Benjamin F. Rush

Fatal acute pancreatitis: A clinicopathologic analysis☆

Abstract This paper reviews eighty patients dying of acute pancreatitis, fifty in a hospital population and thirty who died in the community without ever receiving medical care. Our findings suggest the following conclusions: Death in the hospital from acute pancreatitis is often associated with misdiagnosis. Such patients frequently have associated disease which obscures the primary diagnosis and enzyme levels which are either not elevated or elevated only moderately. When no medical therapy is received by patients, death occurs earlier in the course of the disease, often associated with edematous pancreatitis, and often in younger patients. Acute lesions of the liver are found in half of these patients and we have speculated as to whether this is a cause or a result of the acute pancreatitis. Finally, the different incidence of edematous, hemorrhagic, and suppurative pancreatitis in the two groups indicated that edematous pancreatitis is the earlier lesion and leads subsequently to hemorrhagic and suppurative pancreatitis.

Experiences with integrated operative and radiation therapy.

ABSTRACT Advanced cancers of the hypopharynx and larynx respond poorly to treatment by either irradiation or operation, especially when they are associated with metastases to the cervical nodes. Survival figures at five years for lesions of the larynx with spread to cervical nodes range from 4% to 26%.11,12 Whether they were treated by operation or irradiation, survival rate for similar lesions of the hypopharynx is reported as 10% to 20%.13Challenged by a group of patients with a high incidence of advanced lesions, in 1962 we embarked on a technique of integrating curative levels of radiation therapy followed by en bloc resection of the larynx or hypopharynx and adjacent lymph nodes in four to six weeks.The rationale for this approach follows: (1) It was hoped that the application of a high level of radiation therapy in the so-called curative range would afford maximum tumor regression, and allow either

Diseases of the Breast

Fifteen years have elapsed since first publication of this volume. The first edition, rich in detail and scholarship, was judged the classic in its field; this work has maintained the same standard. Extensively rewritten, expanded, and updated, the new edition has a larger page size and 78 pages have been added. Organization of the subject includes an initial 3 chapters on normal and abnormal anatomy and physiology, followed by 3 chapters on diagnosis, 14 on various aspects of benign and malignant lesions other than adenocarcinoma, 14 on the various lesions of adenocarcinoma, and 5 on treatment. Everything one could possibly wish to know concerning the breast seems to be covered. Much of the work bears the authority of Haagensens 40 years of experience at Columbia-Presbyterian Medical Center where he specialized in disease of the breast. The chapter on selection of patients for operation describes many criteria which he introduced and

Ringer, Hartmann, and Their Solutions

To the Editor:— We note with mild amusement that Dr. Hanson would have us substitute one eponym for another. Hartmann did indeed add lactate to Ringers solution, giving us a better balanced solution with a closer resemblance to the electrolyte content of extracellular fluid and some buffering capacity. Since Dr. Hanson does not wish to invoke the eternal debate concerning the use of eponyms in scientific writing, we feel that Hartmanns solution is the better eponym for the solution we use. Perhaps we are all victims of the language differences that tend to grow up between specialties. Among surgeons, internists, anesthesiologists, and pediatricians the term Hartmanns is a familiar one made comfortable to us by long usage. The commercial solution is labeled Hartmanns Solution in large letters. Pathologists and those of other specialties who have less reason to use this material may find this terminology strange. If so, any questions