Gary Slater

A comparison of multiple synchronous colorectal cancer in ulcerative colitis, familial polyposis coli, and de novo cancer.

Multiple synchronous colorectal cancer (MSCC) among 1537 patients (69 with familial polyposis coli (FPC), 780 with ulcerative colitis (UC), and 685 with de novo colorectal (DNC) cancers) admitted to The Mount Sinai Hospital between 1945 and 1981 was tabulated. MSCC occurred in five of 24 cancer patients with FPC (21%), in 12 of 65 cancer patients with UC (18%), but in only 17 of 685 DNC patients (2.5%). The proportions of MSCC cases with more than two synchronous tumors were also much greater in the former two groups (UC 6/12 = 50%, FPC 3/5 = 60%) than in DNC (0/17 = 0%). Multiplicity of cancers is thus a distinguishing feature of UC and FPC. MSCC differed from solitary cancers by association with older age and more advanced stage at diagnosis in patients with FPC and by a rightward shift in anatomic distribution in all patients, especially those with FPC and UC.

The Nature and Fate of Categorical Surgical Residents Who “Drop Out”

BACKGROUNDnLittle is known about the fate of categorical surgical residents who leave a program or if they differ from those who successfully complete a program.nnnMETHODSnMatching into separate categorical and preliminary categories with elimination of the pyramid began in 1982. The files of all categorical residents matched between 1982 and 1995 were reviewed for demographic and scholastic data. Drop-outs were compared with the residents who completed the program and with the current house staff. All residents have been followed up to the present.nnnRESULTSnBetween 1982 and 1996, 19 of 88 (22%) categorical residents who matched into the program left voluntarily. Eleven of 63 (17%) were male and 8 of 25 (32%) female (P = 0.12; test of proportions-Z = -1.55). They entered both surgical and nonsurgical fields. The major reasons for leaving were related to life-style issues. Their academic credentials are very similar to those who remained.nnnCONCLUSIONSnThe drop-out rate of categorical surgical residents is significant, and replacing them is not easy. We have not identified any characteristics that might predict attrition.

A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction

BACKGROUNDnMany cases of acute adhesive small-bowel obstruction (SBO) can be successfully treated with intestinal tube decompression. There is considerable controversy, however, regarding whether a short nasogastric tube (NGT) or a long nasointestinal tube (LT) is the best method of intestinal tube decompression.nnnPATIENTS AND METHODSnA prospective, randomized trial was conducted to compare NGT and LT decompression with respect to the success of nonoperative treatment and morbidity of surgical intervention in 55 patients with acute adhesive SBO.nnnRESULTSnTwenty-eight patients were managed with NGT and 27 with LT. There were 44 cases of partial SBO (23 NGT, 21 LT) and 11 cases of complete SBO (5 NGT, 6 LT). Twenty-one patients ultimately required operation, including 13 managed with NGT (46%) and 8 with LT (30%) (P = 0.16). The mean period between admission and operation was 60 hours in the NGT group versus 65 hours in the LT group. At operation, 3 patients in the NGT group had ischemic bowel that required resection. Postoperative complications occurred in 23% of patients treated with NGT versus 38% of patients treated with LT (P = 0.89). Postoperative ileus averaged 6.1 days for NGT patients versus 4.6 days for LT patients (P = 0.44). There were no deaths.nnnCONCLUSIONSnPatients with adhesive SBO can safely be given a trial of tube decompression upon hospital admission. There was no advantage of one type of tube over the other in patients with adhesive SBO.

Thymomas in patients with myasthenia gravis.

The records of 141 patients with myasthenia gravis who had thymomas were reviewed. In this series there were 69 noninvasive tumors and 52 invasive tumors. The five year survival for all patients was 60%, with the invasive group demonstrating a poorer prognosis than the noninvasive. The remission rates for the whole group (both invasive and noninvasive) of myasthenics was quite low (7%). Although the overall survival of this series of patients was relatively high, it is felt that by earlier diagnosis and a more aggressive surgical approach their prognosis will be even better.

Age and sex distribution of patients with colorectal cancer

A retrospective review of 922 colorectal cancer patients was undertaken to determine whether the nonuniform anatomic distribution of colorectal cancer was influenced by age and/or sex. The mean age of patients with right colon lesions (71.2 years) was significantly higher than for either patients with left colon lesions (68.2 years) or rectal lesions (65.6 years). Further analysis disclosed that patients with proximal tumors were older than patients with distal tumors primarily because of the later presentation of females with cecal or ascending colon cancers. Comparison of the anatomic distribution of tumors in patient groups above and below the age of 70 revealed that right colon cancers accounted for a greater percentage of colorectal tumors in the older patient group than in the younger patient group. These findings support the roles played by both age and sex in influencing colorectal cancer location. Furthermore, these data provide a plausible explanation for the increasing incidence of proximal colonic lesions

Clinicopathologic correlations of ABO and rhesus blood type in colorectal cancer

There is no specific association established between colorectal cancer and blood group type. In this study, the distribution of ABO and Rh blood groups was studied in 838 patients with colorectal cancer. There was no difference in distribution of ABO blood groups between patients who were Rh+ and Rh-. There was no difference in ABO blood group or Rh factor and tumor location. The highest A/O ratio was found in rectal cancer. Although there was no difference in stage distribution for each ABO blood group, there was a significant difference between the Rh+ and Rh-groups (P<0.037).It is not clear, however, whether the prognosis is different between the two groups since there were more early tumors as well as incurable tumors in the Rh-group. All patients with synchronous cancer were Rh+. Further studies on blood group antigens are needed to elucidate the relationship between these antigens and colorectal cancer.

Preoperative and postoperative immunological evaluation of patients with colorectal cancer

Twenty‐two patients with cancer of the colon and rectum were studied: preoperative and postoperative cell‐mediated and humoral immune factors were assessed, and local concentration of immunoglobulins in tumor tissue and in normal mucosa were measured. Lymphocyte function was found to be reduced in 50% of stage A and B and 66% of stage D patients. On the other hand, when the lymphoblastogenesis was performed in the presence of normal AB plasma, a partial restoration of lymphocyte function was noted, indicating the presence of a serum blocking factor in the blood of these patients. While there was no apparent decrease of B cell subpopulation, 57% of the tested patients showed significant reduction of T lymphocytes.

Distribution of colorectal cancer in patients with and without ulcerative colitis

A comparison of the anatomic distribution of colorectal cancer in patients with and without CUC is difficult because of the unequal number of patients in each group and the changing epidemiologic parameters of colorectal cancer in general. In the present study, the distribution of colorectal tumors in patients with and without CUC was compared over two different time periods at a single hospital. In the early time period (1960 to 1975), there was a significantly higher percentage of proximal tumors in the group with cancer and CUC compared to the group with cancer alone. In the most recent time period (1975 to 1981), there was no difference in distribution of colorectal cancer regardless of whether the patient had CUC or not. We believe that the increased percentage of proximal tumors in patients with colorectal cancers and no CUC that has occurred in recent years has led to the present findings of a similar distribution of tumors in patients with and without CUC.

Temporary loop ileostomy in the treatment of Crohn's disease.

The use of a temporary loop ileostomy for fecal diversion in 15 patients with Crohns disease is discussed. The indications for the use of ileostomy included both emergency and nonemergency situations. Emergency indications included cases of acute peritonitis secondary to perforated bowel or abscesses, and intestinal obstruction. In nonemergency settings ileostomy was used either in conjunction with other surgery that was thought to have a significant risk of anastomotic leakage or to prepare a patient for major resectional surgery. It was the impression of the authors that temporary loop ileostomy was a helpful adjunct in the management of certain difficult cases of Crohns ileocolitis.

Compliance of the Extramural Portion of the Canine Common Bile Duct

Abstract The physiologic characteristics of the biliary tract cannot be adequately evaluated without analyzing both the resistive and compliant characteristics of the common bile duct. We studied the compliance of the common bile duct in six anesthetized dogs. Saline was infused continuously while pressure was monitored with the sphincter of Oddi intact and tied off. The mean opening pressure of the sphincter was 8.45 cm H2O. In the obstructed duct, compliance was found to decrease with increasing pressure. The mean compliance for all five dogs at low pressures (below opening pressure) was 11.0 × 10-2μl/cm H2O/mm2, and at high pressures was 1.7 × 10-2μl/cm H2O/mm2. Changes in flow rate did not affect the compliance of the duct. Although the compliance of the duct was found to be nonlinear overall, it was nearly linear in both the high- and low-pressure ranges.