Henry Sosin

Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy

Seventy‐five patients with complete bowel wall penetration and/or positive lymph nodes at the time of initial “curative surgery” had planned single or multiple reoperations at the University of Minnesota. Tumor due to rectal carcinoma was found in 52. Four were converted to disease‐free status. Areas of failure were analyzed in detail. Distant metastasis (DM) alone was uncommon. Peritoneal seeding (PS) was rare. Local failure and/or regional lymph node metastases (LF‐RF) occurred as the only failure in nearly 50% of the failure group and as some component in 92%. Patterns of failure are fairly predictable if anatomical factors and initial pathologic extent of tumor are considered. Postoperative irradiation may be a logical adjuvant in view of the high percentage of local‐regional failures and the ability to identify subgroups of patients at highest risk for such failure.

Spontaneous perforation of a pancreatic pseudocyst into the colon and duodenum

Summary The second report in the literature and the first successfully treated case of spontaneous pseudocystoduodenocolostomy is p resented. An attempt has been made to clearly distinguish between spontaneous intraperitoneal rupture of pancreatic pseudocysts and spontaneous perforation into the gastrointestinal tract. Rupture presents as an acute abdominal catastrophe in a patient with a history of pancreatitis and should be treated by external drainage. In the past this complication has produced a mortality of 60 per cent. Perforation presents a picture of abdominal pain, fever, nausea and vomiting, and diarrhea. Treatment varies with the location of the communication, and the over-all mortality should be significantly less than 50 per cent.

Reflux gastritis: The consequences of intestinal juice in the stomach

The consequences of exposure of the intact stomach to intestinal contents were examined in six dogs. Diversion of duodenal contents through the stomach lead to the following changes: histologic gastritis in both antrum and corpus, increase in resting and postprandial serum gastrin levels, increased parietal cell density in four of six animals, and enhanced maximal acid secretory capacity in three of six animals. No significant changes were seen in insulin-stimulated acid secretion, insulin-stimulated pepsin secretion, antral gastrin levels, or G cell numbers. We conclude that chronic exposure of the intact stomach to duodenal contents results in gastritis and an amplified gastrin response to food. Parietal cell numbers and maximal acid secretory capacity are increased in some animals.

Metastasis from a pedunculated adenomatous colonic polyp with focally invasive carcinoma: Report of a case

A patient who had metastasis from a focus of invasive carcinoma confined to the head of an otherwise benign pedunculated adenomatous polyp of the sigmoid colon is described. That only 20 such cases have been reported previously attests to the rarity of this phenomenon. Because the morbidity and mortality of radical surgery far outweigh the liklihood of metastasis from such foci of invasive carcinoma in pedunculated adenomatous colonic polyps, local removal is recommended.

Management of focally malignant pedunculated adenomatous colorectal polyps.

A hospital record review identified 59 patients whose sole colorectal pathology was a pedunculated, adenomatous polyp with a focus of malignancy confined to the head of the tumor. Thirty-one patients had polyps with in-situ carcinoma, and 28 patients had foci of invasive carcinoma. Sixteen patients who had lesions in situ underwent laparotomy, and not a single instance of metastasis was found. Twenty patients who had carcinoma in situ received only local treatment, and 15 are alive and well. None of the patients treated locally has developed subsequent colorectal cancer, and 12 have survived at least five years following treatment. Of the 28 patients who had invasive carcinoma confined to the head of an adenoma, 19 are alive and well, and 17 have lived five years or more following treatment. There was one instance of lymph-node metastasis, which occurred in a patient who had a malignant lesion extending to the neck of the tumor and tumor cells in the lymphatics in the head of the polyp. All of the eight patients treated locally are alive and well, and five have lived at least five years following treatment. The results of this study, coupled with the rarity of reported metastasis from focally malignant, pedunculated, adenomatous colorectal polyps, strongly suggest that local treatment is sufficient for the vast majority of these lesions. Evidence from the literature suggests that resective therapy should be considered when 1) lymphatics within the head of the polyp contain tumor cells; 2) the cancer is highly undifferentiated; 3) the pedicle is extremely short and malignant changes extend to the neck of the adenoma.

The effect of serotonin on gastric secretion

S EROTONIN occurs normally in several body tissues and it can be shown to have power[ul effects on nearly all biologic systems. Various investigators have demonstra ted that the gastrointestinal tract is the main source of serotonin in man. Studies by Haverback 1 have shown that intestinal motil i ty is affected by serotonin. Previous work from our laboratory demonstrated a 67°0 increase in gastric blood flow dur ing the intravenous administrat ion of serotonin. 2 Whether serotonin has any effect on gastrointestinal secretion has not been definitely established. Recent work by Drapanas a has shown in dogs that secretin-stimulated pancreatic secretion is inhibi ted by intravenous adminis t ra t ion of serotonin. However, the effect of serotonin on gastric secretion remains controversial; many investigators, utilizing various methods and exper imenta l design, have obta ined conflicting results and have reported either no effect, increase in secretion, or inhibi t ion of gastric secretion, Because of the aforement ioned conflicting findings and our interest in this hornmne, the following studies were performed. T h e purpose of these experiments was to determine the effects of various doses of intravenous serotonin on secretion from Heidenha in pouches in dogs that were ei ther in the fasting state or st imulated with histamine.

Gastric blood flow following simultaneous administration of serotonin and histamine

SummaryLeft gastric-artery flow was measured with a Medicon FM-6 gated sine-wave electromagnetic flowmeter. Histamine, 4 µg./min., produces a small increase (9%) in flow. Serotonin in increasing doses of 10, 20, 40, and 60 µg./kg./min. given concomitantly with the same dose of histamine, progressively augment left gastric-artery flow in increments of 25, 43, 87, and 189%, respectively. The increases in left gastric-artery flow found with increasing doses of serotonin represent a single, direct, exponential relationship.

Correlation of 85Kr gastric mucosal flow determinations

Many factors all sharing in common predisposing damage of the gastric mucosal barrier in the presence of acid have been implicated in the pathogenesis of gastric ulcerations [3, 4, 6, 71. Shock and/or anemia with resultant ischemia of the mucosa, in the experimental animal, appears to be a potent causal factor. Such a mechanism can be implicated in man, if for no other reason than that the clinical setting in which stress ulceration occurs is often characterized by both hypotension and anemia, but direct measurements of mucosal blood flow have not been made because of a lack of a technique which allows for repeated determinations under various conditions. Laboratory techniques usually employed are not directly applicable to man. A method to evaluate gastric mucosal blood flow in the intact, physiologically unaltered state, would be an important tool in both man and animal for demonstrating the nature of the relationship between blood flow and breakdown of the mucosal barrier. Secondly, it is appreciated that the stomach may be thought of as essentially two distinct organs, the antrum (control) and the corpus (secretion), each with a potent influence over the other. The interrelationship between the function of the glandular elements, located in the mucosa, and the blood flow to that particular mucosa is unknown. If blood flow is important in this interrelationship, and on the basis of a demonstrated increase in metabolic activity