Biomedical subjects
Publications and source records attributed to C H Houston.
Forty-three postoperative anorectal bleeding episodes were encountered in the treatment of 4,059 anorectal operations, an incidence of 1.06 per cent. One-third of the postoperative bleeding occurred within the first 48 hours and reflects technical errors; nearly half of the bleeding occurred from the seventh to the 11th postoperative days; the cause of this delayed bleeding remains obscure.
This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.
The successful management of a near-complete sloughage of the anal outlet following aortic graft replacement is reported. Oxygenation in the immediate postoperative period along with appropriate antibiotics may be beneficial in preventing such sloughage. Embolic phenomena or bacterial growth, or both, may have been factors in causing the extensive sloughage.
Forty consecutive anterior resections using TA stapler were studied. No mortality, no clinical leak, and no infection were encountered in this group. The stapler is recommended as an aid in simplifying the operation and lessening the operative time.
A new case of Goltz's syndrome, focal dermal hypoplasia, is documented. The literature is reviewed. The composite individuality warrants considering Golt'z syndrome a separate syndrome in the ectodermal dysplasias. Caution against diagnosing "condyloma-like" lesions occurring in ectodermally dysplastic patients as condyloma acuminatum is urged. Neoplastic transformation and the tendency to recurrence after surgical exicision of the cutaneous angiofibromas pose a difficult problem in surgical management.