Transabdominal and lumbar nephrectomy for renal adenocarcinoma.

The results of 178 transabdominal and 79 lumbal nephrectomies were compared, based on a consecutive series of patients with renal adenocarcinoma. The corrected 5-year survival rate for patients without distant metastases was 64% for transabdominal and 57% for lumbar nephrectomy. This difference is not statistically significant. The transabdominal approach made possible a more extensive operation in patients with tumours extending to neighbouring organs, but none has survived as long as three years. Duration of surgery, need for blood transfusion and duration of postoperative hospital care were similar. Splenic injury occurred in 9.6% of the patients with transabdominal nephrectomy, but this did not result in additional morbidity or mortality. There were a few other sporadic complications.

Abdominal gynaecological emergencies in the surgical unit.

We have studied two types of emergency cases that occurred in the surgical unit who were found to have gynaecological aetiology: 1) patients with the so-called "morbus acutum dexter", i.e. appendicitis, or a gynaecological disease and 2) late complications in patients who had earlier benign gynaecological disease, usually such as tumour and surgery for it. The material with seven years follow-up consisted of 97 patients, who were treated during the periods 1959--60 and 1969--70. The relative numbers in both groups increased during the latter period. Of the patients in the reproductive age with suspected appendicitis, gynaecological diseases--mostly ovarian tumours with complications--constituted 7.6% of patients who had undergone appendicectomy in the surgical unit during the former period and 9.6% during the latter. The late complications consisted mainly of small bowel obstruction, resulting from adhesions caused by previous gynaecological surgery. The time interval between initial surgery and the obstruction was rather long, 3.5 years on the average. In the surgical unit the surgery was carried out in about two thirds of these patients. Our analysis demonstrates the necessity of recognizing cases with gynaecological aetiology as a significant factor in surgical practice; it has to be taken into consideration both in surgical and gynaecological education.