Ligation and cryosurgery of all hemorrhoids. An office procedure.

Over 21,000 patients with symptomatic hemorrhoids were treated either at the Rudd Clinic in Toronto, or at Proctology International in the Cayman Islands, with the ligation or the ligation and cryosurgical technique. The procedures as described are simple, very effective and should be done in the office and not in the hospital. It is better for both patient and doctor and the cost saving is in the tens of millions of dollars in our series alone.

Office treatment of hemorrhoids.

The author holds that the weight of evidence from experience with 20,000 patients indicates overwhelmingly that the office treatment of hemorrhoids by means of ligation and the cryosurgical technique described is the treatment of choice. He gives 10 reasons, most of which are to the benefit of the patient, but some of which also benefit the doctor. The cost saving amounts to millions of dollars, a factor that should be of interest to government and insurers.

A prospective, randomized study of the management of severe ankle fractures.

One hundred and thirty-eight patients with a closed grade-4 supination-external rotation or pronation-external rotation ankle fracture (Lauge-Hansen classification) who were seen in the emergency room of the University of Chicago Hospitals were entered into a randomized study of the results of various methods of treatment. Ninety-six patients with satisfactory initial closed reduction were randomized between continued closed treatment in a plaster cast and open reduction with rigid internal fixation according to the techniques of the Association for the Study of Internal Fixation (ASIF). Forty-two patients with unsatisfactory closed reduction were randomized between open reduction with internal fixation of only the medial malleolus and open reduction with rigid internal fixation according to the ASIF techniques.

The kock pouch: a continent ileostomy with no appliance.

In this new operation, a pouch or reservoir is fashioned out of terminal ileum with a valve mechanism at its exit to the skin surface. This allows storage of the liquid bowel contents in an expandable container with no leakage of stool or gas and therefore no skin problems. There is no need for appliances or bags, no embarrassment from the involuntary noise and smell of flatus through the ileostomy.

Lateral subcutaneous internal sphincterotomy for chronic anal fissure, an outpatient procedure.

We have adapted the lateral internal sphincterotomy technique for the repair of chronic anal fissure to a strictly office or outpatient procedure. The early cure rate in this review of our first 200 patients was very good - well in excess of 98 per cent. Complications were exceedingly minor, the considerable cost to the patient of hospitalization and time off from work has been saved, and patient acceptance has been excellent.

Please doctor - no colostomy.

Many cancers of the rectum are discovered which are too low for the standard abdominal resection and anastomosis; therefore an abdominal perineal resection and colostomy are performed. Three new techniques are described which will allow a number of these patients to have their low rectal tumors resected with primary anastomosis, so that a colostomy is avoided. These are very grateful patients.

The contractile mechanism in cilia.

A detailed analysis is made of the motion and the forces in the cilium of Sabellaria over the complete cycle. The results indicate that the stiffness of the cilium is directly related to the moments produced by the internal contractile elements. A sliding filament model is developed to generate the complete cycle of motion.

Office Surgery for Chronic Fissure-in-Ano.

We have modified a new technique of surgical repair for chronic fissure-in-ano at the Rudd Clinic. The patient is treated by preference in the office under local rather than general anesthetic; he may then drive home and is back to work within two days. Healing is quicker, the cure rate is higher, complications fewer and only minor.

The stiffness of the flagella of impaled bull sperm.

The elastic rigidity (stiffness) of impaled motionless bull sperm flagella has been determined by a manipulatory technique which permitted direct analytical treatment of the experimental system. The effects of external ATP and ADP were measured. It was found that ATP acts as a plasticizing agent, while ADP does not.

Ligation of hemorrhoids as an office procedure.

Hemorrhoidectomy has been done on all our patients in whom operation was indicated, using the ligation method in the office. The patient does not require hospitalization or general anesthesia and rarely has pain or loss of time from work. Many thousands of hospital bed-days have been saved for more serious problems.

Fiberoptic colonoscopy: a dramatic advance in colon surgery.

A new instrument is now available which will allow direct viewing of the lumen of the entire colon from rectum to cecum. Biopsies as well as excision of some lesions are also possible through the instrument. The advantages to the patient are many and obvious.

Condyloma accuminata: a new, more effective treatment.

Nineteen cases of condyloma accuminata in the perianal area and within the anal canal have been treated with bichloracetic acid in our proctology practice. Nine of these had massive involvement of the area, and nine were referred after other types of treatment had failed. The results of the application of bichloracetic acid for this disease in our series has been uniformly successful to date, and this treatment is recommended to the family physician for use in his office.

Office proctology-how I do it.

Several new concepts and some excellent new office procedures are brought out in the discussion of six of the commonest anorectal diseases seen in the family physician's office.