[Surgical treatment of hepatic echinococcosis--10-year experience].

INTRODUCTION: Especially debatable remains the problem concerning the volume of the surgical treatment of hepatic echinococcosis. At present it varies from radical typical and atypical liver resections, through closed conservative approaches, to minimally invasive methods like PAIR or laparoscopic echinococcectomy. AIM: The aim of the present investigation is to elucidate the problems, occurring during surgical treatment of hepatic echinococcosis and to offer adequate treatment-diagnostic algorithm. This retrospective study summarizes our 10-year experience in a number of debatable topics, concerning the surgical treatment of this socially significant disease. RESULTS: To fulfill the aim, we performed a retrospective clinical study for a period of 10 years. One-hundred-forty-seven patients had been admitted to hospital and underwent surgical treatment for hepatic echinococcosis during that period. One-hundred were males (58%) and 47 (32%)--females. The age of the patients included in the retrospective study varies between 6 and 80 years--(mean age 39.1 +/- 8.9). In 19 patients we found multiple echinococcosis of the liver (2 to 7 cysts). Two cysts--in 7 patients, 3 cysts--in 6 patients, 4 cysts in 1 patient, 5 cysts in 2 patients, 6 cysts in 1 patient and 7 cysts in 2 patients. The right hepatic lobe is three times more frequently engaged than the left one--106 patients with right-sided localization (72.1%) compared to 41 with left-sided (27.9%). Combined echinococcosis is found in 14 patients. Concomitant engagement of liver and spleen is present in 2 patients, peritoneal dissemination--in 7 patients and accompanying lung cyst--in 6 patients. Echinococcectomy with capitonage of the residual cavity is performed in 126 patients, echinococcectomy with external drainage in 4 patients, atypical liver resection in 8 patients, echinococcectomy via thoracofrenectomy approach in 6 patients and combined surgical interventions with spleen removal in 3 patients. In their majority the complications are not serious and life-threatening or with permanent consequences to the patient. Severe complications demanding active surgical intervention occur in approximately 4% of the treated patients. Our results are comparable with the ones of leading national and foreign centers and confirm the correctness of our treatment. The average hospital stay is 12 days. We have no lethal cases for the study period. CONCLUSION: Based on our experience, we consider that echinococcectomy with capitonage of the residual cavity and invagination of the fibrous rims is the method of choice for hepatic localization of the parasite. The above-mentioned surgical technique is characterized with low percentage of post-surgical complications, is well-tolerated from patients and relatively atraumatic and shows excellent long-term results. We consider more radical surgical methods, like atypical liver resections, appropriate in selected patients, ones with multiple echinococcosis and vast fibrous-altered areas of liver parenchyma. We find reasonable the obligatory adjuvant post-surgical treatment with Albendazole under parasitologist control, especially in cases of multiple and/or recurrent echinococcosis.

Mammary gland papilloma--diagnostic and therapeutic behavior.

Papillary lesions of the mammary gland represent a serious disease and incorporate a broad spectrum of lesions. The goal of the current article is to reveal the diagnostic methods and therapeutic behavior in patients with pathological discharge from the nipple of the mammary gland. In this article we present 15 cases of histologically proven mammary gland papilloma. Mammographic, ultrasonographic and cytologic methods are applied for diagnostic specification. The chosen therapeutic behavior in all of the women is surgical. We take into consideration the possibilities of the different diagnostic methods as well as the therapeutic behavior-conservative or surgical approach. We reckon that when there is suspicion for mammary gland papilloma a surgical intervention is necessary to be carried out--due to the functional discomfort and due to the possibility intraductal carcinoma in situ to be missed out in some cases.

Our first experience in treatment of ano rectal fistula with SURGISIS AFP Anal Fistula Plug.

AIM: The aim of this study is to present the early results and to discuss the new method of treatment of ano-rectal fistula with SURGISIS AFP ANAL FISTULA PLUG. MATERIAL AND METHODS: Three patients with ano-rectal fistula have been treated in the Department of General Surgery with Coloproctology, using Surgisist AFP anal fistula Plug. Two were with transsphincter and one with extrasphincter ano-rectal fistula. This method of SURGISIS AFP ANAL FISTULA PLUG treatment is presented in details. RESULTS: All patients are with closed fistulas after period of 4, 8 and 12 weeks of follow up. The author emphasized, that with the presented way of treatment the period of hospitalization is shorter, postoperative pain and period of healing are reduced. There are a lot of advantages using this method, compared with the traditional surgical methods. CONCLUSION: The presented material is insignificant, but it helps to initiate a new noninvasive method of treatment of ano-rectal fistula. Surgisist AFP anal fistula Plug method is a safe and successful. It preserves the anal anatomy and function. The data results, which are presented should be reproduced in a wider future study.

[Treatment of chronic anorectal fistulas by fibrin sealant].

UNLABELLED: The surgical treatment of chronic anorectal fistula still remains a problem and a challenge for the coloproctologist. Lately, about 50 articles on fibrin glue treatment of perianal fistulas have appeared The technique is simple and easy to perform can be repeated. many times as minimal surgical trauma and completely preserved function of the anal sphincter. AIM: To analyze retrospectively the efficacy of fibrin glue Tussicol in patients with chronic anorectal fistulas. PATIENTS AND METHODS: The method of sealing with fibrin glue has been applied to 34 patients (29 male and 5 female mean age 48.82 +/- 2.43 years) with chronic perianal fistulas between January 2003 and June 2006. Patients with complicated fistula and those with specific etiology have been excluded. Standard colon cleaning without prophylactic or therapeutic antibiotics was performed. Under spinal or general anesthesia fistulas are observed, probed, the internal and external opening is identified, then curettage of the fistula channel follows, irrigation and filling up with fibrin glue (Tussicol Baxter). After a mean stay of 3.91 +/- 0.40 days in the clinic, follow up of the patients took place in ambulatory settings after 1 week, 1, 3 and 6 months. RESULTS: The common frequency of success is 73.53% (25/34). Patients with recurrent fistula did have poorer final results/frequency of success only 50% (2/4). Neither of the patients did have major postoperative problems like anal incontinence, requiring additional attention and treatment. CONCLUSION: Our study reapproves the complete safety and high effectiveness of fibrin glue treatment of anorectal fistulas. The procedure is easily performed and tolerated by the patients, allowing further expanding of therapeutic modalities of the chronic anorectal fistulas.