Showing papers in "Diseases of The Colon & Rectum in 1970"
126 citations
TL;DR: The use of drains cannot be condemned categorically because in gross and microscopic appearances the anastomoses in seven dogs with Teflon tape drains were not much different from those of the control animals.
Abstract: Information obtained from animal experiments cannot generally be applied to clinical situations, but such obvious differences as the difference between the healing of drained and undrained anastomoses may be applicable. All 15 of the control dogs recovered, and their colonic anastomoses had only filmy adhesions and no stricture formation. In contrast to this, of those with Penrose drains, nine of 20 died of anastomotic disruption and peritonitis, and the rest had extensive adhesions and varying degrees of stricture formation.
77 citations
TL;DR: One patient died of sepsis following operation for a perforation caused by an irrigating catheter after colostomies established in 296 patients.
Abstract: In a series of 307 colostomies established in 296 patients, there were complications in 53 patients (16 per cent), of whom 41 had reoperations to correct the complications. One patient died of sepsis following operation for a perforation caused by an irrigating catheter.
71 citations
TL;DR: The clinical and pathologic characteristics of colorectal carcinoma that did not metastasize to mesenteric lymph nodes have been compared with the same characteristics of carcinomas that did metastasized to lymph nodes by computer-programmed analysis of significant differences.
Abstract: The clinical and pathologic characteristics of colorectal carcinomas that did not metastasize to mesenteric lymph nodes have been compared with the same characteristics of carcinomas that did metastasize to lymph nodes by computer-programmed analysis of significant differences in 420 cancers in the first group and 344 cancers in the second group. Characteristics associated with an increased probability of metastasis to lymph nodes included the past or present association of skin cancers, the existence of metastases outside the field of resection, and the characteristics of the cancer margins (greater stromal and vascular infiltration by cancer and less inflammatory cell infiltration). Factors associated with a decreased likelihood of metastasis to lymph nodes included favorable characteristics of the cancer margins (“pushing” or circumscribed margin and denser infiltration of inflammatory cells), deep local extension through the bowel wall into mesenteric fat and adjacent organs, and absence of distant metastases. The nonmetastasizing variants were found among tumors of all sizes and histologic grades. Further studies of the individual characteristics of both cancers and hosts are necessary for development of an infallible method of identifying tumors that have not metastasized. Such a method could permit the use of localized ablation more frequently.
50 citations
TL;DR: Ischemic colitis must be considered in diagnosing the conditions of elderly patients who have lower abdominal pain and rectal bleeding and who need such treatment because of the possibility that a carcinoma or largebowel obstruction has developed.
Abstract: SummaryIschemic colitis must be considered in diagnosing the conditions of elderly patients who have lower abdominal pain and rectal bleeding. Barium-enema examination and angiography should confirm the diagnosis. Whether the ischemic colitis is occlusive or nonocclusive, treatment depends upon the condition of the patient. All patients thought to have ischemic colitis should be treated with antibiotics. If the clinical course is severe (gangrenous ischemic colitis), a laparotomy and resection should be done. If the clinical course is mild (transient ischemic colitis), no surgery is needed. Some patients who do not require surgical treatment early in the course of the disease later may develop stenosis and need such treatment because of the possibility that a carcinoma or largebowel obstruction has developed.
47 citations
TL;DR: The basic principles of plastic surgery for sliding skin graft have been employed routinely in and about the anal canal andcision of a chronic fissure and covering of the defect with a sliding-flap broad-based skin graft offers the advantages of decreased postoperative pain.
Abstract: The basic principles of plastic surgery for sliding skin graft have been employed routinely in and about the anal canal. In 2,072 patients operated upon by the authors the infected fissure and crypt-bearing hemorrhoidal tissue was excised and the defect closed primarily with a broad-based sliding skin graft. Any associated disease—hemorrhoids, cryptitis, etc.—was also removed, employing the closed technic.
47 citations
34 citations
Abstract: Three patients with metastatic carcinoma to the appendix are reported. One patient had appendiceal perforation with diffuse peritonitis. All three patients died. The primary neoplasms were located in the lung in two patients and the stomach in one patient. Two of the primary tumors were adenocarcinomas and the third was a poorly differentiated carcinoma. The finding of metastasis to the appendix carries a grave prognosis. It is likely that all carcinomas metastatic to the appendix would gradually produce acute appendicitis as a result of luminal obstruction if enough time were allowed to elapse.
29 citations
TL;DR: A case of a rare congenital malformation, duplication of the rectum, has been presented and various theories of etiology considered and the pathology, clinical features and treatment discussed.
Abstract: A case of a rare congenital malformation, duplication of the rectum, has been presented. The literature has been reviewed, various theories of etiology considered and the pathology, clinical features and treatment discussed.
29 citations
TL;DR: Three cases of cecal perforation due to adynamic ileus are described—one following fracture of the right femur and two following elective surgical procedures consisting of routine herniorrhaphy and transthoracic vagotomy.
Abstract: Three cases of cecal perforation due to adynamic ileus are described—one following fracture of the right femur and two following elective surgical procedures consisting of routine herniorrhaphy and transthoracic vagotomy. The mechanism of perforation is though to be ischemia and gangrene on the antemesenteric border of the cecum, due to stretching and narrowing of the nutrient vessels during distention. Cecostomy and decompression are the treatment recommended.
26 citations
TL;DR: Although a familial tendency has been ascribed to epidermoid cysts, the two cases reported are the first in the medical literature to substantiate this impression, and treatment of developmental cysts before infection occurs is simple.
Abstract: Developmental cysts, both epidermoid, were found in a woman and her daughter. Although a familial tendency has been ascribed to epidermoid cysts, insofar as we have been able to determine the two cases which we have reported are the first in the medical literature to substantiate this impression. Incidence, classification, pathology, etiology, symptoms, diagnosis, and treatment of developmental cysts have been reviewed. Developmental cysts include dermoid cysts, epidermoid cysts, and mucous cysts. They must not be confused with teratomas, which are true tumors. Developmental cysts are derived from cell rests that remain during the complex development of the caudal portion of the embryo, and they vary with the types of tissue elements represented. Treatment of developmental cysts before infection occurs consists of simple excision, which is usually complete and results in cure. This was exemplified in the treatment of the daughter (Patient 2). However, the problem becomes complex after infection occurs, and unless the lesion is suspected initially, that is, at the time an abscess is first opened, continued infection after repeated operations may result in such disability that the ultimate in radical surgery—an abdominoperineal resection—may be necessary. This happened in the mother (Patient 1).
TL;DR: A benign lesion characterized by the development of mucus-filled cysts beneath the muscularis mucosae, apparently as a result of ulceration and inflammation of the mucosa as discussed by the authors.
Abstract: Colitis cystica profunda is a benign lesion characterized by the development of mucus-filled cysts beneath the muscularis mucosae, apparently as a result of ulceration and inflammation of the mucosa with extension through the muscularis mucosae. Generally, this disease is diffuse in the colon and more localized in the rectum.
TL;DR: A series of 60 cases of ulcerative colitis seen since 1960 at the Department of Gastroenterology of the University of Ankara School of Medicine is presented.
Abstract: In this paper a series of 60 cases of ulcerative colitis seen since 1960 at the Department of Gastroenterology of the University of Ankara School of Medicine is presented. Symptomatology, clinical courses and complications of the disease in this Turkish series are discussed.
TL;DR: Although the clinical significance of the ileal pylorus remains to be fully elucidated, it appears advisable to preserve this muscular mechanism whenever possible.
Abstract: The termination of the ileum at its junction with the large intestine looks like a papilla and, therefore, has been called the ileal papilla. The ileal papilla projects into the large intestine for a distance of 2 to 3 cm and can be misinterpreted as having a valvular configuration when it is distorted after death. An anatomic muscular mechanism, the ileal pylorus, can be demonstrated within the ileal papilla and terminal ileum. It consists of longitudinal and circular muscle fibers which open and close the starshaped ileal orifice, respectively. Although the clinical significance of the ileal pylorus remains to be fully elucidated, it appears advisable to preserve this muscular mechanism whenever possible.
TL;DR: It can be stated that 64 patients were treated by quite simple means and only two of the 64 died and other methods of treatment have yet to prove more effective than these more simple procedures in the management of acute diverticulitis.
Abstract: It is important to point out that this series of 144 cases of acute diverticulitis is a prospective study, with each case documented in great detail; therefore, the study provides a good basis for the evaluation of treatment. No definite conclusions can be reached at the present time, but it can be stated that 64 patients were treated by quite simple means ( i.e., drainage alone or drainage combined with closure of a perforation) and only two of the 64 died. Other methods of treatment, such as colostomy or emergency resection, have yet to prove more effective than these more simple procedures in the management of acute diverticulitis. The important thing, obviously, is to save the patient's life. The question whether more extensive surgery during this emergency period would prevent future symptoms and complications will require further careful follow up of the patients in the survey.
TL;DR: A case of adenoacanthoma of the sigmoid colon is described in this paper, and twelve other cases have been reported in the literature, suggesting that this histologic tumor differentiation in the colon is rare.
Abstract: A case of adenoacanthoma of the sigmoid colon is described. Twelve other cases have been reported in the literature. This figure suggests that this histologic tumor differentiation in the colon is rare. The histologic appearance and theories of histogenesis are discussed and the literature reviewed.
TL;DR: Surgical treatment of diseases of the perianal region, perineum and buttocks should be attempted only by those familiar with working in the area, and easily and often confused with ordinary fistula in ann or, when limited to the posterior anal space, with pilonidal disease.
Abstract: PERIANAL HIDRADENITIS SUPPURATIVA has been known as a disease entity for more than 100 years. The search for adequate therapy by investigators in dermatology, radiology and surgery has been intensive. Radiotherapy and antibiotics are ineffective in extensive, chronic cases. This presentation deals with a surgical method of treatment which has had gratifying results at the Henry Ford Hospital. Surgical treatment of diseases of the perianal region, perineum and buttocks should be attempted only by those familiar with working in the area. Cases of hidradenitis suppurativa are easily and often confused with ordinary fistula in ann or, when limited to the posterior anal space, with pilonidal disease. \"Hidradenitis\" is derived from the Greek \"hidros\" (sweat), \"aden\" (gland) and \"itis\" (inflammation), and \"suppurativa\" from Latin \"sub\" (under) \"'puris\" (pus). The lesions are caused by blockage of the apocrine sweat glands and superimposed secondary infection. Apocrine glands are found most frequently in the axilla, less often in the perianal region, and even less often in the scrotum, genitalia, areola, back of the neck, and groin. Men and women are affected in about equal numbers. The disease usually begins as a tender red papule, which rapidly evolves into a painful reddish-purple nodule. T h e nodule may rupture 01 n a y s~reaci to adjaren; areas. Se-
TL;DR: In this paper, the concomitant development of gross infection adjacent to sutured colonic wounds and anastomoses did not prevent macroscopic healing of the bowel in any of the 39 dogs in which such abscesses were found.
Abstract: Under the conditions of these experiments, the concomitant development of gross infection (pouch abscess) adjacent to sutured colonic wounds and anastomoses did not prevent macroscopic healing of the bowel in any of the 39 dogs in which such abscesses were found. Bowel preparation with framycetin (used in 17 of 42 dogs) did not produce any obvious difference in macroscopic healing of colonic wounds and anastomoses; nor was there any difference in microscopic healing or resistance to bursting pressure, although the numbers of experiments in these two categories were too small to be significant.
TL;DR: In this paper, a case of colitis cystica profunda in an adenoma which was diagnosed and treated as a benign lesion at celiotomy is presented.
Abstract: Reference is made to cases in which a frozen-section diagnosis of adenocarcinoma of the colon or doubt has led to a segmental resection for a benign condition (colitis cystica profunda). A case of colitis cystica profunda in an adenoma which was diagnosed and treated as a benign lesion at celiotomy is presented. It is proposed that adenomas may play a role in the pathogenesis of colitis cystica profunda. Fecal irritation of the head of a polyp high in the colon may have the same effect that fecal irritation has in the lower sigmoid colon and rectum.
TL;DR: It is concluded that cecostomy should not be neglected for primary relief of ileus, rather, it should be preferred when there is diastatic rupture of the cecum, when the patient’s condition is poor, and when the carcinoma lies in the transverse colon or in the vicinity of the splenic flexure.
Abstract: Seventy-six patients with obstructive carcinoma of the colon were treated with catheter cecostomy. Twenty-three died while still in the hospital, five of complications directly related to cecostomy. There were eight nonfatal incision infections, seemingly associated with the closing of incisions around the cecostomy catheters. Fifty per cent of the cecostomies closed spontaneously after resection.
TL;DR: A new surgical technic with partial closure for treatment of pilonidal sinuses compared favorably with the marsupialization operation in healing time, in lack of morbidity, and in low recurrence rate.
Abstract: A new surgical technic for treatment of pilonidal sinuses is presented and results of its use in 110 patients are evaluated. This excisional technic with partial closure (midway between an open operation and a primary closure) compared favorably with the marsupialization operation in healing time, in lack of morbidity, and in low recurrence rate. The technical steps in the procedure are outlined. The operation is particularly indicated where the tracts are small, tortuous or ill-defined.
TL;DR: Adenomatous polyp is a benign glandular growth that protrudes into the lumen of the bowel but does not infiltrate the bowel wall, and may be so large as to become annular.
Abstract: T H E HISTOPATHOLOGIC SIGNIFICANCE Of polypoid lesions of the colon has been in a state of change since 1948, when Sunderland and Binkley 5 pointed out the malignant potentiali t ies of villous, or papillary, adenomas. Prior to that time all polypoid lesions of the colon were believed to be mal ignant or premal ignant and accordingly, were removed. The surgeon had no anxieties about the logic of his therapy. As the heterogeneous group of \"polyps\" became segregated into three main divisions, adenomatous polyps, villous adenomas, and polypoid carcinomas, therapeutic decisions became more difficult, especially when the tumor was above the reach of the sigmoidoscope, where a biopsy is not obtainable. T h e adenomatous polyp is a benign glandular growth that protrudes into the lumen of the bowel but does not infiltrate the bowel wall. I t may be pedunculated or sessile, and varies in size from 1 m m to several centimeters in diameter. T h e head is usually spherical. Microscopically, there are numerous glands below the surface epithelium, and projections do not extend to the basement membrane at any point. T h e lesion is almost always benign, the incidence of malignancy being less than 1 per cent. T h e papillary~ or villous, adenoma tends to be sessile, and may be so large as to become annular. About lO per .cent have pedicles. The surface is s~mi!ar in color
TL;DR: The incidental discovery of nonpolypoid carcinomain situ of the colon should be an indication for local resection and careful search for additional bowel tumors.
Abstract: A case of multicentric neoplasia of the colon is described. At least two of the lesions fit all the criteria for nonpolypoid carcinomain situ, a lesion previously not described in that location. The lesions are believed to have been potentially malignant, but at the time of excision probably were benign. The incidental discovery of nonpolypoid carcinomain situ of the colon should be an indication for local resection and careful search for additional bowel tumors.
TL;DR: “Cancer-family syndrome” would seem to be the better descriptive term for the changes observed; it covers those aspects of the syndrome which can be verified with greatest reliability.
Abstract: The medical pedigree of a kindred of 50 members is presented. The findings in this kindred suggest the possibility of two genetically determined syndromes, namely those of the “cancer family” and “heritable solitary colonic polyps.” Review and interpretation of evidence already documented suggests that the two syndromes are identical. “Cancer-family syndrome” would seem to be the better descriptive term for the changes observed; it covers those aspects of the syndrome which can be verified with greatest reliability.
TL;DR: A brief summary of the benign adenoma-carcinoma controversy is presented, along with a discussion of how the present case might be interpreted.
Abstract: A 2-cm colonic polyp on a substantial stalk was clearly visible on barium-enema examination in 1964. In 1966, follow-up examination showed no change. Two years later, a small sessile carcinoma was demonstrated at the same site and resected. No residual stalk or benign adenomatous tissue was seen within the small, superficial, sharply demarcated carcinoma. A brief summary of the benign adenoma-carcinoma controversy is presented, along with a discussion of how the present case might be interpreted.
TL;DR: The case of a patient who had ischemic proctitis, first seen because of stricture formation of the rectum which clinically seemed to be granulomatous colitis is presented in this paper.
Abstract: The case of a patient who had ischemic proctitis, first seen because of stricture formation of the rectum which clinically seemed to be granulomatous colitis is presented. Abdominoperineal rectal resection eventually was necessary. The vascular changes appeared to be limited to the rectum and were of a severely proliferative, obliterative type which could lead to ischemia of the tissue distal to the obliteration.
TL;DR: Six cases of proven meningitis complicating perforating colonic and rectal wounds and two suspected cases are described and principles of surgical therapy which should reduce the incidence of this complication are presented.
Abstract: Six cases of proven meningitis complicating perforating colonic and rectal wounds and two suspected cases are described. The mortality rate was 66 per cent. The incidence of this complication in all colonic and rectal injuries is 2 per cent; in combined colorectal injuries involving primary laminectomy it is 12.5 per cent. Principles of surgical therapy which should reduce the incidence of this complication are presented.
TL;DR: Volvulus of the transverse colon is rare and a case report of this unusual condition is presented, along with a review of the literature.
Abstract: Volvulus of the transverse colon is rare. A case report of this unusual condition is presented, along with a review of the literature. Possible factors of pathogenesis are discussed and an outline of diagnostic and therapeutic measures is included.
TL;DR: In this article, a staging system was used instead of Dukes' classification or its modifications for colorectal cancer staging in 429 patients with colonic or rectal carcinomas.
Abstract: The records of 429 patients with colonic or rectal carcinomas were reviewed and, where feasible, a staging system was utilized instead of Dukes’ classification or its modifications. We believe that staging of carcinoma of the colon and rectum is simple, correlates with survival, and offers uniformity.