New "sutureless" technique of ileostomy and colostomy.

BACKGROUND: Brooke ileostomy and colostomy are associated with infection in the stomal and/or main wounds, leading to complications. The source of infection is feces from the open lumen. The objective of the present study was to find a way to prevent infection and subsequent complications. It was started in 1986 by serendipity after discovery that if wound contamination from intestinal contents is stopped in the immediate postoperative period, by a complete small/large intestinal obstruction, infection and complications are prevented. This study was based on the principle of delayed-primary wound closure. METHODS AND PROCEDURES: Following its initial discovery for a Brooke ileostomy, the procedure was used for both ileostomy and colostomy. The stapled stoma was fixed to the opening in rectus sheath. It was covered with an appliance that has a transparent pouch, allowing daily inspection. During the period of postoperative ileus, there is angiogenesis on the serosal surface, making it refractory to infection. The stoma tends to bulge with the appearance of peristalsis. Stoma was then opened with electrocautery in a bedside procedure. The mucosal cuff protrudes, everts, advances with peristalsis, and "grafts" itself on angiogenesis on the surface of a single layer of serosa. The advancing margin of the mucosal cuff fuses with the circumference of the opening in dermis. The maturation of the stoma is natural and automatic. Absence of sutures reduced the tissue trauma and foreign body reaction, resulting in better wound healing. This new procedure was named "delayed-primary self-maturation" (DPSM). RESULTS: Thirty seven colostomies and nine ileostomies were performed using DPSM. Infection in the stomal and/or main wound and subsequent complications were prevented. CONCLUSIONS: Delayed-primary self-maturation is technically easier and more scientific than a conventional ileostomy or colostomy and is recommended for all types of stomas.

Cryoablation of benign breast tumors: evolution of technique and technology.

We report on improvements in cryoprobe design and techniques of cryoablation as a minimally invasive alternative to open surgery for the treatment of benign breast tumors. In the study, which was conducted in 12 centers, 124 lesions in 102 patients were monitored for a period of 12 months after cryoablation. Two different treatment techniques were used: Double HI FREEZE and Tailored Freeze. In patients treated with the Tailored Freeze technique significantly better results were recorded 12 months after the procedure: the median reduction in tumor volume was 91%, 73% of all tumors treated were nonpalpable, 84% of lesions less than 2.5 cm in maximum diameter were nonpalpable, and none of the 31 mammograms performed yielded abnormal findings. Patient satisfaction was good to excellent in 92% of the patients. The safety profile of this technique was excellent; all complications were minor. Evolution of cryoablation freezing techniques, coupled with improvements in cryoprobe design, has resulted in significant improvements in both safety and effectiveness.

Popliteal artery aneurysms. Past and present.

Popliteal artery aneurysms have had an important historic role in the development of modern vascular surgery. Early methods of surgical therapy for these aneurysms are detailed in this report for a persepctive. Clinical aspects of surgical diagnosis and treatment of 35 popliteal artery aneurysms in 26 patients are also reviewed. Such aneurysms often present with varied symptoms and should be considered a treacherous disease entity since limb loss occurs in a considerable number of patients. Coexisting disease frequently complicates both the intraoperative and postoperative course of these patients. In this series of popliteal aneurysms, excision and venous autograft interposition offered the most successful operative therapy.

Multiple drug chemotherapy regimen for patients with hormonally-unresponsive carcinoma of the prostate: a preliminary report.

Of 25 patients with estrogen-unresponsive prostatic adenocarcinoma submitted to multi-drug chemotherapy 6 had partial objective regression, 12 had objectively stable disease and 7 had progressive disease. The survival rates in the 3 groups were 63, 52 and 40 weeks, respectively.

Inflammatory carcinoma of the breast.

Inflammatory carcinoma of the breast was found in 30 of 1,458 patients with carcinoma of the breast seen at this medical center during a 20 year period from 1951 to 1971. These patients were evaluated for predisposing factors, presenting symptoms, physical characteristics and histologic findings. No single mode of therapy produced more than a rare five year survival period. Radical surgical procedures are seldom indicated.

Management of recurrent melanoma of the extremity.

Two forms of therapy employed for treatment of patients with recurrent melanoma limited to the extremity, and carried out during different intervals of time, are presented. Perfusion of the involved extremity with phenylalanine mustard has resulted in a 5-year survival rate of 28% of 43 patients. A second group of 25 patients has been treated by a four-stage immunotherapy program consisting of sensitization with intradermal BCG, followed in 6 weeks by intra tumor injection of BCG. A third stage involved the activation of the patients's lymphocytes, after removal by a blood cell separator, incubated in vitro with irradiated neuraminidase-treated melanoma cells and reintroduced into the patient either by subcutaneous or intratumor injection. The fourth stage of immunotherapy involves injection of an inoculum of irradiated neuraminidase-treated autochothonous tumor cells plus BCG injected intratumorally or subcutaneously. Sixteen of 24 patients receiving immunotherapy treatment program have experienced arrest of their disease lasting from 5 to 42 months.