Prevention and treatment of posthemorrhagic disorders in surgical treatment of scoliosis

The measures of the blood loss prophylaxis and compensation, occurred at the time of 4350 surgical interventions on vertebral column conduction in 2697 patients with scoliosis, are analyzed. While performing osteoplastic fixation of vertebral column the blood loss have constituted 1200-2600 ml. The lowering of the blood loss down to 200-120 ml while conducting of complex correcting interventions was permitted by application of the governed hypotension together with general anesthesia.     

The results of the surgical treatment of bladder cancer patients

A new method for accommodation training making use of a computer is proposed. A specially generated dynamic grid of concentric rings serves the stimulus. Changes of the accommodation parameters (the nearest and farthest points of clear vision) were examined in 11 display users aged 30 to 50 during a training session and in the course of 15 sessions. The training improved the accommodation volume by an average of 0.9 diopters at the expense of approximating the nearest and withdrawing the farthest clear vision points. In 4 subjects anisoaccommodation disappeared almost completely. The proposed method may be used to normalize the accommodation of display users.     

A physiological approach to surgical treatment of progressive early idiopathic scoliosis

The Christ-Siemens-Touraine syndrome (CST syndrome) is the rare an- or hypohidrotic form of the ectodermal dysplasia. During embryonic development, the formation and maturation of the central nervous system and the epithelia of the sense organs, skin, teeth, hair (and less frequently the nails) are disturbed. In addition to the cosmetic impairment, insufficient or absent secretion of sweat and sebum is particularly discomforting as it leads to extreme heat intolerance. The decreased number of apocrine sweat glands and mucous glands in the upper nasopharynx results in diminished resistance to respiratory infections. We describe typical features of the disease in a 60 year old female patient, distinguishing this disease from other forms of ectodermal dysplasia. Diagnostic criteria as well as therapeutic options are discussed.     

The results of treatment for complete prolapse of the rectum in the adult patient

A method of anterior fixation of the bowel in complete prolapse of the rectum is described. The treatment is based on the concept that abdominal pressure should be directed on the bowel against the pubis rather than directly onto the perineum. The results have been universally successful, without mortality and with excellent functional results.     

The late results of combined surgical treatment in peptic ulcer patients

The authors submit a successful case of penile replantation. They discuss the course of the procedure and document the immediate and long-term result of this procedure.     

Long-term results of surgical treatment of thumb polydactyly

One hundred thirteen hands exhibiting thumb polydactyly were treated and followed up for an average of 49 months. Of these, 109 hands were treated by resection of a supernumerary hypoplastic thumb. Radial thumbs were resected in 107 hands and ulnar thumbs in 2 hands. Four hands were treated using a modified Bilhaut procedure. According to a modified Tada's evaluation, the results were evaluated as good in 97 hands, fair in 12 hands, and poor in 4 hands. Patients and/or their parents were satisfied with the results in 100 hands and dissatisfied with the results in 13 hands. The factors that influenced the surgical results were analyzed. The incidence of unsatisfactory results was relatively high in Wassel types 3, 5, and 6 and triphalangeal-type thumb polydactyly. It was higher when the ulnar digit was removed than when the radial digit was removed. The results for those patients treated between 1983 and 1991 were better than for those treated between 1976 and 1982. The type of deformity, type of procedure, and skillfulness of the surgeon were factors in the results after surgery.     

The surgical treatment of renal artery fibrodysplasia. The immediate and late results

Between November 1977 and April 1992, thirty patients carrying several forms of renal artery fibrodysplasia underwent surgical treatment. The series is composed of thirteen male and seventeen female, aged between 1 and 51 years (mean age 32). All patients had arterial hypertension, which was not relieved by medical therapy, consisting in the administration of an average of 2.9 antihypertensive drugs per patients. Bilateral renal artery lesions were diagnosed in ten patients (33.3%). The remaining twenty patients (66.6%) had unilateral lesions, one of which involved a congenital single kidney, making a total of forty renal arteries affected by the disease. Surgical procedures consisted in renal artery revascularization in thirty-one kidneys, in aneurysmectomy alone or associated with aorto-renal bypass in six cases, and in a nephrectomy as a single procedure in one case. Three kidneys were considered lost and were left untouched. There was no operative mortality. Evaluated between 1 and 173 months following the operation (mean 79 months/6.6 years) twenty-six patients (86.6%) were classified as either cured or improved. Only two patients (6.6%) did not get any improvement with the surgical treatment. Two patients whose condition after the operation was considered satisfactory were lost to follow-up. The results of this experience are compared with other series published in the international literature, as well as with the percutaneous transluminal angioplasty which has been regarded as an alternative to arterial reconstructive surgery.     

Comparative results of surgical treatment for perforating and bleeding pyloroduodenal ulcers

Results of treatment of 1309 patients with perforated and bleeding pyloroduodenal ulcers for 20-years period have been analysed. Resection of the stomach performed in 85 cases resulted in high postoperative lethality which made up in bleeding ulcers 14.8%. Drainage operations of the stomach with excision or suturing of ulcer combined with bilateral truncal vagotomy was performed in 60 patients, postoperative lethality rate being 8.4%. 128 patients underwent selective proximal vagotomy together with pyloro- and duodenoplasty, lethality rate being 1.6%. Combined vagotomy (posterior truncal and anterior sero-muscular) with excision of ulcer, transversal pyloroplasty and duodenoplasty was carried out in 1036 patients (postoperative lethality--2.4%). Excellent and good functional results were achieved in 79.6% of the patients.     

Leiomyosarcoma of the esophagus: results of surgical treatment

BACKGROUND: This study examined the results of surgical treatment of leiomyosarcoma of the esophagus. METHODS: Between January 1920 and December 1996, 17 patients (9 men and 8 women) with leiomyosarcoma of the esophagus were treated surgically at the Mayo Clinic. Median age was 58 years and ranged from 26 to 76 years. Symptoms included dysphagia in 11 patients (64.7%) and odynophagia in 6 (35.3%). The tumor was located in the middle third of the esophagus in 10 patients (58.8%) and in the cervical esophagus in 7 (41.2%). Procedures performed included esophagogastrectomy in 9 patients (Ivor Lewis in 5, left thoracoabdominal in 3, and transhiatal in 1), enucleation in 3, transgastric excision in 1, and exploration without resection in 4. RESULTS: The procedure was considered curative in 11 patients (64.7%). There was one operative death (mortality, 5.9%). Complications occurred in 3 patients (17.6%) and included anastomotic leak in 2 and bleeding requiring reoperation in 1. Growth pattern was infiltrating in 7, polypoid in 5, and intramural in 5. Histologically, the tumor was grade 1 in 6 patients, grade 2 in 2, grade 3 in 7, and grade 4 in 2. The tumor was postsurgically classified as stage I in 2 patients, stage IIA in 7, stage IIB in 1, stage IIIA in 5, stage IV in 1, and unknown in 1. Six patients (35.3%) received adjuvant treatment. Follow-up was complete in 16 patients (94.1%) and ranged from 1 to 182 months (median, 48 months). Five- and 10-year actuarial survivals were 47.0% and 31.0%, respectively. Seven patients (41.2%) are currently alive (median survival, 72 months); all underwent curative resection. Factors affecting survival included completeness of resection, growth pattern, postsurgical stage, tumor grade, and tumor location (p < 0.05). CONCLUSIONS: We conclude that leiomyosarcoma of the esophagus is rare. Complete resection provides long-term survival.     

Immediate results of surgical treatment of gastric stump cancer

An immediate result of surgical treatment of gastric stump cancer in 68 patients is presented. The resectability rate was 23.5%. Lethality after radical operations was 18.7%, after symptomatic operations and exploratory laparotomy-9.6%. Gastric resection was performed, using the method developed in the clinic with wrapping the anastomosis, or gastric stump by a loop of the afferent intestine. In development of gastric stump cancer, local spreading of a tumor is not a reason to discard performance of radical operation.     

The early results of surgical treatment of chronic subdural hematomas in computerized tomography imaging

Glutathione (gamma-glutamyl-cysteinyl-glycine or GSH) is a cysteine-containing tripeptide with reducing and nucleophilic properties which play an important role in cellular protection from oxidative damage of lipids, proteins and nucleic acids. GSH regulates the metabolism of proteins and their activities by means of thiol-disulfide exchange. During oxidative stress, GSH plays a key role of protection and detoxification as a cofactor of glutathione peroxidases and glutathione-S-transferases. There are synergistic interactions between GSH and other components of the antioxidant defense system such as vitamin C, vitamin E and superoxide dismutases.     

The late results of the surgical treatment of perforated gastroduodenal ulcers in young people

The article is devoted to surgical treatment of perforating gastroduodenal ulcers. An investigation of remote results of palliative and radical interventions for the perforation of the stomach and duodenum in patients of young age has shown that recurrent ulcers after suturing the perforation take place in 67.2% of the people operated upon against 21% of those subjected to bilateral truncal subdiaphragmatic vagotomy with pyloroplasty. A conclusion is made that for perforating ulcers it is expedient to perform radical operative interventions as a bilateral truncal subdiaphragmatic vagotomy with pyloroplasty.     

The late results of the surgical treatment of patients with a pathologically mobile kidney

Long-term (1-10 years) results of wandering kidney surgery were followed-up for 118 patients. The outcomes were found dependent on the duration of the disease, variety and severity of the lesion, age of the patients. The response appeared better in younger patients, in those with shorter duration of the disease and with unessential changes in the kidney. Recommendations are provided on the regimens, jobs, outpatient and inpatient follow-up for the subjects treated surgically for wandering kidney to reinforce the correction results achieved.     

Urethral duplication in children: surgical treatment and results

PURPOSE: Urethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in 7 boys with incomplete sagittal duplication of the urethra. MATERIALS AND METHODS: Duplication involved hypospadias in 5 cases (group 1) and a bifid urethra with an accessory preanal tract (Y duplication) in 2 (group 2). Group 1 was treated with 1-stage urethroplasty, including marsupialization of the dorsal orthotopic urethra, ventral-to-dorsal urethrourethrostomy and penile island flap onlay repair to cover the open dorsal urethra. In contrast, group 2 was treated with 2-stage urethral reconstruction with detachment and mobilization of the accessory preanal branch in association with a scrotal tubed neourethra followed by urethroplasty, as in group 1. In all cases the dorsal penile urethra was located between the corpora cavernosa and surrounded by the tunica albuginea. RESULTS: A urethrocutaneous fistula developed in 1 of the 5 group 1 patients. In group 2, 1 patient had recurrent penoscrotal meatal stenosis after the 1-stage procedure and 1 had a urethral diverticulum with calculi at the scrotal tubed neourethra 7 years after urethral reconstruction. Six of the 7 patients now void spontaneously through a meatus located normally at the tip of the glans. The remaining patient with a neurogenic bladder is on intermittent catheterization via appendicovesicostomy due to difficult catheterization of the irregular and sensitive neourethra. CONCLUSIONS: While the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation.     

Remote results of surgical treatment of chronic suppurative lung diseases

The work was undertaken to study late results of surgical treatment of suppurative lung diseases during 1950-1974. Questionaries were sent to 420 operated patients. Answers were received from 328 (78%) patients, 86% of them were examined clinically, 14%--were estimated according to questionaries and their physician findings. 50 per cent of patients were followed up for 10-24 years. A positive effect was gained in 94.8%. 82 per cent of the operated patients have practically recovered well. The causes of poor issues are described, and trends for their improvement are delineated.     

Pleuropulmonary aspergilloma: clinical spectrum and results of surgical treatment

From 1974 to 1991, 77 patients were admitted for pulmonary (55), pleural (16), or bronchial (6) aspergilloma. About 50% were asymptomatic. Sixty-three underwent operation. Pulmonary aspergillomas were operated on for therapeutic need in 26 and on principle in 18; the procedures were 28 lobar or segmental resections, 10 thoracoplasties, and 5 pleuropneumonectomies (1 patient had exploration only). Pleural aspergillosis was treated by operation on principle in 5 and for therapeutic need in 8 patients; 10 thoracoplasties, 1 attempt at pleuropneumonectomy, and 2 decortications were performed. All six bronchial lesions were operated on as a rule. Overall postoperative mortality was 9.5%. Major complications were bleeding (n = 37), pleural space problems (n = 24), respiratory failure (n = 6), and postpneumonectomy empyema (n = 4). All patients with pleural disease experienced complications. The outcome was better after lobar or segmental resection than after thoracoplasty (mortality, 6% versus 15%). Asymptomatic and nonsequellary pulmonary or bronchial aspergilloma also had an improved outcome. We conclude that operation is at low risk in pulmonary or bronchial locations in asymptomatic patients and in the absence of sequellae; the risk is high in symptomatic patients for whom operation is the only definite treatment. Pleuropneumonectomy should be avoided. Only symptomatic pleural aspergilloma should be operated on.     

Surgical treatment for severe acute pancreatitis: factors which affect the surgical results

Surgical treatment for severe acute pancreatitis has not yet yielded satisfactory results. Several factors which might affect the surgical results of severe acute pancreatitis were analyzed in this study. The presence or absence of infection was not important as a factor determining the surgical results. The severity scores and some biochemical parameters such as CRP, IL-6, PMN-E, HGF seemed to be closely related to surgical results. It was likely that a significant decrease in lymphocyte counts in the blood on admission was closely related to the prognosis of the surgical patients. Timing and procedures for surgery should be more seriously considered in the treatment for patients with such poor general conditions.