A prospective trial was conducted to compare haemorrhoidectomy alone (control, group 1) with haemorrhoidectomy plus lateral internal sphincterotomy (group 2) for prolapsed piles. Some 33 patients (18 men, 15 women) of mean(s.e.m.) age 40(2.3) years were randomized, 16 to group 1 and 17 to group 2. There were no significant differences in postoperative pain scores. Mean resting and maximum anal squeeze pressures, studied 6 weeks and 3 months after operation, were generally lower in group 2, but were not significantly different. Two patients in group 2 were distressed by incontinence to liquid faeces which persisted in one after 1 year. There were no other complications in either group after a mean(s.e.m.) follow-up of 11(0.4) months. The addition of lateral internal sphincterotomy to routine haemorrhoidectomy is unnecessary and carries the added risk of incontinence.
Interim results have been presented on the use of formalin to treat severe haemorrhagic radiation proctitis l . Long-term results are now reported.
Patients and methodsPatients who had undergone formalin therapy between September 1991 and December 1993 were studied; treatment and follow-up details were obtained from case files and patient interviews. Pretreatment investigations, method of application and mode of follow-up have been described previously'. Briefly, a 4 per cent formalin-soaked gauze was applied to affected areas of the rectum via a rigid sigmoidoscope for as long as was necessary to effect haemostasis. This was repeated for other affected areas until all inflamed mucosa had been treated.
Results
Patient detailsTwenty-nine patients (25 women, four men) of mean age 67 (range 38-94)years were studied. The women had had cancer of the cervix uteri for which external beam and intracavitary radiotherapy had been given. Three of the men had had carcinoma of the prostate and one rectal cancer; each underwent external beam radiotherapy. Colonoscopic biopsy in all patients showed histological changes consistent with radiation proctitis. The length of involved segments of rectum and the number of patients with rectal strictures are shown in Table 1.
Haemorrhage characteristicsThe median time of onset of bleeding to the application of formalin was 6 (range 1-24) months. Fifteen of the 29 patients had had previous hospitalization for severe bleeding requiring blood transfusion. Fourteen patients had not been transfused but ten had a haemoglobin level of less than 10 g/dl at the time of formalin therapy. Fifteen patients had previous failed medical therapy, including sulphasalazine, steroid, tranexamic acid and sucralfate enemas.
The records of 506 patients with histologically proven nodular goitre treated by thyroidectomy between January 1966 and July 1988 were reviewed. There were 21 patients with thyroid carcinoma in nodular goitre giving a proportion of 4.1%. There was an almost equal ratio of papillary to follicular carcinomas in the patients with malignancy occurring in a multinodular goitre (1 1 papillary to 9 follicular). One had an anaplastic lesion. These patients had swelling for a longer period, 9.1 1 years, as compared with an average of 5.48 years for those with only nodular goitre (P= < 0.01) using the Student's I-test. The male to female ratio in those with multinodular goitre alone was 1 : 10.8 while in those with carcinoma in multinodular goitre was 1 : 3.2. Comparing these two groups, the odds ratio of malignancy among males was 2.82 (95% confidence limits of the odds ratio being 1.4-5.5). This indicates that males with multinodular goitre had a significantly higher chance of developing a malignancy, Chi-squared value 5.74 (P < 0.05).
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