Leonard D. Miller

Prognostic factors in carcinoma of the colon and rectum

Abstract The clinical and pathologic findings in 1,084 patients with carcinoma of the colon and rectum have been analyzed. The five year survival for the entire group of patients was 37.3 per cent. The five year survival for patients operated upon for cure was 48.1 per cent. The resectability rate was 93.5 per cent, and the over-all operative mortality 4.4 per cent. If recurrent disease was to occur after curative resection, 94 per cent of the cases appeared by the end of five years. In patients operated upon for cure, sutureline recurrence was high unless 5 cm. or more of normal colon was excised proximal and distal to the lesion. The presence of a palpable mass or symptomatic anemia was not indicative of a poorer prognosis. Vein invasion, nodal involvement, and deep penetration of the bowel wall halved the five year survival in patients operated upon for cure. A plea is made for widespread application of Turnbulls no-touch isolation technic, and for partial application of it in abdominoperineal resection.

The use of serotonin antagonists in postgastrectomy syndromes

Summary Experimental and clinical studies are presented to substantiate the role of serotonin in initiating the “dumping syndrome.” The beneficial effects of a serotonin-inhibitor in the treatment of this postgastrectomy problem as well as in two cases of postvagotomy diarrhea are outlined and discussed.

Changes in intestinal alkaline phosphatase in bowel ischemia

Abstract With the use of the specific substrate inhibitor, L-phenylalanine, the intestinal component of serum alkaline phosphatase was determined in dogs subjected to various intestinal devascularization procedures. In the group of dogs with superior mesenteric artery occlusion, the intestinal contribution of serum alkaline phosphatase gradually fell from a control value of 25 to 0 per cent in four of five animals. Selective devascularization of the proximal half of the small intestine in three dogs produced a similar pattern but there was little or no change in another three dogs when the distal half of the bowel was rendered ischemic. These studies suggest that an adequate blood supply is required for the intestinal elaboration of alkaline phosphatase and that the enzyme production most likely occurs in the proximal small intestine. Histochemical confirmation of the aforementioned results was obtained in an additional four dogs. After anesthesia, control full-thickness biopsy specimens were taken from the jejunum and ileum. The superior mesenteric artery was ligated and biopsy specimens taken again one-half, one, and two hours after ligation. Sections 7 μ in thickness were stained with 5 iodo-indoxyl phosphate in Veronal-hydrochloric acid buffer of pH 9.O. This stain is specific for alkaline phosphatase. In the jejunal specimens the enzyme was concentrated in the tips of the villi and had almost completely disappeared two hours after mesenteric occlusion. There was only a small amount of enzyme in the ileum and there was little change produced there by mesenteric vascular occlusion. Theoretically, determination of the intestinal fraction of total serum alkaline phosphatase might be a useful tool in the clinical diagnosis of superior mesenteric artery obstruction.