Authors report on two rare cases of eosinophilic cystitis, giving a review of the etiologic assumptions and pathogenetic, pathologic aspects of the disease, based on the available literary data. The course of the disease can be either acute or subacute, and is most often chronic. Relapse and progression can interchange in irregular manner, attention is therefore called to the importance of follow-ups. Resection deep into the intact--also containing muscle fibre--as well as histologic examination are considered essential as the only method of differentiation, giving precise diagnosis in the present two cases, too.
The authors retrospective analyze the role of golden standard laparoscopic cholecystectomy for the treatment of acute cholecystitis. They make a comparison between the results of 50 early cholecystectomy and 44 "a froid" cholecystectomy (operation was postponed until 6 weeks after acute cholecystitis had healed). From January 1997 to December 1998 536 laparoscopic cholecystectomies were performed. In 491 cases (91.6%) laparoscopic, and in 45 cases (8.4%) traditional (opening) method was indicated. Converted cholecystectomies were in 36 cases (7.3%). Agreeing to the literature they can determine the optimal timing of the operation in 72 hours from the onset of acute cholecystitis [2, 4]. In this group (first group) there were 50 cases, with 14 conversions (28%). In the second group (postponed, so called "a froid" phase) there were 44 patients. From this group was the intraoperative diagnosis serious acute-subacute cholecystitis in 24 cases (54.54%) causing complicated laparoscopic cholecystectomy and resulting in 11 conversions (11/44: 25%). The causes of the higher rate of conversion were the grave inflammation and slow dissection of central formation. There were no serious complication and mortality in both groups. It was diagnosed bile leak (two cases) which ceased spontaneously, one haematoma in abdominal layers, and one trocar's hernia. The authors have recommended the laparoscopic cholecystectomy for early diagnose acute cholecystitis in order to prevent the complications and reduce the sick-leave. Supporting their viewpoint the most important clinical end economical facts are: the recurrence of inflammation forced urgent surgery and caused more complication in the course of "a froid" phase there were scrutable anatomical situation the patients recovered in a shorter time.
Authors report on two rare cases of eosinophilic cystitis, giving a review of the etiologic assumptions and pathogenetic, pathologic aspects of the disease, based on the available literary data. The course of the disease can be either acute or subacute, and is most often chronic. Relapse and progression can interchange in irregular manner, attention is therefore called to the importance of follow-ups. Resection deep into the intact--also containing muscle fibre--as well as histologic examination are considered essential as the only method of differentiation, giving precise diagnosis in the present two cases, too.
AIM:To report our VATS procedure and results in the treatment of PTX.METHODS:Between 1992-1995, 156 patients with primary PTX were admitted and drained. On the basis of permanent air leak, lung reexpansion and type of PTX, 78 patients were operated on by VATS with early indications. In first episode PTX cases we performed "emergency VATS" in haemopneumothorax and "early or late acute VATS" between 8-48 hours after acute drainage in the others. In recurrent cases "late acute VATS" was done in 24 hours after acute drainage with permanent air leak. We performed "under water-test". In 57 Vanderschueren stage II-III-IV cases the lung disorders and the place of air leakage were resected. In 21 Vanderschueren stage I cases "blind apical resection" was performed. We carried out pleural abrasion, and two pleural drains were inserted.RESULTS:In every "blind resection" case the pathology revealed lung disorders: cystic deformation, fibrosis or inflammation. We had no operative deaths. In 1 case because of intercostal artery bleeding, thoracotomy had to be performed. We had 1 recurrent PTX. There was no late complications.CONCLUSION:The early indications reduced the hospitalization. The "blind apical resections" remove abnormal lung tissue, diagnose the underlying lung disease and the metal staples can cause adhesion reaction in the apex region.
Pericardial abscess is a very rare complication of sepsis. Authors describe the case of a 69-year-old woman. In her case staphylococcus sepsis led to pericardial abscess. During the course positive blood cultures (3x) indicated the sepsis and pus was obtained from the left pleural cavity (pleuropneumonia). Concomitant purulent process in the left shoulder also was noted. Decline immunity due to long-standing corticoid therapy (prednisone) for proctocolitis idiopathica was observed. Following antibiotic treatment successful surgical evacuation of the pericardial abscess was performed.
A case of urethral amyloidosis is presented in a 31-year-old male patient. Through this case, authors draw attention to the recommended forms of examination in the event of this illness being suspected, and also discuss problems in differential diagnosis. A reviewed the relevant data in the literature is also provided.
Cholecystectomies and hernioplasties are the two most frequently performed surgical interventions. The laparoscopic technique can be offered for the simultaneous treatment with both operating indications. The synchronical operation can give all the advantages of the minimally invasive technique. Authors had performed laparoscopic cholecystectomy with laparoscopic hernioplasty in five cases. Two inguinal and three postoperative hernias were reconstructed. The cholecystectomy was performed with a "three punction method", and the hernioplasty by using the same approach, completed by inserting a fourth assisting trocar as required. The hernial ring was covered with an intraperitoneally placed mesh, which was fixed by staplers (the so-called "IPOM-method": intraperitoneal on-lay mesh). There was no intra-, nor postoperative complication. The hernioplasty combined with laparoscopic cholecystectomy did not have effect on postoperative pain and nursing time. The return to the normal physical activity was short, similar to laparoscopic hernioplasty (in 1-2 weeks). Authors conclude that the simultaneous, synchronous laparoscopic cholecystectomy and hernioplasty is recommended and should be the method of choice because it is more advantageous for patients.
In the cases of penetrating injury of the heart and the great thoracic vessels, 80% of the patients die before reaching the hospital care, nevertheless patients with sufficient vital functions can be rescued. Between 01. 01. 1994 and 31. 12. 1998 four patients were operated for penetrating injuries of the great vessels in the 2nd Department of Surgery, University Medical School of Debrecen. The left subclavian vein, arcus aortae and the pulmonary artery (2 cases) were injured. In this study authors report a detailed case operated for gunshot injury of the pulmonary artery. On the base of the situation of the projectile on X-ray picture and on the base of the entrance wound of the projectile on the skin we supposed the injury of the great thoracic vessels and we performed an urgent operation. After thoracotomy we found haemopericardium, bleeding wounds on the anterior and posterior haemorrhagic wall of the left pulmonary artery. We found the projectile inside the wall of the bronchus impacted. The bleeding wounds were finger-tamponaded and sutured. On the tenth postoperative day the patient was discharged from our clinic without complaint. The surgical approach to specific thoracic great vessels is also described.
Results of surgery in oesophageal cancer are still disappointing. The only possible solution is to search actively for early cancer in nonsymptomatic person. The group of patients with Barrett's oesophagus or after lye ingestion was included in the endoscopical screening programme. In order to improve our results and increase sensitivity we have employed the Lugol solution for mucous membrane staining. During five years follow-up period four cases of early cancer were found. All cases were treated surgically showing cancer confined only to the mucous membrane in two patients. Endoscopic ultrasonography is currently the best technique for the staging of oesophageal cancer. Our preliminary data are encouraging shown that its possible to use population screening programme in some well-defined group of patients.
Cervicothoracic junction and upper thoracic spine down to T4 can be reached through anterior approach via sternotomy. Transsternal approach is the best route to gain access to lesions localized within vertebral bodies of the upper thoracic spine allowing for their resection, interbody fusion and replacement with bone cement. Consecutive modifications of transsternal approach evolved towards less extensive osteotomy from full median sternotomy, through manubriotomy with clavicle resection to partial lateral manubriotomy. Less extensive modifications provide limited lateral exposure of the spine and are more demanding technically. We present two cases of the upper thoracic spine tumours operated on through full medial sternotomy. We believe that median sternotomy has several advantages over less extensive modifications: it is technically simple to perform approach for trained thoracic surgeon, safer as it provides better exposure of the mediastinum and thus sufficient control of great vessels including subclavian ones, gives better exposure of T3, T4 and even T5 vertebral bodies, allows perpendicular sight and attack to anterior surface of the upper thoracic spine and therefore good visualizing of the posterior longitudinal ligament and dura, do not destabilize shoulder girdle nor affect function of the upper limb. Additional caudal exposure of the thoracic spine as down as T5 can be obtained by dissecting a plane between the brachiocephalic vein, vena cava superior and ascending aorta.
BACKGROUND:A small proportion of cystic fibrosis patients develop severe localised bronchiectasis. When this persists despite maximal medical therapy it presents a difficult management problem. Lung transplantation cannot be justified. We report encouraging results in six patients with severe localised bronchiectasis and cystic fibrosis who underwent pulmonary resection.METHODS:Each child had severe localised bronchiectasis despite maximal medical therapy. Intensive preoperative toilet was instituted and pulmonary resection undertaken when lung function was optimal.RESULTS:There was a marked improvement in symptoms in every case. No significant long-standing morbidity was associated with the resection. There was no significant decrease in pulmonary function following resection.CONCLUSION:Pulmonary resection should be considered in the management of severe localised bronchiectasis unresponsive to maximal medical therapy in cystic fibrosis patients.
Malignant pleural effusion (MPE) are associated with significant morbidity. Prompt clinical evaluation followed by aggressive treatment often results in successful palliation. Video-assisted Thoracic Surgery (VATS) today can be employed in the diagnosis and treatment of idiopatic and known MPE. Between January 1994 and December 1998 233 MPE patients were treated with pleurodesis. 206 of them underwent tube thoracostomy and drainage alone followed by chemical pleurodesis. In 27 out of the 233 cases VATS management was applied. These patients had undiagnosed pleural effusions or recurrent MPE following failed previous drainage and pleurodesis. The cause of the effusion was breast cancer in 11 patients, lung cancer in 9, urogenital cancer in 3, mesothelioma in 2 and other in 2. VATS intervention was thoracoscopic exploration with biopsy and directed chemical sclerosis in undiagnosed MPE (19/27) and lysis of pleural adhesions with partial decortication and pleurodesis in recurrent effusions (8/27). VATS managements were successful 26/27 after mean follow up of 6 months. Had not mortality postoperatively and severe morbidity. Chest tubes were removed 1.5 +/- 0.5 days postoperatively and hospital stay were averaged 4 +/- 1 days. We concluded that VATS is a safety and effective way of managing selected patients with pleural effusions.
Pulmonary laceration is an uncommon complication of tube thoracostomy technique that is expected vigorous clinically and may be fatal. In this study, we report a case of pulmonary laceration owing to a tube thoracostomy, with no clinical signs, and detected incidentally on thorax computed tomography.
INTRODUCTION:By the introduction of the laparoscopy for the management of gastric pathology many techniques are applied by now. In these techniques the collaboration of the endoscopist and the laparoscopic surgeon is mandatory.AIMS OF THE STUDY:To emphasise the necessity of the collaboration of the endoscopist and the laparoscopic surgeon for the management of the gastric pathology using the double lifting and wedge resection technique.METHOD:A case of a female with 2 x 2.5 cm submucosal tumour is presented. The tumour was located in the antrum. After the onset of the general anaesthesia the gastroscope was introduced to locate the position of the tumour, the free edges of the tumour were elevated by a double lifting method and the tumour was resected by a laparoscopic linear stapler. The process of the proper resection was all through observed and directed by the view of the gastroscope.CONCLUSION:Correct wedge resection of the gastric wall can be safely performed, if the correct gastroscopic control is present. The collaboration of the endoscopist and the laparoscopic surgeon seems to be mandatory, thus avoiding the hazards arising from the use of tattooing.
Authors have performed testis biopsy on 21 male patients according to the predesigned protocol. The biopsy has been carried out from scrotal excision, with the exposure of both testis with microsurgical method. The results have been evaluated according to the spermogram groups. Correlation of FSH values and histological appearance of both testis was analyzed. Their method and experiences have been evaluated the effectiveness of assisted reproduction.
Authors review a case of a calcified renal cyst. The literary data at hand give evidence that the spreading processes in the kidney can be benign or malignant according to their form of calcification and their localisation. Despite the modern diagnostic techniques, it is not easy to set up the diagnosis or to avoid the need for surgery, as was the case in the present report.
Two successfully managed cases of esophageal replacement for cancer complicated by neoesophagotracheal fistula are described. In both cases radical esophagectomy with a gastric pull-up was performed. In the postoperative period different complications necessitated prolonged ventilatory support and tracheostomy. In both cases a tracheo-gastric fistula developed probably because of the ischaemic effort of the tracheostomy tube and the nasogastric tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In the first case resection of four strictured tracheal rings and tracheal anastomosis had to be performed. In the second case the fistula was recognized earlier and stricture did not develop. The defect on the membranous trachea was patched with autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the trachea and the pulled up stomach in both cases to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.
The present study demonstrates by means of histopathologic analysis that most of the renal adenocarcinomas are microscopically heterogeneous--named by authors as heteromorphic. This heteromorphism means the mixture of different cell types, histological patterns and fields of tumor with different nuclear atypia. 300 surgical specimens of renal cell cancer (RCC) were reclassified retrospectively. The histologic classification was as follows: 1. Nuclear atypia (nuclear grading according to Skinner); 2. Histological structure (compact, tubular, papillary, cystic); 3. Tumor cell types (clear, chromophobe, chromophilic basophilic, chromophilic eosinophilic). Homogeneous tumors consist of the three categories of this basic classifications. Heteromorphic tumors have combinations the three categories: different cell types (clear and granular) and/or histological elements (tubulo-papillary) and/or nuclear structure. Heteromorphism of RCC can be graded as: G-I: homogeneous structure (three patterns, one-one pattern of the three categories; G-II: 3 + 1 patterns.... G-III: 3 + 2 patterns.... G-IV: 3 + 3 or more patterns of the classification given above. This grading system is recommended for the heteromorphism of renal adenocarcinomas.
Authors present their experiences with eosinophilic cystitis. In both of their cases the preoperative evaluation presumed bladder cancer, the histologic examination, however, showed eosinophilic cystitis. In this report a discussion is given on the diagnostic and treatment possibilities of the entity.
PURPOSE:This is a retrospective study comparing the clinical data and morbidity of transperitoneal radical nephrectomy (TRN) and simple nephrectomy.MATERIAL AND METHODS:From 1st January, 1989 to 1st January, 1996 a total of 90 simple nephrectomies and from 1st January, 1996 to 1st August, 1999 a number of 85 TRN were performed at the Department of Urology of the Saint Stephen Hospital. The analysis of clinical data included operative time, length of analgesics, postoperative hospital stay and blood loss, as well as morbidity.RESULTS:The mean operative time for TRN was 170 min., being 95 min. for simple nephrectomy. The mean blood loss for TRN was 250 ml, and 400 ml for simple nephrectomy. There were different types of morbidity for TRN and simple nephrectomy. The complications of TRN mean minimal risk and easy correctibility.CONCLUSION:Our results demonstrate an overall clear advantage of TRN when compared to simple nephrectomy.
