The Madigan prostatectomy

A total of 59 patients with bladder outflow obstruction underwent the Madigan prostatectomy. The method, results and complications are described. For select patients with large benign adenomas without a median lobe or hematuria we believe the technique to be the operation of choice, particularly in younger patients. Advantages include absence of postoperative hematuria and clot retention, a decreased requirement for blood transfusions, a 16F postoperative catheter with early removal, avoidance of post-catheter stricture, a low rate of postoperative urinary infection, a short comfortable period of hospitalization and, in the long term (median followup 6 years), preservation of potency and antegrade ejaculation.

Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form

Severe cases of hidradenitis suppurativa affecting the perineum and gluteal regions may be treated successfully by 'deroofing' the sinus and fistulae tracts. These lie in the dermis and are partly epithelialized by cells from involved hair follicles and disrupted sweat glands. Careful preservation of the floor of the tracts leads to re-epithelialization with disease-free skin. More radical surgery is unnecessary and the problems of covering widely excised areas in this heavily contaminated region are avoided. By spreading the treatment over several operating sessions and hospital admissions, postoperative discomfort and in-patient nursing requirements are minimized. The technique of deroofing is described and the treatment of three severe cases is discussed. One patient illustrated the recognized complication of malignant change occurring in long-standing untreated disease. A fourth case illustrates the difficulties in diagnosing perianal hidradenitis suppurativa and literature cited suggests it to be a more common condition than once thought and a diagnosis frequently missed.

A combination of subcuticular suture and sterile Micropore tape compared with conventional interrupted sutures for skin closure. A controlled trial

We have conducted a controlled trial to compare skin closure using conventional interrupted sutures with a combination of subcuticular suture and sterile Micropore tape in 169 patients undergoing appendicectomy, inguinal herniorrhaphy, or saphenofemoral ligation. We have found that the combination technique consistently gives a better cosmetic result and that the tape acts well as a dressing, is convenient, and is well tolerated by patients.

Proctoscopy and sigmoidoscopy

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Perianal skin gangrene due to amoebic infection in a diabetic

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Electrocardiography during manual dilatation of the anus

Manual dilatation of the anus was carried out on 50 unpremedicated outpatients under propanidid, nitrous oxide, and halothane anaesthesia with E.C.G.monitoring. About half of the patients received intravenous atropine with the propanidid. The operation induced a variety of changes in heart rate but in the whole experiment only two isolated cardiac arrhythmic complexes were seen-a single defect of conduction and a solitary ventricular extrasystole. Changes in rate were not modified by atropine. It is concluded that manual dilatation of the anus is a safe procedure when carried out under the anaesthetic described and that prior medication with atropine is not necessary. This work supports the view that propanidid protects patients from most abnormalities of heart action which result from intense visceral stimulation.

Unusual case of pilonidal sinus

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