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December, 1961 HYP ERTENSION FOLLOWING NEPHRECTOMY—ROBICSEK AND OTHERS 93 eases. In the Memorial Hospital group, the average age on admission was 61 years, the youngest patient being a 41 year old male and the eldest a centenarian female who was paying her first visit to a hospital. Eleven, or 73 per cent, of the patients were females. Histology The histology of primary malignancy of the gallbladder has been amply described6. More than 85 per cent of primary malignant tumors of the gallbladder are adenocarcinomas of the scirrhous, papillary, or mucin-producing types. Epidermoid carcinomas, undifferentiated carcinomas, and adenoa-canthomas comprise the majority of the remaining tumors. Fourteen cases in our group were of the adenocarcinoma variety, and one tumor was an epidermoid carcinoma. Clinical Findings The clinical picture associated with gallbladder cancer is variable. Symptoms and signs may be indistinguishable from those of acute or chronic benign biliary tract disease. More commonly the picture is that of a progressive neoplastic process superimposed on chronic biliary symptoms of many years' duration. Occasionally, presenting symptoms are those arising from involvement of surrounding organs, and overshadow the primary lesion in the gallbladder. Eleven patients in our series had a past history of chronic gallbladder disease ranging from 5 to 50 years' duration. Pain, usually localized in the right upper quadrant or epigastrium, was the most common symptom, being present in 80 per cent of the cases, and was frequently the presenting complaint. One patient with spinal metastases complained of upper back and chest pain. Nausea and vomiting was a major complaint in 3 patients and was an associated symptom in 6 others. Two patients had symptoms consistent with upper intestinal obstruction. Four-fifths of the group had a history of recent significant weight loss. Gastrointestinal hemorrhage was observed in 3 cases, 2 of which had episodes of massive hematemesis requiring whole blood transfusions. Fig. 1. Anatomy and lymphatic drainage of the gallbladder. Six of the 15 patients were icteric on admission to the hospital, and a seventh exhibited an elevated serum bilirubin, although clinical signs of jaundice were not evident. The jaundice was found to be of the obstructive variety by laboratory tests, and the serum alkaline phosphatase was usually elevated. The most consistent finding on physical examination was a palpable mass in the right upper quadrant. This finding was present in more than one half of the patients. Clinical hepatomegaly was frequently present, although it was not always possible to distinguish the inferior border of the liver when there was an associated extrahepatic mass in the right side of the abdomen. Nevertheless, liver metastases were subsequently confirmed at laparotomy in 13 of 14 patients where the organ could be adequately examined. Roentgenologic Findings A review of the anatomy of the right upper quadrant and the lymphatic drainage of the gallbladder7 is helpful in understanding the gross pathologic picture and roent-genographic findings associated with cho-lecystic cancer (fig. 1). The gallbladder is a subserosal sac which lies in intimate contact with the inferior surface of the liver. Its fundus frequently extends beyond the anterior liver edge to lie in contact with
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1961 |
Identifier | NCHH-17-022 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 22 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-022.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-022 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
Description
Fixed Title * | Page 593 (image) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1961 |
Identifier | NCHH-17-022-0335 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed22v21961medi_0335.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 22 |
Issue Number | 12 |
Page Number | 593 |
Health Discipline | Medicine |
Full Text | December, 1961 HYP ERTENSION FOLLOWING NEPHRECTOMY—ROBICSEK AND OTHERS 93 eases. In the Memorial Hospital group, the average age on admission was 61 years, the youngest patient being a 41 year old male and the eldest a centenarian female who was paying her first visit to a hospital. Eleven, or 73 per cent, of the patients were females. Histology The histology of primary malignancy of the gallbladder has been amply described6. More than 85 per cent of primary malignant tumors of the gallbladder are adenocarcinomas of the scirrhous, papillary, or mucin-producing types. Epidermoid carcinomas, undifferentiated carcinomas, and adenoa-canthomas comprise the majority of the remaining tumors. Fourteen cases in our group were of the adenocarcinoma variety, and one tumor was an epidermoid carcinoma. Clinical Findings The clinical picture associated with gallbladder cancer is variable. Symptoms and signs may be indistinguishable from those of acute or chronic benign biliary tract disease. More commonly the picture is that of a progressive neoplastic process superimposed on chronic biliary symptoms of many years' duration. Occasionally, presenting symptoms are those arising from involvement of surrounding organs, and overshadow the primary lesion in the gallbladder. Eleven patients in our series had a past history of chronic gallbladder disease ranging from 5 to 50 years' duration. Pain, usually localized in the right upper quadrant or epigastrium, was the most common symptom, being present in 80 per cent of the cases, and was frequently the presenting complaint. One patient with spinal metastases complained of upper back and chest pain. Nausea and vomiting was a major complaint in 3 patients and was an associated symptom in 6 others. Two patients had symptoms consistent with upper intestinal obstruction. Four-fifths of the group had a history of recent significant weight loss. Gastrointestinal hemorrhage was observed in 3 cases, 2 of which had episodes of massive hematemesis requiring whole blood transfusions. Fig. 1. Anatomy and lymphatic drainage of the gallbladder. Six of the 15 patients were icteric on admission to the hospital, and a seventh exhibited an elevated serum bilirubin, although clinical signs of jaundice were not evident. The jaundice was found to be of the obstructive variety by laboratory tests, and the serum alkaline phosphatase was usually elevated. The most consistent finding on physical examination was a palpable mass in the right upper quadrant. This finding was present in more than one half of the patients. Clinical hepatomegaly was frequently present, although it was not always possible to distinguish the inferior border of the liver when there was an associated extrahepatic mass in the right side of the abdomen. Nevertheless, liver metastases were subsequently confirmed at laparotomy in 13 of 14 patients where the organ could be adequately examined. Roentgenologic Findings A review of the anatomy of the right upper quadrant and the lymphatic drainage of the gallbladder7 is helpful in understanding the gross pathologic picture and roent-genographic findings associated with cho-lecystic cancer (fig. 1). The gallbladder is a subserosal sac which lies in intimate contact with the inferior surface of the liver. Its fundus frequently extends beyond the anterior liver edge to lie in contact with |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-022.pdf |
Document Sort | all; nchh-17 |
Article Title | Radiologic Findings In Primary Carcinoma Of The Gallbladder |
Article Author | Stewart L . Mooring |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-022 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
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