Helvetica chirurgica acta最新文献

This study examines the efficacy of three methods for myocardial protection during 8 hours of global ischema at 10 degrees C in immature (28 days) rat hearts subjected to lifelong hypoxia afforded by exposure to simulated high altitude. Hearts in group 1 were protected by rapid topical cooling alone, in group 2 by slow pre-arrest cooling with Krebs-Henseleit solution plus topical cooling and in group 3 by coronary perfusion with St. Thomas' Hospital cardioplegia No 2 (STS 2) plus topical cooling. Hearts in groups 4-6 served as controls without hypoxia and were protected accordingly. Parameters of myocardial function (left ventricular pressure, LVP), the metabolic status (myocardial concentration of ATP and creatine phosphate) and endothelial function (response to the vasodilator acetylcholine) were measured. Myocardial protection by rapid topical cooling alone resulted in equal--or significantly improved--postischemic recovery of LVP and endothelial function compared with slow pre-arrest cooling or additional protection with STS 2. The data advocate topical cooling for myocardial protection during surgical correction of cyanotic congenital cardiac disease in early infancy. In this age group, coronary perfusion with cold crystalloid solutions appears to aggravate ischemic endothelial injury.

Mesenteric venous thrombosis is an infrequent but distinct form of intestinal ischemia. We report 2 cases of acute mesenteric venous thrombosis, treated successfully by carrying out intestinal resection and postoperative anti-coagulation (Heparin, Sintrom). Both patients were diagnosed in the operating room. Improvements in computed tomography may identify patients earlier in their clinical course, heparin has both a primary therapeutic role in early disease and a postoperative adjunctive role in advanced disease. With such care, these patients can expect an acceptable prognosis.

A 27-year experience with 252 popliteal artery aneurysms in 167 patients is reviewed. Long-term results with respect to graft patency and limb salvage rates are analyzed. The results emphasize the importance of early surgical intervention and demonstrate the superiority of autologous saphenous vein over other graft materials.

During the last years the cases of severe group A streptococcus infection have increased. The clinical manifestation of this streptococcal toxic shock syndrome is similar to the better known toxic shock syndrome (TSS) provocated by staphylococcus. Shock, bacteremia and acute respiratory distress syndrome are common features, and death has been associated with this infection in 30% of patients. We present the case of a 46-year-old man who fell gravely ill with sepsis, diarrhoe, scarlatina rash, desquamation of hands and feet and acute abdomen caused by group A streptococcus infection. Finally we discussed the possible port of entry of this infection, the different clinical manifestation and the concepts of treatment.

22 Patients with complex fracture of the distal radius (Fernandez III/Frykman VII-VIII/AO 23.C) underwent treatment with external fixation and auxiliary autologous bone grafting in purpose to reconstruct and stabilize the radiocarpal articular surface, reset the radius length, obtain a quicker bone healing and avoid secondary radius shortening after removing of the external fixation. In spite of reassessment of radius length in 80% and reconstruction of the radiocarpal articular surface in 75%, late control showed the development of radiological signs of radiocarpal arthritis. 50% of the patients have a moderate loss of strength and motility in the wrist; this seems to be a good result for a very negative selection of complex fractures of distal radius. We recommend autologous bone grafting in treatment of complex fractures of the distal radius with external fixation.

Malignancies of the biliary tract are rare diseases. Tumor inductions after radiotherapy are reported in several papers. We report about 3 cases with consecutive biliary tract carcinoma 18-32 years after manifestation of an urogenital carcinoma. All 3 patients (52-63 years) were treated with additive radiotherapy after surgical-urological therapy. Icterus was the top-ranging symptom of this secondary carcinoma. In 2 of the 3 cases surgical tumor resection was performed (biliary duct resection with central liver resection; pancreatico-duodenectomy). Because of the bad general condition of health the third patient got only a biopsy of the tumor. All patients died within 2 years after diagnosis. The accidental accumulation of the rare biliary tract carcinoma after urogenital malignancies in our collection of clinical cases (2 seminoma; 1 bladder tumor) give rise the question about the causal association between primary carcinoma, additive therapy and the development of secondary carcinoma.