THE course taken by the vagus fibres which supply the pyloric region has not been very definitely ascertained. Anatomically the main branches of the anterior and posterior vagal trunks from the cesophageal plexus are traceable to the region of the incisura angularis and their terminal fibres supply the pyloric antrum. In no instance does the anterior or posterior vagal trunk send fibres as far as the pylorus canal or sphincter. Many observers state, however, that all the pyloric region receives its nerve supply from these branches. The anterior vagal trunk has been show-n to give off a branch, and sometimes two or three branches, to the liver, which communicate with sympathetic fibres and have been called the hepatic branch of the vagus. From these, nerve strands descend to supply the pylorus and first part of the duodenum. La tarj et(1) states that the pylorus receives its entire nerve supply, in man and the dog, from above and considers these strands to consist wholly of sympathetic fibres. One of us, McCrea (2), has dissected the hepatic branch in man, dog, cat and rabbit and shown that the strands given off to the pylorus contain vagus fibres. It seemed then desirable to ascertain the effects which this pyloric branch is capable of producing upon the musculature of the pyloric region.In a recent paper, McCrea, McSwiney and Stopford(3), working on the intact stomach, have shown that stimulation of the vagi influences both the motor activity and "postural tonus," the type of reaction depending on the condition of the peripheral mechanism. The entogastric pressure was used as an indication of the state of activity of the peripheral mechanism, as this was found to vary with the degree of contraction of the viscus on its contents. In the passive organ (obtained by starving an animal for at least 12 hours) which did not normally maintain an entogastric pressure, stimulation of the nerve caused an augmentor response. In the active stomach (obtained by feeding a starved animal
No abstract
THE patient, age 31 years, was admitted t o the male wards of the Salford Royal Hospital in May, 1928; he complained of severe pain in the back, obstinate constipation, and a swelling of the abdomen which was rapidly increasing in size.ON EXAMINATION.-A large abdominal tuniour was obvious, apparently arising from the pelvis ; it was fimi, and in size corresponded approximately to that of a 6-to-7-months pregnancy; per rectum a mass could be felt anteriorly. Neither testis was present in the scrotum, but the patient stated that at times both had appeared.OPERATIoN.-Laparotomy revealed a large nodular tumour, in parts cystic, in others solid, emerging from the pelvis, and t o the posterior aspect of which the rectosigmoid was adherent. It was considered t o be a malignant tumour, probably arising from a retained testis, and inoperable. However, on searching for what were assumed to be the testes, both were found ; but it was noted with some surprise that a tube with fimbriated extremity lay in relation t o each. The size of the tumour prevented a thorough exploration of the pelvis, and the abdomen was closed.
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