[Spontaneous rupture of the rectum in combination with prolapse of loops of the small intestine].
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Traumatic rupture of the diaphragm is diagnosed during the acute stage in only 50% of the cases. The reasons for this failure are that in many of these cases clinical symptoms of damage to abdominal organs or of injuries to the limbs predominate. Traumatic rupture of the diaphragm is usually the result of an indirect trauma. Clinical signs of extensive prolapse of viscera into the thoracic cavity are: dyspnoea, tachycardia, cyanosis or intestinal sounds heard over the thorax during auscultation. Once the diagnosis has been established surgical repair should follow. During the acute stage laparotomy is preferable; thoracotomy is indicated during the chronic stage. Post-operative symptoms are: dyspnoea during exercise, pain in the affected half of the chest and roentgeno-kymographically demonstrable restrictions of movement in the ruptured side of the diaphragm.
Reconstruction of the esophagus has been used for more than half a century. Benign as well as malignant diseases are treated in this manner. Viscera used for reconstruction are: colon, jejunum, and stomach. The different modalities of surgical intervention have been briefly summarized. Complications have been enumerated with the major ones stressed in more detail. The exact nature of surgical procedure should be known before attempting to evaluate roentgenologically a reconstructed esophagus. Preoperative roentgen evaluations, including barium study and angiography, are indicated for better postoperative results. Postoperative roentgen studies are needed to detect most of the postoperative complications.
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The method of fixation of a pathologically movable kidney with a graft from the retrorenal fascia, modelled as a poach and strengthened with a heterogenic abdominal stripe, is described. The operation was carried out upon 76 patients. There were no complications. 63 patients were followed up for 6 month to 2.5 years. There were no cases of the recurrence of nephroptosis. The results of the operation are considered as favourable ones.
A new method of nephropexy with an autograft by the upper pole to the diaphragm from intercostal lumbotomy is described. The method induces little injury, is technically simple and can be employed in those patients who do not need a revision or surgery on the renal pelvis, ureter or vascular pedicle. The method was used in operations on 45 patients. Good immediate and remote results were obtained.
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Forty three patients with nephroptosis, complicated by hypertension were examined (4 males and 39 females), aged from 18 to 60. Permanent hypertension was found in nine of them (21%), and renovasographically--organic renal-arterial stenosis at the nephroptosis side was established. After the failure of the conservative treatment, those patients had all the indications for operation. Seven of the patients underwent the operation and only in one woman patient--nephrectomy was performed, and in all the rest six patients--reconstructive revascularization and nephropexy. The follow-up of the operated patients so far reveals a very favourable effect upon the hypertension syndrome after the operation.