Acta chirurgica Academiae Scientiarum Hungaricae最新文献

The experience gained in the course of 127 transurethral resections of bladder tumours are described. After discussing the indications and the technique the authors present their own results. The advantages of transurethral resection are emphasized: reduced operational stress, early mobilization, quick removal of the catheter, few postoperative complications, low cost of nursing. Therefore the operation is given preference mainly in the treatment of elderly patients with bladder tumour.

Even today the majority of authors stress the need for maximum conservatism in the treatment of polycystic kidneys. Since 1979 the therapeutic principles have been modified in agreement with the suggestions of Pytel. It is claimed that the polycystic lesion of kidneys causes--according to the Goldblatt-effect--hypertension due to the compression of the renal arteries by the cysts. Extirpation of the cysts reduces the compression of the vessels, thus reduction of the high blood pressure and of the pressure atrophy of the parenchyma can be expected. The first results (12 patients) have been promising. The operational method described is believed to be one of the possibilities of treating polycystic kidneys.

With the discussion of four cases the authors draw attention to the diagnostic difficulties which arise in the diagnosis of space reducing renal processes. They disapprove of the application of percutaneous puncture of the renal cyst as a therapeutic procedure, and emphasize, in doubtful cases, the importance of intraoperative histological examination. With two of their cases which were diagnosed only at the time of the second hospitalization of the patient, the authors wish to stress the need for a still wider use of angiographic examinations.

After a brief review of renal tumours diagnosed on the basis of metastases, two cases are described in which subcutaneous formations believed to be lipomas were metastases of symptomless hypernephromas. One case was diagnosed early on basis of the histological finding. The primary tumour could be localized only by angiography. After nephrectomy and resection of the contralateral rib and pleura, the patient was free of symptoms for one year. In the subsequent year a pathologic subtrochanteric fracture called attention to a new metastasis. After laminar osteosynthesis function of the hip and knee joints was satisfactory and so has been the general condition ever since the first operation now for three years. In the second case, the knot assumed to be a lipoma was removed but no histological examination was carried out. These experiences have induced the authors to call attention to the importance of histological examination of apparently banal lesions and to the considerable survival which can be achieved in these patients.

In 12 cases of acromioclavicular luxation surgical treatment was applied by applying a coracoclavicular screw. In 8 of the 12 operated cases the results were excellent. The patients could resume their old job. After removal of the device used for osteosynthesis, no symptoms or late relapse appeared. In 2 patients the results were good, in 1 fair and in one patient a relapse was observed. It is suggested on the basis of the good results that the method should be considered suitable for clinical use.

Hartmann's operation has been performed as an elective intervention. In the case of tumours of the sigmoid and the upper two-thirds of the rectum this operation involves less risk and less stress than Dixon's anterior resection or extirpation of the abdominoperineal rectum. Hartmann's operation is being performed on, and is recommended for, elderly patient and for those suffering from some serious intercurrent disease having therefore a reduced resistance to operational strain. The authors removed under these conditions 16 sigmoidorectal tumours. In 12 cases the operation consisted of radical extirpation.

Eight patients were observed by mitogen stimulation and E-rosetting after heart operations with and without cardiopulmonary bypass. The first sample of blood was taken before surgery, the second on the afternoon of the same day and for a week daily examinations were carried out. A depression of mitogen-stimulated lymphocyte transformation was observed, parallel with a simultaneous T cell depression and a general decrease in the total WBC count. The lowest values were found during the first three days after both open and closed heart operations. After open heart surgery it took a longer time until the values had returned to normal. In two other cases the lymphocytes were examined for suppressor activity. The suppressive effect exerted on the response to mitogenic and allogeneic stimulation was not uniform. Suppressor activity was more affected by surgery than the helper effect in these two cases.