Endoluminal prosthesis in protecting high-risk colonic anastomosis: an experimental study.

An experimental study was carried out to evaluate the protective role of an endoluminal prosthesis on high risk colo-colonic anastomoses. One hundred and fifty rats were divided into two groups: Group E with endoluminal latex prosthesis and Group C without. Bursting pressure and collagen concentration in the perianastomotic tissue were tested, respectively, on the 4th, 7th and 12th, and 4th, 7th, 12th, 18th and 38th postoperative days. Bursting pressure was significantly higher in Group E on the 4th postoperative day. There was no significant difference in the anastomotic collagen concentration between the two groups. The presence of the prosthesis did not produce any macroscopic or microscopic evidence of impaired healing or stricture at the suture line. Death due to anastomotic dehiscence occurred in 11/75 (15%) in Group C and in 1/75 (1.3%) in Group E (p less than 0.01). Endoluminal prosthesis appears to have a protective effect on anastomotic healing. The mechanism is probably due to mechanical protection and not to differences in collegen concentration.

[Duodenal obstruction caused by gallstones (Bouveret syndrome)]. / Obstrukcija duodenuma zucnihm kamenovima (Bouveret-ov sindrom).

Gallstone obstruction of the duodenum (Bouveret's syndrome) is a very rare complication of biliary calculosis. A great biliary calculus with long-term persistence causes cholecystoduodenal fistula and after passing through this fistula into duodenum, subsequent duodenal obstruction develops. The authors present a 73-years-old woman with Bouveret's syndrome. She was admitted to the Institute of digestive diseases with clinical signs of high intestinal obstruction. Preoperative radiographic examination detected gallstone obturation of the duodenum. At operation, two large gallstones were extracted from the duodenum, a thickened gallbladder was removed and duodenal suture was done. Post-operative course was delayed, due to respiratory complications and the patient went home on the 37th day after the operation in good condition.

[Early postoperative complications in elective splenectomy in hematologic diseases]. / Rane postoperativne komplikacije elektivnih splenektomija zbog hematoloskih oboljenja.

This study analyses frequency of complications and mortality after elective splenectomy done for various hematological diseases, dependent on the spleen weight. From 1979 to 1988 year, 236 patients were treated by splenectomy for various haematological disorders, including: autoimmune disorders (90), Hodgkin's disease (34), lymphoproliferative diseases (96) and myeloproliferative diseases (16 patients). In the early postoperative period, complications occurred in 51 (21.61%) patients, 10 of which (4.24%) died. Considering the size of the spleen (more or less than 1500 gr) there was no difference in the early postoperative mortality (p greater than 0.05; 3.30%:5.38%), while postoperative complications occurred significantly more often in patients with massive splenomegaly (p greater than 0.05; 1259%:3548%). The most frequent complications were septical (8.90%), prolonged fever (5.51 x), and postoperative bleeding (2.97%), while cardial, pulmonary and urinary complications occurred seldom, but more often caused patient's death. Defining the appropriate indications for splenectomy, performing suitable preoperative preparations and postoperative care, mortality was diminished from 7.14% in the period, 1979-1983 year, to 2.17% in the period 1984-1988.

[Retroperitoneal sarcoma]. / Retroperitonealni sarkomi.

Clinical experience in the treatment of retroperitoneal soft tissue sarcomas during period 1978-1987 is presented. The material consists of 64 patients with the male predominance (60.94%), and the peak occurrence in the forth and fifth decade of life. The difficulties in the diagnostic of these tumours are mostly caused by unspecific clinical picture, which is usually cleared with the stage of inoperability. Modern diagnostic approach, using echotomography and angiography enables earlier diagnosis. The most often seen histological pictures in this series are: M. Hodgkin (28.14%), Liposarcoma (25%) Lympho and fibrosarcoma (twice 12.5%), and the other forms are rarely encountered (1-3%). The operability is very low, and the radical operation is performed only in 16 cases (25.50%), and exploratory procedures are performed in 44 (68.75%). In the rest of cases a reduction of bulk mass of tumour was performed. The 5 year survival in the radically operated is present in 25% (4 patients) what is in accordance with the literature. In the cases with exploration or partial resection, the average survival is 4.5 months, in spite of some longer survivals in the group with Hodgkin's disease, mostly because of the modern cytostatic treatment. Intermediate postoperative mortality is 3.12% (2 patients). In recent years, the more aggressive surgical approach is advised, resulting in better outcome.

[Surgical treatment of breast carcinoma - 30 years' experience]. / Hirursko lecenje karcinoma dojke - tridesetodisnje iskustvo.

Although, carcinoma of the breast, because of its high frequency and many specific properties, belongs to the most studied of malignancies, it remains a fact that during the past 3 decades the incidence of mortality from this disease has changed little. The authors, drawing on their 30 years experience, demonstrate that the mortality rate and the survival rate depend on the kind of surgical intervention as well as the stage of development of the disease at the moment of operation. For this purpose a total of 655 operated cases were recorded (643 female and 12 male) using the Steinthal classification. In this series 68.1% were infertile; the upper outer quadrant was affected in 54% of cases; histologically the most frequent form was scirrhous adenocarcinoma. The greatest number of patients belonged to stage II and III, whereas the average time from the appearance of the first symptoms up to the medical examination was 6-12 months. Further spread of the disease and regional metastases were presented in more than 65% of cases. It was demonstrated that surgical procedure used depended on the extensiveness of the disease; modified radical mastectomy was performed in 54.2% of patients and Halsted's radical mastectomy in 40.15%. 185 patients were given the control examination. A strictly statistical analysis of the results confirmed that whereas the length of survival was not significantly affected by the kind of operation, the mortality rate did vary according to which surgical procedure was used. The author conclude that there is no best or unique surgical method and that each patient should be examined in a multidisciplinary way, and his treatment should be carefully planned.

[Traumatic aneurysms]. / Traumatske aneurizme.

Analysis of 37 surgical treated patients suffered from traumatic arterial aneurysms and fistulas is done. 27 aneurysms and 10 fistulas is presented. Restoration of continuity of damaged artery was performed in 26 patients and ligation was done in 11 patients. Good long term results were obtained in 29 patients (78.38 per cent), satisfactory in 4 patients and unsatisfactory in four, too. The authors advocate early surgery and method of restoration applied because of they give the best functional results. Ligation of vessel is method of necessity. No mortality and no amputation was in presented serie.