H. Marvin Pollard

Staging of cancer of the pancreas

A new protocol for staging carcinoma of the exocrine pancreas has been retrospectively evaluated in 924 cases abstracted from 14 clinics and hospitals; these patients were treated between January 1, 1950, and December 31, 1976. Significant differences (P < 0.05) were observed in the survival rates of Stage I patients, Stage II–III patients, and Stage IV patients who could be evaluated for survival. The median survival of Stage I patients treated by pancreatic resection (6.0 months) was approached in Stage II–III unresected cases with or without bypass procedures; these patients received radiation and/or chemotherapy postoperatively. It is suggested that this protocol may be useful in prospective clinical therapeutic investigations for the evaluation of newer protocols of medical, surgical, and radiotherapeutic treatment.A new protocol for staging carcinoma of the exocrine pancreas has been retrospectively evaluated in 924 cases abstracted from 14 clinics and hospitals; these patients were treated between January 1, 1950, and December 31, 1976. Significant differences (P < 0.05) were observed in the survival rates of Stage I patients, Stage II–III patients, and Stage IV patients who could be evaluated for survival. The median survival of Stage I patients treated by pancreatic resection (6.0 months) was approached in Stage II–III unresected cases with or without bypass procedures; these patients received radiation and/or chemotherapy postoperatively. It is suggested that this protocol may be useful in prospective clinical therapeutic investigations for the evaluation of newer protocols of medical, surgical, and radiotherapeutic treatment.

Twenty years of gastrointestinal carcinoids.

Between 1946 and 1966, a total of 72 patients with gastrointestinal carcinoid tumors were seen. Fifty‐six were diagnosed antemortem by surgery or sigmoidoscopy, while 16 were incidental autopsy findings. There were 40 males and 32 females, with an age span of 12 to 87 years. The most common location was the ileum (31.9%), followed by rectum (27.7%) and appendix (22.2%); 20.8% had metastasized at the time of diagnosis, 86.7% of the primary tumors with metastases were 2.0 cm or more in size. No patient had the carcinoid syndrome, although 4 patients had hepatic metastases; 7% of the total group had an associated peptic ulcer and 32% of the group had a second neoplasm. None had tumors of the adrenal, parathyroid, pituitary, or pancreas, although one had a papillary thyroid carcinoma. Treatment consisted of surgical resection in most cases. The mean follow‐up was 5.8 years, with a range of 2 months to 20 years. The mean survival of those with metastases present at the time of the diagnosis was 4.9 years, while the mean survival of those without metastases was 8.0 years. Nine patients died of unrelated disorders, and 9 died from the tumor of postoperative complications from tumor therapy.

Esophageal motor abnormalities in scleroderma and related diseases

SummaryEsophageal motor activity was measured by intra-esophageal pressure recordings in 53 patients with scleroderma and 29 patients with other collagen diseases. The purpose of the study was to determine the relationship of motor abnormalities to esophageal symptoms, to compare the abnormalities in scleroderma with those in other collagen diseases, and to try to increase understanding of the responsible mechanism. Methacholine was given to 36 of the 53 patients with scleroderma to confirm that the Mecholyl test is negative in scleroderma and to see whether intraluminal pressure changes accompany the resulting improvement in esophageal emptying.Abnormalities in the intraluminal pressure response of the esophagus to deglutition were seen in 79% of the patients with scleroderma. Of those with an abnormal swallowing pattern, 62% showed diminution or absence of the lower esophageal sphincter pressure zone. Although changes in swallowing pattern did not correlate with esophageal symptoms, absence of lower esophageal sphincter pressure did. The 29 patients with other collagen diseases had similar but less severe abnormalities in the motor response to deglutition. Usually there was better preservation of the lower esophageal sphincter. Neither abnormality correlated with esophageal symptoms in this group.The Mecholyl test was negative in patients with scleroderma. No significant change was found in the pressure studies after methacholine.Of the 66 patients who had both X-ray and manometric studies of the esophagus, intraluminal pressure studies showed aperistalsis in all patients without peristalsis on X-ray studies as well as in 18 patients who appeared to show normal esophageal peristalsis on X-ray studies.

The Action of Ethyl Alcohol on Gastric Acid Secretion

Summary 1.Ethyl alcohol given intravenously (10 to 40 ml.) to human subjects consistently stimulated both acid and volume of gastric secretion roughly proportional to the amount administered. 2.The site of action of intravenously given alcohol in stimulating gastric secretion was determined by observing the effects of atropine, of hexamethonium and of vagotomy on alcohol-stimulated secretion. It was concluded that alcohol effects stimulation of gastric secretion by acting centrally, as does hypoglycemia, and that the stimulus is mediated through the vagus nerve and not by any direct action on the gastric cell, as is the case with histamine.

Acid Diffusion Into the Human Gastric Mucosa

Summary The back diffusion of hydrogen ion into the normal and abnormal human gastric mucosa was determined by (1) comparing the acid secretion of the stimulated mucosa with and without a glycine buffer solution in the stomach, and (2) measuring hydrogen, sodium, potassium, and chloride fluxes following the instillation of an acid solution into the stomach. The glycine buffer detected more acid secretion in almost all patients. The increase seen when comparing the normal with the abnormal gastric mucosa was proportionally similar. It appears that back diffusion from the stomach lumen proper does not occur during active secretion in patients with gastric ulcer, gastritis, and hyposecretion; however, back diffusion could be occurring elsewhere along the secretory pathway. A significant net back diffusion of hydrogen ion into the mucosa was noted following the instillation of an acid solution into the stomach of patients with gastric ulcer, gastritis, or hypochlorhydria. An apparent increase in sodium content in the gastric lumen was likewise found. These changes are similar to those found in experimental damage to the canine stomach. We conclude that an abnormally permeable human gastric mucosa exists and that hydrogen ion diffusion into gastric mucosa occurs and may be injurious to the human stomach.

Protein-losing gastroenteropathy: Concepts derived from lymphangiography

SummaryLymphangiograms in 2 patients with protein-losing gastroenteropathy showed abnormalities of both abdominal and lower-extremity lymphatics.With the application of lymphangiography, the generalized nature of the lymphatic dysplasia in primary protein-losing gastroenteropathy has become evident.Striking lymphangiographic similarities between primary protein-losing gastroenteropathy and primary lymphedema suggest that both entities are part of a continuous spectrum of lymphatic dysplasias.

Combined endoscopic pancreatic fluid collection and retrograde pancreatography in the diagnosis of pancreatic cancer and chronic pancreatitis

By endoscopic cannulation of the main pancreatic duct, the authors evaluated analysis of pancreatic fluid aspirates and pancreatography in 22 patients with chronic pancreatitis, 8 patients with pancreatic carcinoma, and 18 subjects without pancreatic disease. An important determination was the CEA content of pancreatic fluid. This combined endoscopic approach gives promise of reliably distinguishing between inflammatory and neoplastic disease in the pancreas and also yielding a diagnosis of relatively early pancreatic carcinoma.

Histamine Stimulation of Gastric Pepsin Secretion in Man

Summary The continuous administration of histamine intravenously in every instance in human subjects stimulated the secretion of pepsin. This effect reached a plateau within 1 hour and was maintained at that level as long as the histamine was administered; viz. , up to 2 hours in 16 studies, to 3 1/2 hours in 11 studies and 5 1/2 hours in 2 studies.

Transoral small-bowel biopsy as an aid in the diagnosis of malabsorption states.

IT was in 1880 that Mansons1 report first established tropical sprue as a clinical entity. Eight years later, Gees2 classic account of a distinct type of diarrhea, occurring in people of all ages...

Gastroscopic findings and fecal blood loss following aspirin administration

A study of 19 healthy young male subjects (Group 1) was made in which a correlation of aspirin ingestion, fecal blood loss, blood salicylate levels, prothrombin concentrations, and ABO blood groups was sought. An initial 4-day control period was followed by a 4-day test period during which subjects ingested 650 mg aspirin with each meal and at bedtime. Gastroscopy with photography was done on Day 1 and Day 7. Daily fecal blood loss was quantitated using the 51-chromium tagged erythrocyte method. Sixteen patients (Group 2) with a variety of upper gastrointestinal disorders underwent gastroscopy and photography before and after the acute ingestion of aspirin. Results reveal: (1) Aspirin produced petechiae in 4 of 18 subjects and a hemorrhagic gastritis in 1 of 18 in Group 1, (2) aspirin produced no visible lesions in the 16 subjects in Group 2, (3) the mean fecal blood loss during the control period was 0.38±0.35 g/24 hr and rose to 1.54±1.42 g/24 hr (P<0.01) during aspirin ingestion, (4) no correlation between normal or abnormal gastroscopic findings and fecal blood loss was apparent, and (5) no correlation between blood salicylate levels, prothrombin concentrations, and gastroscopic findings or fecal blood loss was detected.