Talk:Paper - Horizontal and vertical pancreas, in association with other developmental abnormalities (1922)
Horizontal And Vertical Pancreas, In Association With Other Developmental Abnormalities
Howard H. Bell
Pathological Laboralory, Washington University School of Medicine, St. Louis, Miisouri
Two Figures
This type of abnormality in the development of the pancreas was described by Carnot.' The pancreas in his case possessed a head, a horizontal process 10 cm. long, resembling the body and tail of the normal pancreas, and a vertical process 12 cm. long extending downward from the head along the duodenum. Neve^ mentioned extra tail lobes as an instance of reversion to a lower tj^pe. I have failed to find further reference in the Uterature to pancreas with horizontal and vertical processes, yet I have found two instances of this anomaly.
The first instance occurred in a well-nourished white male child, four months old. The cause of death was bronchopneumonia and extensive atelectasis.
The pancreas completely encircled the second part of the duodenum and possessed a horizontal and a vertical process. The band of pancreatic tissue encircling the duodenum was 10 mm. wide anteriorly, and 6 mm. wide posteriorly. The horizontal process resembled the normal pancreas. It measured 51 mm. long and 11 mm. in the other dimensions. Along the upper border near the duodenum was a rounded enlargement 1 1 mm. across. The vertical process descended along the mesial surface of the second part of the duodenum and passed anterior to the transverse part. This process measured 28 mm. long and 9 mm. in the other dimensions. The two processes and the annular part joined at the site occupied by the head of the nor 1 Carnot. Maladies des glands salivaires. Paris, 1908.
2 Neve. The Indian Medical Record, 1892, vol. 3, no. 3.
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316 HOWAED H. BELL
mal pancreas. The annular part encircled the duodenum from behind forward and was in apposition with pancreatic tissue anteriorh", but not continuous -nith it. The duodenum was sUghtly constricted at this point.
The common bUe duct opened into the duodemmi with the pancreatic duct from the horizontal and vertical processes. The annular part possessed an individual duct opening into the duodenum slightly above and posterior to the ampulla of Vater.
Other developmental abnormalities were present. The interventricular septum of the heart was defective below the membranous part. This defect measured 21 mm. vertical!}', and 11 mm. horizontally. The foramen ovale and ductus Botalli were pervious, but the openings were very small. There was a slight umbihcal hernia and a small inguinal hernia on the right side. Meckel's diverticulima persisted and measured 5 cm. long.
The second anomalj' occurred in association with anterior spina bifida and other abnormaUties which will be described elsewhere.
The infant was still-born at term. The stomach was greatly dilated. The small intestine joined the posterior wall of the stomach in the midhne of the body. It opened into the cavity of the stomach bj' a sht-Uke orifice guarded by a valve-hke fold. From the point where the intestine met the stomach to the site of its gastric orifice, it hes beneath the gastric peritoneiun (See Fig. 2). The gastric orifice of the intestine was 5.5 cm. from the pyloric end of the stomach. The pyloric end of the stomach had the form of a blind diverticulum into which the common bile duct opened. The horizontal and vertical pancreatic processes met upon this diverticulum. The diverticulum was about 1 cm. wide and 1.5 cm. long and ended in a blind rounded extremity.
The pancreas possessed a horizontal and a vertical process. The horizontal process extended across the anterior wall of the stomach and was loosely attached to it. It measured 65 mm. long, 9 mm. wide, and 4 mm. thick. The vertical process extended downward. Its lower extremity was shghtly enlarged and was turned abruptly backwards. The upper part of this process measured 34 nun. long, 9 mm. wide and 4 mm. antero
i
HORIZONTAL AXD VERTICAL PANXREAS 317
posteriorly. The lower part, which was enlarged and turned backwards, measured 12 nun. anteroposteriorly, 14 mm. vertically, and 5 mm. transverseh'. The horizontal and vertical processes were contiguous over the summit of the diverticulum. There were two papiUae with openings into the diverticulum, situated about 5 mm. apart. The duct from the vertical process led in conjunction with the common bile duct into the end of the diverticulvim. The duct from the horizontal process opened into the superior wall of the diverticulum.
The relation of the pancreatic processes and associated organs to the stomach is shown in fig. 1.
Many abnormahties were associated with the second specimen. The Uver was abnormal in shape. There was a funnelshaped diverticulmn from the posterior wall of the stomach below and posterior to the oesophageal opening, which was attached to the meninges through the anterior spina bifida. The relation of this opening to the stomach is shown in fig. 2. A summary of associated abnormahties is as follows:
Posterior spina bifida with myelocystomeningocele
Anterior spina bifida
Intraspinal pons, medulla and rudimentary cerebellum
Absence of tentorium cerebelh
Accessory superior longitudinal fissure in right hemisphere
Absence of islands of Reil
Absence of pineal body, aqueduct of Sj'h'ius and corpora quadrigemina
Abnormahty of heart
Defect in diaphragm on left side
Abnormahty of Uver and stomach
Absence of greater omentimi
Bifurcated ^Meckel's diverticulum
Abnormal arrangement of small and large intestines
Undescended testicles
Tahpes varus. Two related cases described by Graefe and Vesalius were mentioned by I^Iondiere.^ The one described by Graefe pos» Mondiere. Archiv. gen. de Med., 1836, 2d ser., T. 11.
318 HOWARD H. BELL
sessed three pancreatic ducts, one of which opened into the stomach. Richeraud stated in his physiology that VesaUus described a case in which the ductus choledochus emptied into the stomach.
Aberrant pancreatic tissue has occurred in the wall of the stomach in several instances.*
The human pancreas develops from one posterior and one anterior bud; occasionally there are two anterior buds which soon fuse to form one. The posterior and anterior processes grow together to form the mature pancreas. °
The shape of the pancreas varies in different species. The pancreas of the ox and sheep is irregularly quadrilateral in form.^ The pancreas of the horse is very irregular, although triangular in outline. The pancreas of the pig is elongated and situated transversely. The right portion has two lobes; the posterior lobe bends around the great mesenteric artery and the portal vein; the anterior one is pointed, extends downward and forward in the median plane and is attached in the portal fissure and to the duodenum. The left portion is prismatic and rests mainly on the left sac of the stomach, its left extremity being included between the left kidney and the dorsal end of the spleen. The pancreas of the dog is V-shaped, consisting of two long, narrow branches which meet at an acute angle. The right branch extends along the duodenum. The left branch is attached to the peritoneal surface of the stomach. In the cat the pancreas has two processes; one process extends along the duodenum and the other process extends along the stomach. The two processes are nearly at right angles to one another.'
' Opie, E. L. Disease of the pancreas. 1910. J. B. Lippincott Co., Philadelphia.
Keith. Human Embryology. 1913. Edward Arnold, London. ' Sisson. Veterinary anatomy. 1910. W. B.SaundersCompany, Philadelphia.
' Reighard and Jennings. Anatomy of the cat. 1910. Henry Holt & Co., New York.
HORIZONTAL AND VERTICAL PANCREAS 319
The first specimen resembles the pancreas of the dog and cat in that it has a horizontal and a vertical process, although it has in addition an annular process. The position of the pancreatic ducts in this specimen would indicate that the annular part developed from posterior budding and the horizontal and vertical processes from anterior budding.
The second specimen was associated with many unusual abnomiahties. The horizontal and vertical processes were in apposition on the summit of the gastric diverticulum^ although no fusion had taken place.
PLATE 1
EXPLANATION OF FIGCHES
1 Drawing of anterior view of liver, stomach, pancreas and spleen. The liver is raised, and the right end of the horizontal pancreas is elevated with forceps, to show the relation of the liver, the horizontal and vertical pancreas to the diverticulum of the stomach.
2 Drawing of posterior view of organs. The liver is tilted forward. Below and posterior to the oesophagus is shown the diverticulum which was attached to the cleft vertebrae. Below this diverticulum the small intestine passes obliquely through the wall of the stomach and opens into it.
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HORIZONTAL AND VERTICAL PANCREAS
HOWARD H. BKLL
PLATE 1
321
BOOKS RECEIVED
(Contimied from first page)
THE RAXSOHOFF MEMORIAL VOLUME. A Collection of Papers representing Original Contributions to the Art and Science of Medicine by Colleagues and Students of Dr. Joseph Ransohotf, M.D., F.R.C.S. (Eng.), F.A.C.S., LL.D. 574 pages, illustrated, containing 57 papers. Cincinnati, Ohio, S. Rosenthal & Co. 1921. A list is given of the 44 papers published by Dr. Ransohoff between the years 1879 and 1920. From the Editors' Preface. In an effort to express to Dr. Joseph Ransohoff their appreciation of his place in the science and art of Medicine, a group of his former students determined to issue a volume containing papers consisting of original contributions to the advancement of Medicine by his students and colleagues. This was in Jvuie, 1920. The death of Dr. Ransohoff prevented the presentation of this book to him personally, but the publication was continued as a Memorial Volume.
THE RELATIVE VALUE OF THE PROCESSES CAUSING EVOLUTION by Arend L. Hagedoorn, Ph.D. and A. C. Hagedoorn— Vorstheuvel La Brand, with twenty figures, 294 pages. The Hague, Martinus Nijhoff, 1921, printed in the English language. The Chapter headings are: Introduction, Heredity, Variation, Crossing, Reduction of Variability, Mutation, Selection, Species and Varieties, The Law of Johannen. Evolution in Nature and under Domestication, The Status of Man.
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A MANUAL OF STYLE — A compilation of typographical rules governing the publications of The University of Chicago, with specimens of tj'pes used at the University Press, Seventh Edition, 300 pages, size of page 5 x 7^, Price SI. 50, November, 1920, The L'niversity of Chicago Press, Chicago, 111.
Contents: Rules for Composition (capitalization, the use of Italics, quotations, spelling, punctuation, divisions, footnotes, indexing, tabular work). Technical Terms. Appendix (hints to authors, to proofreaders, to copyholders, proofreaders' marks). Specimens of Types. Index.
The first edition was issued in 1906, having been compiled from proofreaders' notes "jotted down by the first proofreader at odd moments for his own guidance; added to from year to year as opportunity offered or new necessities arose; revised and re-revised as the scope of the work, and, it is hoped, the wisdom of the workers increased — it emerges in its present form, .... the blended product of the reflections of many minds."
The fourth edition (1913) was entitled, "A Manual for Writers, Covering the needs of authors for information on rules of writing and practices in printing."
A book has recently been issued by The Atlantic Monthly of the same size page and covering the same subjects, the result of a similar evolution.
MEDIZINISCHE PSYCHOLOGIE, Ein Leitfaden fttr Studium und Praxis, von Dr. Ernst Kretschmer, Privatdozent fur Psychiatric in Tubingen. Leipzig, 1922, Georg Thieme Verlag — size 5x8, 306 pages.
ANXIETY HYSTERIA, Modern View on Some Neuroses, by C. H. L. Rixon, M.D., M.R.C.S. and D. Matthew, M.C., M.B., Ch.B., with a Foreword by Col. Sir A. Lisle Webb, 124pages,4Jx7i,priceS1.50,PaulB.Hoeber, New York, 1921.
SEPARAT-ABDRUCK aus der Zeitschrift fur Morphologic und Anthropologic, Band XXII, Heft 1 und 2. Der Menschenfuss von Dr. Franz Weidenreich, a.o. Prof, der Anatomie z. Z. Mannheim. Stuttgart, 1921. E. Schweizerbart'sche Verlagsbuchhandlung. Size 6? x 94, 282 pages.
THE ANATOMICAL RECORD, VOL. 23, NO. 6,
jnwE, 1922
Resumen por John L. Bremer, por el autor, Kikuo Okamoto.
Un estudio de las venas superficiales de la extremidad superior en sujetos japoneses vivos.
El presente trabajo es una descripcion de las venas superficiales del brazo en una serie de 200 varones japoneses, habiendose notado diversos tipos de variaciones. Comparadas con cuadros de variaciones semej antes encontradas en europeos, puede notarse un tanto por ciento distinto de diferencias.
Trauslatiou by Jos4 F. Nonidez Cornell Medical College, New York
ACTBOBS ABSTRACT OF THIS PAPER ISStTED BT THE BIBLIOGRAPHIC SERVICE, .4J'RIL 17
