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THIS METHOD of resecting the upper part of the rectum and rectosigmoid was reported in 1948.1 The anastomosis is achieved not by suturing, but by invaginating the sigmoid through the intact anal canal. The particular advantage of the procedure is that fecal continence, rather than only a sphincter capable of contracting, is preserved. At the time of the previous report seven patients had been treated. The increased experience with 41 patients serves as the basis for the present report.Resections of the rectum with restoration of continuity of the bowel antedated radical amputations of the lower reaches of the bowel by almost a quarter of a century. Procedures of the Kraske2 type, in which continuity is restored by circular suture, proved quite unsatisfactory because of leakage of the anastomosis. Hochenegg,3 three years after the introduction of the Kraske method, attempted to avoid anastomosis by suturing, by use

IT IS NOW rather generally agreed that the only definitive surgical treatment of chronic ulcerative colitis is the formation of an ileac stoma and resection of the intestine including the terminal ileum, colon, and rectum. Marked progress has been made, particularly during the past few years, in reducing the risk associated with the surgical procedures. In our opinion, use of the skin-grafted ileac stoma has solved several of the problems associated with stomas of the usual type. For reasons that are not entirely clear, skin-grafted stomas have not been widely accepted. Emphasis instead has been placed recently on increased safety of surgical treatment and the virtues of appliances which are cemented to the skin.1 Presumably then, surgical treatment and the management of the ileac stoma have become so satisfactory that surgical treatment seems warranted in a far greater proportion of cases. This presumption seems untenable to us, essentially because

The cases of carcinoma of the thyroid seen at the Mayo Clinic from 1926 through 1955 have been reviewed recently in detail. The study, started some years ago, was undertaken originally to determine the adequacy of the pathologic classification currently in use. The pathologic aspects, late survival rates, and some of the details of treatment have been reported.6 In the present study, an attempt was made to evaluate in greater detail the surgical procedures in the hope of defining with greater confidence the extent of the surgical procedure indicated in the treatment of lesions of different types. PATHOLOGIC CLASSIFICATION The classification of the lesions in this series is shown in Table 1. The papillary carcinomas are well known and need not be discussed at length. The various histologic patterns, whether predominately papillary, mixed papillary and follicular, or follicular, have little bearing on treatment or ultimate outcome. The term "occult"

A type of nonspecific ulcerative colitis in which the most distal part of the colon and the rectum initially are uninvolved was described originally by Bargen and Weber,2 in 1930, as "regional migratory chronic ulcerative colitis." The condition has been termed "right-sided colitis," "regional ulcerative colitis," and "type 2 ulcerative colitis." The preferred name at present appears to be "segmental ulcerative colitis." The inflammatory process may be limited to the right side of the colon or to one or more parts of the colon, or it may extend continuously from the cecum into the sigmoid. Whatever the distribution and extent of the inflammatory process in the more proximal reaches of the colon, the part of the intestine accessible to proctoscopic examination is entirely normal initially.As is true of regional enteritis, the treatment of segmental colitis was considered at first to be primarily surgical. The involved part of the

The treatment of hyperparathyroidism has been discussed in considerable detail previously. Practically all the principles on which treatment is based were first set forth in a remarkably prescient paper by Churchill and Cope1 in 1934. The surgical aspects were again discussed by Cope2 in 1941 and by Rienhoff3 in 1950. The experience at the Mayo Clinic, based on the treatment of 63 patients, was reviewed in 19484 and again after treatment of 112 patients, in 1953.5 Another review of the details of treatment does not seem warranted at this time, but some general impressions can well be considered. The increased experience of the present has provided a better understanding of the pathology of hyperparathyroidism and a far different conception of the anatomy of the parathyroids and of the frequency of mediastinal adenomas. Somewhat surprisingly, the surgical difficulties stressed in practically all previous papers have proved

A procedure of the pull-through type, called descriptively a combined abdominoendorectal resection, has been used in the surgical service of one of us (B. M. B.) since 1948. It differs from the usual sphincter-saving operation in that the most distal 3 to 4 cm. of rectum is preserved instead of the sphincter only. While the technical modification is relatively minor, subsequent fecal control is thereby improved greatly. Experience (through 1956) with the procedure in the treatment of 106 patients with carcinoma, 5 with benign polypoid lesions, 2 with megacolon, and 1 with segmental chronic ulcerative colitis forms the basis for the present report. TECHNICAL CONSIDERATIONS The technical aspects of the operation have been described in detail previously,3,4 and only certain features and changes that have been made in the technique will be considered at this time. The abdominal part of the procedure is identical with that of sphincter-saving operations,

Carcinoma of the rectum and rectosigmoid may recur locally regardless of the type of surgical procedure employed.* It has long been realized that the treatment of local recurrences after combined abdominoperineal resection is largely futile.1 Total excision of the malignant tissue is practically never possible, and external irradiation is of limited value even palliatively. Relatively little is known of the results of treatment of local recurrences after continence-preserving procedures, such as segmental resections and pull-through operations. On the whole, the results should be better than those of treatment of recurrences after combined abdominoperineal resections. The presence of the bowel should permit earlier recognition of the recurrence, since the region in which the recurrences develop is accessible to both digital and proctoscopic examination. The recurrence may involve only the wall of the bowel or the perirectal tissues which can be resected. Radiation therapy should be more successful also, since radium