Biomedical subjects
Publications and source records attributed to J Bátorfi.
A non-tumoral stenosis of the gastrointestinal tract (after rectum resection) was treated successfully with CO2 laser. The case was not suitable for classic surgical resection.
The authors treated forty-two patients with liver abscesses guided by computer tomography or ultrasound percutaneous transhepatic puncture or drainage from January 1 1983, to 1989 December 31. Closed aspiration or drainage was done in 42 patients altogether 56 times. Three patients died (3/42 = 7.2%), postdrainage complications happened in 9 cases (9/42 = 21.4). Operative intervention was necessary in 11 patient after the percutaneous procedure (11/42 = 26.2%). The authors wrote about the technics particularly of the percutaneous puncture or drainage. The authors are considering the method as an effective treatment for pyogenic liver abscesses if the personal and technical circumstances are given.
The Nd:YAG and CO2 laser can be used with benefit in the surgery of the liver, biliary tract and pancreas. The Nd:YAG laser is most suitable for cutting parenchymatous organs, as e.g. the liver. In biliary surgery the CO2 laser can be recommended. Based on their 12 cases, authors discuss the applicability of CO2 laser.
Based on the experience of 727 operations, the technique of proximal selective vagotomy used by the authors is reviewed in stages. They consider pyloroplasty justified to perform only in complicated cases (bleeding, perforation, stenosis) for preventing complications. Based on their results (mortality rate: 0.68%, recurrences: 6.3%, excellent or good results: 90%), they argue for the operation.
Thirty-three patients with pyogenic liver abscess were treated by percutaneous transhepatic puncture or permanent drainage between the period of 1, January 1985 and 31, December 1990. The closed puncture or drainage resulted in the complete recovery of 26 patients (26/33 = 78.8%). Surgical intervention was made 6 +/- 5 days following closed drainage in 7 cases (7/33 = 21.2%). After percutaneous intervention complications ensued in four patients (4/33 = 12.1%). One patient died (1/33 = 3%). Solitary abscess occurred in 24, while multiple in 9 patients. Based on the authors' experiences, they consider the closed percutaneous puncture, or drainage guided by computed tomography--provided that proper shills and facilities are available--them does not enable in all cases the precise preoperative diagnosis even despite its richness of detail. In order to reduce uncertainties and to establish an accurate diagnosis, Herbert et al., McCorrcel et al. and Perera et al. proposed three criteria to be met before establishing the diagnosis of pyogenic liver abscess. According to the authors the conditions for accepting these criteria can be summarized as follows: 1. On the US examination of the liver, echo-free or echo-poor regions can be seen with increased background echoes. CT verifies an inhomogeneous, circumscribed or irregular-shaped, blurred focus of finely deformed contours being hypodense in contrast with the environment. On administration of contrast medium, the change is surrounded by a hyperdense border, and other causes for the above change can be excluded. 2. Verification of the presence of pus (by percutaneous puncture or surgery) from the liver biopsy. 3. The negative result of serological tests characteristic of amoebic infection. CT and US examinations have opened up new vistas not only in establishing diagnosis but also in the management of the disease. The closed percutaneous and effective method in the management of liver abscesses.
The authors examined one of the characteristic complications--dysphagia--of proximal selective vagotomy widely applied in the surgical treatment of duodenal ulcerations. To gain a better knowledge of the causes of this type of complications measuring the pH value for 24 hours and manometric examinations of the lower esophageal sphincter were performed in 12 patients without complaints following operation and in 22 with the complaint of dysphagia. No significant changes were observed between the two groups either in basal sphincter pressure or in the two parameters characteristic for reflux activity, e.g. the number of reflux episodes and reflux index. Operation resulted in a slight increase of the basal pressure and the decrease of reflux activity in both groups. It is likely that postvagotomical dysphagia has a multifactorial background: denervation or mechanical trauma of the lower oesophagus and the uncoordinated and insufficient relaxation of the lower oesophageal sphincter following swallowing.
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Analysing the 5-year material including 164 cases (35 haemorrhages, 50 perforations and 79 stenoses), the authors express their preference for extensive proximal selective vagotomy--in some cases--over traditional operations in treating the complications of duodenal ulcer. Operative mortality was 0.6%, while the frequency of recurrences 5.4%. Excellent or good results were observed in 92.3% of the controlled patients.
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After a survey a the European literature of lesser curvature ischaemic necrosis, a special complication of proximal selective vagotomy, the pathogenesis, and the clinical and pathological forms of the complication as well as the possibilities of its treatment and prevention are analysed. The case of two patients with lesser curvature necrosis is presented.
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The authors present the clinical results of 558 patients, with peptic ulcer vagotomised between January 1966 and December 1977. Characteristic intraoperative and early postoperative complications of vagotomy were more frequent in the beginning. Best results were obtained by vagotomy and antrectomy or by vagotomy and pyloroplasty. Comparing the clinical results of vagotomy and partial gastrectomy (Billroth II) the authors found no significant difference.
The frequency and severity of the post-vagotomic dumping syndrome and diarrhoea were studied in 470 cases. After vagotomy the incidence of the dumping syndrome is lower and that of diarrhoea higher than after conventional gastric resection. The dumping syndrome occurred in 8.30 percent [39 cases], but only three patients belonged into the severe group [0.80 percent]. The frequency of post-vagotomy diarrhoea was 11.49 percent [54 cases] of which six belonged into the severe group [1.34 and 1.04 percent, respectively]. The possibility respectively of preventing or reducing the frequency of these side-effects is discussed.
Based on the clinical pattern (case history, radiological, endoscopic and laboratory examinations) four stages of ulcerous stenoses are distinguished (stage I: subclinical; stage II: compensated; stage III: decompensated; stage IV; complete stenosis). Organ-preserving vagotomy is justified only in stages I and II, in which the motoric function and emptying of the stomach is not yet damaged. In stages III and IV resection is the operation of choice. This view is supported by the results of the authors.
The development of minimally invasive surgery has accepted the challenge by having tried to repair inguino-femoral hernias laparoscopically. The authors performed 65 laparoscopic hernioplasties in one year. "Transabdominal preperitoneal" technique was applied in 61 cases and "intraperitoneal onlay mesh" in 4 cases. Fifty-three patients were operated, 12 of them had bilateral hernias. Recurrent hernia was the indication in 22 patients (34%). The average operating time was 102 and 144 minutes in the unilateral and the bilateral cases, respectively. There was neither wound infection, nor general complication. Spontaneously dissolving seroma/haematoma of the spermatic cord was noticed (detected by ultrasound) in 5 patients (7.7%). The neuralgia caused by the irritation of the nerves of the region in 4 patients (6.1%) disappeared without sequels after treatment with vitamins B. The 2 early recurrences (3.2%) were considered to be caused by technical unexperience; the affected patients were treated successfully with the "intraperitoneal onlay mesh" technique. It is emphasized that laparoscopic hernioplasty has definite advantages, namely minimal postoperative pain, early mobilization, short hospital stay and early restoration of full physical activity (in 1 to 2 weeks). On the other hand, general anaesthesia and intraperitoneal invasion are required and the operation consumes much time and cost.
The Swedish surgeon Jacobaeus was the first to use a lighted cystoscope for the lysis of pleural adhesions /5/. The same author reported, in 1921, five cases of intrathoracic malignancies diagnosed by thoracoscopy /6/. After the appearance of video-assisted cholecystectomy and abdominal surgery, video-assisted thoracic surgery (VATS) also occupied a major share in thoracic surgery. It was long ago that we introduced a thoracoscope (not the video-assisted type) for thoracic intervention. In 1988 we published 24 cases of thoracic sympathectomies in which we used the thoracoscope /16/.
There is no disease that would have as many and variable complications as Crohn's disease. One of the most common complications is bowel obstruction which can be caused by the angulation of the bowel or by inflammation, or by formation of granulation tissue (32.3%). Very common is the formation of fistulae amongst the bowels involved and other abdominal organs, and also entero-cutaneous fistulae occur frequently (11.3-14.4%). The frequency of complications is increasing with the duration of the illness. If they are life-threatening, only surgical treatment can help. Surgical treatment is also indicated when conservative treatment fails. The most commonly used surgical interventions are bowel resection and, recently, the plasty of stenotic areas. The operative mortality (3.7%) is influenced by the length of the disease and by the numbers of complications. Recurrence is very common in Crohn's disease (30.1-34.9%). The mortality rate of the second operation is 17.5%. The prognosis is usually poor because recurrence can occur years after the primary operation. In Hungary, the frequency of surgically treated patients with Crohn's disease is low, they count for 0.06% of all general surgical operations.