File:Interstate medical journal (1917) (14781317844).jpg

Identifier: interstatemedica2419unse (find matches)
Title: Interstate medical journal
Year: 1917 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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rbach in the immediate prox-imity of the valve, establishes for it an important nodal relay inthe alimentary tract second only in importance (if any) to thecenter in the descending portion of the duodenum. The experimental effects produced by separating this proximalcolonic center from the cephalad portions of the alimentary tractare well shown in the dilatation of the duodenum following incom- INTERSTATE MEDICAL JOURNAL 11 plete obstruction of the end-ileum. Mutch,3 of London, corroboratesthese findings clinically. Several of our own human cases haveshown increased duodenal shadows and have been found at opera-tion to be abnormally held down in the ileocecal regions. Casereports comparatively few ileocecal cases with recognizableduodenal changes. X-ray studies from the Mayo Clinic5 have notyet come to associate other than intrinsic duodenal causes with dila-tation of the duodenum. Fortunately, Alvarez,0 working with in-testinal segments, has again revealed an absolute interdependence
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Fig. 1.—Diagram illustrating removal of terminal ileum, ileocecal valve, andascending colon. This is called hemicolectomy, or by Lynch-and-Draperreconstruction. of the upper end of the small gut upon the lower end as far as itsintestinal tone is concerned. The important regulatory influenceof the proximal colonic center is well shown in dogs after resectionof part of the oral colon, with terminal union of the divided endsand with preservation of the ileocolonic sphincter. Similarly humanileostomy cases, as Lynch and MacFarland7 maintained, do revealinhibitory control in the reduction of and in the solidification ofthe contents discharged from the ileac stoma. These observationsserve to indicate the significance of the iliocecum as an importanttone-relay center. It is unnecessary to refer to the rich lymphatic 12 INTERSTATE MEDICAL JOURNAL connections of the end-ileum which establish it as a vital absorp-tive medium. Functionally, this junction of the small and the.largebowel appears

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