Archives of Surgery

TAYLOR, FREDERIC W.;RUTHERFORD, CHARLES E.

doi: 10.1001/archsurg.1963.01310080001001pmid: 13993587

Abstract This brief report deals with loss of a plastic tube into the venous system after its use for ordinary prolonged intravenous therapy. It sounds a warning of the dangers of this seemingly innocuous and common procedure. We are not including a discussion of accidents with long tube catheterizations of the heart. Recently, the surgical service of the Marion County General Hospital was asked to see a patient on the medical service in consultation. The problem was new and baffling to us all. The patient, in his forties, had been admitted with delirium tremens. He was given the usual sedatives and continuous drip of glucose solution by indwelling intravenous tubing. After several days of therapy with gradual improvement, the patient decided to sign his own release from our care. At approximately this time, the plastic tubing was severed, and it slipped into the arm vein. A tourniquet was quickly placed about References 1. Beaulieu, M., and Gravel, J. A.: Cardiotomy for Removal of Intravenous Catheter , Laval Med. 31:458, 1961. 2. Brown, C. A., and Kent, A.: Perforation of Right Ventricle by Polyethylene Catheter Lost During Intravenous Therapy , Southern Med. J. 49:466, 1956.Crossref 3. Knutson, H., and Stenberg, K.: Pulmonary Embolus with Foreign Body , Nord. Med. 62:1491, 1959. 4. Moncrief, J. A.: Femoral Catheters , Ann. Surg. 147:166, 1958.Crossref 5. Trusler, G. A., and Mustard, W. T.: Intravenous Polyethylene Catheter Successfully Removed from the Heart , Canad. Med. Ass. J. 79:558, 1958. 6. Turner, D. D., and Sommers, S. C.: Accidental Passage of a Polyethylene Catheter from Cabital Vein to Right Atrium , New Engl. J. Med. 251:744, 1954.Crossref

HAFNER, CHARLES D.;WYLIE, JOHN H.;BRUSH, BROCK E.

doi: 10.1001/archsurg.1963.01310080004002pmid: 13951839

Abstract A lumbar hernia is a rare pathological derangement of anatomy, especially when the postoperative type is excluded. A Petit's lumbar hernia is, indeed, an extremely rare defect. In fact, this hernia occurs so infrequently that only an occasional surgeon has the opportunity of seeing and repairing one through the course of his entire life. There are many large institutions which do not have 1 such case recorded. Because of their rarity, 2 cases of Petit's hernia are being presented, in addition to our experience with lumbar hernias in general. Only these 2 cases of Petit's hernia were found in over 1 million new-patient registrations. One of these was repaired with Marlex mesh, and this is the first such case to our knowledge at the present time. Anatomy Because of the rarity of this defect, the anatomy of the general area in which this hernia occurs will be reviewed. Several varieties References 1. Flickinger, M., and Masson, J. C.: Bilateral Petit's Hernia and an Anterior Sacral Meningocele Occurring in the Same Patient , Amer. J. Surg. 71:752 ( (June) ) 1946.Crossref 2. Thorek, M.: Lumbar Hernia , J. Int. Coll. Surg. 14:367-393 ( (Oct.) ) 1950. 3. Kretschmer, H. L.: Lumbar Hernia of Kidney , J. Urol. 65:944-949 ( (June) ) 1951. 4. Senger, F. L., and Thomley, M. W.: Amer. J. Surg. 82:766-768 ( (Dec.) ) 1951.Crossref 5. Swartz, W..T: Lumbar Hernias , J. Kentucky Med. Ass. 52:673 ( (Sept.) ) 1954. 6. Adamson, R. J. W.: A Case of Bilateral Hernia Through Petit's Triangle with 2 Associated Abnormalities , Brit. J. Surg. 46:88 ( (July) ) 1958.Crossref 7. Watson, L. F.: Lumbar Hernia , St. Louis, The C. V. Mosby Company, 1948, Hernia, Chap. 26 , pp. 443-456. 8. Dowd, C. N.: Congenital Lumbar Hernia of the Triangle of Petit , Ann. Surg. 45:245-248, 1907.Crossref 9. Rishmiller, J. H.: Hernia Through the Triangle of Petit , Surg. Gynec. Obstet. 24:589-591, 1917. 10. Stubenbord, J. G.: Lumbar Hernia Through Triangle of Petit: Report of Case , U.S. Nav. Med. Bull. 42:381-385, 1944. 11. Goodman, E. H., and Speece, J.: Lumbar Hernia , Ann. Surg. 63:458-560, 1916. 12. Turner, W. Y.: Lumbar Hernia , Brit. Med. J. 2:389, 1917.Crossref

SHERMAN, CHARLES D.;MAY, ALLYN G.

doi: 10.1001/archsurg.1963.01310080011003pmid: 13977165

Abstract Introduction A patient who had had an elective jejunotransverse colostomy with complete exclusion of intervening bowel underwent radioactive vitamin B12 absorption tests before and after reinsertion of 4 inches of ileum into the gastrointestinal stream. Subsequent studies showed that the site of vitamin B12 absorption in this patient is the terminal ileum. Report of a Case A 48-year-old woman with intractable obesity (410 lb.) but in otherwise reasonably good health underwent construction of a jejunotransverse colostomy for weight reduction and control (Fig. 1, A). The procedure left 18 inches of jejunum in normal continuity, the remainder of the small bowel and the right half of the colon being excluded. One year after surgery a Schilling test indicated no absorption of vitamin B12. Fourteen months postoperatively, after a steady weight loss amounting to 200 pounds, the bypass was revised by construction of a jejunoileostomy, thus introducing the absorptive References 1. Castle, W. B.: The Development of Knowledge Concerning Gastric Intrinsic Factor and Its Relation to Pernicious Anemia , New Engl. J. Med. 249:603, 1953.Crossref 2. Halsted, J. A.: Sites of Absorption of Vitamin B12 , J. Lab. Clin. Med. 50:667-672, 1957. 3. Booth, C. C., and Mollin, D. L.: The Site of Absorption of Vitamin B12 in Man , Lancet 1:18-21, 1959.Crossref 4. Doig, A., and Girdwood, R. H.: The Absorption of Folic Acid and Labelled Cyanocobalamin in Intestinal Malabsorption , Quart. J. Med. 29:333-374, 1960.

DAVIS, CARL;BROWN, R. GORDON;ALEXANDER, R. W.

doi: 10.1001/archsurg.1963.01310080014004pmid: 14040528

Abstract After the isolation and identification of radium by the Curies, radium and other closely related radioactive elements were utilized in the treatment of a number of medical disorders, particularly gout,1 arthritis,2,3 syphilis,4 hypertension,5 epilepsy, multiple sclerosis,6 leukemia,7 and various types of anemia.8-10 The oral and intravenous use of radium was well established not only in this country, but also abroad. Although the toxic manifestations of radium and its associated elements were not well defined at that time, there was, nonetheless, much enthusiasm for this mode of therapy because of the presumed clinical improvement in a large number of cases. Looney et al.11 recently emphasized that toxic effects were not anticipated to develop 10 to 20 years after the use of radium therapy. It has been stated that the administration of soluble radium salts has continued, at intervals, until the present time in References 1. Furstenberg, A.: Radium Emanation Treatment for Rheumatism and Gout , Radium 1:13, 1913. 2. Finch, A. E. H.: Treatment of Arthritis Deformans with Radium Emanation Solution: Report of Work Carried out at Radium Institute, London , Radium 12:20, 1918. 3. Cameron, W. H.: Radium Emanation Therapy in Arthritis Deformans , Radium 1:3, 1915. 4. Ayres, W.: Effect of Intravenous Injections of Radium on Persistent Positive Wasserman Reaction , Med. Rec. 88:610, 1915. 5. Proescher, F.: Influence of Intravenous Injection of Soluble Radium Salts on High Blood Pressure , Radium 3:1, 1914. 6. Looney, W. B., and Woodruff, L. A.: Investigation of Radium Deposition in Human Skeleton by Gross and Detailed Autoradiography , A.M.A. Arch. Path. 56:1, 1953. 7. Proescher, F.: Contribution on Therapeutic Value of Intravenous Injection of Soluble Radium Salts in Treatment of Pernicious Anemia and Leukemia , Radium 7:71, 1916. 8. Martland, H. S.: Histopathology of Certain Anemias Due to Radioactivity , Proc. N.Y. Path. Soc. 26:65, 1926. 9. Proescher, F.: Conclusions Concerning the Value of Radium Therapy in Pernicious Anemia , Radium 7:102, 1916. 10. Reitter, G. S., and Martland, H. S.: Leukopenic Anemia of the Regenerative Type Due to Exposure to Radium and Mesothorium , Amer. J. Roentgenol. 16:161, 1926. 11. Looney, W. B.; Hasterlik, R. J.; Brues, A. M., and Skirmont, E.: A Clinical Investigation of the Chronic Effects of Radium Salts Administered Therapeutically , Amer. J. Roentgenol. 73:1006, 1955. 12. Hoffman, F. L.: Radium (Mesothorium) Necrosis , J.A.M.A. 85:961, 1925.Crossref 13. Martland, H. S.: Occurrence of Malignancy in Radioactive Persons , Amer. J. Cancer 15:2435, 1931. 14. Flinn, F. B.: Stimulating Action of Radioactive Deposits in the Body , Radiology 23:331, 1934.Crossref 15. Martland, H. S.: Occupational Poisoning in Manufacture of Luminous Watch Dials , J.A.M.A. 92:466-552, 1929.Crossref 16. Aub, J. C.; Evans, R. D.; Hemplemann, L. H., and Martland, H. S.: Late Effects of Internally Deposited Radioactive Materials in Man , Medicine 31:221, 1952.Crossref 17. Martland, H. S., and Humphrey, R. E.: Osteogenic Sarcoma in Dial Painters Using Luminous Paint , Arch. Path. 7:406, 1929.

McNAIR, T. J.;HOPPE, EVERETT;COLE, W. H.

doi: 10.1001/archsurg.1963.01310080020005pmid: 13932214

Abstract Several authors2,4,7,8 have described a filterable virus capable of inducing tumors in a wide range of hosts (mice, hamsters, rats). Likewise, it has been shown that formation of antibodies is induced by some of these viruses, so that treated animals are protected against inoculation with the live virus3,6,8 Stewart and Eddy8 induced this immunity in hamsters by injecting a mixture of virus culture, culture fluid, and immune serum which had been incubated overnight at 4 C. Herein we are reporting some experiments in which Sarcoma 180 cells were incubated in rabbit serum and a similar number of cells in guinea pig serum, followed by inoculation into Swiss mice subcutaneously. Nineteen days after the last of 3 such injections, these mice were challenged with a fresh suspension of 440,000 Sarcoma 180 cells. Materials and Methods A suspension of Sarcoma 180 cells was prepared by mincing 1 gm. of References 1. Chan, P. Y. M.; Hadden, D. H.; McDonald, G. O., and Cole, W. H.: The Use of "Aging" in Reducing the Development of Tumors After Inoculation of Carcinosarcoma 256 Walker Cells , Cancer 14:1057, 1961.Crossref 2. Friend, C.: Cell-Free Transmission in Adult Swiss Mice of a Disease Having the Character of a Leukemia , J. Exp. Med. 105:307, 1957.Crossref 3. Friend, C.: Immunological Relationships of a Filterable Agent Causing a Leukemia in Adult Mice: I. The Neutralization of Infectivity by Specific Antiserum , J. Exp. Med. 109:217, 1959.Crossref 4. Gross, L.: Spontaneous Leukemia Developing in C3H Mice Following Inoculation in Infancy, with AK Leukemic Extracts on AK Embryos , Proc. Soc. Exp. Biol. Med. 76:27, 1951.Crossref 5. Kidd, J. G.: Regression of Transplanted Lymphomas Induced in Vivo by Means of Normal Guinea Pig Serum: I. Course of Transplanted Cancers of Various Kinds in Mice and Rats Given Guinea Pig Serum, Horse Serum, or Rabbit Serum , J. Exp. Med. 98:565, 1953.Crossref 6. Maduros, B. P.; Schwartz, S. O., and Schoolman, H. M.: Studies in Leukemia: XI. Active Immunization of C3H×101 Mice Against Induction of Leukemia , Proc. Soc. Exp. Biol. Med. 99:222, 1958.Crossref 7. Mirand, E. A.; Grace, J. T.; Moore, G. E., and Mount, D.: Relationship of Viruses to Malignant Disease , A.M.A. Arch. Intern. Med. 105:469, 1960.Crossref 8. Stewart, S. E., and Eddy, B. E.: Tumor Induction by SE Polyoma Virus and the Inhibition of Tumors by Specific Neutralizing Antibodies , Amer. J. Public Health 49:1493, 1959.Crossref

PERRY, THOMAS

doi: 10.1001/archsurg.1963.01310080023006pmid: N/A

Abstract Through the years voices have been raised from time to time to question the standard thigh amputation for peripheral vascular disease as the only reasonable procedure for the removal of the gangrenous extremity. Among others McKittrick et al.2 championed the transmetatarsal procedure, and Silbert and Haimovici,3 below-the-knee amputation. Nevertheless, most surgeons continue to feel that these operations will not succeed in a very high percentage of cases. It is the purpose of this paper to present a below-the-knee amputation that has produced a well-healed stump in 14 of 15 limbs. All amputations were performed by 1 surgeon or by residents under his direct observation and direction. Material The accompanying Table 1 gives the important facts concerning the type of patient selected and the end-results. It will be noted that there were 13 patients. Three were women and 10 men. All had arteriosclerosis except for 1 with Buerger's disease. References 1. Ghormley, R. K.: Amputation in Occlusive Vascular Disease , in Allen, E. V.; Baker, N. W., and Hines, E. A., Jr.: Peripheral Vascular Diseases , Philadelphia, W. B. Saunders Company, 1947. 2. McKittrick, L. S.; McKittrick, J. B., and Risley, S.: Transmetatarsal Amputation for Infection or Gangrene in Patients with Diabetes Mellitus , Ann. Surg. 130:826, 1949.Crossref 3. Silbert, S., and Haimovici, H.: The Results of Midleg Amputation for Gangrene in Diabetes , J.A.M.A. 144:454, 1954.Crossref

DAINKO, EDWARD A.;BOWYER, ALLEN F.;JOHNSON, FRANK R.;BEATTIE, EDWARD J.

doi: 10.1001/archsurg.1963.01310080027007pmid: 14024672

Abstract In most of the recorded cases of gall stones in children no mention is made of the associated condition of sickle cell anemia. Its co-existence may have been present in numerous instances. Gibson, in 1722, first recorded a case of gall stones found at autopsy in a 12-year-old boy.5 Herrick7 has received credit for the first description of sickle cell anemia. Ulin, Nosal, and Martin,18 Glenn and Hill6 and Potter14 have extensively reviewed cholelithiasis and cholecystitis in the child. The 2 former excluded all congenital hemolytic anemias. Potter made no mention of sickle cell anemia associated with any of the 306 cases of cholelithiasis from all causes in the child. Thus, gall stones in the Pediatric age group are rare. Walters, according to Ulin, et al.,18 reported a total incidence of cholelithiasis in children of 1.3 per 1,000 adult cases at the Mayo Clinic. References 1. Ahrens, W. E.: Gall Bladder Disease in Children , Clin. Proc. Child. Hosp. (Wash.) , 13:94, 1957. 2. Barnes, F. E.: Cholecystitis in a 4-Year-Old Child , Amer. J. Surg. 95:1013, 1958.Crossref 3. Cecil, R. L., and Loeb, R. F.: Textbook of Medicine , Ed. 10, Philadelphia, W. B. Saunders Company, 1959, pp. 1122-24. 4. Easton, J. G., and Wright, P. M.: Cholelithiasis Complicating Sickle-Cell Anemia , A.M.A. J. Dis. Child. 93:87, 1957. 5. Gibson, J.: Medical Essays and Observations, Vol. 11-30 6. Snyder, C. C.: Cholecystitis and Cholelithiasis in Young Children , J.A.M.A. 85:31, 1925.Crossref 7. Glenn, F., and Hill, M.: Primary Gallbladder Disease in Children , Ann. Surg. 139:302, 1954.Crossref 8. Herrick, J. B.: Peculiar Elongated and Sickle-Shaped Red Blood Corpuscles in a Case of Severe Anemia , Arch. Intern. Med. 6:517, 1910.Crossref 9. Jaffe, R. H.: Cholelithiasis , J. Lab. Clin. Med. 18:1220, 1933. 10. Jordan, R. A.: Cholelithiasis in Sickle Cell Disease , Gastroenterol. 33:952, 1957. 11. Levitt, M. F.; Hauser, A. D.; Levy, M. S., and Polimeros, D.: The Renal Concentrating Defect in Sickle Cell Disease , Amer. J. Med. 29:611, 1960.Crossref 12. Mallory, T. B., Editor: Case Records of Massachusetts General Hospital (Case #27421) New. Engl. J. Med. 225:626, 1941.Crossref 13. Mintz, A. A.; Gaylord, C., and Adams, E. D.: Cholelithiasis in Sickle Cell Anemia , J. Pediat. 47: 171, 1955.Crossref 14. Pauling, L.; Itano, H. A.; Singer, S. J., and Wells, I. C.: Sickle Cell Anemia, A Molecular Disease , Science 110:543, 1949.Crossref 15. Potter, A. H.: Biliary Disease in Young Subjects , Surg. Gynec. Obstet. 66:604, 1938. 16. Scott, R. B., and Ferguson, A. D.: Studies in Sickle Cell Anemia , A.M.A. J. Dis. Child. 100:85, 1960.Crossref 17. Sharpensteen, J. R., Jr.: Physiochemical Mechanism in the Pathogenesis of Certain Hemolytic Anemias , Amer. J. Med. Sci. 229:506, 1955.Crossref 18. Song, Y. S.: Hepatic Lesions in Sickle Cell Anemia , Amer. J. Path. 33:331, 1957. 19. Ulin, A.; Nosal, J., and Martin, W.: Cholecystitis in Childhood: Associated Obstructive Jaundice , Surgery 31:312, 1952. 20. Wade, E. A.: Sickle Cell Crisis Resembling Obstructive (Cholangiolar Type) Jaundice , Virginia Med. Monthly 87:474, 1960. 21. Weens, H. S.: Cholelithiasis in Sickle Cell Anemia , Ann. Intern. Med. 22:182, 1945.Crossref

LEVEY, STANLEY;PERSKY, LESTER;CZARNECKI, NANCY

doi: 10.1001/archsurg.1963.01310080033008pmid: 13930078

Abstract In a continuing study1 of the effect of various types of injury on the activity of specific enzymes in the kidney, investigations were undertaken to determine the levels of renal transamidinase and glutaminase activity following various types of damage. These 2 enzymes appear in greater concentrations in kidney substance than at any other site. Transamidinase is found in mammalian kidney and is involved in transferring the guanidine group of arginine to glycine, thus forming guanidinoacetic acid. This latter substance can be methylated in the liver to form creatine. The enzyme glutaminase is responsible for the hydrolysis of the amide nitrogen of glutamine, yielding glutamic acid and ammonia. The amide group of glutamine is believed to be the major source of urinary ammonia.2 This enzyme also has been reported to be present in kidneys obtained from 52 different humans; however, it was not found in kidneys from individuals with References 1. Levey, S.; Koenig, S., and Persky, L.: D-Amino Acid Oxidase Activity and Kidney Damage , J. Urol. 85:239, 1961. 2. Van Slyke, D. D., et al.: Glutamine as Source Material of Urinary Ammonia , J. Biol. Chem. 150: 481, 1943. 3. Archibald, R. M.: Chemical Characteristics and Physiological Roles of Glutamine , Chem. Rev. 37:161, 1945.Crossref 4. Davis, J. H., and Coil, J. A.: Studies of Surgically Induced Pyelonephritis , Surgery 50:169, (July) , 1961. 5. Van Pilsum, J. F.; Martin, R. P.; Kito, E., and Hess, J.: Determination of Creatine, Creatinine, Arginine, Guanidinoacetic Acid, Guanidine and Methylguanidine in Biological Fluids , J. Biol. Chem. 222:225, 1956. 6. Archibald, R. M.: Preparation and Assay of Glutaminase for Glutamine Determinations , J. Biol. Chem. 154:657, 1944. 7. White, H. L., and Rolf, D.: Renal Glutaminase and Ammonia Excretion , Amer. J. Physiol. 169:174, 1952. 8. Van Pilsum, J. F.; Berman, D. A., and Wolin, E. A.: Assay and Some Properties of Kidney Transamidinase , Proc. Soc. Exp. Biol. Med. 95:96, 1957.Crossref 9. Davies, B. M. A., and Yudkin, J.: Studies in Biochemical Adaptation: Origin of Urinary Ammonia as Indicated by Effect of Chronic Acidosis and Alkalosis on Some Renal Enzymes in Rat , Biochem. J. 52:407, 1952. 10. Handler, P.; Bernheim, F., and Bernheim, M. L. C.: Ammonia Production by Kidney Slices of Normal, Acidotic and Alkalotic Rats , Arch. Biochem. 21:132, 1949.

PACK, GEORGE T.;BRASFIELD, RICHARD D.

doi: 10.1001/archsurg.1963.01310080038009pmid: 13940975

Abstract The principle of monobloc excision and dissection in continuity for primary cancers metastasizing into regionally adjacent lymph nodes has found general acceptance. It is employed for cancers of the oral group, e.g., lip, tongue, floor of mouth, inferior alveolus, for thyroid cancer, for certain cancers of the vulva and penis, for cancers of the uterine cervix and cancers of the rectum for which pelvic lymph node dissection is feasible. The first standardized application of this principle followed the independent descriptions of the so-called radical mastectomy by Halsted and Willy Meyer in 1894. The operation embodies the sacrifice of the viscus containing the primary cancer or an adequate removal of the tissue, e.g., skin, which contains it, together with a complete dissection of the adjacent and accessible regional lymph nodes into which metastases have occurred or might occur, and, which is equally important, the wide pathway of intervening tissues with the References 1. Pack, G. T.; Scharnagel, I. M., and Morfit, M.: The Principle of Excision and Dissection in Continuity for Primary and Metastatic Melanoma of the Skin , Surgery 17:849-866 ( (June) ) 1945. 2. Urban, J. A.: Radical Mastectomy in Continuity when En Bloc Dissection of the Internal Mammary Lymph Node Chain , Cancer 5:992-1008, 1952.Crossref 3. Urban, J. A.: Radical Mastectomy in Continuity with Internal Mammary Lymph Node Dissection , in Pack, G. T., and Ariel, I. M., Editors: New York, Treatment of Cancer and Allied Diseases , Paul B. Hoeber, Inc., Medical Book Dept. of Harper & Bros., Vol. 4, pp. 109-121. 4. Handley, R. S.: in, Saner, F. D.: The Breast: Structure, Function, Disease , Baltimore, The Williams & Wilkins Co., 1950, pp. 201-207. 5. Halsted, W. S.: A Clinical and Histological Study of Certain Adenocarcinomata of the Breast , Trans. Amer. Surg. Ass. 16:144-181, 1898.

ELLIS, PAUL R.;KEE, JOHN L.

doi: 10.1001/archsurg.1963.01310080042010pmid: N/A

Abstract The technique of cardiopulmonary bypass must frequently be altered to adjust to the specific needs of the patient. Several interesting conditions have recently been encountered in which it seemed desirable to maintain dual inflow perfusion utilizing 2 separate arterial cannulae, 1 supplying the upper and another the lower portions of the body. This technique is especially useful in those cases having an impedance to blood flow through the thoracic aorta. Although somewhat unusual, such problems are occasionally encountered as characterized by the patient with a Hufnagel valve in the descending aorta. In this instance the femoral artery alone would not be a suitable inflow site, inasmuch as blood could not pass through the valve in a reverse direction. Although the bypass could be accomplished through the left subclavian artery, this vessel may be too small to accommodate high flows. The problem may be easily resolved by using 2 inflow catheters, References 1. Kirklin, J. W., and De Vloo, R. A.: Hypothermic Perfusion and Circulatory Arrest for Surgical Correction of Tetralogy of Fallot with Previously Constructed Potts' Anastomosis , Dis. Chest. 39:87, 1961.Crossref 2. Neville, W. E.; Kameya, S.; Oz, M.; Bloor, B., and Clowes, G. H. A., Jr.: Profound Hypothermia and Complete Circulation Interruption , Arch Surg. 82:108, 1961.Crossref 3. Stephen, C. R.; Dent, S. J.; Sealy, W. C., and Hall, K. D.: Anesthetic and Metabolic Factors Associated with Combined Extracorporeal Circulation and Hypothermia , Amer J. Cardiol. 6:737, 1960.Crossref