Conservative surgical treatment of splenic cysts.

The common treatment of splenic cysts is splenectomy, but with today's knowledge of the important position of the spleen in the infection defense, it is advisable to preserve the spleen whenever this is possible, especially in younger individuals. A large non-parasitic, benign splenic cyst is excised. Postoperative ultrasound control presents a normal appearance of the spleen.

Direct vision internal urethrotomy. A critical review of 365 operations.

Internal urethrotomy under direct vision for urethral strictures in the male was employed on 369 occasions in 225 patients during a 4-year period. A retrospective review of results showed an overall cure rate of 77% but the cure rate after each individual operation was less than 50%. Operations for recurrence carried a significantly lower cure rate than initial operations but even after several recurrences there were reasonably good results considering the relatively minor procedure. An active post-operative follow-up employing routine urethroscopy showed significantly better results than mictiographic follow-up. The post-operative period of catheterisation and positive urine culture at the time of follow-up had no significant influence on the results.

Primary pulmonary leiomyosarcoma. Review of the literature and report of a case.

In a review of the literature, 38 cases of pulmonary leiomyosarcoma were found. An additional case with highly progressive course is reported and the diagnostic and therapeutic possibilities are discussed. Prognostic signs are evaluated. The importance of radical surgery is emphasized.

Management of bronchopleural fistula following pneumonectomy.

Bronchopleural fistula developed in 28 (12.5%) of 225 pneumonectomies performed for pulmonary carcinoma of non-small cell types during a 10-year period. The incidence of fistula apparently decreased significantly when chromic catgut was replaced by Dexon for closure of the bronchial stump. The fistula presented as an emergency in nine cases and was subacute in 19. The overall mortality from bronchopleural fistula was 28.6%. Conservative treatment, i.e. bronchoscopic application of silver nitrate to destroy the epithelium in the bronchial stump and induce granulation, achieved closure of fistula in all the surviving patients. In the seven patients with sterile pleural cavity the pleura was not drained. The results justified our principle of conservative management when a bronchopleural fistula does not present as an emergency. In emergency situations, however, or if the pleural fluid is purulent, pleural drainage should be instituted.

Iatrogenic perforation of the esophagus. Causes and management.

A series of 13 perforations of the esophagus in 12 patients is presented. All the perforations were caused by instrumentation. Minimal delay in treatment is advocated. Most importance is attached to gastric decompression, adequate drainage of the mediastinum with parenteral hyperalimentation and, if possible, suture of the lesion.

A solitary malignant schwannoma mimicking a pancreatic pseudocyst. A case report.

A case is presented in which a cystic process occupying the body and tail of the pancreas peroperatively was regarded as a pancreatic pseudocyst but post-operatively showed a microscopic picture of cystic malignant schwannoma. It is concluded that in case of a presumed pancreatic pseudocyst, peroperative microscopy--when possible--of frozen sections of the cyst wall before performing a drainage operation is indicated.