JN recent years non-traumatic hernia of the * stomach through the esophageal opening hi the diaphragm has attracted the at teuf ion of roentgenologists and of surgeons, but the literature of the subject indicates that internists have Bhown but little interest in this abnormality. Numerous interesting accounts of the condition have been given from a roentgenological point°f view and discussions of surgical technique designed to repair the hernia have been presented from time to time. Very few detailed case histories have been recorded and the authors of this paper have failed to find satisfactory autopsy reports concerning the nature of changes occurring in the stomach except in a few instances in which acute complications have been presentt.We do not propose to discuss the anatomical Possibilities of hernia through the diaphragm, the frequency of the condition, its roentgenological diagnosis or its surgical aspects, but wish to focus attention upon the question of anemia due to sIoav loss of blood resulting from mechanical conditions imposed upon the stomach from the stricture caused by the esophageal ring. The problem of diagnosis is difficult because there may be no symptoms referable to the stomach, and if the possibility of hernia has not been registered in the mind of the physician the condition may be overlooked, or, if found by x-ray examination, surgery for other conditions may be undertaken since the inclination of the clinician is to make a diagnosis of a silent undenionstrable ulcer of the stomach or malignant disease of the colon.Hemorrhage from the stomach is readily explained when ulcer or gastric erosions are present as shown in the papers of Truesdale1 and Harrington-. These conditions, however, are relatively uncommon since Truesdale, in 1932, was able to collect from the literature only seventeen cases of ulcer complicating diaphragmatic hernia. In the series of ten patients having anemia whose histories are incorporated in this paper, no history suggesting ulcer was obtainable and x-ray findings ivere negative for this lesion. To account for the cause of the bleeding, to our great advantage, three patients of this series have had thorough abdominal explorations by able surgeons and two others haA'e come to autopsy. This communication is offered with the hope that it may aid in the recognition of an interesting, disabling syndrome, and to give at least one answer to the cause of bleeding.In 1929, one of us3 presented a brief account of three patients, Cases 1, 2 and 3 of the present series, whose chief complaints Avere due to anemia secondary to blood loss as sIioavii by the presence of occult blood in the stools. Tavo of these patients had a history of passing tarry stools. In addition to anemia the only other major factor common to the three was the presence of hernia of the stomach through the esophageal orifice of the diaphragm, demonstrated by x-ray examination. Cases 1 and 3 underwent abdominal explorations because malignant disease of the colon Avas suspected in the first and a possible b...
THE fact that amoebiasis is more common in temperate zones than was previously thought lias been mentioned at different times by authors who are familiar with the organism which causes this infection. In spite of this, however, the number of cases of amoebic dysentery reported in Massachusetts are very few. In fact the differentiation of bacillary and amoebic types of dysentery is seldom made, and when made, is open to considerable doubt inasmuch as the cases are usually reported on clinical evidence alone.The occurrence of dysentery is relatively common, the disease being mentioned by the most ancient writers in medicine. It was not until 1859, however, that any attempt was made at classification of the various forms of the disease.In that year Lambl1 discovered amoebae in the intestine of a child who died of dysentery.Sixteen years later Losch2 first noticed the presence of amoebae in the stools of an infected person.It was not known, however, at that time, that the organisms found were pathogenic and, therefore, responsible for the condition produced in these patients. In 1903 Schaudinn3 was really the first to realize that two species existed, one pathogenic for man, the other nonpathogenic. Work done since then has shown that there are at least five different species of intestinal amoebae belonging to four distinct genera. Only one of these however, is pathogenic, namely, entamoeba histolytiea. Amoebic dysentery is regarded by the vast majority of medical men to be a distinctly tropical disease. That it is endemic in tropical and sub-tropical regions is true, but that it occurs in hot climates alone has been disproved by the increasing number of cases discovered in the temperate zone, especially since the World War.It seems that the disease is found more now in the temperate zone than formerly for the reason that foreign travel has become more common, and people who have resided in the tropics or where the disease is endemic very often become carriers and in this way spread the disease. *"There is a mass of evidence directing attention to the fact that many cases occur in those who have never been in the tropics but have lived in regions very remote from them. Amoebic dysentery has occurred in England, Prance and other portions of northern Europe as well as in northern United States in people who have not "been outside of their respective countries.The purpose of this article is to report four cases of amoebic dysentery occurring in Wor\s=d\Brooke\p=m-\Assistant Physician, Worcester City Hospital.Goodale\p=m-\Resident Pathologist, Worcester City Hospital. For records and addresses of authors see "This Week's Issue," page 159. cester, Massachusetts, and another which came to Worcester from another part of the state for treatment of a condition which was thought to be malignant. So far as is known, one case was never out of New England, and one was never out of the temperate zone. Of the other three, one was in Bermuda twenty years before the onset of symptoms, one was in the West Indies ten years before the ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.