A new algorithm for the management of diabetic foot ulcer: recommendations from Central and Eastern Europe.

There is wide regional variation in clinical practice and access to treatment for patients with diabetic foot ulcer (DFU) from countries in Central and Eastern Europe (CEE). A treatment algorithm that reflects current treatment practices while providing a common framework may facilitate best practice in DFU management and improve outcomes across the CEE region. Following a series of regional advisory board meetings with experts from Poland, the Czech Republic, Hungary and Croatia, we present consensus recommendations for the management of DFU and outline the key features of a unified algorithm for dissemination and use as a quick tool in clinical practice in CEE. The algorithm should be accessible to specialists as well as non-specialist clinicians and should incorporate: patient screening; checkpoints for assessment and referral; triggers of treatment change; and strategies for infection control, wound bed preparation and offloading. Among adjunctive treatments in DFU, there is a clear role for topical oxygen therapy, which can be used concomitantly with most existing treatment regimens in hard-to-heal wounds following standard of care. Countries from CEE face a number of challenges in the management of DFU. It is hoped that such an algorithm will help standardise the approach to DFU management and overcome some of these challenges. Ultimately, a regionwide treatment algorithm in CEE has the potential to improve clinical outcomes and save limbs.

Introduction of the microwave thermoablation (MWA) method to hemorrhoid surgery / A microwave termoablációs (MWA) módszer bevezetése az aranyeresség sebészetébe

Abstract: In addition to the traditional surgical options for hemorrhoid disease, newer treatment methods are evolving along the principle of reducing the burden on patients and providing similar or better healing. Thermo-based systems achieve the desired effect with less physical destruction. In this paper, we discuss the results of hemorrhoid surgery performed with laser and microwave devices. Patients and methods: We compare the results of 26 operations done with laser fibers and 14 operations using microwave rigid antennas. Results: In both groups, the average complaint-free period developed within 2 weeks, no significant difference was found between the two methods. Discussion: As we are always looking for new methods and surgical solutions, an option we are testing now indicates that thermal treatment can provide a quick and complete cure without the need for complicated safety requirements of laser interventions.

[Micro and mini-cholecystectomies in the 21st century]. / Micro- és minicholecystectomiák a XXI. században.

INTRODUCTION: Today the removal of the gallbladder is the safest, the most effective and widely recommended treatment for gallstone disease. Three essential methods are used for the removal of the gallbladder: standard open cholecystectomy, laparoscopic cholecystectomy and minicholecystectomy. Traditionally, the surgical community has resisted accepting minicholecystectomy. AIM: It is the Author's objective to illustrate the advantages and disadvantages of laparoscopic and microlaparotomy cholecystectomy. METHODS: The 2400 unselected patients who were operated with micro- and minicholecystectomy by them and a review of the relevant data of laparoscopic and standard minicholecystectomies permit some inferences to be made about the validity of microlaparotomy cholecystectomy. CONCLUSIONS: Main outcome measures regarding to mortality (0.12%), common bile duct injuries (0.08%), conversion an incision longer than 8 cm (0.29%) and syncronical choledocholithotomy (5.5%) as well as complete cholecystectomy (98.1%) indicate that micro- and minilaparotomy cholecystectomy with suitable technique and equipment are safe, less expensive choice either than the laparoscopic or the standard open cholecystectomy.

[Experiences with endoscopic thoracic sympathectomy]. / Tapasztalataink endoszkóposan végzett thoracalis sympathectomiával.

PATIENTS AND METHOD: Thoracic sympathectomy using thoracoscopy was performed in 38 cases on 35 patients from January 01. 1996, till December 31. 2000. In 3 cases bilateral sympathectomy was carried out. The youngest patient was 18, the oldest was 76 years old, the average age was 42 years. The indications for surgery were Raynaud syndrome, causalgia, post-traumatic sympathetic dystrophy, thoracic outlet syndrome combined with vasospastic syndrome, Buerger syndrome, obliteration of digital arteries, embolism and hyperhidrosis. This method was chosen if conservative therapy was unsuccessful. Laparoscopic instruments are particularly suitable for minimal invasive interventions. RESULTS: Authors describe their operative technique whereby the postoperative pain and also the duration of hospitalisation can be reduced, and the cosmetic result can be improved. In two cases conversion was the only choice due to pleural adhesions. Pneumothorax occurred in two cases, haemothorax in one case and transient intercostal neuralgy was seen in 3 cases. In four cases sympathetic activity returned during the follow up. Ceasing the sympathetic innervation dilates the arterioles of the skin, and the temperature of the skin increases. During follow-up the complaints of the patients improved significantly, the progression became slower and clear improvement was found with instrumental investigations. CONCLUSION: This method can be recommended to every institute where the conditions for traditional laparoscopic surgery are given and staff is experienced in thoracotomy.

[The use of ROMICRO set in plastic surgery]. / Romicro-szett alkalmazása a plasztikai sebészetben.

More than thousand plastic operations were performed in our departments with ROMICRO-set during the last ten years. First we applied it for reconstructive and aesthetic augmentation of the breast. Thereafter, we developed new technique for gynecomastia and reconstruction of diastasis of the m. rectus abdominis sheath. According to our experience, the ROMICRO-set is a useful tool in plastic surgery. The ROMICRO-set can be used through a small incision to achieve three dimensional views with excellent exposure and lighting.

[Left-sided gallbladder]. / Baloldali epehólyag.

Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are almost always situated under the left lobe of the liver between the IV and III segments or on the III segment to the left of the falciform ligament. One left positioned gallbladder was found in a consecutive series of 2536 patients undergoing microlaparotomy cholecystectomy for symptomatic gallstone disease in the "Moritz Kaposi" Teaching Hospital between 1990 and 2000, a prevalence of 0.04 per cent. Despite of the abnormal position of the gallbladder, the biliary pain experienced by the patient was on the right side. Preoperative diagnosis of this anomaly was not made in this patient despite preoperative sonography. The cystic duct may open in the common hepatic duct either side. In this anomaly safe microlaparotomy cholecystectomy or laparoscopic cholecystectomy can be performed.