Raphael Reiss

One-stage subtotal colectomy with anastomosis for obstructing carcinoma of the left colon

Fourteen cases of severe obstructing carcinoma of the left colon were treated by emergency subtotal colectomy and ileorectal or ileosigmoid anastomoses. There was one death after two months and a further two septic postoperative complications. Follow-up stretched from two to 39 months (an average 13.7 months). One patient died of a myocardial infarction after 11 months and another of liver metastases after 21 months. Two patients were lost to follow-up at 12 and 25 months, and nine patients remain alive and well, free of disease. The last nine cases were consecutive, and two additional patients with obstruction had only colostomy performed due to their poor conditions. A staged approach to treatment reduces long-term survival as well as inducing a high cumulative mortality and morbidity rate. Colostomy also reduces the quality of life for the elderly patient. Results of this form of treatment are surprisingly good, and it is advocated as the treatment of choice for the vast majority of patients.

Anal pressure measurements in the study of hemorrhoid etiology and their relation to treatment.

The etiology of hemorrhoids has been explained in the past based on anatomic principles, but this study examines the relationship of resting anal pressures to hemorrhoid etiology in 38 patients with hemorrhoids and 29 controls with no perianal symptoms. Three months after treatment by elastic band ligation, anal pressures were again measured in the hemorrhoid group. Anal pressures were significantly higher in the hemorrhoid group before treatment (102±26.33 mmHg) as compared with the controls (76.75±19.56 mmHg) (P<.001). Three months following elastic band ligation there was a small drop in anal pressure (100±26.84 mmHg) but it remained significantly higher than the control group. There was also a significant correlation between symptoms and level of anal pressures. The results indicate that persons with hemorrhoids have higher anal pressures than controls. Elastic band ligation relieves the symptoms but should not affect the anal sphincter pressure. The fact that the anal pressures remained high after treatment could imply that higher pressures are an etiologic component in the formation of hemorrhoids.

Small bowel obstruction: a review of 264 cases and suggestions for management.

Two hundred and sixty-four cases of acute small bowel obstruction were retrospectively reviewed for the purpose of defining factors which could point to the presence of strangulated bowel. History, physical signs and investigations, including body temperature, X-rays, white blood count, and serum amylase, were not significantly different in the simple and strangulated groups. Although an elevated urinary white blood count and a palpable mass were more common in the strangulated group, they were not sufficiently reliable for early diagnosis of strangulation. In reviewing the literature, it is clear that all hernias with obstruction must undergo emergency surgery. Cases with intra-abdominal complete intestinal obstruction should also undergo emergency surgery. A more conservative attitude can only be taken when there is incomplete obstruction.

Deep Venous Thrombosis of the Upper Limbs

Deep venous thrombosis of the upper limbs is rare and represents less than 2-3% of all cases of deep venous thrombosis. Reviewing our series of 25 patients we decided that follow-up and symptomatic treatment produce acceptable results, since the disease has a benign natural history. Fibrinolytic agents administered under strict limitations (The Consensus Conference 1980, Ann Int Med) are efficient in early cases, but its ability to change the natural course of the disease has not been proved. Surgical approach should be reserved for cases with secondary ischaemia and/or a resectable extraluminal mass.

Involvement of chromosome 22 in a Merkel cell carcinoma in a patient with a previous meningioma

The relatively simple cytogenetic findings in an aggressive metastatic Merkel cell carcinoma are reported. Deletion 2p was found in 100% of the cells. Nevertheless, this was considered a secondary (metastatic?) change because the same aberration has been found in several other kinds of malignancy. The involvement of chromosome 22 [del(22q) and -22] in 85% of the cells seemed more intriguing, considering the fact that the Merkel cell carcinoma followed a previous meningioma.

Biochemical tissue markers of human colorectal carcinoma

The potential therapeutic effects of differentiating agents on leukemic and solid tumor cells are being evaluated worldwide. These effects can be followed by morphologic as well as biochemical parameters. The enzymatic profile of four enzymes and the level of carcinoembryonic antigen were studied in 24 human colorectal carcinoma specimens and their adjacent uninvolved mucosa. The enzymes studied were thymidine kinase and 6-phosphogluconate dehydrogenase as markers of proliferation, and alkaline phosphatase and γ-glutamyl transpeptidase as markers of differentiation. A consistent finding was a marker increase in the activities of thymidine kinase and 6-phosphogluconate dehydrogenase in the tumor cells as compared with the adjacent normal mucosa. The activity of γ-glutamyl transpeptidase was not significantly different between tumor and uninvolved colon tissue. Alkaline phosphatase activity was markedly reduced in the tumor specimens. A relationship between the degree of differentiation and the degree of penetration and CEA expression was demonstrated in the tumor specimens as well as in their surrounding uninvolved mucosa.

Septum of the gallbladder, clinical implications and treatment.

We report four patients with a congenital gallbladder septum whose symptoms resembled those of cholelithiasis, in one case giving rise to acute cholecystitis. Cholecystectomy relieved symptoms in all cases and examination of the operative specimen confirmed the clinical diagnosis and X-ray findings. Ultrasonography made a positive diagnosis in the last two cases and no stones were found in any of the cases described. Cholecystectomy is advocated in symptomatic patients with this condition, even when gallstones are not present.

Perianal Tuberculosis: Report of a Case and Review of the Literature

Tuberculosis of the perianal region is a proportionally rare and misdiagnosed disease. We present a patient who was operated upon 5 times for persistent perianal fistula and recurrent abscess formatio

Familial fragile 8q22 involved as a cancer breakpoint in cells of a large bowel tumor

A familial fragile 8q22 and an interferon-induced fragile 16q22 were found in two sisters. Eight years previously, both sisters developed an endometrial adenocarcinoma and now one of them presented with an adenocarcinoma of the colon. An 8q22 deletion was found in all the cells of the colonic tumor and seemed to be the primary initiating change. Other nonrandom and possibly promoting aberrations were also present, among others, a 16q22 deletion. The possibility exists that a familial fragile 8q22 may predispose to cancer and a fragile 16q22 may have promoting capacities.

Use of a stapling technique in closure of perforation of the esophagus

Abstract A case of rupture of the esophagus is presented. Closure of the perforation was achieved using an Auto Suture stapler, with excellent results.