Norman B. Ackerman

The blood supply of experimental liver metastases. V. Increased tumor perfusion with epinephrine.

The effects of epinephrine on the vascular perfusion of solitary Walker tumors implanted in the liver were studied in Sprague-Dawley rats. Colored silicone rubber (Microfil) solutions were injected into the arterial and portal circulations in each animal, and specimens were studied under a stereomicroscope. Internal vascular volume was calculated on the basis of the interference of light passing through the central portions of the tumors by Microfil-filled vessels. Intraarterial epinephrine, in doses of 100 or 10 micrograms, markedly increased vascular perfusion in the encircling plexus and the internal tumor circulation compared with control animals. Internal vascular volume was significantly increased from 9.4 percent in controls to 22.5 percent in epinephrine-treated animals. Increased perfusion was also seen when epinephrine was administered through the portal system, and in larger tumors after intraarterial administration. Internal tumor vessels were capillary-like in appearance.

Consequences of intraperitoneal bile: bile ascites versus bile peritonitis.

Recent experience with patients with bile ascites and bile peritonitis prompted a review of other case histories in the medical literature of these conditions. The clinical courses of 24 patients with bile ascites and 34 with bile peritonitis were reviewed. Bile ascites occurred most often as a postoperative complication of biliary tract operations and also occasionally after trauma. Clinical signs were minimal except for abdominal distention, and operations were delayed for an average of 30 days. Peritoneal fluid was sterile in the 11 patients studied. In contrast, bile peritonitis occurred most commonly after spontaneous perforation of the gallbladder or hepatic ducts but also after trauma. All patients had severe signs of peritoneal irritation, and operation was performed earlier, at a mean of 4 days after onset of symptoms. Of 11 patients with specimens of their peritoneal fluid cultured, 6 had sterile fluid and 5 had bacteria. Although both bile salt concentration and bacteria have been implicated in the development of bile peritonitis rather than bile ascites, our understanding of the mechanisms involved is still incomplete.

Perforated diverticulum of the transverse colon

Abstract Six patients with perforated diverticula of the transverse colon were treated at the Menorah Medical Center. Acute appendicitis was suspected preoperatively in four patients, acute peritonitis caused by a lesion of the descending colon was suspected in one patient, and one patient was thought to have a carcinoma or perforated diverticulum. Segmental resection of the diverticular mass of the transverse colon was performed in five patients and ileotransverse colectomy in one patient. All patients recovered without complication. This condition, although rare, should be kept in mind particularly during “negative” exploration for acute appendicitis.

Perforated diverticulitis of the terminal ileum

Abstract The clinical course of a patient with perforated diverticulitis of the terminal ileum is described and six other reports in the literature are reviewed. The acute symptoms and signs simulate those of acute appendicitis, although two patients were seen with a less acute stage of disease; one had an enterovesical fistula and one (our patient) a walled-off abscess. Primary resection with ileotransverse colostomy is probably the preferred treatment, but mortality and morbidity have been significant.

Hyperparathyroidism with coexisting hyperthyroidism

Diagnosis of parathyroid disease in patients with hyperthyroidism may be difficult on clinical findings alone. Radiologic examination of the bones suggested the possibility of parathyroid disease in this patient. Confirmation of the diagnosis was made when serum calcium levels remained elevated in spite of adequate antithyroid medication. Measurement of serum parathyroid hormone levels may prove to be of greatest value. Of additional interest is the fact that the patient, before her symptoms became apparent, delivered an infant with congenital hypoparathyroidism.

The natural history of tumors implanted beneath the gastric serosa in rats

The spontaneous occurrence of gastric cancer in most wild and domesticated animals is extremely rare [l-5]. Gastric cancer can be induced in normal or acid-deficient animals with the use of such carcinogens as methylcholanthrene, N, N’-2, 7-fluorenylenebisacetamide, 4-nitroquinoline 1 -oxide, or N-methyl-N’-nitroN-nitrosoguanidine [6-131. Unfortunately, in many of the reported studies in which these carcinogens were used, the incidence of cancerous gastric lesions produced was low, ranging from 10 to 20 per cent. In all studies, even when the yield was higher, it took many months for these lesions to develop. In our laboratories we have had the need for a cancerous lesion growing in the stomach which could be produced quickly and in relatively large numbers of animals. The implantation of a small piece of tumor beneath the antral serosa has provided us with a preparation which grossly simulates gastric cancer in human subjects. By observing the growth and natural history of these tumors, certain similarities to and differences from the tumors in man have become apparent.

Comparison of changes in intestinal length and circumference after 90 per cent bypass and 90 per cent resection

Compensatory hypertrophy was compared in rats that had undergone 90 per cent small intestinal resection and rats that had undergone 90 per cent small intestinal bypass. Increases in intestinal length and circumference occurred rapidly in both groups and were virtually identical. Lengthening was more pronounced in the jejunum; increase in circumference was greater in the ileum. Increases in length and circumference of the appendix were seen in both experimental groups. These studies suggest that compensatory hypertrophy can occur in patients after either intestinal bypass or resection, and that patients with bypasses have a less difficult postoperative course because of their preexisting obesity.

Pitfalls in the surgery of aldosterone-producing tumors

Aldosterone-producing tumors of the adrenal present the surgeon with problems relating to preoperative localization and operative identification and resection. Adrenal venography and measurement of adrenal vein aldosterone levels have been of greatest value in preoperative localization but require skillful placement of catheters, cause occasional complications, and may occasionally give false-positive and false-negative results. Intraoperative problems include difficulties in identifying small or intraglandular tumors, as well as detecting multiple and bilateral adenomas.

Clinical and experimental uses of radioisotopes in the diagnosis of cancer

Abstract Radioisotopes are currently useful clinically in the diagnosis of cancer of the thyroid, brain, eye, liver, and bone. They are of less help in the diagnosis of cancer of other anatomic sites but are occasionally of value in detecting tumors of the pancreas, kidney, lung, and parathyroids. Considerable research is in progress in laboratories throughout the world, and the outlook for improved diagnostic technics with radioisotopes in the near future is very good