The Medical and scientific archives of the Adelaide Hospital. No. 2.

  • Adelaide Hospital (Adelaide, S. Aust.)
Date:
[1923]
Catalogue details

Licence: Public Domain Mark

Credit: The Medical and scientific archives of the Adelaide Hospital. No. 2. Source: Wellcome Collection.

    44/50 (page 42)
    mid-epigastric region. Loss of weight had been very great in the last few months. Jaundice became evident five weeks before admission, and had remained constant. Haematuria had occurred in the last three weeks. Almost pure blood and numerous clots were passed, associated with pain, felt chiefly at the end of micturition. Oedema of the left leg appeared four days before admission. He gave a history of occasional attacks of biliousness and indigestion, associated with acid eructations during the past 12 months. Otherwise his health had been good. We are indebted to Dr. H. K. Pavy, the patient’s private medi¬ cal attendant, for much of the above information. On examination, the patient was an emaciated, deeply jaun¬ diced boy, lying in bed in a good deal of pain. Examination of the eyes, teeth tongue and chest was negative. The abdo¬ men was distended, pulsation was present in the epigastrium, dilated veins crossed the abdominal wall, and signs of free fluid were present. Nodules were palpable between the umbilicus and the xiphoid process. The liver was one finger’s breadth below the costal margin in the mid-clavicular line. It was not en¬ larged upwards. The urine was alkaline, the specific gravity 1030, and pus, blood, albumin, and bile were present. The stools were clay colored. Two days after admission vomiting Commenced, projectile in character. Pain was complained of behind the left ear and in the neck. Hsematuria was constant. Weakness increased, and death occurred on July 21st. Post-mortem Examination (No. 90/22).—The pyloric region of the stomach was found to be infiltrated by a growth for a distance of, approximately, 2in. from the ring, especially in its lower half. The inner aspect showed irregular, softish elevations. There was extensive malignant invasion of the gastro-hepatic omentum, the peritoneal covering of the trans¬ verse colon and the parietal peritoneum, giving rise to thickened plaques. The omentum was infiltrated and matted together into .a mass about 3in. long. The large bile ducts were constricted by carcinomatous deposits. The peritoneum covering the urinary bladder was infiltrated with a carcinomatous deposit, which ex¬ tended laterally into the left common iliac vein. An ante¬ mortem thrombus was present there, extending as far as the inferior vena cava. The liver showed greatly distended bile ducts, but there was no carcinomatous deposit in it. The lungs showed consolidation posteriorly. The other organs showed nothing of note. Microscopically the primary growth and secondary deposits had the usual structure of a columnar-celled carcinoma. (3) CARCINOMA OF THE BREAST, WITH MULTIPLE SECONDARIES AND HHEMOPOIETIC REACTION. (Under the care of Dr. Angas Johnson, Honorary Physician. Notes by Dr. C. Finlay son.) E. T., female, cet. 42, single, was admitted to hospital on September 28th, 1922, complaining of pain in the back and in the legs, especially the right thigh and hip. General weakness had increased greatly during the last few months. She had been told that she had ‘ ‘ fibrositis. ’ ’ She gave a history of hav¬ ing had carcinoma of the breast. The right breast had been removed 14 years before. Nodules recurred in the scar five years after this operation. She had had X-ray treatment. In July, 1921, the left breast was removed, and a section of the tumor was reported on as carcinomatous.