Biomedical subjects
Publications and source records attributed to H Pinter.
In severely emphysematous or otherwise destroyed lung parenchyma, staples often cut through, which causes prolonged postoperative air leakage. A mechanical suture line reinforced by a polydioxanone ribbon is a simple, safe, and effective method for closure of air leaks, resection, or biopsy in such cases.
In five patients solitary pulmonary lesions were detected radiographically during routine follow up after malignant melanoma. Surgical removal was done in each case under the tentative diagnosis of metastases. Histologically, two lesions turned out as benign chondroma, one as organized pulmonary infarction and one as bronchogenic carcinoma. Only in one patient was a melanoma metastasis present. The findings underline the usefulness also in malignant melanoma of a surgical approach in suspected solitary pulmonary metastases.
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We report a case of Fournier's gangrene of the scrotum, involving the right lower extremity. Radical surgical intervention (hip joint exatriculation) was necessary.
A patient is described with the unusual findings of intrapericardial diaphragmatic rupture combined with total disruption of the pericardium and partial abruption of the diaphragm from its costal origin. Through a third traumatic diaphragmal leak, the small intestine had prolapsed intercostally without contact to the pleural space. Surgical repair was done by direct diaphragmatic suturing and lyophilized dura allograft reconstruction of the left pericardial circumference. Postoperatively, atrioventricular block secondary to myocardial contusion necessitated pacemaker implantation. The patient left the hospital five weeks after the injury.
Important features of diagnostic and operative management and the postoperative course of tracheobronchial injuries as well as pathological findings at the anastomosis are discussed in a review of our 11 cases from the last 12 years. Diagnosis was established clinically, localization of the rupture was carried out by rigid or fiberoptic bronchoscopy. Tracheobronchial continuity was reestablished by end-to-end anastomosis of the ruptured bronchi, by direct suture of any tracheobronchial tears, or by patching inveterated lesions. Two cases of rupture of the right main bronchus are presented separately, considering clinical, diagnostic, operative and histopathologic criteria.
Haemorrhage caused by oesophageal varices, will produce the highest complication rate of portal hypertension. Fiberendoscopic sclerotherapy has been widely introduced for treating those oesophageal varices. Two methods which are technically different are applied: intravariceal injection of the sclerosing solution and paravariceal injection inducing subepithelial fibrosis of the oesophageal wall. Twenty-five patients with oesophageal varices were subjected to 103 fiberendoscopic sclerotherapy sessions. Before every session a Sengstaken-Blakemore tube was inserted in the oesophagus. Sclerotherapy took place along this tube. This modified technique of paravariceal sclerotherapy of the oesophageal wall provides the possibility of secure sclerotherapy by using no specially adapted fiberoptic endoscopes.
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In the last years non operative and surgical efforts could not diminish the high lethality of severe acute haemorrhagic necrotising pancreatitis. While majority of patient die in consequence of pancreatitis-shock, hyperbaric oxygen therapy (HBO) can improve all hypoxic circulation situations. Therefore the value in treatment of experimental necrotising pancreatitis in pig is examined. 5 pigs were treated with, 5 without HBO and 5 served as control. With HBO liquid sequestration was diminished and total protein loss prevented significantly, but foremost survival time was significantly prolonged. In consequence demarcation of necrosis with connective tissue was possible, but nevertheless operative treatment remain necessary. Without HBO all pigs and with HBO only 2 pigs died in consequence of necrotising pancreatitis. It is demonstrated, that HBO as additive therapy can improve the prognosis of necrotising pancreatitis.
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A pancreatic necrosis was produced in 7 piglets by means of a sodiumdesoxycholacid trypsin mixture. 4 animals served as control. All animals get a basis-infusion therapy. Hyperbaric oxygen therapy (HBO) was applied additionally in 3 animals. All control animals survived. The three animals with HBO deceased in average after 22 days, those without HBO deceased already after 4.25 days. Laboratory and circulatory measures show no significant differences. The autopsy statements were different from the age of necrosis. The conclusion by the extension of the average survival time in experimental pancreatic necrosis by means of HBO is that the high lethality of the pancreatic necrosis can be reduced by means of HBO.
The diagnosis of life threatening situations due to blunt chest trauma, the priority of treatment, and therapeutical consequences are discussed. Rib fractures, pulmonary contusions could be treated conservatively. Tension pneumothorax and haemothorax need immediate decompression by intercostal tube drainage. The necessity for prompt exploratory surgery should always be considered in patients with massive haemothorax, tracheobronchial disruption and traumatic rupture of the diaphragm. Rupture or perforation of the oesophagus, traumatic aneurysms of the thoracic aorta, large diaphragmatic herniations, and penetrating thoraco-abdominal wounds demand an early thoracotomy. Indications for late thoracotomy are: clotted haemothorax and diaphragmatic herniations primarily not diagnosed.
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Five children with malignancies developed invasive pulmonary aspergillosis during chemotherapy-induced neutropenia. All patients were treated with liposomal amphotericin B and human recombinant granulocyte colony-stimulating factor. Two patients did not recover from bone marrow aplasia and died from organ-infiltrating fungal invasion. Two patients who recovered from bone marrow aplasia survived after surgery of the pulmonary lesions. The fifth patient had a complete resolution of invasive pulmonary aspergillosis after neutrophil recovery without surgical intervention. We conclude that not only the antifungal treatment but also the recovery of granulocytes are important in localizing invasive forms of Aspergillus infections in patients with profound immunosuppression.