Laparoscopic treatment of nonparasitic cysts of spleen and liver.

Laparoscopic treatments of nonparasitic splenic and liver cysts in the period between March 1993 and April 1995 have been reported: partial decapsulation-fenestration and evacuation of a splenic pseudocyst in one patient, fenestration of large congenital liver cysts with total excision of a few smaller liver cysts in two patients and two unsuccessful treatments of splenic cysts. After successful laparoscopic procedures the patients experienced immediate and complete relief of the symptoms. Two years after the splenic cyst procedure and 6 months after the liver cyst operation, the patients remained free of the symptoms, and complete absence of the cysts was confirmed by computerized tomography scans. Laparoscopic fenestration of nonparasitic splenic and liver cysts with total excision of smaller liver cysts is a simple and safe surgical method with lower morbidity and a quick return to normal activity.

Laparoscopic cholecystectomy following abdominal surgery of the lower part of abdomen.

In this prospective study, laparoscopic cholecystectomy was performed in patients with previous abdominal surgery of the lower part of abdomen. According to authors experience, the usual method of 'blind' beginning of the laparoscopic procedure, with safety tests, is a safe and reliable method to start the laparoscopic procedure, even in these patients. This method does not carry a higher risk of intra-abdominal injury.

Laparoscopic cholecystectomy: results after 1000 procedures.

From May 1992, when the first laparoscopic cholecystectomy was performed at University Department of Surgery, Sveti Duh General Hospital, till October 1994, the authors performed more than 1000 procedures. Laparoscopic approach was successfully used in 965 (96.5%) patients. Thirty-five (3.5%) cases were converted to open surgery. Dangerous anatomy, some technical problems and perioperative bleeding were the most often reasons for conversion. Further, liver metastases and perioperatively recognized common bile duct lesion necessitated conversion in one case each. In total, there were 18 (1.8%) abdominal complications. Common bile duct lesion, postoperative common bile duct stricture and duodenal perforation occurred in one patient each. Major bleeding was present in eight and bile leak in seven patients. The mean duration of hospitalization was 2.8 days. Analyses of the results show laparoscopic cholecystectomy to be safe procedure with low perioperative and postoperative complications.

[Hemostasis and treatment of stress hemorrhage in the upper gastrointestinal tract of trauma patients]. / Blutstillung und Behandlung von Stressblutungen im oberen gastrointestinalen Trakt bei Verwundeten.

Despite the use of H2-receptor antagonists for the prevention of stress lesions, 32 (9%) of the 354 wounded treated at the surgical intensive care units presented with upper gastrointestinal bleeding. 28 (87.5%) patients underwent endoscopic examination. The types of hemorrhage (capillary, venous and arterial bleeding) and the efficacy of hemostasis were analyzed. The bleeding ceased spontaneously in 17 (53.1%) patients, and 3 (9.4%) died in spite of all the endoscopic and surgical procedures undertaken.

[Prevention of early postoperative hematoma with the use of elastic bandages. Its ultrasonic diagnosis and control]. / Prevencija ranih poslijeoperacijskih hematoma primjenom elasticnog zavoja. Njihova ultrazvucna dijagnostika i kontrola.

The authors stress out the importance of an application of elastic bandage for a prevention of the early postoperative hemathomas in traumatized patients, whose effect can be controlled by ultrasound. 58 patients were elaborated, of whom in 30 cases an elastic bandage was placed at the end of surgery, and 28 patients (control group) without dressing. In 8 patients of the control group, an existence of postoperative hemathomas was proved by ultrasound, while only in two cases with postoperative bandage a presence of such hemathoma could be discovered. Lesser number of postoperative hemathomas in patients with elastic bandage is statistically important (p less than 0.001). Obtained results indisputably point out the value of elastic bandage application in the course of first three postoperative days in traumatized patients.

The effect of piracetam on the recurrent inhibition of motor neurones.

Piracetam as a nootropic agent is known to exert its effect by activating and protecting the neuronal cell functions. The mechanism, how piracetam acts, is still unknown. However, some experimental data point to the facilitating role of piracetam in the cholinergic synaptic transmission. According to the generally accepted fact that the recurrent inhibition of motoneurons occurs as a result of cholinergic activity, this model has been used in our experiments, which were performed on the spinal cord of decerebrated cats. The significant potentiation and prolonged duration of the recurrent inhibition following intravenous application of piracetam (100 mg/kg) obtained in our experiments, as well as the fact that atropine (1.0 mg/kg i.v.) antagonize this effect, offers the conclusive evidence of direct facilitatory action of piracetam in the cholinergic neurotransmission process.

[Use of the EEA stapler in surgery of the rectum and rectosigmoid junction]. / Upotreba EEA sivaca (staplera) u kirurgiji rektuma i rektosigmoidnog prijelaza.

The application of mechanic sewing apparatus has obtained significant position in surgery of gastrointestinal tract. The EEA stapler (ILS Proximate) is improved, suitable and useful instrument for the performance of anastomosis after resection, and technically is equivalent to the normal suture techniques. It is especially convenient for the creation of low rectal anastomoses, thus definitive anus preter can be avoided. In 10 cases of rectal carcinoma, anterior resections and stapled anastomoses (3 were below 7 cm from anal border) were applied. In spite of insufficient number of surgically treated cases, surgical treatment was without technical problems and without postoperative dehiscence. Especially at low anastomoses, the importance of satisfactory suture techniques, adequate vascularization, avoidance of tissue tension, adequate selection and regulation of instruments are emphasized.

Dopamine antagonists induce gastric lesions in rats.

Gastric lesions were provoked in all rats that had received intraperitoneally a single dose of the dopamine antagonists haloperidol, metoclopramide or domperidone 24 h before. Dose-dependence was demonstrated for haloperidol. This drug induced gastric lesions as early as 90 min after its application. The ulcerogenic effect of haloperidol was completely prevented or markedly reduced by simultaneous applications of dopamine agonists bromocriptine or L-dopa. We conclude that the model of gastric lesions induced by dopamine antagonists could be successfully applied in further investigations of the role of dopamine in the pathogenesis of ulcer disease.

[The value of contrast lymphography in the planning of abdominal surgery]. / Vrijednost kontrastne limfografije u planiranju nekih kirurskih zahvata u abdominalnoj kirurgiji.

Contrast lymphography is a significant diagnostic method for metastatic changes discovery in lymph nodes of pelvic and abdominoretroperitoneal area. Preoperatively it enables surgeon to plan the surgical treatment, and postoperatively it is indispensable for the successful treatment and radiotherapy planning. From 1965-1977. yrs. 325 contrast lymphographies were accomplished. The patients with urinary bladder and rectum carcinomas were examined. The ones with pelvic and long bones tumors were presented too, because of the congruent lymph supply and insufficient reviews in literature. Lymphographically visible metastases were pathologically proved in more than 80% of cases. For better visibility of lymph nodes during the surgical treatment, in 100 cases, chromolymphography was applied. There were no complications before or after the performance of the method. In less visible changes, supplementary researches should be accomplished to make the changes interpretation more reliable.