Showing papers on "Surgical oncology published in 1981"

Palliative resection for colorectal carinoma

Abstract: In an attempt to identify those patients who would benefit from palliative resection of the colon or rectum and those who would not, an analysis of ten years of resections was undertaken. For the 81 patients who underwent palliative resection, the operative mortality was 10 per cent and the postoperative morbidity was 50 per cent. The mean survival was 11.4 months and the median survival nine months. Poor prognostic factors deduced were patients with extensive liver metastases, those over the age of 75 years, and a previous history of cardiovascular disease. It is believed that patients with a combination of these factors may not benefit from palliative resection. Otherwise, resections satisfactorily relieve patients of the symptoms of impending obstruction and rectal bleeding and are, therefore, believed to be worthwhile.

Abdominoperineal resection for recurrent cancer following anterior resection

Abstract: Cases are reviewed of 12 patients who had abdominoperineal resections for cancer recurrence subsequent to anterior resection. Although this procedure is technically more difficult, we experienced no mortality or significant morbidity, and the postoperative hospital stay was similar to that of patients who received an abdominoperineal resection as a primary procedure. Although we have no long-term cures, at least significant palliation can be achieved in selected patients who have no evidence of distant metastases

Rapidly growing carcinoma of the colon.

Abstract: Carcinoma of the colon is usually considered a slow growing neoplasm. Three case reports are presented demonstrating growth rapid by previous standards, stimulating a reassessment of the literature. The present data suggests that rapidly growing colonic cancers may not be unusual and this might ultimately be reflected in changing currently accepted screening practices.

Colonoscopic removal of hemangiomas.

Abstract: A case is reported in which a colonic hemangioma was successfully removed endoscopically. The authors recommend that the colonoscopist be skilled and use the technique only for polypoid lesions

Classic articles in colonic and rectal surgery

Abstract: Benjamin Collins Brodie was born in 1783, the sort of a clergyman, in Winterslow, Wiltshire. In 1798, when only 15 years old, he fought against Napoleon. Iv, 1801 he decided to pursue a career in medicine, eventually becoming house surgeon at St. George's Hospital in 1805. Three years later, at the age of 25 he became assistant surgeon, and in 1822, surgeon. In 1810, he was elected Fellow of the Royal Society after presenting a paper entitled \"Dissection of a Fetus.\" It was because of this presentat ion that he began to achieve a considerable reputation not only as a surgical anatomist, but as a writer and speaker. In 1813, Brodie described the joint disease that was later to bear his name. So universal were his writings that he seemed as comfortable on the subject of influence of the nervous system on production of animal heat as with describing the pathology of anal fissure. He combined the skill of a surgeon with the intellectual accomplishment of an academician. In 1828, he became surgeon to King George IV. He held man)\" p res t ig ious pos i t ions , i n c l u d i n g P re s iden t of the MedicoChirurgical Society., President of the Western Medical and Surgical Society of London and President of the General Medical Council. He was the first surgeon to hold the position of President of the Royal Society. IIe died October, 21, 1862, of a malignant disease originating in his shoulder, probably sarcoma. The article which is reproduced here was published in 1835. One is struck by the keen obse~'at ion of the author in describing the signs, symptoms, pathologic findings, and treatment of several anal conditions. In the discussion on stricture of the rectum he could be describing lymphogranuloma venereum, as difficult a condition to treat now as then. But this article is pr imari ly presented because Brodie was the first person to describe sphincterotomy in the treatment of anal fissure. g; jd'd'j-r-o

Pseudo-obstruction of the colon during pelvic radiotherapy.

Abstract: Pseudo-obstruction of the colon, or Ogilvie’s syndrome, is characterized by an adynamic, dilated, unobstructed colon, the exact cause of which remains obscure. Although several precipitating factors have been described in the literature, we have observed three patients whose pseudo-obstruction of the colon occurred during interstitial and intracavitary pelvic irradiation. Such a cause has not been noted previously. Pseudo-obstruction of the colon can have serious consequences if it is not recognized early and treated vigorously.

Enteroduodenal fistulas in Crohn's disease.

Abstract: A case report of a patient suffering from an ileoduodenal fistula due to Crohn's disease is presented. Other reports are reviewed and different views on the treatment of such a fistula are discussed.

Spontaneous appendicocutaneous fistula: Report of a case and review of the literature

Abstract: A case of spontaneous appendicocutaneous fistula, a rare complication of acute perforating appendicitis, is reported, and the literature is reviewed.

Colonic tuberculosis mimicking annular carcinoma: Report of a case

Abstract: Tuberculosis of the colon may be difficult to distinguish from Crohn's diseases or other causes of benign or malignant stricture, but rarely is seen as a classic solitary “apple-core” lesion on barium-enema examination. Such a case is presented, and the radiologic and pathologic features discussed.

Implanted pump concentrates chemotherapy for liver cancer.

Abstract: An implantable infusion pump is prolonging survival in hepatic cancer, both primary and metastatic. The pump delivers 100 to 400 times the amount of floxuridine that the liver receives through conventional systemic chemotherapy—without the life-threatening side effects, as only 2% of the drug reaches the systemic circulation. Surgery to implant the pump is somewhat tricky, but ten to 14 days afterwards, patients go home and, if their disease is not too advanced, resume normal lives. The pump, manufactured by Infusaid Corporation, Sharon, Mass, was originally developed by the University of Minnesota's biomedical engineering department for the administration of heparin; it also has been used for insulin delivery. At the University of Michigan Medical Center, Ann Arbor, William D. Ensminger, MD, PhD, associate professor of internal medicine and Burroughs Wellcome Scholar in Clinical Pharmacology, and John Niederhuber, MD, head, Division of Surgical Oncology, began using the device for chemotherapy administration about

Report of a family with cancer family syndrome.

Abstract: A report of the history and management of colonic cancer in two brothers with Cancer Family Syndrome is presented. An analysis is made of the prevalence of colonic and endometrial cancer in this family. The risk to the progeny of affected and unaffected individuals is discussed, and recommendations for screening for early signs of cancer are offered.

A method of management of a circumferential villous tumor of the rectum.

Abstract: A case is presented in which a very large circumferential villous tumor was totally removed transanally with complete anatomic and physiologic restoration. Large circumferential tumors of the rectum present formidable technical problems. They may be malignant. When they are benign, abdominoperineal resection can be avoided. A less radical procedure that may be employed with complete resection of the tumor and without stricture formation, is described briefly.

Pseudocarcinomatous invasion of colonic polyps.

Abstract: The recently described but little-recognized entity of “pseudocarcinomatous invasion” or “epithelial misplacement” in adenomatous polyps of the colon and rectum is discussed, with the presentation of a recent case. The entity's clinical characteristics, histologic features, and pathogenesis are described. The implications of recognizing such a lesion are emphasized.

Esophageal carcinoma associated with neurofibromatosis-a case report.

Abstract: An unusual occurrence of esophageal carcinoma in a 58-year-old man with neurofibromatosis is reported. The patient underwent radical surgery, but died of multiple metastases to the bones, lungs, liver kidneys, adrenal glands and heart shortly after the operation. This paper contributes new information to documented cases of the association of malignancies to neurofibromatosis.

A clinical comparison of handsewn vs. stapled anastomoses.

Abstract: Earlier in the week several questions were raised as to the safety of the EEA stapler, its speed of anastomoses, and a question was raised about whether or not there might, indeed, be a higher risk for recurrent carcinoma in patients who have an anterior anastomosis with the EEA stapler. These questions are only going to be adequately answered by carrying out randomized prospective studies We have carr ied out such a prospective randomized trial to evaluate the EEA stapler in pe r tb rming anterior anastomosis. We def ined an an te r io r anastomosis as the un ion o f peri tonealized colon to nonper i toneal ized rectum. The patients were apprised preoperat ively o f the study and permission for entry into the study was obtained. At the time of surgery, the complete dissection was carried out and, at that point, a decision was made as to whether either o f the techniques ~a twolaver handsewn anastomos~s or a stapled anastomosis) could be carried out. I think it is impor tan t to emphasize that this looks at the traditional two-layer handsewn anastomosis, not a single-layer anastomosis~ I f either could be used, then by a c o m p u t e r randomizat ion , one technique was selected. If, however, it was decided that one method, for any one of a number o f conceptual reasons, offered an advantage to the patient, then that procedure was utilized and the patient was excluded and followed m a separate group, but following the same postoperative parameters. We therefore followed two groups of patients: those who were randomized and those that we could not randomize and were followed in an excluded group. The study was designed to de te rmine if the EEA is faster, safer, and /o r technically advantageous. Eighty patmnts were entered in the study in slightly over one year; 35 were randomized into the staple g r o u p ; 35 were r a n d o m i z e d into the h a n d s e w n group, and 10 were excluded. Al though there were a number o f theoretical reasons why a patient might be excluded, in fact, all o f these patients were excluded because it was feb. at the time of surgery, that a s tandard two-layered anastomosis could not be done wherever a stapled anastomosis could be created.

Classic Articles in Colonic and Rectal Surgery

Abstract: John Morgan's brief article is here reproduced as a “Classic” with perhaps a little less fanfare than other more renowned contributors to our literature. He was not the first to resect a colon nor the initial describer of a new disease. But his contribution, which appears almost as an afterthought in his paper, is unique in that it represented the first report of what was to become for 100 years the primary treatment for office management of hemorrhoids—injection therapy.

Benign ulcer of the cecum

Abstract: Benign cecal lesions, although not frequently encountered, are often difficult to differentiate from carcinomas. With the general availability of colonoscopy, cecal lesions can be visualized and a biopsy can be done. If the biopsy specimen reveals inflammatory changes only, the patient should be managed nonoperatively and colonoscoped again in four weeks.

Colonic obstruction as a complication of ulcerative colitis

Abstract: Colonic obstruction requiring specific treatment as a complication of ulcerative colitis occurred in four of 644 patients with ulcerative colitis seem from 1969 through 1979. Four other cases have been reported by others. These obstructions were caused by strictures or pseudopolyps. Although the treatment is nonoperative in some cases, surgery is indicated if carcinoma cannot be ruled out or if obstruction persists.

Smooth muscle tumors of the stomach

Abstract: In retrospect, we analyzed 12 cases of gastric smooth muscle tumor, nine cases of leiomyomas and three of leiomyosarcomas. In only half the number of these patients was an adequate preoperative diagnosis made. Ulceration of the tumor apparently led to a misjudgment in some cases. Features more relevant to leiomyosarcoma than to leiomyoma were findings of a larger size, exogastric growth, ulceration and tumor in patients over 50 years of age. It is stressed that enculeation is the treatment of choice for leiomyoma and an extensive gastrectomy for cases of leiomyosarcoma.