Murray T. Pheils

Surgery for large bowel cancer in people aged 75 years and older

Three hundred ten predominantly male patients who were 75 years of age or older and had surgery for colorectal carcinoma had a hospital mortality rate of 9 percent and a cancer-related five-year survival of 50 percent. These results and a detailed analysis of the causes of complications and mortality were compared with the outcome of 710 patients who were treated concurrently and who were younger than 75 years. Tumors in older patients had a tendency to occur on the right side and were more locally advanced. Increased mortality was particularly attributable to sepsis and cardiovascular causes. Increased morbidity was due principally to respiratory and urinary problems. There were no significant differences, however, in wound or anastomotic complications, nor was therapy for the older patients more costly. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should be the same as those for any younger group.

Elective resection for diverticular disease and carcinoma

A retrospective comparison was made of 47 patients who underwent elective surgical resection for diverticular disease and 106 patients who had sigmoid colectomy or left hemicolectomy for carcinoma over an eight and one-half-year period. There was higher morbidity and mortality in those patients with diverticular disease.

The Results of Surgical Treatment for Peptic Ulceration, 1960 ‐ 1964

The results of 530 consecutive operations for peptic ulceration have been assessed and classified as satisfactory or unsatisfactory. The disabilities which determined the result have been analysed, and their incidences after gastrectomy and after vagotomy and drainage compared.

Colonic diverticular disease

ConclusionThere is much evidence from the history and from the geographic distribution of diverticular disease that it is the result of a deficiency of fiber, and in particular cereal fiber, in our modern over-refined diet. The symptoms of the uncomplicated form of the disease can be abolished or relieved by adding bran to the diets of the majority of patients. The low-residue diet formerly used to treat the disease is contraindicated, as it is the cause of the condition.Furthermore, surgery deals only with the complications of the disease; it does not remove the cause. Hence, we should put all our patients on a high-fiber diet post-operatively to prevent the recurrence of symptoms.

Primary Carcinoma of the Male Breast: A Report of 16 Cases in Australian Ex‐Servicemen

A report of 16 cases of primary male breast carcinoma is presented. The average age was 70 years. Crude five-year survival was 38% overall. The aetiology and management of the disease is discussed. Special reference is made to the use of modified radical mastectomy for the early lesion and the role of orchidectomy for palliation in the advanced case.

The Surgical Treatment of Pyloric Obstruction due to Peptic Ulceration

The results of surgery in 232 cases of peptic ulcer complicated by pyloric obstruction have been reviewed and the results of different operative procedures compared. SUMMARY In this series vagotomy and drainage gave much better results in the presence of pyloric obstruction than in the treatment of peptic ulcer in general, whereas the results of Pólya gastrectomy appear marginally worse. It appears that the risk of stomal ulceration is the major difference, as the stomal ulcer rate for vagotomy and drainage in the presence of pyloric obstruction was 2% as compared with 8% in the total series. Conversely, the incidence of stomal ulcer following gastrectomy appears to be slightly increased. These findings suggest that vagotomy with drainage is the treatment of choice in pyloric obstruction.

Exploration of the common bile duct.

One hundred and fifty patients have had cholecystectomy and there have been 62 common duct explorations during the last four years carried out by the members of the Professorial Surgical Unit, Repatriation General Hospital, Concord. Thirty-eight patients had duct exploration at cholecystectomy, an exploration rate of 24%. Negative exploration occurred in four patients. The indications for duct exploration, the use of cholangiography and the technique of duct exploration are discussed.