Biomedical subjects
Publications and source records attributed to R H Thorlakson.
The background to the granting of a coat of arms for the Canadian Association of General Surgeons is described. To help the reader understand the process, the author details how he applied the basic rules and philosophies of the art of heraldry to his design. He hopes this description will stimulate other societies and associations to create their own coats of arms.
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A set of double-angled needle holders and long, angled tissue forceps have been designed and presented for use in surgery of the abdomen. The problems of passage and control of curved needles in all directions is well recognized. The marriage of design and presentation addresses the mechanical and anatomic needs of surgeons in the pelvis, subdiaphragmatic area, and in large and obese patients. Multiple variables in use provided by these instruments, particularly when used together, enhance surgical control at problem sites.
A set consisting of long-angled and straight intestinal forceps has been designed for use in the control of tubulovisceral structures in abdominal surgery. Their design addresses the mechanical and anatomic needs of deep and difficult areas of the abdomen, especially the pelvis. The configuration can improve and enhance control at a number of surgical sites.
New operating proctoscopes have been designed that facilitate the passage of a stapling head without its anvil in rectal procedures which call for this technique to be used.
This set of new hand held, deep retractors can be recommended for use by all abdominal surgical disciplines. It should be a useful and welcome addition to give improved and more controlled exposure during many surgical procedures.
New occlusive clamps have been designed to facilitate anterior resection of the rectum. A T shaped upper occlusive clamp with centrally placed arms, curved transverse end and its total length and light weight provide more secure control of the intestine and allows the surgeon a less obstructed view of the distal site of section than the traditional L shaped rectal clamps. A lower occlusive clamp has been designed to obviate many of the inherent problems of controlling and suturing a rectal stump in the depths of the pelvis. Main concerns and technical troubles are retraction of the stump, loss of control of the flabby rectal remnant and difficulty handling the anterior and posterior walls as the surgeon attempts to make the anastomosis. The lower clamp keeps the rectum from retracting and the proximal cut end is held open by four stay sutures to wings on the right and left blades of the clamp. It is used to facilitate the placement of a purse-string suture in the EEA stapling technique or in a hand sutured anastomosis.
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Thorlakson RH. A simplified draping of patients in the lithotomy-Trendelenburg position for anterior resection by stapling or abdominoperineal excision of the rectum.
The introduction of stapling for anterior resection of the rectum has made the use of the lithotomy-Trendelenburg position almost mandatory in the surgical treatment of cancer of the rectum. Use of this position allows the surgeon to choose, after initial dissection, which of the two principal procedures (abdominoperineal excision or restorative resection) to perform, regardless of the procedure originally planned. This can be done without altering or modifying the chosen procedure in any way. The authors describe the proper placement of all special equipment used and the sequence of steps for correct positioning and draping of the patient.
The removal of benign tumors of the rectum is usually accomplished using well recognized transanal procedures. Occasionally an abdominal approach with limited excision as described herein may be appropriate.
A total of 208 plasma samples from 115 patients with gastrointestinal carcinomas and nine patients with other intestinal disease were examined for the presence of IgE tumor antibodies by a solid-phase radioimmunoassay. Approximately one-third of the patients gave significant reactions with gastrointestinal carcinoma extracts compared with normal tissue extracts. Absorption with tumor and normal tissue extracts, with type AB human red cells, and with CEA indicated tumor specificity in some of the samples so examined. None of the 50 serum samples tested from normal blood donors contained tumor-specific IgE. IgE tumor antibodies decreased or completely disappeared in the majority of patients 8-13 days after surgical treatment.
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A case of malignant carcinoid tumor (neuroendocrine carcinoma) of the cecum is described. The neoplasm arose in a patient who had chronic ulcerative colitis for 16 years. There is no previous documentation of this combination, which is surprising, in view of the known association of colonic adenocarcinomas and lymphomas with ulcerative colitis. The reasons for this discrepancy are discussed and it is postulated that ultrastructural examination of poorly differentiated colonic neoplasms may result in a more frequent identification of this association.