[Urethral diverticulum in a patient with two stones after combined treatment of prostate cancer with metastasis to the left cavernous body of the penis].

Urethral diverticula are sac-like dilatations of the urethra that communicate with its lumen. They may be congenital or acquired. In males, urethral diverticula are rare and classified as congenital (true) and acquired, which are associated with trauma, abscess, strictures, surgical procedures, in particular in patients with hypospadias. A clinical observation of urethral diverticulum with two stones in a man after complex treatment of prostate cancer with metastasis to the left cavernous body of the penis is presented in the article. At the first stage, the patient underwent endoscopic lithotripsy with a biopsy of the diverticulum wall and laser ablation of the stricture of urethrovesical anastomosis. At the second stage the excision of the diverticulum with urethroplasty was performed. The team of authors considers this clinical observation to be unusual. Previously, postoperative urethral diverticula with two stones in patients after complex treatment of prostate cancer with metastasis to the left cavernous body of the penis was not described in the scientific literature.

Jugular venous aneurysms: when and how to operate.

BACKGROUND: Jugular venous aneurysms are rare, usually congenital, and present particular problems in management. Whether to perform surgery or not is controversial, cosmetic considerations being the primary factor in the decision. METHODS: Over the past nine years, 10 patients with unilateral jugular venous aneurysms have been closely followed up in our department. The most informative diagnostic procedure for the condition was considered to be ultrasonographic imaging after a positive Valsalva manoeuver, but in six cases phlebography was necessary. Various operative techniques were used--venous ligation, tangential venorrhaphy with or without aneurysm resection and autovenous banding, according to the pathological findings. RESULTS: No complications from the surgery were reported. Over a follow-up period ranging from six months to eight years both operated and non-operated patients were found to be doing equally well. CONCLUSIONS: Problems with the terminology of the disease, its diagnosis and the indications for surgery are discussed. Surgical methods are reviewed and a new operative technique is presented. We conclude that apart from cosmetic considerations, thrombosis and aneurysmal expansion are the principal indications for surgery.

Severe acute hand ischemia following an accidental intraarterial drug injection, successfully treated with thrombolysis and intraarterial Iloprost infusion. Case report.

A young woman with acute upper extremity edema and ischemia after intraarterial drug injection is presented. Unsatisfactory results from standard treatment were the reason for changing the therapy to temporary thrombolysis, which led to significant improvement. Some days later severe impairment forced another attempt at applying standard therapy, again unsuccessful. Only after continuous intraarterial infusion of Iloprost, a new improvement occurred and saving of the hand was possible. It became obvious that more effective therapeutic measures ought to be applied when severe hand ischemia following intraarterial drug injection is present.

[Combined heart injuries]. / Kombinovaná poranení srdce.

Cardiac injuries associated with a penetrating thoracic injury are not frequently encountered. The usual course is characterized by massive haemorrhage, cardiac tamponade and an entering wound in the cardiac area. Diagnostic problems arise if these clinical syndromes are absent. In the course of two years at the authors' department two cases of tangential cardiac lesions in the posterior left ventricular wall without penetration into the heart without massive haemorrhage and tamponade were absent as haemorrhage of the pericardial lesion into the pleural space occurred. It is not without interest that the entry wound was far away from the heart and the cardiac lesions were detected during surgical intervention made on account of other symptoms.

[In situ femorodistal autovenous bypass]. / In situ femorodistalen avtovenozen baipas.

Bypass in-situ surgical technique was applied in 49 cases of femorodistal arterial reconstructions. The operative technical details, as well as intra- and postoperative complications are discussed. A patency of the bypass in 87.5% after 18-month following are documented as well as limb salvation in 97.6%. The technical advantage of the bypass in-situ method are discussed and a recommendation for its appliance in suitable cases is given.

Management of acute arterial trauma of the upper extremity.

During a 3.5 year period ending in September 1991, 50 patients with 51 arterial injuries of the upper extremity were operated on and followed up for more than 6 months. The majority of the cases suffered penetrating injuries, but in 18% blunt trauma led to thrombosis. The most frequently observed signs were haemorrhage, neurological disorders and a peripheral pulse deficit. The brachial artery was most frequently injured. Preoperative arteriography was performed in 20% and peroperative angiography in 16% of cases. Reconstructive surgery was performed in 88% and the brachial artery was ligated in a single patient who was in shock. An end to end anastomosis was possible in 55% and in 45% of cases an autogenous vein graft was used. A microsurgical technique was used in cases of forearm arterial injuries. In five patients with prolonged ischaemia, forearm fasciotomies were needed. Additional procedures such as venous, bone or nerve repair was also necessary. In four cases a temporary shunt was used. All patients were alive with late patency of 91% in the axillobrachial arterial segment. A single failure after repeated brachial artery reconstruction was observed following severe traumatic amputation with large tissue defects. Post-operative arteriography revealed a good anastomosis with patent grafts. Arterial reconstruction is clearly necessary in these injuries and we believe that an experienced vascular surgeon should be involved.

[Antithrombin III deficiency as a cause of unexplained thrombosis recurrences in vascular surgery]. / Defitsit na antitrombin III kato prichina na neobiasnimi retrombozi v sudovata khirurgiia.

Antithrombin deficit may be a cause of spontaneous vascular thrombosis or rethrombosis, following vascular operations, which remain inexplicable to clinicians. Three cases are reported of A III deficit, in two of whom vascular rethrombosis resulted from considerable fall in A III activity, measured by kinetic method and in the third patient this severe postoperative complication was averted. The importance of measuring A III in patients with arterial insufficiency in whom vascular reconstruction is forthcoming is discussed. The substituting therapy in patients with this pathology and arterial reconstruction is given due consideration. Substituting therapy is recommended as means for avoiding rethrombosis in patients with proven A III deficit, as well as a method of treatment, together with heparin therapy, after successful reoperation of such patients.

[Is there any decline in the frequency of perforative appendicitis? (AUTHOR'S TRANSL)]. / Zeigt die Häufigkeit der Appendicitis perforativa eine abnehmende Tendenz

The authors are concluding the letality of appendicitis displays a steadily declining tendency. The rate of perforations observed at their institution corresponds to the average in international surgical literature. They found that letality statistics of appendicitis improved considerably during the last century, whilst perforation percentage has remained practically the same, though the conditions in public health care and possibilities of hospitalization have considerably improved. They expect the number of perforations to decline by establishing the diagnosis even more consistently stage and by performing operations at an early stage, as well.