Richard B. Cattell

The Surgical Significance of Duodenal Diverticula

DIVERTICULA of the duodenum are not uncommon, but reports of their surgical removal are infrequent. This infrequency reflects, probably more than anything else, the difficulty encountered in decidi...

The Choice of Therapeutic Measures in the Management of Chronic Relapsing Pancreatitis and Pancreatolithiasis

Summary The difficulty of selecting the proper surgical procedure in the treatment of chronic relapsing pancreatitis is stressed. The clinical and pathologic features of the disease are discussed. Our experience with, and preference for, the various surgical maneuvers commonly employed in the management of the disease are detailed. Thoracolumbar sympathectomy appears to offer temporary relief. Pancreatoduodenectomy offers the best chance for permanent relief.

The surgical treatment of ulcerative colitis.

THE treatment of ulcerative colitis is primarily medical. Experience has shown, however, that at least 25 per cent of patients with ulcerative colitis require surgical intervention,1 , 2 to preserv...

CALCINOSIS TREATED BY PARATHYROIDECTOMY

Excerpt Subcutaneous calcinosis, a disease tending to serious bodily disability, presents a most difficult therapeutic problem. It is usually the sequel to dermatomyositis or some inflammatory dise...

Surgical Treatment of Ulcerative Colitis

The surgical treatment of ulcerative colitis has greatly improved in recent years, reflected best by the reduction of operative mortality from 20 per cent to 5 per cent. Indications for surgical intervention are discussed. Experiences with approximately 400 patients treated surgically at the Lahey Clinic are reported, including an improvement in the management of ileostomy.

One-stage abdominoperineal operation for cancer of the rectum

THE ONE-STAGE abdominoper ineal resection of the rectmn, or Miles 2 operation, has been our procedure of choice in dealing with cancer of the rectum and rectosigmoidal areas, since the gradual abandonment of the two-stage Lahey operation. In a series of 702 patients with mal ignant disease of the colon and rectum operated on between 1945 and 1949, 84 per cent of the lesions of the rectum and rectosigmoid were resected by the Miles one-stage procedure. In our more recent experience (1950 to 1953), 3 the one-stage abdominoper ineal operat ion was utilized in 80 per cent of the cases for cancer in this same region. T h e operation, as now performed, is nlore radical than the procedure utilized previously. We believe that the most impor tant factor in the improvement of survival rates in this disease has been the increase in the amount of mesentery and adjacent lymph node tissue removed. Thus, instead of dividing the inferior mesenteric vessels at the brim of the pelvis as we did years ago, particular emphasis is now placed on prel iminary ligation of the inferior mesenteric vessels at the point of origin of the artery from the aorta, and resection of a m a x i m u m amount of mesentery. Ligation of the internal iliac or hypogastric artery near its origin from the common iliac artery has also been of considerable assistance in removing larger segments of lymphatic tissue in the pelvis. Other significant technical details have made this operat ion more effective than that originally described by Miles 2 in 1908; these will be commented on later.

Total hysterectomy with resection of primary carcinoma of the bowel: A report of forty-seven cases☆

Abstract Carcinoma of the sigmoid and rectum tends to become adherent or invade the uterus and its appendages as well as the vagina in many cases. Under these circumstances the lesion is usually found to involve all coats of the bowel and in approximately 40 per cent of cases in which the bowel is adherent to the uterus, malignant invasion can be demonstrated histologically. When the lesion is contiguous to the vagina, involvement may be as high as 88 per cent. At operation it is impossible to determine whether adherence is due to inflammation or malignancy so that all patients should have the benefit of complete hysterectomy and removal of the posterior vaginal wall. Complete hysterectomy combined with resection of the bowel is reported in forty-seven cases with two postoperative deaths, a mortality of 4 per cent. Of the patients followed up five years or more 38 per cent were shown to be free of recurrence. Resection of structures adherent to carcinoma of the sigmoid and rectum is essential to obtain the greatest salvage rate and is an important means of increasing the number of lesions amenable to resection.

Lesions of the sigmoid and rectum.

Carcinoma is the most frequent lesion found in the sigmoid colon and rectum; its early discovery is possible if, in the presence of bowel symptoms, rectal, sigmoidoscopic and radiographic examinations are immediately carried out. Radical operation, preferably abdominoperineal resection, should result in a five year curability rate of approximately 50 per cent. Future improvement in results will depend on the discovery and treatment of the premalignant lesion—the intestinal polyp.