PHYSIOLOGY OF THE APPENDIXThe microscope discovers an extremely interesting structure of the appendix in which we observed follicles of a special nature, similar to the lymphatic ganglions and tonsils. If we remember that the ganglion and the tonsil are extremely abundant in elements whose role is very important in the fight against microbes and infection, we will feel compelled immediately to connect the appendix with a defensive mechanism against intestinal infection.
Because of such facts, the appendix has been called “the intestinal tonsil.” Its protective function is analogous to the tonsils that guard the larynx from the microbes that abound in it. The appendix constitutes something like a fortress able to lodge a powerful army of leukocytes fighting against powerful germs that can be in the intestine. When the leukocytes are victorious, there is no sign that reveals the importance of this victory; but when they are not, a condition that we call appendicitis appears.
Another interesting function of the appendix has been put in evidence by an Italian researcher named Soli. According to this author, the appendix plays an emunctory role similar to the role of the kidneys, the intestine, the saliva, or the skin. It is known that the mentioned organs have the duty among other assignments, to eliminate substances that are foreign or injurious to the organism, as well as dangerous microbes. Soli includes the appendix among the organs of this class.
He based his affirmation, on the fact that if a rabbit is injected intravenously with cultures of certain bacilli, they appear in the appendix, before any of the other organs of elimination like kidneys, gall bladder, etc. This therefore demonstrates the most important role carried out by the appendix: the elimination of germs. In addition, when the other organs do not contain any more microbes, the appendix continues eliminating them. This seems to indicate that the appendix is, indeed, the most important of all the emunctory organs by the precocity whereupon it does it, by the intensity, and by the persistence of its work.
From all this arises evidence of the injustice that we have committed against the appendix. Its name even reveals the contempt with which it is considered.
It has the functions of an internal secretion gland, that is to say, that its secretion instead of being within its lumen, enters the blood flow, just as it happens with the other internal secretion glands, and, surely, it must work in unison with them. The histologic examinations of the researchers who have made observations of the appendix have found very similar elements to those of these glands. When they have injected appendix extract, it is seen in the animals in observation, that the intestines are contracting very energetically. From this is deduced the role, so important, that it has upon intestinal contractions. The peristaltic waves begin in the appendix, which works as a regulating valve, and they are propagated to the caecum, to the colon, until the fecal content is expelled.
Undoubtedly, and it is already confirmed, the appendix secretes a viscous, mucilaginous, substance, within its lumen, to assist the passage of the intestinal contents.
Summarizing: the discovered functions of the appendix as of today (1953) are:
1. Elimination of germs and toxins.
2. Internal secretion.
3. Peristaltic hormonal function.
4. Lubricating role by its secretion within the intestine, that completes the hormonal peristalsis.
The above mentioned functions of the appendix lead us to justify what all doctors observe daily: those individuals who were deprived of the appendix, for medical necessity or as a prophylactic measure, because of the amputation, later suffer chronic constipation, pain in the appendix area, and other additional symptoms deriving from these main two.
In the present state of our knowledge and of medical practice, there is the ineluctable aphorism of Dieulafoy and Kean, which says: “In the presence of appendicitis, the first indication for the doctor is to call a surgeon.”
We are presenting a brief description of the medical treatment that would fill Dieulafoy with astonishment.
By acute appendicitis are understood a collection of symptoms and cardinal signs formed by: Pain in the right iliac fossa, more remarkable indeed in the points of MacBurney, Lanz, or Morris, or also in epigastric, or both simultaneously. Cutaneous muscular defense and hyperesthesia in the sites of pain; accompanied or not by nausea, followed by vomit. Difficulty in the expulsion of intestinal gas. Swelling and contracture of the abdomen with muscular defense and general symptoms caused by toxic infection, such as: frequency, faintness, irregularity, and acceleration of the pulse. Pale facies with the noticeable characteristics. Syncopal state, and changes in temperature that can be high, and in the serious cases can be low.
A condition similar to this allows to us to think that it is appendicitis and then we must proceed to the examination of the patient.
An individual bent forwards, who holds or touches his abdomen, with nausea, or vomiting, with or without expulsion of matter. Expressing a pain starting unexpectedly in the right iliac fossa or epigastric area, or that in other occasions has had something similar, or that gradually, and as the days went by, has increased. The pain is sometimes similar to the pain produced during the formation of an abscess, and it is increased with exercise or by the ingestion of food. We must immediately corroborate our suspicion of appendicitis by other means of examination.
Pain to palpation in the right iliac fossa or epigastric area, with muscular defense or hypersensitivity, are signs that only allow us to make a superficial palpation. In general these signs are accompanied by a certain rise in the afflicted area, and these can even be a superficial edema. The ailing area is slightly dull or subdull, in contrast to the rest of the abdomen that is distended.
The symptomatic triad of Dieulafoy (pain, cutaneous hyperesthesia, and muscular defense), as well as the pathognomonic symptoms, do not exist. The triads happen in variable combinations, at times in pairs, or also as one unique symptom. Because of this, the signs should not be COUNTED, but VALORIZED.
We must always take into account for the diagnosis: the diversity of anatomopathologic types of inflammation, topography of the appendix, and differences in the evolution of the process related to the age of the affected individual.
According to clinical experience, acute appendicitises are classified as:
a. slight, abortive, or fleeting appendicitis;
b. congestive appendicitis without peritoneal repercussion;
c. appendicitis of medium intensity with peritoneal localized inflammation;
d. and serious appendicitis (destructive or gangrenous), with extensive peritoneal inflammation.
According to the appendiceal topography, the appendicitises are: pelvic retroceded, high pelvic or mid-celiac, subhepatic, herniated, and sinistral. All these well valorized symptoms allow us to enter the diagnosis of ACUTE APPENDICITIS.
There could be in the site in which we find the patient with this condition, what is necessary to confirm the clinical diagnosis; using the two following procedures: X-rays and the leukocyte formula.
Usually X-rays, are used as a confirmation means or almost as a pathognomonic sign to make the diagnosis of appendicitis. Dr. Hartmann, of the Mayo Clinic, says: “we never X-rayed a patient to do the study of acute or chronic appendicitis. Few subjects do not have some degree of appendix inflammation and practically each appendix that is removed for one reason or another, is reported by the pathologist, as a chronic catarrhal appendicitis.”
The distinguished Colombian radiologist, Dr. Gonzalo Ezguerra Gómez, insists on the importance of the sign of “erectibility of the appendix,” but he stands on this sign, that some will take as pathognomonic, “... I have not had the opportunity to verify its effectiveness...”
Our teacher, Dr. Manuel Madrazo, says: “... acute appendicitis must be diagnosed by clinical exploration and in very rare occasions will be associated to a radiological study...” The subacute, chronic, or recurrent appendicitises will have to be diagnosed mainly by clinical examination... In few occasions the necessity of an operation can be pronounced definitively by enterogenological means...”
The doctor also has the laboratory at his disposal, of which we can have the same opinion that we have of the respectable radiologists.
In the blood of patients suffering any acute infection, the number of leukocytes increases; but for this leukocytosis to appear, it is necessary that the microbes producing the infection are able to produce the leukocytic reaction; that the infection is not extremely acute; that the hematopoietic organs are normal and able to produce leukocytosis, and that there is pressure in the infected region, in order for absorption to take place. In addition, proteinic shocks, allergy, intestinal occlusion, hemorrhage, and often emotional shocks, can originate leukocytosis.
According to the most eminent authors of treatises, operations to remove the appendix are performed with 6 to 20% of diagnosis errors.
The symptomatic polymorphism of the disease is one of the main difficulties for diagnosis of this ailment, depending on the diversity of anatomopathologic types, the swelling, the topographic particularities of the appendix, and the evolution of the process in relation to the age of the patient.
The inflammatory process can present from a slight appendix congestion that gives the symptoms of fleeting pain that heals in spite of the doctor, up to a gangrenous appendix with repercussions in the whole peritoneum and with serious symptoms of toxemia.
When the doctor is confronted with the latter, the diagnosis errors reach the one hundred percent mark. In the case of using the classic therapy, that is to say appendectomy, arriving at the exact diagnosis does not have much importance, because in the great majority of these cases the patient always passes away. However, in the case of making the exact diagnosis and using Cellular Therapy, it is of great importance to make a good diagnosis, because in the great majority of cases, using this therapy, the patient is saved in a rapid and spectacular manner.
The topographic situation of the appendix carries innumerable difficulties in the diagnosis. For example, the symptomatology and evolution of a retro-cecal appendicitis is totally different from an appendicitis where the appendix is located in the right abdomen. Confusing signs and symptoms, that correspond simultaneously to the appendix and to the contiguous organs, almost always make us deviate from the exact diagnosis of appendicitis.
It is in the woman where the confusions are more serious and more frequent. Only a detailed and meticulous study, that most of the time is not possible to do, would take us to an approximate diagnosis. Whenever it is not an acute abdomen, it is known, almost no means of exact examination can be put in practice.
Perforated ulcers, intestinal occlusion by invagination, acute pancreatitis, acute cholecystitis, renal lithiasis, acute salpingitis, extrauterine pregnancy, cysts with rupture or torsion, acute nephritis, etc., etc. Briefly we will talk about each one of the main errors of diagnosis.
There are perforations by juxtapyloric ulcers, with little contracture in the high abdomen,that causes pain to pressure. And sometimes it presents the typical contracture in the right iliac fossa (muscular defense) corresponding to appendicitis, but due to the draining of the gastric juice that follows the parietal colonic space towards the iliac fossa this produces an intense inflammatory reaction around the zone of MacBurney.
Errors of diagnosis are also committed in inverse fashion as before mentioned. Epigastralgia that is frequent in appendicitises, sometimes as the only symptom and without a previous precise diagnosis having been made, gives rise to erroneous diagnosis. If previous suspicious gastric antecedents exist, it is most likely to be mistaken as a gastric ailment, and in reality, being nothing more than appendicitis.
The special subject of acute cholecystitis is not very well delineated if the gallbladder is not in its place, having descended because of the same inflammation. Then the inflammatory symptoms appear in their maximum intensity in the right iliac fossa. Another reason for confusion depends on the anatomopathologic lesions of the same process. In both cases, simple congestive forms are observed with some frequency, as they heal without the intervention of the doctor. But the ulcero-phlegmonous, gangrenous, suppurating, and perforated forms, are acute disorders that happen in the chronic forms. Jaundice is not a frequent symptom. Intense jaundice speaks in favor of a disorder of the biliary ducts, but the lack of it does not exclude a vesicular disease. Even the same radiological study in both disorders frequently does not give any diagnostical data.
Acute pyelitises, which almost always begin with intense pains, elevated fever, vomiting, and muscular defense, all present the very similar picture as does appendicitis. There is greater confusion when a renal ptosis exists.
Renal lithiasis, when there is no macrocospic hematuria, is frequently confused with appendicitis. Hydronephrosis and nephritic phlegmons are others disorders confused with appendicitis.
All the disorders in the right abdomen of the woman result in too frequent confusions. The differential diagnosis between an acute affection of the pelvic areas, and appendicitis, is very difficult in the beginnings of both disorders, because of the extraordinary similarity of the symptoms and because the antecedents of the gynecological disorders are almost always distorted. Although acute genital conditions almost never begin in a patient free of previous troubles, they are locally manifested by pain in the lower abdomen (exacerbated by exercise), purulent flow or muco-purulent, dysmenorrhea, pains in both inferior limbs, etc., and by the general symptoms of cold sweats alternated with light fever.
The great majority of these pelvic ailments of gonococcal origin or a septic infection consecutive to an obstetric intervention. If the acute peritoneal crisis of doubtful origin has been preceded by some of these antecedents, we win within the best logic, with the pelvic ailment rather than with the appendicitis.
The pancreas having a very important part in digestive functions and being an organ located in the middle and deep part of the abdomen, acute pancreatitis or the hemorrhagic or supurative form, always have lent to confusions, most frequently with acute appendicitis.
The constant, distressing, intense pain around the navel accompanied by nausea or vomits, and symptoms of collapse, fast pulse with low blood pressure and sometimes with noticeable muscular defense, and to make this picture more confusing, with pertinacious constipation sometimes getting to present the iliaco-paralytic form; all these symptoms, without a doubt, are perfectly confusing with an attack of acute appendicitis.
Intestinal obstruction by invagination, mainly when it takes place in the ileo-cecal area, lends itself very clearly to confusion with acute appendicitis. The pain, which is the predominant symptom, of colic character, with serious paroxysms of progressive intensity, is located exactly in the area of the appendix. When the obstruction is by invagination, the vomitus have the following characteristics: at the beginning they are of reflective nature, as happens in almost all acute abdominal affections; vomitus begin to be bilious, to later become fecaloid when the obstruction has been in the colon. Constipation is almost constant in the intestinal obstruction in the first days; although it is necessary to make the reservation that, due to the peristaltic movements, the distal portion of the intestine empties. The evacuations are in small quantities, diarrheal, and accompanied by blood and mucous.
In the open wounds of extrauterine pregnancy, with abundant hemorrhage, manifested by pallor and accentuated in the skin and the mucous, vertigo, ringing ears, lipothymias, low blood pressure and fast pulse. At the abdominal palpation and using both hands, we perceived, to the pressure, a painful spongy mass, badly defined, and fluctuating. All this together with the anamnesis, takes us to the direct diagnosis of complicated extrauterine pregnancy. But when these symptoms do not have the precision we just finished describing, then ambiguity is frequent.
Another gynecological process that lends itself to confusion with appendicitis is the torsion of the pedicle of an ovary cyst, that is accompanied by low, intense abdominal pain, and symptoms of peritoneal irritation that increase progressively if the torsion does not resolve by itself. When the ovarian cyst is not of a size that can be felt by the usual gynecological procedures, error is almost the rule.
Ovarian hemorrhages and hematomas, mesenteric lymphadenitis, diverticulitis, intestinal occlusion, regional ileitis, typhlitis, and some ascending acute ileitis, resemble the appendicitis condition.
The most benign of the disorders mentioned above, much complicates the appendicular picture. The laparotomy by itself can be the cause of death. Once the abdomen is opened, in addition to the appendicitis, any other disorder must be treated surgically, if any. But if not, it is more serious yet for the patient who endure diagnosis errors.
It is evident that when a slightly congested appendix has been operated, or when the appendicitis does not exist and the appendix is removed, the evolution towards the cure by cicatrization of the peritoneal wounds, both internal and external, occurs in the course of four or five days without any repercussions in the general state. And if the anesthesia has been chosen carefully, the danger and the complications coming from the anesthetic, which sometimes reach more than 50%, in fact do not exist. With sulfas and penicillin, postoperative deaths have considerably diminished; the average number recognized is now 7% mortality.
MEDICAL TREATMENT OF APPENDICITIS
Since 1896, the date when Dieulafoy established that an operation was the only remedy for any form of appendicitis, no one has dared, not even to look for another form of treatment of appendicitises and to confirm the assertion of Dieulafoy. Almost no importance has been given to the study of the physiology of the appendix; but there is verified research in this respect.
Supported in all the facts, this organ is systematically extracted surgically from all appendicitis patients.
The great number of well operated patients often later complain of problems, mainly of the digestive apparatus, constipation, autointoxication, migraines, rheumatoid pains, asthenia, neurasthenia, etc., pain located in the area of the appendix etc. These are the most frequent symptoms left by the correct ablation of this organ. On the other hand, the little studied physiology, which has been totally confirmed by small researchers, shows us that it is a necessary organ for well being. Then, the best solution of the appendicitis problem, must be to return this organ to its physiological state. If appendicitis is considered as a classic disorder, and necessarily surgical, and if we have managed to ruin these concepts, then almost all the inflammatory disorders considered until today as surgical will become medical.
The true medical-scientific ideal is that medicine can resolve all the problems, even those called surgical.
The memory of the last World War gives us the example of what is already done without surgical intervention. How many wounded limbs of obvious gravity, down to the most benign, were amputated by surgeons? Sulfas, penicillin, streptomycin, in short, the endless number of chemical or biological medications that have come to replace many interventions, have simplified and abolished many operating techniques and have saved many lives.
The haste to save a life almost always prevents us from doing the examination by means of X-rays or laboratory tests, in the cases of acute appendicitises.
From all this we can infer or deduce that, in fact, we only count on good clinical observations to make a correct diagnosis of acute appendicitis.
CONSEQUENCES OF APPENDECTOMY
Surgery has always been the true barrier that has hindered the advancement of medicine. Indeed, one has thought that any problem whose solution cannot be found immediately with medicine, is solved in partially or totally removing or extirpating the ailing organ.
One of our distinguished masters, capable surgeon Dr. Ricardo Suárez Gamboa, said: “You calculate your merit by the number of organs that you have preserved, never by those that you have mutilated.”
In fact, for the surgeon, everything ends up happily when the patient does not die during the operation, or shortly thereafter. It has been fatal for medicine to give, as the final resolution to its problems, the removal of certain injured organ. Few doctors have been interested in the course that follows the operation, after the removal. After the surgeon, other specialists come to solve the problems created by the lack of the organ; but his task will be difficult, because no fake can substitute for the natural. A high percentage of patients with appendectomy later have many varied disorders, attributed by the surgeons to adhesions, and until now, almost all irremediable.
Appendicitis is an initial infectious process of SUBMUCOUS-ADENOIDAL tissue. The primitive lesion is folliculitis, that is to say, inflammation of the lymphatic follicles forming a discontinuous reticular tissue assembly, underneath the mucosa of the organ.
Since 1891, Bland Sutton demonstrated the importance of the appendix, similar to the adenoid tissue of the pharyngeal tonsils, where it resides and the infection begins. First, it is in the lymphatic tissues, and later in the contiguous lymphoid tissues of the appendix where the infection localizes itself, extending later to the mucosa, muscular and serous, forming small centers of suppuration including all the walls and perforating them. Or it can end up in partial or total gangrene. In these last two cases the end is the same: perforation. If it is a simple folliculitis, and the defenses of the organism are powerful and repel the infection, then the appendicitis can disappear spontaneously. We have all observed patients recovering on their own. There is another type, whose cure we attribute to certain medications; but in this work we are talking about the appendicitises that do not cure by themselves, that in similar conditions have needed the intervention of a surgeon. We will present only three typical cases of acute appendicitis.
THREE CLINICAL CASES WITHOUT SURGERY
The first two clinical cases that we are going to relate, are of generalized peritonitis, confirmed by examinations of other doctors. And the third also seems to be with peritonitis. All are of extreme gravity; in this last one we had the time to perform the leukocyte test before and after treatment.
Case # 1: F.P.G., Male, Age 50, Weight 55kg (121lbs.), appeared on February 4th 1941.
The patient and his wife report that, on January 31st, of the same year, he began to feel a malaise in the stomach that made him reduce his food intake, taking only a bowl of soup, and coffee with milk. When finishing he felt a great need to sleep; against his custom, he had to lie down for several hours. Lying in that position he felt an intense pain in the side and the right iliac fossa. As the pain increased they gave him an enema of chamomile decoction with glycerin. He evacuated the intestine twice with much delay; nevertheless, the pain increased without being very intense. They put ice on his abdomen and the following day they gave him a laxative of sodium sulfate that made him evacuate; increasing the intensity of the pain localized at the point of MacBurney. The temperature climbed up to 39.9°C (103.8°F). The pain continued to increase and it extended to the whole abdomen, so that any attempt of movement increased the pain. Gas expulsion was very difficult; and it increased the distress of the abdomen. To relieve him, they replaced the ice pouch with a hot water pouch.
Doctor R. Flores Gómez was called, and gave the following certificate: “...on February 3rd., in view of the gravity, I consulted in his residence, in Taxco, Gro. Mr. F.P.G. Commander of the 70th Reserve Battalion, which, following a rigorous medical examination, was diagnosed as ACUTE ATTACK OF APPENDICITIS, and urged to go immediately to the city of Mexico, to be operated...”
On February 4th., 1941, my examination presented the following signs and symptoms: peritoneal facie, the wing of the nose moves at each breath, the face has a dirty yellow color, sunken eyes, expressing great pain and distress. Finds every positions he assumes uncomfortable. Can barely tolerate the sheet since it also brings him discomfort. Lifting it, a great generalized swelling of the abdomen is observed, that is not in agreement with the emaciation of the rest of the body, showing a great contrast. The extreme hypersensitivity did not allow me to touch the right iliac fossa. A rise of about 10cm in diameter is observed, whose center is the point of MacBurney. The rest of the abdomen was examined with much gentleness because of the intense pain. During these maneuvers, he made many efforts to vomit. The temperature was of 38°C (100.4°F), heart rate 62 per minute, and very low blood pressure. This picture corresponds to a generalized peritonitis from acute appendicitis.
The same day as the examination, he received the first application of Cellular Therapy. Three hours later, his temperature was 37°C (98.6°F); the blood pressure was up, and the heart rate had a frequency of 62 pulses per minute. All symptoms clearly diminished. But the most interesting, and this we have observed in all the serious appendicitis cases, was that one hour after the application of this treatment, he felt the need to evacuate the intestine. He rose from the bed with relative ease, in spite of his great exhaustion, and made an evacuation of normal character, very abundant; evacuation that brought relief from the discomfort that he had in the abdomen. At the same time began the gentle release of intestinal gas.
We must remark that appendicitis patients, mainly the abdomen operated patients, due to surgical practices, suffer for hours or days without being able to expel intestinal gases, which cause great discomfort.
The day following the first application, almost all the symptoms had disappeared. He began to take some food. Without the need of any laxative, he had two daily evacuations, without any discomfort. On the fourth day, after the second application, the regression of all the symptoms accelerated even more.
Apparently, with these two treatments, he was healthy> Except that the patient was complaining of a pain in the right half of the chest, pain that began when he was transferred from Taxco to this capital. Examining both lungs, one had crepitant rale in the base of the right half of the chest; slightly sanguinolent sputum, migraine, and a temperature of 38°C (100.4°F). He presented the picture of pneumonia of the right base. Respectively, on the 11th and 15th of the same month, he received the last two treatments; before the last treatment, he received two laxative enemas.
The peritoneal and pulmonary conditions had disappeared completely. In order to confirm this assertion, eight days after the last application, Dr. Manuel Madrazo made an X-ray examination of the state of the appendix and lungs. Clearly posted in the record book: “non-visible appendix. Little movement of the caecum. Regional moderate pain. No organic lesions are observed in the rest of the colon. General transit and position of the intestines is normal. Radioscopically there is darkness in the base of the right lung. Dr. Manuel Madrazo, signature.”
On the following day he began his habitual life. Eight days later, he had regained 12kg (26lbs.), that were lost during these diseases.
Since it had been agreed, with the patient and his relatives, to verify the state in which the appendix had remained, feeling perfectly healthy, four months later, a laparotomy was performed on him. When the abdomen was open, a small appendix floated free of all class of adhesions, with no visible lesions. The doctors witnessing the operation said: "Doctor, this patient has never had appendicitis, right? Because it is free and there is no visible trace that he has had or that he has any inflammation...” A quick history of the patient was presented to them, that, of course, they did not believe. The small appendix was extracted. The cavity closed in record time and three days later, he was discharged from the hospital, because he was cured.
THE THERAPY USED WAS: the average dose of insulin injected intravenously, 18 units; the time of presentation of first symptoms of the change of the blood properties (beginning of hypoglycemia), was 22 minutes; the time of the Therapeutic Moment, 41 minutes. The medications used were:
In a 20cc syringe:
• Hydrochloride of
diaminomethylacridine chloride 100mg
• Methylene Blue 10mg
• Resorcinol 10mg
• Dextrose 100mg
in a 50% dextrose solution 20cc.
In another syringe of 20cc:
• Vitamin B1 200mg,
• Vitamin B2 6mg,
• Vitamin B6 6mg
• Vitamin C 100mg
in a 50% dextrose solution 20cc.
In another 5cc syringe:
• Sulfatiazol 500mg
in a 5% glucose solution 5cc.
This last injection intramuscularly.
When the symptoms of the change of the properties begin, the intramuscular solution is injected; and when these changes have reached their maximum, and an imbalance takes place, of which we already talked about, the solutions are injected intravenously.
In about 3 to 8 minutes, in the patient, all the induced phenomena disappear immediately. He felt a noticeable improvement, which almost always goes together with a great sensation of euphoria.
After 41 minutes, the second change of the blood properties appears; but as in all the other cases, no longer with the same intensity. By mouth, the patient received 1g of sulfaguanidine and 250mg of nicotinic acid dissolved in sweetened water. Later, during the day, he continued drinking sweet beverages, as needed to satisfy.
Case # 2: R.P.G., Male, Age 38, average fasting blood sugar 78mg, pH 7.15.
In 1915, he had tertiary malaria; it lasted 6 months. In 1927, jaundice accompanied by colics; he lost a lot of weight after this disease; in 1929, loss of hair and eyebrows. He was cured with injections of Neosalvarsan and Bismuthoidol.
Married in 1928, he had 8 children; 7 died very small and for one of them there was placenta previa. He was a smoker and heavy drinker of many years.
On April 10th, there appeared a very intense pain in the epigastric area that radiated to both sides, following the rib edge, accompanied by vomitus, formed first by the food in the morning, later, soft, they became yellowish and bitter. He was given an enema to evacuate his intestines. On the following day, the abdomen became distended and hardened by gas. The pain generalized in the whole abdomen, and the vomitus became greenish and bitter, accompanied later by much blood. He could not evacuate the intestines nor expel gas, and was anuric. This same day they gave him an antiperitoneal serum ampoule and one liter of physiologic serum. From the first day he had a fever of 39°C (102.2°F). Three days later, a light examination was all that his state of gravity allowed to be performed. The abdominal pains did not even allow contact with the sheets.
This condition had occurred about 6 years ago, although without this intensity. Since this, it happened 6 more times, but without the current gravity. The first time, the diagnosis was alcoholic gastritis. The second time, besides that, he had convulsions in the whole body, fainting, had vomitus wich turn mulberry greenish, was biting his tongue, and foaming at the mouth. An epileptiform fit was diagnosed.
He was admitted to the clinic in a semicomatose state, with distended, ligneous abdomen, and so much pain that it was not possible to palpate him. The distention included the inferior part of the thorax. When he attempted to pass gas, the pain increased, and for days this had been impossible. The vomitus, which was still greenish, aggravated the situation of the patient. Once in a while he had hiccups. For many days he has not been defecating or urinating. The fever, that in the beginning was 40°C (104°F), was now almost normal. The heart rate was weak, with 130 pulses per minute. The face expressed anguish and pain; the eyes deeply sunken, the nose sharpened, the furrows of the face deep, the skin dry and dirty.
When I made the examination of the patient, his wife informed me that his state worsened due to and immediately after an enema. The patient declared that he felt as if a liquid was spilled in his belly and from that moment began a kind of agony.
The described clinical condition corresponded to an acute peritonitis, possibly due to a perforated appendix. The diagnosis by Dr. Jose Huitrón says: “...PERITONITIS BY PROBABLE ACUTE APPENDICITIS... they are preparing his transfer to a sanatorium for his surgical treatment...”
The first Cellular Therapy application was immediately after the examination. Two hours later he had a bowel movement, the pulse became regular, he expelled gas, and it can be said that his acute state of peritonitis had disappeared.
After eight days the patient was normal. He received a total of six applications of Cellular Therapy. The average dose of medications was the following:
Insulin, 20 units intravenously; the first symptoms appeared after 23 minutes. Twelve minutes later, the symptoms were maximum, having received the average dose of the four applications:
• Hydrochloride of
diaminomethylacridine chloride 70mg,
• Methylene Blue 5mg,
• Resorcinol 5mg,
in 50% dextrose solution, 20cc;
• Vitamin B1 20mg,
• Vitamin B2 6mg,
• Vitamin B6 6mg,
• Vitamin C 100mg,
in 50% dextrose solution, 20cc.
• Penicillin 200,000 Units
• Sulfatiazol 500mg
in 10% glucose solution 5cc.
Both last medications to be injected as soon as the symptoms produced by the pancreatic hormone begin.
After 45 minutes, the symptoms return, and at this time the patient ingested sulfaguanidine 1g, nicotinic acid 250mg, in water saturated with sugar, until the thirst and the hunger were satisfied.
Case # 3: A.G., Male, Age 14, Weight 40kg (88lbs.). March 12th, 1947.
Twelve days ago his symptoms began with pain in the epigastric area that later included the navel, and finally the whole abdomen. Two days later, he had light cold sweats followed by irregular fever that rose up to 39°C (102.2°F). As of that date the pain in the whole abdomen was very intense. In the beginning, he was allowed to take some foods, but in the last days, just the attempt to eat produced nausea or slimy vomitus, and finally greenish and bitter vomitus. The unanimous diagnosis of several doctors was of acute appendicitis. In order to corroborate it, a blood count was ordered, whose results were:
“Alberto Lezama G.-M.C. of the UNA.
Medical Laboratory of the Béistegui Hospital.
Name of the boy, A.G.M.
Requested by Dr. Miguel Jose Aiza.
• Product to study: Blood.
• Investigation requested: cytological study.
• Number of Leukocytes: 32,300 per mm3.
• Number of erythrocytes: 5,210,000 per mm3.
• Hemoglobin: 12g, 4 per 100cc of blood
(80% of normal).
• Globular Value: 0.76.
• Granulocyte neutrophils 9%.
• Monocytes: 9% .
• Metamyelocyte neutrophils: 0%. .
• Granulocyte de Turek: 1%. .
• Image of Arneth: — I: 39%. — II: 45%. — III: 16%.
— IV: 0%. — V: 0%.
There was a slight anisocytosis with predominance of the microcytes.
• There were no other erythrocytary deformations.
• Little reticulocytes (0.71%).
• Most of the neutrophils present toxic granulation.
Mexico, DF, March 11, 1947.
Regards, Alberto Lezama.”
On the day following this analysis, we were called to operate on his appendix, because all the previous doctors agreed that surgical intervention was urgent.
The clinical condition was: subject very emaciated, expressing much suffering by the aspect of the face. His abdomen was uncovered because he could not bear the weight of the sheet, as it caused him intense pain. With light palpation there was muscular defense. It was not possible to touch the point of Mac- Burney. The muscular defense was generalized, but when it was touched an elevation was seen that occupied the right side and the iliac fossa. The examination caused vomiting; the temperature was 39°C (102.2°F).
Clinically and cytologicallly, the patient had Generalized Peritonitis from Acute Appendicitis.
Four applications of Cellular Therapy, five days apart, were necessary to leave the patient healthy. At the first application, the pain disappeared. At the second, the elevation began to disappear. After the third, the rise of the abdomen was no longer felt. Two more were sufficient for him to begin his normal life and to start gaining weight. He was given a discharge in the course of 20 days.
The results of the cytological study were:
“Dr. Alberto Lezama G.-M.C. of the UNA.
Mexico, DF, April 1st., 1947.
Name of the boy: A.G.M.
Requested by Dr. D.P.G.
• Product to study: Blood.
• Requested for investigation: Cytological study:
• Number of erythrocytes: 5,840,000 per mm3.
• Number of leukocytes: 5,200 per mm3...
Regards, Alberto Lezama. - Signature.”
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