Ward O. Griffen

The prognosis and management of recurrent abdominal malignancies

Summary Systemic and regional chemotherapy, when used with the proper anti-cancer drug and the optimum record of administration, offer for each patient with inoperable and/or metastatic intra-abdominal cancer significant means of increasing survival time and at the same time controlling symptoms. With a knowledge of the several drugs and the different methods and types of chemotherapy programs available, the surgeon can offer some hope, greater comfort and prolongation of life to at least one third of the patients with noncurable intra-abdominal cancer.

Problem-based learning: an effective educational method for a surgery clerkship.

Problem-based learning (PBL) has been implemented during the clinical years in a few medical schools. The purpose of this study is to determine whether PBL provides a better education than traditional methods. Students in the first and third rotations (n = 42) went through the traditional clerkship, which utilized Socratic teaching (SI), while students in the second and fourth rotations (n = 36) were taught by the PBL method. Two performance measures were used to assess clerkship effectiveness. One was a modified essay examination (MEE) administered as part of the departmental evaluation. The other was the NBME-II exam and its surgery subsection NBME-II-S. The MEE was designed to measure six dimensions of the problem-solving process. The NBME-II was utilized to measure knowledge. Unpaired t tests were used to identify statistically significant group differences. The PBL group performed significantly better on two MEE dimensions: (1) differential diagnosis formation (PBL, 92.5 +/- 0.8; SI, 89.1 +/- 0.5; P < 0.01) and (2) interpretation of clinical data (PBL, 93.3 +/- 0.6; SI, 91.6 +/- 0.4; P < 0.03). A third dimension, ordering appropriate lab and diagnostic studies, approached significance (P = 0.057), and the PBL group performed better. On the NBME-II there was not a significant difference between the two groups. However, the trend (P = 0.059) was for the PBL group to score higher on the NBME-II-S (PBL mean: 502 +/- 15; SI mean: 468 +/- 12). When overall achievement was controlled for, the PBL group performed significantly better than the SI group (P = 0.046) on the NBME-II-S.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholecystectomy: to drain or not to drain. A randomized prospective study of 200 patients.

Abstract During the 24-month period commencing January 1975, 200 patients underwent elective cholecystectomy for chronic cholecystitis. According to a prospective randomized protocol, 100 patients were drained and an identical number were not drained. The two groups were similar with respect to age, weight, diabetic history, and all other measured clinical parameters. Patients who were not drained had less postoperative fever in terms of actual temperature elevation and duration of fever and were discharged from the hospital earlier. There was no difference in the incidence of wound infection or other complications between the two groups. This study confirms that elective cholecystectomy without drainage of the subhepatic space can be done safely and that less postoperative fever and shorter hospitalization can be expected.

Gastric Bypass for Morbid Obesity

The gastric bypass operation is intended to decrease caloric intake by decreasing the size of the food receptacle. Although the gastric pouch can be overeaten, weight loss following a bypass procedure is satisfactory, the mordibity and mortality rates are acceptable, and the rate of development of late complications is low.

Spontaneous ischemic colitis

Eighteen cases of spontaneous ischemic colitis are reviewed. The diagnosis was established according to the following criteria: 1) clinical background, 2) clinical characteristics, 3) morphologic characteristics, and 4) clinical and morphologic course. The last three constituted the diagnostic criteria. The cases were divided into mild-to-moderate, moderate-to-severe, and gangrenous categories. Although data on clinical background did not establish the diagnosis of spontaneous ischemic colitis, they were essential in strict diagnosis. Patients who had histories of Crohns disease, chronic ulcerative colitis, and recent antibiotic administration were excluded from consideration. Appropriate stool examinations obtained in all of the mild-to-moderate and all except two of the moderate-to-severe cases excluded colitis due to pathogenic bacterial organisms or parasites. Spontaneous ischemic colitis generally occurs in older individuals; the average age in our patients was 60 years. Twelve of the 18 patients had at least some evidence of major cardiovascular disease.

Physiology of the Colon and Rectum

The colon has an important role in body homeostasis: it has an important transport function, and is associated with electrolyte balance; it protects the body from toxic substances and may preserve some small bowel activity. Better knowledge of its physiology can only enhance ones ability to utilize and preserve it more intelligently. Motility; flatus production; water, electrolyte, and nutrient metabolism; bile and ammonia in the colon; and colonic obstruction are discussed.

Colon Carcinoma and Immunologic Phenomena

Preliminary results with a clinical program of immunotherapy show that immunologic unresponsiveness occurs in individuals with advanced disease, and that objective responders often show brisk immunologic reactions. The basis of immunotherapy of colorectal carcinoma is outlined.

Stapling in Gastroesophageal Surgery

This article gives a brief history of stapling equipment used in gastroesophageal surgery. A variety of surgical procedures, which can be performed on the gastrointestinal tract easily and safely with present-day stapling devices, are then described.

Transit time and bacterial overgrowth as determinants of absorptive capacity.

Abstract A detailed account is given of the hospital course of a newborn male infant who at 18 days of age underwent resection of all small bowel but 2.5 cm. of duodenum and 5 cm. of terminal ileum. He was maintained on parenteral nutrition while compensatory growth of the gut permitted him to exist by eating a diet supplemented with medium-chain triglycerides and enteric antibiosis. Elimination of the iodochlorhydroxyquin results in increased stool frequency and weight. As absorptive area decreases, transit time and bacterial growth seem to be critical determinants of absorptive capacity.

Newer concepts of cancer of the colon and rectum: Immunotherapy for patients with cancer of the large intestine

I WOULD LIKE TO DISCUSS a program of immunotherapy for disseminated malignant disease which we have been utilizing at the University of Kentucky Medical Center for five years now. 2, 4 T h e program was originated by Dr. Humphrey, who is now at Emory, and has been continued by Dr. Jewell, Dr. Meeker, and myself. Although patients accepted in the program have had a variety of neoplasms, our greatest experience has been with those who harbor malignant melanoma and carcinoma of the colon. For this audience the resMts of only the latter group of patients will be given. T h e rationale of tumor immunotherapy is based on the premise that neoplastic ceils contain or are coated with tumorspecific antigens which are capable of inducing an antibody response in a foreign host. Yghile the evidence for such antigens is good in animals, in humans it is mostly circumstantial, but it is becoming more convincing.