Comparison of topically applied 0.2% glyceryl trinitrate ointment, incision and excision in the treatment of perianal thrombosis.

BACKGROUND AND AIMS: Topically applied 0.2% glyceryl trinitrate ointment to the anal region, incision and excision were compared in the treatment of perianal thrombosis, in order to establish which method is the best in terms of pain relief, number of recurrences and the appearance of anal skin tags. PATIENTS AND METHODS: A total of 150 patients were randomly divided into three groups of 50, each group being treated by one of the above-mentioned methods. The results of the treatment were evaluated during the first 4 days, after one month and after one year. RESULTS: A statistically significant reduction of pain was achieved by excision if compared with incision or conservative treatment with glyceryl trinitrate (p<0.001), and by conservative treatment with glyceryl trinitrate if compared with incision (p<0.01 on the 4th day of follow-up. Comparison of patients treated by the three different methods did not reveal any significant difference between these methods after one month (p>0.05). After one year the number of recurrences was significantly reduced after excision if compared with incision (p<0.05) or conservative treatment with glyceryl trinitrate (p<0.05). The number of patients without symptoms was significantly greater after excision if compared with incision or conservative treatment with glyceryl trinitrate (p<0.001). The number of patients with anal skin tags was significantly reduced in patients treated by excision if compared with incision (p<0.001) or glyceryl trinitrate treatment (p<0.001). CONCLUSION: Excision is a significantly better method of treatment of perianal thrombosis than incision or topically applied 0.2% glyceryl trinitrate ointment.

Peroxyacetic acid effect on the bacteriologic status of war wound.

In this study, the efficiency of peroxyacetic acid as a local antiseptic in war wound healing was investigated. Peroxyacetic acid was specially prepared for local application. The acidity was reduced from pH 2 to pH 5 using acetate buffer, the concentration was reduced to 0.2% and the use of sulfuric acid was avoided in the peroxyacetic acid preparation. Thirty-five patients with at least two similar wounds requiring daily dressing were included on a voluntary basis. Cranial wounds and wounds on the right side of the body were treated by peroxyacetic acid compresses, while other wounds were treated by the application of hypertonic NaCl solution. On day 12, the wounds treated by peroxyacetic acid (chi 2 = 52; df = 4, P < 0.001) were observed to be statistically significantly cleansed than the wounds treated conventionally. The use of peroxyacetic acid as a local antiseptic has not yet been described in the available literature. The possibilities and efficiency of peroxyacetic acid for this purpose, previously prepared for use in living tissue, are emphasized.

Hydraulic optimalization of surgical flow drainage in physical model.

In the present study, the flow in deep, closed wound with various types and position of drain was studied. A physical model of regular geometrical wound was designed to investigate the events occurring in the wound from the standpoint of hydraulics. Results of the study showed that the commonly used method of drain application could be improved. The results may also prove helpful for improvement of the existing drains and their more favorable positioning.

Primary malignant melanoma of the rectum: a case report.

The aim of the study was to describe the diagnostic procedure, indications for operation and operative result in a patient with primary malignant melanoma of the rectum. In the patient, hospitalized at the Department of Surgery, School of Medicine in Zagreb, a malignant melanoma of the rectum was diagnosed by rectoscopy and histology. Tumor staging was determined by endorectal ultrasonography. Operation was indicated for malignant disease with partial obstruction of the rectum. Since the tumor was locally inoperable, with liver metastases a palliative operative procedure (sigmoidal colostoma) was performed. The operative finding confirmed the tumor stage obtained by ultrasonography. The patient died 5 months after the operation due to widespread dissemination of the malignant disease. Thereby, the accuracy of preoperative tumor staging by ultrasonography was confirmed. We believe that, in view of its accuracy, endorectal ultrasonography can be used for tumor staging in patients with primary melanoma of the rectum. Therefore, expensive diagnostic imaging methods like CT and MRI are no longer necessary.

[Current approaches in surgical treatment of ulcerative colitis (reports of our results)]. / Suvremeni pristupi kirurskom lijecenju ulceroznog kolitisa (prikaz vlastitih rezultata).

The results of surgical treatment of ulcerative colitis in 19 patients in the period from 1989 to 1997 are presented. Of surgical techniques, in 17 patients a pouch was formed, namely, in six patients W pouch, in four patients S pouch, and in seven patients J pouch, while in two patients the pouch was not formed due to the incontinence of anal sphincter. In these patients the stool derivation was achieved by permanent terminal ileostomy. Fifteen patients were operated in elective program, while in four patients emergency surgery was indicated. In emergency surgery the first step was subtotal colectomy, with ileostomy and sigmoidostomy. In further treatment we introduced corticosteroid clyster in the opening of sigmoidostoma, with good results. The quality of life of persons with the pouch is higher compared to patients with permanent ileostomy. In patients who require surgical treatment of ulcerative colitis, the operation of forming an ileal pouch and anal anastomosis should be done.

[Humeral fractures with radial nerve injuries]. / Zlom nadlehtnice z poskodbo nervus radijalisa.

There are, predominantly, two methods in the operative treatment of a humerus's fracture accompanied by a lesion of a radial nerve, as discussed by the author in his paper. He points out that recently such traumas have become more frequent, and should be treated either by a reposition of fractured fragments by AO osteosynthesis, or by Kirschner's nail placed intramedullary (Hackethal's method). In all traumatized patients showing clinical signs of a radial nerve's lesion, this nerve must first be revised, intraoperatively well presented, and then a perineurolysis should be done. Finally, the nerve should be put in its correct anatomical position, on the muscle, or medially on the humerus. Following the surgery, a mobilization and rehabilitation should be done as soon as possible. In the postoperative follow-up, a callus formation should be monitored by X-ray, and re-innvervation monitored by electromyography.

[Perforation of idiopathic ulcer in the small intestine]. / Perforacija idiopatskega ulkusa na tankem crevesju.

The authors present the case of 51 year old woman admitted to surgical unit from dermatology because of symptoms of diffuse peritonitis urgent laparotomy revealed perforated ulcer of terminal ileum. Segmental resection of small bowel with end to end anastomosis was septic coli peritonitis performed, histologically with non-specific appearance. On 7th postoperative day the patient died. The cause of death was septic coli peritonitis with dehiscence of anastomosis.

[The preventive and therapeutic effect of peracetic acid on the development of surgical infection]. / Profilakticko i terapijsko djelovanje peroksioctene kiseline na razvoj kirurske infekcije.

The paper reports on the possibility of application of peracetic acid on live tissue by correcting those properties which presented the obstruction for its former application on live tissue. Using laboratory technique the degree of peracetic acid acidity was put to pH 5 and the concentration of 0.2% was determined by testing in vitro on the resistant hospital strains of Staphylococcus aureus and Pseudomonas aeruginosa. The prophylactic and therapeutic activity on artificially induced infection of wounds by above mentioned bacteria was investigated in experiments (rabbits n = 30). The prophylactic and therapeutical efficacy of peracetic acid of certain properties was proved by comparing it with the control group of wounds where physiological solution was used as a compress.

[Prevention of early postoperative hematoma with the use of elastic bandages. Its ultrasonic diagnosis and control]. / Prevencija ranih poslijeoperacijskih hematoma primjenom elasticnog zavoja. Njihova ultrazvucna dijagnostika i kontrola.

The authors stress out the importance of an application of elastic bandage for a prevention of the early postoperative hemathomas in traumatized patients, whose effect can be controlled by ultrasound. 58 patients were elaborated, of whom in 30 cases an elastic bandage was placed at the end of surgery, and 28 patients (control group) without dressing. In 8 patients of the control group, an existence of postoperative hemathomas was proved by ultrasound, while only in two cases with postoperative bandage a presence of such hemathoma could be discovered. Lesser number of postoperative hemathomas in patients with elastic bandage is statistically important (p less than 0.001). Obtained results indisputably point out the value of elastic bandage application in the course of first three postoperative days in traumatized patients.

[Osteosynthesis revision in war fractures]. / Osteosynthesenwechsel bei Kriegsfrakturen.

The results of early conversion of war fractures by the application of AO osteosynthesis in A group (n = 32) of the injured, were compared with B group (n = 187) of injured, treated definitely with external fixator. There were statistical evaluations and X-ray observations of healing in both groups, as well as the appearances of the most frequent complications such as: Pintract infection, osteitis, pseudoarthrosis and reoperation. Statistically less significant appearance of complications in A group during 2nd and 6th month (p < 0.001) was observed. In 12th month of observation, these differences statistically disappeared. Healing observed by X-ray in 2nd, 6th and 12th month of observation were no statistically significant differences between the two observed groups.

Effects of ozone on how well split-thickness skin grafts according to Thiersch take in war wounds. Results of prospective study.

In a prospective study on 35 wounded persons we examined the effects of ozone on how well split-thickness skin grafts took in war wounds. Each of the 35 wounded persons hat at least two similar gunshot wounds, one on the lower leg or forearm and the other on the upper leg or upper arm. During the first 10 days all wounds were treated with 10% NaCl water solution dressings until the moment when healthy granulations were observed. Thereafter, the defects were covered with split-thickness skin grafts according to Thiersch. For technical reasons we treated grafts on the lower leg and forearm with ozone following the usual scheme. Grafts on the upper leg or upper arm were treated in the conventional way and they served as a control group. The results obtained in the group followed up are presented by percentage of graft takes after 10 days and accordingly compared with the results obtained in the control group. There was a higher percentage of takes in ozone-treated split-thickness skin grafts. More than 74.3% of the split-thickness skin grafts treated with ozone had a take of more than 75% of the covered surface as apposed to only 40% of the grafts treated with the conventional method. The results in these two groups were compared with a chi square matched pair test. Difference in take of the skin grafts in these two groups was statistically significant at P < 0.01.

[Mathematical model of hydrodynamic flow in irrigation-suction drainage]. / Mathematisches Modell von Strömungsverhältnissen bei Spül-Saug-Drainagen.

The aim of this study was to evaluate the flow of fluid between closed drains in deep wounds and osteomyelitic and abscess cavities. For the purposes of this study we created a numerical wound model. This model had a symmetric geometrical shape and we simulated flow of fluid between the drains in four variants of distance between these drains. The results of this model showed that the distance often used between drains in clinical practice is not effective. Better drainage could be achieved by spacing the drains more. These results can be used for more functional and better drainage if drains are placed properly in osteomyelitic or wound cavities.

[Structural analysis of external fixators of bones and the anatomy of the olecranon process]. / Strukturalne analize vanjskih fiksatora kostiju i anatomske kukaste plocice za olecranon.

Shown is the structural analysis of the broken bone metal fixator and of the anatomic hooked metal sheet for olecranon, from the structural engineering point of view. The FE models are structurally examined using the ICES STRUDL system and the COMPUTERVISION for graphics simulations.

Metronidazole in the treatment of chronic radiation proctitis: clinical trial.

AIM: To evaluate the effectiveness of metronidazole in combination with corticosteroids in enema and mesalazine (5-aminosalicylic acid) in comparison with the same protocol without metronidazole in the treatment of chronic radiation proctitis. METHODS: Sixty patients with rectal bleeding and diarrhea were randomly divided into two groups. Patients in the first group were treated with metronidazole (3x400 mg orally per day), mesalazine (3x1 g orally per day), and betamethasone enema (once a day during 4 weeks). Patients in the second group were treated with mesalazine and betamethasone enema, but without metronidazole. The efficacy of metronidazole was assessed on the basis of rectal bleeding, diarrhea, and rectosigmoidoscopy findings in all patients. RESULTS: The incidence of rectal bleeding and mucosal ulcers was significantly lower in the metronidazole group, 4 weeks (p=0.009), 3 months (p=0.031), and 12 months (p=0.029) after therapy. There was also a significant decrease in diarrhea and edema in the metronidazole group, 4 weeks (p=0.044), 3 months (p=0.045), and 12 months (p=0.034) after treatment. CONCLUSION: Metronidazole in combination with mesalazine and betamethasone enemas successfully treats rectal bleeding and diarrhea in chronic radiation proctitis.