Délorme's operation for rectal prolapse.

Between 1981 and 1988 inclusive, 22 patients with full-thickness rectal prolapse presenting to two surgeons in this hospital were treated using the Délorme operation. There was no mortality and morbidity was minimal. Twenty-one patients (95.5%) were cured of prolapse and 19 patients (86.4%) had normal anal sphincter function after the operation.

Malignant lymphoma in ulcerative colitis. Report of a case.

The authors present the case of a 40-year-old woman with primary malignant lymphoma complicating chronic ulcerative colitis. Twenty-one cases reported in the literature are reviewed and the various available data analyzed. Variations in the distribution of lymphoma in both the normal and colitic bowel supports a relationship between both conditions. Any lymphocytic infiltrate seen in biopsies obtained from ulcerative colitis should be assessed to exclude associated lymphoma. The prognosis is poor.

Metronidazole in the prevention of anaerobic infection.

One of the most common complications of appendectomy, or major colorectal surgery and gynecologic surgery, is surgical sepsis. Its incidence may vary from 2% to 4% for normal appendices, up to 20% for hysterectomy, and from 50% to 60% for some colonic operations including gangrenous or perforated appendices. During the last decade, one has become increasingly aware of the importance of non-spore-forming anaerobes as the major cause of serious sepsis associated with these types of operation. Studies carried out at the Luton and Dunstable Hospital, and subsequently at other centers, have shown that metronidazole, a specifically anaerobicidal agent without significant activity against aerobic organisms, is highly effective in preventing postoperative morbidity resulting from anaerobic infections. Moreover, its use has greatly modified the surgical approach in a number of conditions.

Metronidazole in prevention and treatment of bacteroides infections in elective colonic surgery.

A double-blind randomised trial was carried out among 46 patients undergoing elective colonic surgery; 27 patients received prophylactic metronidazole and 19 received placebo. Anaerobic infections did not develop in any of the metronidazole-treated patients, but did develop in 11 (58%) of 19 controls who were subsequently successfully treated with metronidazole.

Frey's syndrome after parotid surgery.

The operative records of seventy-one patients who had parotid surgery carried out in the ten year period from 1964 to 1973 were reviewed. Forty-one (67%) of the operations were suprafacial parotidectomies. Of the fifty patients who agreed to reassessment in a special clinic, seventeen had a noticeable degree of Frey's syndrome, and of these fourteen were submitted to further investigations. Minor's test in these fourteen patients showed the greater auricular nerve to be involved in six patients, the ariculotemporal nerve in four, and both nerves in two. The results in two patients were inconclusive. Because the starch test reveals only the distribution of the gustatory sweating, a useful adjunct is described for investigating Frey's syndrome. By blocking of the contralateral greater auricular nerve in the neck and mapping out of the anesthetized area, its sensory distribution is demonstrated. We conclude that it is manifestly unwise to avulse the auriculotemporal nerve if the sweating occurs in the distribution of the greater auricular nerve.

A controlled trial of drainage after cholecystectomy.

A prospective controlled trial of drainage after cholecystectomy has been carried out. In a consecutive series of 143 patients undergoing cholecystectomy, 50 patients were randomly allocated to a drainage group and a further 50 patients to a non-drainage group. The remaining 43 patients were drained electively because the common bile duct was explored or because of infection or incomplete haemostasis. There was no significant difference in the incidence of wound infection or other complications between the drainage and the non-drainage groups. The duration of postoperative pyrexia, the number of analgesic injections and the length of postoperative hospital stay were the same in both the randomized groups. One patient in the randomized drainage group had a reactionary haemorrhage from the drain site requiring transfusion. There was no mortality but one patient in the elective drainage group had to be re-explored for a subhepatic abscess. Three patients in this group drained bile from the drain for 3-9 days but all had a T tube in place. This trial fails to demonstrate any advantage or disadvantage in draining the gallbladder bed after cholecystectomy.

Metronidazole in prevention and treatment of bacteroides infections after appendicectomy.

The frequency of non-clostridial anaerobic infection was studied in 95 patients who had undergone acute appendicectomy: 49 received prophylactic metronidazole and 46 received placebo. Anaerobic infection did not develop in any of the metronidazole-treated patients, but infections did develop in nine (19%) of the 46 controls. Metronidazole is conveniently administered by suppository to patients who cannot take oral drugs. Five patients with intra-abdominal infections caused by non-clostridial anaerobes were successfully treated with metronidazole.