Biomedical subjects
Publications and source records attributed to C H Organ.
A triple lumen balloon tube has been designed to study the neutralization and dilutional factors in the pathogenesis of acid-peptic ulceration. This tube is designed to create an in situ duodenal pouch from which duodenal contents may be retrieved before and after stimulation with 0.1 N hydrochloric acid.
During the twenty year span from 1951 to 1970, the combined operation was selected as the procedure of choice 663 times in the surgical management of duodenal ulcer disease. A retrospective study of these cases represents a 70 per cent follow-up rate; thirty-two additional patients expired during this period of causes unrelated to peptic ulcer disease or the procedure, bringing the crude follow-up rate to 77 per cent. The known recurrence rate was 0.85 per cent and the mortality 0.6 per cent. None of the deaths were due to the operative procedure itself. Diarrhea (11 per cent) and dumping (24 per cent) were the principle postoperative sequelae, neither of which represented a significant problem after twelve to fourteen months. Their incidence after 1960 in this series was decreased due to improved technic, better overall total surgical care, and reduction of the extent of resection from 75 to 50 per cent. The results, as interpreted by surgeon, patients, and gastroenterologist, have been reviewed.
In a study of 70 cases of fibroadenoma of the female breast, two ages of peak incidence were recorded, one of them in the late 20s to early 30s and a second in the late 40s to early 50s. At the time of diagnosis, the lesions usually were less than 3.0 cm in diameter. Almost two thirds of the tumors were situated in the lateral quadrants of the breast. Incidence of fibroadenoma was significantly higher among parous females tham among nulliparas. Review of family histories showed a remarkably high incidence of breast disease of all types in the mothers and sisters of the patients studied. An inordinately high proportion of patients under 40 years of age were nonwhite. Recurrences and multiple lesions were much more frequent in patients over 40. "Recurrences" are undoubtedly serial presentations of multicentric lesions.
This retrospective study of 174 patients with proven duodenal ulcer perforation was undertaken to delineate the natural history of those patients primarily managed by suture plication. During this 25-year period, 122 patients (70%) were treated with suture plication and 52 (30%) underwent a definitive procedure. There were 13 deaths in the overall group (7.4%) of which the mortality was 6.5% in the plicated group and 9.6% in the definitive group. Of the 122 patients treated with suture plication, 48% either 1) died of ulcer complications later, 2) required reoperation for ulcer disease, or 3) were under active treatment for ulcer symptoms. The reperforation rate in the entire series was 9% and the reoperation rate 32%. Suture plication is a time-honored, life-saving procedure, however, definitive surgery is a superior form of long-term management of the perforated duodenal ulcer patient.
The results of jejunoileal bypass have been satisfactory in 80 per cent of the patients. In the remaining 20 per cent, one or more problems eventually may require revision of the bypass. These problems fall into four categories: inadequate weight loss; excessive weight loss; persistent uncontrollable diarrhea or associated severe anorectal problems, or both, and severe unmanageable electrolyte and metabolic imbalance with or without liver failure. In our series, 108 patients were observed for one to five years, and ten patients required revision, one revision for every 12 bypass operations performed. The preoperative evaluation and management and the options available to the surgeon in correcting the abnormalities are evaluated. The results of ten patients who underwent revision of the bypass and the rationale for the revision are outlined. Criteria for an ideal operation have not as yet been attained.
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To document the point that the hyperparathyroidism should be considered a possible cause of unexplained neurological and psychiatric symptoms, the authors present five case reports of confirmed primary hyperparathyroidism in which the patients initially appeared with problems that seemed mainly psychiatric. The presenting symptoms in these cases consisted of varying degrees of depression, catatonia, confusion, disorientation, fatigue, and lethargy; there was no associated bone or renal pathology in four of the cases. The authors include a review of the pertinent literature and a discussion of the effect of calcium and magnesium bivalent ions on the central nervous system associated with hyperparathyroidism. They conclude that more investigation of the role of magnesium in this disease seems warranted.
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A report of a functioning mediastinal parathyroid cyst is presented with a review of the world literature. This represents the tenth functional, eleventh mediastinal, and third functioning mediastinal parathyroid cyst reported. The predilection of functional cysts for aberrant locations would suggest on hypothesis of their occurrence by degeneration of pre-existing adenomas based on an inadequacy of their blood supply. The criteria for ascribing functional activity to a parathyroid cyst are presented and discussed.
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