[Fibrinolytic treatment with streptokinase].
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A case of congenital hepatic fibrosis (CHF), a relatively rare disease, was diagnosed preoperatively on the basis of clinical and radiological findings. The diagnosis was confirmed by computerized tomography and later proven by a liver biopsy performed during cholecystectomy. Increased awareness of this entity may reveal heretofore unidentified cases of CHF.
The treatment results in 133 patients who underwent bilateral upper dorsal sympathectomy (BUDS) for palmar hyperhidrosis (HH) are reported. Group 1 (67 patients) was followed for 5 to 10 yr (mean 7) and Group 2 (66 patients) was followed for 1 to 4 yr (mean 2). Early results and complications, early and late sequelae, late recurrence and patient satisfaction with the results of the operation were analyzed. The immediate success rate was 98%, and late recurrence of HH was noted in 5.3% of the patients. The incidence of technical complications was lower in Group 2 than in Group 1, otherwise both groups were similar. Persistent, severe Horner's syndrome was present in only one patient at late follow-up. Troublesome compensatory HH persisted in one-third of the patients. Overall patient satisfaction was good, and only 10 patients regretted having undergone the operation. BUDS appears to be the best solution for severe palmar HH in properly selected patients.
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Two policies concerning portosystemic shunt for bleeding esophageal varices were compared. In 18 patients, splenorenal or portocaval shunts were performed according to anatomic and hematologic considerations. In 13 patients, only mesocaval H grafts were performed. In the latter group, more patients had poor liver reserve and required urgent surgery. Accordingly, early and late mortality and morbidity were higher in these patients. the technical ease of performance of the mesocaval H graft did not cancel out increased risk in poorer candidates for surgery.
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During the period 1973-79, 26 infections occurred in 931 vascular operations. The overall infection rate was 2.8%, and 80% of the infections occurred in groin incisions. There was a significantly higher infection rate when a synthetic graft was inserted, when there was an infected foot ulcer prior to operation, or when early reoperation was necessary. Several regimens of antibiotic treatment are described. The current practice of a short perioperative course of cefazolin, combined with irrigation of the wound with 1% povidone-iodine solution before closure of the skin resulted in an acceptably low rate of infection (less than 2%) during the last three years of the study period. There is no advantage in continuing postoperative antibiotic therapy for more than one to three days.
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