On The Comparative Value of Clinical Investigation: Radiology and Fractional Analysis in The Diagnosis of Peptic Ulcer and Carcinoma Ventriculi

Lindsay, James (1927) On The Comparative Value of Clinical Investigation: Radiology and Fractional Analysis in The Diagnosis of Peptic Ulcer and Carcinoma Ventriculi. MD thesis, University of Glasgow.

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In all, sixty-two cases of organic gastric disease were investigated by:- (a) Careful inquiry into clinical history. (b) Radiological methods. (c) Fractional test meal. Of these sixty-two cases, twenty-five had gastric ulcer; thirty had duodenal ulcer; seven had carcinoma. A. CLINICAL INVESTIGATION-. (1) In the presence of gastric ulceration,clinical investigation proved of little help. The clinical picture was not well defined. Even in the most favourable cases (20%) one felt diffident about giving a definite diagnosis. (2) When we take cases of duodenal ulceration, however, the clinical investigation assumes a much higher value. The histories given were remarkably constant, and, by avoidance of leading questions, were almost always spontaneously given. In only three cases (10%) was any doubt entertained as to the diagnosis. (3) With regard to the seven cases of gastric carcinoma,in only two would one have been justified in operating without further investigations being made, and with reasonable certainty of finding a neoplasm. The old maxim, however, of regarding with suspicion any primary and incipient dyspeptic symptoms in a patient over forty years, still holds good. It is therefore highly culpable, given such a patient, if no further steps are taken to arrive at a definite diagnosis. It is only in the advanced and usually inoperable cases that a definite picture is provided by clinical investigation alone. B. RADIOLOGY. (1) Direct evidence of gastric ulceration was given by fourteen cases (56%): indirect evidence by eight cases (32%): in only three cases (12%) was a normal passage of the meal noted. (2) In duodenal ulceration, direct evidence was obtained in only five cases (18%): indirect evidence, however, was given in thirteen cases (43%) while in twelve cases (40%) no evidence was found. (3) In three cases of carcinoma the findings definitely suggested malignancy: in the remaining four there was direct evidence of abnormality, but no definite opinion could be expressed as to whether malignancy were present or not. C. FRACTIONAL TEST MEAL (1) Eleven cases (44%) of gastric ulceration afforded graphs conforming to a more or less uniformly abnormal type, Curves essentially within normal limits were provided by eight cases (32%). The evidence obtained by this mode of investigation is not nearly so conclusive as that obtained in cases of duodenal ulceration. (2) Taking the thirty cases of duodenal ulceration it was found that only four cases (13%) had curves showing no deviation from normal: the remainder, (87%) fell into three definite and uniform types. Type 1. comprises two cases where there was evidence of excessively rapid emptying and excessive neutralisation. Type 2. Ten cases in which very little neutralisation was effected and where persistent pylorospasm was present. Type 3. Fourteen cases which showed proof of intermittent pylorospasm. In 80% therefore, it can be said that spasm of the pyloric sphincter, either persistent or intermittent, was present with consequent defective neutralisation,and this percentage represents the duodenal type of graph. (3) In each of the seven cases of carcinoma, the findings of the fractional test meal afforded definite proof of the presence of that disease. From the foregoing results I now assess the respective values of the three different methods of investigation. In gastric ulceration I find that radiological methods afford the most conclusive evidence for diagnosis. Where indirect evidence is obtained by this method, further help may be obtained by correlating the findings with those obtained from the other two methods. Pride of place in the diagnosis of duodenal ulcer must be given to clinical investigation, but very considerable help is obtained from fractional analysis, By comparing the findings from these two methods,one can reasonably hope for a definite diagnosis in the majority of cases. With regard to the diagnosis of carcinoma ventriculi, in my opinion practically 100% of cases are capable of being proven by fractional test meal alone. Apart from the percentage number of cases proven by any of these methods of investigation, it must be borne in mind that positive radiological evidence is palpable, and, when present, outweighs all other findings.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1927
Depositing User: Enlighten Team
Unique ID: glathesis:1927-81052
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 30 Jan 2024 14:45
Last Modified: 30 Jan 2024 14:45
URI: https://theses.gla.ac.uk/id/eprint/81052

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