Total gastrectomy in a patient with an in situ right gastroepiploic artery graft.

A 60-year-old man in whom coronary artery bypass grafting was performed with an in situ right gastroepiploic artery presented with a gastric adenocarcinoma 22 months after myocardial revascularization. He underwent a total gastrectomy with preservation of the patent right gastroepiploic artery graft to the right coronary artery. Because of the difficulty of abdominal reoperations in patients with in situ right gastroepiploic artery grafts, surgeons must consider right gastroepiploic artery free graft or alternative conduits.

[Pierre Masson: the father of histopathology teaching in Canada]. / Pierre Masson: pilier de l'enseignement de l'histopathologie au Canada.

Pierre Masson's influence on teaching of pathology in Canada has been unique. One of the most eminent pathologist, director of the Institute of anatomopathology of Strasbourg, he accepts, in 1926, to be the ambassador of the french science in North America. He is named professor and Chairman of the Department of pathology of the University of Montreal. Very soon, his "school" is world renowned and contributes to the excellent reputation of his new country of adoption. During his career, Pierre Masson has published more than 131 original scientific papers and written his masterpiece "Les tumeurs humaines" which has been translated in English. Masson died in 1959, but his influence is prolonged be his collaborators and students who still cherish his memory.

Physiologic response to cricopharyngeal myotomy and diverticulum suspension.

Ten patients who had a cricopharyngeal myotomy and diverticulum suspension for pharyngoesophageal diverticulum have been studied clinically, radiologically, and manometrically. There were no deaths or morbidity and all patients have achieved marked improvement of their symptoms. Before operation all patients but one had low resting tone in the upper esophageal sphincter and all patients had normal relaxation of the sphincter upon swallowing. The coordination of pharyngeal contraction and sphincter relaxation was normal in six patients and abnormal in four patients. After operations the only change was an increase in resting tone in seven patients, and there was no change in three patients. We conclude that cricopharyngeal myotomy and diverticulum suspension constitute an effective form of treatment for pharyngoesophageal diverticulum.

The gastric antisecretory effects of clofibrate in the rat.

The object of this study was to explore the effect of clofibrate on gastric secretion. The volume and the total acid output of Shay-treated rats (pyloric ligation) was studied after intragastric, intraduodenal, intramuscular and intraperitoneal administration of clofibrate. The experimental model was a factorial (3 X 4) random block design. The treatment factor had 3 levels: water, oil and clofibrate. The route of administration factor had 4 levels: intragastric, intraduodenal, intraperitoneal and intramuscular. The data were analyzed by analysis of variance. Compared to the control group (water and oil) the intraduodenally and intraperitoneally administered clofibrate produced a statistically significant (p less than 0.001) reduction in the volume and total acid output. The intragastric and intramuscular groups did not show a statistically significant reduction on the gastric secretion. It is concluded that clofibrate acts systemically rather than locally to reduce gastric secretion.

Early gastric cancer at the Hôtel-Dieu de Montréal: a 30-year review.

Early gastric cancer is usually defined as a lesion involving the mucosa alone or the mucosa and submucosa, regardless of whether lymph-node metastases are present. Between 1948 and 1978, 1295 gastric cancers were diagnosed at the Hôtel-Dieu de Montréal. Of these, 65 (5%) were early gastric cancers. Sixty of the 64 patients underwent gastric resection for cure. The other four cancers were found incidentally at autopsy. One patient (1.7%) died following operation. Ten patients were followed up for less than 5 years and therefore were excluded from survival analysis, as were 6 patients who died of unrelated causes. Forty-one of 43 patients survived, free of disease, for more than 5 years following operation, a survival rate of 95.3%. The annual yield of early gastric cancers has remained relatively constants since 1948, even with a decreasing number of gastric cancers treated at the hospital. The advent of fiberoptic endoscopy significantly (P less than 0.005) increased the number of early gastric cancers detected. Further improvements will depend on a more vigorous approach to endoscopy, especially in high-risk patients. A refined radiologic technique, including double-contrast roentgenography after a barium meal, was diagnostic in all patients who underwent operation in this study.

[Mortality in the emergency surgical management of upper gastrointestinal hemorrhage due to ulcers and gastritis]. / Mortalité dans le traitement chirurgical d'urgence des hémorragies digestives hautes par ulcères et gastrites.

A retrospective study of 68 patients with acute upper gastrointestinal bleeding (excluding bleeding from esophageal varices) revealed that all patients had emergency surgery. The factors influencing the mortality and the recurrent bleeding have been sought. The overall mortality was 29.5%. Age of patients and type of surgical procedure did not affect the mortality raate, while chronicity of lesions and their duodenal location had a favourable influence. Most deaths were due to hypovolemic shock and its complications. Gastric resection with vagotomy is the operation of choice for control of bleeding. The authors present a brief review of the literature and stress the importance of early diagnosis and resuscitative measures, as well as the need for aggressive surgical intervention.