H. Earl Gordon

Excision of rectal lesions by the Kraske approach

Abstract The Kraske operation is a little used procedure which has value in the treatment of selected benign lesions of the rectum below the peritoneal reflection. The operation is especially suitable for broad-based villous tumors or large adenomatous polyps. Total excision of villous tumors is essential to obviate invasive cancer and to prevent recurrence. The principal complication of the posterior proctectomy is the development of proctocutaneous fistulas (four of twenty cases). In three of the four cases the fistulas closed spontaneously. The Kraske operation is curative for villous adenomas showing atypia or carcinoma in situ and probably is sufficient treatment for tumors showing superficial foci of adenocarcinoma, but it should be emphasized that there is still no place for this procedure in the treatment of invasive carcinoma.

Massive hemorrhage from the celiac axis in pancreatitis

Abstract Four patients with massive hemorrhage from the celiac axis secondary to pancreatitis are presented. There were three survivors. Celiac axis arteriography was useful in making the diagnosis and determining operative management. Extended gastric resection was required in three patients. An early and continued aggressive diagnostic approach is indicated in patients with chronic pancreatitis and/or pseudocyst and significant upper gastrointestinal bleeding.

Assay of aspirin and naproxen analgesia

To establish the relative potency ofnaproxen and aspirinfor oral analgesia, a 4‐point, noncrossover bioassay with placebo control was undertaken with 197 patients. Subjective‐response methods were used to determine two measures of postoperative analgesia over aperiod of 6 hr. With reasonable confidence for an oral analgesic assay, we found 220 mg of naproxen to be equivalent to 600 mg of aspirin for pain relief and 330 mg of naproxen to be equivalent to 600 mg of aspirin for decreased pain intensity.

Carcinoma of the gastroesophageal junction: A ten year experience with esophagogastrectomy

Eighty-six patients with carcinoma of the gastroesophageal junction were treated between 1966 and 1976. Adenocarcinoma was present in 62 patients and squamous cell carcinoma in 24. Surgical exploration was performed on 68 patients (79%) and 52 lesions (60%) were resected by combined midline laparotomy and right thoracotomy. There were 6 deaths (11%), 2 due to anastomotic leak. The mean survival for all resected patients was 2.1 years with a 22% three year life table survival (10/52). Five of 14 patients with negative nodes are alive more than five years. Palliative resection in 17 patients resulted in a mean survival of 10.5 months and no five year survivals. Esophagogastrectomy utilizing the Lewis technic reduces operative mortality and extends survival for patients with carcinoma of the gastroesophageal junction.

Persistent and recurrent hyperparathyroidism

Twenty-six patients with persistent or recurrent primary hyperparathyroidism after an initial cervical exploration are presented. Failure of the first operation was related in part to an ectopic location of the abnormal parathyroid tissue (in 58 percent), and to a discrepancy in the histologic diagnosis between the frozen-section analysis at the time of operation and the final pathologic interpretation (in 55 percent). Before secondary operation, selective venous sampling for parathormone levels and arteriography were accurate in localizing the lesion in 88 and 71 percent of cases, respectively. A plan for intraoperative management of these difficult problems is suggested.

Experimental infection of dacron and bovine grafts.

Abstract This study compared the susceptibility of Dacron and ficin treated bovine grafts, implanted in dogs, to infection induced by a staphylococcal bacteremia. Forty mongrel dogs had a 2-cm segment of the infrarenal aorta replaced with either a 6-mm diameter Dacron or bovine graft. The dogs were divided into four groups: Control Groups I and II consisted of 5 dogs with Dacron grafts and 5 dogs with bovine grafts, respectively. In Group III, 16 dogs had Dacron grafts implanted and were given a S. aureus bacteremia. Group IV consisted of 15 dogs with bovine grafts subjected to S. aureus bacteremia. All dogs were sacrificed at 6 wk postoperatively, unless death occurred earlier. The grafts were cultured in beefbrain broth, plated, and bacterial growth identified by phage typing. Control Groups I and II showed no growth on cultures of the grafts. In Group III (Dacron grafts) 5 dogs died between the seventh and ninth postoperative days due to disruption of the infected anastomoses. Fifteen of the 16 Dacron grafts yielded growth of S. aureus phage type 29/52/81 on culture. All 15 bovine grafts in Group IV were infected with S. aureus and there were 14 deaths between days 5 and 8 due to hemorrhage from the disrupted grafts. It is concluded that Dacron and bovine grafts are equally susceptible to bacteremic infection, but disruption occurs more frequently and earlier in the infected bovine graft.

Marginal Ulcer: A Guide to Management

A marginal ulcer occurring after an initial operation for gastroduodenal ulcer disease is a serious threat to the patient and a difficult challenge to the surgeon. This review is intended to acquaint the surgeon with factors in the etiology of marginal ulceration, and to provide some useful diagnostic aids.

Diagnosis and management of gastrointestinal bleeding.

Abstract An aggressive diagnostic approach is advocated for the patient with gastrointestinal bleeding in order to provide a rational basis for therapy. Since routine barium studies may be negative...

Intraoperative antibiotics in the prevention of experimental dacron graft infection.

Moore and colleagues have shown that newly inserted Dacron-) vascular grafts are very susceptible to infection from circulating bacteria.’ Since S. Martin Lindenauer demonstrated in 1967 that prophylactic use of penicillin prevented the infection of Teflon patch grafts in a group of five dogs, experiments have been designed to justify the widespread use of prophylactic antibiotics in vascular surgery.’ 6

Nonpancreatic abscess of the lesser sac

Posterior perforation of a peptic ulcer is the major cause of nonpancreatic abscess of the lesser sac. The characteristic clinical presentation, laboratory data, and diagnostic x-ray findings are reviewed. Results of surgical drainage are good, although patients may subsequently require a more definitive operation.