Twenty-five years of experience with radical surgical treatment of carcinoma of the extraperitoneal rectum.

Between the years 1950 and 1975, 1,100 patients with carcinoma of the rectum were seen at the Toronto General Hospital. Of these, 519 had tumors below the peritoneal reflection. The resection rate in this latter group of patients was 94%. One hundred and thirty-three patients were treated by low anterior resection (LAR) and 316 by combined abdominoperineal resection (APR). Although the incidence of postoperative complications was high (LAR 41%, APR 53%), the operative mortality was low (LAR 2.2%, APR 2.9%). Recurrent tumor appeared more frequently in the pelvis (24%) than at distant sites (18%), was more common in more advanced disease, and correlated with the incidence of late death. The overall (actuarial) survival figures were 50% at 5 years and 37% at 10 years, with no significant difference between LAR and APR. For curative resections, the 5- and 10-year survival figures were 59% and 44%, respectively. Clinical staging (Dukes) influenced survival greatly, both at 5 years (Dukes A 77%, B 65%, C 33%, D 3%) and at 10 years (Dukes A 55%, B 53%, C 20%, D 0%). The level of the lesion did not influence either recurrence rate or survival.

Fiberoptic endoscopy during laparotomy in the diagnosis of small intestinal bleeding.

A patient with recurrent gastrointestinal bleeding caused by hereditary hemorrhagic telangiectasia localized to the small intestine is described. The diagnosis was made by combining two recognized investigational tools-fiberoptic endoscopy and laparotomy.

Protein-sparing therapy in postoperative patients. Effects of added hypocaloric glucose or lipid.

In patients receiving hypocaloric total parenteral nutrition, protein sparing with infusions of amino acids alone is alleged to occur because low insulin levels allow mobilization of endogenous fat. Four groups of patients studied for their first four postoperative days received all their nutrition parenterally as: 150 g per day of glucose, protein (as amino acids, 1 g per kilogram per day) alone, protein plus 50 g per day of soybean-oil emulsion or protein plus 150 g per day of glucose. All groups of patients receiving protein had lesser negative nitrogen balance than patients receiving glucose alone. The addition of glucose to protein did not increase negative nitrogen balance. The protein-sparing effect of amino acids appears to be a function of the infused amino acids alone and is not related to the degree of endogenous fat mobilization.