Peyronie's disease and sclerosing cholangitis in a patient with ulcerative colitis.

A 51-year-old patient with a 30-year history of ulcerative colitis developed sclerosing cholangitis and later Peyronie's disease. The occurrence of these diseases in the same patient supports the view of an immunological origin of these associated disorders.

Evaluation of autosutures in gastrointestinal surgery.

Autosuture surgical instruments were used in over 300 gastrointestinal operations including 60 gastric resections. The technic and its advantages and disadvantages are reviewed, specifically for gastric surgery. Operating time required has been decreased, and results have been good. The instruments have wide application, and their safety has been proved.

Evaluation of hematologic abnormalities in the nonbleeding postoperative patient.

With a seriously ill postoperative patient, selecting the best course of action may be difficult when laboratory data suggest hematologic abnormalities. If an Afro-American is to undergo major surgery, simple postoperative screening procedures are available for certain hereditary erythrocyte abnormalities. Acute hemolysis, from any cause, may mimic advanced liver disease. Bleeding into closed body spaces, with erythrocyte destruction secondarily, may mimic generalized hemolysis. One basic premise is always to review the medications being administered; many drugs may induce granulocytopenia or anemia. Because there is a compensatory increase in erythrocyte 2,3-diphosphoglycerate content that increases oxygen release to the tissues in the normovolemic anemic patient, less frequent use of blood transfusion is possible in these patients. Healing will continue even when the packed red cell volume is 25 per cent.

Primary carcinoma of the gallbladder. The role of adjunctive therapy in its treatment.

Of forty-three patients with carcinoma of the gallbladder discovered ih a twenty-five year period (during which 10,349 patients were diagnosed as having cholelithiasis), eighteen patients (42 per cent) had no obvious tumor outside of the gallbladder at the time of operation, nineteen patients (44 per cent) had local spread of the disease, and six patients (14 per cent) had abdominal carcinomatosis or distant metastasis. In the twenty-one patients who underwent surgical therapy for cure of their disease, the five year survival rate was 33 per cent. The more extensive surgical procedures (other than cholecystectomy alone) did not significantly increase survival. Neither the duration of the symptoms nor the pathologic type of the tumor altered the eventual outcome. No patients with tumor outside the gallbladder at the time of operation survived longer than two years. Compared to those who did not receive it, the fifteen patients treated postoperatively with adjunctive therapy (radiation therapy or chemotherapy or both) lived longer and also were significantly better palliated when tumor outside of the gallbladder was found at the time of operation. From these findings, the routine use of adjunctive therapy is recommended in all patients with disease outside of the gallbladder and serious consideration should be given to its use in all patients found to have carcinoma of the gallbladder.