Testicular-epididymal hemodynamics and inguinal hernia.

Testicular-epididymal hemodynamics is studied by ultrasonographic color velocity imaging (CVI) in patients with primary, uncomplicated inguinal hernias. This procedure allows more precision than any other known Doppler system in measuring hemodynamic parameters such as peak systolic and diastolic velocity, resistance index and pulsatility index. The results of the exploration of 480 arteries of various testicular vascular territories are compared with those obtained by other authors in young healthy individuals using color Doppler.

Treatment of uncomplicated hydatid cyst of the liver by closed marsupialization and fibrin glue obliteration.

Treatment of hepatic echinococcosis remains a surgical problem not only in endemic countries. Between January 1983 and December 1999 a total of 29 patients underwent surgical treatment for hepatic hydatidosis at the Department of General Surgery at the University Hospital of Granada. The diagnosis was based on clinical criteria, serology, and imaging techniques.

Dehydroepiandrosterone sulfate and growth axis hormones in patients after surgery.

We selected 38 patients scheduled for cholecystectomy and studied their serum concentrations of dehydroepiandrosterone (DHEA) and growth axis hormones [growth hormone/insulin-like growth factor-1 (GH/IGF-1)]. We aimed to determine whether alterations in these concentrations resulted from surgical stress or, on the contrary, preceded surgery and were themselves a cause of chronic diseases that reduce life expectancy. We measured the serum concentrations of DHEA sulfate (DHEA-S), ACTH, cortisol, human GH (hGH), IGF-1, and IGF-1 binding protein-3 (IGFBP-3) preoperatively and then 2 and 7 days after surgery; we also compared the preoperative findings with those of a healthy control group.

[The behavior of atherogenic indices under the effect of growth hormone in postoperative disease].

Objective: It has been studied the effect of the growth hormone (GH) in the atherogenic indexes, during the postoperative period in 28 patients, operated for digestive surgery.

Method: Patients were divided in: I) control group, patients without treatment, and II) treatment group, patients treated with 8 U.I.

[Growth hormone and its effects on cholesterol and lipoprotein metabolism following surgical intervention (hGH and cholesterol metabolism during surgery)].

The objective of this work was to determine whether the increase in serum GH, IGF1, glucose and insulin levels caused by the administration of hGH modifies the normal response of cholesterol and lipoproteins to surgical aggression. A prospective, randomized, and double blind study is carried out in 28 patients operated for gallstones and diverticulitis. The control group (n = 15) was not given anything except conventional fluidtherapy in the postoperative period: the patients in the hGH (n = 13) group were also given 8 IU of hGH during the first five days after the intervention.

Severe head injury combined with orthopedic and vascular trauma of the limbs.

From 1982 to 1992, 2766 brain injury patients were admitted to the University Hospital San Cecilio of Granada, Spain. In 873 cases head injury was concomitant with other injuries but the association of severe head injury and combined orthopedic and vascular trauma of the limbs was observed only in 23 cases (incidence 2%). Thirteen patients were scheduled for revascularization, and of these secondary amputation was mandatory in two cases to keep rising intracranial pressure under control.

Effects of human growth hormone on the catabolic state after surgical trauma.

The aims of our studies were: (1) to determine if the protein catabolic response after a major or moderate surgical trauma can be restrained by the administration of exogenous human growth hormone (hGH); (2) to determine if the administration of hGH can improve systemic host defenses, thus reducing the risk of infection, and (3) given that the postoperative fatigue syndrome (POF) is mediated by the endocrino-metabolic response to surgery we attempt to determine if the administration of hGH can prevent or reduce POF. Therefore, we performed three placebo-controlled randomized double-blind trials on 216 patients. Major gastrointestinal surgery was treated only with total parenteral nutrition (TPN; n = 20) or TPN plus 4 IU hGH (n = 18).

Can the use of growth hormone reduce the postoperative fatigue syndrome?

Convalescence after surgery is characterized by a period of fatigue (POF). If we assume that the POF syndrome has a multifactorial etiology, it is clear that the aim of therapeutic measures should be to reduce the response to surgical stress. The purpose of the present study was to determine if administering exogenous human growth hormone (hGH) can prevent the development or reduce the duration of the POF.

[Physiology and physiopathology of postoperative disease. Therapeutic implications].

The organism responds to each and every aggression by means of a neuro-endocrine activation, which is translated into a metabolic change. The action of the surgeon should not be any other than to improve the neuro-endocrine-metabolic response. This review describes the physiological and physiopathological occurrences which develop in every traumatized patient.

Indications and advantages of laparoscopy-assisted colon resection for carcinoma in elderly patients.

The controversy about laparoscopy assisted colectomy for cancer is based on doubt about performing a radical resection and adequate histopathological staging. Therefore, we selected a group of patients who could profit from the accepted benefits of the technique, while avoiding its uncontrolled outcome. We operated on patients with colorectal cancer with distant metastasis and on patients over 70 years old and American Society of Anesthesia (ASA) III-IV with a high operative risk with standard surgery.

Graves' ophthalmopathy after subtotal thyroidectomy and radioiodine therapy.

Forty-five patients with Graves' ophthalmopathy were studied prospectively. Twenty-one patients (42 orbits; group 1) were treated surgically by subtotal thyroidectomy and 24 (48 orbits; group 2) received radioiodine therapy. All patients underwent tests of thyroid function, ophthalmological examination, and axial and coronal computed tomography before and 12 months after treatment.

Exogenous growth hormone: effects on the catabolic response to surgically produced acute stress and on postoperative immune function.

The first purpose of the present prospective randomized study was to determine if the protein catabolic response after operation could be restrained by administration of hypocaloric parenteral nutrition (HPN) plus human growth hormone (hGH). Our second aim was to determine if the administration of hGH could improve the systemic host defenses, thereby reducing the risk of infection. We performed a placebo-controlled randomized double-blind trial in 180 patients after elective cholecystectomy with or without choledochoduodenostomy (placebo = control group, n = 93; hGH-treated group, n = 87).

[Minimally aggressive surgery in advanced cancer of the colon].

We evaluated minimally aggressive surgery in the treatment of metastasic cancer of the colon in 6 patients: 2 females and 4 males, with an average age of 71.8. Preoperative studies showed cancer of the colon (right colon = 4; sigmoid colon = 2) with multiple hepatic metastasis.

[Xanthogranulomatous cholecystitis].

Ten cases of xanthogranulomatous cholecystitis are presented, 5 women and 5 men, from a total of 439 cholecystectomies (2.2%). In 50% of cases the clinical course was consistent with acute cholecystitis; in 30%, gallbladder cancer was suspected preoperatively; and in 70% of cases cancer was suspected during surgery but intraoperative biopsies showed no malignancy.

[Effect of growth hormone and parenteral nutrition on the catabolic phase following major digestive surgery].

The purpose of the present study was to determine if the administration of a biosynthetic human growth hormone (bGH) was able to enhance the efficacy of total parenteral nutrition (PN). Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided in two groups. Group I (n = 20) treated only with PN and Group II (n = 18) treated as in Group I plus bGH (4 UI/daily).

Effects of growth hormone in patients receiving total parenteral nutrition following major gastrointestinal surgery.

The purpose of the present study was to determine whether the administration of a biosynthetic human growth hormone was capable of enhancing the efficacy of total parenteral nutrition. Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided into two groups. Group I (n = 20) treated only with PN, and Group II (n = 18) treated as in Group I plus human growth hormone (4 IU daily).

Intrathoracic meningocele presenting as a mediastinal mass lesion. Case report.

A routine chest X-ray in a 52-year-old man revealed a widening of the posterosuperior mediastinum and the patient was hospitalized on the suspicion of having a mediastinal mass lesion. Further investigations revealed an anterior cervicothoracic meningocele (intrathoracic meningocele), the dural herniation passing through two large midline congenital openings of the C7-T3 vertebral bodies which appeared partially fused and associated with other regional skeletal malformations.

[Thovara inguinal hernia operation. Results of follow-up in adults].

A new procedure for inguinal hernia operations is described: the Thovara method, which is really a modified version of the plastic technique by Bassini-Kirschner-Lichtenstein. From 1985-1986 167 patients were operated on for inguinal hernia in our University Hospital, using this hernia plastic technique with a tension-free mesh. Though the rate of early complications is good, we should mention that there were 19 cases of testicle swelling.

[Echinococcosis of the spleen. Its conservative surgical treatment].

Echinococcosis cysts in the spleen are very rare, even in endemic areas. We report here on 4 patients (0.5% of the total number of cases of echinococcosis disease) who have been treated in the University Hospital Granada from 1970 to 1990.

[Treatment of distal venous thrombosis of the lower extremity with "moderated" doses of heparin].

The effectiveness of a therapeutic protocol, using 15,000 to 22,500 IU/day of heparin by subcutaneous injection, to treat the distal postoperative vein thrombosis on the lower limb, was evaluated. The study was made on 427 patients, which were analyzed by the Fibrinogen I125 marked accumulation test, to give an early diagnostic and follow-up of their thrombosis (thrombus lysis, stabilization or expansion). Treatment made, showed its efficacy preventing from proximal expansion, as well as avoiding pulmonary embolism and postphlebitic syndrome.

[Shunt infection in hydrocephalus].

Infection is a generally feared complication of liquor drainage. Shunt sepsis is reported in this paper with reference to 284 patients with liquor drainage. The rate of infection amounted to 9.

Phenol treatment of pilonidal sinuses.

Pilonidal disease of the natal cleft is a common condition responsible for much morbidity. The results of phenol injection used in 67 patients treated in our Department of Surgery between 1986-1988 are reviewed. Our study shows that this procedure is an effective treatment.