Multiple-stage Procedure Research Articles

Multiple-Stage Procedures for Drug Screening

SUMMARY Completely general methods are developed to obtain the average sample size and the probability of accepting the hypothesis p = po for binomial probabilities in mnultiple stage sampling procedures. An example illustrating the use of a multiple-stage plan of this type for a drug screen is considered. Data on the actual performance of the screen is also given.

Single stage proctocolectomy for severe ulcerative colitis: Comparison with less extensive surgical procedures

Fifty patients with severe ulcerative colitis were submitted to major colonic resections during a fifteen year period. Thirty-six patients had single stage ileostomy and proctocolectomy with one early death (operative mortality 2.8 per cent). Fourteen patients had multiple stage procedures: usually ileostomy, abdominal colectomy with rectum left in place as the first stage. There were two early deaths in this group (operative mortality 14 per cent) and two later deaths. Second stage abdominoperineal resection of rectum because of recurrent ulcerative colitis has been necessary in seven of ten survivors of this group. This retrospective study validates the continued advocacy of single stage proctocolectomy in both elective and emergency management of patients with severe ulcerative colitis. An impressive degree of rehabilitation has been obtained in every patient after successful proctocolectomy.

Treatment of chronic ulcerative colitis

Fifty patients with severe ulcerative colitis were submitted to major colonic resections during a fifteen year period. Thirty-six patients had single stage ileostomy and proctocolectomy with one early death (operative mortality 2.8 per cent). Fourteen patients had multiple stage procedures: usually ileostomy, abdominal colectomy with rectum left in place as the first stage. There were two early deaths in this group (operative mortality 14 per cent) and two later deaths. Second stage abdominoperineal resection of rectum because of recurrent ulcerative colitis has been necessary in seven of ten survivors of this group. This retrospective study validates the continued advocacy of single stage proctocolectomy in both elective and emergency management of patients with severe ulcerative colitis. An impressive degree of rehabilitation has been obtained in every patient after successful proctocolectomy.

Surgical treatment of diverticulitis.

One of the serious complications of diverticulitis eventually develops in 25 to 30 per cent of patients with this disease.The use of the multiple-stage procedure for these complications has considerably reduced surgical mortality, but morbidity remains high.To reduce the surgical morbidity in diverticulitis, inadequate operative procedures should be avoided. However, a more effective method is to operate on patients likely to have obstruction or perforation before these serious complications develop. A one stage procedure can then be safely used.Inability to exclude carcinoma is also an imperative indication for surgery in patients with diverticulitis.

Repair and complications of esophageal atresia and tracheoesophageal fistula.

ESOPHAGEAL atresia and tracheoesophageal fistula are congenital anomalies that, until twenty years ago, had a very grave prognosis. Leven1 and Ladd,2 using a multiple-stage procedure, were among the first to repair the anomaly successfully, and Haight and Towsley3 performed the first successful primary anastomosis a short time later. The etiology, incidence and much other pertinent material have been reviewed by Haight.4 As summarized in Figure 1, there are five varieties of the anomaly in the following order of frequency: Type 1 consists of esophageal atresia with a fistula from the lower segment to the trachea; Type 2 has simple esophageal atresia . . .

Surgery in the Aged

Age alone is no longer a contraindication to surgery. Proper preoperative treatment and use of adjuvant therapy reduce the operative risk in the aged.Elderly patients do not tolerate postoperative complications well; thus, early recognition and treatment of complications are essential.Subradical operations or simple palliative procedures for cancer are often best in this age group. Multiple-stage procedures should be considered in conditions requiring extensive surgery.Emergency surgery is far more dangerous than elective surgery in the aged; therefore, early elective surgical treatment of conditions likely to cause surgical emergencies is advised.

Partial reconstruction of the nose

In spite of abrogating certain fixed principles, such as extending a donor site out toward the cheek, per se, grafting the external portion of the flap rather than the internal aspect of the flap and gambling on the vascular distribution as generally conceived, I believe an approach has been found which is cosmetically superior, with no disfiguring donor site to be complained of, and which is produced in a single-stage procedure rather than a multiple-stage procedure. The advantages to be found with the aforementioned approach lead me to believe that its future employment in partial reconstruction of the nose deserves serious consideration.

Surgical treatment of ulcerative colitis: A comparison of single-stage coloproctectomy with other procedures

We would sum up our attitude as favoring total coloproctectomy when ulcerative colitis becomes intolerable and is no longer responsive to medical management. Medical management should be continued as long as the patient is able to adjust himself to the disease. We favor one stage over planned multiple stages for total resection with ileostomy because it brings immediate relief to the patient without a prolonged convalescence in which complications may arise and in which the patient suffers economic loss. Surgical mortality does not appear to be a factor against the one-stage procedure. The immediate postoperative convalescence is more satisfactory than with multiple-stage procedures probably because of the immediate and total removal of the source of the toxic absorption. While multiple stages may give the patient an opportunity to adjust to the acceptance of permanent ileostomy during the weeks or months between stages, we do not believe this is an important enough consideration to weigh against the use of the one-stage procedure.

Repair following pharyngo-œsophago-laryngectomy

Summary Pharyngo-œsophago-laryngectomy poses problems in repair that are solved by reconstruction at the time of resection, by Negus's method, or by multiple stage procedures. The Negus operation is described and the advantages are stressed. The disadvantages are mainly technical and will be overcome when a suitable indwelling tube is designed for use during the contractile phase of the graft. The multiple-stage repair is discussed with special reference to the survival time and the duration of the repair. A method of reconstruction is presented that is eminently suitable in cases where the tracheal defect is a major problem. Stricture formation is a complication of the Negus method and multiple-stage repairs. Recurrences are not uncommon during a protracted repair, and for this reason we have concentrated upon quick methods. The main nursing problems are outlined, and the major an˦sthetic difficulties are discussed.