Fichardt, J.B.

Isakov, T.

Kruger, M.J.

Lion-Cachet, J.

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472 S.A. TVDSKRIF VIR GENEESKUNDE 12 J unie 1965solvent for the ills of man. It is very unlikely that muchsympathy will be found in a computer. Weelum MacLure,beloved doctor of Drumtochty, immortalized by lan MacLarenin the DOClOr of the Old School, is not a forgotten legend.Disregard of self and a dedicated devotion to his patients isstill the guiding precept of a large segment of our professionhere and everywhere, I am yery certain. Medicine and love ofhumanity are inseparable.The Great and ihe Good 50cieiyOur President, Lyndon Johnson, has eloquently ~rtrayedthe role of education in developing 'the great society': Medicaleducators have a responsibility and an opportunity to contri-bute to the building of the good society. It is every physician'sprivilege to contribute richly to this important cause. The lateCarl Eggers, a New York thoracic surgeon, well known tomany surgeons here, paid a visit to his native Hanover shortlybefore his death, and was asked to inscribe his name on thecity's official ledger. After a moment's reflection, he wrote:'It is easy to do good and it makes one so happy'. Such isdaily the great privilege of all of us, and particularly so inmedicine.Liberal Support of UniversitiesThe interests of professions and the public are best servedwhen our educational institutions, and especially our universi-ties, are well supported. Some of you may remember theimmortal words of the Poet Laureate of England, John Mase-field, who said: 'There are few things more enduring than auniversity. Religions may ~plit into sects or heresies: dynastiesmay perish or be supplanted, but for century after centurythe university will continue, and a stream of life will passth rough it, and the thinker and the seeker will be boundtogether in the undying cause of bringing thought into theworld.''''Liberal support of our schools, universities, and professionalcolleges by the public is a sound, and probably the wisest,investment for a bright and glorious future for any country.I wish to express my appreciation to Mrs. Jacqueline Smith,Assistant Surgical Librarian, for her help in tracking downmany of the sources referred to in the table, most of whichhave been seen in the original.BIBLIOGRAPHY TO TABLEBell, A. N. (1887): Transactions of the 9th International Medical Congress.4, 567.De Chauliac, G. (1537): Chyrurgia Guidol/is de Cauliaeo, tractatus 3, fol.39·49.Delpech. l. M. (1823): ChiTlirgie Clinique de Montpellier, tome I. pp. 177-192. Paris: Gabon et Cie.Hippocrates. in Withington. E. T. (1948): Hippocrates, vol. 3. pp. 151, 163.165 and 431. London: Heinemann.Holmes. O. W. (1842): New Eng!. Quart. l. Med. Surg .. I, 505.Holy Bihle (New Testament) St. Luke 10: 34.Lemaire, J. (1860): Du Cooltar Saponine, Desinfecrant Energique arreranlles FermeJltGlions. Paris: Germer-BaiIJiere.Idem (1863): De fAcide PJzenique. et de SOn Action sur les Vegetaux, lesAnimaux. Pans: Caen.Nightingale. Florence (1860): Notes on Nursing: What It is, and What ItIs Not, pp. 53, 43. London: Harrison.Idem (1859): Notes on Hospitals, p. 61. London: John W. Parker & Son.Pagel, J. l. (1890): Atch. klin. Chir.. 40, 737.Pasteur. Louis (1861): Annales des Sciences Naturelles, partie Zoologique,4e ser, 16, pp. 5 - 98.Ptingle, J. (1749 - 1750): Royal Society of London, Philosophical Trans-actions, 46, 483. 486. 527 and 529.Pritchard, A. (1860): Btit. Med. J., pp. 860. 861.Semmeiweis, I. (1847): K.K. Gesellschaft der Ante in Wien, Zeitschtifl,2, 243.Spallanzani. L. (1765): Saggio di osservazioni microscopiclre concernentiif sistema della generazione de'Signori di Needham, e Buffon. Modena:Bartolomeo Soliani.Stromeyer, G. F. l. (1833): Magazin fUr die gesammte Heilkunde, 39, 195.Theodoric. in De Chauliac. G. (1546): C/tirurgia edica et campi/aca abexcell. domino fratre Theodorico episcopo Cerviensi ordinis praedicato-rI/m, liber I, cap. Ill, fol. 135, v. H.REFERENCESI. livingstone. D. in Schapera. I. ed. (1959): David Livingstone FamilyLetters, 1841 - 1856, vol. I, p. 34. London: Challo & Windus.2. livingstone. D. in Wallis, J. P. R. ed. (1945): Matabele Mission 1858,p. 10. London: Chatto & Windus.3. National Research Council (1963): News Report, 13, 82.4. U.S. National Office of Vital Statistics (1947): SI/mmary of Interna-tional Vital Statistics, 1937 - 1944, p. 25. Washington, DC: U.S.Government Printing Office.5. American Jewish Yearbook (1946· t947): 48, 599.6. United Nations (1962): Demographic Yearbook, 14th ed., p. 555. NewYotk: UNO.7. U.S. National Office of Vital Statistics (1947): Viral Statistics Rates inthe United States. 1900 - 1940, p. 210. Washington, DC: U.S. Govern·ment Printing Office.8. Metropolitan Life Insurance Company (1964): Statistical Bulletin,45. 10.9. U.S. National Office of Vital Statistics (1963): Vital Statistics of theUnited States. 1960, vol. 2A. sect 1. p. 23. Washington. DC: U.S.Government Printing Office.10. Listet. J. (1867): Lancer. 1. 326.11. Lennander. K. G. in Ekehorn. von G. ed. (1912): Gesammelte Werkevon K. G. Lennander, Teil I, p. 9. Uppsala: Almqvisl & WikseIls.12. Shumway. N. E.. Lower. R. R .. Hurley, E. l., Dong, E. and Stofer,R. C. (1963): Minn. Med .. 46, 229.13. Padgetl. E. l. (1932): Sth. Med. J. (Bgham. Ala.), 25. 895.14. Merrill, J. P.. Murray. J. E., Harrison, J. H. and Guild, W. R.'(956): J. Amet. Med. Assoc .. 160. 277.15. Keen. W. W. (1897): Ibid., 28. !l1O.16. King George V of England (1928): 1st International COl/ference onCancer, London, p. 5. New York: William Wood.17. POlt. P. (775): The Chirurgical Works of Percival POtt, vol. 5, pp.63 - 68. London: Hawes. CIarke & CoIlins.18. Kennaway. E. L. (1924): Industr. Hyg. 5. 462.19. Gilbertsen. V. A .. Wangeosteen, O. H., Knatlerud, G. and Lober, P.() 965): Surgery. 57. 363.20. U.S. Bureau of Labour Statistics (1962): ORRRC Study Report,23, 10.2L Beaumonr. W. (1833): Experiments and Observations on the GastricJuice and the Physio!o1(v of Digestion. Plattsburgh: F. P. Alien.22. White. P. D. (1962): Wld-Wide Abstr. Gen. Med., 5, 10.23. TroIlope. A. (1862): The Bolton Chronicle (12 December), p. 3.24. James. G. (1964): New Engl. J. Med .. 270, 1286.25. Johnson. l. B. (1964): Minneapolis Sunday Tribune (31 May). p. 10.26. Masefie1d. J. (1946): In Annual Report of the University of Sheffield,El/gland, Appendix 9. p. 73.NEUROFIBROSARKOOM VAN DIE MAAGJ. LION-CACHET, M.CH. (PRET.); J. B. FICHARDT, M.B., CH.B. (!>RET.); M. J. KRUGER, M.B., CH.B. (!>RET.) ENT. ISAKOV, M.B., CH.B. (PRET.); Departement van Chirurgie, Algemene Hospitaal, Pretoria en die Universiteitvan PrelOria/nsidensieDie voorkoms van benigne mesenchiem-tumore in diemaag is 66·7% van alle benigne tumore van die maag.'Die voorkoms van maligne mesenchiem-tumore is 1% vanalle maligne tumore van die maag.'Volgens Fenwick3 is 8°6 van maligne mesenchiem-tumorevan die maag neurofibrosarkome. Rulle is dus geweldigseldsaam. In D'Aroy en Laleu se reeks van 135 sarkomevan die maag was daar net een geval van neurofibrosar-koom.' Dit het voorgekom in 'n meisie van 16 jaar watreseksie van die maag ondergaan het en wat 5 jaar laternog geleef het. By Johns Hopkins-hospitaal was daar in10 jaar se tyd 20 gevalle van sarkoom van die maag;daarvan was 11 Iimfosarkome, 8 leiomyosarkome en 1neurofibrosarkoom.PatologieMikroskopiese klassifikasie.' Dit sluit 3 tipes in, nl.(a) 'n tipe skleroserende fibrosarkoom; (b) spindelselneurosarkoom; en (c) sellulere anaplastiese neurosarkoom.12 June 1965 S.A. MEDICAL JOURNAL 473A/b. 1 A/b. 2 A/b. 3Toenemende grade van maligniteit word deur die klassi-fikasie verteenwoordig.Makroskopiese klassijikasie: Gewoonlik is hulle grooten bloedryke tumore wat in die lumen van die maagprojekteer. 80% van sarkome kom in die fundus voor,15°~ in die kardia en 5% in die pre-piloriese deel van diemaag.'Kliniese en Radiologiese BeeldDie kliniese beeld is die van 'n maagtumor en hang afvan die grootte, posisie, ulserasie, bloeding en uitsaaiings.Meestal kom dit voor tussen die ouderdomme van 45 tot55 jaar en dit het gewoonlik al groot geword voordat ditenige simptome veroorsaak. Dit is dus klinies baie moeilikte onderskei van 'n maagkarsinoom.Ook radiologies word hierdie tumor in die meeste vangevalle moeilik van maagkarsinoom onderskei.Behandeling en PrognoseT otale radikale gastrektomie en postoperatiewe bestral-ing is die aangewese behandeling vir die limfogene groepwat goed respondeer op radioterapie. Die ander groeperespondeer swak op radioterapie en in hierdie geval ischirurgie die enigste behandeling. Neurofibrosarkoom valin laasgenoemde groep.',llDie prognose van maag sarkoom is beter as die vanmaagkarsinoom. Die 5-jaar oorlewingssyfer soos gemelddeur verskillende skrywers·· lO wissel tussen 10·5% en 50%.BESKRYWING VAN 'N GEVAL'n 43-jarige Naturelle-man is tot die hospitaal toegelaat metklagtes van pyn in die epigastrium en linker hipochondriumvir 3 maande. Hy was ook bewus van 'n massa in die gebiedvir die voorafgaande It maande. Na spesiale ondervraginghet dit geblyk dat maaltye (lie pyn vererger het en dat daar 'npaar episodes van melena was. Daar was ook gewigs- en eet-lusverlies, en toenemende swakheid vir die voorafgaande 3maande. Daar was geen klagtes rakende die andersisteme nie.By olldersoek was hy 'n volwasse Naturelle-man wat duide-like tekens van anemie en onlangse gewigsverlies getoon het.In die buik was daar 'n groot nodulere, harde tumor in dielinker hipochondrium tasbaar, ongeveer 9 duim in deursnee.Dit was teer met betasting en het effe beweeg met asemhaling.Die buikondersoek was andersins normaal.Spesiale OlldersoekeDie toets vir okkulte bloed in die stoelgang was sterkpositief: die alkaliese fosfatase en plasma-prote"iene was heelte-mal normaal. Die bloed-ureum was ook binne normale perke.Die bloedbeeld was die van 'n mikrositiese anemie met 'nmatige leukositose. Die bloedplaatjies was normaal. Urine-ondersoek en Kolmer en Price se ondersoeke was ooknormaal.Met radiologiese ondersoek was daar by deurligting van dieborskas en buik geen duidelike afwykings sigbaar nie. Diepasient is barium toegedien en daar is dadelik gesien dat diebarium deur 'n perforasie op die groter boog van die maagvloei na die bursa omentalis (Afb. I). Intraveneuse pielogramhet geen afwyking getoon nie.Operatiewe Bevilldings'n Groot bloedryke tumor, redelik hard van konsistensie ennoduler van voorkoms is aan die groter kurwature van diemaag aangetref. Dit het die stert van die pankreas, die arterielienalis en die milt ge"infiltreer. Geen kliere is gevind nie. 'nProksimale gastrektomie, ~plenektomie en distale pankreatek-tomie is gedoen.Met ondersoek van die monster was daar 'n groot holte indie tumor wat met die lumen van die maag verbind was; dithet die radiologiese beeld verklaar. Die chirurgiese monsterkan op Afbs. 2 en 3 gesien word.By histologiese ondersoek het snitte van die tumor die beeldvan 'n neurofibrosarkoom nn die maag getoon.OPSOMMINGI. Die insidemie, patologie, kliniese- en radiologiese beeld,behandeling en prognose van neurofibrosarkome van die maagword bespreek.2. 'n Beskrywing van 'n geval van neurofibrosarkoom vandie maag word gegee.Ons dank gaan aan prof. C. H. Derksen, Hoof van dieDepartement Chirurgie van die Universiteit van Pretoria virsy toestemming om die geval te publiseer; aan dr. J. H. Enslinvir die histologiese verslag en dr. L. Lingenfelder vir die radio-Iogiese ondersoek: aan die Departement Kliniese Fotografievan die Universiteit van Pretoria vir die foto's: en aan dfT.P. J. Kloppers en F. Steenkamp wat die gevaI ria ons verwyshet.VERWYSINGSI. Mines. J. F. en Geschicker. C. F. (1936): Amer. J. Cancer. 28, 136.2. Ewing. J. (1940): Neoplastic Diseases, 4de uitg .. p. 234. Philadelphia:Saunders.3. Fenwick. W. S. (1961): Lancet. I. 464.4. O'Aroy en Zoller. A. (1930): Op. cit. 35. France. C. J. en O,borne, A. (1950): Arch. Surg .. 61, 101.6. Trimble, I. R. (1960): Surg. Gynec. Obstet.. 110. 4.7. Snoddy, W. T. (1952): Gastroenterology, 20. 537.8. Jordan. G. L. et al. (1955): Surg. Gynec. Obslel .. 100. 453.9. Marshall. G. F. (1950): Ann. Surg .. 131. 824.10. Shahon. O. B. et af. (1956): Surgery. 39, 204.11. Fichardl. T.: Persoonlike kommunikasie.

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Neurofibrosarkoom van die maag

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Neurofibrosarkoom van die maag

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