Helvetica chirurgica acta最新文献

We describe a rare variant of carcinoma of the ampulla of Vater. A 70-year-old man with several illnesses and a newly appeared jaundice was investigated and a signet-ring cell carcinoma of the ampulla of Vater diagnosed. We performed a local transduodenal excision. One year after operation the patient is asymptomatic. This is the second case report in the literature.

We present a case of a 74-year-old-woman who developed 3 episodes of intestinal pneumatosis, 2 times complicated by pneumoperitoneum, with consequent lethal outcome after 4 months. Intestinal pneumatosis, according to the literature, is a difficult and rare problem, associated with a large number of current diseases, can be complicated by pneumoperitoneum, mostly without clear etiology, whose treatment remains empirical (antibiotics, O2-therapy), not excluded laparotomy, if the clinical situation requires it.

To control heat damage in the liver after cholecystectomy caused by electrosurgery or Laser, gallbladders were resected at autopsy partly by the Holmium:YAG-Laser and Nd:YAG-Laser and partly by electrosurgery. Heat damage was documented by histological examinations of the liver-bed of the gallbladder. Microscopical evaluation showed that electrocautery tends to produce deeper heat damage in the liver-tissue than the Holmium:YAG-Laser.

Herniation through the foramen of Winslow (HFW) is exceedingly rare, the ileum, coecum or ascending colon is involved mostly. One new case is presented here to illustrate the clinical findings, which are often discreet, and the characteristical radiographic features, which can lead to definitive preoperative diagnosis. Treatment is by surgical reduction of the hernia, resection of non-viable bowel or fixation of coecum and ascending colon. Closure of the foramen is generally considered unnecessary. Without delay in diagnosis and treatment, the former high letality rate of the condition is now nearly zero.

Between 1978 and 1992, 70 patients were operated for type B aortic dissection (tear in the descending aorta without involvement of the ascending aorta). 15/70 (21%) patients had an acute dissection (onset of symptoms < 24 h), 19/70 (27%) a subacute dissection (onset of symptoms < 14 days), and 36/70 (51) a chronic dissection (onset of symptoms > 14 days). The indications for surgery in cases of acute dissection were: hematothorax, oliguria, leg ischemia and persistent pain. Persistent hypertension was an additional indication in cases of subacute dissection. In large majority (93%) of chronic dissections the indication for surgery was enlarged aortic diameter. In 86% (60/70) graft replacement of the aorta was performed, in 6% (4/70) extra-anatomic bypass, in 3% (2/70) fenestration, in 3% (2/70) thrombendarterectomy, in 3% (2/70). The overall mortality was 17% (12/70); 27% of acute dissection, 26% for subacute dissection, and 8% for chronic dissection. The morbidity for acute dissection was 73%, of subacute dissection 43%, and of chronic dissection 12%. The most frequent complications were: leg ischemia (8 patients), renal failure (4 patients), paraparesis (4 patients) and sepsis (2 patients). No paraparesis was encountered in surgery of the chronic dissection. Conservative treatment was tried in all acute B-dissections, with surgical therapy being reserved for complications of the dissection, such as rupture, such as rupture, risk of rupture (hematothorax, large aortic diameter resp. expansion, persistent hypertension, persistent pain) or ischemia of distal vascular beds. Long-term survival for chronic type B dissections is good. Strong control of risk factors (hypertension) is essential.

Our video shows the laparoscopic drainage of a big lymphocele responsible of kidney graft obstructive failure. Apart from the laparoscopic access, the technique is similar to open surgery. An ellipsoid peritoneal window (approximately 6 x 3 cm) is created with scissors and electrocautery. The lymphocele is entered and completely drained. A few adhesions are divided. To keep the window open, we secured its anterior margin with clips. Postoperative period was uneventful, with immediate improvement of the kidney graft function. After 4 months, there was no lymphocele seen on computerized tomography.

Since 1990 the Surgical Department of the Kantonsspital Schaffhausen has been taking part in a quality assurance program organized by the "Bundesland Baden-Württemberg". The traceroperation "appendectomy" will be used to demonstrate the principle of quality assurance and our results for the years 1991 and 1992 will be presented.

Panniculitis mesenterialis is an illness of the mesenterium of the small intestine and is not familiar to all clinical physicians. The rare reports in the literature mostly describe a good outcome with a few cases ending lethal. Pathologists paying attention to detect panniculitis during postmortem examination report about an incidence of about 1%. This discrepancy may be based on the fact that only extended changes of the mesenterial fat tissue cause symptoms. The pathological base consists in extensive necrosis of fat tissue with fibrosis of the mesenterium. Aetiology is unknown, diagnosis is usually made during laparotomy. There is no specific treatment, prognosis is generally good.