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The manometric and cineradiographic features of 14 patients with oropharyngeal dysphagia are described. Failure of the upper-esophageal sphincter (UES) to relax completely and incoordination of UES relaxation with pharyngeal contraction were noted as was poor initiation of swallows and disorganization of pharyngeal contraction. The relative merits of cine esophagography and esophageal manometry in evaluating oropharyngeal dysphagia are assessed, and a functional classification for this disorder is proposed. Clinical improvement in 4 of 5 patients who underwent UES myotomy for severe intractable dysphagia did not always correlate with improvement in manometric and cine studies.

Nasogastric intubation has been implicated as a cause of benign esophageal stricture. To evaluate this association, a retrospective nine-year analysis was made of 200 patients with benign and malignant esophageal obstruction. Only three cases were found in which it appeared likely that esophageal stricture was causally related to nasogastric intubation. Esophageal stricture due to gastric intubation, a lesion of significant morbidity, is rare, possibly because a nasogastric tube may not permanently harm an otherwise normal esophagus. Also, tube-induced strictures may form only in the presence of other adverse host factors. Preventive measures include elevation of the head of the patient's bed, positioning of tubes for feeding or antacid administration above the cardioesophageal junction in alert patients in whom the danger of aspiration is minimal, and administration of antacids through the tube.

HYPERSPLENISM, first described by Wiseman and Doan,1 includes a variety of hematologic syndromes which can be attributed to overactivity of the spleen. The spleen has three major functions: the destruction of red blood cells, the storage of blood, and the production of lymphocytes from the lymphoid elements in the organ. In hypersplenism, there may exist a diminution in any of the cellular elements of the blood. The patient may exhibit findings consistent with neutropenia, thrombocytopenia, or anemia, either singly, or in combination, or all three together.2 The etiologic factors enumerated by Dameshek3 in a study of 28 cases included rheumatoid arthritis, syphilis, cirrhosis of the liver, Gaucher's disease, Boeck's sarcoid, malaria, and Hodgkin's disease, and 16 were classified as idiopathic. The diagnosis is based on the cytopenia associated with a normal or hyperfunctioning bone marrow, and in the case of anemia, with no obvious cause of blood

HYDATID disease of the lung is relatively rare in the United States, but it is endemic and very common in sheep-raising countries, such as Australia, Italy, Greece, New Zealand, Ireland, Argentina, Uruguay, Syria, and Algiers. The global travels of the war veterans and the ease and popularity of foreign travel may lead to a relative increase of the disease in this country. Hydatid disease of the lung must be seriously considered in the differential diagnosis of intrathoracic pulmonary lesions.The following case report of a pulmonary Echinococcus cyst in a war veteran in whom the diagnosis was made six years after discharge from the service seems of sufficient rarity and interest to review. REPORT OF CASE F. P., a 29-year-old white prison guard, entered the hospital on Nov. 19, 1951, with a chief complaint of "spitting up blood" of 10 months' duration.The history revealed that the patient served with

CHONDROSARCOMA of the larynx is a rare lesion. Havens and Parkhill1 reviewed 1,100 cases of malignant tumor of the larynx observed at the Mayo Clinic from 1910 to 1940. They found only 11 cases of sarcoma, of which two were chondrosarcomas. In that series carcinoma occurred 100 times as frequently as sarcoma. Clerf2 reported that 740 cases of carcinoma of the larynx were encountered from 1930 to 1946 at the Jefferson Hospital. During this time only eight sarcomas, of which one was classified as chondrosarcoma, were observed. Jackson and Coates3 found no instances of sarcoma in a series of 643 cases of malignant tumor of the larynx observed up to 1929. Thomson and Colledge4 observed only one case of sarcoma in their experience.Eighty-nine cases of chondroma of the larynx have been reported in the literature. Moore5 found 53 cases recorded before 1925. McCall6

CHRONIC relapsing pancreatitis is characterized by recurring attacks of pain in the upper abdominal region, often radiating to the back or to either side of the hypochondrium. The pain is usually severe during the first few days of the attack and is followed by a dull, distressing ache during the subsequent five to seven days. Increase of blood amylase or lipase, transitory hyperglycemia and glycosuria, steatorrhea and creatorrhea and roentgenologic evidence of calcification in the pancreas help to establish the diagnosis. The attacks may recur so frequently and with such great severity that the patient is unable to work or, worse still, may become addicted to opiates. For the relief of pain in the intractable case, dorsal sympathectomy and splanchnicectomy have proved successful.1The rationale of this procedure is based on the fact that after bilateral sympathetic denervation pain cannot be elicited by applying pressure against the pancreas. White

ALTHOUGH diaphragmatic hernia in general has ceased to be a rare disease, the anterior subcostosternal type (i. e., through the foramen of Morgagni) is unusual. Hedbloom1 stated that about 60 poorly documented cases had been described up to 1938 in a study of 1,003 diaphragmatic hernias of all types. Harrington2 pointed out that 24 instances were reported between 1930 and 1942. Only 5 patients had undergone surgical treatment. In his own series of 270 diaphragmatic hernias there were 4 of the subcostosternal type operated on. In a later article3 the same author added 4 more cases of this type, which made a total of 8 in his personal experience with 404 diaphragmatic hernias.Subcostosternal hernias or hernias through the foramen of Morgagni have been classified as congenital and acquired. As stressed by Harrington, the constant location of the hernial hiatus, the constant relation of the neck of

The clinical importance of parenteral therapy with vitamin K has become well established. The most prolonged improvements in prothrombin clotting time so far reported have followed the intravenous administration of either synthetic vitamin K1 or 2-methyl-1,4-naphthoquinone (menadione). The chemical reactivity and the toxicity of menadione as described by Fieser1 make it less desirable for general use than vitamin K1. A single dose of one of these drugs can restore and maintain normal blood prothrombin levels for periods as long as two or three weeks.2 Some inconvenience is caused by their lack of solubility in water and their sensitivity to ultraviolet rays. This has led to the continued use of water-soluble preparations; the effects of these are of much shorter duration, so that repeated injection is required for prolonged effect.After the synthesis of vitamin K1, Fieser3 postulated that this light-sensitive vitamin probably did not

INTRODUCTION The treatment of chronic ulcerative colitis is primarily medical, with surgical treatment reserved for those patients with the complications of perforation, hemorrhage, carcinomatous degeneration, perirectal abscesses and fistulas, or intractable disease. Zetzel1 has stated that most of the patients remain in a satisfactory state of health in spite of chronicity and recurrence and that only 10% to 15% require surgery. Many of the patients with extensive colitis come to the surgeon only after they have reached a state of emotional and physical exhaustion. The numerous postoperative complications have been extensively reported.2,3 Two complications that have not been adequately emphasized are the development of sensitization to minor blood groups following multiple transfusions and the insidious occurrence of acute tubular necrosis accompanying surgery.The purpose of this paper is to describe the genesis of these complications and their management in a patient who had a onestage ileostomy and total

Benign vascular tumors of the stomach are rare, and of these lymphangioma is the rarest. Many benign tumors present as a radiological finding during a barium contrast examination of the gastrointestinal tract—the demonstration of a filling defect of the stomach—which directs attention to their presence. In Palmer's collected series1 of 46 benign angiomas "X-ray examination has revealed gastric tumor in 17 of the 18 patients studied." Only three or possibly four cases of lymphangioma of the stomach have been recorded in the world literature.2-4 All were discovered as incidental findings at postmortem examinations, and no mention was made of roentgenologic studies in these cases.Lymphangiectasis of the stomach, a variant of lymphangioma although not truly neoplastic, may also present roentgenologically as a filling defect suggestive of a benign intramural tumor. To our knowledge, only one case of probable lymphangiectasis of the stomach has been reported.2 In the