J. Arnold Bargen

Multiple Carcinomas of the Large Intestine: A Review of the Literature and a Study of 261 Cases

Summary 1. The literature concerning multiple colonic carcinomas has been reviewed. 2. We have presented data on 261 cases in which multiple carcinomas of the colon were seen at the Mayo Clinic from January 1, 1944, through December 31, 1953. This represents a known rate of occurrence of 4.3 per cent. 3. The concept of carcinoma of the colon as a multicentric lesion has been discusbed. 4. A marked tendency to multiplicity has been observed in carcinoma of the colon associated with multiple polyposis or with chronic ulcerative colitis. 5. We have obtained some evidence of hereditary factors in predisposition to malignant disease of the colon. 6. When the diagnosis of a malignant lesion of the colon or rectum has been made, the entire large bowel must be considered a potential source of malignant disease. An integral part of the management of carcinoma of the large bowel must be constant vigilance to ensure early diagnosis and adequate treatment of both simultaneous and interval lesions.

Complications and Sequelae of Chronic Ulcerative Colitis

Excerpt Every serious disease entails dangerous consequences, either during the progress of the illness or as a result of natures effort to restore destroyed tissue. Particularly is this true of s...

A Study of the Motility Patterns and the Basic Rhythm in the Duodenum and Upper Part of the Jejunum of Human Beings

Summary 1. Balloon-photokymographic recordings of duodenal and upper jejunal motility have been made in 21 normal persons, 5 patients who had duodenal ulcer and 5 who had chronic ulcerative colitis. 2. The waves seen in the records were classified in two types designated I and III. Measurements of the dimensions of these waves and their frequency of occurrence were made and the percentage of the observation time during which activity was present was also determined in each record. 3. In all of the records, periods of activity alternated with periods of quiescence. When the normal persons and the patients fasted overnight, motility was present 60 to 70 per cent of the time. This percentage was reduced in normal persons to 34 by a fast of 24 to 36 hours. During the active periods, type I waves occurred almost continuously and type III waves were seen about half of the time. 4. Bursts of type I waves in rhythmic sequence occupied about 2 per cent of the tracings from normal persons and from patients who had duodenal ulcer. In the patients who had ulcerative colitis the incidence exceeded 6 per cent. In all of the persons studied, the mean rate of the type I waves when in rhythmic sequence was 11 per minute and the variations around this mean were less than 1 per minute. This rate of rhythmic type I waves has been presented as representing the basic rhythm of the small intestine.

Pseudomembranous enterocolitis: clinicopathologic study of fourteen cases in which the disease was not preceded by an operation.

Summary This report is based on a review of the clinical and pathologic findings in 14 cases of pseudomembranous enterocolitis in which the disease was not preceded by a recent operation on the abdomen. In the cases which previously have been reported in the literature the disease has occurred after an operation on the abdomen. The following pathologic conditions were associated with the pseudomembranous enterocolitis: obstruction of the large intestine in 5 cases, heart disease in 5 cases, and miscellaneous pathologic conditions in 4 cases. In 4 of the 5 cases of obstruction of the large intestine the cause of the obstruction was carcinoma. Severe infection was present in 3 of the 4 cases in the miscellaneous group. The most significant clinical features were the sudden onset of profound circulatory collapse which was resistant to the usual supportive measures, and the presence of watery diarrhea, abdominal distention with features suggestive of paralytic ileus, and abdominal pain. All but one of the patients were more than 50 years of age. At necropsy, segments or long stretches of the small and large intestine had a characteristic appearance. The mucosa was covered or replaced by a gray, loosely adherent wrinkled, fibrinous membrane which contained necrotic cellular debris, leukocytes and bacteria. The submucosa was markedly edematous and hyperemic. The muscular coat usually appeared normal, but partial necrosis of inflammation occasionally was present in this layer.

STUDIES ON THE LIFE HISTORIES OF PATIENTS WITH CHRONIC ULCERATIVE COLITIS (THROMBO-ULCERATIVE COLITIS), WITH SOME SUGGESTIONS FOR TREATMENT

Excerpt Two types of colitis in which intestinal ulceration occurs have long been recognized as entities; that is, tuberculous colitis and amebiasis. Until 1924, all other types of colitis were unc...

A critical analysis of the use of salicylazosulfapyridine in chronic ulcerative colitis.

Excerpt Of the many disease states that the internist or general practitioner may be called upon to treat, few if any have proved to be more frustrating to the physician and more demoralizing to th...

Scleroderma of the small intestine.

Involvement of the small intestine in scleroderma appears to be more common than was formerly supposed. The cause of the disease is obscure, and the clinical states associated with it range from spruelike syndromes to conditions resembling mechanical intestinal obstruction. In a series of 11 patients, the most prominent gastrointestinal complaint was vomiting. The most characteristic roentgenographic finding was persistent dilatation of the intestinal loops after passage of barium.

Ulcerative Duodenitis and Chronic Ulcerative Colitis: Report of Two Cases

Summary Two cases are reported showing that diffuse upper intestinal inflammation, which fortunately is seen uncommonly in regional enteritis, also may be a complication of chronic ulcerative colitis.

Chronic ulcerative colitis and pregnancy

Abstract 1. 1. An analysis has been presented of 34 patients with chronic ulcerative colitis during 50 pregnancies. 2. 2. Seven pregnancies in five patients did not proceed to term, three of these being operative interferences. All occurred before coming under our observation. 3. 3. Pregnancy was not adversely affected in any of the remaining 43 instances. They resulted in full-term, live births. 4. 4. During 58 per cent of the pregnancies, the ulcerative colitis was definitely improved. 5. 5. From the data presented, it appears that termination of pregnancy is not indicated in the presence of chronic ulcerative colitis.Abstract This report is based on 19 cases in which pregnancy occurred in association with chronic ulcerative colitis. In 15 of the 19 cases, the colitis did not have any effect on the pregnancy. Premature delivery occurred in 2 cases and spontaneous abortion occurred in 2 cases. In 5 cases the chronic ulcerative colitis improved in the course of pregnancy, and in 4 cases it became worse than it had been previously. No change in the colitis was observed in 4 cases. In 6 cases the colitis started with the onset of pregnancy. A remission of the colitis occurred in the postpartum period in 3 cases, and a definite relapse occurred in 5 cases. The results of our study appear to warrant the conclusion that pregnancy has an adverse but unpredictable effect on the clinical course of chronic ulcerative colitis. It is our opinion that patients who have chronic ulcerative colitis should be advised to refrain from becoming pregnant unless a remission of the disease has been present for a long time.

ILEOSTOMY FOR CHRONIC ULCERATIVE COLITIS (END RESULTS AND COMPLICATIONS IN 185 CASES)

Excerpt The evolution of ileostomy as the foremost surgical procedure for the treatment of chronic ulcerative colitis of the thromboulcerative type has had a long and devious course. The long years...