Colorectal cancers in Jamaica: a review (1958-1967)

Two conditions seem necessary for better results in the treatemnt of colorectal cancer in Jamaica: dissemination to the public information about the early signs and symptoms of cancer, and a greater alertness by the medical profession in the interpretation of the patient's gastointestinal complaints. (Summary)

Spontaneous rupture of the distal large bowel

Six new cases of spontaneous rupture of the normal distal large bowel are described and 19 cases from the literature are reviewed, bringing the total of the recorded cases to 25. The aetiology of these cases is discussed. The ruptures occur in the region of the pelvi-rectal junction, in the sigmoid loop, and in the upper rectum. The tear is considered to be mechanical in origin and to be due to a sudden rise in intraluminar pressure which results from sudden obstruction during active peristalsis. Rupture may occur quite spontaneously but is more likely to occur in the presence of constipation and during def‘cation. The diagnosis, treatment, and mortality are also discussed. (Summary)

Massive gastro-duodenal haemorrhage

The etiology and management of massive gastro-duodenal haemorrage is discussed, on the basis of findings in 225 cases. (AU)

Acute intussusception in childhood

Twenty eight cases of acute intussusception in childhood are described. A total mortality of 14 percent and a post-operative mortality of 12 percent indicates the need for earlier diagnosis and improvements in surgical management. In only 9 cases was there a classical clinical picture and in 8 of these, the tumour remained in the right half of the colon with normal peritoneal fixation. Misleading a typical symptoms commonly occurred when the tumour had reached the left half of the colon and rectum and in all of these the right half of the colon was llax and pendulous. These cases had a variable incidence of pain, pyrexia, vomiting, diarrhoea and of blood in the stools, making it important to differentiate intussusception from infective gastro-enteritis in infancy and to recognise that intussusception may be a complication or a sequel of infective gastro-enteritis. Surgical reduction and methods of resection are discussed. The importance of careful pre-operative resuscitation and of post-operative care is stressed and a plea, based on results elsewhere, is made for the co-operation of paediatrician, surgeon, radiologist and anaesthetist in the management of these cases (AU)

The use of gastric cytology in the early diagnosis of carcinoma of the stomach

Hitherto the diagnosis of gastric carcinoma has been made by the clinician with the assistance of the gastrocopist and radiologist. The results remain dissappointing for not more than 50 percent of the cases are operable when first seen and of these only about 10 percent survive post-operatively for five years or more. An earlier diagnosis is required if results are to be improved. Exfoliative gastric cytology is a new diagnostic procedure which in the hands of the trained pathologist can reveal the presence of malignant cells in gastric washings in over 90 percent of gastric cancers. Experience has shown that cells are shed from even the smallest carcinoma in situ and that by cytology it is possible to detect a growth before there is any radiological or positive gastroscopic evidence of it. Gastric resections in these cases furnish material for the study of these early lesions and the surgeon may reasonably hope that his results will be vastly improved. The associations of such lesions with chronic atrophic gastritis suggests that this is a malignant condition (AU)