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Biomedical subjects

M L Corman

Publications and source records attributed to M L Corman.

At least 19 recordsLinked to original sources
PubMed1991

Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational Group.

A randomized trial was undertaken to compare the biofragmental anastomotic ring (BAR) with conventional intraperitoneal colorectal anastomotic techniques. Patients were randomized into one of two schemes: BAR versus sutured or BAR versus stapled anastomosis. There were 782 patients entered into the study and 283 patients (36%) had a sutured anastomosis, 104 patients (13%) had a stapled anastomosis, and 395 (51%) had the BAR. Comparison of the BAR with combined suture and stapled controls revealed no significant differences in wound complication, abscess rate, bleeding, anastomotic leaks, ileus, obstruction, or deaths. There were no differences in return of bowel function, return to normal diet, or hospital stay. Intraoperative difficulties occurred in 46 BAR patients (17%), and this was significantly higher (p less than 0.001) than for sutured (3%) but not for stapled anastomoses (11%). The occurrence of these problems did not adversely effect the outcome. The data suggest that the BAR is a safe, satisfactory alternative to sutured or stapled colorectal anastomoses.

Adolescent↗
PubMed1989

Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial.

In a randomized, prospective study of 438 patients, the safety and efficacy of the Valtrac biofragmentable anastomotic ring (BAR) was compared with stapling and with conventional suture techniques. There was no significant difference in the morbidity, mortality, and clinical course of the patients. The BAR can effect reestablishment of intestinal continuity somewhat more rapidly, but its major advantage is its uniform applicability to all areas of the intestinal tract, except the low rectum.

Adolescent↗
PubMed1988

Long-term results of open and closed sphincterotomy for anal fissure.

Three hundred fifty patients who underwent open or closed lateral internal anal sphincterotomy for acute or chronic anal fissure between January 1981 and June 1985 were reviewed. Minimum follow-up was 14 months (mean, 37 months). No patient underwent an additional procedure at the time of sphincterotomy. Twenty-one failed to heal or developed a recurrence in the interval (6 percent). Five of these individuals were found subsequently to have Crohn's disease. Excluding these patients, the incidence of nonhealing was 4.6 percent. Eight patients (2.3 percent) developed postoperative infections requiring drainage, one half of which were associated with fistulas. Sixty patients (17 percent) complained of incontinence for flatus or feces. For two thirds, this was transient. There was no statistically significant difference in rate of healing or morbidity when comparing the open with the closed method.

Abscess↗
PubMed1988

Rectal prolapse. Surgical techniques.

The varied operative procedures available for the treatment of rectal prolapse can be confusing. Most of the maneuvers are relatively esoteric and can be performed successfully only by the few surgeons who have developed the specialized techniques. It is recommended, therefore, that the surgeon who is less experienced with rectal prolapse adopt one of the standard operations. A rectopexy or suspension procedure without resection can be performed safely with good results, low morbidity, and a low mortality rate. Anterior resection with or without sacral fixation, an operation familiar to most surgeons, also offers an excellent cure rate. The Thiersch-type approach should probably be reserved for those patients who cannot tolerate laparotomy. The material chosen should be one of the commercially available synthetic products; wire should not be used. The Silastic-impregnated Dacron prosthesis for this operation has some potential benefit, especially for the incontinent patient. Results of further studies are awaited.

Anal Canal↗
PubMed1986

Are we really operating on diverticulitis?

The results of elective surgery for diverticulitis in 100 consecutive patients were reviewed. Follow-up was possible in 82 individuals. Seventy-seven (94 percent) were improved. There was no inflammatory change apparent on histologic examination of the resected specimens in 24 percent of patients. These individuals were less likely to have favorable results. There are a number of preoperative factors which may predict the likelihood of a successful surgical outcome.

Adult↗
PubMed1985

Anal incontinence following obstetrical injury.

Insufficient attention has been given to the anatomical anomaly as a predisposing factor for obstetrical injury. The operative approach and results in 28 patients indicate that excellent function can be achieved by recognition of the deformity and by the appropriate repair.

Adult↗
PubMed1985

Rectal prolapse in children.

Rectal prolapse in children is an uncommon clinical entity in western countries. Treatment is generally supportive with surgery reserved for the intractable case. If operative intervention is advised, it should consist of one of several limited procedures that can be safely performed with low morbidity: anal encirclement, presacral packing, sclerosing injection, or linear rectal cauterization.

Child, Preschool↗
PubMed1979

Management of postoperative constipation in anorectal surgery.

Fifty patients who had undergone proctologic operations were given a combination of standardized senna concentrate and dioctyl sodium sulfosuccinate for prevention or treatment of postoperative constipation. Two Senokot S tablets were given on the evening of the first postoperative day. Patients who had bowel movements after receiving this dose and remained in the hospital received two tablets on each of the following two days. Otherwise, dosage was increased gradually to a maximum of four tablets twice daily until defecation occurred or until the four-day treatment period was over. All patients achieved bowel movements, and in no case was it necessary to administer an enema. No hard stools were passed on the day patients were discharged from the hospital. Overall results were excellent or good in 94 per cent of cases; these results were not affected by age. Ninety-two per cent had bowel movements after the first or second dose was administered. On the day of discharge from the hospital, fecal consistency was satisfactory in 88 per cent of cases and loose in 12 per cent. Except for a single instance of diarrhea after administration of one dose, which involved a patient with a history of loose stools, no side effect occurred during the trial. In view of these responses and the virtual absence of side effects in this study group, Senokot S tablets are judged to be of demonstrated value in the postoperative management of patients undergoing proctologic operations.

Adult↗
PubMed1979

Management of late complications of Teflon sling repair for rectal prolapse.

Recurrent rectal prolapse or postoperative rectal stricture occurred in four of 88 patients (4.5 per cent) who underwent Teflon sling repair at the Lahey Clinic during the past 15 years. Management of these and six other similar patients referred for treatment suggests that young men appear to be at a higher risk for recurrence. Strictures may be more likely to develop in patients with a long history of prolapse or problems with constipation. Teflon sling repair followed by recurrent prolapse or stricture formation should probably be treated by low anterior resection.

Adult↗
PubMed1979

Colorectal carcinoma: a decade of experience at the Lahey Clinic.

Carcinoma of the colon and rectum is the commonest visceral malignancy in this country today. Uncorrected five-year survival rates (1967-1971) for Dukes' A, B, and C lesions were 81 per cent, 62 per cent, and 33 per cent respectively, and are essentially the same as those observed in the previous five-year period (1962-1966). The actuarially corrected five-year survival rates for Dukes' A, B, and C lesions for the ten-year period (1962-1971) were 95 per cent, 90 per cent, and 55 per cent. Further improvement in these statistics depends on bringing the patient to operation with less advanced disease and possibly on supplementing resection with other modalities of therapy.

Colonic Neoplasms↗
PubMed1978

Perineal wound healing after proctectomy for inflammatory bowel disease.

One hundred fifty-one cases of patients who underwent proctectomy for inflammatory bowel disease at the Lahey Clinic were analyzed with respect to the factors that predispose to delay in perineal wound healing. Significantly poorer healing took place in patients with Crohn's colitis, in men with ulcerative colitis, and in patients with ulcerative colitis who underwent one-stage operations. Factors that were not statistically significant but that appeared to contribute to delay in healing were younger age of patients and presence of anal fistula. A comparison is made with the results of other series, and recommendations for treatment and prevention are presented.

Adolescent↗
PubMed1978

Colostomies--indications and contraindications: Lahey Clinic experience, 1963--1974.

Over a 12-year period, 276 temporary colostomies were performed on 271 patients. During this interval 118 colostomies were closed. The morbidity rate of colostomy construction was 21 per cent, and for closure it was 49.1 per cent. No definite factor could be indentified as contributing to this high rate of complications for colostomy construction. With respect to colostomy closure, predisposing factors that seemed to increase morbidity were shorter interval between creation and closure of the stoma and resection of colostomy (as opposed to closure without resection). Intra-abdominal drains were associated with a prohibitively high rate of wound infection, although subcutaneous drainage was not successful in reducing the incidence of infection significantly.

Adolescent↗
PubMed1978

Colonic hemorrhage.

We have briefly presented our concepts of the investigation and management of lower intestinal bleeding. Such bleeding was divided into massive and nonmassive colonic hemorrhage, and the differences in the investigative techniques were discussed for each of these circumstances. An algorithm of our diagnostic and management protocol for massive large bowel hemorrhage may be followed in a somewhat varied fashion in the investigation of those patients having nonmassive large bowel bleeding.

Barium Sulfate↗
PubMed1977

Rubber band ligation of hemorrhoids.

While rubber band ligation has found increasing acceptance as a method of dealing with internal hemorrhoids, there is a paucity of literature on the subject. This report gives a detailed, step-by-step approach to this technique.

Hemorrhoids↗