Edward S. Judd

Carcinoid tumors of the vermiform appendix

The carcinoid tumor of the appendix is a small, and usually innocuous, lesion most frequently discovered incidentally in an appendix removed for other reasons. It will only uncommonly contribute to the development of acute appendicitis. Although more frequently diagnosed in the female, the incidence of this tumor is equal in both sexes. The appendiceal carcinoid can occur in early childhood and reaches a peak incidence in young adults. Among patients older than 60 years the incidence seems to decrease more rapidly than can be explained by the frequency of appendectomies. Invasion of muscular layers, lymphatic invasion, and peritoneal involvement are common with appendiceal carcinoids. Metastasis is rare. The malignant carcinoid syndrome can occur but is even less common. Simple appendectomy is adequate treatment for the patient with an appendiceal carcinoid and no gross evidence of metastasis. Right hemicolectomy is justifiable only for the rare primary tumor measuring 2 cm or more in diameter.

Some uncommon causes of appendiceal mucocele

Abstract In the absence of marked intraluminal contamination a mucocele of the appendix may be formed whenever the rate of appendiceal secretion exceeds the rate of absorption and proximal drainage. The majority of mucoceles develop distal to an inflammatory stricture. During a forty-year period eleven cases in which the mucocele was not the result of inflammatory stricture were encountered at the clinic. In seven cases the appendiceal lumen was patent, the mucocele being produced by partially obstructing carcinoma of the cecum; in three cases obstruction was caused by a carcinoid, and in one case obstruction resulted from a polyp. Two mucoceles were associated with appendiceal endometriomas but it was impossible to prove that the endometrial tissue had caused obstruction.

Untreated gastric pseudolymphoma.

SummaryGastric pseudolymphoma is an inflammatory process that may simulate malignancy. In most reported cases, the initial diagnosis has been malignant lymphoma and treatment has been applied accordingly.We report a case of gastric pseudolymphoma wherein the diagnosis was made from multiple surgical biopsies, and follow-up now exceeds 11 years. To our knowledge, no other case of untreated gastric pseudolymphoma has been reported. This case may more closely represent the biologic nature of this presumably benign condition.

An instrument for colorectal anastomosis without sutures

Summary and ConclusionsA new instrument for joining the colon to the lower part of the rectum without sutures has been described. Initial tests in dogs and its use in one patient have been satisfactory. Further trial of the device is considered justified.

Preoperative neomycin-tetracycline preparation of the colon for elective operations.

During a randomized prospective double-blind survey of 196 patients the preoperative combination of oral neomycin and tetracycline was proven significantly superior to other treatment regimens in terms of postoperative sepsis.

Traumatic avulsion of the skin of penis and scrotum

I T wouId be difhcuh to contempIate a more terrifying accident than the sudden Ioss of the skin of the penis and scrotum. Indeed, when the victim of such a mishap presents himseIf in the emergency ward, the equiIibrium of the most experienced observer may suffer a transient disturbance. The recent admission of two such patients in cIose order prompted a study of the probIem. Review of the Iiterature reveaIed a wide range of injuries which produce this type of avuIsion. The mechanism may seem rather triviaI, as evidenced by the case reported by Vernon and KeIIy,5 in which the patient, a saiIor, was engaged in friendIy scufhe on shipboard. During the activity, his adversary Iifted him from the deck by grasping him by the neck and by the cIothing in the pubic region. There was no great pain but the victim Iater noticed bIood stains on his cIothing. It was then discovered that the skin of the dorsum of the penis had been torn I inch (2.5 cm.) from the pubis and avuIsion had extended toward the head of the penis. FortunateIy, a Iong prepuce existed and it was possible to utiIize this to cover the defect. Veseen and O’NeiIP reported a case in which a man was brought to the hospita1 in a drunken stupor, unabIe to recaI1 what events had transpired. The penis was found to be denuded over the entire shaft except for one smal1 area posterior to the glans. In addition, the integument was missing from part of the anterior surface of the scrotum. In this case, it was possibIe to transpIant the penis into the scrotum, Ieaving the gIans free. Dissection was carried out two weeks Iater. This ahowed the Section on Laryngology, Oral and Plastic Surgery, Mayo Clinic

The usefulness of vagotomy in treatment for gastric ulcer.

Two groups of patients treated with and without vagotomy during the same period are compared in a retrospective study to help clarify the controversy about the use of vagotomy in the management of chronic benign gastric ulcer. Associated factors considered include coexisting duodenal ulcer, prepyloric position of the ulcer, and technical aspects of resection when the ulcer is high in the stomach.

Effects of intravenously administered solutions on electrolytes and energy substrates during surgery

SummaryThe comparative effects of three kinds of intravenous infusion and of no infusion were studied in 20 patients during and after abdominal operation. Plasma concentrations of electrolytes were little different in patients receiving lactated Ringer’s solution or 5 per cent dextrose in water at a rate of 300 ml/hr. Patients receiving 5 per cent dextrose, in water or in lactated Ringer’s solution, gave evidence of greater glucose metabolism and less lipid utilization than did patients receiving lactated Ringer’s or no solution.RésuméSur un groupe de 20 malades, durant et après intervention abdominale, une étude comparative a été faite sur les effets obtenus chez les malades recevant l’un des trois types de solutés (solution de Ringer avec lactate, dextrose 5 pour cent dans l’eau, et dextrose 5 pour cent en solution de Ringer avec lactate) et chez les malades ne recevant aucune infusion. Les concentrations plasmatiques d’électrolytes n’offrirent que peu de différence entre les malades qui recevaient la solution de Ringer avec lactate ou le dextrose 5 pour cent dans l’eau au rythme de 300 ml/heure. Par ailleurs, les malades à qui on administrat du dextrose 5 pour cent, soit dans l’eau soit dans la solution de Ringer avec lactate, firent preuve d’un métabolisme accentué du glucose et d’une moindre utilisation des lipides que ne le firent les malades recevant la seule solution de Ringer avec lactate ou ne recevant aucun soluté.

Current Practice of Biliary Surgery

This volume is obviously the result of carefully kept notes and records while the author was in his training period in England and also at the Lahey Clinic. There is a very pleasant foreword presented by none other than Frank Glenn. The author is most gracious in acknowledging his indebtedness to colleagues and mentors. The book is a simple, direct, straightforward outline. It starts, logically, with surgical anatomy, including a profusion of illustrations. In fact, the illustrations throughout the book are outstanding, concerning themselves entirely with line drawings which are crystal clear. Later in the volume, x-ray reproductions assume a very large role. There is a short chapter on applied physiology. This may seem too brief but is well outlined and carefully documented. As is typical of all chapters, a more than complete list of references is offered. The Lahey Clinic influence through the person of Kenneth Warren, becomes more

Atlas of Surgery of the Stomach and Duodenum

This atlas was prepared by six surgeons; five were staff associates and one was a colleague of the late Dr. Ellison. It is most appropriately dedicated to Dr. Robert M. Zollinger. The legends are brief and very practical. The artwork is superb. The common operations are all included and the clinical applications seem sound and thoroughly worthwhile. Some of the operations appear almost too technically detailed, as many extra drawings are employed to gradually develop the progress of the procedure. This is mentioned, not as any stern criticism, but as a suggestion which might possibly have reduced the size and, obviously, the expense of the volume. In general, the legends presented on pages facing the drawings are clear, concise, and devoid of tiresome detail. They are well suited to the visual aid so aptly presented. Alternative methods are mentioned occasionally and safeguards are presented where they seem appropriate. The views