Desmoid of the anterior chest wall

The tumor is of interest for several reasons. It occurs in males but in a minority of cases. Likewise it usually is found in connection with the musculo-aponeurotic structures of the anterior abdominal wall and only occasionally in other sites. A definite history of trauma was obtained from the patient which gives further support to the theory of traumatic origin in connection with individual predisposition as a cause for the appearance of these tumors.     

Acute pancreatitis

The difficulty in differentiating between acute pancreatitis and other abdominal catastrophes is proven by the high incidence of diagnostic errors. It is most important to recognize perforations of peptic ulcers as immediate surgery is mandatory to good results. On the other hand, conservative treatment of acute pancreatitis gives a far lower mortality than that following early operative intervention. The determination of serum amylase levels has been a valuable addition to our diagnostic armamentarium as these rise sharply in the early stages of acute pancreatitis but are not increased in other acute abdominal conditions.The usual symptoms of acute pancreatitis are as follows: The history of acute abdominal pain varying in intensity and being most frequently located in the epigastrium and the right upper quadrant; tenderness and often rigidity in the area of the pain; nausea and vomiting invariably existing with shock accompanying severe attacks. There is often a history of previous milder attacks or of biliary colic. Jaundice is not infrequent. The leucocyte count is markedly elevated. Glycosuria and albuminuria frequently are found.Conservative therapy consists of relief of pain, rest in bed, continuous gastric rest and suction, adequate parenteral feedings to maintain blood chemistry and fluid balance, blood transfusions to overcome shock and careful observation. When the acute symptoms have subsided and the patient's condition has improved, biliary tract surgery should be contemplated if evidences of disease are found. Late drainage of pancreatic abscesses may be indicated.     

FIBRILLATION OF THE AURICLES: ITS EFFECTS UPON THE CIRCULATION

When the auricles fibrillate, the following effects are observed. 1. The arterial blood pressure may rise, fall, or remain stationary. Usually it falls. If it falls, it generally rises again towards or to the initial pressure. 2. The venous pressure changes are the reverse of the arterial. 3. The intestinal volume and the cardiac output changes are in the same direction as those of arterial blood pressure. 4. From these observations it may be concluded that the peripheral circulatory effects are purely passive. 5. The volume of the heart decreases except in instances where there is reason to believe that the circulation is failing. All the changes described in the foregoing paragraphs, and also the variations in blood pressure reactions which occur from time to time, are attributable to alterations in the rate of ventricular contraction. Similar, though perhaps less profound changes, are seen when the heart rate accelerates in like degree in response to regular induction shocks.