Diane W. Crocker

Tumors of the small intestine

Abstract 1. 1. This review of primary tumors of the small intestine consists of 115 cases from the files of the Peter Bent Brigham Hospital. In forty-four cases the tumor was malignant: twenty-two were adenocarcinomas, fifteen were malignant lymphomas, four were malignant argentaffinomas, two were leiomyosarcomas and one was a malignant hemangio-endothelioma. The majority of tumors producing symptoms were malignant. 2. 2. The three clinical manifestations caused by tumors of the small bowel are intestinal obstruction, bleeding and abdominal pain. 3. 3. Diagnostic procedures including motility series or small bowel enema may be necessary to localize the lesion in symptomatic patients whose upper gastrointestinal series and barium enema are within normal limits. 4. 4. The treatment of small bowel tumors is surgical excision. The results of treatment are excellent in benign tumors but poor in the malignant lesions. 5. 5. An unusual case of multiple malignant hemangio-endotheliomas of the small bowel with bleeding is reported in detail.

A twenty-five year experience with soft tissue sarcomas

Abstract Thirty patients with soft tissue sarcomas were treated at the Peter Bent Brigham Hospital from 1940 to 1965. Fibrosarcoma was the most common lesion [6], followed by synovial sarcoma [5], rhabdomyosarcoma [4], leiomyosarcoma [4], and liposarcoma [4]. Liposarcoma had the best prognosis, with three patients surviving more than five years after radical surgery. Fibrosarcoma showed a 50 per cent five year survival with wide excision. Well differentiated sarcomas had a better prognosis than poorly differentiated ones and microscopic evidence of invasion usually exceeded the palpable limits of tumors. Early radical local surgery offered the best chance for therapy of soft tissue sarcomas.

Results of surgical management of unilateral pyelonephritis with hypertension: An analysis of twelve cases☆

Abstract This report reviews the results of nephrectomy in twelve cases of unilateral pyelonephritis and three cases of unilateral hydronephrosis with hypertension. Those patients showing the best response usually have a prominent element of ischemia superimposed on the pyelonephritis. Half of the cases reported herein have been either “cured” of their hypertension or markedly improved by nephrectomy.

Dissecting aneurysm distal to coarctation of the aorta, with long survival☆

Abstract A long survival of coarctation of the aorta with dissecting aneurysm distal to the constriction is presented; the patient lived to age 65 years. This is also the longest documented survival of a patient with a healed dissecting aneurysm of the aorta; the diagnosis was made clinically 25 years prior to autopsy confirmation. Death was due to congestive heart failure but cardiomegaly did not occur until sometime during the final 15 years of life.

A COMPARISON OF UNILATERAL PYELONEPHRITIS AND RENAL ARTERY STENOSIS ASSOCIATED WITH HYPERTENSION.

Summary A comparison of the findings in fourteen patients with unilateral pyelonephritis and hypertension and fourteen patients with renal artery stenosis and hypertension is made. There was nothing in the preliminary work-up that would routinely separate the two groups, although a history of urinary tract infection was higher in the pyelonephritis group, and an abdominal bruit and hypokalemia were suggestive, when found, of renal artery stenosis. The intravenous pyelogram suggested the correct diagnosis in about three-quarters of instances, but further tests were needed for confirmation. Thus, the renogram pointed to the involved kidney in the majority of instances, but a number of false positives have been observed. Divided renal function studies, with particular emphasis on a comparison of the osmolarity of the urine from the two ureters, was diagnostic of renovascular hypertension, practically without exception, and of unilateral pyelonephritis in three-quarters of instances. A positive aortogram was the final requirement for the diagnosis of renovascular hypertension. Evidence for the operation of the renal pressor mechanism in the renovascular group is cited and corroborated by the good surgical results in 80 per cent of the cases. By contrast, evidence for the operation of a similar mechanism in the group with hypertension associated with unilateral pyelonephritis was lacking, and the comparatively poor results of renal surgery on the hypertensive process was noted. A simple causal relationship between the unilateral pyelonephritis and the hypertensive state cannot be supported although the coincidence of the two disorders probably cannot be relegated to chance alone. At the present time it is difficult to decide which, if any, patients with the latter complex should be subjected to nephrectomy in the hope of improving the hypertension.

Relationship of Intrinsic Renal Pathology to Efficacy of Surgery for Renovascular Hypertension.

Excerpt The long-term postoperative effect of surgery on the hypertension of 29 patients with renal artery stenosis has been determined and correlated with the renal pathology. In 20 patients bilat...

A clinicopathologic correlation of the effect of hypophysectomy in seven female patients with advanced carcinoma of the breast.

Abstract The histologic features of tumor cells before and after hypophysectomy for advanced carcinoma of the breast are presented with concurrent clinical and laboratory data in seven patients. The hormonal influences affecting remission and recurrence are discussed. Changes in the thyroid glands of seventeen patients who had had hypophysectomy are also reviewed.