Acta chirurgica Academiae Scientiarum Hungaricae最新文献

Serious complications of the introduction of pacemaker electrodes and of the catheterization of large veins performed in the course of 6 years are discussed. The majority of the 24 observed complications occurred on the left side. In the case of constant suction and thoracic haemorrhage, surgical exposure is unavoidable. In five cases the complications were due to temporary pacemaker electrodes. Four of the patients died of organ damage. Three typical case records are presented.

Pyelonephritis during pregnancy was found to have a higher incidence when the patient's history contained some indication of an earlier renal disease. Pregnancy associated with chronic nephritis has to be interrupted in the first trimester as the particular conditions of pregnancy predispose to pyelonephritis. Provided pregnancy pyelonephritis is diagnosed and treated early enough the incidence of intrauterine fetal death, premature, birth and perinatal fetal loss will not be higher than the average, but developmental retardation has a slightly higher incidence. The degree of renal disturbance not only increase the probability of pyelonephritis but also the damage suffered by the mother and fetus. The prevention of inflammatory renal and appropriate treatment of inflammatory renal diseases and the constant control of the patient is the task of prenatal and nephrological care, so as to avoid early and late complications.

The iron, copper, zinc and chromium content of the amniotic fluid was determined on the occasion of 56 deliveries in the 35th to 40th week of pregnancy and the following results were obtained: iron 32.1 +/- 32.6 microgram, copper 11.4 +/- 4.5 microgram, zinc 30.3 +/- 31.4 microgram, chromium 0.363 +/- 0.205. Simultaneously performed determinations revealed that the concentration of all the investigated trace elements was higher in the maternal and cord blood than in the amniotic fluid. The results were analysed according to the weight of the infant at birth and the pathologic events of delivery and compared to the results of other authors.

The effectiveness of the orthograde lavage of the colon with isotonic saline and 153-electrolyte solution, resp., was checked by means of a comparative prospective study. The most important factor in the pre-operative preparation of the colon is mechanical cleaning which is best performed by way of orthograde lavage leading in 90% of the cases to a complete emptying of the colon. Reduction of the intestinal flora can be improved in addition to lavage by a short prophylaxis with large doses of antibiotics. This method was applied to 100 operations performed in the colorectal region and only in 6% of the cases was an infectious complication observed. Lavage of the colon raises no problems and is well tolerated even by elderly patients. Ileus and the risk of perforation in the gastrointestinal tract are absolute contra-indications. Because of its almost iso-ionic composition the authors prefer the 153-electrolyte solution to isotonic saline. Due to the increase of the extracellular space some blood parameters tend to decrease.

Lymphocytes of 30 patients were examined for cellular immune function one day prior to operation. In 11 patients the tests were repeated six weeks after surgery. In comparison with 26 healthy blood donors the E rosette values were strongly reduced in the patients group. The zymosan-complement rosette counts were significantly lower if percentages were compared, but not significant when they were expressed in absolute numbers. Lymphocyte transformation tests revealed significant differences between the patients and control cases with all three mitogens applied (PHA, ConA, PWM). In the 11 patients with the tests repeated after operation, the effect of autologous plasma on the cultures was also studied. The main tendency was inhibition but in some cases the patients' plasma enhanced the reaction. Killer cell activity by ADCC was significantly lower in patients' than in the healthy donors' lymphocytes in different target-effector cell ratios.

In the experiments intact dog hearts with ligated descendents, hearts with aorta insufficiency and others with a cardiopulmonary bypass were perfused. It was demonstrated that both ischaemia and relative oxygen deficiency induce within a comparatively short time the same type of irreversible damage in the structure of the subendocardial layers of the myocardium (lysis and rupture of the myofilament, swelling of the mitochondrium, rupture and lysis of the crista, clearing of the matrix). Consequently, the aimed protection of the myocardium during cardiac surgery is of the greatest importance.

Ureterectasia can be congenital (mega-ureter) or acquired (hydro-ureter). Mega-ureters can be of reflux and non-reflux (obstructive) type. The essence of primary non-reflux mega-ureters is the presence of a prevesical adynamic segment which causes functional obstruction. The musculature of this segment is abnormal in both function and structure. A surgical solution of the malformation is recommended mainly in children and young adults. In 10 years, 17 patients were subjected to 22 operations. After removal of the obstructive segment and straightening of the ureter, it was implanted into the vesicle through an intravesical tunnel. With the exception of two cases where nephrectomy had to be done and a case with persisting reflux, the other operations were successful. Narrowing of the ureter was not done. Ureteral neo-implantation is preferred to Boari's operation. Isolated pelvis ureters are operated only in the case of complications.