A critical review of the classifications and staging of colorectal cancer.
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Biomedical subjects
Publications and source records attributed to L D Zinkin.
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Prolapse of a colostomy is a common problem. Although rarely a significant risk to life, it does present serious problems for patient care and stomal function. Button colopexy can be done easily as an outpatient procedure and is best suited for those patients who are not candidates for more extensive revisions.
A case of Crohn's disease with carcinoma of the rectum is reported, bringing the number of reported cases to 44. Although the exact incidence of carcinoma arising in a segment of Crohn's disease is not known, a review of the literature emphasizes that there does seem to be a definite increased risk.
A case of transverse colon volvulus is reported, bringing the total number of collected cases in the English language medical literature to 45. Although this type of volvulus is rare, a definite pattern can be appreciated. Patients tend to be young, female, and give a history of chronic or recurrent difficulty in having bowel movements. A triad of underlying factors predisposes to the development of the volvulus: a distal impediment (either organic or functional) to the evacuation of the bowel, a redundant bowel and mesocolon and a fixed point around which the bowel can twist. The best treatment is resection with either anastomosis or exteriorization, depending on bowel viability.
The use of the resectoscope has several advantages in treating the patient with inoperable obstructive carcinoma of the rectum, particularly when compared with fulguration. It is immediate in its results, as often testified to by the sudden outpouring of blockaded feces. It is also safer in allowing greater amounts of tissue to be resected with less depth of tissue injury by the electrical output. It does, however, require the skills of someone able to handle the instrument, and the procedure should be a joint effort by the surgeon and urologist. The use of the urologic resectoscope should prove to be a useful addition in the surgeon's armamentarium in a selected number of patients.
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A case of cecal herniation through the foramen of Winslow is presented. Although rare in occurrence, it carries a high mortality risk when diagnosis and treatment are delayed. A better understanding of the nature of this hernia and appreciation of the classic radiographic findings will allow for earlier recognition and treatment.