[Effect of pancreatin replacement on pancreatic function in the postoperative period after pancreatic surgery]. / Pankreatin-kezelés hatása a pancreasfunkcióra hasnyálmirigymütétek utáni posztoperatív periódusban.

There is evidence that disturbances of exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recovery of exocrine function. A placebo-controlled trial of enteric-coated pancreatin (25,000 U lipase; 3 x 1 caps/day) was performed during 2 weeks following pancreatic surgery (resection and drainage operation). A total of 39 patients were randomized, 20 to pancreatin group and 19 to placebo group. The exocrine function was tested via serum and faecal elastase determinations, the amylum tolerance test (ATT) and checks on the symptoms of maldigestion. After medication for 10 days, there was evidence of the beneficial effect of pancreatin suggested by a 35% improvement in ATT, an unchanged body weight and the disappearance of symptoms of maldigestion. In the control group, abnormal ATT and symptoms of maldigestion were remained, while the body weight decreased with by 3.5 kg. In both groups, no significant change was noted in the elastase concentration. The results suggest that enteric-coated pancreatin treatment after pancreatic surgery may lead to a rapid improvement of exocrine pancreatic function, probably by reducing the cholelcystokinin response to stimulation by food and represent a new indication of the enteric-coated pancreatin medication.

Different techniques for creating oesophageal anastomoses. A historical review and personal experience.

UNLABELLED: Among the surgical techniques used to create a reliable oesophageal anastomosis, mention should be made of the handmade (in one or two layers, wire or Vicryl) and the different stapler anastomoses. 41 oesophageal anastomoses were performed by stapler technique between 4 March 1985 and 4 March 1991. The EEA stapler was used in 15, and the SPTU stapler in 26 patients. The average age was 56.8 years overall, 53.6 in the female (7 patients) and 57.4 years in the 34 male patients. Tumours in the middle and lower third of the oesophagus and on the cardia were the indications for resection in 30 instances. Total gastrectomy was performed in 9 patients and oesophageal resection for peptic stricture in 2 cases. Replacement with stomach was carried out after oesophageal resection (17 patients), and with Roux-loop in 24 cases. The EEA anastomoses were not covered by a hand-made layer of interrupted sutures as is compulsory in the case of the SPTU gun. The intraoperative complication rate was 12.2%--two severe complications with the SPTU and 3 mild ones with the EEA (2 cases) and SPTU (1 case) machines. The postoperative complication rate was 17%--the severe ones with the SPTU gun. The only fatal anastomosis insufficiency was observed in this group. 3 of the 41 patients died--a mortality rate of 7.3%--but only one of them was due to technical failure in the SPTU group: 2.4%. CONSEQUENCES: Both the intra- and postoperative complications were more severe with the SPTU technique. The early postoperative complications are closely related to the intraoperative ones. Mortality due to technical failure was only observed in the SPTU group. The EEA stapler gun is superior in every respect to the SPTU sewing-machine. The future belongs to the even more sophisticated bent and modifiable devices. These were used in our Department Between 1992 and 1997, with practically no morbidity and no mortality. Although they are the most expensive of all the possibilities, the low morbidity and mortality rates pay off from the aspects of the short hospital stay and the savings in human life.

Recurrent phyllodes tumor in a man.

The case of a 35-year-old man with a borderline-type cystosarcoma phyllodes is presented. Four years after the primary excision of the tumor, wide excision of a local recurrence and postoperative radiotherapy were performed. No repeated relapse was observed during a 5-year follow-up. Neither significant endocrine changes nor genetic alteration could be proven. However, a slightly increased SHBG concentration was detected, resulting in a decreased biologically available androgen level reduced testosterone/SHBG index. This phenomenon might be a consequence of the chronic liver disease of the patient due to his type II diabetes mellitus and alcohol abuse. In addition to the conventional histopathological examinations, immunohistochemical and electron-microscopic investigations were carried out on tissue sections, and the steroid receptors, EGF receptors and EGF-like activity of the tumor were also studied.

The results and failures of creating a pelvic reservoir in oncology (surgery, urology).

The results of abdominal and pelvic pouch operations are described in surgical and urological material. The lateral ileal pouch (Fonkalsrud) was used in 8 patients with diffuse colonic polyposis and in 4 cases of colitis ulcerosa. The second step of this two-phase operation was completed in 7 patients. Five complications were observed. One patient died of faecal peritonitis. Some sort of pouch operation was carried out in 22 patients after radical cystectomy in urological practice. The indication was tumour of the urinary bladder in 18, tuberculosis in 2 and interstitial cystitis in 2 cases. The distribution of the different types of reconstructions was as follows: Kock's pouch in 11, Mainz-pouch I in 5, and Mainz-pouch II in 6 patients. Early complications were observed in 3 cases with kock's reservoir, in 2 with Mainz I and in 2 with Mainz II intervention. Overnight incontinence appeared as a late complication in 30-60% of the cases. One of these patients died of a suture-line insufficiency after a Mainz-I substitution.

[Laparoscopic cholecystectomy. Initial experiences]. / Laparoscopos cholecystectomia. Kezdeti tapasztalatok.

Between February 1991 and July 1991, 74 laparoscopic cholecystectomies were performed. The number of all cholecystectomies during this period was 168. Two surgeons performed the operations. Stone in the common bile duct, old age, acute cholecystitis, severe obesity and heart rhythm disorders were regarded as contraindications. The duration of the operation was 45-210 min. (mean 127 min). The intervention was diverted to open cholecystectomy in 2 instances (2.7%). Early postoperative complications were observed in 2 cases (2.7%): biliary discharge and bleeding. Reoperation was necessary in one patient (1.3%) because of bleeding. There was no operative mortality. The mean duration of hospitalization was 5.6 days, and the mean postoperative period was 2.7 days. It is considered that, laporoscopic cholecystectomy can be carried out only by specialists in both bile surgery and laparoscopic techniques, provided that all the personal and technical conditions necessary for traditional cholecystectomies are at hand. Both medically and economically, the laparoscopic cholecystectomy results attain or even exceed those of the traditional open technique.

Comparison of the postoperative changes in the humoral and cellular immune activity in septic and non-septic colorectal cancer patients.

The effect of sepsis on the host resistance of 34 colorectal cancer patients with normal preoperative immune reactivity was studied. A significant change (p less than 0.01) was found in the IgG level of the septic patients (n = 13) when comparing their values with those of the non-septic patients (n = 21), on the third and 7th days postoperatively. There was no appreciable change in the IgA and IgM levels. The E rosette formation and the blast transformation values of the patients showed a marked decrease on the 7th day postoperatively. In the non-septic patients the normal initial values reappeared on the 10th postoperative day, while in the septic cases they significantly decreased as compared to both their own values and to those of the non-septic patients assessed during the same period (p less than 0.05). The possible factors serving for the prevention of decrease in the resistance of the host organism, are discussed.

Changes in the tendency of lymphocytes to undergo blastic transformation in the postoperative period, in immune-stimulated and untreated colonic tumour patients.

A study was made of the blastic transformation of lymphocytes in the postoperative period in colonic tumour patients: 23 who had been immune-stimulated by vaccination, and 28 who had not been vaccinated. The immune reactivity decreased significantly in the majority of the cases; however, the deterioration of the immune status affected 68% of the nonvaccinated group, but only 48% of the vaccinated group. The data indicate that the vaccination primarily averted the deterioration of the defence ability in the early postoperative period in patients with a normal preoperative immune activity. An evaluable change in the immune reactivity did not occur in the 6-10 preoperative days following vaccination. Three months postoperatively, the number of patients giving a normal immune reaction was three-fold in the vaccinated than in the non-vaccinated group.

[Experiences with the Soviet SPTU stapler device in colon and rectum surgery]. / Erfahrungen mit dem sowjetischen Klammernähgerät SPTU in der Kolon- und Rektumchirurgie.

From 1970-1982, 96 rectal and colonic anastomoses were performed by the stapler device SPTU. The results obtained were at least as good as anastomotic sutures made by hand.

[Relationship of immunological status to infections complicating surgery of the large intestine]. / Die Beziehungen des Immunstatus zu den Dickdarmoperationen begleitenden Infektionen.

The patients immuno-activity has a well-known importance for the outcome of postoperative complications. The authors evaluated the immuno-activity of 95 patients before selective, radical colorectal surgery: 1) 40% of the patients were anergic compared to healthy controls. 2) The incidence of wound infections was significantly higher in the anergic groups than in normal or hyperergic ones. 3) 25% and 50% decrease in wound sepsis has been observed in anergic and normal or hyperergic groups respectively after vaccination 7 to 10 days before operation with vaccine made of E. coli, Proteus, Klebsiella and Pseudomonas strains. The difference indicates the lowered immuno-reactivity on anergic patients.

Modern trends in colorectal surgery.

In 39 patients, the 'classical' pretreatment for colorectal surgery (mechanical purgation, laxatives, irrigation and sulfaguanidine administration) was supplemented with the oral administration of 750 mg metronidazole daily for 3 days. This dose was later increased to 1 g daily. The 75 control cases received the same pretreatment as in the test group, with the exception of the metronidazole. In the test group, obligate anaerobic pathogens could not be cultivated from the wound discharge in the infected cases, and there were no surgical fatalities. In the control group, however, anerobic strains could be cultivated in 9 cases, and the surgical mortality was 8%. The proportion of wound suppurations induced by aerobic pathogens was 41% in the test group, and 55% in the control group. The results of the metronidazole pretreatment and treatment are evaluated on the basis of the pertinent literature. The use of metronidazole is strongly advisable in the pretreatment of patients subjected to colorectal surgery and in other fields of septic surgery as well. Seven hundred and fifty five elective colorectal operations were carried out in the 11 years between 1971 and 1981, and the surgical mortality rates in the periods 1971-1977 and 1978-1981 are compared. Beside the metronidazole pretreatment, technical modifications (greater use of a stapler) and cimethidine prophylaxis were introduced in the latter period. This led to a decrease in the surgical mortality rate from 12.8% to 6.5%, and no case of fatal anaerobic sepsis occurred.

[Urinary enzyme excretion after prophylactic antibiotic therapy in patients following colorectal surgery (author's transl)]. / Harnenzymausscheidung nach präventiver antibiotikatherapie bei dickdarmresezierten patienten.

The urinary excretion of N-acetyl-beta-glucosaminade (NAG) and alanine aminopeptidase (AAP) was measured as an indicator for nephrotoxicity to neomycin and gentamycin in patients after colorectal surgery. We found that the continuous determination of urinary enzymes is a good indicator for the degree of kidney damage. The dose dependence of nephrotoxicity was influenced by the severity of colorectal surgery. The simple method of urinary enzyme determination seems to be a very valuable test to detect parenchymal damage of the kidney after prophylactic antibiotic therapy.