William G. Pace

Gastric partitioning for morbid obesity.

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50–60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17–62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, live have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.

Cryotherapy for malignant tumors.

Summary o 1. 2. A cryoprobe which uses a gas refrigeration system and has definite advantages over the conventional liquid nitrogen systems is described. 3. Useful in multiple entaneous lesions which can be easily and painlessly controlled. 4. Antibodies directed toward DNA, RNA, and tumor cells develop after cryotherapy. The significance of this remains to be determined.

Morphological changes in canine trachea after freezing

Abstract Cryonecrosis of normal bone is followed by repair of the defect by regeneration of bone from the periosteum and endosteum 2 . Similar results have been observed after freezing of malignant cells invading bone 4 . Since regeneration of bone and cartilage are similar, the possibility of regeneration of cartilage after destruction of a local area by freezing is suggested. Reconstructive problems make excision of some tracheal tumors hazardous or unacceptable. If freezing does not permanently impair the architecture of the trachea, it may offer a method of controlling or eradicating neoplasms which invade or arise from the trachea. Mongrel dogs each underwent an operation to allow the application of a cryoprobe to the external surface of the trachea. Sixty per cent of the circumference of three tracheal rings was frozen by repeated applications of the cryoprobe, each for a period of 5 min, to the anterior and lateral surfaces of the trachea. After freezing, two animals were sacrificed at each of several intervals varying from 5 min to 6 weeks. Necropsy examinations were performed on all animals. The mucosal response of trachea to freezing included gross evidence of ulceration within 6 hrs, histological evidence of beginning reepithelialization at 72 hrs, and complete healing after 2 weeks. Changes in connective tissue and vascular elements were apparent for 2 to 3 weeks after freezing. Cryonecrosis and subsequent repair of the tracheal cartilage lagged behind the sequential changes described for the mucosa and connective tissue. Although subtle changes in the staining characteristics of cartilage occurred within 6 hrs, absence of chondrocytes in the area of maximum freezing was not seen until 24 hrs. Fragmentation of cartilage did not occur until 72 hrs and was not maximal until 5 days. Healing of cartilage was first apparent after 2 weeks, and chondrocytes reappeared between 2 and 4 weeks after freezing. The most striking observation was the remarkable return of frozen cartilage to a near normal form and appearance. The progressive return from destruction of all layers to an essentially normal tracheal architecture suggested that the cryoprobe may be of value in the management of some tracheal tumors.

Insulin-induced attenuation of glucose-stimulated gastric inhibitory polypeptide secretion

Administration of exogenous insulin before and after intraduodenal glucose results in blunting of the GIP response to glucose. Physiologic levels of serum insulin were attained. Therefore, the present study suggests the existence of negative feedback regulation of GIP release by endogenous insulin (pancreatico-GIP axis).

Regression of metastatic renal carcinoma following nephrectomy

Abstract A case of biopsy-proved postnephrectomy regression of a metastatic skin lesion of renal carcinoma is presented. The incidence of postnephrectomy regression, occurrence of other pulmonary entities resembling metastases, and the possible mechanisms of postnephrectomy regression are discussed. Biopsy of suspected metastatic lesions in renal carcinoma is advocated. We further advocate nephrectomy in the face of distant metastasis, and also consider excision of single metastases, and chemotherapy and/or irradiation when indicated.

Pancreatic polypeptide in acute pancreatitis and small-bowel infarction in dogs

Serum and urine concentrations of pancreatic polypeptide (PP) were measured during experimental acute hemorrhagic pancreatitis and small-bowel infarction in dogs. The mean serum PP, concentration in animals with pancreatitis increased markedly after 1 hr and remained elevated, while the mean serum PP concentration in the animals with infarction showed a late trend to increase. The urine PP concentration in pancreatitis increased nonsignificantly, whereas, during bowel infarction, there was no increase. In the infarction group, PP clearance correlated with the serum PP concentration. During pancreatitis, PP was cleared independently of the serum PP concentration. The results suggest that during acute hemorrhagic pancreatitis there is an acute release of PP related to immediate cell injury in the pancreas. The high serum concentration of PP may lead to an override of the normal renal handling of PP. In small-bowel infarction there may be a delayed mode of PP release.

The portal hypertensive effect of dopamine

Abstract Intravenous infusions of either dopamine, vasopressin, or simultaneous dopamine and vasopressin were administered to normal adult mongrel dogs, and the effect on systemic and portal hemodynamics monitored. Dopamine increased superior mesenteric artery blood flow and portal venous pressure. Because of this portal hypertensive effect, dopamine should not be given to patients with cirrhosis and portal hypertension. Dopamine administered with vasopressin failed to protect against a reduction in cardiac output, and completely reversed the portal hypotensive effect of vasopressin. Isoproterenol remains the drug of choice for offsetting the adverse hemodynamic effects of vasopressin administration.

Experience with intrathoracic injury following automobile accidents

Abstract The charts of over 400 patients admitted to the Ohio State University Hospital following automobile accidents have been reviewed. Eliminated from the study were those patients with primarily neurologic, orthopedic or intraabdominal injuries, and those patients with damage to the ribs and chest wall without intrathoracic manifestations. Of the seventy-six patients remaining, the types of injury and the basis for the mortality are discussed. The management of the specific injuries is presented.

Endometrial adenocarcinoma eleven years after pelvic radiation for cervical epidermoid carcinoma

Abstract 1. 1. A case of adenocarcinoma of the endometrium which developed 11 years after radiation therapy for squamous-cell carcinoma of the cervix is presented. 2. 2. Progression from adenomatous hyperplasia of the endometrium to adenocarcinoma of the endometrium was not arrested by cancerocidal levels of radiation to the uterine cervix. 3. 3. The role of radiation in the stimulation of endometrial carcinoma is briefly discussed. 4. 4. Radiation as a treatment for adenomatous hyperplasia of the endometrium should be discouraged.

Pelvic perfusion and carcinoma of the rectum

Summary A method of regional chemotherapy through isolation of the pelvis has been presented. All of the subjects were near the terminal stage at the time of perfusion. The survival time and degree of palliation have been encouraging.