Experimental and clinical study in the treatment of sigmoid volvulus.

The aim of the study was to introduce an alternative surgical procedure for the treatment of primary volvuius of the sigmoid colon. Sigmoid colon plication was performed in 42 dogs, and afterwards in six patients. The procedure consists of systematic plaiting the sigmoid colon wall with interrupted serosubmucosal 3/0 Vicryl sutures along the whole circumference, except on the mesenteric border. Five parallel circular folds were done in dogs, and 20-30 folds in patients, with appropriate bowel length reduction. In the experimental study, dogs were randomly divided into three experimental and one control group of 14 animals each. The group 1 dogs were sacrificed on day 8, group 2 dogs on day 15, and group 3 and control group dogs on day 30 postoperatively. On exploration, sigmold colon adhesions were found in 6 (14.3%) animals. Intestinal wall and lumen were normal. In the clinical study, six patients with sigmoid volvulus were operated on within 6-8 hours of admission. A viable colon was a prerequisite for the sigmoid plication procedure. The operating time was 60-90 minutes. Recovery was uneventful, with average hospitalization 11 (range 8-15) days. No volvulus recurrence was recorded during the three-year follow-up. Based on our experimental and clinical data, we believe that the plication procedure could be appropriate treatment in some selected patients with volvulus of the sigmold colon.

Flail chest stabilization with palacos prosthesis.

The approach and management of patients with post-traumatic flail chest continue to be a controversial issue. A method of surgical stabilization of flail chest using palacos, a cement-like material is described. A ready-made prosthesis is placed on the external side of the ribs vertically bridging the flailed chest segment, and fixed to the first upper and first lower intact rib as well as to the mobile segments of the affected ribs. Surgical fixation was carried out in 56 patients. The results proved the method to be a simple and effective procedure.

[Pancreatic resection and hypothermic peritoneal irrigation in the treatment of patients with necrotizing pancreatitis]. / Pankreaticna resekcija i hipotermicna peritonealna irigacija u lijecenju bolesnika s nekrotizirajucim pankreatitisom.

Mortality of non-operated patients suffering from necrotizing pancreatitis is very high, while at those operated is considerably less but not satisfactory. Because of in 1976 we have managed our own modified treatment which includes surgical removal of all necrotic tissue followed by the hypothermic continuous peritoneal lavage-drainage procedure for evacuation of residual devitalized dead tissue and elimination biologically active substances. Using this curative method, we succeeded to reduce mortality rate to 26 percent.

Patch reconstruction of hemidiaphragm agenesis by the polypropylene mesh prosthesis.

We present a case of a middle-aged woman with right hemidiaphragm agenesis, which became evident after a blunt injury. Ultrasound, X-ray, and computed tomography confirmed the diagnosis, and the diaphragmatic congenital defect was closed by insertion of a polypropylene mesh prosthesis.

[Pancreatic pseudocysts and cysts treated during the last 10 years]. / Pseudociste i ciste pankreasa lijecene u zadnjem desetogodisnjem razdoblju

In the period from 1965 to 1975, in our department were treated ten pseudocysts and cysts of the pancreas. All of them, except two, were operated. Operation was performed in eight patients (external drainage 2 cases, internal drainage 5 cases and excision in 1 selected case), and in two patients occured spontaneous regression. Diagnostic problems, review of treatment and postoperative results were taken into consideration. The most satisfactory results of treatment of uncomplicated pseudocysts have been obtained by internal drainage.