L. Kraeer Ferguson

Pathology and treatment of ganglion

Abstract 1. 1. A study of ganglia is presented with the review of 50 personally treated cases. We are inclined to the belief that trauma is a definite etiologic agent. 2. 2. From a pathological study we have been able to confirm Kings idea that these masses appear first as a solid tumor mass with later formation of small cysts which progress to the formation of larger cysts by the disappearance of the intercystic septa. 3. 3. Various staining methods have led us to believe that the contents of ganglia are myxoid rather than mucinous and therefore the process is one of degeneration of collagen fibres rather than a secretion of connective tissue cells as suggested by King. Analysis of Cases Age in Years Male Female Total 11–20 7 8 15 21–30 8 13 21 31–40 3 3 6 41–50 2 2 4 51–60 0 1 1 61–70 2 1 3 22 28 50 4. 4. Recurrence of ganglion following rupture or excision probably takes place due to a continuation of the degenerative process in tissues adjacent to the original ganglion. 5. 5. By simple rupture and dispersion, a permanent cure can be expected in about 50 per cent of cases. By excision a cure can be expected in about 85 per cent of cases. Best results are obtained by a fairly wide excision of the tissues surrounding the ganglion in order to be sure that all the tissue undergoing myxoid degeneration be removed.

Cancer and the reluctant surgeon

Abstract Factors influencing some surgeons to withhold surgery in extending or recurrent cancer are reviewed, and an analysis of each is made with illustrative examples. These include: (1) lack of increase in survival rates with improved surgical technics; (2) advanced age of the patient; (3) evidence of recurrence or metastasis; (4) the natural history and histopathologic grade of a tumor; (5) apparent disability of certain patients and the presence of intercurrent disease; (6) distaste for careful follow-up examinations; and (7) possible blame for failure to cure. An attitude of attempting to do the most good for patients with cancer rather than the least harm is urged.

The surgical management of massive melena.

Abstract When melena is associated with hematemesis its source is usually proximal to the ligament of Treitz. When melena occurs alone the bleeding may arise anywhere from the esophagus to the rectum. Operation is advised when the melena is obviously exsanguinating, persistent or repeatedly recurring. Many of the lesions causing melena can be diagnosed clinically. Their treatment will depend on the nature of the disease. In other patients a diagnosis cannot be made by the usual methods. In this group we advise diagnostic laparotomy while the bleeding is active, before the bleeding recurs too many times. In this manner bleeding Meckels diverticula, extramural small bowel neoplasms, etc. may be discovered. If a lesion cannot be found, the highest level of intraluminal blood may serve as a guide to the bleeding point. Multiple enterotomies and colotomies are performed and the adjacent mucosa is intussuscepted into the opening in the bowel wall. If still no lesion is found, intestine containing obvious disease such as diverticulosis is resected. We believe, however, that in many elderly patients with sclerotic vessels the bleeding arises from rupture of an intestinal submucosal artery rather than from the coincidental diverticular disease. Illustrative case histories are included.

Successful anastomosis of severed brachial artery.

Abstract A case of successful anastomosis of a brachial artery one and one-half hours after injury has been reported. Suture was accomplished by everting stitches of fine silk after careful removal of clots, especially from the distal end. The prophylactic use of penicillin and anticoagulants probably played a large part in preventing infection and thrombosis. The repeated and continued use of sympathetic (stellate) blocks proved to be a definitive factor in overcoming vascular spasm and thereby in maintaining an adequate circulation to the distal arm and hand during the period of healing.

Idiopathic massive hemobilia

Abstract 1. 1. A case report of idiopathic massive hemobilia is presented. 2. 2. The occurrence, classification and management of hemobilia are discussed.

Neuromyoangioma of the leg with symptoms similar to glomus tumor

Abstract A case is reported of a subcutaneous neuromyoangioma of the leg producing severe attacks of local pain brought on by cold. The symptoms are similar to those commonly associated with a glomus tumor but the pathologic examination failed to show glomus cells. Excision of the nodule produced immediate relief.