Cleveland City Hospital Research Articles

American Pancreatic Association

American Pancreatic Association

AINHUM-OCCURRENCE OF A CASE IN NORTHERN OHIO

Since the first description of (dactylolysis spontanea) by Clarke1in 1860, many case reports have appeared, primarily from the tropical areas and the southern part of the United States. Until 1945, only about 50 cases had been reported from the United States; at the time of writing somewhat more than 100 have been reported.2 Whether the condition is actually rare in the United States or simply not well recognized by the medical profession is not known. Most authors believe the latter be true. The first case seen at the Cleveland Veterans Administration Hospital in the 13 years of its existence is reported herein. One case was previously diagnosed at the University Hospitals of Cleveland (1944), while no cases have been seen at the Metropolitan General Hospital (Cleveland City Hospital) in the past 35 years. The term ainhum is derived from an African word meaning to saw.

NEWS AND ANNOUNCEMENTS

Postgraduate Courses—AAP The first two of a series of postgraduate courses being sponsored by the American Academy of Pediatrics will be held at the University of Michigan Medical Center, Ann Arbor, Michigan, March 2, 3, 4, and 5, 1959; and at Vanderbilt University Medical Center, Nashville, Tennessee, on March 17, 18, and 19, 1959. Tuition for these courses is $50 and $40, respectively, for Academy members. Fees for nonmembers will be $70 and $60, respectively. These courses will both be organized so that each day will be devoted to papers and discussions on a different pediatric problem. At the University of Michigan, Dr. James Wilson and the pediatric staff will be hosts, as well as part of the faculty for the course. Other speakers will include members of other departments and the guest speakers, Dr. Warren Wheeler, Professor of Pediatrics and Bacteriology, Ohio State University Medical School, and Dr. Frederick C. Robbins, Director, Department of Pediatrics and Contagious Diseases, Cleveland City Hospital.

The Nurse in a Fertility Clinic

Mrs. Malone (Cleveland City) studied public health nursing at Frances Payne Bolton School of Nursing, Western Reserve University, and hat been with the clinic she describes here for the past three years. Prior to that she was on the staff of Cleveland City Hospital

Lawrence A. Pomeroy, M.D.

The death of Dr. Lawrence Alson Pomeroy on April 20, 1955, was a great loss to the medical profession, particularly in the field of cancer therapy. Dr. Pomeroy, son of Dr. Harlan Pomeroy, was born in Cleveland on May 10, 1883, and except for four years at Yale University, spent his life in his native city. He received his degree in medicine in 1908 from Western Reserve University School of Medicine. Early in his medical career, Dr. Pomeroy became associated with Dr. George W. Crile, under whose influence he developed a keen interest in the treatment of cancer. Though few physicians at that time had much interest in radium therapy, Dr. Pomeroy's prophetic insight led him to investigate the advantages of this new modality and to train himself in intracavitary and interstitial technics for gynecological cancer. In the early twenties, he started a follow-up clinic in the admitting room at Cleveland City Hospital. In 1930, he spearheaded the formation of the first formal tumor clinic in Cleveland at City Hospital, with the approval of the American College of Surgeons. Dr. Pomeroy was a regional director of the Founders of the American Cancer Society. He was the first president of the Ohio Division for the American Cancer Society from 1937 to 1943, and in March 1951 he received the Distinguished Service Medal of the Society for his outstanding service to cancer control. He was a consistently active participant in organized medicine and served as president of the Cleveland Academy of Medicine in 1927, president of the American Radium Society in 1939, and chairman of the Board of Trustees of the Cleveland Medical Library Association from 1942 to 1945. In May 1952, he received the Distinguished Service Award of the Cleveland Academy of Medicine for his service to the community and to organized medicine.

Ascending thrombosis of abdominal aorta as fatal complication of Leriche's syndrome.

THROMBOSIS of the abdominal aorta with gradual complete occlusion of one or both common iliac arteries undoubtedly occurs more frequently than is commonly realized. In an autopsy series from the Metropolitan State Hospital (for the insane) in Massachusetts, there were 13 instances in a series of 382 consecutive cases. 1 This is an unusually high incidence, and a more typical experience is reported from the Cleveland City Hospital, where there were nine cases in the autopsy material from 1930 to 1939. 2 Although in a few instances the thrombosis was thought to be secondary to such conditions as polycythaemia vera and Buerger's disease, 3 the majority of reported cases have resulted from ulceration of atheromatous deposits at the bifurcation of the aorta. Until recent years, most instances of primary aortic thrombosis were undiagnosed clinically. Leriche, in 1940, published an account of a case treated by resection of the aortic bifurcation

Over a Thousand Arrived!

PLANNING for a national convention was a new experience for us. But with the help of our advisors and fellow students, we feel that our venture was a successful one. This doesn't mean that our ulcers got a rest during the weeks of planning and replanning. We made mistakes and were disheartened and discouraged. However, we feel that our theme, Prescription for ProgressUnity, which was suggested by Mrs. Maude Jennings, a student at Cleveland City Hospital School of Nursing, helped us to keep our sights set when things seemed darkest. One of our big mistakes was in not dividing into working committees soon enough; too few of us were trying to do too much. As the details of planning the program increased, we became overwhelmed and seemed to be getting nowhere. We decided to divide the responsibilities among the eleven nursing schools in Cleveland. The students in each school selected

Cecostomy and colostomy in acute colon obstructions: experiences in ninety-nine cases.

The relative merits of cecostomy and colostomy as decompressive measures in acute large bowel obstruction have long been debated. During the past decade the management of large bowel lesions has undergone many changes; chemotherapeutic and antibiotic agents are now extensively employed, and single stage procedures with end-to-end anastomoses are considered in most instances the procedures of choice. However, when the lesion has produced complete obstruction, surgical decompression must still precede definitive surgery. Under these circumstances the surgeon is often confronted with the choice between two procedures, cecostomy or colostomy. For this reason it was considered worth while to review our experiences with these measures during the past 13 years at Cleveland City Hospital. MATERIAL Between Jan. 1, 1940, and Jan. 1, 1953, 99 patients with acute large bowel obstruction were admitted to City Hospital, Cleveland. During this period there were 161,765 admissions to the hospital and 27,241 admissions to the

Hysterosalpingography studies following ectopic pregnancy

1.1. A series of 70 consecutive patients operated upon for ectopic pregnancy is reviewed briefly. An unusually high recurrence rate (14.3 per cent) is noted at Cleveland City Hospital.2.2. Twenty-five of these cases were studied by hysterosalpingography following the operation for ectopic pregnancy. Sixteen patients showed patent residual tubes, 9 showed occlusion. Only 4 showed a normal residual tube. The various diagnoses are shown in chart form and are discussed.3.3. Two cases of repeat ectopic pregnancy which were studied between operations are presented and discussed.

Papillary muscle rupture due to a myocardial abscess.

Case Reports1 April 1953PAPILLARY MUSCLE RUPTURE DUE TO A MYOCARDIAL ABSCESSDONALD B. HACKEL, M.D., NATHAN KAUFMAN, M.D.DONALD B. HACKEL, M.D.Search for more papers by this author, NATHAN KAUFMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-38-4-824 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRupture of a papillary muscle of the heart due to a myocardial abscess is a rare occurrence. To the best of our knowledge, no previous reports of this condition have been published. Papillary muscle rupture from any cause, in fact, is rare, with only 41 cases having been reported previously. Davisson1summarized 26 cases which had been reported prior to 1948 and added three of his own. In 1950, two cases were reported by Smith2and one by Schwartz.3In the same year Askey4reported eight additional cases, bringing the total to 40. A case of rupture of a papillary...Bibliography1. Davison S: Spontaneous rupture of a papillary muscle of the heart, J. Mt. Sinai Hosp. 14: 941, 1948. MedlineGoogle Scholar2. Smith JC: Rupture of a papillary muscle of the heart, Circulation 1: 766, 1950. CrossrefGoogle Scholar3. SchwartzCanelli HFR: Spontaneous rupture of papillary muscle of the left ventricle, Am. Heart J. 40: 354, 1950. CrossrefMedlineGoogle Scholar4. Askey JM: Spontaneous rupture of a papillary muscle of the heart, Am. J. Med. 9: 528, 1950. CrossrefMedlineGoogle Scholar5. Kleberger K: Fernwirkungen mechanischer Gewalten im Korper, Virchows Arch. f. path. Anat. 228: 1, 1920. CrossrefGoogle Scholar6. StevensonTurner RRWJ: Rupture of a papillary muscle in the heart as a cause of sudden death, Bull. Johns Hopkins Hosp. 157: 235, 1935. Google Scholar7. PayneHardy WCHH: Traumatic rupture of the papillary muscles of the mitral valves, New Orleans M. and S. J. 89: 373, 1937. Google Scholar8. GlendyWhite REPD: Nonpenetrating wound of heart, Am. Heart J. 11: 366, 1936. CrossrefGoogle Scholar9. Spaldingvon Glahn EDWC: Syphilitic rupture of a papillary muscle of the heart, Bull. Johns Hopkins Hosp. 32: 30, 1921. Google Scholar10. Merat : Observations sur une lesion organique du coeur par rupture d'une des colonnes charnues du ventricle gauche, J. de med., chir. pharm., Paris 6: 587, 1803 (quoted by Stevenson6). Google Scholar11. Bertin RJ: Traite des maladies du coeur et des gros vaisseaux, 1824, Bailliere, Paris (Cas 31). Google Scholar12. Spanton WD: Case of rupture of one of the musculi papillares of the tricuspid valve, Tr. Path. Soc. London 16: 73, 1865. Google Scholar13. WiggersFeil CJH: The cardio-dynamics of mitral insufficiency, Heart 9: 149, 1922. Google Scholar14. Saphir O: Myocarditis, Arch. Path. 33: 88, 1942. Google Scholar15. Flaxman N: Myocardial abscess, J. A. M. A. 122: 804, 1943. CrossrefGoogle Scholar16. WeissWilkins SRW: Myocardial abscess with perforation of the heart following staphylococcal pyemia, Am. J. Surg. 60: 277, 1943. CrossrefGoogle Scholar17. Gladden JR: Myocardial abscess with perforation of the heart following staphylococcal pyemia, Am. J. Surg. 60: 277, 1943. CrossrefGoogle Scholar18. MillerEdwards RDJE: Abscess formation in an acute myocardial infarct, Proc. Staff Meet., Mayo Clin. 26: 178, 1951. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, Ohio*Received for publication June 20, 1952.From the Departments of Pathology, Cleveland City Hospital, and Western Reserve University School of Medicine, Cleveland, Ohio.†This work was done during the tenure of a Research Fellowship of The American Heart Association. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAcute Anterolateral Papillary Muscle Rupture in the Absence of Coronary Artery DiseaseInfection of an avulsed papillary muscle tip simulating bacterial endocarditisIatrogenic rupture of left ventricular papillary muscleEtiology and differential diagnosis of acute mitral regurgitationThe Clinical Spectrum of Papillary-Muscle DiseaseThe mitral complexRight ventricular outflow tract obstruction produced by a myocardial abscess in a patient with tuberculosisCase 41-1967Traumatic rupture of a papillary muscle in a childMyocardial abscessesMyokarditis und weitere Myokardiopathien 1 April 1953Volume 38, Issue 4Page: 824-830KeywordsAbscessesFellowshipsHeartHospital medicineMyocardiumPapillary muscles ePublished: 1 December 2008 Issue Published: 1 April 1953 PDF downloadLoading ...

FUNCTIONING STRUMA OVARII

From the Dept. of Surgery of Cleveland City Hospital and the School of Medicine, Western Reserve University, Cleveland, Ohio

Mycosis fungoides with verrucous lesions; report of a case.

Milian and Périn¹in 1923 described a case of mycosis fungoides with verrucous and hyperkeratotic lesions. Jeanselme and Burnier²in 1926 reported two similar cases and pointed out the scarcity of reports of hyperkeratotic and verrucous lesions in mycosis fungoides. The verrucous lesions in these three cases were covered with large, thick, adherent scales. At times the lesions were dry and fissured, and they sometimes ulcerated with a serous discharge. Other manifestations of mycosis fundoids accompanied the verrucous lesions. In the case reported herein there were exhibited no lesions of mycosis fungoides other than verrucous plaques and nodules confined to the lower extremities. Scaling and clinically evident hyperkeratosis were not present. <h3>REPORT OF CASE</h3> H. K., a white widow aged 63, was first seen in Cleveland City Hospital Dermatology Clinic on March 16, 1950, complaining of unsightly growths of seven years' duration on the lower extremities. The individual

Cerebellar-macular abiotrophy.

RECENTLY at Cleveland City Hospital and at Lakeside Hospital there were observed a father and a daughter, both of whom had degenerative disease of the nervous system. The father showed both cerebellar and macular degeneration, and because of this unusual combination the cases are presented. PRESENTATION OF CASES The patient, a Negro aged 28 (Cleveland City Hospital no. 295-788), had been well until five years before admission, at which time he noted gradually failing vision. For two or three years he had noted slowly progressive ataxia, clumsiness and nervousness (tremors) and complained that people thought he was drunk because of his gait. There was a loss of weight of 36 pounds (16.3 Kg.) in the past five years. His occupation was that of molder in a foundry. His only other illness had been gonorrhea in 1948, which had been treated with penicillin. His mother died of unknown cause when he

Spontaneous renoduodenal fistulas.

Renovisceral fistulas developing without surgical or traumatic intervention, the so-called spontaneous fistulas, are relatively uncommon. They are the result of an inflammatory process in the kidney which invades an adjacent viscus. There may first develop a perirenal abscess which ruptures into the viscus. For a general review of spontaneous renovisceral fistulas, the reader is referred to papers by Higgins and Hicken (3) and Mertz (4). The present communication deals specifically with spontaneous renoduodenal fistulas, which are particularly uncommon, only one case having been previously reported by American writers. A total of six cases have been found in the literature and these are briefly summarized below and in Table I. (A case described by Fernelius and cited by Higgins and Hicken (3) is omitted because the report is incomplete.) Rayer's description of a case of Campaignac's in 1839 is the earliest record of spontaneous renoduodenal fistula. The patient, a 45-year-old female, had a tender swelling in the right side which decreased in size following episodes of vomiting foul urine-like material. The fistulous communication was found at autopsy. Perry and Shaw (5) cite a case of Barlow's in which autopsy revealed hydatid cysts of the right kidney. These cysts had eroded into the duodenum. It was stated that the patient had vomited material corresponding to that found in the cysts. Perry and Shaw also cite a case of Turner's in which autopsy revealed pulmonary tuberculosis and tuberculosis of the right kidney, with fistulous communication between the kidney pelvis and duodenum. Bang (1) reported a tuberculous renoduodenal fistula, found at autopsy, in a 22-year-old female. Tuberculosis was present in almost every organ. A right ureteral stricture and right hydronephrosis were present. Another case secondary to tuberculosis was reported by Pulvertaft (6). The right kidney was pyonephrotic and contained many calculi. One calculus plugged a fistulous tract between the renal pelvis and duodenum. There was a severe scoliosis which, together with the infection and calculi, was thought to be responsible for the formation of the fistula. The first case in the American literature was contributed by Biondi (2) in 1935. His patient was a 28-year-old white female with symptoms of dyspepsia and vomiting soon after eating. Pain radiated from the right flank around anteriorly to the right costal margin and down to the groin. A gastro-intestinal study was reported as showing periduodenal adhesions, but the fistula was demonstrated only by retrograde urography. Nephrectomy was eventually done, and the pathologist's examination revealed tuberculosis of the kidney. The present case is reported as follows. A. M., a 62-year-old white male, was admitted to Cleveland City Hospital on April 23, 1948, suffering from chronic urethral strictures.

Dr. Edgar P. McNamee

Leadership, knowledge of the problems confronting physicians in these times of social change, administrative experience, and a gift of friendship—these are the qualities that Dr. Edgar P. McNamee, who now assumes the presidency of the Radiological Society of North America, brings to that high office. Dr. McNamee has been a practising radiologist in Cleveland since his return from service in the first World War. His training in the specialty began in the Army X-Ray School, Pittsburgh, Penna., in 1917 and continued at Cleveland City Hospital. He has been in charge of the Department of Roentgenology at St. Alexis Hospital since 1920 and from an early date has devoted part of his time to the private practice of roentgenology. Dr. McNamee was born in Butler, Penna., in 1890 and, after receiving his early education there, went to the University of Pennsylvania, where he was awarded his M.D. degree in 1913. In the course of the first World War he saw service as a medical officer with the Third Division during en...

HERXHEIMER REACTIONS IN PENICILLIN TREATMENT OF SYPHILIS IN PREGNANCY

SINCE October 1943 treatment with sodium penicillin has been carried out in a total of 182 cases of pregnancy complicated by early syphilis at the Cleveland City Hospital and the University Hospitals. Although total doses of penicillin increased as time went on from 60,000 to 9,600,000 units, in the bulk of the cases (86 per cent) at least 2,400,000 units were given in divided doses every three hours for from sixty to one hundred and twenty injections. The results of treatment are measured in terms of the efficacy of penicillin in protecting the fetus or, better, in curing the fetus of the maternal infection. In this study there were 5 cases of primary syphilis, 63 cases of secondary syphilis and 114 cases of early latent syphilis. Excluded were all cases of patients thought to have had adequate treatment who were re-treated for protection of the fetus, and all late latent

CUTANEOUS TESTS AND IMMUNIZATION IN DIPHTHERIA AND SCARLET FEVER

CUTANEOUS testing for susceptibility to diphtheria and scarlet fever has been a widespread practice for many years. The reliability of the former is generally accepted. To immunize against diphtheria three antigens are now in use. Immunization of certain groups of persons, especially nurses and physicians, against scarlet fever is practicable,1but the reactions encountered in giving Dick toxin have been such that it has never become officially recommended as public health procedure. The following report is a survey of twenty years of cutaneous testing and immunization of student nurses at the contagious department of Cleveland City Hospital. Since 1925, all student nurses who entered contagious service have been given Schick and Dick tests routinely. Those who had positive reactions were immunized against the antigen to which they were susceptible. For about ten years all tests and injections for our own and for nurses from other hospitals affiliated with City Hospital

SPONTANEOUS HEMOPNEUMOTHORAX: REPORT OF A CASE OCCURRING IN A SOLDIER

Excerpt The true incidence of spontaneous hemopneumothorax is unknown. Whereas the literature contains reports of sporadic cases, many cases are not reported, and many cases are misdiagnosed as hydropneumothorax, when roentgen evidence of fluid alone is accepted without the benefit of a diagnostic thoracentesis. In 1937, Hopkins1 collected 43 cases from the literature and reported three cases of his own. Hartzell2 in 1942, reported 40 selected cases from the literature and three cases observed at Cleveland City Hospital during the preceding 10 years. The apparent rarity of this complication of spontaneous pneumothorax prompts me to report the following case. CASE REPORT

The Roentgen Diagnosis of Pulmonary Infarcts

The Roentgen diagnosis of a pulmonary infarct is probably subject to a greater percentage of error than that of any other lesion of the lung. The error is almost always a “negative” one, that is, failure to suspect an infarct as the cause of the abnormal shadow present on the roentgenogram. In its protean manifestations this pathologic process may mimic almost any other lung disease. This factor and the supposed rarity of the disease probably account for the high percentage of “negative” errors. This paper is based, in part, on 344 instances of aseptic hemorrhagic infarction of the lungs seen at autopsy in a ten-year period (1930–39) at the Cleveland City Hospital. In 174, the infarct was the major cause of death or was an important contributory factor, but in only 22 per cent was the correct diagnosis made. In 73 cases adequate clinical and/or roentgenologic correlation with the autopsy findings was possible. A study of this series, stressing the clinical aspects, has been reported (7). In the course of that study, a number of patients were seen who recovered from a pulmonary infarct, and since that time several others, including some with various complications, have also been followed. These two groups have also been studied in the preparation of this report. A brief review of the clinical findings will be presented, the roentgen signs will be discussed in detail and illustrated, and the differential diagnosis considered. It is hoped that, in this manner, a clearer concept of the entire picture will be gained and that the number of diagnostic errors will be reduced. If the roentgenologist is able to make a correct diagnosis of an infarct of the lung, he will have rendered the clinician a real service because of the grave prognostic import of such a diagnosis. In recent years the differentiation of infarcts from the pneumonias has become more important, since treatment with the sulfa drugs has lowered the mortality in the latter group. Review of the Literature The first definite papers on the subject of roentgen diagnosis of pulmonary infarction appeared about twenty years ago. In 1922 Wharton and Pierson (12) reported 9 cases, all of which followed abdominal surgery. They described clouding of the costophrenic angle as the earliest sign and stated that the shadows of the infarct, when seen, were sharply defined. In 1923, Wessler and Jaches (10) stated that large triangular shadows with the base toward the axilla were most characteristic. In 1924, Kohlmann (6) expressed the opinion that radiological examination might help to clinch the diagnosis in cases of pulmonary infarction in which the clinical evidence was not conclusive. This statement reflected the general opinion held at that time, that shadows cast by infarcts were inconstant. It also revealed a lack of clearly established criteria on which a roentgenologic diagnosis could be based.

RAPID TREATMENT OF EARLY SYPHILIS WITH SMALL DOSES OF PENICILLIN

Since the report by Mahoney, Arnold and Harris1that penicillin is effective as a chemotherapeutic agent for early syphilis, the members of the medical profession have been eagerly awaiting appraisal of this drug. A subsequent report was given by Mahoney and his group2and a preliminary report by Moore and his associates3on the results of the treatment of early syphilis by members of the penicillin panel.4The panel, recognizing the necessity of determining optimal dosage and time schedules, assigned the University Hospital and the Cleveland City Hospital the schedules of treatment herein reported on as part of a larger investigation. Before participating in the studies of the penicillin panel, we obtained sufficient penicillin for the treatment of 10 patients with early dark field-positive syphilis in October 1943.5The first 5 patients received 400,000 units of the drug intravenously in