Daher E. Cutait

Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins.

The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.

Abdominoperineal endoanal pull-through resection

Abdominoperineal endoanal pull-through resection with colorectal anastomosis was performed on 728 patients—primarily those with chagasic megacolon and cancer of the rectum. Intestinal continuity was reestablished through immediate anastomosis (Swenson procedure) in 229 patients and through delayed anastomosis (Cutait-Turnbull procedure) in 499. Comparative studies showed: that the incidence of leakage was 31.9 percent in immediate and only 2.2 percent in delayed anastomosis; that presacral infection occurred in 27.9 percent in immediate and in 6.8 percent in delayed anastomosis; that stenosis was observed in 4.4 percent in immediate and 1.8 percent in delayed anastomosis; that mortality was 6.1 percent in immediate and 2.2 percent in delayed anastomosis; that anal continence was good in both procedures and that sexual disturbances were rare in benign and frequent in malignant lesions in both procedures. The final conclusion is that, in abdominoperineal endoanal pull-through resection with colorectal anastomosis, complications and mortality are less frequent in delayed than in immediate anastomosis and that continence and sexual behavior are identical in both procedures.

Stapled anastomosis in colorectal surgery.

The authors review their experience with stapled anastomosis in colorectal and ileorectal resections for malignant and benign lesions of the large bowel. They describe the technique and results in a series of 49 patients (24 with cancer of the rectum and rectosigmoid junction; six with familial polyposis, associated with cancer in four; 12 with chagastic megacolon; three, Crohn’s disease; two, ulcerative colitis; and one each, diverticular sigmoiditis and ischemic sigmoiditis). Anterior resection was performed in 38 patients and total colectomy with ileorectal anastomosis in 11. Main complications and mortality are presented. They conclude that stapled anastomosis is an efficient method for intestinal reconstruction after resection for malignant and benign lesions of the large bowel

Rectosigmoidal hemangioma: Report of two cases

ConclusionsRectosigmoidal hemangioma is of extremely rare occurrence. The diagnosis is based on proctoscopic and radiologic examination. The cause is unknown and the prognosis is always serious because of the danger of uncontrollable hemorrhage that may occur at any moment. Treatment is surgical.

Giant follicular lymphoblastoma of the rectum (brill-symmers disease)

Summary and ConclusionsThe authors have presented a case of giant follicular lymphoblastoma (Brill-Symmers disease) involving the rectum. It is a rare disease which pursues a fairly characteristic clinical course. The lesion can be discovered by proctoscopic examination but, to establish the differential diagnosis, microscopic examination is essential. Biopsy should not be relied upon: the entire lesion should be available for microscopic study. Eventually, the lesion may become malignant. Specific treatment consists of complete removal of the tumor by surgical operation; subsequently, irradiation should be administered to destroy residual cells.

Immediate and late results of anal ileostomy after total proctocolectomy for ulcerative colitis

SummaryThe various surgical and physiologic problems associated with anal ileostomy after performance of total proctocolectomy are discussed. An opinion is given as to the value of this procedure. It is judged that anal ileostomy can be performed only when “colonization” of the terminal part of the ileum has taken place after performance of abdominal ileostomy.The immediate and late results obtained for five patients thus operated upon are presented.

Submucous subserous lipoma of the colon

ConclusionsAmong lipomas of the colon, mixed submucous-subserous lipomas are rare. The etiology is obscure. Diagnosis is difficult and rarely made without radiologic study of the colon with double-contrast technic and air insufflation.Treatment is always surgical and prognosis is good.