Acta chirurgica Academiae Scientiarum Hungaricae最新文献

The plasma triglyceride, cholesterol, and free fatty acid levels were determined in patients with acute subrenal kidney failure. Like in chronic uraemia, the levels were higher than normal. The findings were confirmed in animal experiments which showed that the plasma lipid fractions will rise after a single day of bilateral renal occlusion and the rise is proportional to the duration of the occlusion. The lipid levels remain higher than in the controls for some time after relief of the occlusion.

Ewing sarcoma (E.S.) is a rare malignant tumour of the bone, dubious in origin and uncertain in the direction of its differentiation [2,3,7,10]. Recent reports have presented description of primary neoplasms of soft tissues which revealed no differences from E.S. in light and electron-microscopy but had no connection with the skeleton [1,4,5,6,8,9]. These lesions, found in subcutaneous tissue of the trunk and limbs, in the retroperitoneum and in paravertebral regions were called extraskeletal Ewing sarcoma (E.E.S.) or soft tissue Ewing sarcoma. As tumours of this type are infrequent and may cause diagnostic difficulties, we shall present a recently diagnosed case of extraskeletal Ewing sarcoma.

The author deals with natural history an clinical appearance of malignant melanomas occurring at unusual sites. Diagnostic problems, treatment and prognosis are discussed on base of pertinent literary data and own experiences described in case reports of the related clientel (1 case with primary melanoma of the breast region; 1 case with melanoma of the tongue; 4 anorectal melanomas; 1 case with a neurotropic melanoma). Finally, the neurotropic variant of malignant melanoma is described, not for its unusual location but rather for its special histological picture and differential-diagnostic importance.

Clinical trials with gestonorone led to favourable results in 65% of the patients. The drug is recommended particularly to patients in stage I or II of prostatic adenoma. It is justified to prescribe this treatment to high risk patients who cannot be operated because of their serious conditions. An objective assessment of the effect of the drug was possible by means of urodynamic and ultrasound tests which detected also fewer latent changes suggesting a continuation or repetition of the treatment.

After a brief review of the pertaining literature, 10 patients treated for adult respiratory distress syndrome between 1974 and 1978 are reported. Eight patients died; in 4 cases the cause of death was some other irreversible lesion. Respirator treatment with the Bird-8 apparatus was supplemented with cardiac diuretic and antibiotic therapy. Improvement of the results can be hoped partly from prevention, partly from the early diagnosis of ARDS and its adequate treatment.

The authors present a patient with chronic myelopathy after atlanto-axial fracture and vertebral artery occlusion treated by removal of the arch of the atlas. The natural arterial collaterals and their role are discussed. It is suggested that the knowledge of all the anastomoses is very important to avoid damage of blood flow during surgery. Fenestration of the vertebral artery causing by kinking is to be seen--a rare form of pathological collaterals.

After a brief review of the treatment of articular tuberculosis costovertebrotomy-spondylodesis is recommended on the basis of experience in 196 cases. Spondylodesis with the resected rib is performed after cleansing of the focus. The method allows early mobilization of the patient and promotes healing of the destroyed vertebrae. The late results are also discussed.

In the years between 1967 and 1978, Billroth I-type antrectomy and truncal vagotomy were performed in 44, and primary gastric resection in 19 cases of perforated duodenal ulcer. It was found that in the case of perforated ulcer causing extensive scarring, stenosis or penetration, antrectomy is not more complicated than pyloroplasty. In the absence of other local lesions and mainly in high-risk patients with cirrhosis, diabetes, chronic renal disease, tuberculosis, etc. excision of the perforated duodenal ulcer, pyloroplasty according to Finney and vagotomy were performed (48 operations), while in purulent peritonitis (8 patients) suturing only was applied. Bearing in mind the above aspects, the authors lost none of their patients. Final and similar results can be achieved with performed (in 48 cases), while in the case of purulent peritonitis only suturing was applied in 8 patients. None of the patients was lost. Similar results can be achieved with emergency antrectomy and vagotomy as under elective conditions. In the majority of cases the perforated duodenum can be operated upon in such a way which will abolish the perforation and ensure a final healing of the ulcer.

Wounds caused in the dorsal musculature of guinea pigs were sutured with various types of threads and the histological reactions caused by the latter were studied. Light and electron microscopic methods revealed that the best resorption can be achieved with Dexon threads. This synthetic thread is resorbed in 14 to 16 weeks causing only a minimal histological reaction and without cicatrization in its vicinity. Around threads which are not absorbed a connective tissue capsule is formed; this one is thin in the case of Ethilon and Chrom cat gut and somewhat more marked when Rixo or Supramid threads are used. The histological reaction is the most intense around the traditional linen thread which leads to cicatrization. In the resorption of Dexon a decisive role is attributed to the giant cells of the foreign body while in the case of non-absorbable synthetics and linen threads the fibre forming roles of the histiocytes, mastocytes and fibroblasts dominate.