CASE REPORT
Diagnosis: Inoperable stomach carcinoma with metastases in hepato duodenal ligamentum and pancreas - VO
The following reports issued in 1974 by Dr. H. Malski, Chief Doctor of the Second Surgery Clinic at the Kirchen/Sieg Regional Hospital, Germany, and Dr. Sackey, are translated into English in order to describe the medical history of the patient before she presented to Dr. Ozel.
Beginning of medical report translation
"H. Malski, M.D.
Chief Doctor of the 2nd Surgery Clinic
Kirchen/Sieg Regional Hospital-Section II
5242 Kirchen, 2.8.1974
Announcement: Lassnig, M.D.
H e r d o r f
To the doctors in Turkey
Mr. Adorf, M.D.
Expert in Internal Medicine
Regional Hospital Section: II
Kirchen
Dear Colleague Dr. Adorf,
We express our thanks for referring to us Mrs. Vxxxxx Oxxx born on April 19, 1932 and from Sassenroth and whom we accepted to our Surgery Clinic on July 11, 1974.
Diagnosis: |
Inoperable stomach carcinoma infiltrating pancreas and duodenum. Laparotomy, examination of the resected specimen, ascariasis. |
The patient has been experiencing pain similar to colic in the right hypochondrium of epigastrium and right costal curvature, and vomiting for many months. She had no appetite, and had experienced considerable loss of weight. While being clinically examined, she was found to be very sensitive to palpation at the upper site of the abdomen and especially at the center of the costals and at both sides. Although there was a weak muscle resistance, the pain persisted even after the pressure was ceased. The abdomen was soft, and the kidney site was free. Stomach roentgenogram demonstrated a pylorus penetrating tumor.
Following these findings, a stomach surgery was attempted on July 18, 1974 after an intubation narcosis. A tumoral mass as big as a punch was revealed at the upper site of the pylorus originating from the small curvature and the rear parietal. Please refer to the enclosed surgery report for further information.
Histological examination of the infiltrating fatty specimen taken from mesocolon revealed the diagnosis as follows: sclerosis mesenteric fat cells with some inducing sclerosis character carcinoma cells (Sklerosierendes mesenteriales Fettgewebe mit einigen Carcinom zellverbanden vom induzierend, sklerosierenden Character).
The first lesion recovered in bed. The patient was transfused two units of Rh positive blood. Today, on August 2, 1974, we are discharging Mrs. Oxxx, because she wishes to go back to Turkey..."
End of medical report translation
The surgery report disclosed the laparotomy details:
Beginning of surgery report translation
"...
Narcosis type: Applied by tube (intubation) Trapanal, Fluothan. Succinil, Panc., Lachgas, Oxygen.
Nurse: Hasibe
Dr. Malski |
Dr. Sackey |
Diagnosis: |
Inoperable stomach carcinoma infiltrating pancreas and duodenum, laparotomy, examination of the resected specimen, ascariasis. |
The abdomen of the patient was opened in a transrectal manner. When peritoneum was reached, a tumoral mass as big as a punch was revealed at the upper site of the pylorus and originating from the small curvature and the rear parietal. The tumor infiltrated the entry of pancreas as well as duodenum after crossing underneath the entry of the liver. Widespread infiltration was observed to have started in the intestine. The large lymph node bunches at the retroperitoneal site were observed to have joined together with duodenum, intestine and infiltration. The gall bladder was mixed together with the intestine and the pylorus infiltration. Clinical observation revealed no metastasis in the liver. No illness was observed in peritoneum. The stomach entry was actually large enough and did not block any passage. Infiltrating fatty specimen resected from pylorus was examined. Abdomen was checked. Abdomen was closed in steps. Antiseptic bandage was applied.
Remark: An 20 cm ascaris was revealed in the intestine."
End of surgery report translation
( Appendix VO0 )
The histopathologic examination of the specimen was performed on July 18, 1974 with reference code 10345/74 at the "Pathologisches Institute des Ev. Jung-Stilling-Krankenhauses in Siegen."
Following this surgery and diagnosis, the West German Social Security Institution, Landesversicherungsanstalt Oberfranken und Mittelfranken (LVA) [of which the address in 1974 was: 8580 Bayreuth 2, Postfach 2720, West Germany] placed the patient on pension since a person with such a diagnosis could only live for another few months ( Appendices VO1A and VO1B ).
After she left the hospital in Germany, the patient was flown directly to Turkey and hospitalized at Turkish Social Security Organization's (TSSO) Istanbul Hospital. The report of the medical council of the hospital issued on 19 August 1974 stated that the patient was admitted on August 3, 1974 and discharged on 8 August 1974 to spend the remaining of her life at home. On the same report the diagnosis of the patient was corroborated as inoperable stomach cancer with metastases, and the patient was prescribed morphine.
She presented to Dr. Ozel on September 15, 1974 with disorientation, word finding difficulty, and decreased memory function symptoms. She continuously used morphine and behaved as if she were intoxicated. Her tongue was very dry. A swelling was palpated in epigastrium, and there was a laparotomy cicatrix in the same region. She had experienced extreme loss of weight. When tested, 0.5cc of NOI caused a fever of 38.5o C, and she was placed on a regimen with 0.4 cc dose of NOI to be given daily 6 days per week, and 0.5cc of NOO to be given three times every day after the meals.
The patient's pains diminished gradually, then disappeared completely within a month. At the end of the second month after she started N.O. treatment, no more rise in fever occurred following NOI administrations. She was then placed on a maintenance regimen with 0.4 cc dose of NOI to be given at two day intervals and 3x0.5mL NOO daily. She received the maintenance treatment for another three months, and was recommended to stop the N.O. treatment.
In 1975 the patient experienced provoked vomiting, and showed pyloric stenosis symptom. She underwent surgery for this, and no sign of her old malignant disease was observed at the surgery.
After she got well, the patient did not return to Germany, continued to live in Turkey and receive pension from LVA, the German social security organization. LVA requested a medical check up in 1982. That was performed on 3 November 1982 ( Appendix VO2 ) at the Istanbul Hospital of Turkish Social Security Organization (TSSO). The patient was found to be in complete health, and LVA asked her to go back to work in Germany. Since she had then settled in Turkey, she could not move to Germany again, and LVA stopped paying her pension. (LVA's file on the patient with reference code 18 190432 Y 503 was very detailed. Similarly TSSO's file on the patient with reference code 565209 was a very thick one.)
In 1988 she presented her case on the Turkish national television.
Dr. Ozel last heard of her in 2002. She has been in remission since 1974.