[Employment of prolene net in ventral hernia]. / Anvendelse af prolene-net ved ventralhernier.

Patching with prolene net in cases of ventral hernia where it is not possible to close the defect in the abdominal wall with the patient's own tissue has been employed since 1979 in several departments for plastic surgery. Our clinical experience from 1979 to 1985 in 55 patients submitted to this form of operation shows that this is an employable method with few peroperative and postoperative complications and with satisfactory results over a prolonged period. Satisfactory results have been obtained, in particular, in patients with chronic bronchitis and obstructive pulmonary disease and several previous herniotomies. Introduction of the prolene net strengthens the weak tissues and permits closure without tension because the net acts as a substitute for the previously destroyed tissue. The prolene net does not reduce the intraperitoneal volume postoperatively. The prolene net causes a suitably slight foreign-body reaction and, in the course of six weeks, it is permeated by fibroblasts and converted to a fibrous plate. If intra-abdominal operations should prove necessary at a later date, the net may be divided as part of the abdominal wall.

Mustard gas: clinical, toxicological, and mutagenic aspects based on modern experience.

Based on a study of the literature and our own experience treating fisherman poisoned by mustard gas, this article outlines the clinical effects, and toxicological and mutagenic properties of the agent. Mustards are very persistent chemical agents that easily penetrate clothing. Mustard gas usually causes clinical symptoms after the liquid penetrates the skin or the vapor is inhaled. Skin lesions are similar to first- or second-degree burns and usually heal spontaneously in 4 to 6 weeks. Eye symptoms are photophobia and reduced vision. Following inhalation of the agent, pulmonary edema and long-term dyspnea may be seen. As mustard gas is an alkylating substance, it is conceivable that the risk of developing cancer may be increased, as observed in people who were involved with the production of mustard gas and in animals exposed to the gas. Also, transient significantly increased sister chromatid exchange rates have been found in fishermen exposed to mustard gas. Patients exposed to mustard gas must be treated immediately after exposure. Treatment should consist of cleaning of the exposed skin and clothes with an antigas powder and water and soap. The skin lesions should be treated as burns. Eye lesions and respiratory problems should be treated symptomatically.

Bronchial carcinoid tumours. A clinicopathologic study of 82 cases.

A clinical and "blind" histologic review of 82 cases of bronchial carcinoid tumour is presented. The malignant potential of the tumours was only partly predictable from their histologic appearance. Histologically 65 of the tumours were typical benign carcinoids. Regional metastases were found at operation in two of these patients. Fatal carcinoid syndrome with regional and distant metastases appeared in two patients about 1 and 3 years postoperatively. One of the patients with regional metastases at operation is clinically free from carcinoid 12 years later. Malignancy was histologically suspected in 17 cases, in ten of which regional metastases were found at operation. Three of these ten patients are alive 6 to 16 years postoperatively, but two without regional metastases at operation died of local recurrence and distant metastases after 3 to 4 years. Carcinoid syndrome was not seen in these 17 patients. There was one peroperative death. Altogether ten patients (12%) died of recurrence. Among the cases judged at the "blind" histologic review to be suspectedly malignant, the corresponding figure was 50%. For typical carcinoids, conservative resection, including lymph-node metastases, is the treatment of choice. Wedge or sleeve resection with or without pulmonary resection were employed in ten cases. Suspectedly malignant carcinoid tumours may require more extensive surgery.

Superior vena caval syndrome in benign mediastinal goitre.

The superior vena caval syndrome is the clinical condition which develops at too high a pressure in the superior vena cava and the afferent veins. Its aetiology has changed in the course of time, but at present 97% of the cases are due to intrathoracic malignancy. An extremely rare aetiological factor is substernal and intrathoracic goitre. In such cases the syndrome is often of fairly acute onset due to haemorrhage in the goitre, and as a rule it is associated with dyspnoea and dysphagia. The treatment is always operative.

Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment of the so-called middle lobe syndrome.

Isolated atelectasis of the middle lobe has been known for many years as the "middle lobe syndrome". Several clinical studies have shown that it may bae caused by malignant tumours. A 10-year study of 135 patients with isolated middle lobe atelectasis is presented. Fifty-eight patients (43%) had malignant tumours. Of 38 who had a thoracotomy, lung resection was possible in 25. In 20 patients regional or systemic dissemination of the tumour had been diagnosed before operation. Seventy-seven patients had benign diseases, of which 74 were non-specific infections. Bronchography was performed in 46 of these cases, and all had abnormal findings in the middle lobe, eight revealing definite bronchiectasis. In three cases tuberculosis was found. In 16 cases the benign diagnosis was established at thoracotomy. Only three patients out of 58 with malignant tumours lived more than five years. Atelectasis of the middle lobe is always a sign of potential malignancy especially in patients with a previously normal chest radiograph.

Results of operative treatment of hypopharyngeal diverticulum.

The so-called hypopharyngeal diverticula may be classified, according to their size, localization, and form, into three stages. Small diverticula (first stage) should not be surgically removed, whereas all other diverticula, that is, those causing symptoms, must be surgically removed as soon after diagnosis as possible. Diverticulectomy performed in one stage is the treatment of choice. A series of patients is reviewed. The risk involved in surgery is found to be of minor degree, and the incidence of complications is low. Radiologically demonstrable recurrence may develop in 10% to 12% of all patients while clinical symptoms of recurrence are seen in only about 2%.