Harry C. Saltzstein

The Relation of Sex Hormones to Peptic Ulcer

Clinical, experimental and laboratory data are presented on the relation of female sex hormones in peptic ulcer.

Effect of Cortisone on the Size of Experimentally Produced Myocardial Infarcts

In a total of 57 dogs the anterior descending branch of the left coronary artery was doubly ligated. Cortisone apparently (1) reduced the area of residual fibrosis; (2) increased the vascularity of the heart.

The prevention or healing of experimental peptic ulcer in mann-williamson dogs with the anterior pituitary-like hormone (antuitrin-s) A Preliminary Report

(1). There is clinical evidence that ulcer and its complications are infrequent during pregnancy. (2). The attempt was made to prevent or heal experimental ulcers (Mann-Williamson dogs) by daily injections of estrogenic and gonadotropic hormones which are known to be excreted in greatly increased amounts during pregnancy. (3). Twelve untreated (control) Mann-Williamson dogs all died with typical jejunal ulcers. 75% died of peritonitis following perforation. There was no evidence of healing. (4). Fifteen Mann-Williamson dogs treated with theelin all died with typical jejunal ulcers. 73% died of peritonitis following perforation. There was no evidence of healing. These dogs died sooner than the control dogs which appears to indicate that theelin accelerates perforation as compared with the control series. (5). Fifteen Mann-Williamson dogs were treated with antuitrin-S. 53% of the dogs failed to show ulcer at postmortem examination (death due to inanition). Of the seven dogs that died with ulcer, four (27% of the total) showed definite evidence of healing microscopically, as fibroblasts proliferation, newly formed blood vessels, a thin pyogenic membrane, and early covering of the ulcer surface at the margins. A total of 80% of the Mann-Williamson dogs either had their ulcers prevented, healed, or healing during antuitrin-S treatment. Only one died of a perforated ulcer. (See Table IV). (6). The improvement in peptic ulcer noted during pregnancy may have a relationship to the large amounts of antuitrin-S present in the body at this time.

Deaths from perforation and hemorrhage of gastroduodenal ulcer during pregnancy and puerperium

Abstract 1. 1. While pregnancy as a rule has a beneficial effect on the symptoms and course of peptic ulcer, active symptoms of ulcer may occur during pregnancy. Nausea, vomiting, and epigastric distress or epigastric pain during the second or third trimester of pregnancy in a woman with a history of a pre-existing ulcer should be considered as “warning signals” of ulcer reactivation. Medical management should be immediately instituted to prevent hemorrhage or perforation of the ulcer. These complications may follow with fatal results, particularly during the first several days of the puerperium. 2. 2. Thirteen deaths, resulting from perforation and hemorrhage from gastroduodenal ulcer during pregnancy and puerperium, with autopsy reports, were found in the literature. We have added one case, the only record of peptic ulcer in all the 70,310 pregnant women admitted to five Detroit hospitals in a period of ten consecutive years. Probably more deaths during pregnancy and the puerperium occurred as a result of ulcer complications but the deaths may have been classified as “other accidents of pregnancy.” 3. 3. In the above 14 cases, prior to autopsy, death was thought to be due to varicosities from esophagus, gastric malignancy, “cardiac death,” and nephritis in the hemorrhage cases, and mesenteric thrombosis, twisted cystoma, acute pancreatitis, cystic duct stone, ruptured gall bladder, eclampsia, septic peritonitis or puerperal sepsis in the perforation cases. 4. 4. Ulcer patients as a rule have “a past.” The typical ulcer history (intermittent attacks, food, soda relief, ect.), while at times difficult to obtain, may be the decisive factor in arriving at a proper diagnosis and in instituting adequate therapy. 5. 5. Pregnancy or puerperium should not be considered as contraindications to surgery when this is indicated for peptic ulcer.

The value of histidine in prevention of experimental ulcer in dogs.

We are unable to corroborate the original experimental work of Weiss and Aron, that histidine has a protective value against peptic ulcer produced in dogs by the Exalto-Mann-Williamson operation. Of fourteen dogs receiving daily injections of histidine, following surgical duodenal drainage, (2 c.c. Larostidin daily which contains 80 mgm. of histidine) 13 or 93% showed ulcer formation. Of 12 controls, all developed ulcers. The histidine deficiency theory of peptic ulcer is discussed. There is no evidence that a deficiency or absence of histidine is the cause of peptic ulcer.

The effect of pregnancy and of antuitrin-s on cinchophen ulcers in dogs

1. Pregnancy and injections of Antuitrin-S had only slight effect on cinchophen ulcers in dogs. 2. There was a definite difference in the rapidity with which ulcers were produced by two different commercial preparations of cinchophen. This may be due to a small admixture of phenylquinoline or the presence of the unknown impurity in one product and its absence in the other. 3. Mann-Williamson ulcers and cinchophen ulcers respond differently under treatment with Antuitrin-S.

Results in treatment of 374 Mann-Williamson dogs.

Summary The average survival time of our control (untreated) Mann-Williamson series was 63 days. All died of ulcer. The longest survival was 135 days. Eight per cent of the ulcers showed epithelization. With these data as a base line, our results are as follows: (1)Best results were obtained by daily injections of commercial human pregnancy urine extract (Antuitrin-S). Inactivating this by heat destroyed much of its potency. Marked benefit was obtained from extracts of normal male and normal female urine (parenteral administration) which did not contain the anterior pituitary-like hormone. Extracts made from urine of ulcer patients, administered parenterally, had very much less, if any, activity. (2)Oral administration of a human pregnancy urine extract, in small doses, failed to prolong the survival time, but it stimulated epithelization in a significant number of the ulcers. (3)The follicle-stimulating hormone from pregnant mares serum (Gonadogen) was definitely beneficial (parenteral therapy). (4)Parenterally, the posterior pituitary extract (surgical pituitrin) was of no benefit. A combination of the posterior pituitary extract (pituitrin) and the anterior pituitary-like or luteinizing hormone (Antuitrin-S) failed to prolong the survival time but a significant number of the animals died without ulcer. (5)Estrone (Theelin) administered by injection, failed to produce any effect. Progesterone (Proluton), also by injection, did not prolong the survival time of the animals but it stimulated epithelization. (6)An extract obtained from urine of patients with inoperable carcinoma of the stomach and an extract prepared from beef heart muscle tissue (each used parenterally) produced some benefit. The number of animals in these two series is too small for definite conclusions. (7)Parenteral administration of a foreign protein from def atted milk (aolan) prolonged the survival time slightly. Not one of the ulcers examined microscopically showed epithelization. (8)Oral enterogastrone was of some benefit. Very little, if any, effect was obtained with the parenterally administered enterogastrone we used. (9)Vagotomy had no beneficial effect. (10)All of our Mann-Williamson animals with total gastrectomy died without ulcer. However, because of the nutritional disturbances that followed, all the animals died within 40 post-operative days.

Diagnostic difficulties in rectosigmoid lesions

The difficulties encountered in the differential diagnosis of recto-sigmoid lesions are discussed. Close correlation is necessary between the clinical history and examination and the various diagnostic aids. Laparotomy may be required to establish the final diagnosis.

Diagnosis of tumors of the neck: Especial reference to anatomic location

Abstract Anatomic location plays a large role in the accurate diagnosis of tumors of the neck, (1) Thyroglossal cysts may appear lateral to the midline. (2) Papillary adenocarcinoma of the thyroid (previously termed carcinoma primary in aberrant thyroid tissues) may appear anywhere in the midline from the nasopharynx to the mediastinum, including the trachea and the esophagus, and almost anywhere in the lateral neck regions. It frequently appears as isolated masses, either single or multiple, along the jugular chain or underneath the lateral or posterior border of the sternomastoid muscle. It may even appear laterally near the acromion and outer end of the clavicle. (3) Various simple benign conditions must always be thought of in diagnosing neck lesions; especially sebaceous cysts, lipomas, mild inflammatory conditions and tumors arising from superficial nerves, fascia, muscles, etc. (4) Lymphomas present diagnostic problems which often prevent an accurate solution until the microscopic section is obtained, and even then there may be confusion among the pathologic interpretations. (5) Oral metastatic carcinoma follows the lines of the lymphatic drainage in the neck. The diagnosis often rests upon the accurate interpretation of this lymphatic drainage.

The follow-up examination for cancer; with a few remarks on the diagnosis of cancer.

Summary o 1. A follow-up routine for patients with cancer adaptable for a private office is detailed. 2. Specific points in the follow-up examination of patients with cancer in the mouth, stomach, bowel, breast or cervix are briefly mentioned. 3. The early diagnosis of cancer in these different body regions is commented upon.