Archives of Surgery

REKERS, PAUL E.;COULTER, MOLLY P.;WARREN, STAFFORD L.

doi: 10.1001/archsurg.1950.01250010656001pmid: N/A

Abstract SINGLE dose roentgen irradiation to the whole body has been noted to produce conspicuous alteration in the hematopoietic system.1 Chief of these alterations is the damage incurred to the bone marrow. The mechanism whereby this damage is incurred is the subject of a great deal of study, but it is well established that it results from the direct effects of irradiation.2 Since such damage to the hematopoietic tissues leads to severe disability and frequently to death, it becomes important to direct therapeutic measures that will offset or correct the derangements. The studies incorporated in this report were made primarily to determine what benefits, if any, may be derived from the transplantation of normal bone marrow in animals that have suffered damage to their bone marrow as the result of single dose roentgen irradiation. Precise evidence for definite favorable results from transplantation of bone marrow is lacking. Neuhof3 References 1. Prosser, C. L.; Painter, E. E., and Swift, M. M.: The Clinical Physiology of Dogs Exposed to Single Total Body Doses of X-Rays, Metallurgical Laboratory, Chicago University, Report no. CH 3738. 2. Shouse, S. S.; Warren, S. L., and Whipple, G. H.: Aplasia of Marrow and Fatal Intoxication in Dogs Produced by Roentgen Radiation of all Bones , J. Exper. Med. 58:421 ( (March) ) 1931.Crossref 3. Lawrence, J. S.; Valentine, W. N., and Dowdy, A.: Is There an Indirect Effect of Radiation? Blood 3:593, 1948. 4. Neuhof, H.: The Transplantation of Tissue , New York, D. Appleton & Company, 1923. 5. Loeb, L.: Transplantation and Individuality , Physiol. Rev. 10:547, 1930. 6. Osgood, E. E.; Riddle, M. C., and Mathews, T. J.: Aplastic Anemia Treated with Daily Transfusions and Intravenous Marrow: Case Report , Ann. Int. Med. 13:357, 1939.Crossref 7. Sanchez Yllades, L. S.: Ultimos estudios sobre la transfusión de médula , Medicina, México 23:75, 1943. 8. Sanchez Yllades, L. S., and del Castillo, H.: La medulotransfusion en las anemias secundarias: Notas preliminares , Medicina, México 22:371, 1942 9. La transfusión de médula en algunos estados enfecciosos: Notas preliminares , del Castillo Medicina, México 22:624, 1942 10. La medulotransfusion en diversas hemopatias: Notas preliminares , del Castillo Medicina, México 22:283 and 268, 1942. 11. Morrison, M., and Samwick, A. A.: Intramedullary Transfusion of Human Bone: Preliminary Report , J. A. M. A. 115:1708 ( (Nov. 16) ) 1940.Crossref 12. Castroviejo, R., and Elliot, A. J.: Inclusion of Sclera in Corneal Transplantation: Gross and Microscopic Study , Arch. Ophth. 27:899 ( (May) ) 1942.Crossref 13. Young, F.: Homogenous Cartilage Grafts: Experimental Study , Surgery 17:616, 1945. 14. (a) Greene, H. S. N., and Lund, P. K.: Heterologous Transplantation of Human Cancers , Cancer Research 4:352, 1944. 15. (b) Greene, H. S. N.: Heterologous Transplantation of Embryonic Mammalian Tissues , Cancer Research 3:809, 1943. 16. (c) Greene, H. S. N., and Murphy, E. D.: Heterologous Transplantation of Mouse and Rat Tumors , Cancer Research 5:269, 1945. 17. (d) Greene, H. S. N.: Personal communication to the authors. 18. (a) Rekers, P. E., and Coulter, M. P.: A Hematological and Histological Study of the Bone Marrow and Blood of the Adult Dog, Am. J. M. Sc., to be published. 19. (b) Rekers, P. E.: Transplantation of Bone Marrow into Dogs that Have Received Total Body Single Dose Radiation, University of Rochester, Atomic Energy Project Report, UR-11. 20. (c) Field, J. B., and Rekers, P. E.: Studies of the Effects of Flavonoids on Roentgen Irradiation Disease: I. Protective Influence of Rutin in Irradiated Dogs , Am. J. M. Sc. 218:1, 1949.Crossref 21. Gey, G. O., and Gey, M. K.: The Maintenance of Human Normal Cells and Tumor Cells in Continuous Culture: I. Preliminary Report , Am. J. Cancer 27:45, 1936.Crossref 22. Theil, G. A., and Downey, H.: The Development of the Mammalian Spleen with Special Reference to Its Hematopoietic Activity , Am. J. Anat. 28:279, 1921.Crossref 23. Warren, S. L., and Whipple, G. H.: Roentgen Ray Intoxication: II. A Study of the Sequence of Clinical, Anatomical and Histological Changes Following a Unit Dose of X-Rays , J. Exper. Med. 35:203, 1922.Crossref 24. Higgins, G. M., and Ingle, D. J.: Functional Homioplastic Adrenal Grafts in the Rat , Proc. Staff Meet., Mayo Clin. 12:69, 1937. 25. Maksimov, A., and Bloom, W.: Textbook of Histology , ed. 2, Philadelphia, W. B. Saunders Company, 1934, p. 136. 26. Science 109:630, 1949Crossref 27. Unpublished data of this laboratory. 28. Ask-Upmark, E.: Tumor Simulating Intrathoracic Heterotropia of Bone Marrow , Acta. radiol. 26:425, 1945.Crossref 29. Tocantins, L. M.: Blood Platelets , Medicine 17:155, 1938.Crossref 30. Drinker, C. K., and Yoffey, J. M.: Lymphocytes, Lymph and Lymphoid Tissue , Cambridge, Mass., Harvard University Press, 1941, p. 277. 31. Drinker and Yoffey,18 pp. 17 and 217. 32. Drinker and Yoffey,18 p. 16. 33. Allen, J. G., and Jacobsen, L. O.: Hyperheparinemia: Cause of the Hemorrhagic Syndrome Associated with Ionizing Radiation , Science 105:388, 1947.Crossref 34. Rekers, P. E., and Field, J. B.: Control of Hemorrhagic Syndrome and Reduction in X-Radiation Mortality with a Flavonone , Science 107:2766, 1948.Crossref 35. Winternitz, M. C.; Mylon, E., and Katzentstein, R.: Studies on the Relation of the Kidney to Cardiovascular Disease , Yale J. Biol. & Med. 13:595, 1940.

MAYO, CHARLES W.;KENDRICK, DOUGLAS B.

doi: 10.1001/archsurg.1950.01250010689002pmid: N/A

Abstract CONGENITAL abnormalities and malpositions of the gallbladder are relatively rare, but since they are encountered occasionally in surgery of the biliary tract it is desirable for the surgeon to be familiar with them. Many types of anomalies of the gallbladder have been described. These include congenital reduplication of the gallbladder, bilobed gallbladder, anomalous positions of the gallbladder, "hourglass" deformities and congenital absence of the gallbladder. The various types of congenital abnormalities of the gallbladder have been reviewed by several authors including Schachner,1 Gross2 and Meade.3 In a review of the literature, Guyton4 found only 40 cases of congenital reduplication of the gallbladder that had been proved at necropsy or at operation. For descriptive purposes, Boyden5 has divided anomalies of this type into two groups: vesica divisa, or cleft gallbladder, which has two cavities emptying into a single cystic duct, and vesica duplex, which consists of References 1. Schachner, A.: Anomalies of the Gall-Bladder and Bile-Passages, with the Report of a Double Gall-Bladder and a Floating Gall-Bladder , Ann. Surg. 64:419-433 ( (Oct.) ) 1916.Crossref 2. Gross, R. E.: Congenital Anomalies of the Gallbladder: A Review of One Hundred and Forty-Eight Cases, with a Report of a Double Gallbladder , Arch. Surg. 32:131-162 ( (Jan.) ) 1936.Crossref 3. Meade, H. S.: Congenital Abnormalities of the Gallbladder , Irish J. M. Sc. , (May) 1944, pp. 161-162. 4. Guyton, W. L.: Double Gallbladder , Am. J. Surg. 72:118-120 ( (July) ) 1946.Crossref 5. Boyden, E. A.: The Accessory Gall-Bladder—An Embryological and Comparative Study of Aberrant Biliary Vesicles Occurring in Man and the Domestic Mammals , Am. J. Anat. 38:177-222 ( (Nov.) ) 1926.Crossref 6. Gay, R. J.: Developmental Anomalies of the Gallbladder: Report of a Case , Tr. Path. Soc., Chicago . 5:108-113 ( (May 12 to June 9) ) 1902. 7. Dixon, C. F., and Lichtman, A. L.: Congenital Absence of the Gall Bladder , Surgery 17:11-21 ( (Jan.) ) 1945. 8. Walter, O. M., and Neiman, A.: Case Report of an Intrahepatic Gall-Bladder in an Adult, with a Review of the Literature , Illinois M. J. 60:478-480 ( (Dec.) ) 1931. 9. McNamee, E. P.: Intrahepatic Gallbladder , Am. J. Roentgenol. 33:603-610 ( (May) ) 1935. 10. Lane, W. R.: Empyema of Intrahepatic Gall-Bladder: Report of a Case , Australian & New Zealand J. Surg. 15:304-305 ( (April) ) 1946. 11. Walton, A. J.: Congenital Malposition of the Gall-Bladder , Lancet 1:925-926 ( (April 6) ) 1912. 12. McGowan, J. M.; Nussbaum, C. C., and Burroughs, E. W.: Cholecystitis Due to Giardia Lamblia in a Left-Sided Gallbladder , Ann. Surg. 128:1032-1037 ( (Nov.) ) 1948. 13. Short, A. R., and Paul, R. G.: Torsion of the Gall-Bladder , Brit. J. Surg. 22:301-309 ( (Oct.) ) 1934. 14. Barber, A. H.: Acute Torsion of the Gall-Bladder , Brit. M. J. 2:1272-1273 ( (Dec. 30) ) 1939. 15. Meeker, W. R., and Lisenby, J. O.: Ptosis and Torsion of the Gall-Bladder , South. M. J. 25:609-614 ( (June) ) 1932. 16. Brewer, G. E.: Preliminary Report on the Surgical Anatomy of the Gall-Bladder and Ducts from an Analysis of One Hundred Dissections , Ann. Surg. 29:721-730, 1899. 17. Wendel, A. V.: A Case of Floating Gall-Bladder and Kidney Complicated by Cholelithiasis with Perforation of the Gall-Bladder , Ann. Surg. 27:199-202 ( (Jan.-June) ) 1898. 18. Husband, C. W., and Schmitt, N. L.: Torsion of the Gallbladder Associated with Acute Appendicitis , J. Internat. Coll. Surgeons 8:348-351 ( (July-Aug.) ) 1945. 19. Gowland, M. M.: Acute Volvulus of the Gallbladder , Canad. M. A. J. 54:485 ( (May) ) 1946.

BUSARD, J. MAX;WALTERS, WALTMAN

doi: 10.1001/archsurg.1950.01250010695003pmid: N/A

Abstract THE TERM "heterotopic pancreatic tissue," currently favored by Barbosa, Dockerty and Waugh1 to describe the condition of an anatomically separate mass of pancreatic tissue in an ectopic position, is not universally adhered to in the literature, which made the recent count of the number of described cases difficult. Although the medical history of this condition reaches back to 1727, when Jean Schultz has been given credit for first having described this condition without the aid of microscopic confirmation,2 and to 1859, when Klob made the first histologic study of 2 cases, it was in 1903 that Magnus-Alsleben3 reported a series of five "adenomyomata" of the stomach and described alveoli of Brunner's glandular, pancreatic and undifferentiated types surrounded by smooth muscle masses, thereby focusing attention on the possibility of a gradation of differentiation of these ectopic masses. In 1909 Gruzdeff4 described an "adenomyoma" which produced clinical symptoms, References 1. (a) Barbosa, J. J. de C., and Waugh, J. M.: Heterotopic Pancreatic Tissue, Clinically Significant in the Gastric Wall of a Boy Six Years of Age , Proc. Staff Meet., Mayo Clin. 22:25-30 ( (Jan. 22) ) 1947. 2. (b) Barbosa, J. J. de C.; Dockerty, M. B., and Waugh, J. M.: Pancreatic Heterotopia: Review of the Literature and Report of Forty-One Authenticated Surgical Cases, of Which Twenty-Five Were Clinically Significant , Surg., Gynec. & Obst. 82:527-541 ( (May) ) 1946. 3. Hunt, V. C., and Bonesteel, H. T. S.: Meckel's Diverticulum Containing Aberrant Pancreas , Arch. Surg. 28:425-439 ( (March) ) 1934. 4. Magnus-Alsleben, E.: Adenomyome des pylorus , Virchows Arch. f. path. Anat. 173:137-156 ( (July) ) 1903. 5. Gruzdeff, D. A.: Rare Case of Adenomyoma of the Stomach, with Heterotype of the Epithelium of the Mucosa , Med. Obozr., Mosk. 71:805-811, 1909. 6. Lauche, A.: Die Heterotopien der ortsgehöregen Epithels im Bereich des Verdauungskanals , Virchows Arch. f. path. Anat. 252:39-88, 1924. 7. Stewart, M. J., and Taylor, A. L.: Adenomyoma of the Stomach , J. Path. & Bact. 28:195-202, 1925. 8. Woolsey, J. H., and Millzner, R. J.: Adenomyoma of the Stomach , Arch. Surg. 16:583-592 ( (Feb.) ) 1928. 9. Clarke, B. E.: Myoepithelial Hamartoma of Gastrointestinal Tract: Report of Eight Cases with Comment Concerning Genesis and Nomenclature , Arch. Path. 30:143-152 ( (July) ) 1940. 10. Mitchell, N., and Angrist, A.: Myo-Epithelial Hamartoma of the Gastrointestinal Tract (Clarke) , Ann. Int. Med. 19:952-964 ( (Dec.) ) 1943. 11. Warthin, A. S.: Two Cases of Accessory Pancreas (Omentum and Stomach) , Phys. & Surg. 26:337-351, 1904. 12. Horgan, E. J.: Accessory Pancreatic Tissue: Report of Two Cases , Arch. Surg. 2:521-534 ( (May) ) 1921. 13. Ritter, L.: Zum klinischen Bilde und Sitz versprengter Pankreaskeime , Beitr. z. klin. Chir. 124:157-172, 1921. 14. Simpson, W. M.: Aberrant Pancreatic Tissue: Analysis of One Hundred and Fifty Human Cases with Report of New Case, Warthin Ann. Vol., 1927, pp. 435-459. 15. Poppi, A.: Sui pancreas aberranti: (Rivista sintetica completa e contributo casistico) , Arch. ital. d. mal. d. app. diger. 4:534-579 ( (Dec.) ) 1935. 16. Branch, C. D., and Gross, R. E.: Aberrant Pancreatic Tissue in the Gastro-Intestinal Tract: A Report of Twenty-Four Cases , Arch. Surg. 31:200-224 ( (Aug.) ) 1935. 17. Faust, D. B., and Mudgett, C. S.: Aberrant Pancreas with Review of the Literature and Report of a Case , Ann. Int. Med. 14:717-728 ( (Oct.) ) 1940. 18. Present, A. J.: Aberrant Pancreas , Am. J. Roentgenol. 56:55-57 ( (July) ) 1946. 19. Waugh, T. R., and Harding, E. W.: Heterotopic Pancreatic Tissue in the Region of the Pyloric Orifice: A Radiological and Pathological Analysis of Five Cases of Clinically Suspected Peptic Ulcer in Which Only Pancreatic Rests Were Found , Gastroenterology 6:417-435 ( (May) ) 1946. 20. Marshall, S. F., and Aronoff, B. L.: Symposium on Gastrointestinal Surgery: Tumors of Stomach , S. Clin. North America 24:607-617 ( (June) ) 1944. 21. Barbosa and Waugh.1a Woolsey.7 22. Bolognesi, G.: Le pancréas accessoire: Contribution clinique , Arch. d. mal. de l'app. digestif. 23:708-745 ( (July) ) 1933. 23. Troll, M. M.: Aberrant Pancreatic and Gastric Tissue in the Intestinal Tract , Arch. Path. 38:375-380 ( (Dec.) ) 1944. 24. Nicholson, G. W.: Studies on Tumor Formation , Guy's Hosp. Rep. 73:37-64, 1923. 25. (a) Mallet-Guy, M. M., and Marion, P.: Pancréas aberrant de la première portion du duodénum , Lyon chir. 37:380-384 ( (May) ) 1941. 26. (b) Martins, M.: Pancreas aberrante , Bol. San São Lucas 7:115-120 ( (Feb.) ) 1946. 27. (c) Chapman B. M.; Vogel, W. F., and Schomaker, T. P.: Massive Gastric Hemorrhage Associated with Aberrant Pancreas in Stomach , Gastroenterology 8:367-374 ( (March) ) 1947. 28. Collett, R. W.: Prepyloric Polypus in Stomach of Child Diagnosed Histologically as Aberrant Pancreatic Tissue: Report of a Case and Review of the Literature , Am. J. Dis. Child. 72:545-551 ( (Nov.) ) 1946.Crossref 29. Toland, C. G., and Kroger, W. P.: Myoma of the Stomach , West. J. Surg. 46:259-266 ( (May) ) 1938. 30. Weinberg, T. B., and Raider, L.: Pedunculated Tumors of the Stomach Prolapsing Through the Pylorus , Radiology 41:52-55 ( (July) ) 1943.Crossref 31. du Bourguet and Berge: Pancréas accessoire pylorique , Mém. Acad. de chir. 68:330-331 ( (Oct. 14) ) 1942. 32. (a) Andersen, D. H.: Cystic Fibrosis of the Pancreas and Its Relation to Celiac Disease , Am. J. Dis. Child. 56:344-399 ( (Aug.) ) 1938.Crossref 33. (b) Russo, M.: Tre casi di pancreas aberrante (contributo clinico) , Gior. di med. 3:261-264 ( (July-Aug.) ) 1946. 34. Present.17 Waugh and Harding.18 Mallet-Guy and Marion.24a du Bourguet and Berge.26 Marshall and Aronoff.19 Martins.24b Bolognesi.21 35. Kalfayan, B.: Duodenitis with Diverticulum and Ectopic Pancreatic Tissue , Arch. Path. 42:228-231 ( (Aug.) ) 1946. 36. Roach, J. F., and Poppel, M. H.: The Roentgen Demonstration of an Aberrant Pancreatic Nodule in the Stomach: Report of Three Cases , Am. J. Roentgenol. 56:586-589 ( (Nov.) ) 1946. 37. Brown, S.; Flachs, K., and Wasserman, P.: Aberrant Pancreatic Tumor in the Duodenal Wall , Radiology 43:385-386 ( (Oct.) ) 1944.Crossref 38. Young, H. B.: A Case of Accessory Pancreas in an Unusual Position Complicated by Acute Necrosis , Glasgow M. J. 142:156-164 ( (Nov.) ) 1944. 39. Garin, and Coudert: Deux cas de pancréas aberrants avec ulcères gastroduodénaux , Lyon méd. 167:197-201 ( (March) ) 1942. 40. Norris, J. C.: Aberrant Pancreas in the Duodenum , South. M. J. 39: 549-551 ( (July) ) 1946.Crossref 41. Norris.34 Young.32 42. Baylin, G. J.: Aberrant Pancreatic Tissue as a Roentgenologic Problem , Am. J. Roentgenol. 53:277-280 ( (March) ) 1945. 43. Krieg, E. G.: Heterotopic Pancreatic Tissue Producing Pyloric Obstruction: A Review and Case Report , Ann. Surg. 113:346-370 ( (March) ) 1941.Crossref

LARGE, ALFRED

doi: 10.1001/archsurg.1950.01250010704004pmid: N/A

Abstract MANAGEMENT of the critically ill patient with moist gangrene of an extremity has always been a difficult problem. Treatment by the standard types of amputation with closure of the stump was abandoned years ago because the mortality was so high—often close to 100 per cent. Guillotine amputation with the stump left wide open was found to be much safer, the idea being to get rid of the gangrenous part as rapidly and simply as possible and to reamputate at a higher level when the patient's condition improved enough to warrant the procedure. But even with the protection afforded by the sulfonamide compounds and penicillin, such staged procedures have left much to be desired. Since the operative mortality has remained alarmingly high, investigations leading toward other more satisfactory methods of management of this critically ill group of patients have continued. With the introduction of refrigeration anesthesia by Allen and Crossman,1 References 1. (a) Allen, F. M.: Resistance of Peripheral Tissues to Asphyxia at Various Temperatures , Surg., Gynec. & Obst. 67:746-751 ( (Dec.) ) 1938. 2. (b) Allen, F. M.: Reduced Temperatures in Surgery: I. Surgery of Limbs , Am. J. Surg. 52:225-237 ( (May) ) 1941. 3. (c) Crossman, L. W.; Allen, F. M.; Hurley, V.; Ruggiero, W., and Warden, C. E.: Refrigeration Anesthesia: Current Researches in Anesthesia and Analgesia 21:241-254 ( (Sept.-Oct.) ) 1942. 4. (d) Crossman, S. W.; Ruggiero, W. F.; Hurley, V., and Allen, F. M.: Reduced Temperatures in Surgery: II. Amputations for Peripheral Vascular Disease , Arch. Surg. 44:139-156 ( (Jan.) ) 1942. 5. (a) Melick, D. W.: Refrigeration Anesthesia , Am. J. Surg. 70:364-368 ( (Dec.) ) 1945. 6. (b) Kirz, E.: Gas Gangrene After Amputation under Refrigeration Anesthesia: A Warning , Brit. M. J. 2:662 ( (Nov. 18) ) 1944. 7. (a) Bruneau, J., and Heinbecker, P.: Effects of Cooling on Experimentally Infected Tissue , Ann. Surg. 120:716-726 ( (Nov.) ) 1944. 8. (b) Large, A., and Heinbecker, P.: The Effect of Cooling on Wound Healing , Ann. Surg. 120:727-741 ( (Nov.) ) 1944. 9. (c) Large, A., and Heinbecker, P.: Nerve Degeneration Following Prolonged Cooling of an Extremity , Ann. Surg. 120:742-749 ( (Nov.) ) 1944. 10. Large, A., and Heinbecker, P.: Refrigeration in Clinical Surgery , Ann. Surg. 120:707-715 ( (Nov.) ) 1944. 11. Heinbecker, P.: Personal communication to the author. 12. McKittrick, L. S., and Pratt, T. C.: The Principles of and Results after Amputation for Diabetic Gangrene , Am. Surg. 100:638-653 ( (Oct.) ) 1934. 13. Since the preparation of this paper, 2 other patients in the series are known to have died of other causes. 14. Maxeiner, S. R.: The Temporary Tourniquet Amputation , Minnesota Med. 24:491-492 ( (June) ) 1941. 15. Adolph, P. E.: Preoperative Measures Used in War Surgery in China with Special Reference to the Delimiting Tourniquet , Ann. Surg. 119:246-252 ( (Feb.) ) 1944. 16. Ravdin, I. S., and Johnston, C. G.: Refrigeration in Surgery , Am. J. M. Sc. 209:253-257 ( (Feb.) ) 1945.

KEELEY, JOHN L.

doi: 10.1001/archsurg.1950.01250010712005pmid: N/A

Abstract THE PURPOSE of this communication is to report an instance of intussusception in a 3½ year old boy in whom aberrant pancreatic tissue was found at the apex of the intussusceptum. A portion of the bowel containing the pancreatic tissue was found to be nonviable and was resected. A closed end to end anastomosis was done, and the patient made an uneventful recovery. Six cases found in the literature in which there were similar pathologic changes are summarized. REPORT OF A CASE T. W., a white boy aged 3½ years, was admitted to the Children's Surgical Service of Cook County Hospital on Feb. 10, 1942, because of nausea, vomiting and abdominal pain of sixty-six hours' duration. The child had been well until February 7 at 10 p. m., when he complained of nausea. Although he was restless and irritable, he slept until 3 a. m. the following morning, when he References 1. Vaughan, R. T., and Thorek, P.: Abdominal Auscultation , Am. J. Surg. 45:230-234 ( (Aug.) ) 1939.Crossref 2. Branch, C. D., and Gross, R. E.: Aberrant Pancreatic Tissue in the Gastrointestinal Tract: A Report of Twenty-Four Cases , Arch. Surg. 31:200-224 ( (Aug.) ) 1935.Crossref 3. King, E. S. J., and MacCallum, P.: Pancreatic Tissue in the Wall of the Stomach , Arch. Surg. 28:125-138 ( (Jan.) ) 1934.Crossref 4. Barbosa, J. J. de Castro; Dockerty, M. D., and Waugh, J. M.: Pancreatic Heterotopia: Review of the Literature and Report of Forty-One Authenticated Surgical Cases, of which Twenty-Five Were Clinically Significant , Surg., Gynec. & Obst. 82:527-542 ( (May) ) 1946. 5. Gross, R. E., and Ware, P. F.: Intussusception in Childhood , New England J. Med. 239:645-652 ( (Oct. 28) ) 1948. 6. Harkins, H. N.: Intussusception Due to Invaginated Meckel's Diverticulum: Report of Two Cases with a Study of One Hundred Sixty Cases Collected from the Literature , Ann. Surg. 98:1070-1095 ( (Dec.) ) 1933. 7. Bize: Etude anatomo-clinique des pancreas accessoires situes a l'extremite d'un diverticule intestinale , Rev. d'orthop. 15:149-159 ( (March 1) ) 1904. 8. Brunner, C.: Ein Beitrag zur Chirurgie und pathologischen Anatomie der Darminvagination , Beitr. z. klin. Chir. 25:344-363 ( (Nov.) ) 1899. 9. Hulst, J. P. L.: Ueber einem in einem Darmdivertikel gelagerten Pankreaskeim mit sekundarer Invagination , Centralbl. f. allg. Path. u. path. Anat. 20: 12-15 ( (Jan.) ) 1909. 10. Taylor, A. L.: The Epithelial Heterotopias of the Alimentary Tract , J. Path. & Bact. 30:415-449, 1927. 11. Benjamin, A. E.: Accessory Pancreas with Intussusception , Ann. Surg. 67:293-298 ( (March) ) 1918. 12. Azzolini, O.: Invagination of Small Intestine Due to Accessory Pancreas: Case , Gazz. internaz. med.-chir. 45:553-558 ( (Aug. 31) ) 1935. 13. McLaughlin, C. W., Jr.: Surgical Management of Irreducible Intussusception , Arch. Surg. 56:48-55 ( (Jan.) ) 1948. 14. Ripstein, C. B.: Intussusception Due to Heterotopic Pancreas , Surgery 25:76-77 ( (Jan.) ) 1949. 15. Bosworth, B. M., and Stein, H. D.: Intussusception in Adults: Report of a Case Due to Aberrant Pancreas , Am. J. Surg. 74:801-804 ( (Dec.) ) 1947. 16. Ravitch, M. M., and McCune, R. M., Jr.: Reduction of Intussusception by Barium Enema , Ann. Surg. 128:904-917 ( (Nov.) ) 1948.

BURNETT, W. EMORY;ROSEMOND, GEORGE P.;BUCHER, ROBERT M.

doi: 10.1001/archsurg.1950.01250010720006pmid: N/A

Abstract THE PURPOSE of this paper is to present 3 cases of mesenteric cysts, 1 of which was a calcified cyst. In addition, certain data derived from a review of the literature will be presented in an attempt to add something to the knowledge of this relatively rare condition. There have been many excellent articles written on this subject covering its various phases, and the reader is referred to a recent article by Vaughn, Lees and Henry, in which the previous literature has been summarized rather completely from the standpoint of history, etiology and classification and in which a case of calcified mesenteric cyst is reported. We have included only cases which were reported in sufficient detail to obtain certain pertinent facts and will present in tabular form the results in 197 cases reviewed plus the 3 cases reported in this paper, which make a total of 200 cases. The incidence References 1. Benedict, A. L.: Bibliography of Chylous Cysts of the Mesentery , Surg., Gynec. & Obst. 16:606, 1913. 2. Berger, L., and Rothenberg, R. E.: Cysts of the Omentum, Mesentery and Retroperitoneum: Clinical Study of Eighteen Cases , Surgery 5:522, 1939. 3. Block, F. B.: Chylous Mesenteric Cyst , Ann. Surg. 128:158, 1948. 4. Carter, R. M.: Cysts of the Mesentery , Surg., Gynec. & Obst. 33:544, 1921. 5. Collins, A. N., and Berdez, G. L.: Chyle Cysts of the Mesentery , Arch. Surg. 28:335 ( (Feb.) ) 1934. 6. Dutton, F. K.: Report of Case of Ruptured Chylous Mesenteric Cyst , New England J. Med. 203:1032, 1930. 7. Eliason, E. L., and North, J. P.: Perforated Chylous Cyst of the Mesentery , Ann. Surg. 101:1452, 1935. 8. Flynn, C. W.: Mesenteric Cysts, with Report of Case of Cystic Lymphangioma , Ann. Surg. 91:505, 1930. 9. Gale, J. W., and Keeley, J. L.: Mesenteric Cysts Causing Intestinal Obstruction , Am. J. Surg. 40:647, 1938. 10. Gaston, E. A.: Cystodenoma of the Ovary Incorporated Between the Leaves of the Mesosigmoid , Surgery 6:389, 1939. 11. Goldberg, S.; Widerman, A. H., and Friedman, P. S.: Congenital Mesenteric Cyst Associated with Failure of Rotation of the Intestinal Tract: Report of Case , Arch. Pediat. 57:499, 1940. 12. Guthrie, R. F., and Wakefield, E. G.: Mesenteric Cysts , Proc. Staff Meet., Mayo Clin. 18:52, 1943. 13. Hastings, J. P.: Mesenteric Cyst , Brit. M. J. 1:947, 1934. 14. Jackman, W. A., and Mayston, E. A.: Cysts of the Mesentery , Brit. M. J. 2:1079, 1936. 15. Jewesbury, R. C.: Lymphatic Cyst of the Mesentery and Volvulus in a Child , Lancet 1:1170, 1937. 16. Judd, E. S., and Crisp, N. W.: Primary Tumors of the Mesentery , Proc. Staff Meet., Mayo Clin. 7:555, 1932. 17. Judd, E. S., and Heimdal, O. C.: Mesenteric Cysts , Surg. Clin. North America 12:849, 1932. 18. Kross, I.: Mesenteric Cysts , Rev. Gastroenterol. 9:281, 1942. 19. Larkin, F. L.: Mesenteric Cysts , Pennsylvania M. J. 43:1446, 1940. 20. Loeb, M. J.: Mesenteric Cysts: Review of Literature, Genesis and Classification , New York State J. Med. 41:1564, 1941. 21. Lubitz, J. M., and Flynn, R. W.: Chylangioma Cavernosum Mesenterii , Surgery 18:772, 1945. 22. Millar, R. E., and Robertson, G.: Enterocystoma , Brit. J. Surg. 17:373, 1929-1930.Crossref 23. Miller, L. A.: Rarity of Congenital Mesenteric Cyst , Am. J. Dis. Child. 50:1196, 1935. 24. Muir, J. B. G.: Mesenteric Cyst Causing Attacks of Subacute Obstruction in a Child , Lancet 1:742, 1935.Crossref 25. Nordland, M., and Larson, L. M.: Mesenteric Cyst , Ann. Surg. 101:1289, 1935.Crossref 26. Parsons, Eugene O.: True Proliferating Cystic Lymphangioma of the Mesentery , Ann. Surg. 103:595, 1936.Crossref 27. Paul, M.: Mesenteric Cysts , Brit. J. Surg. 35:308, 1948.Crossref 28. Peterson, E. W.: Adenocarcinoma in a Cyst of the Transverse Mesocolon , Ann. Surg. 97:782, 1933. 29. Cysts of the Mesentery , Ann. Surg. 112:80, 1940.Crossref 30. Mesenteric and Omental Cysts , Ann. Surg. 96:340, 1932.Crossref 31. Phelan, G. W.: Mesenteric Cyst , Am. J. Surg. 22:321, 1933.Crossref 32. Rea, C. E.: Enterogenous Cyst: Observation of Unusual Physical Sign , Ann. Surg. 112:300, 1940.Crossref 33. Riggall, F., and Riggall, C.: Mesenteric Cyst , Brit. M. J. 1:345, 1940.Crossref 34. Roller, C. S.: Mesenteric Cysts: Brief Discussion and Report of Three Cases , Surg., Gynec. & Obst. 60:1128, 1935. 35. Schunke, G. B., and Waugh, J. M.: Mesenteric Cyst: Report of a Case , Proc. Staff Meet., Mayo Clin. 16:676, 1941. 36. Slocum, M. A.: Surgical Treatment of Chylous Mesenteric Cyst by Marsupialization , Am. J. Surg. 41:464, 1938. 37. Stewart, J. and Mallory, T. B.: Case Report: Mesenteric Cyst , New England J. Med. 213:1251, 1935. 38. Vaughn, A. M.; Lees, W. M., and Henry, J. W.: Mesenteric Cysts , Surgery 23:306, 1948. 39. Warfield, J. Ogle, Jr.: Study of Mesenteric Cysts with Report of Two Recent Cases , Ann. Surg. 96:329, 1932.

KREUTZER, FREDERICK L.;MILLER, EARL R.;SOLEY, MAYO H.;LINDSAY, STUART

doi: 10.1001/archsurg.1950.01250010728007pmid: N/A

Abstract IN 1940 Hamilton, Soley and Eichorn1 described a method of localizing administered radioactive iodine in the human thyroid. Patients were given an oral tracer dose of radioactive iodine prior to operation. Histologic sections were made of the excised portion of the gland and the secretions placed in contact with unexposed photographic film. Areas of uptake of radioactive iodine in the section produced a blackening on the film. With this technic, these authors found the greatest uptake of iodine in areas of hyperplasia. Of great interest was their observation that the carcinomatous tissue in two thyroid studies showed no uptake. Since their publication, there have been a few reports of thyroid carcinomas showing appreciable uptake of iodine. These authors also noted that the concentration of radioactive iodine was great in the more cellular regions of the thyroid and did not show any predilection for the colloid. LeBlond2 in 1942, References 1. Hamilton, J. G.; Soley, M. H., and Eichorn, K. B.: Deposition of Radioactive Iodine in Human Thyroid Tissue , Univ. California Publ., Pharmacol. 1:339-368 ( (Nov.) ) 1940. 2. LeBlond, C. P.: Localization of Newly Administered Iodine in Thyroid Gland as Indicated by Radio-Iodine , J. Anat. 77:149-152 ( (Jan.) ) 1943. 3. LeBlond, C. P.: Behavior of Radio-Iodine in Resting and Stimulated Thyroids , Anat. Rec. 88:285-290 ( (March) ) 1944.Crossref 4. LeBlond, C. P.; Fertman, M. B.; Pukkel, I. D., and Curtis, G. M.: Radio-Iodine Autography in Studies of Human Goitrous Thyroid Glands , Arch. Path. 41:510-515 ( (May) ) 1946. 5. Keating, F. R., Jr.; Rawson, R. W.; Peacock, W., and Evans, R. D.: Collection and Loss of Radioactive Iodine Compared with Anatomic Changes Induced in Thyroid of Chick by Injection of Thyrotropic Hormone , Endocrinology 36:137-148 ( (Feb.) ) 1945.Crossref 6. Nickson, J. J.: Dosimetric and Protective Considerations for Radioactive Iodine , J. Clin. Endocrinol. 8:721-731 ( (Sept.) ) 1948.Crossref 7. Seidlin, S. M.; Marinelli, L. D., and Oshry, E.: Radioactive Iodine Therapy: Effect on Functioning Metastases of Adenocarcinoma of the Thyroid . J. A. M. A. 132:838-847 ( (Dec.) ) 1946.Crossref 8. Dobyns, B., and Lennon, B.: A Study of the Histopathology and Physiologic Function of Thyroid Tumors Using Radioactive Iodine and Radioautography , J. Clin. Endocrinol. 8:732-748 ( (Sept.) ) 1948.Crossref 9. Keston, A. S.; Ball, R. P.; Frantz, V. K., and Palmer, W. W.: Storage of Radioactive Iodine in a Metastasis from Thyroid Carcinoma , Science 95:362-363 ( (April) ) 1942Crossref 10. Frantz, V. K.; Ball. R. P.; Keston, A. S., and Palmer, W. W.: Thyroid Carcinoma with Metastases, Studied with Radioactive Iodine , Ann. Surg. 119: 668-689 ( (May) ) 1944.Crossref 11. Leiter, L.; Seidlin, S. M.; Marinelli, L. D., and Bauman, E. J.: Adenocarcinoma of the Thyroid with Hyperthyroidism and Functional Metastases , J. Clin. Endocrinol. 6:247-261 ( (March) ) 1946.Crossref

GERWIG, WALTER H.

doi: 10.1001/archsurg.1950.01250010742008pmid: N/A

Abstract THE NOUN volvulus has its origin from the Latin verb "volvere" which means "to turn about" or "to roll." During the past one hundred years physicians have created and firmly established the word "volvulus" as a vernacularism common to their profession and without meaning if employed in any other manner. The term is interpreted as describing a process in which a torsion or twisting of a segment of bowel results in an obstruction to the lumen and a disturbance in circulation to the wall of the intestine. Even though volvulus may occur almost anywhere in the gastrointestinal tract, this paper is designed primarily to deal with lesions of the colon. Eight cases of volvulus of the colon, encountered during the past ten years, form a basis for this study. A personal interest in volvulus of the colon was inspired by the rather unique experience of observing 5 of the 8 References 1. (a) Gilchrist, R. H.: Obstruction Due to Volvulus of the Colon , Arch. Surg. 56:79 ( (Jan.) ) 1948.Crossref 2. (b) Grace, A. J.: Volvulus of the Cecum , Canad. M. A. J. 38:346 ( (April) ) 1938. 3. (c) Griffin, W. D.; Bartron, G. R., and Meyer, K. A.: Volvulus of the Sigmoid Colon , Surg., Gynec. & Obst. 81:287 ( (Sept.) ) 1945. 4. (d) Hendricks, W., and Griffin, W. D.: Symposium on Clinical Advances in Surgery: Intestinal Obstruction; Analysis of Three Hundred and Fifty-Two Cases , S. Clin. North America 27:51-72 ( (Feb.) ) 1947. 5. (e) Leonard, E. D., and Derow, S.: Volvulus: Study of Twenty-Two Cases , New England J. Med. 218:388 ( (March 3) ) 1938. 6. (f) Miller, J. M., and Clagett, O. T.: Volvulus of Ileocecal Region , Proc. Staff Meet., Mayo Clin. 15:424 ( (July 3) ) 1940. 7. (g) Pratt, J. P., and Fallis, L. S.: Volvulus of the Cecum and Ascending Colon: Report of Three Cases , J. A. M. A. 89:1225 ( (Oct. 8) ) 1927. 8. (h) Rothman, M.; Bruckner, J. P., and Zetena, D. F.: Volvulus of the Cecum and Ascending Colon , Am. J. Surg. 60:292 ( (May) ) 1943. 9. (i) Simon, H. E.; Senturia, H. R., and Keller, T. B.: Volvulus of the Sigmoid Colon , Am. J. Surg. 71:550 ( (April) ) 1946. 10. (j) Sweet, R. H.: Volvulus of the Cecum , New England J. Med. 213:287 ( (Aug. 15) ) 1935. 11. (k) Wangensteen, O. H.: Intestinal Obstructions: A Physiological and Clinical Consideration with Emphasis on Therapy, Including Description of Operative Procedures , ed. 2. Springfield, Ill., Charles C Thomas, Publisher, 1942. 12. (l) Weinstein, M.: Volvulus of the Cecum and Ascending Colon , Ann. Surg. 107:248 ( (Feb.) ) 1938. 13. 2. (a) Bona, T.: Volvulus of Cecum , Zentralbl. f. Chir. 65:2425 ( (Oct. 29) ) 1938 14. The 1939 Year Book of General Surgery, Practical Medicine Series , Chicago, The Year Book Publisher, Inc., 1939. 15. (b) Bruusgaard, C.: Volvulus of the Sigmoid Colon and Its Treatment , Surgery 22:466 ( (Sept.) ) 1947. 16. (e) Norgaard, F.: Periodic, Spontaneously Remittent Volvulus and the Symptoms in Cases of Colon Elongatum , Acta. radiol. 26:163, 1945 17. Internat. Abstr. Surg. 83:146, 1946 18. Surg., Gynec. & Obst. , (Aug.) 1946. 19. Bruusgaard.2b Edgren.2c Laurel.2d Peterson.2f Touvinen.2g 20. Scott, W. J. M., and Serenati, Q. J.: Megacolon: Mechanism and Choice of Treatment , Surgery 20:603 ( (Nov.) ) 1946. 21. Groth, K. E., cited by Bruusgaard.2b 22. Laufman, H., and Method, H.: The Role of Vascular Spasm in Recovery of Strangulated Intestine , Surg., Gynec. & Obst. 85:675 ( (Dec.) ) 1947. 23. Wilms, M., cited by Bruusgaard.2b Norgaard.2e 24. Holmgren, B. S.: Volvulus , Acta. radiol. 19:230 ( (Sept.) ) 1938 25. The 1939 Year Book of General Surgery, Practical Medicine Series , Chicago, Year Book Publishers, Inc., 1939. 26. James, K. L.: Volvulus of Pelvic Colon in Young Person , Brit. M. J. 2:569 ( (Sept.) ) 1938. 27. Ritvo, M., and Golden, J. L.: Roentgen Diagnosis of Volvulus of Sigmoid with Obstruction , Am. J. Roentgenol. 56:480 ( (Oct.) ) 1946.

COSTIN, MAURICE E.;GASTON, EUGENE A.

doi: 10.1001/archsurg.1950.01250010764009pmid: N/A

Abstract IN A RECENT review of the literature Anderson1 found only 91 cases of solitary diverticulum of the cecum. He collected an additional 8 cases from the Mayo Clinic, which made a total of 99 cases of solitary diverticulum reported in the entire literature. The purpose of this communication is to present 2 new cases recently observed at the Framingham Union Hospital. REPORT OF CASES Case 1. —A 67 year old white married housewife was admitted to the Framingham Union Hospital on Nov. 27, 1947, with the chief complaint of obstipation of three days' duration. During the three months preceding her admission the patient had noted increasing constipation. Increasingly large doses of cathartic were required, and the resulting stools were loose and watery and associated with much flatus. The last bowel movement was three days before admission in spite of repeated enemas and catharsis. There were no other symptoms referable References 1. Anderson, L.: Acute Diverticulitis of the Cecum , Surgery 22:479-488 ( (Sept.) ) 1947. 2. Noon, Z. B., and Schenk, H. L.: Solitary Diverticulitis of the Cecum , Am. Surg. 68:364-368 ( (June) ) 1945.Crossref 3. Greensfelder, L. A., and Hilder, R. I.: Cecal Diverticulosis with Special Reference to Traumatic Diverticula , Surg., Gynec. & Obst. 48:786 ( (June) ) 1929. 4. Waugh, T. R.: Appendix Vermiformis Duplex , Arch. Surg. 42:311-320 ( (Feb.) ) 1941.

GROSS, ROBERT E.;MOORE, THOMAS C.

doi: 10.1001/archsurg.1950.01250010770010pmid: N/A

Abstract DESPITE the rarity of its occurrence, the anomaly of double urethra has long excited interest within the ranks of the medical profession and a rather extensive literature has developed pertaining to the subject. The versatile Aristotle is credited with being the first to make observations from a case of double urethra. Vesalius mentioned Arab writings with descriptions of such malformations. More modern attention begins in the nineteenth century with the published observations of Vidal de Cassis (1834), followed by the reports of Cruveilhier,1 Jerjavay, Luschka,2 Lejars3 and many others. For recent reviews and discussions we are indebted to Fantl,4 MacKenzie5 Oudard and Jean,6 Fronstein and Saigrajeff,7 Chauvin8 and Lowsley.9 DESCRIPTION OF THE MALFORMATION An accessory urethra may occur as a complete, second passageway from the bladder to the dorsum of the penis, or it may appear as only a segment of References 1. Cruveilhier: Traite d'Anat. 1852, p. 614. 2. Luschka: Virchow's Arch. f. path. Anat. 34:992, 1865.Crossref 3. Lejars: Ann. d. mal. d. org. genito-urin. 6:392, 1888. 4. Fantl, G.: Folia urol. 8:193, 1913. 5. MacKenzie, D. W.: Surg., Gynec. & Obst. 22:344, 1916. 6. Oudard, and Jean, G.: J. d'urol. 11:177, 1921. 7. Fronstein, M., and Saigrajeff: Ztschr. f. urol. Chir. 17:187, 1925. 8. Chauvin, E.: J. d'urol. 23:293, 1927. 9. Lowsley, O. S.: New York State J. Med. 39:1022, 1939. 10. O'Herron, M. D., and Webster, F. A.: J. Urol. 55:391, 1946. 11. Haslinger, K.: Ztschr. f. urol. chir. 33:24, 1939. 12. Rinker, J. R.: J. Urol. 50:331, 1943. 13. Fong, E. E.: Radiology 46:380, 1946. 14. Irmisch, G. W., and Cook, E. N.: Minnesota Med. 29:299, 1946. 15. Meisels, V.: Pest. med.-chir. Presse, Budapest 29:585, 1893. 16. Pribram: Praeger Vierteljahrsschr. 4:44, 1867. 17. von Dittel: Wien. med. Wchnschr. 39:395, 1869. 18. Lenartowicz, J. T.: Dermat. Wchnschr. 56:97, 1913. 19. Bernadet, G.: Bull. de méd., Paris 37:1162, 1923. 20. Pytel, A.: Urol. & Cutan. Rev. 39:23, 1935. 21. Bonanome, L.: Arch. ital. urol. 19:361, 1942.