Vagectomy with drainage procedure for duodenal ulceration

Vagal resection when combined with adequate gastric drainage is a simple, safe, rapid and reliable means of controlling the symptoms of the majority of patients who require surgical treatment for duodenal ulceration. The vagal resection should be complete. The drainage should be adequate and this can be accomplished either by pyloroplasty or juxtapyloric gastroenterostomy. The rationale for this approach is discussed and the satisfactory experience with a small group of patients managed in this way at the University Hospital of the West Indies is presented (AU)

Complications of esophageal by-pass

Esophageal by-pass is essentially a palliative procedure when performed for malignancy. The mortality and morbidity should be commensurate with this objective. A critical selection of patients is necessary or palliation may be obtained at an exorbitant price, and criteria are suggested to this end. The complications attending by-pass are discussed - many of them are avoidable. Esophageal by-pass provides satisfactory results in patients with corrosive stricture of the esophagus. The development of peptic ulceration in the juxta-gastric portion of the colon segment will probably be encountered with increasing frequency. This may warrant the addition of vagectomy and pyloroplasty to the by-pass operation in patients with corrosive strictures (AU)

Tumors of salivary gland origin

In 64 patients, an unusually high percentage of salivary gland tumors occurred in accessory salivary tissue, ectopic sites, and in accessory salivary tissue, ectopic sites, and sublingual gland, corroborating experiences in other tropical hospitals. The incidence of all tumors was: parotid 57.8 per cent, submaxillary 17.2 per cent, sublingual 4.7 per cent, and accessory and ectopic sites 20.1 per cent. The ratio of benign to malignant tumors was 3 to 1. Two benign tumors occurred in unusual sites which were the external auditory canal and the lacrimal gland. Recurrences, particularly in the parotid gland, resulted from inadequate excision. Facial nerve palsy occurred postoperatively in 7.8 percent of the patients. One patient died as a result of surgery. Mucoepidermoid carcinoma was the commonest type of malignant tumor found, involving particularly the parotid and subligual glands. The sentinel node of the parotid gland was found to be a useful guide, and frozen sections of tumor were not altogether reliable. The method of treatment of malignant tumors of salivary gland origin should be based largely on the histology, and more radical operations should be adopted (AU)

Replacement of the cervical oesophagus

The cervical oesophagus can be replaced or by-passed safely by means of an isolated segment of transverse colon brought via the chest. Two illustrative cases are discussed in which corrosive strictures of the oesophagus made this necessary. A brief history is given regarding the various methods employed in replacing the oesophagus and reasons advanced for favouring the transverse colon for this purpose (AU)

Hidradenitis suppurativa

Hidradenitis Suppurativa is a rare disease affecting the apocrine glands. The etiology is discussed and a method of treatment outlined that has been found successful for this disease when extensive and involving the buttocks. Two representive case records are given (AU)

Carcinoma of the ano-rectal junction

The importance of anal ducts in the pathogenesis of disease at the ano-rectal junction is stressed. A knowledge of the anatomy of this area helps to clarify the pathogenesis of certain infections such as cryptitis and fistula in ano and modifies the treatment of such disorders. A knowledge of the embryology of this area also provides a clearer explanation of the morphological complexities of malignancies encountered in this region. A case is presented with a transitional cell carcinoma occurring at the ano-rectal junction. The findings and treatment are discussed. Complete transposition of the viscera was an interesting additional finding. (AU)

Portal hypertension in veno-occlusive disease of the liver (abstract only)

Veno-occlusive disease of the liver is the commonest cause of cirrhosis of the liver in Jamaican children and accounts for 30 per cent of all cirrhosis at all ages. The first 100 documented cases of veno-occlusive disease at the University College of the West Indies, Jamaica, have been studied. Sixteen per cent died in the acute phase, 23 per cent made a complete clinical recovery, 17 per cent passed into the chronic phase and then died of their disease. 17 per cent defaulted to follow up, 27 per cent passed into the chronic phase with cirrhosis of the liver and are being followed, in some instances for over five years. Seventeen patients have died of oesophageal haemorrhage, 5 during the acute phase of veno-occlusive disease and 12 during the chronic phase. The majority succumbed during the first bleeding episode. In an attempt to salvage patients who develop portal hypertension, portal-caval shunts have been created during the past three years. There have been 6 such patients, all children. There was no operative mortality and all of these patients have done very well clinically since operation and have been followed regularly. Certain unusual details of the clinical picture and of the pathology as noted at operation are presented. The disease has now been produced in dogs and details of experimentral work using Crotalaria extract are presented. It is suggested that with better public health education this disease will become a rarity but that it has provided us with a valuable research tool for experimental production of cirrhosis in laboratory animals (AU)

Cysts of the spleen

Cysts of the spleen are rare and a case recently encountered in a patient with antecedant malaria is recorded. Details of classification, pathogenesis and diagnosis are reviewed. It has been emphasized that the majority of secondary cysts of the spleen are the result of intraparentymatous haemorrhage. An attempt has been made to correlate the factors responsible for cysts with spontaneous rupture of the spleen, with particular emphasis on the role played by malaria. (AU)

Veno-occlusive disease of the liver: surgical aspects

Veno-occlusive disease of the liver is a recently established disease entity. Its etiology, pathology, and symptomatology, and natural history are discussed on the basis of 99 cases of this disease so far authenticated at the University College of the West Indies. In the surgical literature the disease is added to the list of causes of intra-hepatic portal hypertension, and the cases of 4 patients are presented in detail in whom portacaval anastomoses were performed for the decompression of esophageal varices. The surgical implications of this disease have been stated and some of the difficulties enountered in the treatment of portal hypertension in infants and children outlined (Summary)

Triple biopsy technique in cancer of the breast

Cancer of the breast should be treated by radical mastectomy only when there is reasonable expectation of cure. It is now possible to assess prognosis more logically if clinically operable patients are regarded in terms of the "triple biopsy", criteria for which operation are discussed. It is suggested that evidence of microscopic metastases to the apex of the axilla or to the internal mammary chain denotes inoperability and that in such instances radiotherapy has more to offer than radical surgery. The clinical experience with breast cancer as encountered at the University College Hospital of the West Indies for the past six years is reviewed and compared with that reported from other centres in America and Europe. Areas are indicated where local improvements are necessary. A strong plea is made for the urgent provision of better facilities and trained personnel for modern radiotherapy - surely Jamaica's most important medical need at this time (AU)

Anomaly of first branchial cleft

An anomoly referable to the first branchial cleft is reported. This is a rare lesion and the thirteenth to be recorded after an extensive study of the literature. The embryology is discussed and emphasis is directed to the means by which diagnosis may be made and surgical management undertaken. The success of excision is dependent on anticipation of the course taken by the fistulous tract in such cases (Summary)

Fluid management in burns

A brief review of the patho-physiology of burns is presented. The main cause of shock following body burns is loss of circulating blood volume either to the exterior or into the burn area. This is best remedied by prompt replacement in accordance with the recommendations of Evans as far as volume and composition are concerned. The hourly urinary output and clinical response of the patient should be the milestones of therapy. Special care must be exercised in the management of the following categories:- children with more than 10 percent body burns, all patients with more than 50 percent involvement, patients over 50 years of age, those with pre-existing cardiovascular, respiratory or renal disease, and those with respiratory burns. Significant nitrogen depletion and anaemia follow most major burns and these must be anticipated or corrected promptly if delayed convalescence and retarded wound healing are to be avoided. (AU)