Radical surgical therapy of abdominal cystic hydatid disease: factors of recurrence.

A series of 74 consecutive patients (48 women, 26 men) were operated for abdominal hydatid disease between June 1949 and December 1995. The patients ranged in age from 15 to 81 years (median 49 years). In 69 cases only the liver was affected; two patients had concomitant extrahepatic disease (one spleen, one spleen and lung), and 3 had cysts in the spleen only. Cysts were multiple in 11 patients and calcified in 24. Conservative surgical procedures were used for 22 cysts in 20 patients [open partial (n = 3), open total (n = 6), closed total cystectomy (n = 9), marsupialization (n = 2), drainage (n = 2)] and radical surgical procedures for 72 cysts in 54 patients [pericystectomy (n = 41), wedge liver resection or hemihepatectomy (n = 25), splenectomy (n = 5), radical resection of a lung cyst (n = 1)]. Altogether 37 patients (50%) were given perioperative antihelmintic chemotherapy with mebendazole (18 patients) or albendazole (19 patients). Operative mortality rates were 5.0% after conservative surgery and 1.8% after radical surgery. Morbidity rates were 25.0% following conservative surgery and 24.1% following radical surgery. Antihelmintic therapy was well tolerated by all but five patients. All side effects were entirely reversible. Among the 74 patients, 60 (81.0%) were available for long-term follow-up (median 7.2 years; range 2.0-47.0 years). Recurrence of disease was seen in 9 of 60 patients at an interval of 3 months to 20 years from the first operation. The rate of recurrence was significantly lower after radical surgical procedures (p = 0.03) and after closed removal of the cyst (p = 0.04).

[The influence of different therapeutic approaches on the survival of elderly burn patients]. / Behandlungsergebnisse von Brandverletzungen im Alter und ihre Beeinflussung durch intensivtherapeutische Massnahmen.

The present study analyzes the outcome of 51 patients aged more than 65 years, who were admitted between 1993 and 1997 to a specific burns unit with the possibility of intensive care medicine including respirator therapy and hemofiltration. The results were compared to an historical control group treated between 1980 and 1990. The overall survival rate was 54 %. Analyzing the patients' mortality, an increase in the number of nurses, improvement of enteral nutrition and wound monitoring had more influence on the survival rates than respirator therapy, hemofiltration and catecholamines. This is in contrast to our experience with younger individuals. The positive influence of intensive care on survival was restricted only to a small number of cases. The group of patients who died on the intensive care unit showed a relatively long median survival time of 24 days. Septic multiorgan failure was the main cause of death.