[Comparison of open and laparoscopic appendectomy]. / Usporedba otvorene i laparoskopske apendektomije.

The first laparoscopic appendectomy was performed by Senn in 1982. Since then, the dilemmas about the validity of this operation in relation to open operation have persisted. Many authors presented the technique modifications and results that are very different. The retrospective results, cost, duration of hospital stay and postoperative recovery analyses for fifty patients in each group were done in this study. Laparoscopic operations were done by "two-handed" technique and in different ways of appendix and mesoappendix closing and cutting. Endoscopic linear cutters were used in the second part of the study. When comparing parameters, laparoscopic operation in relation to open operation is equally safe; quicker; with less postoperative pain; with less wound infections rate; with shorter hospital stay; with less staff time involved; with faster recovery and return to work; more expensive; with better cosmetic effect. In conclusion, laparoscopic appendectomy is better, although more expensive, than open operation, so it should be recommended.

The sigmoidorectal pouch (Mainz pouch II).

A sigmoidorectal pouch was constructed in 20 patients (18 with invasive bladder cancer, 2 with complete urethral destruction with multiple vesicovaginal fistulas). The rectal-dynamic studies showed that by detubularization and reconfiguration of the sigmoid colon and rectum, we obtained a low-pressure reservoir, with the high-pressure contractions eliminated. Preoperatively, the basal rectum pressure was 21.4 cm H2O; rectum contractions reached a mean of 27.6 cm H2O (maximum 48 cm H2). Postoperatively (9-36 months) the mean basal pressure of the pouch was 19.3 cm H2O (p > 0.05; t test comparison with the preoperative value), with a mean contraction value of 19.1 cm H2O (p < 0.05). All the patients experienced continence day and night with a pouch emptying frequency of four times during the day and once at night, after 9 months. By fixing the pouch to the promontory or psoas muscle, without compromising the blood supply to the pouch, the risk of ureteral kinking and upper urinary tract dilatation were considerably decreased. The price to be paid for almost perfect continence was hyperchloremic acidosis in most patients.

Ultrasonically guided percutaneous fine needle aspiration biopsy of the hepatic and pancreatic focal lesions: accuracy of cytology in the diagnosis of malignancy.

Ultrasonically guided percutaneous fine-needle aspiration biopsies were carried out on 153 patients with focal liver and pancreatic lesions, and were subsequently evaluated cytologically. A correct diagnosis of malignancy was made in 66 of 74 patients with proven hepatic malignancy, and in 38 of 41 patients with proven pancreatic malignancy, showing an overall accuracy of 92% and 94%, respectively. The specificity of the procedure was 100%. Ultrasonically guided fine-needle aspiration biopsy followed by cytological examination appears indispensable in diagnosis and differentiation between benign and malignant hepatic and pancreatic focal lesions.

Production of prostaglandin E by squamous carcinoma of the head and neck and adenocarcinoma of gastrointestinal tissue.

The production of prostaglandin E ex vivo was studied in samples of 31 squamous cell carcinomas of the head and neck (SCCHN) and 12 adenocarcinomas of gastrointestinal tract (ACGI). As a control, the PGE production was measured in 22 samples of noninvolved mucosa in patients with SCCHN and 12 samples of gastrointestinal mucosas. The mean PGE production by SCCHN was significantly higher than in normal mucosa. Furthermore, the PGE production by tumors which recurred or spread to regional lymph node within 18 months after surgery was higher than in tumors which did not recur within that interval. Also, production of PGE by noninvolved mucosa was significantly higher in patients in which tumor recurred after surgery than in patients which were tumor free. On the other hand, the mean production of PGE by ACGI was not different from that of normal mucosa. These data show that determination of PGE production might have prognostic significance in SCCHN.

Amoebic liver abscess: ultrasonographic characteristics and results of different therapeutic approaches.

This prospective study was carried out on 33 patients with clinically, serologically and ultrasonographically confirmed amoebic liver abscess. All patients were randomly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage. Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape, usually hypoechogenic content with specific dorsal sonic enhancement, and in the majority of cases, location near liver capsule. Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment. The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses.

[Factors influencing physiologic pressure variations of the lower esophageal sphincter in healthy probands]. / Untersuchung von Faktoren mit Einfluss auf physiologische Druckschwankungen des unteren Osophagussphinkters in gesunden Probanden.

Manometric characteristics of lower esophageal sphincter (LES) in 59 healthy persons have been investigated. The aim of the investigation was to find out possible physiological changes of LES pressures considering posture, part of the day, maximal inspiration and expiration, empty or partially full stomach and abdominal compression. It has been proved that the minimal value of lower esophageal sphincter pressure in all the investigated patients was 1.77 kPA (13.3 mm Hg) while the maximal one was 4.53 kPa (34.0 mm Hg). The absolute difference between the lowest and the highest measured lower esophageal sphincter pressure was 1.43 kPa (10.77 mm Hg). The mean value of all pressures was 2.99 kPa (22.4 mm Hg). It seems that the posture during pressure measuring is irrelevant. The pressure does not vary more significantly considering neither the time of the day nor any exertion of the examinee.

Variations of ultrasonic anatomy of the hepatic veins within the human liver.

The aim of this study was to investigate various physiological variations of the hepatic veins within the liver of the 60 healthy subjects. All participants required physical examinations, different laboratory tests and upper abdominal ultrasonogram--all completely normal. Demonstration of the hepatic veins have been performed on sector real-time systems. The results clearly demonstrated that the physiological variations of the hepatic veins are very common. Ultrasonography obviously represents a diagnostic method of choice in the evaluation of anatomy of the hepatic venous system.

[The value of systematic monitoring of oxygen consumption in the diagnosis and therapy of septic shock]. / Vrijednost pracenja sistemske potrosnje kisika u dijagnostici i terapiji septickog soka.

In 31 patients with sepsis and multiple organic dysfunction, changes in the systemic oxygen consumption (VO2) during reanimation were observed in order to discover more objective indicators of the course and prognosis of the disease. In a prospective randomized study, 21 live (Group 1) and 11 dead patients (Group 2) were included. The investigation was based upon the application of the invasive tracing of oxygen hemodynamics and transport. The findings of the initially hypovolemic status were compared with those of the stabile normovolemic status obtained by the application of infusions and the blood volume substitute. In the early phase of the disease there were no significant differences in the clinical finding of the circulatory shock and the volume deficit of the circulated blood between these two groups of patients. Group 1 patients had lower values of the cardiac index (CI) and the systemic oxygen transport (DO2). In them there was a greater frequency of acute organic insufficiency, especially pulmonal, renal and hepatal. In the initial status VO2 decreased. In the normovolemic status of Group 1, a significant VO2 was found, while in Group 2 in spite of a DO2 increase and hemodynamics improvement, a more significant VO2 increase was not obtained. As VO2 is an objective indicator of oxidative metabolic reactions of the organism and the circulatory system, the authors maintain that by the VO2 tracing, a better insight into the seriousness and course of the disease is obtained, and that an inadequate VO2 finding during the therapeutic treatment requires a revision of the treatment.

[Diverticula of the jejunum as a diagnostic and therapeutic problem]. / Divertikuli jejunuma kao dijagnosticki i terapijski problem.

Five patients with jejenal diverticuli verifed by X-ray were discussed. Four of these patients under-went surgery because of the size of the diverticuli and due to their associating symptoms. In the fifth patient, more conservative therapy has prooved this far to be successful. With the four who underwent surgery, the diverticuli were totally resected and sutured at their bases. In one of the operated cases the intestinal lumen was made too narrow by resuturing the neck of the diverticulum (which was 2 cm in diameter). A reoperation in which the lumen would be widened was deemed necessary so as to promote normal passage of the intestinal contents. Postoperative control checkups showed that all five patients were relieved of the symptoms they had for years prior to their treatment. The X-ray finding were decisive in makings the diagnosis, and the presenting symptoms were indicative of surgery.