William T. Fitts

Ten years experience with intravenous hyperalimentation and inflammatory bowel disease.

A retrospective analysis was conducted on 74 patients with inflammatory bowel disease who were treated with intravenous hyperalimentation at the Hospital of the University of Pennsylvania between the years 1967–1976. Intravenous hyperalimentation can ameliorate the inevitable protein-calorie malnutrition present in patients with inflammatory bowel disease. Combined with complete bowel rest, intravenous hyperalimentation can effectively function as the primary treatment or as an adjunct to the surgical management of the complications of inflammatory bowel disease. Intravenous hyperalimentation can be safely administered to these severely ill patients, almost certainly improving survival rates in the patients treated.

Pyogenic liver abscess secondary to asymptomatic sigmoid diverticulitis.

A patient with multiple pyogenic abscesses in both lobes of the liver secondary to asymptomatic sigmoid diverticulitis is presented. The rarity of this illness is noted. It is suggested that barium enema be performed in patients who present with pyogenic liver abscess of unknown etiology because of the association with asymptomatic sigmoid diverticulitis.

An analysis of twenty years' experience with operations for carcinoma of the stomach.

We analyzed the records of 242 consecutive patients with adenocarcinoma of the stomach operated on for cure. We correlated survival with several factors, including the type of primary lesion, the operation performed, operative mortality, state of regional lymph nodes, margins of the resected specimens, and duration of preoperative symptoms. Overall survival at 5 years was only 18.6% and at 10 years was 7.1%. Patients with small malignant gastric ulcers, however, enjoyed increased survival at 5 years (53.8%) and at 10 years (15.0%). Overall operative mortality was 7.1%, but was 0% for patients with small malignant gastric ulcers. Even with large or high-lying lesions, radical operation can be accomplished with acceptable mortality and definite chance for cure. Thirteen of 45 five-year survivors had positive lymph nodes, and 7 of the 45 had positive margins of resection. Longer symptomatic preoperative periods, correlated positively with increased survival. Thirty patients with preoperative symptomatic periods exceeding 24 months had a 30.0% 5-year survival. Perhaps some of these lesions underwent malignant change in areas of symptomatic benign disease. We advocate early operation for gastric ulcers which do not heal promptly and stay healed.