign Conditions , New Engl. J. Med. 260:197, 1959.Crossref 14. Copeland, M. M., and Geschickter, C. F.: Diagnosis and Treatment of Premalignant Lesions of the Breast , Surg. Clin. N. Amer. 30:1717, 1950. 15. Gross, R. E.; Clatworthy, H. W., Jr., and Meeker, I. A., Jr.: Sacrococcygeal Teratomas in Infants and Children , Surg. Gynec. Obstet. 92: 341, 1951. 16. Bodian, M.: Neuroblastoma , Pediat. Clin. N. Amer. 6:449, 1959. 17. Koop, C. E.; Kiesewetter, W. B., and Horn, R. C.: Neuroblastoma in Childhood , Surgery 38: 272, 1955. 18. Wittenborg, M. H.: Roentgen Therapy in Neuroblastoma , Radiology 54:679, 1950.Crossref 19. Gross, R. E.; Farber, S., and Martin, L. W.: Neuroblastoma Sympatheticum , Pediatrics 23:1179, 1959. 20. Riker, W., and Bigler, J. A.: Unpredictability of Tumors in Childhood , Pediatrics 24:666, 1959. 21. Potter, E. L.: Pathology of the Fetus and the Newborn , Chicago, Year Book Publishers, Inc., 1952, p. 166. 22. Lister, W. A.: Natural History of Strawberry Nevi , Lancet 1:1429, 1938.Crossref 23. MacCollum, D. W., and Martin, L. W.: Hemangiomas in Infancy and Childhood , Surg. Clin. N. Amer. 26:1647, 1956. 24. Lampe, I., and Latourette, H. B.: Management of Hemangiomas in Infants , Pediat. Clin. N. Amer. 6:511, 1959. 25. Ravitch, M. M.: Radical Treatment of Massive Mixed Angiomas in Infants and Children , Ann. Surg. 134:228, 1951.Crossref 26. Andersen, D. H., and Perrin, E. V.: Soft Tissue Tumors , Pediat. Clin. N. Amer. 6:543, 1959. 27. Ladd, W. E., and White, R. R.: Embryoma of the Kidney , J. A.M.A. 117:1858, 1941.Crossref 28. Richardson, W. R., and Watkins, E., Jr.: Blood Volume Studies in Pediatric Surgical Patients, Presentation, American College of Surgeons Forum, San Francisco, 1960 ; A.C.S. Surgical Forum 11:106, 1960. 29. Gross, R. E.: The Surgery of Infancy and Childhood , Philadelphia, W. B. Saunders Company, 1953. 30. Ober, W. E.; Smith, J., and Rouillard, F. C.: Congenital Sarcoma Botryoides of the Vagina , Cancer 11:620, 1958.Crossref 31. Craig, J. M.: Tumors of the Lower Genitourinary Tract , Pediat. Clin. N. Amer. 6:491, 1959. 32. Edmondson, H. A.: Differential Diagnosis of Tumors and Tumor-Like Lesions of Liver in Infancy and Childhood , A.M.A. Amer. J. Dis. Child. 91:168, 1956. 33. Donovan, E. J., and Santulli, T. V.: Resection of the Left Lobe of the Liver for Mesenchymoma , Ann. Surg. 124:90, 1946.Crossref 34. Clatworthy, H. W., Jr., and Boles, E. T., Jr.: Right Lobectomy of the Liver in Children , Surgery 39:850, 1956. 35. Gans, H.: Introduction to Hepatic Surgery , Amsterdam, Elsevier Press, Inc., 1955. 36. Lam, C.: Material Presented to American Association for Thoracic Surgery, Miami Beach, May, 1960. 37. Richardson, W. R., and Gliedman, M. L.: Pulmonary Resection for Metastic Neoplasm in Children, presented at the American Academy of Pediatrics meeting, 1958, to be published. 38. Collins, V. P.: The Treatment of Wilms' Tumor , Cancer 11:89, 1958.Crossref 39. Uson, A. C.; Del Rosario, C., and Melicow, M. M.: Wilms' Tumor in Association with Cystic Renal Disease: Report of Two Cases , J. Urol. 83:262, 1960. 40. Ellis, F. H., Jr., et al.: Surgical Implications of the Mediastinal Shadow in Thoracic Roentgenograms of Infants and Children , Surg. Gynec. Obstet. 100:532, 1955. 41. Boyd, G. L.: Solid Intrathoracic Masses in Children , Pediatrics 19:1, 1957.

KNOX, W. GRAHAM;WEST, JOHN P.

doi: 10.1001/archsurg.1961.01300110018002pmid: 13757240

Abstract Arteriography is of prime importance in the diagnosis of occlusive arterial disease and in evaluating patients for reconstructive arterial surgery. Unfortunately, these examinations are not without some risks. Hemorrhage,14 thrombosis,13 and tissue necrosis,5,7 as well as renal1,6,7,10,12 and spinal cord2 damage have been reported. In some cases these complications have resulted in death of the patients.3,4,12 The purpose of this report is twofold—first, to present an analysis of 330 arterial dye injection studies using sodium acetrizoate (Urokon), illustrating a minimal complication rate; and second, to document precautions which can minimize many of the more serious complications inherent in the technique employed. Clinical Experience In an 8-year period, 1952 through 1959, there was a total of 330 arteriographic studies performed which may be divided into 3 categories: (1) 135 abdominal aortograms obtained by translumbar injection of 70% sodium acetrizoate; (2) 64 femoral arteriograms performed References 1. Beall, A. C., Jr.; Crawford, E. S.; Couves, C. M.; DeBakey, M. E., and Mayer, J. H.: Factors Influencing Renal Function Following Aortography with 70 Per Cent Urokon , Surgery 43:364, 1958. 2. Boyarsky, S.: Paraplegia Following Translumbar Aortography , J.A.M.A. 156:599, 1954.Crossref 3. Ciccantelli, M. J.; Gallagher, W. B.; Skemp, F. C., and Dietz, P. C.: Fatal Nephropathy and Adrenal Necrosis After Translumbar Aortography , New Engl. J. Med. 250:433, 1958.Crossref 4. Conger, K. B.; Reardon, H., and Arey, J.: Translumbar Aortography Followed by Fatal Renal Failure and Severe Hemorrhagic Diathesis , A.M.A. Arch. Surg. 74:287, 1957.Crossref 5. Crawford, E. S.; Beall, A. C.; Mayer, J. H., and DeBakey, M. E.: Complications of Aortography , Surg. Gynec. Obstet. 104:129, 1957. 6. Derrick, J. R.; Logan, W. D., and Howard, J. M.: Pitfalls of Translumbar Aortography and Peripheral Arteriography , A.M.A. Arch. Surg. 76:517, 1958.Crossref 7. Foster, J. H., and Killen, D. A.: Aortography and Peripheral Arteriography. (Analysis of Results in a University Medical Center) , Ann. Surg. 149:321, 1959.Crossref 8. Goodwin, W. E., and Walter, R. C.: Intra-Aortic Procaine Injection in Aortography , Angiology 4:410, 1953.Crossref 9. Huger, W. E.; Margolis, G., and Grimson, K.: Protective Effect of Intra-Aortic Injection of Procaine Against Renal Injuries Produced in Experimental Aortography , Surgery 43:52, 1958. 10. Killen, D. A.; Lance, E. M., and Owens, G.: Relative Suitability of Urokon (70 Per Cent) and Hypaque (90 Per Cent) for Use as Aortographic Contrast Media , Surgery 45:436, 1959. 11. Kincaid, O. W., and Davis, G. D.: Abdominal Aortography (Medical Progress) , New Engl. J. Med. 259:1067, 1958.Crossref 12. McAfee, J. C.: Survey of Complications of Abdominal Aortography , Radiology 68:825, 1957.Crossref 13. McDowell, R. F. C., and Thompson, I. D.: Inferior Mesenteric Artery Occlusion Following Lumbar Aortography , Brit. J. Radiol. 32:344, 1959.Crossref 14. Smith, R. G., and Campbell, D. A.: Some Technical Considerations in the Arteriographic Examination of the Lower Extremity , Surgery 24:655, 1948. 15. Trippel, O.; Bernhard, V.; Hohf, R., and Laufman, H.: Considerations in the Accuracy and Safety of Arteriography , Surgery 41:153, 1957. 16. West, J. P.; Ada, A. E. W., and Knox, W. G.: Arteriosclerotic Occlusion of the Terminal Aorta, Iliac, and Femoral Arteries (Surgical Treatment) , Surg. Clin. N. Amer. 34:403, 1954. 17. Wylie, E. J., and Goldman, L.: The Role of Aortography in the Determination of Operability in Arteriosclerosis of the Lower Extremities , Ann. Surg. 148:325, 1958.Crossref

BERENS, JAMES J.

doi: 10.1001/archsurg.1961.01300110024003pmid: N/A

Abstract Recent studies1-5 have been reported from several laboratories demonstrating the presence of malignant cells in the blood streams of patients having malignant neoplasm. The cytologic studies are positive for malignant cells in a significant number of patients in blood specimens drawn from the peripheral blood as well as from the regional veins draining the tumor. Of even greater importance is the observation that showers of cancer cells may follow various types of tumor manipulation, such as diagnostic examinations (pelvic exams), surgical preparation of skin (mammary tumors), and operative procedures. These excellent studies serve to confirm the works of Tyzzer,6 who in 1913 demonstrated that gentle massage of a transplanted carcinoma in a mouse greatly increased the number of metastases in the lung, and of Knox7 (1922), who observed that gentle massage of tumors in the mouse increased the number of tumor emboli which can produce metastatic tumors. References 1. Potter, J. F.; Longenbaugh, G.; Chu, E.; Dillon, J.; Romsdahl, M., and Malgrem, R. A.: The Relationship of Tumor Type and Resectability to the Incidence of Cancer Cells in Blood , Surg. Gynec. Obstet. 110:734-738, 1960. 2. Long, L.; Jonasson, O.; Roberts, S.; McGrath, R.; McGrew, E., and Cole, W. H.: Cancer Cells in Blood , A.M.A. Arch. Surg. 80:910-917, 1960.Crossref 3. Moore, G. C.; Sandberg, A. A., and Watne, A. L.: Spread of Cancer Cells and Its Relationship to Chemotherapy , J.A.M.A. 172:1729-1733, 1960.Crossref 4. Engell, H. C.: Cancer Cells in Blood: Fiveto Nine-Year Fellow-Up Study , Ann. Surg. 149: 457-461, 1959.Crossref 5. Pruitt, J. E.; Hilberg, A. W., and Kaiser, R. E.: Malignant Cells in Peripheral Blood , New Engl. J. Med. 259:1161-1164, 1958.Crossref 6. Tyzzer, E. E.: Factors in the Production and Growth of Tumor Metastases , J. Med. Res. 28:309-332, 1913. 7. Knox, L. C.: The Relationship of Massage to Metastasis in Malignant Tumors , Ann. Surg. 75:129-141, 1922.Crossref 8. Meyer, W.: An Improved Method of the Radical Operation for Carcinoma of the Breast , Med. Record 46:746-749, 1894. 9. Berens, J. J.: Reappraisal of Surgical Treatment of Mammary Carcinoma , J.A.M.A. 170: 1365-1369, 1959.Crossref

SPELL, JAMES P.;HARDY, JAMES D.

doi: 10.1001/archsurg.1961.01300110027004pmid: N/A

Abstract The clinician is frequently disappointed in the quality of the diagnostic assistance gained from liver function studies where it is important to differentiate medical jaundice from surgical jaundice. At operation the surgeon may find a grossly diseased liver when the preoperative liver function studies had been relatively normal. The purpose of our investigation was to evaluate in dogs the effects of specific lesions upon liver function tests. Procedure and Methods Thirty mongrel dogs varying in weight from 12-25 kg. were employed. They were divided into 7 groups in which the following specific lesions were produced:A liver function test battery (serum bilirubin, alkaline phosphatase, cephalin flocculation, and thymol turbidity) was run preoperatively and at 24 hours, 48 hours, 72 hours, 1 week, and 2 weeks postoperatively. Results Alkaline Phosphatase: Effect of Different Lesions upon This Measurement. —In Figure 1 are shown the serum alkaline phosphatase values before and after ligation

HORVATH, STEVEN M.;BENDER, A. DOUGLAS

doi: 10.1001/archsurg.1961.01300110030005pmid: 13716031

Abstract Blood flow through the splanchnic bed has long been considered a major component of the total circulation by virtue of its function as a blood depot,1,2 and thus, under control of the nervous system, plays a significant role as a determinant of cardiac output.3 Alterations in hepatic blood flow may cause or reflect physiological changes in the systemic circulation. It has been shown4 that after total occlusion of the thoracic aorta hepatic blood flow persisted at a level 27% of the control flow rate. This finding suggested the presence of collateral arterial circulation. Indeed, a subsequent study5 confirmed anatomically the presence of arterial anastomoses which connected the thoracic and abdominal aortas, and which became functional within a few seconds after the obstruction of the major channel. The development of collateral venous circulation has been demonstrated by complete occlusion of inferior vena cava in man6 and References 1. Grindlay, J. H.; Herrick, J. F., and Mann, F. C.: Measurement of Blood Flow of Liver , Amer. J. Physiol. 132:489, 1941. 2. Horvath, S. M.; Kelly, T.; Folk, G. E., Jr., and Hutt, B. K.: Measurement of Blood Volumes in the Splanchnic Bed of the Dog , Amer. J. Physiol. 189:573, 1957. 3. Werner, A. Y.; MacCanon, D. M., and Horvath, S. M.: Fractional Distribution of Total Blood Flow to and Oxygen Consumption of the Liver as Influenced by Mild Hemorrhage , Amer. J. Physiol. 170:624, 1952. 4. Allbaugh, E., and Horvath, S. M.: Effect of Total Occlusion of Thoracic Aorta on Blood Pressure, Splanchnic Blood Flow and Metabolic State in Dogs , Amer. J. Physiol. 180:451, 1955. 5. Horvath, S. M.; Allbaugh, E., and Hamilton, L.: Demonstration of Collateral Circulation During Acute Obstructions of the Thoracic Aorta , Amer. J. Physiol. 183:193, 1955. 6. Rossall, R. E., and Caldwell, R. A.: Obstruction of Inferior Vena Cava by a Persistent Eustachian Valve in a Young Adult , J. Clin. Path. 10:40, 1957.Crossref 7. Schilling, J. A.; McCoord, A. B.; Clausen, S. W.; Troup, S. B., and McKee, F. W.: Experimental Ascites: Studies of Electrolyte Balance in Dogs with Partial and Complete Occlusion of the Portal Vein and of the Vena Cava Above and Below the Liver , J. Clin. Invest. 31:702, 1952.Crossref 8. DaCosta, I. A.; Ratcliffe, J. W., and Gerbode, F.: Liver Circulation in General Hypothermia: II. Effect of Occlusion of the Inferior Vena Cava and Aorta on Oxygen Saturation and Electrolytes in Hepatic Blood , Stanford Med. Bull. 14:92, 1956. 9. Owens, J. C.; Liddle, E. B.; Tune, L., and Zeavin, I.: Studies on Occlusion of the Inferior Vena Cava Above and Below the Hepatic Veins in Normothermic and Hypothermic Dogs , Surg. Forum 4:63, 1953. 10. Cohen, M.; Hammerstrom, R. N.; Spellman, M. W.; Varco, R. L., and Lillehei, C. W.: The Tolerance of the Canine Heart to Temporary Complete Vena Caval Occlusion , Surg. Forum 3: 172, 1952. 11. Oughtred, O. W., and Reynolds, S. R. M.: Collateral Pathways Utilized upon Ligation of the Inferior Vena Cava at Different Levels in the Dog , Surg. Gynec. Obstet. 111:63, 1960. 12. Cohen, M., and Lillehei, C. W.: Quantitative Study of "Azygos Factor" During Vena Cava Occlusion in the Dog , Surg. Gynec. Obstet. 98:225, 1954. 13. Coleridge, J. C. G., and Hemingway, A.: Partition of the Venous Return of the Heart , J. Physiol. 142:366, 1958. 14. Kershner, D.; Hooton, T. C., and Shearer, E. M.: Production of Experimental Portal Hypertension in Dog: Anatomy of Hepatic Veins in Dog , Arch. Surg. 53:425, 1946.Crossref 15. Kershner, D.; Hooton, T. C., and Feinberg, W. G.: Chemical Studies on Experimental Hepatic Congestion in Dog , Arch. Surg. 57:24, 1948.Crossref 16. Soskin, S.; Essex, H. E.; Herrick, J. F., and Mann, F. C.: Mechanism of Regulation of Blood Sugar by Liver , Amer. J. Physiol. 124: 558, 1938. 17. Blalock, A., and Mason, M. F.: Observations on Blood Flow and Gaseous Metabolism of Liver of Unanesthetized Dogs , Amer. J. Physiol. 117:328, 1936. 18. Bradley, S. E.; Ingelfinger, F. J.; Bradley, G. P., and Curry, J. J.: Estimation of Hepatic Blood Flow in Man , J. Clin. Invest. 24:890, 1945.Crossref 19. Werner, A. Y., and Horvath, S. M.: Measurement of Hepatic Blood Flow in the Dog by the Bromsulphalein Method , J. Clin. Invest. 31: 433, 1952.Crossref 20. Van Slyke, D. D., and Neill, J. M.: The Determination of Gases in Blood and Other Solutions by Vacuum Extraction and Manometric Measurement , J. Biol. Chem. 61:523, 1924. 21. Guyton, A. C.; Abernathy, B.; Langston, J. B.; Kaufman, B. N., and Fairchild, H. M.: Relative Importance of Venous and Arterial Resistance in Controlling Venous Return and Cardiac Output , Amer. J. Physiol. 196:1008, 1959.

HARTSOCK, ROBERT J.;FISHER, EDWIN R.

doi: 10.1001/archsurg.1961.01300110036006pmid: 13712005

Abstract Although squamous metaplasia of the pancreatic ducts is not uncommon, being found in 9% to 64% of pancreases routinely examined at necropsy,1,2 squamous cell carcinoma of this organ is rare. Only 8 cases have been documented.3-8 Sommers and Meissner9 failed to encounter such a lesion in a review of 142 cases of pancreatic carcinoma, although 5 instances of adenocanthoma were observed. Lowry and associates7 and Lawrence6 noted squamous metaplasia of the pancreatic ducts in their solitary case reports of primary pancreatic squamous cell carcinoma, and they postulated that the tumor developed from areas of squamous metaplasia, although this transition was not demonstrated. Wolbach and Howe,10 in 1925, noted focal changes in areas of squamous metaplasia of pancreatic ducts in vitamin-deficient rats which changes they considered to be early carcinoma. Similar changes considered to represent in situ carcinoma in areas of squamous metaplasia have not References 1. Balo, J., and Ballon, H. C.: Metaplasia of Basal Cells in Ducts of Pancreas; Its Consequences , Arch. Path. 7:27-43, 1929. 2. Yotsuyanagi, S.: Studien über das menschliche Pankreas: mehrschichtigkeit des Ausführungsgangsepithels , Trans. Jap. Path. Soc. 21:401-411, 1931. 3. Arkin, A., and Weisberg, S. W.: Carcinoma of the Pancreas: A Clinical and Pathologic Study of 75 Cases , Gastroenterology 13:118-126, 1949. 4. Case Reports of Massachusetts General Hospital (Case 39,282) , New Engl. J. Med. 249:74-77, 1953.Crossref 5. Cornil, L.; Mosinger, M.; Olmer, J., and Audier, M.: Epithelioma Malpighien du Pancreas , Ann. Anat. Path. 11:751-755, 1934. 6. Lawrence, D. H., Jr.: Squamous Cell Carcinoma of Pancreas , Colorado Med. 31:172-175, 1934. 7. Lowry, C. C.; Whitaker, H. W., Jr., and Greiner, D. J.: Squamous Cell Carcinoma of Pancreas , South. Med. J. 42:753-757, 1949.Crossref 8. Papadopoulas, M. C.: Le sarcinome Simultanement cylindrique et pavementeux du pancreas , These du Lausanne, Geneva, 1917. 9. Sommers, S. C., and Meissner, W.: Unusual Carcinomas of the Pancreas , A.M.A. Arch. Path. 58:101-111, 1954. 10. Wolbach, S. B., and Howe, P. R.: Tissue Changes After Vitamin A Deficiency , J. Exper. Med. 42:753-777, 1925.Crossref 11. Black, H., and Ackerman, L. V.: Importance of Epidermal Carcinoma in Situ in Histogenesis of Carcinoma of Lung , Ann. Surg. 136:44-55, 1952.Crossref 12. Gordon, G. R.: Ketosis of the Larynx: Report of Case with Underlying Carcinoma in Situ , Laryngoscope 60:1,201-1,209, 1950.Crossref 13. Hertig, A. T.; Sommers, S. C., and Bengloff, H.: Genesis of Endometrial Carcinoma: III. Carcinoma in Situ , Cancer 2:964-971, 1949Crossref 14. Mallory, T. B.: Carcinoma in Situ of the Stomach and Its Bearing on the Histogenesis of Malignant Ulcers , Arch. Path. 30:348-362, 1940. 15. Ewing, J.: Neoplastic Disease: A Treatise on Tumors , Ed. 4, Philadelphia, W. B. Saunders Company, 1940, p. 764. 16. Sommers, S. C.; Murphy, S. A., and Warren, S.: Pancreatic Duct Hyperplasia and Cancer , Gastroenterology 27:629-640, 1954. 17. Collins, W. T., and Gall, E. A.: Gastric Carcinoma: A Multicentric Lesion , Cancer 5:62-72, 1952.Crossref 18. McGrath, E. J.; Gall, E. A., and Kessler, D. P.: Bronchiogenic Carcinoma: Product of Multiple Sites of Origin , J. Thor. Surg. 24:271-283, 1952. 19. Willis, R. A.: The Mode of Origin of Tumors: Solitary Localized Squamous Cell Growths of the Skin , Cancer Res. 4:630-644, 1944. 20. Anderson, W. A. D.: Pathology , Ed. 3, St. Louis, C. V. Mosby Company, 1957, p. 403. 21. Wohl, M. G., and Goodhart, R. S.: Modern Nutrition in Health and Disease , Ed. 2, Philadelphia, Lea and Febiger, 1960, pp. 292-294. 22. Popper, H.; Steigmann, F., and Szanto, P. B.: On Variations of Plasma Vitamin A Level After Administration of Large Dosage of Vitamin A in Liver Disease , J. Clin. Invest. 22:775-783, 1943.Crossref 23. Willis, R. A.: Pathology of Tumors , Ed. 2, St. Louis, C. V. Mosby Company, 1953, p. 446.

WAGNER, MARVIN;BENJAMIN, H. B.;ZEIT, WALTER

doi: 10.1001/archsurg.1961.01300110041007pmid: 13782510

Abstract The classical clinical features and treatment of carotid insufficiency secondary to vascular lesions in the neck have been well documented.1,4 Our purpose in this paper is to present 3 cases, each of which presented different etiological factors and each of which had to have a tailored surgical procedure to satisfy the respective situation. Fortunately, our neurological and neurosurgical colleagues are alert to the fact of cervical vascular disease as an etiological factor in cerebral catastrophies. One wrote in a recent paper, "It cannot be stressed too strongly that modern adequate therapy in the stroke patient rests upon the solid bedrock of a promptly established, precise, focal anatomical diagnosis."3 In the following case studies the segmental anatomical pathology was made manifest by virtue of angiography, with a resultant picture of occlusive vascular disease. However, surgical exploration demonstrated in one patient periadventitial fibrosis of a congenital stenotic internal carotid artery, References 1. Fields, W. S.; Crawford, E. S., and DeBakey, M. E.: Surgical Considerations in Cerebral Artery Insufficiency , Neurology 8:801, 1958.Crossref 2. Grant, J. C. B.: An Atlas of Anatomy , Ed. 3, Baltimore, Williams & Wilkins Company, 1951, pp. 510-512. 3. Kuhn, R. A.: Modern Concepts Concerning Etiology and Treatment of Cerebrovascular Accidents , Angiology 10:342-354, 1959.Crossref 4. Prondfit, W. L.: Headache: A Common Symptom in Thrombosis of the Internal Carotid Artery , Cleveland Clin. Quart. 27:25-28, 1960.Crossref

ROGERS, FRANK A.

doi: 10.1001/archsurg.1961.01300110045008pmid: 13742752

Abstract Because of its complex physiology and its potent biologic influences, the adrenal gland has provided a most challenging and at the same time, fascinating frontier of investigation. From the laboratory and the clinical research wards has finally come clarification, at least in part, for some of the varied and often baffling metabolic pictures that can develop when function of this important organ becomes altered. One of the most important contributions in recent times (1953) has been the identification of the 18-aldehyde of corticosterone as the highly active, sodium-retaining corticoid in extracts of adrenal cortex.31 The isolation, and finally the synthesis, of this important steroid has opened the way for new explorations and better understanding of basic problems in electrolyte metabolism to be found in such seemingly unrelated conditions as familial periodic paralysis, toxemia of pregnancy, congestive heart failure, cirrhosis of the liver with ascites, emotional stress, nephrosis, and hypertension. References 1. Studies were conducted under the direction of Dr. John Holloway, Dr. Milton Crane and staff. 2. Prior to his operative treatment this patient was cared for by the College of Medical Evangelist Medical Service at the Los Angeles County General Hospital, under the direction of Dr. Varner Johns, senior attending physician, and Dr. F. Mintz, resident physician. Radioisotope and endocrine studies were done under the direction of Dr. Milton Crane and staff, at the College of Medical Evangelist Medical Research Laboratory, Los Angeles. 3. Aird, I.; Milne, M. D., and Muehrcke, R. C.: Potassium-Losing Nephritis, Correspondence , Brit. Med. J. 1:1042-1043 ( (May 5) ) 1956.Crossref 4. August, J. T.; Nelson D. H., and Thorn, G. W.: Medical Progress: Aldosterone , New Engl. J. Med. 259:967 ( (Nov. 13) ) 1958.Crossref 5. Ayres, P. J.; Gould, R. P.; Simpson, S. A., and Tait, J. F.: The in Vitro Demonstration of Differential Corticosteroid Porduction Within the Ox Adrenal Glands , Biochem. J. 63:19 ( (Sept.) ) 1956. 6. Bartter, F. C.; Liddle, G. W.; Duncan, L. E., Jr.; Barber, J. K., and Delea, C.: The Regulation of Aldosterone Secretion in Man: The Role of Fluid Volume , J. Clin. Invest. 35:1306-1315 ( (Nov.) ) 1956.Crossref 7. Bartter, F. C.; Mills, E. G.; Biglieu, E. G., and Delea, C.: Studies on the Control and Physiologic Action of Aldosterone , Recent Progr. Hormone Res. 15:311, 1959. 8. Casey, J. H.; Bickel, E. Y., and Zimmermann, B.: The Pattern and Significance of Aldosterone Excretion by the Postoperative Patients , Surg. Gynec. Obstet. 105:179-185 ( (Aug.) ) 1957. 9. Chalmers, T. M.; Fitzgerald, M. G.; James, A. H., and Scarborough, H.: Conn's Syndrome with Severe Hypertension , Lancet 1:127-132 ( (Jan. 21) ) 1956.Crossref 10. Conn, J. W.; Fajans, S.; Louis, L.; Streeten, D.; Holbrooke, S.; Johnson, R.; Gittler, R.; Hennes, A., and Wajchenberg, B.: Intermittent Aldosteronism in the Patogenesis of Familial Periodic Paralysis , J. Lab. Clin. Med. 48:797 ( (Nov.) ) 1956. 11. Crane, M. G.; Short, G., and Peterson, J. E.: Observations on a Case of Aldosteronism , Amer. J. Med. 24:313-322 ( (Feb.) ) 1958.Crossref 12. Farrell, G.: Regulation of Aldosterone Secretion , Physiol. Rev. 38:709-728 ( (Oct.) ) 1958. 13. Farrell, G.: The Factors Which Influence the Secretion of Aldosterone , Recent Progr. Hormone Res. 15:275, 1959. 14. Foye, L. V., and Feichtmeier, T. V.: Adrenal Cortical Carcinoma Producing Solely Minerolocorticoid Effect , Amer. J. Med. 19:966-975 ( (Dec.) ) 1955.Crossref 15. Genest, J., cited by Giroud and McCall.14 16. Giroud, C. J. P., and McCall, M. F.: Aldosterone in Experimental and Clinical Medicine , Pediat. Clin. N. Amer. 5:397-416 ( (May) ) 1958. 17. Giroud, C. J. P.; Saffran, M.; Schally, A. V., and Venning, E. H.: Production of Aldosterone by Rat Adrenal Glands in Vitro , Proc. Soc. Exp. Biol. Med. 92:855-859 ( (Aug.-Sept.) ) 1956.Crossref 18. Hudson, B.; Barnett, A. J., and Bornstein, J.: Primary Aldosteronism , Aust. Ann. Med. 6:250-260 ( (Aug.) ) 1957. 19. Jackson, W.; Zilberg, B.; Lewis, B., and McKenzie, D.: Cushing's Syndrome in Childhood: Report of a Case of Adrenocortical Carcinoma with Excessive Aldosterone Production , Brit. Med. J. 2:130-133 ( (July 19) ) 1958.Crossref 20. Kretchmer, N.; Dickinson, A., and Karl, R.: Aldosteronism in a Nine-Year-Old Child , A.M.A. Am. J. Dis. Child. 94:452 ( (Oct.) ) 1957. 21. Laragh, J. H., and Stoerk, H. C.: On the Mechanism of Secretion of the Sodium-Retaining Hormone (Aldosterone) Within the Body , J. Clin. Invest. 34:913 ( (June) ) 1955. 22. Llaurado, J. G.: Increased Excretion of Aldosterone Immediately After Operation , Lancet 1:1295-1298 ( (June 25) ) 1956. 23. Luetscher, J. A., Jr.; Neher, R., and Wettstein, A.: Isolation of Crystalline Aldosterone from the Urine of a Nephrotic Patient , Experientia 10:456-458 ( (Nov. 15) ) 1954.Crossref 24. Luetscher, J. A., Jr.; Neher, R., and Wettstein, A.: Isolation of Crystalline Aldosterone from the Urine of Patients with Congestive Heart Failure , Experientia 12:22-23 ( (Jan. 15) ) 1956.Crossref 25. Luetscher, J. A., Jr., and Curtis, R. H.: Aldosterone Observations on the Regulation of Sodium and Potassium Balance , Ann. Med. 43: 658-666 ( (Oct.) ) 1955.Crossref 26. Mach, R. S.; Fabre, J.; Dukert, A.; Borth, R., and Ducommun, P.: Action Clinique et Metabolique de l'aldosterone (Electrocortin) , Schweiz Med. Wchnschr. 84:407-416 ( (April 10) ) 1954. 27. Moran, W. H., Jr.; Rosenberg, J. C.; Schloff, L., and Zimmermann, B.: The Relationship of Adrenal Steroids to Postoperative Electrolyte Metabolism , Surgery 46:109-122 ( (July) ) 1959. 28. Moran, W. H., Jr.; Rosenberg, J. C., and Zimmermann, B.: The Regulation of Aldosterone Output: Significance of Potassium Ion , Surg. Forum 9:120-122, 1959. 29. Muller, A. F.; Riondel, A. M., and Mach, R. S.: Control of Aldosterone Excretion by Changes in Volume of Body Fluid , Lancet 1:831-832 ( (June 2) ) 1956.Crossref 30. Prunty, F. T. G.; McSwiney, R. R.; Mills, I. H., and Smith, M. A.: The Effects of Aldosterone in Addison's Disease and Adrenal Pseudohermaphroditism , Lancet 2:620-629 ( (Sept. 25) ) 1954.Crossref 31. Riondel, A. M., and Mach, R. S.: Control of Aldosterone Secretion by Changes in Volume of Body Fluids , Lancet 1:831-832 ( (June 2) ) 1956. 32. Rosenfield, G.; Rosemberg, E.; Ungar, F., and Dorfman, R. I.: Regulations of the Secretion of Aldosterone-like Material , Endocrinology 58: 255-261 ( (Feb.) ) 1956.Crossref 33. Simpson, S. A.; Tait, J. F.; Wettstein, A.; Neher, R.; Von Euw, J.; Schindler, O., and Reichstein, T.: Konstitution des Aldosterons, des neuen Mineralo-Corticoids , Experentia 10:132-133 ( (March 15) ) 1954.Crossref 34. Spaulding, W. B.; Oille, W. A., and Gornall, A. G.: Mineralocorticoid-Like Disturbance Associated with Adrenal Metastases from a Bronchogenic Carcinoma , Ann. Int. Med. 42:444-451 ( (Feb.) ) 1955.Crossref 35. Speirs, R. S.; Simpson, S. A., and Tait, J. F.: Certain Activities of Crystalline Electrocortin , Endocrinology 55:233-235 ( (Aug.) ) 1954.Crossref 36. Van Bucham, F. S. P.; Doorenbos, H., and Elings, H. S.: Primary Aldosteronism Due to Adrenocortical Hyperplasia , Lancet 2:335-337 ( (Aug. 18) ) 1956.Crossref 37. Venning, E. H.; Singer, B., and Simpson, G.: Adrenocortical Function in Toxemia of Pregnancy , Amer. J. Obstet. Gynec. 67:542-548 ( (March) ) 1954. 38. Zimmermann, B., and Moran, W. H., Jr.; Aldosterone , Amer. J. Surg. 99:503-511 ( (April) ) 1960.Crossref 39. Zimmermann, B.; Moran, W. H., Jr.; Rosenberg, J. C.; Kennedy, M. D., and Frey, R. J.: Physiologic and Surgical Problems in the Management of Primary Aldosteronism , Ann. Surg. 150:653-665 ( (Oct.) ) 1959.Crossref

REDO, S. FRANK;FARBER, SIDNEY;GROSS, ROBERT E.

doi: 10.1001/archsurg.1961.01300110058009pmid: 13740233

Abstract Atresia of the mitral valve, often reported with cases of single ventricle or the hypoplastic left heart syndrome, is an uncommon cardiac lesion. Maude Abbott1 in her classic monograph described 5 specimens encountered in 1,000 postmortems of patients with congenital heart disease. It has been reported by Keith, Rowe, and Vlad2 that it occurs in 2% of their cases of congenital heart disease, or once in 50,000 children. Teller3 referred to 88 cases he was able to collect from the literature. The etiology of this malformation is not known, although several theories as to pathogenicity have been advanced. Among these are theories that aberrations in the usual bending of the primary cardiac tube (Spitzer4,5,6) occurs; that there is maldirected g r o w t h of the interventricular septum (Moenckeberg7); that fusion between the septum primum and the endocardial cushions (Brockman8) takes place; that References 1. Incompatible with life 2. Abbott, M. E.: Atlas of Congenital Cardiac Diseases , New York, The American Heart Association, 1936. 3. Keith, J. D.; Rowe, R. D., and Vlad, P.: Heart Disease in Infancy and Childhood , New York, The Macmillan Company, 1958. 4. Teller, W. M.: Congenital Mitral Atresia , Amer. Heart J. 56:304, 1958.Crossref 5. Spitzer, A. L.: Über die Phylgenese der Herzseptierung und ihre Bedeutung für die Erklarung der Herzmissbildungen , Wien. Klin. Wschr. 35:561, 1922. 6. Spitzer, A. L.: Über den Bauplan des normalen und missbildeten Herzens , Virchow Arch. Path. Anat. 243:81, 1929.Crossref 7. Spitzer, A. L.: Versuch einer Erklarung des Smetanàschen Falles von Transposition der Kammerostien des Herzens auf Grund der phylogenetischen Theorie der Herzmissbildungen , Z. Kreislaufforsch. 21:523, 1929. 8. Moenckeberg, J. G.: Handbuch der speziellen pathologischen Anatomie und Histologie , Vol. 2, Berlin, Julius Springer, 1924. 9. Brockman, H. L.: Congenital Mitral Atresia, Transposition of the Great Vessels and Congenital Aortic Coarctation , Amer. Heart J. 40:301, 1950.Crossref 10. Castrovinci, F., and Cucci, C. E.: Cor Triloculare Biatriatum Combined with Atresia (or Hypoplasia) , Dis. Chest 31:180, 1957.Crossref 11. Farber, S., and Hubbard, J.: Fetal Endomyocarditis: Intrauterine Infections as the Cause of Congenital Cardiac Anomalies , Amer. J. Med. Sci. 186:705, 1933.Crossref 12. Nadas, A. S.: Pediatric Cardiology , Philadelphia, W. B. Saunders Company, 1957. 13. Taussig, H. B.: A Single Ventricle with a Diminutive Outlet Chamber , J. Tech. Methods 19:120, 1939.

GIANNELLI, STANLEY;MAHAJAN, D. RAJ;NAVARRE, J. ROBERT;PRATT, GERALD H.

doi: 10.1001/archsurg.1961.01300110075010pmid: 13705015

Abstract In a previous article, it was shown that marked splanchnic congestion, with uptake of blood from the extracorporeal circuit, usually occurred during experimental cardiopulmonary bypass perfusions.7 This paper presents our subsequent findings, showing that the above are part of an anaphylacticlike reaction to the homologous canine blood, used for priming the pump oxygenator. No red-cell isoagglutinins could be demonstrated, suggesting that the reactions were due to plasma incompatibility. General Methods The methods employed have already been described in detail.7 In brief, a Kay-Cross disk oxygenator and Sigmamotor pump were employed, with 100% oxygen as the oxygenating gas. The perfusions were carried out upon a scale in such a manner that an increase in weight represented the net transfer of blood from the extracorporeal circuit to the dog. Vascular pressures were monitored with U-tube manometers. Venous return was accomplished by gravity drainage. Crossmatching employed 2 drops of the recipient's References 1. J. Thorac. Cardiov. Surg. , (April) , 1960. 2. Baker, C. H., and Remington, J. W.: Acute Circulatory Collapse of the Adrenalectomized Dog Following Plasma Infusion , Circulat. Res. 6:294, 1958.Crossref 3. Bauer, W.; Dale, H. H.; Poulsson, L. T., and Richards, D. W.: The Control of Circulation Through the Liver , J. Physiol. 74:343, 1932. 4. Bliss, J. Q.; Johns, D. G., and Borgen, A. S. V.: Transfusion Reactions Due to Plasma Incompatibility in Dogs , Circulat. Res. 7:79, 1959.Crossref 5. Bliss, J. Q., and Stewart, P. B.: The Selective Response of Skin to Autologous and Non-Autologous Plasma in Non-Sensitized Subjects , Canad. Med. Ass. J. 76:847, 1957. 6. Bliss, J. Q.; Stewart, P. B., and Fuller, J. L.: The Selective Cutaneous Response to Autologous and Non-Autologous Plasma in Dogs—Observations on the Effects of Inbreeding and of Immaturity , Brit. J. Exp. Path. 39:30, 1958. 7. Bliss, J. Q., and Walker, J. D.: Histamine Release by Homologous Plasma in the Dog , Canad. J. Biochem. 37:371, 1959.Crossref 8. Giannelli, S.; Mahajan, D. R.; Navarre, J. R., and Pratt, G. H.: Blood Volume Changes During Cardiopulmonary Bypass in Dogs , Ann. Surg. 152:190, 1960.Crossref 9. Haddy, F. J.: Effect of Histamine on Small and Large Vessel Pressures in the Dog Foreleg , Amer. J. Physiol. 198:161, 1960. 10. Hanzlik, P. J., and Karsner, H. T.: Anaphylactoid Phenomena from the Intravenous Administration of Various Colloids, Arsenicals, and Other Agents , J. Pharmacol. Exp. Ther. 14:379, 1920. 11. Maher, F. T.; Watkins, L. C., Jr.; Boardbent, J. C., and Bellman, J. L.: Significance of Homologous Donor Blood to the Toxic Reaction in Dogs Undergoing Extracorporeal Dialysis , Circulat. Res. 6:47, 1958.Crossref 12. Simonds, J. P., and Brandes, W. W.: The Effects of the Mechanical Obstruction of the Hepatic Veins and Peptone Shock , Amer. J. Physiol. 75:201, 1926. 13. Wright, A.: Isohemolysins and Isoagglutinins Occurring in Dogs , Proc. Soc. Exp. Biol. Med. 34:440, 1936.Crossref