Gordon F. Madding

Hepatic artery ligation for metastatic tumor in the liver

Summary A case is reported of extensive metastatic disease of the liver in which hepatic artery ligation resulted in marked clinical improvement. In addition, there were dramatic changes in the liver as demonstrated by liver scan. The results in this patient support the thesis of Breedis and Young that the blood supply of secondary tumors of the liver is predominantly, if not exclusively, arterial in origin.

Chronic alcoholic pancreatitis: Treatment by ductal obstruction

Abstract The results of treatment of seven patients with chronic alcoholic pancreatitis by ductal obstruction are presented. In addition, one case is reported in which pancreatic ductal obstruction was carried out that provided an opportunity to study the histologic changes resulting from ductal obstruction after a period of thirty-two months. The procedure we now prefer is described. This operation is the equivalent of subtotal pancreatectomy, but will not cause diabetes or ulcers. We believe the principle of complete ductal obstruction in the treatment of chronic pancreatitis is physiologically sound and has advantages not associated with other surgical approaches. The results to date warrant a continued trial of the procedure.

Subtotal cholecystectomy in acute cholecystitis

Abstract When feasible, total cholecystectomy is still the operation of choice in the surgical treatment of acute gallbladder disease and subtotal cholecystectomy should not be considered to supplant it. However, when complete removal cannot be safely accomplished, subtotal cholecystectomy recommends itself for consideration to obviate the use of cholecystostomy. Subtotal cholecystectomy incorporates the advantages of total cholecystectomy and has none of the drawbacks of cholecystostomy. A procedure such as cholecystostomy, which is followed by the need for further biliary tract surgery in such a large percentage of cases, leaves much to be desired. In all, excepting the extreme bad risk case in which a drainage operation only is permissible, subtotal cholecystectomy has proved, in my hands, a safe operation, yielding just as satisfactory permanent results as complete cholecystectomy. Four cases are reported with no mortality and a morbidity comparable to that following total cholecystectomy in the treatment of chronically infected gallbladder with cholelithiasis.

Three years' experience with long-term endocardiac pacing. Complications: their care and prevention.

Abstract Forty patients had implantations of endocardiac pacemakers between September 1964 and January 1968. There was no immediate mortality, although there have been eleven late deaths. In only two instances could the pacemaking system be indicted as the cause of death. Complications occurred in thirteen patients. In two instances conversion to epicardial pacemaking had to be done. The remainder were cared for by simple measures. We believe that the incidence of complications can be further reduced.

Primary pyloric hypertrophy in the adult

Abstract A case of primary pyloric hypertrophy in the adult with coexisting patchy discrete hypertrophy (satellite nodules) of the muscularis mucosae of the stomach is presented. It represents an additional type to those previously reported. The literature has been reviewed and possible etiologic mechanisms have been considered. Diagnostic and therapeutic considerations are discussed.

The macroscopically non-pathologic gallbladder

T HE majority of gaIlbIadders removed contain stones which may or may not produce symptoms. When symptoms are present the patient is improved in go to g5 per cent of cases by choIecystectomy. When there is gross disease of the gaIIbIadder without evident stones, its remova is attended by relief of symptoms in a sIightly smaIler percentage of cases. The care of the third type of gaIIbIadder, encountered on rare occasions, which has previousIy been diagnosed as chronic ChoIecystitis but which at the time of surgery shows none or onIy minima1 evidence of disease, is the probIem to be discussed. At Ieast go per cent of biIiary tract disease is associated with caIcuIi but in most reported series 4 to 6 per cent of a11 gaIIbIadders removed are both non-acute and acaIcuIous. That such a probIem exists has been cIearIy stated by SneII [20] who writes: “It is we11 recognized that al1 symptoms of cholecystic disease incIuding those cIoseIy reSembIing coIic may be present without much visibIe evidence of either infection or ChoIesterosis; yet remova

Endometrioma of the sigmoid with vicarious menstruation and intermittent intestinal obstruction.

Abstract Endometriosis of the bowel producing obstruction and vicarious menstruation is sufficiently unusual to justify its presentation. Such a case is reported with a review of the more characteristic signs and symptoms. Favorable response to castration was obtained in spite of the extent of the lesion.