Magyar sebészet
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Heart disease during pregnancy necessitating cardiac surgery is potentially increasing maternal and fetal morbidity and mortality. Most patients know about their heart disease long before conception however the relation between the deteriorating cardiac function and the perinatal complications is not emphasized. Best possible results can be achieved by providing preconception counseling for cardiac patients. ⋯ Fetal monitoring is inevitable for prompt correction of operative conditions in case of impending hypoxemia. The perioperative fetal risk can be reduced by applying normothermia, high mean arterial pressure and cardiac index during the intentionally shortest intervention. Cardiac operation with cardiopulmonary bypass during pregnancy has become a relatively safe procedure for the mother but not for the baby.
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Successful treatment of penetrating chest trauma largely depends on the accurate and rapid diagnostic work-up, as well as the adequate surgical management. The authors discuss current issues in the diagnosis and the treatment of penetrating chest injuries based on the analysis of 109 cases. ⋯ Patients with penetrating chest trauma should undergo a rapid and accurate diagnostic work-up followed by an adequate surgical management in order to keep their prognosis relatively good.
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Review Case Reports
[The abdominal compartment syndrome (ACS) in general surgery].
Mortality due to the abdominal compartment syndrome is extremely high (38-71%). It may be defined as adverse physiologic consequences that occur as a result of an acute increase in the intraabdominal pressure. ⋯ The diagnosis depends on the recognition of the clinical syndrome followed by an objective measurement of intraabdominal pressure, preferably that of the urinary bladder. The treatment consist of adequate fluid resuscitation and surgical decompression when necessary.
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Breast preserving surgery combined with adjuvant radiotherapy became more frequent in the last 20 years in the surgical treatment of early stage (Std. I-II) breast cancer in Hungary. Those who refuse this method usually allude to the frequent multifocality and the high recurrence rate of breast cancer. ⋯ According to histological grade the Grade 1 tumors had a recurrence rate of 2.3%, in Grade 2 we found 6.2% and in Grade 3 as high as 15.8%. Other unfavorable histo-morphological signs are the absence of estrogen receptors, the presence of extensive intraductal component and vessel invasion. Their opinion is that in case of local recurrence with favorable prognostic factors excision should be performed if acceptable cosmetic result can be achieved.