Pressure sores. How to prevent and treat them.

The consequences of immobility among hospitalized and bedridden patients, especially the elderly, can be devastating if pressure sores develop. Such sores are not only painful for the patient and expensive to manage, but they are potentially life-threatening. What can be done to prevent them? Which patients are most vulnerable? The authors address these questions and discuss treatment options.

Survival after resection of carcinoma of the splenic flexure.

Nine hundred ten patients undergoing colectomy for colon cancer were studied retrospectively. Seventy-four cancers (8 percent) were located at the splenic flexure. The stage at presentation was no different between splenic flexure cancers and colon carcinomas at other sites. Although splenic flexure cancers had twice the incidence of obstruction as did other colon cancers and obstruction in the overall series adversely affected survival, there was no difference in survival between splenic flexure cancer patients and patients with other colon cancers.

Colonoscopy in critically ill patients. What conditions call for it?

Indications for colonoscopy in the intensive care unit include acute lower intestinal bleeding, sigmoid volvulus, pseudo-obstruction of the colon, and suspicion of pseudomembranous colitis. Although the incidence of cardiorespiratory complications may be higher in these critically ill patients, the procedure can be done safely with proper attention to detail. Because of colonic dilatation, endoscopy can often be done without bowel preparation.

Surgical treatment of anorectal fistula in patients with Crohn's disease.

Forty-seven patients with Crohn's disease were operated upon for fistula in ano during a 22 year period with an average follow-up time of 82 months. In 29 of the patients, the fistulotomy or fistulectomy wound healed primarily; in 37, a state of complete healing or minimal disability, sometimes after multiple fistulotomies, was achieved. Five patients required proctectomy, but the need for removal of the anorectum was not caused by surgical treatment of the fistula in any instance. Of the 31 patients who had a classical internal opening at the dentate line, 23 healed primarily after surgical treatment of the fistula, compared with only seven of 16 patients without such an internal opening. The 21 patients in whom the rectum was not involved and in whom there was a classical internal opening at the dentate line were an especially favorable group: 18 of these healed primarily after surgical treatment of the fistula, and although ten of them had one or more recurrences of the fistulas, 18 ultimately achieved a state of complete healing or minimal disability. We conclude that operative treatment of fistula in ano is a safe and effective modality in a carefully selected group of patients with Crohn's disease.

Safe resection for diverticular disease of the colon.

A retrospective study of 83 patients undergoing surgery for diverticular disease over two years at a colorectal specialty hospital was undertaken to assess the safety of resection. No patient had free perforation. Eighty-nine percent of 46 patients with neither abscess nor fistula underwent resection and primary anastomosis, the remainder undergoing other resectional therapy; there was no mortality in this group. Of the 37 patients with abscesses, fistulas, or both, all had resections with or without primary anastomoses and one of these 37 patients died (2.7 percent mortality). In the entire series of 83 patients, the operative mortality was 1.2 percent, although 69 percent had morbidity. Resection can be performed safely for diverticulitis, and primary anastomosis can be safely added in uncomplicated and selected complicated cases.

Computers in surgical education.

Medical records and billing are not the only hospital settings that can benefit from the use of microcomputers. The authors describe how a microcomputer in their department of surgery preserved valuable time for teaching and patient care.

The use of cyclic home hyperalimentation for malabsorption in patients with scleroderma involving the small intestines.

When scleroderma involves the small intestines, malnutrition with resulting immune incompetence and sepsis can occur. Two cases are presented in which patients with scleroderma involving the gastrointestinal tract were treated with cyclic home hyperalimentation, restoring their nutritional status and improving their quality of life.