I have stated on the pain clinic in the field of colonic and anal disturbances. Nerve blocking is not a monopoly of the department of anesthesiology, except for some special methods. It is a technique which can be utilized more extensively by a larger number of physicians, and as a result, it may be anticipated that the diagnosis and therapy for which no adequate means have hitherto been available will become easy.
The statistical studies on the 217 cases who had operated for hemorrhoidal diseases in our department from 1964 to 1968. We made inquiries about the postoperative dissatisfaction about between the group who had been treated by the Whitehead's method and the group by the Braatz's method. Satisfaction is 74.4% of the former and 43.3% of the latter. Then the recurrence of the hemorrhoids, the group of the Braatz's method is more than that of the Whitehead's method. And so on the anal stricture after the oporation, the group of the Braatz's method is more than that of the Whitehead's method. On the other hand, disagreeable complications these are to say prolapse of mucous membrane and anal insufficiency, is much more observed in the group of Whitehead's method. Next, the investigation on the reoperation after the surgical treatment for hemorrhoidal diseases was performed. As the latter reoperation we treated with the Dieffenbach's method about the stricture of the anus after the operation of the Whitehead's method. As the result of this observations, the Whitehead's method is better method than the Braatz's method so far as the good operater performed the operation.
We carried out operations on the anus in 368 patients in the 5-year period from January, 1964 to December, 1968. They comprised 200 cases of piles and prolapsus ani, and 168 cases of anal fistula, etc. A modification of Whitehead's operation was adopted for operation on all cases of prolapsus ani. We believe that this procedure is satisfactory, only if it is skillfully performed. We do not adopt this procedure on moderate prolapses, but it is particularly effective for serious, semi-circumferent prolapses. We have been using resection and suture for internal piles free of prolapse.
To prevent the prolapse of the mucous membrane, more skin should be left than that in the past. The anus is sufficiently pulled out ; and as it is thick, a pair of forceps are applied deep and resection performed, leaving a margin to suture. Because the suture and needle are hooked deep and wide, hemostasis and suture are completed simultaneously. This modified procedure contributes to reduction in time and prevention of prolapse of the mucous membrane. We have adopted this procedure in 204 of 318 patients of anal disturbances, and the inquires made to 83 of them indicated that the procedure gave rise to a better result in 88.3%, no change in 7.4% and a poor result in 4.3% of them a satisfactory result was attained by the procedure.
The long-term results of hemorrhoidectomy by the ligature and excision method in 674 patients from January 1965 through June 1966 in my clinic were studied by the mail method and examined. The results obtained were as follows: 1. The reply was obtained from 479 cases : the percentage was 71.1%. 2. The results of the operation : No. of cases Percentage Excellent 215 450 93.9% Good 235) Unchanged 24 29 6.1% Exacerbated 5) 3. The feeling about the treated anus : No. of cases Percentage Well 352 73.4% Unwell 127 26.6% 4. Sequelae : No. of cases Percentage Recurrence 4 0.8% Stricture 31 42 8.8% Prolapse of the mucous membrane 0 Anal incontinence 11)
354 operations for internal haemorrhoid which is called "Ligature and Excision Method" were carried out at the Kosei Gen. Hospital during the past 4 years and 7 months. Written inquiries were sent off to all patients, and 175 answers (49.7%) were received. 148 cases had improved without any trouble but 27 cases had a slight degree of disorder such as anal bleeding, anal pain, anal wetness and anal prolapse. These were 2 cases who complained of a moderate amount of pain. It was found that most of these disorders were caused by postoperative hard feces, constipation or diarrhea.
Two hundred seventy six patients were operated on the hemorrhoids at this department from 1955 to 1967. Concerning the method of operation, Withead's operation and Braatz's method were perforomed mainly from 1955 to 1968. But the ligature operation by Milligan-Morgan was adopted at this department since 1956. And nowadays the ligature method by Milligan-Morgan or Parks were performed usually for treatment of the hemorrhoids. This report is the follow up results in such methods about operation of the hemorrhoids. 1. Whitehead's operation The patients who have no complaint after operation were 12 of 26 cases (46.2%). Recurrence of the hemorrhoids was 3 cases (11.5%), anal bleeding 5 cases (19.3%), incontinence 2 cases (7.7%), prolapse 3 cases (11.5%) and anal stricture 1 case (3.8%). 2. Braatz's operation The patients who have no complaint after operation were 13 of 24 cases. Recurrence of the hemorrhoids was 8 cases (33.4%), anal bleeding 2 cases (8.4%) and pruritus ani 1 case (4.2%). 3. Milligan-Morgan's method The patients who have no complaint after operation were 47 of 70 cases (67.0%) Recur-rence of the hemorrhoids was 16 cases (22.8%), anal bleeding 3 cases (4.4%), pain on defeca-tion 3 cases (4.4%) and prolapse 1 cases (1.4%). 4. Parks's method The patients who have no complaint after operation were 22 of 28 cases. Recurrence of the hemorrhoids was 5 cases (17.8%). No person have complaint such complications as anal bleeding or pain on defecation after this operation. Conclusion of this report was that Whitehead's operation was frequently accompanied with the postoperative disturbance of anal stricture, prolapse and defecation bleeding. The other hand the ligature operation (Milligan-Morgan and Parks) was not almost complicated with above various postoperative disturbance but the recurrence of the hemorrhoids was recognized in few cases.
Post-operative condition of hemorrhoidectomy was followed up in 348 cases for 5 years recently, of which 67 cases were Whitehead operation, 58 cases were ligature and excision operation, and other's. This statistical study obtained was as follows. Until 1964, Whitehead operation was performed in high frequency, but it had slowly decreased and ligature and excision operation generally increased since 1965. No complaint cases postoperatively were 36 percents in whitehead operation and 29 percents in ligature and excision operation, however other method had more complaints.
Histochemical studies for a carcinoid tumor which had removed surgically from a 61 year-old female were reported. The tumor located at the site of ileocecal valve and had a hen-egg size. The patient had revealed no carcinoid symptoms. Histologically, the tumor was a typical carcinoid and infiltrated into the muscular layer, indicating malignant carcinoid tumor, PAS and alcian blue stain were almost negative but were feebly positive in the scantly existing glandular structure. According MASSON-FONTANA'S method, argentaffin reaction showed many fine and brown granules in the protoplasm, these granules distributed in the basal portion of the cells in the glandular structure. Both reactions of chromaffin and diazosafranin were positive. RNA and acid phosphatase were demonstrated intensely in the tumor cells, especially located in the apical portion of the cells in the glandular structure, on the other hand, alkaline phosphatase was found only in the luminal portion. Activity of phosphamidase was intense but succinic dehydrogenase was weak. It is to note that the tumor cell exhibited the two different natures, the one was the positive reaction of argentaffin, chromaffin and diazosafranin, which was never seen in normal intestinal epithelium. Another was the histochemical specificity of RNA, PAS, alcian blue,