Timo V. Kalima

Histologic classification of Hodgkin's disease

Ninety‐seven cases of Hodgkins disease with 5 to 15 year follow‐up were classified according to the recommendation of the Symposium on the Obstacles to the Control of Hodgkins Disease, presented in New York in 1965, into four histologic groups: lymphocytic predominance, nodular sclerosis, mixed cellularity and lymphocytic depletion. A definite correlation was found between survival and the different groups, the first two groups having a markedly better prognosis than the last two. The nodular sclerosis type differed in many respects from the other types. In this group were more young patients and more females than in the other groups. Also, mediastinal and osseous involvement was more common. These facts argue for the assumption that the nodular sclerosis type is not merely evidence of the good reaction of the organism but that this type is a distinct form of Hodgkins Disease from the onset, a clinicopathologic entity.

Gastric blood flow, tissue gas tension and microvascular changes during hemorrhage-induced stress ulceration in the pig

Various features of blood supply to the gastric mucosa were studied in the piglet stomach during stress ulceration induced by hemorrhagic shock. Gastric blood flow, as measured by the radioactive microsphere technique, significantly decreased during shock, but no major change occurred in the gastric function of total cardiac output. There was no difference in the magnitude of the decrease of mucosal blood flow between the nonulcerating antral mucosa and the more readily ulcerating corpus or fundic mucosa. At the same time, a significant decrease in tissue partial pressure of oxygen and increase in tissue partial pressure of carbon dioxide occurred, but again no difference was observed between the antrum and the corpus. Microangiographic studies demonstrated a clearly diminished filling of the arterial and capillary bed of the gastric mucosa during shock, suggesting intense vasoconstriction, thrombosis of the mucosal blood vessels, or both. These changes were more prominent in the corpus portion of the stomach than in the antrum. At the site of mucosal lesions, the filling defects persisted even after the shock, suggesting permanent thrombosis of the blood vessels.

Bile acid composition and esophagitis after total gastrectomy.

Ten patients who had undergone total or subtotal gastrectomy for carcinoma 1 to 8 years earlier were evaluated in terms of subjective symptoms, endoscopy and the presence of bile in esophagojejunal aspirates obtained by direct aspiration during endoscopy. The concentrations of individual bile acids were determined by means of gas chromatography. Six of the patients had macroscopic esophagitis and all of them also had bile in their aspirate. The remaining four patients with normal esophageal mucosa did not have positive specimens. Neither did the total bile acid concentration nor any of the individual bile acids, regardless of whether they were free or conjugated, correlate with the severity of symptoms or the degree of endoscopic esophagitis. Esophagitis healed in all three patients who underwent conversion of loop esophagojejunostomy to a long Roux-Y reconstruction.

Urinary free and total hydroxyproline in hyperparathyroidism and the effect of removal of parathyroid adenoma

Abstract The urinary excretion of total hydroxyproline was elevated above the upper limit of normal values in 8 out of 13 patients with surgically confirmed primary hyperparathyroidism. All patients with normal urinary total hydroxyproline excretion had normal plasma alkaline phosphatase levels and normal bone X-rays, whereas 3 of the 8 patients with increased total hydroxyproline excretion had increased plasma alkaline phosphatase levels, and 4 of these 8 patients showed evidence of bone involvement in X-rays. These results support the suggestion that the urinary excretion of total hydroxyproline may be a more sensitive index of bone involvement in hyperparathyroidism than plasma alkaline phosphatase or bone X-rays, but that even normal hydroxyproline excretion does not exclude bone involvement. After removal of the parathyroid adenoma, the urinary excretion of total hydroxyproline decreased in all 7 patients in whom this effect was studied, including 2 patients with initially normal urinary total hydroxyproline values.The ratio of free to total urinary hydroxyproline was determined in 9 patients with hyperparathyroidism, including 4 patients with normal urinary total hydroxyproline excretion. This ratio was found to be elevated in 8 out of 9 patients studied. The content of free serum hydroxyproline was normal in 3 of these 8 patients, suggesting that the increased ratio in the urine was probably due to renal effects of parathyroid hormone

Role of Pyloric Reflux in Experimental Stress Ulceration during Haemorrhagic Shock

The significance of pyloric reflux of bile and duodenal juice in experimental gastric stress ulceration was studied using a swine shock ulcer model. Following a haemorrhagic shock of 3 h duration, nine of the ten control piglets (90%) with normal bile flow have gastric mucosal lesions. None of the five piglets with permanent bile diversion (ligation of common bile duct; cholecystojejunostomy) has gastric lesions. Intragastric instillation of pure bile prior to the shock in piglets with permanent bile diversion induced gastric lesions in only one of the five test animals (20%). If duodenal juice was used instead, four of the six test animals (67%) have lesions. The results indicate that, in the pig, an uninterrupted flow of bile into the duodenum is a prerequisite for the development of gastric mucosal lesions following haemorrhagic shock. They also suggest that duodenal juice containing both bile and pancreatic juice has a stronger ulcerogenic influence on shocked porcine gastric mucosa than bile alone.

Left paraduodenal hernia

Abstract A case is presented of left paraduodenal hernia with unusual anatomic features. The mechanism of origin is briefly discussed, and the importance of familiarity of the abdominal surgeon with the basic anatomic features of internal hernia is stressed.

Decreased prevalence of gallstones in gastric cancer

The prevalence of gallstones and the frequency of previously performed cholecystectomy were examined in 498 autopsy subjects who had gastric cancer and their age- and sex-matched control subjects. The frequency of gallstones not treated by operation and previous cholecystectomy was significantly (p less than 0.01) lower in those with gastric cancer than in the matched-control subjects. It is not possible to determine on the basis of this study what the possible factors that cause this phenomenon are.

Modification of Porcine Stress Ulceration by Methylprednisolone, Vitamin A and Methysergide Treatment

Using a swine shock ulcer model, three pharmacological agents, methylprednisolone, vitamin A and methysergide were evaluated, as they protect gastric mucosa against acute ulceration. Following haemorrhagic shock (3 h duration; mean arterial pressure 40 mm Hg) nine of the ten control animals (90%) developed gastric ulceration. Of the six test animals treated with intravenous methylprednisolone during the shock, only one (17%) developed gastric lesions (p less than 0.02; x2 = 5.76). Of the ten test animals pretreated with massive doses of parenteral vitamin A, only three (30%) developed lesions (p less than 0.05; x2 = 5.21). In contrast to this, treatment with methysergide, a serotonin antagonist, did not significantly effect the ulceration rate, since four of the six test animals (67%) had gastric lesions. The results suggest that methylprednisolone and vitamin A do protect the gastric mucosa from experiment stress ulceration, but their mechanism of action remain obscure and further investigation is needed to judge their value in clinical use.

Leiomyoma of the ischioanal region

SummaryA case of a patient with benign leiomyoma, adherent to the musculature of the anal canal, is reported. If this can be considered a tumor of the anal canal, it is believed to be the third case reported in English medical literature. Perianal leiomyomas grow away from the lumen of the rectum and musculature of the anal canal and cause few, if any, intestinal symptoms. The tumor can be removed easily by local excision and no recurrences have been reported. Nevertheless, we believe that careful follow-up procedures should be adopted to determine if malignant degeneration develops.Medical literature on leiomyomas is reviewed briefly.

122. Oesophagitis und OesophaguBtriktur nach Gastrektomie

SummaryOf 189 patients operated on for gastric cancer from 1970 to 1975, total gastrectomy was performed in 22% (41) with a mortality of 12%. At follow-up of 2.5 years 56% of patients did not have esophageal symptoms, 25% had chronic, severe esophagitis, 36% developed stenosis. Malignant recidivations caused half of them and in the others the benign scar strictures were often combined with esophagitis.To decrease these late complications, emphasis was placed on preventing alkaline reflux by operative methods. The patients were examined endoscopically and when neceBary, Eder-Puestow dilators were used without complications.Strictures at anastomoses yielded best results. When stenosis and esophagitis were compined, it was in some cases neceBary to repeat dilatations, and in malignant strictures the complaints were relieved transiently.ZusammenfaBungOesophagitis und OesophaguBtriktur nach totaler Gastrektomie sind recht allgemeine Komplikationen, die den Hauptanteil der postoperativen Beschwerden dieser Patienten verursachen. Da diese Patienten oft in schlechtem Zustand sind, ist das Risiko operativer Eingriffe groB und wir sind deshalb mit recht guten Resultaten zur Anwendung von Eder-Puestow-Dilatatoren übergegangen. Das Perforationsrisiko ist gering und ebenso anschlieBend die Möglichkeit einer Ruptur, falls genügende Vorsicht gewahrt wird.