James A. Ferguson

Prevention of urinary retention by fluid restriction following anorectal operations

SummaryIn a carefully controlled prospective randomized study of 500 patients, the postoperative catheterization rate following anorectal surgical procedures was dramatically reduced by a combination of severe dehydration of the patients and reorientation of the nursing personnel to delay catheterization until the bladder is distended. The effectiveness of fluid restriction was clearly demonstrated.

Prophylactic oophorectomy and colorectal cancer in premenopausal patients

ConclusionSince 1960, 162 patients with colorectal carcinoma have undergone oophorectomy at the Ferguson Clinic; 137 of these patients were operated on from 1969 to 1976 and were reviewed.Six of 12 patients developing metastasis to the ovaries were premenopausal. In review of the overall experience with premenopausal patients, metastasis to the ovaries developed in 22 to 25 per cent of patients. This is significantly higher than the usual overall rates of metastasis which are reported to occur with a frequency of 3 to 8 per cent.The survival rate of prophylactic oophorectomy for microscopic metastasis to ovaries and the high rate of metastasis in premenopausal patients, warrants prophylactic oophorectomy in all patientsregardless of age. Oophorectomy in patients with colorectal cancer can no longer be considered prophylactic, but therapeutic.

Hemorrhoidectomy revisited--a computer analysis of 2,038 cases.

SummaryA computer analysis of the 2,038 cases of consecutive patients who underwent closed hemorrhoidectomy is presented. Results based on a five-year follow-up study are tabulated.

Anal S-plasty for “Whitehead deformity”

SummaryThe S-plasty, or double-rotation flap, operation for the Whitehead deformity has proved successful. Thirteen patients having the procedure over the past 13 years at the Ferguson Clinic have all had excellent anatomic results

Ischemic proctitis with obliterative vascular change

SummaryThe 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.

Hindgut duplication: report of a case.

SummaryA case of complete duplication of the hindgut is reported. Attention is drawn to the surgical dilemma which can result when such a case comes to operation and the true diagnosis has not been established.

The surgical significance of complete retrograde obstruction of the colon

SummaryOf 44 patients in whom total retrograde large-bowel obstruction was seen on barium-enema studies, half had no clinical evidence of antegrade colonic obstruction; in spite of this, diagnosis of the cause of the obstruction on the basis of barium-enema studies was found to be significantly accurate. The most common cause was carcinoma, either primary or extrinsic, accounting for 64% of the cases. In 23 per cent, the cause was diverticulitis. It is significant that no pathologic changes were found in two patients. Two-thirds of the obstructions occurred in the sigmoid portion of the colon. A decision to perform an emergency operation for large-bowel obstruction should be based upon clinical findings, plain roentgenograms of the abdomen, and barium-enema studies, but not on the results of barium-enema studies alone.

Single and double-layer anastomosis of the colon

Summary and ConclusionsAn attempt is made to compare the relative safety and reliability of single and double-layer anastomosis of the colon. The records of 33 patients representing each group are analyzed. Complications are described and autopsy findings are presented.The double-layer anastomosis has proved to be more reliable in our hands and there is no objection to its use. It is valuable to know that a single-layer anastomosis can be used as it may be peculiarly useful in certain situations.