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.     

Early and late results of surgical treatment in patients with primary mediastinal germ cell tumors]

A group of 37 patients--20 (54%) men and 17 (46%) women--aged 2-65, mean 31.6 years, was treated between 1978 and 1995 for different kinds of primary mediastinal germ cell tumours. In 14 (37.8%) of them a mature solid teratoma was diagnosed, in 13 (35.1%)--dermoid cyst, in 5 (13.5%)--malignant teratoma, in 1 (2.7%)--immature teratoma, in 4 (10.8%)--seminoma. Mediastinal tumour was removed completely in 30 (81.1%) patients, partially in 7 (18.9%). Out of 37 patients, 3 (8.1%) died during postoperative time. Out of 26 patients discharged after surgical removal of mature teratomas, all are alive and have been followed-up for 10 years (17 patients) or 5 years (6 patients). Out of 8 discharged after surgical removal of malignant neoplasm, 3 are alive and all of them had primary mediastinal seminoma. One of them has survived 17 years after complete resection, and two patients--7.5 years and 2 years after partial resection and radiotherapy. Mean survival time is 4 years and 2 months for all patients with malignant neoplasm.     

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.     

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.     

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.     

Analysis of the surgical treatment results in patients with acute pancreatitis

The results of treatment of 248 patients with an acute pancreatitis (AP) are analyzed. Conservative therapy was effective in 178 of them. Mortality was 0.3%. Surgical intervention was done in 64 patients, including 25 with AP, of them 2 (8%) have died; 27--with destructive AP, after cholecystectomy, drainage of bursa omentalis and abdominal cavity 15 (55.5%) died. Pancreatic resection, necrotomy, programmed relaparotomy with permanent necrotomy of pancreas and retroperitoneal cellular tissue were conducted in 17 patients, 3 (17.6%) died.     

Immediate and late results of the surgical treatment of the aneurysms and dissections of the ascending aorta

Cyclosporine (CsA) and some of its metabolites (M9, M17, M18, M21) have been determined by means of an LC-MASS method in eight psoriatic patients developing nephrotoxicity. In comparison with a control group (15 psoriatics who after the same period of time, with the same daily dose, did not develop nephrotoxicity) they showed an increase of CsA metabolites, especially M17. Because M17 blood concentrations in the nephrotoxic group tended to be higher than in the control group from the first week of treatment we suggest that M17 might be considered a marker of ongoing nephrotoxicity.     

The late results of the surgical treatment of gigantic carotid-ophthalmic aneurysms of the internal carotid artery (2 cases)]

It is described a new born child with many hemangiomas on the liver. It is made a karyogram to exclude. The possibility of chromosome disease. We fixed male karyotype 46 XY--syndrome Morris. We found out that it is a rare combination of testicular feminization with disseminated hemangiomatosis. After the medical treatment with high doses of cortisone the hemangiomas decreased their sizes.     

The results of surgical treatment for adult scoliosis

This study was done to define and characterize those adult patients with scoliosis who will have problems of pain and/or progression leading to a surgical procedure and to review the results of these surgical procedures. The authors reviewed the cases of 49 adult patients who had undergone surgical treatment for scoliosis (average follow-up, 34 months; range, 24-140 months). The patients were categorized according to age, which allowed analysis of the data comparing age and the incidence and level of pain, age versus the degree of curvature, and age versus the incidence of progression. The relative incidence of pain and progression as indications for surgery were found to vary with respect to age. In the younger groups, progression was more often the indication for surgery than in the older groups. The younger groups also had larger curves than did the older groups, on average. The degree of pain was not found to correlate with the magnitude of the deformity. Surgical complications occurred in 20 patients; however, 14 of these were minor complications during the perioperative period, which did not result in any sequelae. Surgical treatment can be done with a relatively low serious complication rate and good results in terms of pain relief and reasonable correction of the deformity.     

Chronic anal fissure: results of the surgical treatment of 220 patients

Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in treatment of chronic anal fissure. Posterior sphincterotomy may persist effective and safe since continence impairment was not identified in the present study.     

The surgical results in patients with different forms of torsion dystonia

The paper describes stereotactic operations made in 278 patients with different forms of torsion dystonia during 20 years. Late outcomes were studied and assessed in 130 patients. The duration of follow-ups was 3 to 23 years. The patients' mean age at surgery was 30.5 years. The indications for surgical treatment were ineffective medical treatment and progressive disease. Positive early and late postoperative outcomes were achieved in 93 and 70% of patients, respectively. Complications developed in 3.2 and 12.3% of patients after the first and second operations, respectively. The positive outcome depends on the form, etiology, the destructible structure or a complex of structures. Surgical treatment of patients with torsion dystonia by stereotactic operations on basal ganglia is an effective treatment that provides a steady-state positive result in 70% of patients in the late period.     

Early and late results of surgical repair of truncus arteriosus

Ninety-two patients had corrective operation for truncus arteriosus between 1967 and 1975. During the first 30 days after surgery, 23 patients died. No significant differences appear between early mortality and sex, type of truncus, variations in pulmonary arterial anatomy, truncal valve regurgitation, associated anomalies, previous operation, or duration of extracorporeal circulation. Greater risk is probably encountered with the higher but still operable levels of pulmonary resistance. Reoperation has been required in three patients. Fifty-nine percent of survivors are symptom-free, with all but two of the remainder (38%) being in NYHA functional class II. The late result is suggestively less satisfactory in patients with significant preoperative truncal valve regurgitation. Some late complications related to deterioration of the earlier aortic homograft conduit may be avoided by use of a porcine valve Dacron conduit. The current operative mortality of 9%, and the well-being of 97% of surviving patients suggest the continued advisability of recommending operation for appropriate patients.     

Hypertrophic obstructive cardiomyopathy in pediatric patients: results of surgical treatment

Between April 1975 and May 1995, 25 pediatric patients on one hospital service underwent extended left ventricular septal myectomy because of hypertrophic obstructive cardiomyopathy. Ages ranged from 2 months to 20 years (mean, 11.2 years). Seventeen patients had moderate to severe mitral valve insufficiency. Medical therapy had failed in all patients and one patient had undergone dual-chamber pacemaker implantation without improvement. Left ventricular outflow tract gradients ranged from 50 to 154 mm Hg (mean, 99.9 +/- 25.2). Concomitant cardiac procedures included mitral valve repair (n = 2), automatic implantable cardioverter defibrillator implantation (n = 1), and closure of atrial septal defect (n = 1). Intraoperative premyectomy left ventricular outflow tract gradients ranged from 20 to 117 mm Hg (mean, 60.4 + 26.2) and postmyectomy gradients ranged from 0 to 20 mm Hg (mean, 6.6 +/- 5.9). Postmyectomy mitral insufficiency was reduced to a regurgitant fraction of 0% to 12%, and no patient required mitral valve replacement. One patient required a pacemaker because of complete heart block; on subsequent follow-up, normal sinus rhythm had returned. There was no early mortality and no instance of aortic or mitral valve injury or ventricular septal defect. Follow-up ranged from 10 months to 20 years (mean, 6.4 years). There were no late deaths. Left ventricular outflow tract gradients by echocardiography were a mean of 14.2 mm Hg with a median of 5.0 mm Hg. All patients had normal sinus rhythm. Reoperation because of recurrent left ventricular outflow tract obstruction was necessary in two patients at 3.2 years and 12.4 years after initial myectomy, respectively. All patients but one have New York Heart Association class I or II function. We conclude that extended septal myectomy is a safe and effective means of relieving cardiac symptoms and left ventricular outflow tract obstruction in pediatric patients with severe hypertrophic obstructive cardiomyopathy unresponsive to medical management, and late survivorship compares favorably with the natural history of the disease.     

Survival of patients with pathologically proven multiple system atrophy: a meta-analysis

A systematic review of the neurologic literature identified 433 cases of pathologically proven multiple system atrophy over a 100-year period. Earlier case reports included patients younger in age with more frequent cerebellar involvement. Mean age of onset was 54.2 years (range 31 to 78) and survival was 6.2 years (range 0.5 to 24). Survival analysis showed a secular trend from a median duration of 4.9 years for publications between 1887 and 1970 to 6.8 years between 1991 and 1994. Older age of onset was associated with shorter survival; the hazard ratio for patients with onset after 60 years was 1.8 (95% CI 1.4 to 2.3) compared with patients between 31 and 49 years. Cerebellar features were associated with marginally increased survival (6.1 years versus 5.4 years; p = 0.04). There were no difference in survival according to gender, parkinsonian, or pyramidal features or whether the patient was classified as striatonigral degeneration or olivopontocerebellar atrophy type. These results demonstrate the poor prognosis for patients with multiple system atrophy but may be biased toward the worst cases. Future research needs to recruit more representative samples.     

The late results of the combined therapy of patients in 2nd-stage lymphogranulomatosis

AIM: To define the scope of combined therapy according to prognostic factors in patients with Hodgkin's disease state II. MATERIALS AND METHODS: 98 patients with favorable and unfavorable Hodgkin's disease (HD) prognosis according to EORTC criteria (41 and 57 of group 1 and 2, respectively) entered the study. Unfavorable factors were: mixed HD variant and lymphoid depletion, ESR above 50 mm/h in stage A and 30 mm/h in stage B, involvement of more than 3 groups of lymph nodes, age over 40. Patients of group 1 received CVPP program: 2 courses before and after radiation of the primary disease zones in the total dose 40 Gy. Therapy of group 2 patients consisted of 3 CVPP courses before and 3 courses after irradiation of all the lymphatic collectors above the diaphragm in the total dose 35 Gy or radiation according to the extended program. Efficacy of therapy was assessed by EORTC criteria. The survival curves were calculated by Caplan and Meyer methods. RESULTS: In groups 1 and 2 a complete a complete remission was achieved in 98 and 93%, 6-year survival was 100 and 91%, recurrence-free survival--94 and 87%, respectively. Survival free of the treatment failure reached in group 1--88%, in group 2--81%. CONCLUSION: Reduced treatment in HD stage II in favourable prognosis did not worsen the results of treatment.     

Surgical treatment of bronchogenic carcinoma. Long-term results in 496 surgical patients

BACKGROUND: The operability of lung cancer and the period of survival after resection of the lungs in our country does not yet attain the standard recorded in some advanced countries. The objective of the present work is to analyze factors which influence the survival period after resection therapy of lung cancer. METHODS AND RESULTS: In 1985-90 in our department 496 patients were operated on account of lung cancer. This number comprised 31 patients subjected to explorative thoracototomy and three patients with pulmonary resection on account of a stage IIIb (pTNM) tumour who were excluded from the statistical analysis. The retrospective study proper analyzes the results of 462 patients (403 men and 59 women) operated in stages I, II and IIIa. Their mean age was 57 years (range 30-74 years, SD 7.5 years). The most frequent histological type was epidermoid carcinoma (68.8%), adenocarcinoma 18.2%, small-cell tumours 5.4% (25 patients). In 262 patients operated on account of lung cancer in stage I (pTNM) the probability of five-year survival was 49.2%, in patients in stage II 42.1%, in 158 patients in stage IIIa 20.9% (for all histological types combined). In 437 patients after resection of the lungs on account of non-small-cellular carcinoma the probability of five-year survival was as follows: stage I 50.0%, stage II 45.0%, stage IIIa 21.2%. CONCLUSIONS: The probability of five-year survival for the whole group of 462 patients in stages I, II and IIIa was 38.8%. The most important factor which influenced the probability of five-year survival was the stage of the disease. Neither age nor sex of the patients nor the histological type of the tumour had a statistically significant effect on the probability of five-year survival.