Nephrectomy - indications, complications and postoperative mortality in 646 consecutive patients.

OBJECTIVE: To gain information about the indications for and complications of conventional nephrectomy, also to create standards for future evaluation of nephrectomies performed by minimal invasive techniques. METHODS: We present a historical 20 years' series of 646 consecutive nephrectomies performed in the period of 1978-1997. Malignant disease led to the operation in 437 cases, of which 98 were urothelial tumors in the renal pelvis or ureter. 209 kidneys were removed due to benign conditions. The incidence of nephrectomy for benign conditions has declined from 75 in the first 5-year period to 32 in the last. RESULTS AND DISCUSSION: Postoperative complications occurred in 100 patients (15.5%). Nephrectomy for malignant disease had a significantly higher rate of complications than operations for benign conditions (p<0.001), especially hemorrhagic complications and pneumonias were more frequent. There were no differences as a result of the operative approach. Reoperation was carried out in 3.0% of the cases. Overall mortality rate (<30 days) was 3.1%.

Survival after radical treatment for transitional cell carcinoma of the bladder.

AIMS: To investigate survival after radical treatment for transitional cell carcinomas of the bladder. METHODS: This retrospective study included 135 patients with transitional cell carcinoma of the bladder undergoing radical cystectomy or radiotherapy at Haukeland Hospital, Bergen, Norway, during the period 1981-1986. Forty-five patients had cystectomy and 90 underwent external high-dose radiotherapy. RESULTS: The overall 5- and 10-year survival rates were 39 and 23%, respectively. After cystectomy 10-year overall survival rates for superficial and muscle-infiltrating tumours were 67 and 26%; after radiotherapy, the corresponding survival rates for superficial and muscle-infiltrating tumours were 26 and 5%, respectively. CONCLUSIONS: Long-term survival and cure can be achieved after cystectomy in many patients with aggressive superficial or muscle-infiltrating bladder carcinoma. The introduction of orthotopic neobladder reconstruction should encourage the use of cystectomy in patients with aggressive superficial tumour.

[Bladder rupture. Diagnosis, etiology and treatment]. / Blaereruptur. Diagnostikk, etiologi og behandling.

The majority of bladder ruptures (80-90%) are caused by major blunt abdominal trauma. Penetrating injuries account for the rest. Bladder rupture is seen most often in patients with pelvic fracture. More seldom, the rupture can be caused by energetic blunt abdominal trauma. The rupture can either be intraperitoneal or extraperitoneal. The symptoms are macroscopic haematuria, suprapubic pain and, in some patients, an inability to avoid. Retrograde cystography is the diagnostic procedure of choice. An intravenous infusion pyelogram does not provide adequate examination of the bladder. The rupture is treated by operative closure and drainage by catheter. Extraperitoneal rupture may be treated with only catheter drainage and close clinical evaluation. We describe two patients with intraperitoneal bladder rupture after low energetic abdominal trauma.

Sliding of the compression hip screw in femoral neck fractures.

Backing out of the compression screw in the sliding screw-plate hip osteosynthesis was analyzed in a series of 71 hips with medial femoral neck fractures during an observation period of 12-42 months, with a median of 26 months. In addition to the compression screw device, a parallel cranial lag screw was used. A postoperative primary diastasis in the fracture space of 1-5 mm in 11 cases did not predispose to major sliding of the screws or to healing problems. Thirteen of 27 fractures with late screw telescoping of 4 mm or more showed healing disturbances, 11 late segmental collapses, and 2 nonunions, compared with 7 disturbances, 6 late segmental collapses, and 1 nonunion among 39 cases with screw gliding of 3 mm or less. The difference was significant (p less than 0.05, Mann-Whitney). Five early mechanical failures were excluded from this analysis.