CARCINOMA OF THE NASOPHARYNX—Treatment with Radioactive Cobalt

A method of treatment of carcinoma of the nasopharynx is described, using a bead of radioactive cobalt in a Foley catheter placed through the nose and inside the nasopharynx. As an aid in proper placement of the cobalt bead a portion of the nasal septum is removed first. This method of treatment is to supplement rather than replace other methods of treatment such as external x-ray therapy and surgical excision of lymph nodes in the neck.Twenty-two patients were treated with radioactive cobalt beads and the results indicated that it is a useful method for treating carcinoma in the nasopharynx.     

BASAL CELL CARCINOMA OF THE NOSE—Treatment with Chemosurgery

Basal cell carcinomas of the nose probably originate from embryologic cell rests left between cartilages and bones in the fusion and migration of the nasal precursors. Some carcinomas have been found to invade to the mucosal surface between subcutaneous structures or around the alar margins. Recurrences are particularly likely to develop deep extensions due to overlying scar tissue.In many cases, chemosurgical removal has disclosed unsuspected deep and lateral extensions. It is the treatment method of choice for many such lesions.     

DIVERTICULITIS OF THE COLON—Surgical Treatment

Appropriate surgical treatment of diverticulitis of the colon can result in a highly satisfactory proportion of permanent cures, with an operative mortality of 2 to 5 per cent.Colostomy is a valuable emergency procedure for the control of severe infection or the relief of obstruction but is not a satisfactory definitive treatment for the cure of diverticulitis. Definitive surgical treatment requires resection of the involved segment of colon.Three indications for surgical intervention in “uncomplicated” diverticulitis are: (1) continued or repeated attacks, (2) persistent deformity as seen by x-ray examination, and (3) persistent blood in the stools.Although a three-stage operation is usually considered a safer procedure, one-stage resections may be safely and satisfactorily employed in many instances.     

CARCINOMA OF THE PROSTATE—Diagnosis and Treatment

About 28 per cent of men between the ages of 71 and 75 have cancer of the prostate. Many of them do not die of the disease, but with the life span ever increasing, this problem is becoming more important.In the early stages the condition is asymptomatic; when the symptoms of urinary obstruction arise, the cancer is usually too advanced for cure. Cure depends on early diagnosis and, therefore, on routine rectal examination. The solitary hard nodule of early prostatic cancer becomes a stony hard fixed prostate as the condition progresses. X-ray and acid phosphatase studies are of help only after the cancer has metastasized. As many as 50 per cent of patients with rectally palpable early carcinoma of the prostate can be cured by radical perineal prostatectomy. Often, simple enucleation or transurethral resection is sufficient to effect cure in the case of occult carcinoma. However, some observers believe that when cancer is detected by microscopic examination of a prostate that has been removed, a radical operation should be done as soon after the initial operation as feasible. Early orchidectomy and estrogen therapy are of considerable help in slowing the process of advanced prostatic cancer and may postpone the need of transurethral resection to relieve obstruction. When these measures fail, bilateral adrenalectomy, cortisone therapy, pituitary irradiation, and pituitary extirpation have been employed, with moderate success, in an effort to diminish the androgen level.     

RECURRENT CARCINOMA OF THE RECTUM—Surgical Treatment

Following operations on the rectum for carcinoma, approximately half of the patients have recurrence in the perineum, pelvis, abdomen or at the suture line of anastomosis. The prognosis is almost uniformly poor and although the problems of management are complicated, dealing with them may give the patient worthwhile physical, emotional and economic benefits. Surgical procedures used in the treatment of the common types of recurrence are discussed.     

FRACTURE OF THE METACARPAL SHAFT—A Method of Treatment

Anatomically, metacarpal fractures, when reduced, are not spontaneously stable. They require maintenance of this reduction because of the forces acting on the fragments. Closed methods of maintaining this reduction are ideal, but in selected cases, intramedullary fixation of the fracture, using the Kirschner wire, gives excellent results. The method under consideration does not disturb the fracture site itself, the Kirschner wire being introduced “blind.” Correct placement of the site of insertion of the wire, coupled with the rigid immobilization thus attained, gives excellent results in a high proportion of selected cases.     

CANCER OF THE LARYNX—The Advantages of More Conservative Treatment

Properly administered irradiation therapy for cancer of the larynx in properly selected cases can be successful. Reported herein is the case of a woman 49 years of age with a Grade 3 squamous cell carcinoma of the larynx, who at first was scheduled for radical operation but was treated by irradiation therapy with an estimated total dose of 5292 r given in 29 treatments. The tumor and all subjective and objective symptoms disappeared. The patient was still well when last observed a year later.     

INJURIES OF THE HAND AND FOREARM—Treatment of Damaged Soft Tissues

Successful primary repair of soft tissue injuries of the hand and forearm holds the ultimate disability to a minimum. The kinds of trauma and the resultant soft tissue damage may be classified. Attention to details and technique in carrying out the primary reparative operation on the injured hand largely obviates a crippling deformity or the need for much reconstruction later.     

CARCINOMA OF THE ESOPHAGUS AND GASTRIC CARDIA—With Special Reference to Treatment

During the last five years the thoracic and abdominothoracic approaches in esophageal and gastric surgery have become established. With improvements in surgical and anesthetic technique mortality rates have declined. Preoperative and postoperative care are of great importance.     

THE USE OF FIBRINOLYTIC AGENTS—Present Status in the Treatment of Cardiovascular Disease

Fibrinolysins are involved in the dissolution of clots. They are still in the experimental stage and are not yet ready for use by practicing physicians. The materials available for clinical use have undesirable serious side effects. However, the future for fibrinolysins in clinical practice has promise.     

A STUDY OF INFLATION OF THE LUNGS OF THE NEWBORN—A Preliminary Report

There seems to be no reasonable doubt that the lungs in a newborn expand progressively during the first few days of life. Some degree of atelectasis seems to be perfectly normal. This is indicated by a number of roentgenographic studies (including those here reported); by the reported findings of pathologists; by the fact that in experimental animals the lungs inflated very unevenly; and by the fact that aeration of only a portion of the lung is needed for complete oxygenation of the blood. The relation of atelectasis to neonatal death is not entirely clear and is probably not always the same. The infant may die from other causes before the lungs are fully expanded. Atelectasis may develop secondarily to other debilitating conditions. The frequent coincidence of prematurity and extensive atelectasis is impressive. It may be that the lungs are so incompletely formed that they cannot expand. On the other hand, atelectasis and massive collapse in the adult is a serious condition and there seems to be no good reason to suppose that this cannot also occur in infants and be serious per se.The air pressures found necessary to expand the lungs in rabbit fetuses were found to be about ten times what adult humans use in quiet respiration and were of about the same magnitude as the pressures found necessary to expand the lungs of stillborn humans. An attempt to produce atelectasis in newborn rabbits by chilling was most inconclusive. Atelectasis did develop in three of 15 animals used in the experiment, but the relation to chilling was not at all clear.     

CARCINOMA OF THE FLOOR OF THE MOUTH—Successful Results with Monoblock Resection and Suprahyoid Dissection in Early Lesions

In 33 cases of carcinoma of the floor of the mouth, the lesions were classified according to the extent of invasion and involvement and a plan of surgical procedure was followed that fitted the operation to the classification.A monoblock resection plan for early intraoral lesions appeared to be quite satisfactory. It was used in two cases in which node involvement was not known until discovered in the pathologic specimen, but in neither case was there recurrence in a period of six years.     

CARCINOMA OF THE THORACIC ESOPHAGUS—A Discussion of Early Diagnosis and Surgical Treatment

Dysphagia, substernal or epigastric distress, and regurgitation of food are important early symptoms in the diagnosis of carcinoma of the esophagus. Temporary remission in symptoms does not rule out esophageal cancer. The use of thick barium meal and routine thorough examination of the esophagus in upright and supine positions in all upper gastrointestinal roentgen studies, even though the clinical symptoms point to the upper abdomen, are of great importance.The spread of the cancer to both mediastinal and subdiaphragmatic lymph nodes makes transthoracic thoracolaparotomy the one approach which will permit the surgeon to perform a one-stage esophagogastrostomy, and to adequately evaluate and deal with cancerous tissue on both sides of the diaphragm. This one-stage procedure permits the patient to swallow normally after operation, and the costly and time-consuming uncertainties of the many-staged operations are avoided. The comfort which the operation gives to otherwise doomed patients, along with the improving postoperative mortality rate, offers new hope to those who have cancer of the esophagus.     

THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose

To engender discussion of what the scope and responsibility of medicine ought to be in today''s society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession''s responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are four contributions selected from those received to date. Others will be published in the months ahead.If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.     

THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose

To engender discussion of what the scope and responsibility of medicine ought to be in today''s society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession''s responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are three contributions selected from those received to date. Others will be published in the months ahead.If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.