James Barron

Colostomy closure by the intraperitoneal method

Summary and ConclusionsA series of 200 patients in whom colostomy stomas have been closed by the intraperitoneal method is presented. There were no deaths. There was only one anastomotic failure. Morbidity is insignificant.The intraperitoneal method of colostomy closure is preferable to the extraperitoneal procedure which subjects the patient to the discomfort of repeated application to the spur, of the crushing clamp and fails to accomplish its purpose in a high percentage of cases.

A shunt operation for obesity

ConclusionThe shunt procedure can be performed with reasonable safety in properly selected, well-motivated and relatively young patients. Improvements in appearance, emotional outlook and family relations of the patients have been remarkable. The procedure has been accepted well by the patients and they have recommended it to others who are obese. Jejuno-ileostomy (about 20 inches) has caused fewer complications than jejunocolostomy. Every attempt should be made to prevent internal herniation and intussusception as weight is lost. Adequate nutrition for hepatic protection is most important. A careful follow-up medical program is extremely important; the procedure should not be performed unless this is provided.

Anorectal pain relief by use of local silastic suppositories

THE RELIEF OF DISCOMFORT in the anal and perianal areas is sought by countless patients. A simple observation of the varieties and types of suppositories and ointments that are available, and the huge numbers sold, is ample proof of this statement. Pain, touch, and temperature feelings in the anal-canal area are very acute, diffuse and heightened as compared with the skin elsewhere on the body. For the perianal skin, these feelings are about the same as those of the skin on the dorsum of the finger. T h e sensitivity of the rectal mucosa is almost negligible except for 5 to 10 mm proximal to the anal crypt line (transitional epithelium). Suppositories given for relief of discomfort in the anal canal, unfortunately, pass well up into the rectum, where they dissolve, and at best, only a small portion of the material will reach the anal canal, which is the site of the discomfort. We present a new Silastic suppository, which we have worked on for the past few years. Silastic (polydimethylsiloxane elastomeric capsule) was selected because it was non-irritating and could give a slow, controlled release of a local anesthetic. Previous work has shown that subcutaneous silastic implants containing steroids are not irritating and can control fertility. Dr. William Dennis, of Medical Products Division, Dow Coming Corporation, developed a method for us whereby lidocaine (Xylocaine | cou ld be prepared to give slow, controlled permeation through the Silastic capsule walls. Without his help, this

Implications of involvement of small bowel in ulcerative colitis

Summary and ConclusionsIn a series of 99 patients operated upon for ulcerative colitis, 29 had ileal involvement. X-ray examination is not of great diagnostic value.At operation, gross external evidence of ileal involvement was present in only one third of the patients. Inspection of the opened ileum during surgical exposure is mandatory.The long-range mortality rate was five times greater in patients with ileal involvement than in those in whom the small intestine was not involved.