Primary retroperitoneal mucinous cystadenocarcinoma. A case report and review of the literature.

A case of a primary retroperitoneal mucinous cystadenocarcinoma in a 38-year-old female is presented. The literature concerning primary retroperitoneal cystadenocarcinomas is reviewed and it is concluded that close postoperative follow-up is necessary.

[Immediate postoperative course and late results after inguinal herniotomy in children]. / Det umiddelbare postoperative forløb og senresultater efter ingvinal herniotomi hos børn.

Three hundred consecutive children less than 18 years of age were treated for inguinal hernia by the same surgeon from 1970 to 1985. The surgical procedure was the same in all cases, namely ligation of the tunica vaginalis and extirpation of the hernial sac. Hernioplasty was not performed. Twenty patients were excluded. Seven patients had a recurrent hernia, i.e. a cumulative recurrence rate of 2.4 per cent after a median follow up of 12 years (range 5-19). Five of seven (71%) recurred within five years after operation, while only two recurred from the fifth to the 15th year. We conclude that recurrence five years after operation is seldom and the recurrence rate in our work is acceptable compared with other publications.

[Vasovasostomy in previously sterilized men. The functional result]. / Vasovasostomi hos tidligere steriliserede maend. Det funktionelle resultat.

A simple method of vasovasostomy by a macroscopic technique using a stent placed in the ductus deferens lumen is evaluated. In the reported 88 cases the patency is 74% and the pregnancy-rate is 31%. This type of vasovasostomy can be performed by all surgeons. The results are acceptable and can be compared to more advanced microsurgical methods.

PIP: A simple method of vasovasostomy by a macroscopic technique using a stent placed in the ductus deferens lumen was evaluated retrospectively at the urological department of Hvidovre Hospital, Copenhagen, Denmark, during 1978-1990. 88 operations were performed on 86 sterilized men. The average age was 38 years and the average time that elapsed from the original sterilization was 5.5 years. All patients were invited to undergo postoperative sperm analysis, and 71 (80.7%) answered a questionnaire about postoperative pregnancies. In all, postoperative sperm analysis responses were obtained from 61 patients (69.3%), and the analysis was performed an average of 7 months after the operation. In 52 cases (59.1%) information was obtained both about the eventual postoperative pregnancies and the results of the sperm analysis. In the reported 88 cases the patency was 74%, and 22 (31%) of the partners among these 71 patients became pregnant. Among 30 patients with severely reduced or reduced sperm quality there were 13 pregnancies (43%), while among 8 patients with normal sperm quality there were 2 pregnancies (25%). This indicates that there is no association between pregnancy and sperm quality. The chance of pregnancy was not related to the time period from sterilization to refertilization. In 10 patients the sperm analysis was repeated at a later time point, and in 5 patients the quality improved spontaneously. In 2 cases when refertilization was attempted again because of azoospermia, sperm analysis still showed continued azoospermia after the reoperation. This type of vasovasostomy can be performed by all surgeons. The results are acceptable and can be compared to advanced microsurgical methods.

[Pelvic floor reconstruction with a Prolene net in enterocele]. / Baekkenbundsrekonstruktion ved enterocele med Prolene-net.

Nine women, all of whom were multiparae with large symptom-producing enteroceles and all of whom had been submitted to operation by other methods without permanent effect, were submitted to total pelvic floor reconstruction with non-absorbable mesh. No complications of this intervention were observed and the discomfort due to enterocele disappeared in all of the patients during the follow-up period which averaged 11 months (range 1-24 months). The method is recommended in the treatment of large enteroceles where other forms of surgical treatment have failed.

[Discontinuing postoperative wound dressings]. / Seponering af postoperativ sårforbinding.

The influence of postoperative dressings on wound healing was investigated. Clean and potentially contaminated operation wounds were subdivided at random into a group with dressings until the sutures were removed or a group with dressings during the first 24 hours after operation only. No significant differences in the incidences of wound infections were observed in the two groups. The majority of the patients treated with dressings for a brief period only did not desire prolonged periods with dressings after possible future operations.

Recurrences after inguinal herniotomy in children. Long time follow-up.

Three hundred consecutive children all under 18 years of age were treated for inguinal hernia by herniotomy by the same surgeon from 1970-1985. Hernioplasty was not performed. Seven patients had a recurrent hernia, i.e., a cumulative recurrence rate of three per cent after a median follow-up of 12 years (range 5-19). Five of seven (71%) recurred within five years after the operation, while only two recurred from the 5th to the 15th year. Long term follow-up is necessary to assess incidence of recurrence after inguinal herniotomy in children.

Aerococcus-like organism, a newly recognized potential urinary tract pathogen.

During the last 10 to 15 years, Aerococcus-like organisms have been isolated from urinary tract specimens from hospitalized patients at Bispebjerg Hospital, Copenhagen, Denmark, with signs of urinary tract infection, and a single strain has been deposited at the National Collection of Type Cultures (NCTC 12142). An additional 63 isolates from the urine specimens of as many patients with suspected urinary tract infection have been identified from seven departments of clinical microbiology in Denmark. Clinical information indicates that this organism may be involved in urinary tract infection. These strains and ten previously collected strains, two of which were from blood cultures, were characterized phenotypically. By comparing the results with data on other gram-positive, catalase-negative cocci or coccobacillary organisms, the identified organisms seem to represent a separate taxon.

Recurrent benign retroperitoneal lipoma.

A case of a rare recurrent lipoma originating from the perirenal fat is reported. Onset of symptoms (abdominal pain, weight loss, appetite loss, abdominal swelling, nausea, constipation) is late and the treatment is surgical, but postoperative radiation or chemotherapy may be indicated. Ultrasound, CT and NMR scans, pyelograms and barium enemas are the most important diagnostic investigations. Follow-up in these patients is important.

Hypoxaemia and myocardial ischaemia during and after endoscopic cholangiopancreatography: call for further studies.

Sixteen non-selected patients undergoing endoscopic cholangiopancreatography (ERCP) after diazepam premedication were monitored for oxygen saturation (SpO2) with a pulse oximeter and for myocardial ischaemia with a Holter tape recorder from 2 h before ERCP to 6 h after the procedure. One patient was excluded from data analysis because of oxygen therapy. Oxygen saturation was significantly decreased (p less than 0.05) both during endoscopy and in the postendoscopy recovery period. Heart rate was significantly increased (p less than 0.05) both during and after the procedure. ST depression occurred in no patients before endoscopy, in 10 patients during, and in no patients after endoscopy. Concurrent ischaemia and episodic hypoxaemia were found in 5 patients, isolated ischaemia in 7 patients, and isolated episodic hypoxaemia in 13 patients. Concurrent ischaemia and tachycardia were found in 10 patients, ischaemia without tachycardia in no patients, and isolated tachycardia in 1 patient. There was no significant correlation between diazepam dose and SpO2 during endoscopy. These results suggest tachycardia to be more important than hypoxaemia in the pathogenesis of myocardial ischaemia during upper gastrointestinal endoscopy. Cardioprotective measures other than oxygen therapy should soon be evaluated before the implications of the new standards of care in endoscopy have become generally adopted.

Effect of epidural blockade and oxygen therapy on changes in subcutaneous oxygen tension after abdominal surgery.

The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous oxygen tension, arterial oxygen saturation, heart rate, and skin temperature on the day after operation, and arterial blood for gas analysis was drawn every 15 min during the study. A fluid challenge (10 ml saline/kg body wt) did not alter any of the measured values. The epidural blockade did not change any of the measured values. Oxygen therapy before epidural blockade increased median subcutaneous oxygen tension from 60 to 71 mmHg (P < 0.02) and, after epidural blockade, from 64 to 71 mmHg (P < 0.02) Time to reach steady state in subcutaneous oxygen tension with oxygen therapy was 30 (15-55) min without epidural blockade and 15 (10-20) min with blockade (P < 0.03). In conclusion, epidural local anesthetic blockade did not increase subcutaneous oxygen tension with or without oxygen therapy after elective uncomplicated major abdominal surgery.

Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy.

In a double-blind, randomized study, 32 patients scheduled for elective inguinal herniotomy under general anaesthesia received subcutaneous infiltration with 40 ml ropivacaine 2.5 mg/ml or bupivacaine. Postoperative pain intensity was assessed repeatedly for 24 hours at rest, during cough and movement on a visual analogue scale (VAS) and by means of pressure algometry. No differences between pain intensities or wound tenderness were found between the groups. The demand for analgesics was similar in the two groups. We conclude that incisional ropivacaine is as effective as bupivacaine in the management of post-herniotomy pain.

Need for surgical wound dressing.

The need for dressings on clean and clean contaminated surgical wounds was investigated. A total of 1202 patients with 1202 clean or clean contaminated surgical wounds were randomized into two groups: 633 wounds were covered by dressings up until the time of suture removal, and 569 wounds were treated without dressings after the first postoperative day. In the group characterized by long dressing time, the rate of postoperative wound infections was 4.9 per cent. The rate was 4.7 per cent in the group represented by short dressing time. Using short dressing time not only reduces the number of nursing hours but also limits the need for costly dressing material. In addition, both wound observation and patients' personal hygiene are made easier.