Magyar sebészet
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Median sternotomy is still the most commonly used approach in cardiac surgery. Closure of the sternal halves is usually performed with stainless wires. ⋯ On the other hand in a small number of patients this simple method is not efficient to resist the great spreading forces on the sternal halves leading to sternal instability and other serious complications. We describe successful application of a newly introduced device, the Ley-prosthesis, which may be a very useful treatment for postoperative sternal dehiscence even in complicated cases.
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Procalcitonin test (PCT) has been proposed to check severity of generalized infections or sepsis. The authors measured the PCT values with PCT-Q quick test (BRAHMS DIAGNOSTICA GmbH, Berlin) at 14 surgical patients treated in their intensive care unit (7 sepsis, 4 peritonitis, 2 localized pancreatic abscess, 1 postoperative fever). At 3 septic patients (2 pancreatitis, 1 intestinal necrosis) they measured the PCT levels repeatedly during treatment. ⋯ In 2 septic patients with pancreatitis elevated PCT levels indicated the need for surgery. In most patients PCT was a good indicator of generalized infections. PCT levels measured repeatedly in sepsis were lower than in patients with peritonitis.
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After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. ⋯ We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.
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Pancreatic trauma is relatively uncommon, but it has high morbidity and mortality rates, especially when the diagnosis is delayed or inappropriate surgery is attempted. We analysed the management of 11 patients in a university teaching hospital treated with distal pancreatic transsection without (grade II--according AAST score) and with main pancreatic duct (MPD) injury (grade III) caused by blunt abdominal trauma. The average age of the 10 male and 1 female patients was 24.9 years (5-56). ⋯ Every patients needed subsequent resection (1), internal drainage due to fistula (2), or drainage of developed abscess (2). Three of them had severe septic and pulmonary complications; one patient with MPD injury died. Patients who require delayed surgery after an unsuccessful period of conservative treatment or a subsequent operation due to undetected MPD injury demonstrated higher pancreas-specific mortality and morbidity rate.
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Infiltrating lobular cancer is biologically different from invasive ductal cancer and there is disagreement regarding appropriate local management of this disease. ⋯ Results of long-term follow-up confirmed that breast-conserving surgery and radiotherapy is a reasonable treatment for patients with early invasive lobular breast cancer. The majority of local recurrences are curable by salvage surgery.