PARTIAL HEPATECTOMY ever it met a fibrous septum. It was thereupon clamped on the band, which was ligated and cut. The dissection went on slowly round the tumour, which was lifted up as it became free. Some of the bands encountered were tiny, some were of nioderate size, but none were really large. When the tumour was finally removed the cavity left in the liver was like a tea-cup, oozing slightly from its whole surface, but not bleeding from any particular point. The total blood loss cannot have been more than three or four ounces (85-115 ml.).It was clear that such a cavity could not be closed. A long forceps was therefore passed down between the diaphragm and the liver till its point could be seen bulging the abdominal wall at the costal margin. An incision was made over the point and a strip of corrugated rubber was drawn back and laid in the cavity. The diaphragm was repaired, the lung re-expanded, and the thoracotomy incision closed.Dr. de Navasquez reported as follows on the specimen: "The specimen shows a spherical tumour 8 cm. in diameter which is an argentaffin tumour or 'carcinoid' of similar morphology to the tumour in the rectum. The excision appears to be complete, as the tumour is surrounded by normal liver."The patient was slightly jaundiced for a few days after the operation, but his condition was never alarming. Drainage was maintained for about a week. He is now back at his work as a fruit farmer, playing games, and feeling well. He has gained 30 lb. (13.6 kg.) in weight. He has lost his fiancee, who was more upset by the series of operations than he was, and threw him over. Perhaps he has gained more by his ordeal than he realizes. ConclusionI cannot claim to be familiar with the literature of partial hepatectomy, nor have I consulted more than the standard textbooks of operative surgery. It would, in any case, be out of place to burden a clinical report of a single case with references to the experience of others.The surgeon to-day is confronted with the almost impossible task of keeping in touch with a literature that increases in volume every year. He can read most of that which concerns the small branch in which he is particularly interested. For the rest he must be content to let others do the hard work at the coal face, and get the knowledge from them, picked, assorted, graded, and delivered in clean sacks. The knowledge thus acquired gains in perspective from being unclogged by excessive detail, and it is laid down in the association centres of a mind clarified by idleness. What I have learned of surgery since taking my Fellowship has been gleaned from registrars, house-surgeons, dressers, and sisters; from meetings of the Association of Surgeons. the Royal Society of Medicine, and the Medical Society of London; from journeyings round Europe with the Surgical Travellers; and from the Colchester Surgical Group and those who visit them. At a recent Colchester meeting we were discussing the surgery of the liver, and I learned for the first time that the method that proved so useful to me ...
IN preparing extracts of the water-soluble vitamin from rice polishings, we noticed that, unless precautions were taken, alcoholic fermentation readily occurred at laboratory temperature. This fermentation was due to the presence of yeasts, and while yeast has the power of synthesising at least one of the water-soluble vitamins, it has been shown that its growth in wort, or in cultures containing substances which are possibly akin to these vitamins, is superior to that obtained on purely synthetic media [Nelson, Fulmer and Cessna, 1921; Harden and Zilva, 1921]. It was decided, therefore, to ascertain whether fermentation had any deleterious effect upon our extracts. When our original extract was fractionated by lead acetate, we observed that the filtrate, which contained the curative factor, alone underwent fermentation. The precipitate portion could not be induced to grow yeasts. During the progress of our experiments a paper by Kon and Drummond [1927] appeared, in which they show that the activity of sucroclastic enzymes is not diminished in the polyneuritic pigeon, which, these authors state, is not in accord with the experiments of Farmer and Redenbaugh [1925]. The inference drawn by Kon and Drummond that vitamin B is associated only with protein metabolism, and bears no relationship to the metabolism of fat and carbohydrate, appears at variance with the evidence of Randoin and Simmonet [1924], and of Plimmer, Rosedale and Raymond [1927]. At the time of the arrival of Kon and Drummond's paper, our first series of experiments was giving evidence of deterioration of our extract by fermentation, so that it became of interest to ascertain whether any reason for metabolic disturbance could be obtained from our birds. Although Plimmer and Rosedale [1922] investigated the distribution of enzymes in the alimentary canal of the normal chicken, we could find no such data for the normal pigeon, so that we were obliged to secure this in order to
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