John M. Waugh

Intestinal polyposis associated with mucocutaneous melanin pigmentation Peutz-Jeghers syndrome; review of literature and report of six cases with special reference to pathologic findings.

Summary A review of the literature disclosed 69 cases of intestinal polyposis associated with mucocutaneous melanin pigmentation (Peutz-jeghers syndrome). Six new cases are reported herein, bringing the total to 75 cases in the world literature. The diagnosis should be entertained in any instance in which there are areas of unusual pigmentation on the lips or the buccal mucosa or both. Suitable x-ray studies will reveal the presence of polyps in the small bowel in almost 100 per cent of cases. The stomach, colon and rectum are involved less frequently. Eighty per cent of these polyps are benign adenomas and 20 per cent may show low-grade malignant changes. The evidence for establishing truly malignant transformation in the polyps is not completely convincing and warrants more careful investigation in the future. Our findings suggest that these polyps are developmental abnormalities (hamartomas) rather than neoplasms. A hereditary tendency is found in 55 per cent of the subjects. The chief symptoms are those of intussusception and gastrointestinal bleeding.

Pharmacologic and Chemical Tests as an Aid in the Diagnosis of Pheochromocytoma

Today pharmacologic and chemical tests are helpful in screening a relatively large number of patients for pheochromocytoma and are a definite aid to a correct diagnosis. No one test is infallible, and knowledge concerning the drugs used or the manner in which the blood and urine are collected, or both, is necessary to avoid a false-positive or false-negative result from the tests.

Painless Single Stone in Pancreatic Duct: Report of a Case with Steatorrheal Diarrhea

Summary We have reported the case of a 67-year-old white man with a four-month history of passing fat and oil per rectum, this being his sole complaint originally. The lesion was an isolated calculus occluding the duct of Wirsung, with associated pancreatic atrophy and fibrosis. The calculus was removed, with lessening, but not disappearance, of steatorrhea postoperatively. Two years after removal of the calculus, more calculi were visible in roentgenograms of the pancreatic area, apparently in the main pancreatic duct. Three years postoperatively, roentgenograms revealed that the stones in the duct had increased in size and number, extending throughout the length of the gland. Although the possibility that this case represents an instance of painless chronic pancreatitis cannot be excluded, it is perhaps more likely that the primary event was formation of a stone in the duct of Wirsung. Removal of a solitary stone in the pancreatic duct seems advisable in an effort to restore ductal patency and to prevent secondary pancreatic parenchymal atrophy and fibrosis. Although encountered infrequently, pancreatic duct calculus must be kept in mind as one of the more unusual causes of steatorrhea and azotorrhea.

Endometriosis as a cause of ileal obstruction.

Abstract This paper presents the first analysis of clinical data of a series of cases in which ileal obstruction was caused by endometriosis. The subject is of particular significance because the obstructive involvement of the distal part of the ileum by this highly invasive nonmalignant tissue often has been confused clinically with appendicitis accompanied by ileus, with malignant lesions causing obstruction of the intestine, and with intestinal obstruction caused by the adhesions of pelvic inflammatory disease. The importance of endometriosis as a cause of ileal obstruction has not been sufficiently stressed. The clinical picture of this condition, as revealed by a detailed analysis of the clinical data of sixteen cases, will be presented, as will also (1) certain facts higly pertinent to the differential diagnosis, (2) pathologic lesions and (3) surgical treatment. The term “endometriosis” indicates the existence of endometrial tissue in any extrauterine location.

Pregnancy following gastric resection

T H E P RO B r. E ivr of pregnancy in patients who have had gastric resection has received little attention in the literature. Since pregnancy is associated with altered intestinal motility, increased nutritional requirements, and increased blood volume, maternal health could be affected adversely during a pregnancy occurring after gastric resection. This study was undertaken to investigate this problem.