[Causes of recurrence after laparoscopic hiatal reconstruction]. / Laparoszkópos hiatus rekonstrukciók után fellépó recidívák okai.

The authors report our recurrent hiatal hernias occurred after laparoscopic hiatal reconstruction. The situation found during laparoscopic re-operations are illustrated on pictures. The show the methods against the recurrence.

[Laparoscopic cardiomyotomy in the treatment of achalasia]. / Laparoszkópos cardiomyotomia az achalasia kezelésében.

The laparoscopic cardiomyotomy (Heller) with Dor type anterior fundoplication is accepted for treatment of esophageal achalasia. Between December 1994 and December 1998, 21 patients with esophageal achalasia underwent laparoscopic Heller's operation with Dor's antireflux procedures after preoperative assessment which involved radiological, endoscopic and manometric investigations. Results were evaluated on the basis of our experiences and postoperative investigations. There were no intraoperative complications. Operating time was 40-90' (mean 65'). Conversion to laparotomy was not required. One patient had postoperative stenosis, and another had esophageal perforation which was treated. Postoperative manometry in all patients showed a decreased lower esophageal sphincter pressure. Based on the obtained results it could be concluded that cardiomyotomy with Dor fundoplication through a laparoscopic approach leeds to good functional results and seems effective and safe procedure in the treatment of esophageal achalasia.

Laparoscopic fenestration of symptomatic solid spleen cyst with harmonic scalpel instrument.

The treatment of two operated solid splenic cysts has been reported by authors. Laparoscopic cyst fenestration has been demonstrated to be a useful alternative method to open surgery. The aim of the authors was to analyse the use of Ultracision Harmonic Scalpel in two spleen preserving procedures. Cysts were located in the superior and the anterior-inferior pole of the spleen. Cyst wall not covered by spleen tissues was removed, drain was left in the abdomen. In the demonstrating spleen cyst operation the advantages of HS instrument was the clean operating field, correct coagulation of cyst wall, short hospital stay. Authors believe that this new technology will make it easier and more desirable for surgeons to fenestrate symptomatic spleen cysts.

Laparoscopic hiatal reconstruction and use of harmonic scalpel instrument.

The method of laparoscopic repair of hiatal hernia is accepted in surgery. Usually associated with Nissen fundoplication which is the most commonly performed antireflux operation. Within a ten-year period authors have done 90 antireflux operations, 52 was laparoscopic procedures. (30 operations for GERD, 10 for hiatal hernia, 12 for the combination of both.) A patient was submitted to operation with large hiatal hernia. He was treated laparoscopic way with success and good results. The Ultracision Harmonic Scalpel instrument helped their operation in many ways, and provided correct bloodless preparation of cardiac region. The authors demonstrate our procedure and the use of the Harmonic Scalpel. Their patient were completely pleased with the results after discharge, they are still under regular control.

Use of harmonic scalpel at laparoscopic cardiomyotomy. A new method.

The laparoscopic cardiomyotomy with anterior fundoplication (Heller-Dor procedure) is accepted for treatment of esophageal achalasia. The crucial point of the procedure is proper myotomy and avoid perforation of the esophagus. Hook cautery is widely accepted to dissect the oesophageal muscle. We'd like to demonstrate our experiences with a new device--Ultrasonically Activated Harmonic Scalpel-, witch was used at our operation for achalasia to make the cardiomyotomy. Between December 1993 and December 1996, 11 patients with esophageal achalasia underwent laparoscopic Heller's operation with Dor's antireflux procedures. In one patient we applied the Ultrasonically Activated Harmonic Scalpel (HS) to make the cardiomyotomy. The use of HS and results were evaluated. Application of the Harmonic Scalpel is effective for cardiomyotomy. It can be used more safe than electrocoagulation, because it cause less thermic lesion. It's easy to use at laparoscopic way. A perforation of the esophagus didn't occur. There was no intra-, or postoperative complications. After the operation the patient is free of complains. After our first operation, we have found, that Ultrasonically Activated Scalpel can be applied with safe and good results for the cardiomyotomy at laparoscopic operations for esophageal achalasia.

[Quality of life of post-colostomy patients]. / Colostomás betegek életminöségének vizsgálata.

The psychosomatic care of patients after surgical treatment must comprise the analysis of quality of life with colostomy. Five different parameters were assessed of 100 colostomy patients. Sixty-one percent of our patients had skin irritation problems. Twenty-eight patients applied regular irrigation. Seventy-two percent of these had daily motions, 20% had bidaily, the remaining 8% had irregular bowel movements. Seventeen percent of the nonirrigating patients observed very irritating fecal discharge around the stoma. Embarrassing noises concomittant with bowel movements were observed by 42% and 45% struggled with bad odors. Irrigating patients had hardly any of these problems. For 65% of the patients the idea of having a colostoma meant the greatest psychological burden before the operation. The stress situation culminated in the immediate postoperative period in 10%. Forty percent of those asked were seriously worried about the reaction of their social environment. In 65% a significant decrease of social relations could be observed. Sixteen percent reported an increased social activity after colostomy had been performed. Sixty percent admitted considering the option of suicide at least once. Thirty-five percent revealed to have any kind of sexual problems after colostomy. Eight of our 100 colostomy patients experienced serious adverse reactions from their family members. In eighty percent of the cases family members showed great sympathy although they acted naively. The quality of life of colostomy patients may be best taken care of by qualified stomatherapists, out-patient proctology departments and the ileo-colostomy movement (ILCO).

The treatment of falciparum malaria in children with halofantrine suspension.

Malaria treatment of children is particularly difficult because of the absence of palatable suspensions for young children. Halofantrine hydrochloride is available as a suspension which is both palatable and simple to administer, and has been studied in a number of trials in the past 5 years. Children (331) ranging from 4 months to 17 years of age (mean 4.7 years) were treated with the 5% suspension using various dose regimens and 364 children ranging from 4 months to 14 years of age (mean 5.7 years) were treated with the 2% suspension 6 hourly for 3 doses. Using the 3-dose regimen there were only 2/462 (0.4%) who failed to clear the initial parasitaemia. Recrudescence occurred in 28/367 (7.6%) children with evaluable follow up data. The mean parasite clearance time in this group was 57.1 h (n = 417) and the mean fever clearance time was 50.9 h (n = 325). Symptoms related to malaria cleared rapidly following treatment generally by 24-48 h post treatment. Side effects possibly related to treatment were uncommon but were similar to those reported in adults. The frequency of diarrhoea and abdominal pain was lower than that seen in adults and was also less frequent following multiple doses and the use of the more dilute suspension. Since there was evidence that the majority of recrudescences were seen in younger children or those living in areas with low or seasonal transmission it is recommended that a further course of treatment 7 days later is given to these patients to prevent recrudescence.(ABSTRACT TRUNCATED AT 250 WORDS)

The treatment of falciparum malaria in children with halofantrine suspension

Malaria treatment of children is particulary difficult because of the absence of palatable suspensions for young children. Halofantrine hydrochloride is available as a suspension which is both palatable and simple to administer, and has been studied in a number of trials in the past 5 years. Children (331) ranging from 4 months to 17 years of age (mean 4.7 years) were treated with the 5% suspension using various dose regimens and 364 children ranging from 4 months to 14 years of age (mean 5.7 years) were treated with the 2% suspension 6 hourly for 3 doses. Using the 3-dose regimen there were only 2/462 (0.4%) who failed to clear the initial parasitaemia. Recrudescence occurred in 28/367 (7.6%) children with evaluable follow up data. The mean parasite clearance time in this group was 57.1h (n = 417) and the mean fever clearance time was 50.9 h (n = 325). Symptoms related to malaria cleared rapidly following treatment generally by 24-48 h post treatment. Side effects possibly related to treatment were uncommon but were similar to those reported in adults. The frequency of diarrhoea and abdominal pain was lower than that seen in adults and was also less frequent following multiple doses and the use of the more dilute suspension. Since was evidence that the majority of recrudescences were seen in younger children or those living in areas with low or seasonal transmission it is recommended that a further course of treatment 7 days later is given to these patients to prevent recrudescence. Halofantrine suspension appears to be effective and well tolerated in children and is a useful addition to the drugs available for the treatment of paediatric malaria

Clinical experience with halofantrine in the treatment of malaria.

Halofantrine hydrochloride (HF) belongs to a new class of antimalarials, the phenanthrene methanols. Preliminary clinical studies suggested that an adult dose of 500 mg 6-hourly for three doses, with a weight-based regimen of 8 mg/kg 6-hourly for three doses in children, would be effective. In an ongoing clinical programme, 1973 patients with acute malaria were analysed, of whom 1474 (1315 with P. falciparum and 122 with P. vivax malaria) received the above regimen. In the studies 931 adults and older children were treated (61 with capsules and 870 with tablets) while 520 infants and young children used 5% or 2% suspension. The majority of studies were performed in areas of high chloroquine or multidrug resistance. Only eight (0.6%) of 1282 evaluable patients with falciparum malaria failed to clear their parasitaemias within 7 days. Recrudescence of parasitaemia occurred in 77 patients (6.0%). Reinfection cannot be excluded in several of the cases, where protection from malaria transmission was not maintained. The majority of recrudescent patients were either non-immune (normally residing in malaria-free areas) or were infants below 2 years of age. In vivax malaria cases, there were six recrudescences (5.4%). The mean parasite clearance time was 57.9 h and the fever clearance time 50.2 h in falciparum malaria cases, while the clearance times for vivax cases were 57.3 h and 49.6 h respectively. Clinical events were uncommon and consisted of mild transient diarrhoea or abdominal pain in less than 5% of cases. Laboratory findings were generally abnormalities related to the acute disease rather than drug treatment. Experience to date would indicate that HF is a safe and useful drug for the treatment of acute malaria, particularly in areas where there is extensive resistance to current antimalarials.