Raymond J. Jackman

The etiology of pilonidal sinus.

ConclusionsThe gross and microscopic pathologic findings in our 354 patients overwhelmingly favor the theory of acquired origin in most patients with pilonidal sinus. The facts appear to show that the reason there has been so much debate over whether pilonidal disease is congenital or acquired in origin is because there are two different types of the disease.A new classification of pilonidal disease based on etiology is proposed as a result of this study. In this classification the disease is divided into two groups: (1) congenital, and (2) acquired. These two types are further subdivided; the congenital into the neurogenic and ectodermal, and the acquired into the post-traumatic and postsurgical.Neurogenic and ectodermal pilonidal sinuses are relatively uncommon, probably less than 10 per cent of the total, whereas the acquired variety of post-traumatic and postsurgical lesions constitute 90 per cent of the cases.

Conservative management of selected patients with carcinoma of the rectum

SummaryIn a ten-year period 252 selected patients with carcinoma of the rectum for whom conservative treatment was advocated were studied. Of 211 patients who were treated conservatively and whose condition was followed eight to 18 years, the procedure was successful in 96.2 per cent of cases; it was a failure or a partial failure in 3.8 per cent of cases.Conservative treatment was recommended in an additional 41 patients, but radical operation was performed. Examination of the surgical specimen showed that on the basis of Dukes’ classification, 40 of the 41 patients could have been treated by conservative means.Experience at the Mayo Clinic indicates that a conservative approach in certain selected cases of carcinoma of the rectum is safe and justifiable.

STUDIES ON THE LIFE HISTORIES OF PATIENTS WITH CHRONIC ULCERATIVE COLITIS (THROMBO-ULCERATIVE COLITIS), WITH SOME SUGGESTIONS FOR TREATMENT

Excerpt Two types of colitis in which intestinal ulceration occurs have long been recognized as entities; that is, tuberculous colitis and amebiasis. Until 1924, all other types of colitis were unc...

A modified thiersch operation in treatment of complete rectal prolapse

Summary and ConclusionsThe perisphincteric wiring operation is an efficient, safe and relatively simple procedure which has yielded results in a much wider field of application than was anticipated when we first began its use ten years ago. It has served as the sole operation in extensive prolapse, especially in the aged and infirm, and we consider it to be a valuable adjunct in the combined abdominoperineal approach to complete rectal prolapse in younger, more active, patients.The technic, as herein described, represents an improvement in both method and materials in the performance of this operation and has thereby given it greater scope. It is our opinion that our results to date justify wider application of this operation.

Evaluation of conservative management of certain polypoid lesions of the lower part of the large intestine

Summary and ConclusionsThe impression had been gained in the section of proctology of the Mayo Clinic that many of the polyps and polypoid lesions of the lower part of the large intestine could be managed satisfactorily by conservative means (local excision or fulguration). In order to determine just how satisfactory the proctologists’ judgment had been in deciding upon the proper course to follow in the management of equivocal lesions, a study was made of 244 patients who had polypoid lesions in which microscopically proved, early adenocarcinomatous changes were diagnosed in the years 1945, through 1949. The results of the study indicate that conservative management is effective when applied to certain early polypoid lesions of low-grade malignancy that meet the following requirements: (1) no fixation to surrounding structures and lesion freely movable over underlying muscularis of bowel wall, (2) no firmness or nodularity within lesion, (3) no gross evidence of linear or serpiginous infiltration of adjacent mucosa or submucosa, (4) no evidence of obstruction as manifested by dilatation of bowel proximal to lesion and (5) no evidence of ulceration of lesions whether sessile or pedunculated, and no defect in contour of lesion indicative of necrosis.Conservative management would possibly be more successful if lesions measuring 5 cm. or more in greatest diameter were considered unsuitable for fulguration or local excision.Although the matter of invasion was not determined in this series when the original biopsy specimens were examined prior to treatment, those lesions subsequently shown to be associated with invasion were treated successfully by conservative means when the gross features of the lesions seemed to warrant fulguration.

Value of proctoscopy in the diagnosis of amebiasis

A study of 115 consecutive patients who had amebic dysentery was carried out for the purpose of determining how much value proctoscopy has in the diagnosis of the condition.

Regional enteritis: proctoscopic clues in diagnosis.

SummaryA series of 489 cases of regional enteritis seen at the Mayo Clinic in the years 1950 through 1959 has been reviewed. The diagnosis of anorectal abscess or fistula was noted in 127 (26.0 per cent) of these patients. Certain relationships between rectal findings and the activity of the regional enteritis are discussed. This study clearly emphasizes that an awareness of certain anorectal complications may be important clues in the diagnosis of regional enteritis. The possibility of enteritis should be considered whenever a young adult is found to have an anorectal abscess or fistula.

Polypoid lesions of the large intestine

Summary and ConclusionsCertain polyplike lesions of the anus and large intestine that project into the lumen of the bowel and resemble true polyps are encountered rather frequently on digital examination of the anus and rectum, on endoscopy of the lower portion of bowel and on x-ray studies of the colon. It is generally accepted that true polyps have malignant propensities while most polypoid lesions do not. For this reason the differential diagnosis is important. Features that assist in the differential diagnosis are consistency, location and appearance of the lesion.

Tumors originating in the ischioanal fossae

Abstract Tumors originating in the ischioanal fossa are rare. Such tumors present problems interesting in differential diagnosis and treatment. The subjective symptoms caused by tumors of the ischioanal fossa, as shown by these cases, are not definitely peculiar to the lesion but in general include painless, progressive swelling which causes difficulty on sitting or defecation. The findings of asymmetry in the ischioanal region, overlying normal skin, and circumscribed movable tumor mass that is not tender are of value in differential diagnosis. These tumors should always be excised and the tissue examined microscopically for the correct diagnosis.