There is a lack of calibration of POSSUM and P-POSSUM systems at the extremes of age and high emergency workload. This has important implication in clinical practice, as consultants with a high emergency workload may seem to underperform when these scoring systems are applied. Recalibration or remodelling strategies may facilitate the application of POSSUM-based systems in colorectal surgery.

Wide excision of the rectum in inflammatory bowel disease is both unnecessary and undesirable as the healthy pelvic floor is damaged and the pelvic nerves put at risk. An operative technique is described which includes dissection of the anal canal and rectum in the intersphincteric plane, i.e. the plane of fusion between the visceral rectum and anal canal and the somatic pelvic musculature, which minimizes these undesirable elements. Fifty-three cases are presented. Perineal wound healing rates are comparable with those of other methods of resection and only 1 of 14 men reported partial sexual dysfunction following this operation.

The effect of Dicynene on blood loss during and after transurethral resection for benign enlargement of the prostate was studied in 76 patients. Median loss of blood at operation was 17 ml in those given Dicynene compared with 72 ml in the placebo group (p equals less than 0.001). Median postoperative blood loss was 38 ml in the Dicynene group, and 103 ml in the placebo group (p equals 0.05). Clinical evidence of deep vein thrombosis was found in neither group. Dicynene helps to reduce blood loss in transurethral resection.

A patient with primary squamous carcinoma of the proximal colon, who also had a previous adenocarcinoma of the large bowel, is described along with a review of the literature. Clinical features, etiologic factors, and possible pathogenesis are discussed.