Harold D. Caylor

Anterior sacral meningocele

Abstract Three cases of anterior sacral meningocele are reported. The lesion manifests itself as a palpable and cystic tumor mass between the rectum and sacrum and represents a herniation of the meninges through a defect in the anterior plate of the sacrum. In 68 per cent of cases reported it has been associated with a characteristic deformity of the sacrum which may be recognized in roentgenograms. Surgical interference has resulted in high mortality due to postoperative meningitis. Thirty-four cases have been reported in the literature including the three cases in this study.

CONCOMITANT HYPERPARATHYROIDISM AS A CAUSE OF THE HYPERCALCEMIA ASSOCIATED WITH HYPERTHYROIDISM

Excerpt The hypercalcemia reported as occurring in association with hyperthyroidism has been thought by some authors to be caused in some way by the thyrotoxicosis. It is the purpose of this paper ...

Anomalous termination of the common duct.

Abstract An unusual termination of the common duct into the main pancreatic duct disclosed by cholangiography has been presented.

Unusual tumors of the stomach

Abstract Leiomyomas and sarcomas of the stomach must be considered in the differential diagnosis involving a large intra-abdominal mass. Leiomyomas give symptoms according to size, location and degree of pyloric obstruction, whether or not there has been malignant change in the tumor. Diagnosis can be made usually by x -ray study. Treatment of such tumors is surgical following recognition. Lymphosarcomas represent the exception because of their radio-sensitivity. The type of surgery depends upon the degree of involvement of the stomach and upon the presence or absence of malignancy as determined by fresh frozen section at the time of operation. Thus local excision, partial or total gastrectomy may be required. Three cases in which the patients underwent operation at this clinic are reported.

Biliary system inflammation and cholecystitis; a study of 200 liver biopsies done at cholecystectomy.

Abstract Two hundred cases of liver biopsy were studied in patients with proved acute or chronic gallbladder disease, 97.5 per cent with stones. Thirty-two per cent of these patients demonstrated changes consistent with a diagnosis of biliary tree inflammation or what is termed as “cholangitis.” It is believed that acute or chronic cholecystitis with or without stones is only one facet of a generalized process. An ascending type of inflammation as a means of etiology is presumed but not proved. There was a significantly large percentage of patients showing fatty change which was quite variable in extent, amounting to 29 per cent of the total cases. Fatty metamorphosis seemed to be independent of any other process. Attempt was made to correlate an impaired convalescence of the patient with the status of the liver but this was difficult and not conclusive. A discussion of the method of taking the biopsy has been made. Artefacts are an extremely common occurrence in the specimens, but are usually easily recognized. Pathologic descriptions are included and represented by the photomicrographs. We believe that due to the lack of a control group this problem warrants further study.

Cardiac arrhythmias during anesthesia; a comparison of cyclopropane and pentothal-nitrous oxide-ether anesthesia.

Abstract Statistical data is given on the incidence of arrhythmias induced during 334 major surgical cases. Under cyclopropane anesthesia 62 per cent (70 out of 113 patients) had some type of arrhythmia. Six types of ventricular arrhythmias occurred eighty-five times in sixty-three cases. The multiple and multifocal ventricular premature contractions were the most frequent and dangerous arrhythmias; in this group of cases intravenous procaine for various ventricular or combined supraventricular and ventricular arrhythmias apparently benefited 93 per cent of the patients. Under pentothal-induced nitrous oxide-ether anesthesia 9 per cent (21 patients of 221) had some type of arrhythmia. Contrast this with 62 per cent arrhythmias in the cyclopropane group. Only eight patients had ventricular arrhythmias. The auricular arrhythmias were more common in this group but not worrisome. Intravenous procaine was effective in the ventricular arrhythmias in this group except in the case of cardiac arrest. A case of cardiac arrest occurred in each group and these are included as case reports. We believe that this study demonstrates a significant difference between the anesthetics in regard to their potentialities for causing serious disturbances of cardiac rhythm. This study also emphasizes the advantage of using the electrocardiograph in surgery 12 to evaluate better the effect of anesthetic agents on the cardiac mechanism.

Adenocarcinoma of the common bile duct with resection, anastomosis of the hepatic duct to the cystic duct and cholecystogastrostomy.

A CASE of papihary adenocarcinoma of the common biIe duct is presented with resection of the growth, anastomosis of the common hepatic duct to the cystic duct and estabhshment, with a cholecystogastrostomy, of continuity with the gastrointestinal tract. A short review of the Iiterature is aIso presented. In this study, cancer of the ampuha of Vater is not considered. Carcinoma of the extrahepatic biIe ducts differs in many respects from the more common carcinoma of the gaIIbIadder. “The reIative infrequency of gaII stones (22 per cent in 264 cases) and the predominance of the disease in males 50/35 contrast carcinoma of the Iarger bile passages with that of the gaILbladder.“’ AIthough carcinoma of the extrahepatic biIe ducts is considered quite rare by most observers, a review of 46,442 autopsies2+ reveaIs 123 cases of primary cancer in the extrahepatic biIe ducts. This gross incidence of .26 per cent means that this disease was found in about one out of every four hundred patients coming to autopsy in this series. PaInar reported 103 cases of cancer in the biIiary passages in over 53,000 necropsies-0.19 per cent of a11 autopsies or 2.2 per cent of al1 carcinomas found.7 An anaIysis of the Iiterature indicates that the most common site for cancer of the extrahepatic ducts (exchrsive of the ampuIIa of Vater) is the confluence of the cystic, common hepatic and common biIe ducts. Cancer of the common biIe duct occurs primariIy past middIe age (fifty to seventy). In many of the cases there is associated biliary tract disease: ChoIecystitis, cholangitis, cirrhosis, or stones. “AIthough primary carcinoma of the common biIe duct is comparativeIy a rare pathoIogica1 entity, it should be given consideration as a possibIe cause of persistent obstructive jaundice in a11 cases occurring past middle age.“* Carcinoma of the extrahepatic biIe ducts is of three types according to Ewing: diffuse, noduIar and viIIous. UsuaIIy the viIIous or papiIIary type of growth attains the Iargest size without severe obstructive symptoms, is of Iowest degree of maIignancy and is most amenabIe to surgica1 management. Metastasis from carcinoma of the biIe ducts is not common9 and occurs Iate. In MarshaII’s series of forty-nine cases, onIy tweIve showed metastasis-nine to Iiver, five to regional lymph nodes, three to pancreas and one to the Iungs. MarshaII, in specuIating on causes of maIignancy of the extrahepatic ducts, noted that if stones were the principa1 etioIogica1 factor, this disease shouId be more common in women than in men, but as aIready mentioned, the opposite is the case. Dick suggested that cancer of the common biIe duct might be due to Iong continued appIication of a carcinogenic agent acting on an hereditarily susceptibIe person. He postuIated that choIic acid, which is reIated chemicaIIy to known carcinogenic substances, might be this etioIogica1 factor.4 The symptoms and signs of cancer of the extrahepatic biIe tracts are those of obstructive biIiary disease and of malignancy. Among the earIy symptoms are vague gastric distress, Iassitude and fatigue, loss of appetite and loss of weight. Jaundice