W. Emory Burnett

Mechanism of the disordered physiology involved in the Zollinger-Ellison syndrome

SummaryA detailed study of the altered gastrointestinal physiology and findings at autopsy in a patient with Zollinger-Ellison syndrome is presented. The results warrant certain considerations with regard to mechanisms involved in the altered physiology.The importance of the discovery by Gregoryet al. of a gastrinlike substance in the pancreatic tumor of such a patient is obvious in relation to the excessive gastric secretion which was first emphasized in this syndrome. Our results indicate that undue vagal activity may also play a role, in some cases at least.Data are presented which indicate that the parietal cell mass in some of these patients may be maximally or nearly maximally stimulated at all times.A rather remarkable effect of adequate anticholinergic and ulcer therapy on the control of the gastric secretion, diarrhea, and ulcer healing is recorded.It is our belief that the characteristic features of this disease, the fulminant peptic ulcer diathesis, the watery diarrhea with or without excessive potassium loss, and steatorrhea can all be related to the inordinate increase of gastric secretion; that the non-B cell tumor or islet hyperplasia must be very important in the gastric hypersecretion; and that vagal activity can also exert an important influence on this secretion (demonstrated in the case reported above).Finally, the nonfunctioning parathyroid adenoma found microscopically was of no importance in the patients clinical picture.

Value and limitations of aspiration biopsy for lung lesions.

We have been convinced of the value of needle biopsy in diagnosing malignant lesions of the lung since shortly after we first started using it in 1936. From 1936 to 1947 inclusive, we performed biopsies by this method in approximately 272 lesions of the lung, in 231 patients. It was necessary to repeat the procedure in a number of patients, and on numerous occasions we were unable to made a diagnosis. We were greatly encouraged by the excellent reports of Craver (1, 2) from Memorial Hospital, which appeared in 1939 and 1940. Memorial Hospital diagnosticians are still enthusiastic about this procedure. Others, however, including Ochsner (3) and Holman (4), who are experienced in diagnosing and operating on patients with carcinoma of the lung, have been strongly opposed to what we have come to consider a very useful method of diagnosis. We do not contend that all patients who are suspected of having pulmonary carcinoma should have needle biopsy. We much prefer, in fact we insist, that needle biopsy be prece...

The role of chronic perforation in intractable massive peptic ulcer hemorrhage

Abstract Fifty-seven cases of proved massive peptic ulcer hemorrhage have been reviewed. Generally they were managed by early, adequate blood replacement and dietary and alkali therapy. If manifest bleeding continued or recurred, they were considered surgical emergencies. Sixteen patients of this group of fifty-seven required emergency surgery and fifteen required partial gastrectomy with direct surgical control of the bleeding. In one patient with a high erosive lesion of the stomach ligation excision of the ulcer was done combined with vagotomy and gastroenterostomy. Two of these sixteen patients died as a result of their surgery. Nine of them had chronic perforating ulcers as the source of their hemorrhage, the ulcers being located either on the posterior duodenal wall or along the lesser curvature of the stomach. Of the six non-surgical deaths reported five had surgically amenable lesions. Four of these five lesions were chronic perforations. Ten of thirteen patients with chronic perforation had a history of either past manifest hemorrhage or past acute perforation. Seven of thirteen patients with chronic perforation had a history of a constant type of pain preceding their hemorrhage.