Intracellular demonstration of growth hormone in human mammary carcinoma cells.

Intracellular growth hormone has been demonstrated in human mammary carcinoma cells by using an unlabeled antibody enzyme technic with horseradish peroxidase and antihorseradish peroxidase complex. Intense reaction was seen in both male and female mammary carcinoma cells. Positive staining was observed in nuclei and cytoplasm and on cytoplasmic membranes.     

Role of angiography in the diagnosis of pancreatic neoplasms.

The vascular architecture of the pancreas has been described, but few reports indicate preoperative accuracy. During the last 3 years, selective superior mesenteric and celiac angiography was performed in 471 patients. In 35 of these patients, additional selective angiography of the superior pancreaticoduodenal and inferior pancreaticoduodenal arteries was performed to reveal the detailed vascular pattern of the pancreas and its surrounding structures. Exploratory surgery was performed in all patients except the four control subjects. The angiographic findings reflected a poorly vascularized infiltrating lesion with invasion of the blood vessels and serpiginous encasements. Peripancreatic extension of the tumor indicated nonresectability. In early pancreatitis, the pancreas showed increased vascularity and occasional stretched vessels. In more advanced pancreatitis, the arteries were prominent and irregular with increased parenchymal accumulation of contrast medium in the capillary phase. In pseudocysts of the pancreas, the only finding was stretching of the vessels around the lesion. A well circumscribed lesion with increased contrast medium in the capillary and venous phases diagnostic of pancreatic adenoma. Pancreatic angiography is an important diagnostic tool in evaluating and staging pancreatic neoplasms.     

Thyroid angiography

Twelve patients were studied by selective thyroid angiography for the evaluation of solitary thyroid nodule. Under aseptic conditions with local anesthesia a #7 preshaped catheter was introduced through the femoral artery and guided to the thyrocervical trunk and inferior thyroid artery. Selectively, 2 to 6 cc of the contrast material was injected and a series of radiographs were taken. Striking differences were noticed in vessels in abnormal thyroid gland. In colloid goiter there was no filling of the vessels in the nodule. In fetal adenoma there was unusual branching of the vessels but no arteriovenous communications. In carcinoma, along with increased vascularities and abnormal branching, arteriovenous communications were noted.     

Ultrastructural study of stroma in human mammary carcinoma

This investigation was designed to study the origin of the stromal component of human mammary carcinoma. Tissues from 30 proved breast carcinomas were studied. Under a light microscope with special stains, an increased connective tissue component was seen in carcinoma. Gluteraldehyde-fixed tissue was examined under an electron microscope. The stroma appeared to be composed of fibroblastic, myofibroblastic, histiocytic and primitive mesenchymal cells. Elastic fibers were intimately intermingled with collagen and reticulin and seen in close association with carcinoma cells. In some areas they were seen inside the carcinoma cells with discontinuous cytoplasmic membrane, as if they were formed by the cancer cells. This observation suggests that breast carcinoma cells play an important role in the production of elastic fibers in association with stromal cells and also stimulate the proliferation of the stromal cellular component.     

Endoscopic sclerotherapy in acute variceal hemorrhage

Acute variceal hemorrhage in patients with alcoholic cirrhosis and poor liver function is associated with a high mortality. A nonoperative treatment, endoscopic sclerotherapy, was employed in 22 patients with cirrhosis and poor liver function who had 24 episodes of acute variceal hemorrhage over a 20 month period. Portal hypertension was secondary to alcoholic cirrhosis in 21 patients and cystic fibrosis in 1 patient. Of the 24 patient admissions, 21 were of patients in Child's class C and 3 were class B. Endoscopic sclerotherapy was performed under endotracheal general anesthesia using a modified Negus rigid esophagoscope. The sclerosant (5 percent sodium morrhuate) was injected into all visible varices near the gastroesophageal junction using a MacBeth needle. Definitive control of variceal hemorrhage for the entire hospitalization was achieved in 19 of 24 admissions (79 percent). The in-hospital mortality for acute variceal bleeding was 29 percent; 81 percent of the patients were discharged after control of hemorrhage. There were two major and five minor complications related to sclerotherapy. Based on this preliminary experience it is concluded that injection sclerotherapy controls bleeding and reduces mortality associated with acute variceal hemorrhage in patients with poor liver function.     

Splenic preservation in adults after blunt and penetrating trauma

This study was carried out to evaluate the possibility and safety of splenic preservation in adults subjected to both blunt and penetrating trauma. In an 18 month period there were a total of 36 splenic injuries studied (in 36 patients): 18 due to blunt trauma, 11 due to gunshot wounds, and 7 due to stab wounds. A total of 18 spleens were repaired: 8 (45 percent) in the blunt trauma group, 4 (36 percent) in the gunshot group, and 6 (85 percent) in the stab wound group. There were no deaths in the entire group nor were there any complications associated with splenic salvage. Splenic preservation after both blunt and penetrating trauma is both safe and feasible in the adult population, except in those instances specified herein.     

Operative repair for tricuspid atresia.

Twelve patients with tricuspid atresia underwent physiological operative repair. The criteria for their selection for operation included normal pulmonary vascular resistance and normal left atrial and left ventricular end-diastolic pressures. Four patients died (30% mortality). The 8 surviving patients developed pleural effusion, ascites, and hepatomegaly, which markedly improved in the subsequent weeks. Five of the 8 survivors underwent cardiac catheterization. The arterial oxygen saturation in these patients averaged 82% preoperatively, 89% immediately postoperatively, and 94% or better six months later. All had improved subjectively and developed increased exercise tolerance.     

Membershi Roster Southern doraac Surgical Association

A new clamp designed to facilitate the handling and placement of various shapes and sizes of cardiac patching materials is described.     

Prevention of Recurrent Empyema

Fourteen patients underwent a physiological operation for tricuspid atresia. Seven patients survived up to 3 years after operation. Six patients underwent hemodynamic studies 2 to 34 months postoperatively (mean, 15 months). Average age at the time of operation was 14 years (range, 5 to 25 years).Postoperative studies showed 4 patients to be in sinus rhythm and 2 in junctional rhythm. Right atrial pressure was elevated an average of 17 mm Hg (range, 10 to 34 mm Hg). All patients showed good atrial transport function regardless of their rhythm. Two had a right atrium-left pulmonary artery gradient of 1.5 to 10 mm Hg across the conduit. Average arterial saturation was 92% (range, 87 to 97%), an improvement of 13% over preoperative values. Residual hypoxemia was due to pulmonary vein desaturation and to atrial right-to-left shunting early postoperatively and later, to atrial right-to-left shunting alone.     

Hickman catheter placement simplified

A simplified technique to place the Hickman indwelling right atrial catheter has been devised. This involves securing the catheter to a trocar, which is easily advanced to the cutdown site of the selected vein. Experience in more than 75 patients shows this technique to be associated with less discomfort and fewer complications than seen with standard techniques.     

External fixator use in comminuted gunshot fractures of the proximal phalanx.

Comminuted low velocity gunshot fractures of the proximal phalanx were stabilized with an external fixator in 15 patients. This device was found to be useful. It allowed healing of the fracture in good alignment in 13 patients. And motion of the metacarpophalangeal joint was preserved.     

Chemoimmunotherapy of head and neck cancer.

The present review aims at developing a perspective for surgeons of the role of chemoimmunotherapy in the management of head and neck cancer. The biochemical pharmacology of high dose methotrexate with leucovorin "rescue" is also discussed. The need for a combined modality approach in the treatment of patients with this cancer is emphasized.     

Antral reactivity: effect of vagal innervation on antral gastrin release by various stimuli

We have demonstrated that temporary vagal blockade does not decrease gastrin release from an isolated antral pouch when gastrin is stimulated by local factors in the pouch. At the same time this sort of temporary vagal blockade decreases the responsiveness of the Heidenhain pouch to endogenous stimuli from the antral pouch but not to exogenous stimuli. These findings suggest that truncal vagotomy may be more efficient and might achieve a greater degree of gastric secretory reduction than does parietal cell vagotomy. The implications of these findings with regard to parietal cell vagotomy in the treatment of duodenal ulcer are discussed.     

Neural control of blood flow in gastric mucosa.

The innervation of the small vessels in the fundic mucosa of the rat and the effects of vagotomy on this innervation were studied ultrastructurally. The capillaries and arterioles, but not the venules, were found to receive direct innervation. Vagotomy causes degeneration of the nerve endings that innervate these vessels, confirming their vagal origin. This finding, and the fact that some morphologic changes in the capillaries were observed after vagotomy, provides morphologic evidence for the neural control of blood flow in the rodent gastric mucosa.     

Giant insulinoma.

A patient with an extremely large insulinoma but short duration of symptoms is reported on. Fasting hypoglycemia, hyperinsulinism, and angiography were the modalities used to diagnose and locate the tumor.