ulcerative colitis during 1965-7. All were given identical mechanical preparation and identical sulphonamide therapy preoperatively. Fifty patients chosen at random were, in addition, given Colomycin (colistin sulphate) during the 24 hours before operation, in a dose of 3 million units 8-hourly. (Thirty-nine of the roo patients were also receiving steroids before, during, and after operation.)At operation, the degree of bowel loading was noted, as was the degree of faecal contamination during the operation itself. Postoperatively, the development of complications, particularly sepsis, was recorded in detail.Initial results indicate that:-I . Addition of Colomycin made virtually no difference to subsequent mortality and morbidity.2. There was no significant difference in mortality or morbidity between those groups of patients who did or did not receive steroids.3. The incidence of sepsis was significantly raised ( a ) in patients with a loaded colon at operation, and (b) where faecal contamination, however slight, occurred.It is concluded that in attempting to reduce sepsis after radical surgery from colitis, Colomycin is of little value. Mechanical preparation and avoidance of contamination seem the factors more closely related with the development of subsequent sepsis.Haemorrhoidectomy has the unfortunate reputation of be/ng followed by an inordinate amount of postoperative pain. Previous studies (Watts et al., 1964(Watts et al., , 1965 have suggested that the type of operation employed makes little difference to the degree of postoperative pain. But these same studies indicated that the addition of a sphincterstretch prior to operation might possibly reduce the subsequent pain.In the present prospective random controlled trial roo patients undergoing haemorrhoidectomy were allocated to two groups. In the first group of 50 patients the anal sphincters were stretched for 4 minutes prior to operation. In the second group, this step was omitted. All IOO patients then underwent haemorrhoidectomy as described by Milligan et al. (1937). At postoperative follow-up the amount of pain was assessed, as was the state of anal continence at 3 and 24 months after operation.Patients following sphincter-stretch suffered slightly less pain than the controls, but this difference was not statistically significant. There was moreover a significantly higher rate of minor imperfections of anal control in the months following sphincter-stretch.It is concluded that preliminary sphincter-stretch does little to lessen the discomfort following haemorrhoidectomy, and carries the additional risk of postoperative impairment of continence.
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