To the surgeon, congenital abnormalities of the error in diagnosis and be capable of complicating blood-supply of abdominal viscera and variations operative procedures. in the position and structure of these organs are ofThe following three cases illustrate an unusual considerable importance. This is so because such type of anomaly in which the small intestine lies contents displayed. attachments of the sac wall in both cases (ac, ascending colon ; dc, descending colon). vertical attachments of the sac wall (St, stomach ; D, duodenum ; T, transverse colon ; B, bladder ; R, rectum).
Sir?I have gone through the able article on ' Chronic ulcerative colitis' by Colonel Chopra and Dr. Roy published in the Indian Medical Gazette of February 1939 with , interest. I agree with all that has been stated therein. But I miss very much the mention in it of ' Bale' fruits as an adjunct to treatment although '
DURING the past ten years our whole attitude toward the problem of gastric and duodenal ulcer has undergone a radical change. Formerly, the diagnosis and treatment of gastric or duodenal ulcer directed attention chiefly to the local lesion and largely ignored constitutional factors, which we now know to be of fundamental importance. At present, ulcers are believed to be due to a combination of factors acting in a susceptible individual.The two opposing conceptions of the etiology of ulcer have contended for first place for many decades: First, the view suggested by Rokitansky, in I84I, that some central factor is the real cause of all ulcers; second, the view upheld by Virchow, in I853, that local factors are quite sufficient to explain the pathogenesis of ulcer.Undoubtedly both the central and the local factors are important but the accumulating evidence suggests that central factors, either in the nature of organic disease of the brain, or neurogenic stimuli from the cortex in a vagotonic type of individual, are fundamental or predisposing causes of peptic ulceration.The local factors which are of significance will merely be enumerated here. They are: Trauma; acid chyme erosion; and bacterial invasion. These factors are of, importance, but it is probable that their effect is secondary to the preexisting central disturbance. Alterations in the gastric motility and secretion and actual peptic ulceration may be produced by stimuli originating in higher centers.The view one takes as to the relative importance of the central or local group of factors will influence one's line of treatment. If the predominant factor in a given case is central-that is to say due to either a functional or organic cerebral disturbance-and it cannot be satisfactorily controlled, then any form of local surgical therapy is apt to be followed by early recurrence of the ulcer. In this type of case medical treatment should be persisted with. However, if for any reason operative interference becomes necessary, a radical procedure must be adopted. On the other hand, if the central factors are negligible or controllable, and the local factors predominant, then medical treatment or conservative surgery offers the patient a much greater chance of cure.
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