[Quality control of medical documentation of in-patients at the St. Stephen Municipal Hospital in Budapest]. / A fekvöbetegek orvosi dokumentációjának minöségellenörzö vizsgálata a FB1árosi Szent István Kórházban.

Within the frame of hospital quality control programme, the authors have investigated since 1997 the medical documentation concerning in-patients of St. Stephen Hospital Budapest. An assessment form of 26 items related to main elements of medical documentation has been created for the study. Choosing of both order of departments' succession and cases to be investigated took place at random. Evaluation was performed at a scala of 0-3 points, by a five-membered work-group; all members first carried out the qualifications independently of each other, and then they formed the final opinion together at common sessions. Investigation of 204 "first round" cases proved the feasibility of the applied method. As it turned out from the results, the quality of documentation showed statistically significant differences between departments of the hospital and the average standard of documentation could not be declared as satisfying at the period of basic survey. Deficiencies of documentation especially in respect of case history, disease course, personal data and informed consent have been found. On the other hand, registration of status on admission and final report got a relatively high average score-number. The authors call attention to the importance of ordinary control of medical documentation.

Idiopathic carpotarsal osteolysis with Bartter's syndrome. A case report and review of the literature.

Idiopathic carpotarsal osteolysis is 1 of the rare types of disappearing bone diseases characterized by painful limitation of movement and deformity of the wrist and tarsal joints, and associated with frequent episodes of joint inflammation and a radiographic appearance of osteolysis. Reported here is an 8-year-old girl with idiopathic carpotarsal osteolysis and Bartter's syndrome with significantly decreased re-absorption of chloride at distal renal tubules, low level of serum potassium, a metabolic alkalosis, and high levels of aldosterone and renin. Bartter's syndrome associated with idiopathic carpotarsal osteolysis has not been published previously. The typical plantar nodule in this patient confirmed the presence of fibromatosis with aggressive histologic signs in light and electron microscopic examination.

Limb saving surgery in bone tumours: experiences in Hungary.

A retrospective clinical review of 28 low- and 47 high-grade bone tumours, managed by limb salvage operations, was performed in the Orthopaedics Department of the Semmelweis University Medical School, Budapest. The mean follow-up period was 37.2 months. Ten bone tumours were classified as stage I/A, 18 as I/B, 16 as II/A and 31 as II/B. The overall 3 years survival rate was 97% in low-grade bone tumours, 84% in osteosarcomas and 50% in Ewing's sarcomas. Local recurrences were observed in 14%. Tumour prostheses were implanted in 25 patients (33%); 2 complications in this material were seen. In 50 patients resection and reconstruction with autografts or allografts were performed; 13 complications (26%) were registered in 9 patients. These results suggest that limb saving surgery is an acceptable method in selected cases of early recognized bone tumours which respond well to the chemotherapy.

Bone tumours in childhood.

The author gives a survey of literature on bone tumours in childhood and a comparison with his own work. Introducing four cases he concluded, that the survival rate of malignant bone tumours are increasing, the autologous bone transplantation seems to take priority against prosthesis in childhood, and the autologous bone transplantation is more reliable method, than the homologous one.

Osteotomy of the synostosis mass for the treatment of congenital radio-ulnar synostosis.

Our experience with the surgical treatment of radio-ulnar synostosis in the period from 1985 to 1992 is reviewed. Operative procedures were performed in eight patients with radio-ulnar synostosis. In five patients bilateral, and in three patients unilateral, synostosis was present. The results were better in patients in whom synostosis mass osteotomy perpendicular to the longitudinal axis of the forearm was performed. Usually, treatment attempts to achieve a neutral position for the forearm. This position is more suited to unilateral synostosis than to bilateral synostosis. Vascular and/or neurological complications did not arise during the operation or during the follow-up period. All patients were satisfied with the operative outcome.

[Results with endoprostheses and bone transplantation in surgery for bone tumors]. / Eredményeink endoprotézisekkel és csonttranszplantációval a csonttumorsebészetben.

Seventy six bone tumor patients were treated by limb salvage operations at the Orthopaedic Department of the Semmelweis Medical School in Budapest from 1981 through 1991. The bone defect was reconstructed with endoprostheses in 25 cases and with bone grafts in 51 cases. The mean follow-up period of 72 patients was 51 months (min. 12 months). There were local recurrences in 11% of the patients. Two complications occurred at the tumor endoprostheses, which functional rating were excellent or good in 75%. The most common complications at the bone grafting were infection (9.8%), fracture (11.8%), which did not influence the end result, and nonunion (9.8%) occurring often in homografts of resection-arthrodesis during the chemotherapy. This complications could be managed in all but two cases without loss of the limb. The bone grafts performed acceptable (excellent or good) functional result in 66% of the patients. Authors suggest reconstruction of the bone defect with bone grafting in cases of semimalignant and low malignant tumors, prefer, however, tumor endoprosthesis implantation in high malignant bone tumors which need chemotherapy.

Role of surgery in the prevention and correction of hip subluxation and dislocation in cerebral palsy.

Forty-three patients (80 hips) were available for clinical and radiological follow-up. These patients underwent adductor tenotomies separately or in combination with other procedures on the hip, with or without proximal femural correction. The range of abduction in all hips before surgery was 40 degrees or less, and in 54 hips combined with flexion-contracture (10 degrees-50 degrees).

Limb lengthening with simultaneous correction of the deformity.

In congenital malformation of the limbs the shortening of the extremity appears frequently together with its deformity. With Ilizarov's apparatus the limb may be lengthened simultaneously with the correction of the deformity. In spite of the fact that the use of the apparatus is rather complicated and complications are frequent, in 75 cases out of 102 excellent, in 23 good results were achieved. The various indications and results are demonstrated in 4 cases.

Limb lengthening operations.

Limb lengthening operations were first used at the beginning of this century, they were, however, performed more frequently only in the fifties. The various, continuously elongating devices have made possible a substantially greater lengthening than earlier. Wide-range investigations were begun with the various distraction devices and the results were examined in regard to the site of lengthening, the injury of the periosteal and endosteal vascular supply during the operation and the extent and rate of the lengthening. Detailed results of 224 lengthening operations performed in 191 patients are presented in Tables 1 to 8. Attention is called to the fact that the operation should be performed strictly individually, and the patients should be well prepared to the operation and followed carefully. The number of complications increases in direct ratio with the measure of lengthening, the end result is, however, influenced only by a minor part of the complications.

Tumor endoprostheses vs. bone grafts in bone tumor surgery: experiences in Hungary.

From 1981 through 1991, 76 bone tumor patients were treated by limb salvage operations at the Orthopaedic Department of the Semmelweis Medical University in Budapest. The bone defect was reconstructed with endoprostheses in 25 cases and with bone grafts in 51 cases. The mean follow-up period of 72 patients was 51 months (minimum 12 months). There were local recurrences in 11% of the patients. The functional rating of the tumor endoprostheses was "excellent" or "good" in 74%. Complications occurred in two cases. The most common complications with bone grafting were infection (9.8%), fracture (11.8%), which did not influence the end result, and nonunion (9.8%), which often occurred in homografts of resection-arthrodesis during chemotherapy. These complications were successfully managed without loss of the limb in all but two cases. The bone grafts were rated as functionally acceptable ("excellent" or "good") in 66% of the patients. The reconstruction of bone defect with bone grafting is suggested in cases of semimalignant and low malignant tumors; however, tumor endoprostheses implantation is preferred in high malignant tumors that need chemotherapy.

Surgical treatment of the hip in cerebral palsy.

Hips are affected generally in CP but in favourable cases we can prevent dislocation by adductor tenotomy performed in time (530 cases). Posterior transposition of the origins of the adductor muscles is performed if the patient walks with inwood rotated inferior extremities (105 cases). In the treatment of real subluxation and valgus deformity the open tenotomy of adductor muscles and femur osteotomy with derotation and varisation were used (180 cases). We accomplish open reduction in frank dislocation (35 cases). In such cases it is often necessary to shorten the femur. Also normal acetabulum is found in elder children.

[Limb lengthening with simultaneous correction of deformities]. / Végtaghosszabbítás egyidejü deformitás korrekcióval.

In congenital malformation of the limbs the shortening of the extremity appears frequently together with its deformity. With Ilizarov's apparatus the limb may be lengthened simultaneously with the correction of the deformity. In spite of the fact that the use of the apparatus is rather complicated and complications are frequent, in 75 cases out of 102 excellent, in 23 good results were achieved. The various indications and results are demonstrated in 7 cases.

[Spondylolysis and spondylolisthesis in the young]. / Fiatalkori spondylolysis és spondylolisthesis.

Authors think the early recognition of the spondylolysis and spondylolisthesis in young age important, as for the further life of the patients (sport, military service) adequate councels have to be given. In mild or more serious lumbago in adolescents, appearing mainly on load, other developmental anomalies, easy to be recognized, call attention to the presence of spondylolysis and spondylolisthesis. Considering the factors of risk the development of the disease and its tendency may be followed on Roentgenogram of exact projections.

Differential diagnostic problems in desmoid and fibrosarcoma.

On the basis of 10 patients treated at the Orthopaedic Clinic of the Semmelweis University Medical School, the histology, clinical symptoms, recurrence rate and principles of surgical treatment of the disease are discussed. Two further cases are described in detail in which initially a desmoid was diagnosed but later based on the clinica-history and the histological appearance of recurrences the diagnosis of a differentiated fibrosarcoma had to be established. An account of differential diagnostic criteria between desmoid and fibrosarcoma is given.

[Reoperations in the management of clubfoot]. / Reoperációk a dongaláb kezelésében.

The results of 118 operations for club-foot are assessed, of these 57 were reoperations. It is stated that the relapse is most often the consequence of the insufficient primary operation and the relapse and the residual deformity are the more serious the more insufficient was the primary operation. The severity of the deformation is defined first of all by the position of the calcaneus. In milder cases the soft tissue operation only may be successful, in the more severe cases bony operation (Evans' operation in this series of the authors) has also to be performed. After their own primary operations reoperation was in 24 per cent necessary. The number of the bony operations was half of the soft tissue operations. The second and rarer case of the relapses was that the foot proved to be even originally rigid, not redressable, "rebel". First of all in these cases may multiple reoperations be necessary and the transposition of the anterior tibial muscle is also useful. The club-foot with a major dominant adduction deformity of the tarsometatarsal joint is thought to be a separate entity and it is corrected with tarsometatarsal capsulotomies or serial metatarsal osteotomies.

Reoperation in treatment of clubfoot.

We evaluated 118 operations (including 57 reoperations) on clubfeet. We concluded that relapse is most often the consequence of insufficient primary surgery, and the less sufficient the intervention, the more severe the relapse or residual deformity. The severity of deformity is determined and shown, first of all, by the position of calcaneum. In milder cases, soft tissue operation can prove useful, whereas more severe cases require bony intervention as well. The second, rarer cause of relapse was the fact that the foot was originally stiff and nonreducible. These feet may need multiple reoperations.

[Results following total laryngectomy at the Budapest Clinic of Head-Neck surgery]. / Die Ergebnisse nach Kehlkopftotalexstirpation an der Budapester Klinik für Kopf-Hals-Chirurgie.

The data on 356 laryngectomies during a 12-year period were analysed retrospectively. The operations were divided into three groups: group I, laryngectomy alone; group II, laryngectomy and secondary neck dissection; group III, one-stage laryngectomy and radical neck dissection. Most patients had advanced disease (stage III and IV: 54.5% and 23.9%, respectively). Supraglottic and glotto-supraglottic tumours were commonest (39.6% and 36.8%, respectively). The results of palpation, fine-needle biopsy and histology of the lymph nodes are compared. The mean survival time for the three groups was 53.4, 42.7 and 29.8 months, respectively, and the 5-year survival rates were 61.9%, 32.0% and 30.8%, respectively.