The significance of Chlamydia pneumoniae in symptomatic carotid stenosis.

An association between symptomatic carotid stenosis and recent infection with Chlamydia pneumoniae is reported. Thirty-five patients (20 symptomatic and 15 asymptomatic) with carotid stenosis of 70% to 90% underwent carotid endarterectomy. Endarterectomy was performed without patch and shunt; the average occlusion time of the internal carotid artery was 14 +/- 3 min.

Preduodenal portal vein in the adult.

We present three cases of preduodenal portal vein in adult people, which were diagnosed in our department. All of them were identified during elective operation for cholelithiasis, caused some technical difficulties to the performance of the operation, but led to no major intraoperative or postoperative complications. None of them had any preoperative symptoms, which could be related to this anomaly.

Secondary achalasia due to a mesenchymal tumour of the oesophagus.

A rare case of a secondary achalasia or pseudoachalasia due to a mesenchymal tumour of the oesophagus is presented. A 67-year-old Caucasian man had symptoms including dysphagia, odynophagia, and weight loss for 8 months. Radiological examination revealed no signs of neoplasia but an exploratory laparotomy revealed the presence of a mesenchymal tumour of the oesophagus.

E. Kondoleon: the man behind the procedure.

Unlabelled: Historical events and their in-depth analysis have much to teach us about medicine today. Moreover, the lives of those who have made their mark in medical history can be a source of inspiration to future generations of medical scientists. A case in point is the career of E.

Carotid endarterectomy without protective measures in patients with occluded and non occluded contralateral carotid artery.

Background: Comparison of carotid endarterectomy in patients with and without occluded contralateral carotid artery.

Design: evaluation of results without using shunt or patch.

Setting: <> Hospital, Medical School, University of Athens.

Prevention of postherniorrhaphy persistent pain: results of a prospective study.

Anterior tension-free and laparoscopic inguinal herniorrhaphies represent one of the most common surgical procedure. Postherniorrhaphy persistent pain due to injures of inguinal regional nerves is rare, difficult to cure, often disabling and involving malpractice litigation. In a prospective study, we evaluated the effectiveness of neurectomy of the iliohypogastric nerve in prevention of postoperative persistent pain after anterior tension free herniorrhaphy.

Management of inflammatory abdominal aneurysms--immediate and late results.

Introduction: Despite progress in the technical approach to aneurysms, inflammatory aortic aneurysms (IAA) in particular present the surgical team with a unique challenge. This retrospective study investigates immediate and late results after surgical treatment of IAA.

Patients And Method: Fifteen cases of IAA among 520 aneurysmectomies of the abdominal aorta were operated during the period 1986-1995.

Lessons learned from a complicated case of cephalic obstructive chronic pancreatitis.

The authors report the complex case of a 51 year-old man admitted to his local hospital for gallbladder and common bile duct lithiasis, 1 year before admission to our hospital. There, he was treated by cholecystectomy and transduodenal biliary sphincteroplasty. He was readmitted after 3 months because of a painful episode and was discharged with the diagnosis of "relapsing acute pancreatitis in chronic pancreatitis.

Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports.

Objective: To evaluate the outcome after total and subtotal thyroidectomy for the treatment of single and multinodular goitres in two comparable groups of patients.

Design: Prospective randomised study.

Setting: University hospital, Italy.

Monograft reconstruction of all the major aortic arch trunks.

Male aged 56 years, a smoker of 60 cigarettes daily, with multifocal disease, presented with vertigo, headaches, syncopal crises and intermittent claudication in both lower extremities. Angiography revealed pre-occlusive stenosis at the origin of the innominate artery, a significant degree of stenosis at the origin of the left common carotid and occlusion of the left subclavicular artery with steal syndrome as well as injury to the aortoiliac system. Revascularisation of all the branches of the aortic arch concomitantly was achieved with the technically simple monograft method using only one Dacron double velour 8 mm prosthesis, restoring circulation to both the cerebral and upper extremities without postoperative complications.

Esophageal metastasis from clear cell carcinoma of the kidney.

Esophageal metastasis from distant primary malignancies is an uncommon occurrence. The first case of a clear cell carcinoma of the kidney metastatic to the esophagus 5 yr after nephrectomy is reported.

Differential effect of stress on gastric somatostatin, prostaglandin E and gastrin release in the rat.

Background: The relationship between gastric mucosal damage induced by stress, peptides present in the gastric mucosa and is not clear. Aim of this study was to determine whether cold-restraint stress affected the release of gastric somatostatin, gastrin and in the isolated perfused stomach preparation.

Methods: Male Sprague-Dawley rats were used, 12 cold-restraint stressed and 12 unstressed controls.

Our experience in the surgical treatment of liver tumors in the years 1994-1996.

The study is based on the evaluation of a study group consisting of 61 patients who underwent surgery for liver tumors in the 2nd Surgical Clinic in Brno between 1994 and 1996. Liver resections were carried out in 39 patients, port-systems for regional chemotherapy were implanted in 29 patients. In recent years, port-systems have been inserted even in liver resections in indicated cases.

Immunoadsorption with protein A in humoral rejection of kidney transplants.

The presence of alloantibodies may play a role in accelerated or acute humoral rejection. Different therapeutic strategies based on a removal of anti donor antibodies and prevention of their resynthesis have been used in the management of transplant rejection episodes. Immunoadsorption with staphylococcal protein A, a method to selectively remove immunoglobulin G, may represent a new treatment to reverse humoral rejection in kidney transplantation.

Lymph distribution of different non-steroidal anti-inflammatory drugs assessed by microsurgical cannulation of the thoracic duct in rat.

The motility of lymphatic vessels is regulated by arachidonate metabolites and, therefore, can be altered by cyclo-oxygenase blockers such as non-steroidal anti-inflammatory drugs (NSAIDs). In order to investigate the lymphotropic properties of different NSAIDs, pharmacokinetics in plasma and lymph following intragastric administration of three model compounds, namely racemic ibuprofen, tenoxicam and nabumetone, were investigated in rats. Microsurgical cannulation of the thoracic duct allowed cumulative sampling of lymph fluid up to 48 hrs (n = 16).

Ischemia of spinal cord following elective operative procedures of the infrarenal abdominal aorta.

Objective: Ischemia of the spinal cord following procedures of the infrarenal abdominal aorta and the iliac arteries due to aneurysmatic or occlusive disease.

Design: Retrospective study, duration of follow up: two years.

Settings: Vascular Department of the 2nd Surgical Clinic of the University of Athens, Medical School.

Lost intraperitoneal stones after laparoscopic cholecystectomy: harmless sequela or reason for reoperation?

Laparoscopic cholecystectomy has become the "gold standard" in the therapy of noncomplicated cholelythiasis. Gallbladder perforation with bile and calculi spreading in the abdominal cavity is one of the most frequent intraoperative complications of laparoscopic cholecystectomy. When not recognized during surgery or unproperly treated, it may lead to intraperitoneal abscess formation and may require a reoperation.

Historical evolution of the surgical anatomy of the liver.

The authors report the history of the anatomy and surgical anatomy of the liver from the paleolithic age up to now. Particular emphasis has been reserved to the changing anatomical knowledge in these last decades which represents the basis of the modern surgery of the liver.

Perforated diverticulitis: a surgical dilemma.

Thirty-eight patients, 18 males and 20 females (mean age 61 years) have been operated on for perforated diverticulitis, over the past 14 years. We assigned the patients into stage A (n = 12) when the inflammation was confined to the mesosigmoid folds, stage B (n = 16) when an intraabdominal abscess was walled off and stage C (n = 10) when a generalized peritonitis had developed. Resection of the perforated sigmoid was carried out in 24 patients either as Hartmann's procedure (n = 18) or with primary anastomosis (n = 6).

Immediate effects of mammary artery revascularization versus saphenous vein on global and regional myocardial function: an intraoperative echocardiographic assessment.

The immediate effect of coronary artery bypass surgery on global and regional myocardial function using the internal mammary artery (IMA) versus saphenous vein (SV) was studied intraoperatively using transesophageal echocardiography (TEE). Thirty-two patients received an IMA and 10 patients only SV. Transesophageal echocardiography was recorded before thoracotomy, 5 minutes after the end of cardiopulmonary bypass (CPB) and after chest closure.

Transesophageal echocardiographic evaluation in mechanically assisted circulation.

Transesophageal echocardiography (TEE) has assumed an increasing importance in cardiothoracic surgery, but its use in patients with mechanically assisted circulation is unclear. We performed TEE in 11 patients: total artificial heart (TAH) 2, right ventricular assist device (RVAD) 2, left ventricular assist device (LVAD) 6, biventricular assist device (BVAD) 1. TEE was helpful in three areas.

Glucose-based versus fat-based total parenteral nutrition (TPN): effects on hepatic function in septic patients complicated with cholestatic jaundice.

A prospective study of two types of total parenteral nutrition (TPN) was carried out in 34 patients suffering from sepsis and complicated liver dysfunction. Group 1 (18 patients) received non-protein energy as glucose plus fat emulsion in a caloric ratio of 19:1, while group 2 (16 patients) received the same energy intake but with a ratio of 1:1. Group 1 exhibited higher levels of bilirubin and alkaline phosphatase with values of 93.

Two level entry concept for analog digital conversion package: usage as blackbox or toolkit.

Analog/Digital conversion of up to 16 channels can be set up and executed interactively with sampling rates individually adjusted for each channel. Additionally, asynchron and parallel digital I/0 is provided, including the possibility of triggering the beginning and the end of data acquisition on an external TTL signal. For non-experienced personnel the package can be run fully interactively with help-menus.

Emergency laparoscopy in multiple trauma patients: experience with 106 cases.

Emergency laparoscopy was successfully used in 106 multiple-trauma and often unconscious patients with blunt abdominal traumas. In 40 cases a negative result avoided any subsequent exploratory laparotomy; two false negative were registered, while a diagnosis of retroperitoneal hematoma was possible in 6 cases.