Bernard D. Rosenak

Detection of surgical lesions of the small bowel by enteroclysis

Enteroclysis is an examination in which barium is infused directly into the small intestine, and compression radiographs are taken on each segment. This method eliminates many of the inherent limitations of the conventional small bowel follow-through examination. This report concerns 45 patients with 48 small bowel lesions. They were missed on the conventional examination but detected within 3 months by subsequent enteroclysis and confirmed surgically. There were 15 patients with Meckels diverticula, 7 with obstructive adhesive bands, 5 with Crohns disease, 5 with blind pouch syndrome (1 with a leiomyoma inside the blind pouch), 2 with other leiomyomas, 3 with metastatic carcinoma, two with primary carcinoma 3 with radiation stricture, two with sinus tract lesions and fistulas, and 1 with another lesion. Improved intubation techniques and better barium mixtures make enteroclysis possible in most hospitals. As surgeons appreciate the value of enteroclysis, they can request this examination for appropriate patients to sooner find many surgical lesions of the small bowel which frequently go undiagnosed.

Hypotonic Duodenography with Glucagon

In a double blind crossover study, the effects of 2 mg glucagon and 1 mg atropine sulfate on duodenal tonicity and motility were compared to placebo in 6 asymptomatic men. In a similar study, 2 mg glucagon and 30 mg propantheline bromide were compared to placebo. In 10 to 30 minutes after intramuscular administration of the drug there was a significant decrease in duodenal motility and tonicity with glucagon. Both tonicity and motility were near normal at 60 minutes. Responses to atropine sulfate and propantheline bromide were sometimes evident at 10, 30, and 60 minutes, but were variable and not consistently greater than with placebo. With atropine sulfate and propantheline bromide, intensity of reported side effects was greater than with placebo or glucagon.

Double-Blind Radiographic Study of Dose Response to Intravenous Glucagon for Hypotonic Duodenography

This study was undertaken to determine a dose response to glucagon during hypotonic duodenography. Fifteen male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg, and 2 mg of glucagon intravenously, double-blind, and crossover. Onset of drug effect occurred in approximately 45 seconds, regardless of the dose of glucagon given. There was a significant (p less than 0.01) decrease in gastrointestinal tonicity with all doses. The larger the dose, the greater the duration of drug action. Satisfactory stomach, duodenal, and small bowel hypotonicity for radiography were obtained with 0.25 to 0.5 mg of glucagon given intravenously with few side effects.

Effect of Glucagon on Size of Visualized Human Gallbladder Before and After a Fat Meal

Four methods of measuring the size of the gallbladder shadow were employed in a study to determine the effect of the administration of glucagon and a fat meal on a standard cholecystogram. These methods included an estimate by an experienced roentgenologist, measurement of the width of the gallbladder shadow, determination of the weight of a photographic reproduction of the shadow, and estimation of the volume represented by the shadow. Some measure of the sensitivity of the methods of measure was obtained by determining the sample size needed to give statistical significance. At a ± 20% change of the over-all mean, approximately, 7, 7, 14, and 22 subjects for visual estimate, picture width, weight, and volume, respectively, would be needed to show a significant difference in response. Evaluation of the gallbladder shadow by the roentgenologist was most easily accomplished and was at least as good as any of the other methods. When a fat meal was given first or after glucagon there was a decrease in the size of the gallbladder shadow by all four methods. When glucagon was given first there was an increase in the width of the gallbladder shadow. No significant change was demonstrated with the other methods of evaluation. When glucagon was given after fat the gallbladder shadow increased in size significantly (P

Dose response to intramuscular glucagon during hypotonic radiography.

In a study to determine a dose response to glucagon during hypotonic duodenography, 15 male and female volunteers received placebo and 0.25 mg 1 mg and 2 mg glucagon intramuscularly, double-blind and cross-over. When 0.25 mg glucagon was given, the onset of drug effect was approximately 13--18 min: the mean duration of moderate hypotonicity was approximately 4--7 min. The larger the dose, the greater the duration of drug action. When 2 mg glucagon was given, the onset of drug effect occurred in approximately 4--7 min; the mean duration of moderate hypotonicity was 22--32 min. There were no changes in pulse or blood pressure attributable to the drug with these doses, and reports of nausea and diarrhea did not increase significantly until a dose above 1 mg was given. One mg glucagon given IM is useful in hypotonic upper Gl radiographic examinations. The onset of hypotonicity was 8--10 min with a duration of 12--27 min when this dose was given. Few reports of side effects were attributable to this dose.

Traumas resulting from sigmoid manipulation

1. Perforation of the sigmoid as a result of diagnostic and therapeutic manipulation is not infrequent. 25 reported perforations in the experience of 28 physicians reveals it not as a rare occurrence.

Bile salt therapy in liver and gall bladder disease.

1. Results of surgical treatment of patients with symptoms of biliary tract disease, but who do not have gall stones or attacks of biliary colic, are frequently unsatisfactory.

The intravenous modification of the hippuric acid test of liver function

1. The intravenous modification of the hippuric acid test according to the technic of Quick is a safe method which has the advantages of being shorter in time and more accurate from the point of view of absorption than the oral test. It is an important adjunct to the list of laboratory procedures which may be of value in the diagnosis and in checking the clinical course of various hepatic diseases, but it is not a perfect liver function test in the sense that it will reveal minimal hepatic damage. 2. The estimation of hippuric acid in the urine may be done by precipitation and weighing or by the ether extraction—Formol titration methods. The latter method is more time consuming and tedious than the former, but has the advantage of eliminating the possibility of obtaining what appears to be excessive excretion of hippuric acid which in our opinion may be due to the excretion of sodium benzoate itself. 3. We consider it of great importance to have some definite idea of the functional capacity of the kidneys before a proper interpretation of the hippuric acid test can be made. 4. There may be an advantage in placing the absolute level of pathologic excretion at 0.7 of a gram. There is little doubt that the liver is not functioning to its full capacity if the synthesis of hippuric acid is below this level when the kidneys are able to excrete the hippuric acid. Excretion of between 0.7 of a gram and 1.0 gram is suggestive of impaired liver function.

Gall bladder dyspepsia

In analyzing the results of this investigation, one is impressed by the fact that no definite entity of gall bladder dyspepsia can be established. There was nothing in the histories to separate this dyspepsia from that originating from other sources. One finding seems important; if the dyspepsia is associated with the acute attack alone, then relief is likely to follow cholecystectomy. There was no difference in the food intolerance in the post-cholecystectomy group and that found in the irritable colon group. This was rather surprising in view of the commonly-held belief that fat intolerance is pathognomonic of gall bladder disease. The foods mentioned most often as causing dyspepsia were identical with those found in the so-called irritable colon syndrome. We are unable to explain adequately the frequent occurrence of abnormal glucose tolerance. There was no correlation between the degree of pathology found in the excised gall bladders and the clinical symptoms or relief by cholecystectomy. The various laboratory procedures revealed no uniform abnormalities. While we do not suggest that the diseased gall bladder with stones should not be removed, we do feel that the patient should be informed of his chances for obtaining relief from dyspepsia. Every effort should be made to determine the true cause of the dyspepsia and, if possible, measures instituted to correct it before operation.

A new tube for exfoliative cytology of the esophagus and stomach

SummaryThe technique described above has been used over a period of several months in the Marion County General Hospital and the Indianapolis Veterans Hospital. An analysis of the cases thus examined has not yet been carried out. The pathologists who have been accustomed to interpreting gastric washings for malignant cells in these hospitals have been impressed with the superiority of the material provided by the means described.