The case histories of two patients with an extragonadal germ-cell tumour are discussed. One had a retroperitoneal embryonal carcinoma, and the other had a mediastinal choriocarcinoma-seminoma. The pathogenesis, symptomatology, diagnosis and treatment of these rare tumours are discussed in some detail.?
We report a rare case of extragonadal germ cell tumour in a 55-year-old man. He presented with a painless mass in right inguinal region, a few days after hernioplasty for right direct inguinal hernia, which caused diagnostic difficulties and treatment problems.
Twenty-five bovine arteriografts were placed in 18 patients for maintenance of haemodialysis. Type of vascular access, complications and their management and long-term results are discussed.
Diverticulitis of the colon may be the cause of the formation of subcutaneous or submuscular air in the hip or leg region. This phenomenon results mostly in an inflammation or abscess. A case is presented in which sigmoid diverticulitis caused submuscular air without any clinical discomfort.
A case is reported of a 64-year old man with Candida albicans sepsis of pulmonary origin. It was complicated by a hemorrhagic ischemic enteritis that made it necessary to resect 2 1/2 m of small bowel. The specimen contained many pseudohyphae and yeast cells in the layers of the wall, especially in the necrotic areas. The superior mesenteric artery and its branches were patent and not occluded by infected thrombotic material, as has been described in another case of necrotizing enteritis accompanying Candida albicans sepsis. The pathogenesis and treatment of the ischemic enteritis in this case are discussed.
Two cases of multiple gastric polyps are described. In both cases a large number of hyperplastic polyps were found in the antrum and body of the stomach. A total gastrectomy was performed in these two patients. Histologically the polyps were benign; in one case gastritis with metaplasia was present. The pathological and clinical aspects of multiple gastric polyps are discussed with reference to the literature.
UNLABELLED:In a 10-year period (1967-1977) 273 patients were operated upon for hyperthyroidism at the Department of Surgery of the St. Franciscus Gasthuis, Rotterdam. The evaluation of the results was carried out in 1978. A total of 205 patients appeared for investigations and drawing of blood samples. Total resection of one thyroid lobe and subtotal resection of the other lobe was the procedure of choce.RESULTS:85% of the patients were euthyroid at the follow-up; 7% of the patients had a recurrent hyperthyroidism and 8% became hypothyroid. In three cases a persistent unilateral vocal cord paralysis was encountered. Surgery remains an effective and satisfactory method of treatment for appropriately selected cases, with a low rate of immediate and late complications.
Delayed perineal wound healing frequently complicates a proctocolectomy in patients with inflammatory bowel disease. In almost half of the patients the eviscerated dead space is not closed 6 months after surgery. A new technique is described. The gracilis muscle can be used as a transplant to fill the perineal cavity. It is an easy procedure that solves a difficult problem.
The results of treatment of 52 supracondylar fractures of the humerus in children by means of percutaneous transfixation with two Kirschner wires are discussed and compared with the results of other methods of treatment, such as repositioning and immobilization in a plaster cast, and traction by the Baumann or Dunlop techniques. The functional results are equivalent to those of other methods of treatment. Although the number of cases studied was only small, it appears that the cosmetic results are better, while the duration of hospitalization is markedly shorter.
Intraosseous ganglia are benign cystic lesions of the bone; morbid-anatomically, they show no difference from the ganglia that occur in soft parts. The cases of two patients are reported. As far as we have been able to find out these are the first descriptions in the Dutch literature. The clinical aspects, morbid anatomy, pathogenesis and treatment are discussed with reference to the literature.
In this paper two patients with uncommon syndromes, viz. acrodermatitis enteropathica-like eruption due to acute zinc deficiency, when on long-term intravenous hyperalimentation for Crohn's disease, and necrolytic migratory erythema as a consequence of a malignant glucagon secreting alpha-cell tumour of the pancreas (glucagonoma syndrome) are reported. Attention is paid to the many common features of the skin lesions in both syndromes. This is discussed in detail. Both patients passed through a catabolic stage. Laboratory investigations, however, failed to demonstrate a common biochemical mechanism which might be responsible for the skin lesions. Administration of zinc in the first patient and surgical treatment of the second patient results in rapid clearing of the skin lesions and other symptoms.
The clinical course of two patients who had peripelvic extravasation associated with passage of small calculi is reported, and clinical data of 65 similar case histories published in the literature since 1960 are reviewed for discussion of the clinical consequences of the condition. The occurrence of extravasation following sudden ureteral obstruction can be sufficiently explained by biophysical and urodynamic principles involved in the mechanism of blow-out of the elastic renal collecting system and this matter is discussed briefly. It appears that in renal pelves not obviously affected by disease, blow-out occurs oftenest in the fornix calices, but is generally an infrequent phenomenon. The condition often runs a benign clinical course provided the ureteral obstruction is relieved rapidly and the extravasated urine is sterile. Persisting ureteral obstruction and/or an infected extravasate will in general lead to serious clinical consequences requiring surgical intervention within one to several days.
Case report of a 60-year old asymptomatic male with a chylous cyst in the right anterior mediastinum. It communicated with the thoracic duct through a narrow vessel with a length of 4 cm. During the eight years of pre-operative observation the cyst varied in size. At one time it disappeared completely, though temporarily. The rarity of this type of mediastinal tumor is stressed.
A case of chylous ascites after resection of an abdominal aneurysm in a 72-year old male is presented. The complication is extremely rare. Therapy should start medically with a diuretic and medium chain triglyceride (M.C.T) diet. This is the ninth reported case of iatrogenic chylous ascites and the second after resection of an abdominal aortic aneurysm.
The effect of cross clamping the lower abdominal aorta on systemic blood pressure and right and left heart pressure was studied in 17 patients requiring surgical treatment for abdominal aortic aneurysm or aortic occlusive disease, in neuroleptanaesthesia. After cross clamping the systemic systolic blood pressure rose 24 mmHg (p is less than 0.01) and the systemic diastolic blood pressure 8 mmHg (p is less than 0.01). There was no influence of cross clamping on the right (CVP) and and left (PCWP) heart filling pressure even in patients with preexistent readings beyond the normal range.
Ten patients with various stages of enterovesical fistulization in Crohn's disease are discussed. These fistulae can develop at different times in the course of the disease, but may also cause the presenting symptoms. Cystoscopy and radiologic examination rarely visualizes the fistulae. Conservative treatment by medication can sometimes suppress the symptoms, but cannot cure. Surgical treatment, which can consist of resection of intestine but need not involve resection of parts of the bladder, gives good results at least so far as the urinary infection is concerned.
In a clinical trial thromboembolic prophylaxis with subcutaneous low-dose heparin was given to 20 patients admitted for surgery on the larynx. All patients (40 totally) had a malignancy. The study was not primarily directed on the antithrombotic effect, but on complication factors. In the control group pulmonary embolism was found four times, but not in the group of patients receiving heparin. No increase of blood loss in the heparin group appeared, although this group included very difficult operations. No complications were seen to arise from the injections of the heparin.
Side-to-side arteriovenous fistulae established in patients on chronic intermittent hemodialysis can cause venous hypertension. This gives rise to pain, pigmentation and trophic ulcers. Four patients with these complications are described. In three patients, with a fistula between the radial artery and the cephalic vein, the thumb and the second and third fingers were affected. In the fourth patient, with a fistula between the ulnar artery and the basilic vein, the fourth and fifth fingers were involved. This finding suggests segmental venous drainage of the hand. All patients were cured by ligation of the distal vein. An end-of-vein-to-side-of-artery fistula does not cause the complication described, and for this reason is to be preferred.
Experiences with the Swan-Ganz catheter in 'high risk' surgical intensive care patients are described. After description of the catheter and catheterization technique, normal values from the literature are presented. Attention is drawn to the occurrence of artefacts in the pressure curve, which can lead to the inference of faulty results from the measurements. Attention is also drawn to the effect of intrathoracic pressure on pulmonary vascular pressures. A review of possible complications is given, with recommendations how these may be avoided or at least reduced to a minimum. The authors' material is used to demonstrate the value of the catheter, showing that the CVP is not always a trustworthy parameter for hemodynamic monitoring. The conclusion is drawn that the 'high risk' patient on the surgical intensive care unit gains from the use of the Swan-Ganz catheter.
