Current trends in the treatment of mycotic infections

Several new drugs have recently been developed which will contribute to improve control of mycoses. Especially oral broad spectrum antifungals seem to open a new era of antimycotic therapy. As many mycoses are based on limited deficiencies of the host's defense systems, immunostimulating therapy becomes increasingly important, but is still in the beginning of its development. World-wide programmes stimulated by WHO, ISHAM and other international Medical Associations should help do distribute the achievements of pharmaceutical research to regions of greatest need.     

Surgical treatment of mesotympanitis

A chronic sluggish suppuration in the middle ear, mesotympanitis, leads to impairment of sound conduction and onset of hypoacusis. Otogenic labyrinthopathy is also possible. As to complications, present-day course of mesotympanitis is close to epitympanitis. Intensive conservative therapy should be followed by revision of the middle ear system earlier than 4-6 months of remission. In minor lesions tympanoplasty with retroauricular drainage of the antrum is indicated, in serious affection surgical intervention is needed.     

Surgical treatment of endocarditis

Since early investigators first suggested that the treatment of endocarditis should include valve replacement for infections not readily controlled with medical therapy alone, the role of surgery has become expanded, yet refined, to improve the outcome of patients with this potentially fatal disease. Innovative surgical techniques have also been developed in an effort to improve the results of surgical treatment for complex sequelae of invasive infections. This article examines the current indications for surgical intervention, compares the various surgical options, and assesses the expected short-and long-term outcome after valve replacement for patients with native valve or prosthetic valve endocarditis.     

Surgical treatment of thymoma

This paper presented 6 cases of thymomas, surgically treated at the Newcastle Regional Cardiothoracic Surgical Service-England during the period 1970-1971. Excision of the tumour alone was carried-out in two patients. In the remaining four, a thymectomy and removal of the tumour was performed. In one case histological appearance suggested malignancy. The author insists upon an early excision, because the because the benign thymomas are potentially malignant tumours and the possibility of recurrence can be more effectively prevented by thymectomy at the same time. The coincidence of thyretoxicosis and thymoma, respectively aplastic anaemia and thymoma, were presented in 2 patients. To date, all patients have been well.     

Surgical treatment of syringobulbia

The treatment of syringobulbia requires a precise diagnosis of the etiology. This allows a surgical procedure directed at treating the underlying etiology or decompressing the hindbrain. In most cases, symptoms can be greatly improved.     

Surgical treatment of coccygodynia

The data on surgical treatment of 53 patients who suffered from posttraumatic coccygoynia are presented. To prevent suppuration of the postoperative wound the incision of the skin was performed not nearer that 5-6 cm from the anus and was directed proximally. The coccyx has been removed without injury of longitudinal sacro-coccygeal ligament. Postoperative complications were observed in 1.7% of patients. By follow-up (from 2 to 5 years) there were no relapses of the disease.     

Surgical treatment of ectopic pregnancy

Ectopic pregnancy is a common occurrence. Laparoscopic surgery is the treatment of choice when possible. In this retrospective study we report that the type of surgical treatment of ectopic pregnancy is influenced by the degree of haematoperitoneum, but not by delay by doctor or patient.     

Surgical treatment of renovascular hypertension

Two hundred sixty-four patients exhibiting renal artery occlusive disease underwent operation for renovascular hypertension between 1961 and 1977. Included were 27 pediatric patients. Fibrodysplastic disease affected 132 adults. Atherosclerotic lesions affected 51 patients with and 54 patients without clinically overt extrarenal arteriosclerotic cardiovascular disease. Ischemic kidney renin hypersecretion (renal: systemic index greater than 0.48), associated with suppressed contralateral kidney renin secretion (renal: systemic index approaching 0.0) predicted curability most reliably. Three hundred forty-eight operations were performed, of which 297 were primary and 51 were secondary procedures. Nephrectomy was initial therapy in 15 cases. Three operative deaths occurred among 51 patients manifesting overt extrarenal arteriosclerotic disease. No operative mortality was encountered among the other 213 patients. Surgical benefits were afforded 96% of pediatric patients and adults with fibrodysplastic disease, 91% of patients with focal renal arteriosclerosis, and 73% of those exhibiting overt extrarenal arteriosclerosis.     

Surgical treatment of mal perforans

Mal perforans is a chronic foot ulcer commonly found in diabetics with neuropathy. Although it will often respond to conservative measures, recurrence is frequent and brings with it the risk of spreading infection and serious destruction of tissues. Surgical treatment of seven patients, based on excision of the distal metatarsal bone (five patients), or excision of the distal metatarsal and amputation of the first toe (two patients), gave satisfactory results and is indicated to achieve long-term healing. A special shoe, designed to remove pressure from the healing areas as well as from potential new pressure points, was used in the last four patients.