Effect of taurocholic acid and BSP on conjugation patterns and suspension stability of human and rat bile

Experiments were carried out to demonstrate conjugation patterns in rat bile during the formation and dissolution of lithocholic acid stones. Stone dissolution was clearly related to increased excretion of taurine conjugates and reduction of the glycine to taurine conjugation ratio. Man has a similar dual conjugating mechanism for bile acids, and feeding of 3.0 gm of taurocholic acid daily produced increased bile salt excretion and alteration of the glycine to taurine ratio toward taurine conjugation. Acute doses of BSP produced increased bile stability as measured by the increase in negative zeta potential of a standard particle in bile, but interfered with taurine-conjugated and total bile salt excretion at high BSP excretion levels. Use of negatively charged ion excretion in bile, however, represents a fruitful field for further investigation.     

Current status of heparin dissolution of gallstones. Experimental and clinical observations.

Investigation of the use of heparin in bile indicates that it has the ability to disperse suspended particles. Clinical experience using a heparinized saline flush in forty-three patients with retained gallstones demonstrated disappearance of the stones in thirty-one of the patients. On this basis we would recommend this treatment for further clinical trials in patients with retained common duct stones.     

Analysis of patient disability after curative resection for colonic and rectal cancer.

Ninety-seven patients undergoing curative resection for colonic or rectal cancer were investigated to determine the degree of early disability, that is, disability one to four years postoperatively. Seventy per cent of the patients were disability free postoperatively and fully employable, and among those who died of the disease, 73 per cent had no disability three months prior to death. The results indicate that waiting five years to determine cure in this disease wastes many man-years of fruitful employability.     

Repair of large chest wall defects using pedicle flaps

Three cases of chest wall resection illustrate the use of three different full thickness pedicle flaps which can be used to cover almost any area of the anterior chest wall. The medially based acromiothoracic flap was swung inferiorly to cover a lateral defect. Laterally based abdominal wall and axillary flaps were used to cover more medial defects. In case III bilateral axillary flaps were necessary to cover a huge central defect after resection of the anterior sternum and anterior cartilages of seven ribs for a sebaceous carcinoma.     

Analysis of survival versus patient and doctor delay of treatment in gastrointestinal cancer

Three hundred twenty-eight patienta with gastrointestinal cancer were reviewed. Coefficients of correlation between patient or doctor delay prior to treatment and survival were not significant at p < 0.05. No significant relation between delay and whether patients were ward or private was found.Although this report represents no evidence that early diagnosis is or is not beneficial, the concept of early diagnosis needs to be re-evaluated to include primarily asymptomatic patients. Once symptoms have occurred, factors inherent in the tumor-host relationship play a more significant role in survival than does time.     

Urologic complications in renal primary and retransplantation: Experience with 202 consecutive transplants

In a period of two years, 202 kidneys were transplanted in 162 patients at the Downstate Medical Center. One hundred twenty-nine patients had primary transplantations, twenty-nine second transplantations, and five third transplantations. Urologic complications occurred in twenty-four of the patients (12 per cent). There were eight complications involving the urinary bladder and fifteen ureteric complications. In twenty-one patients the complications appeared within six weeks after surgery. Surgical correction immediately upon diagnosis of the urinary complications resulted in a high degree of early restoration of the urinary tract continuity and preservation of renal function.Leakage from the bladder was frequently associated with previous surgery. In five of eight patients, bladder leakage occurred after the second or third transplantation. Complications of the urinary bladder in general had a significantly favorable prognosis as compared with ureteric complications. Although all the patients with bladder complications fully recovered and maintained good renal function, four patients with ureteric complications either died or lost the graft.     

Urease as a contributing factor in ulcerative lesions of the colon

Urease immunization protects animals against the development of uremic colitis. This indicates that ammonia formed by bacterial urease is the causative factor in the breakdown of the colonic mucosa.     

The computer as an unbiased medical investigator: Experience on an active surgical service

An adaptable on-line computer system for entry, retrieval, and analysis of medical discharge summaries has been developed and applied in the Trauma Service of a busy city hospital. Each summary occupied 5 to 10 minutes of the physician's time and compared favorably in cost to the standard dictated summary. While the average dictated summary contained 15 ± 7 relevant facts, the machine-generated summaries were found to have 53 ± 20 relevant facts. The summaries are well organized, easily comprehensible, and a duplicate copy can be obtained at any time by using the patient's name or number for identification. To date, 495 discharge summaries have been entered and reside in the memory of the computer. Statistical analysis from the data base is done by the computer, thus eliminating human prejudice. It provides facility for rapid and accurate retrospective studies as well as pattern-of-care and individual case review.     

Tracheal or esophageal compression due to benign thyroid disease

Tracheal or esophageal compression was present in 91 (33 percent) of 273 consecutive patients with benign goiter during a 7 year experience. The underlying disease was nodular colloid goiter in 66 percent, adenoma in 21 percent, thyroiditis in 9 percent and Graves' disease in 4 percent. The incidence of tracheoesophageal compression was higher in patients with thyroiditis (67 percent) than in those with colloid goiter (46 percent). Thirty of 91 patients were completely asymptomatic but had marked tracheal deviation on roentgenography. Two thirds presented with significant dyspnea, or dysphagia or both. A long history of goiter preceding the onset of symptoms and progressive worsening of compression symptoms after its onset were common in the latter group. Previous radiographs demonstrating significant tracheal deviation during a previous presymptomatic period were available in 11 of 36 dyspneic patients. Sudden tracheal occlusion developed in 3 percent and required emergency treatment.Tracheal compression occurred more often and when present was a more ominous symptom. Compression manifestations were more frequent in patients with multinodular goiter, were more likely to appear when the underlying disorder was thyroiditis, affected the trachea more often than the esophagus and were generally gradually progressive with time.A clinical spectrum ranging from a presymptomatic tracheal compression stage to one wherein progressive worsening of symptoms occurs is suggested. After symptoms of tracheal compression become clinically manifest, the occurrence of complete airway occlusion may be sudden and unpredictable. Early operation whenever roentgenographic evidence of tracheal deviation becomes manifest is recommended.     

Secretory effects of intravenous serotonin on the proximal jejunum of the awake dog

The intestinal secretory effects of hyperserotoninemia were studied in conscious dogs with cannulated, exteriorized chronic proximal jejunal segments. A basal absorptive state for water and electrolytes was significantly changed to a secretory state for water, sodium ion, chloride ion, and potassium ion when serotonin was infused intravenously at 30 micrograms/kg per minute. This effect disappeared with the cessation of the infusion. During infusion, whole blood serotonin concentrations were similar to those in patients with the carcinoid syndrome. Diarrhea developed in all animals studied during infusion, and significant hypokalemia also occurred. These results support a primary role for serotonin in the pathogenesis of diarrhea associated with the carcinoid syndrome.     

Bombesin: A vagally independent stimulator of gastrin release

In this study we demonstrate that bombesin is a potent stimulant of canine gastrin and gastric acid secretion. Bombesin was shown to release almost fourfold more gastrin than a meal by a mechanism which is independent of vagal integrity. An exogenously administered cholinomimetic agent released only minimal amounts of gastrin after vagotomy and virtually none in the intact canine model. The combination of bombesin and bethanechol caused a significant increase in acid secretion compared with bombesin alone and was associated with a marked inhibition of gastrin release both before and after vagotomy. Gastric acid secretion in response to bombesin was not significantly altered by vagotomy. We interpret these data to reflect the sensitivity of bombesin-stimulated gastrin release to gastric luminal pH, although they also suggest the existence of a cholinergic inhibitory mechanism for gastrin release.The data provided by this study are consistent with the hypothesis that bombesin might function as a paracrine neuromodulator of gastrin release. In view of its presence in the nerves and mucosa of human stomach and its potent actions on gastrin release and gastric acid secretion, bombesin may play a role in gastric physiology.     

Operative treatment of massive hemoptysis

Fifty-five pulmonary resections have been performed at our institution for hemoptysis of 600 ml. or more in 24 hours. The overall mortality was 18% as compared with more than 75% in patients who bled 600 ml. or more in 16 hours and 54% in patients who bled 600 ml. or more in 48 hours, all of whom were managed conservatively. Mortality correlated with the rate of bleeding irrespective of the extent of resection. Nineteen patients were bleeding massively at the time of pulmonary resection and required single lung ventilation; of these, 7 (37%) died. Of the 36 patients in whom active bleeding had ceased at the time of pulmonary resection, 3 (8%) died. In 2 patients with extensive bilateral disease, cavernostomy and packing of bleeding cavities was employed. The most common cause of death was respiratory insufficiency. Our experience indicates that operative treatment of massive hemoptysis offers a reduced mortality as compared with conservative management.     

The Distribution Patterns of Biatrial Myxomas

Biatrial myxomas are extremely rare, and by 1970 only three of eight attempts at removal had been successful. Another successful removal, the difficulty of establishing the biatrial nature of a myxoma by echocardiography, and a summary of the distribution patterns of biatrial myxomas are presented here. In more than 50% of patients, both pedicles grew into separate atrial chambers from a common location in the atrial septum. The surgical implications are discussed.     

Traumatic perforation of the sigmoid colon through schistosomal ulcerations

A case is presented in which the colon was perforated through a S. mansoni ulcer after blunt abdominal trauma. This is believed to be a unique situation. The colonic complications of schistosomiasis are discussed, and it is expected that they will be seen more frequently in the United States.     

Cavitary legionnaires' pneumonia: Nosocomial infection in renal transplant recipients

Cavitation is an unusual manifestation of legionnaires' pneumonia. Mortality rates range from 24 to 58 percent with effective therapy. Antibiotic therapy is not standardized and is largely based on anecdotal reports. This report has described nosocomially acquired cavitary legionnaires' pneumonia in five renal transplant recipients. The diagnosis was made by seroconversion and immunofluorescent staining of lung tissue or transtracheal aspirates. Frequently seen associated symptoms were not present. All patients were successfully treated with 2 to 4 g of erythromycin for at least 4 weeks.     

Reoperation for amputation neuroma of the cystic duct.

Two cases of amputation neuroma of the cystic duct are reported. In both instances, significant symptoms were totally relieved by excision of the neuroma. Review of the literature reveals at least twenty similar cases with the same results. Emphasis is placed on the importance of considering this diagnosis in postcholecystectomy patients after all the usual causes of right upper quadrant symptoms have been ruled out.