John H. Remington

Definitive treatment of anal-canal carcinoma by means of radiation therapy and chemotherapy

In the light of the relatively poor response of squamous-cell carcinoma of the anus to surgery, an alternative method of treatment has been sought. During the past five years, in a series of 19 patients, the first four were treated by a combination of preoperative irradiation, 5-fluorouracil (5-FU) and mitomycin C as radiosensitizers plus surgery. As a result of complete responses at the time of surgery of all these patients, 15 additional patients have been treated by definitive radiotherapy combined with 5-FU and mitomycin C, thereby avoiding abdominoperineal resection. Eighteen patients had local control, and the one treatment failure is discussed. The method of treatment is described, and recommendations are made concerning techniques to be used or to be avoided.

Treatment of rectal carcinomas by means of endocavitary irradiation: a progress report

Treatment of rectal carcinomas with endocavitary irradiation is now an established method in the United States and is an important advance in the curative management of patients with selected cancers of the rectum that should be available to all such patients. Excellent palliation can also be achieved in many cases with advanced local disease. The total experience at Highland Hospital, Rochester, New York, is over 70 cases. Now that there are more centers using this method of treatment, an awareness of some of the problems and pitfalls encountered at Highland Hospital becomes relevant.

Treatment of rectal carcinomas by means of endocavity irradiation.

Direct contact irradiation may be used in the curative treatment of patients with carefully selected early rectal lesions. With earlier diagnosis, a large number of patients may present with suitable lesions. The treatments last three minutes and are administered every two weeks to a total dose of 9,000 rad to 12,500 rad. The patients require no general anesthesia or hospitalization and may continue working during this treatment. There appears to be no risk of morbidity or mortality. The rectum is preserved. Most beneficial of all to the patient, a colostomy is avoided, although later surgery is not precluded for local failures. It has been found that recurrence, should it occur, appears within the 18 months immediately following treatment. Good palliation can be achieved in some cases for patients with metastatic disease, for their local symptoms. We believe that the endocavity method of irradiation contributes an important advance in the management of patients with cancer of the rectum and feel it should be available universally.

Prevention of ureteral injury in surgery of the pelvic colon

THE PROBLEM Of surgically inflicted ureteral injury dates back more than a century. In 1841 Berard reported a method of reimplantat ion of the ureter into the bladder to correct such an injury. T h e first cutaneous ureterostomy was performed by Simon in 1869 following injury inflicted during an ovarian operation. Just after the turn of the century Sampson -°2 published several papers dealing with the incidence, prophylaxis, and treatment of ureteral injuries. T h e problem still is far from solved and perusal of the li terature confirms the fact that thousands of ureteral injuries occur every year during performance of pelvic operations and the incidence is increasing. I t is the purpose of this paper to calt at tention to various significant facets of the problem and to suggest a technic that can prevent many ureteral injuries, and at the same time perhaps broaden the scope of pelvic surgery. T h e possibility of nreteral injury confronts every abdominal surgeon. He can tolerate unavoidable comDlications inherent in many major surgical procedures, but it is much more difficult when there are avoidable complications for which he is personally responsible. It is understandable that surgeons are reluctant to publish reports of such experiences. Recently Conger and associates 4 could find in a review of medical li terature only seven reports by surgeons of ureteral injuries they personally had inflicted dur ing surgical procedures. In contrast to this paucity of reports scores of articles have been published report ing repair of injury to the ureters.

Villous adenoma with severe electrolyte depletion: report of a case.

SummaryA case of villous adenoma complicated by severe fluid and electrolyte depletion has been reported. Some unique features of the villous adenoma and the treatment of the electrolyte depletion syndrome have been discussed. Several points should be stressed in relation to this syndrome: (1) Villous adenomas are easily missed on digital examination because of their soft consistency. (2) The electrolyte depletion syndrome, though uncommon, can be severe, and several deaths are reported in medical literature. They resulted from failure of early or adequate treatment. (3) Malignant change occurs frequently and necessitates wide removal.

Treatment of advanced carcinoma of the sigmoid and rectum

SummaryAdvanced carcinoma of the sigmoid flexure and rectum will continue to present multiple problems until the diagnosis is made at an earlier stage of the disease. Delay in the diagnosis is a serious problem and merits a major crusade on the part of all who are interested in carcinoma of the colon and rectum.Preoperative knowledge, or suspicion that a carcinoma of the sigmoid flexure or rectum has extended to adjacent structures, provides an opportunity to prepare the patient adequately and to plan the operative procedure. The more that is known preoperatively about a patient’s physical and mental condition, the better is the opportunity to decide just what is the best procedure when advanced carcinoma is found. In spite of careful preoperative investigation, the surgeon occasionally will be surprised to discover unsuspected advanced disease at operation. On the other hand, what appears at first to be a non-resectable advanced carcinoma of the rectum or sigmoid flexure may still be curative. A concerted effort,consistent with sound surgical judgment, should be made to remove the involved organs. The end results in a given case will depend upon many factors, which often will be surprising and gratifying. “Preventive colostomies” are unnecessary and should be avoided.A few technical procedures have been discussed, including intralymphatic injection of radioactive gold and 5-fluorouracil, preoperative radiation, intra-abdominal ureteral catheterization, ligation of internal iliac arteries and the primary blood supply to the pelvis, concomitant hysterectomy, oophorectomy, cystectomy, prostatectomy, vaginectomy and reconstruction of the vagina.