James C. Cain

Intractable hiccup. Etiologic factors in 220 cases.

Hiccup previously was thought to be due to a single disease that produced an abnormal irritation of the phrenic nerve or of the higher centers. A study of 220 cases of intractable hiccup suggests that there may be several exciting causes that one must elucidate in the same patient.

HEREDITARY HEMORRHAGIC TELANGIECTASIA AND GASTROINTESTINAL HEMORRHAGE

Summary In 1.59 patients with hereditary hemorrhagic telangiectasia, the chief manifestation of the disease was hemorrhage (89 per cent), with epistaxis being most common (81 per cent). The telangiectatic lesions were located primarily on the face, mucous membranes of the head, and hands. Local treatment of the lesions and occasional estrogen therapy were of some benefit. Systematic replacement of iron and transfusion of blood were the most helpful forms of treatment. Twenty-one of the 159 patients (13 per cent) had significant gastrointestinal bleeding; 20 of these had melena and 10 had hematemesis. The bleeding occurred primarily during and after the fourth decade of life. Only rarely could the typical lesions of hereditary hemorrhagic telangiectasia be visualized at operation on the gastrointestinal tract. Gastroscopic examination occasionally demonstrated them. Surgical resection of portions of the gastrointestinal tract for bleeding was almost universally unsuccessful, probably because of the diffuse nature of this disease.

Primary Malignant Neoplasms of the Duodenum. Excluding the Papilla of Vater: A Clinicopathologic Study of 31 Cases

Summary Primary malignant neoplasms of the duodenum, excluding the papilla of Vater, are rare. Thirty-one cases were found at necropsy at the Mayo Clinic from 1910 through 1953, an incidence of 0.12 per cent. Twenty-seven of the 31 tumors were adenocarcinomas; the remaining 4 were sarcomas of various types. There was no evidence in this series that a benign ulcer had undergone neoplastic change. Metastasis had occurred in 20 of the 31 cases. The commonest sites of metastasis were the regional lymph nodes and the liver. The commonest clinical features in this series were pain, loss of weight, vomiting and anemia. Melena, jaundice and an abdominal mass were also prominent findings. A lesion was found by roentgenologic examination in 15 of 22 cases. In no case was a correct diagnosis made without positive roentgenologic evidence of the lesion.

Chronic disease of the liver associated with systemic scleroderma

SummaryOf 727 patients with systemic scleroderma, 8 had evidence of serious hepatic disease. This low incidence hardly suggests a relationship between the diffuse cutaneous sclerotic process and the chronic hepatic disease, although the association should always be looked for. It is not possible to exclude hepatitis and malnutrition as causative factors of the hepatic disease, although the histologic appearance did not suggest the latter. The hepatic disease usually developed insidiously after years of involvement by the sclerotic process. Similar disease of the liver previously noted in other related diffuse processes, such as lupus erythematosus, and the overlapping of these diffuse processes, particularly as noted in the first case, are further suggestive of a possible etiologic relationship. Special studies of the ascitic fluid in one instance presented some direct evidence to support the concept that hepatic involvement was primary and not secondary to other causes such as cardiac involvement in scleroderma. Finally, it should be emphasized again that postnecrotic cirrhosis is a morphologic and not an etiologic diagnosis and may result from many diverse causes. Careful study of the liver and its function in future instances of diffuse systemic disease such as scleroderma and lupus erythematosus may shed further light on this relationship.

Lupus erythematosus cell phenomenon in patients with chronic ulcerative colitis

Present knowledge of systemic lupus erythematosus, albeit scarce, has been accumulated slowly since its original description to its present recognition as a complex systemic disease responsible for a number of syndromes previously considered unrelated. The true incidence of systemic lupus erythematosus, though still unknown, evidently is much greater than was realized before the discovery of the L.E. cell phenomenon by Hargraves, Richmond, and Morton (1948). From their finding has stemmed also the concept that autoimmune mechanisms operate in systemic lupus erythematosus and probably are responsible for at least some of its clinical and laboratory manifestations. Little also is known of the pathogenesis of chronic ulcerative colitis. Studies on the role of immunity in that condition have been inconclusive (Good and Condie, 1961; Kraft, Bregman, and Kirsner, 1962) but extracolonic manifestations are being recognized with increasing frequency (Sloan, Bargen, and Gage, 1950; Hightower, Broders, Haines, McKenney, and Sommer, 1958). Particularly interesting are the associated arthritis and the hepatic damage. We have found 11 cases of systemic lupus erythematosus associated with chronic ulcerative colitis reported in the literature (Brown, Haserick, and Shirey, 1956a; Gray, Mackay, Taft, Weiden, and Wood, 1958; Bartholomew, Hagedorn, Cain, and Baggenstoss, 1958; Larson, 1961; McEwen, Lingg, Kirsner, and Spencer, 1962). Although the paucity of these reports may indicate that this association is merely coincidental, the systemic manifestations of both diseases and some peculiarities of the cases reported may indicate that the association is of some significance. During the year 1962, 475 patients with chronic

POSTBULBAR DUODENAL ULCER

Excerpt Postbulbar duodenal ulcer, as the name implies, is one situated in the duodenum distal to the duodenal bulb. Anatomically, such an ulcer is in the postbulbar part of the first portion, or i...

Immune mechanisms in chronic pancreatic disease

SUMMARYThe presence of precipitins to pancreatic antigens was investigated by gel diffusion in two experimental conditions in dogs: pancreatic-duct ligation, and ethionine-induced pancreatitis. Precipitins to the pancreas were not demonstrable after pancreatic-duct ligation, but were demonstrable in other dogs, after small doses of ethionine had been administered for a short time, and in the absence of clinical or other laboratory evidence of pancreatic damage.Histologic study of the pancreases of dogs that were sacrificed after ethionine administration showed disruption of acini and focal inflammation. The pancreas from a dog that was kept alive for 10 weeks following ethionine administration was found to be histologically normal-even though circulating precipitins to its own pancreas had been demonstrated in this animal.The administration of dog-pancreas antisera to normal dogs did not produce any appreciable damage to their pancreases.Our data suggest that, in dogs, certain forms of pancreatic damage may result in the production of circulating precipitating antibodies. Their significance in the production or perpetuation of pancreatic disease is unknown, but it is possible that they have no pathogenetic significance.

The Effects of Chlorpromazine Hydrochloride on the Dynamics of the Biliary Tree: An Experimental Study

Summary From the data in hand we can conclude that Thorazine, when given intravenouslyto dogs in doses of 5 to 10 mg. per kg. of body weight, increases the resistance of the biliary sphincter mechanism with a resulting sluggish evacuation of bile in the animals which have an intact gallbladder and a rise in the biliary intraductal pressure in the cholecystectomized animals. Part of these changes may be related to a decrease in duodenal motility, which was also observed.

Immune mechanisms in chronic pancreatic disease. II. Serum precipitins to pancreatic homogenates in patients with pancreatic disease: preliminary clinical observations.

SummaryPrecipitins to pancreatic homogenates, presumably representing isoantibodies, have been found in 28 of 33 patients with various pancreatic exocrine diseases. In 4 of 5 patients without demonstrable precipitins, pancreatic damage had either occurred more than 3 years previously or had just begun at the time of the study. Similar precipitins were found in 7 of 35 diabetics but in only 1 of 52 controls with various nonpancreatic diseases.It is unlikely that these precipitins have any pathogenetic significance. Their determination, however, might prove useful in the diagnosis of pancreatic inflammation and malignant neoplasia.

Cholestasis (So-called Biliary Cirrhosis): Problems in Classification

Although conditions designated as biliary cirrhosis may present uniform clinical syndromes, the pathologic findings are often variable. As a result, confusion still exists between the clinician and pathologist regarding the nature of the syndrome. The authors review case histories of patients with primary, cholangiolitic, toxic and Secondary biliary cirrhosis.