Labas P

Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker: Tamsulosin

Background:Alpha – 1 blockers decrease the tension and release the spasm of smooth muscles and thus lessen the obstruction and irritation symptoms in the lower urinary tract (LUTS). They make a faster passing of calculi from the terminal part of the ureters possible.Objectives:The goal of this study was to objectively assess the improvement of difficulties caused by obstructions in ureterolithiasis localized in the lower part of the ureters of 104 randomly chosen patients (pts.) in a double-blind study.Methods:During a period of 2 and half years (June 1999–January 2002) 104 pts. suffering from ureterolithiasis of the lower urinary tract were treated and observed. Patients were divided into two groups: A (n:53; later only 51 were evaluated) which was subjected to standard treatment and group B (n:51) where the standard treatment was supplemented by the alpha – 1 blocker. As alpha – 1 blocker one capsule of Tamsulosin /OMNIC 0.4 / was administered daily.Results:With alpha – 1 blocker, we have registered a more speedy passing of calculi from the terminal parts of ureters in 17.6% of pts. Recurrence of renal colics was less frequent and occurred in one of eight pts. as compared with group A (without the alpha – 1 blocker) where a recurrence of the renal colic was observed in about every fifth pts. In group A (n:51), 62.8% of the pts. passed the calculi, whereas in group B (n:51), where standard treatment was supplemented by the administration of the alpha – 1 blocker Tamsulosin, this percentage increased to 80.4%.Conclusion:The treatment by alpha – 1 blockers considerably decreased not only LUTS but also helped to accelerate the passing of minor calculi from the terminal parts of the ureters of 80.4% of pts. It seems that alpha – 1 blockers potentiate the spasmoanalgetic action of drugs used in standard methods of treatment.

Fournier's gangrene: Can aggressive treatment save life?

Fourniers gangrene (FG) is a rapidly progressive, fulminant infection of the scrotum, perineum and the abdominal wall. FG is caused by synergic aerobic and anaerobic organisms. Modern surgical series report mortality of up to 67% [2, 3]. This originally rare disease has become more frequent. Aggressive treatment including antibiotics, antigangrenous serum, and treatment of all accompanied diseases and disorders can be successful. Treatment also includes debridement and plastic corrections. Authors describe management of 8 patients with FG. Treatment of FG and all accompanied diseases was in all cases successful. Treatment costs of this kind of patients were approximately 20 times higher than treatment of patients with other urologic diseases.

Importance of Different Grades of Abdominal Obesity on Testosterone Level, Erectile Dysfunction, and Clinical Coincidence:

The aim of the current study was to investigate the influence of different grades of abdominal obesity (AO) on the prevalence of testosterone deficiency syndrome (TDS), erectile dysfunction (ED), and metabolic syndrome (MetS). In a cross-sectional descriptive study, a total of 216 males underwent a complete urological, internal, and hormonal evaluation. Males were divided according to waist circumference into five groups: less than 94 cm (Grade [G] 0), 94 to 101 cm (G1), 102 to 109 cm (G2), 110 to 119 cm (G3), and more than 120 cm (G4). Incidence of ED, TDS, and MetS was compared in these groups and in participants without AO. Some degree of ED was identified in 74.7% of males with AO. In G1, there were 61% of males with ED, in G2 68%, in G3 83%, and in G4 87%. A strong correlation between testosterone (TST) level and AO was identified. Ninety-eight out of 198 (49.5%) males with AO and 1/18 (5.5%) males without AO had TDS. There were significant differences between individual groups. In the group of males with AO G4 (more than 120 cm), 87.1% had TDS. MetS was diagnosed in 105/198 (53.0%) males with AO, but in G4, 83.9% of males with AO had MetS. Males older than 40 years of age with AO have a higher incidence of ED, TDS, and MetS. Dividing males into five groups according to waist circumference seems to be reasonable. With growing AO, there were significantly more males with ED, TDS, and MetS.

The combined algorithm of venous ulcer therapy.

AIM This prospective study was undertaken to find a new combined algorithm to help patients suffering from long-term chronic non-healing venous ulcers. METHODS A total number of 20 patients suffering from chronic venous ulcers and important co-morbidities such as diabetes mellitus or cardiac failure and not responding to other therapeutic modalities were treated at our surgical department with a combination of compressive sclerotherapy, and maggot debridement therapy (MDT) using larvae of green blowfly Lucilia sericata. RESULTS Using the combined therapy we have achieved a significant clinical effect in 19 patients (95 %). In 1 patient, this effect was only impermanent while 5 patients (25 %) were completely cured. Eleven patients (55 %) benefited despite incomplete healing of the ulcer. With three of our patients we have lost contact. CONCLUSIONS Even though the number of patients in our study is not large, we have achieved remarkable results with the combined algorithm of venous ulcer therapy. We start the healing process with compressive sclerotherapy and when this kind of therapy does not bring about the expected effect, we continue with Maggot debridement therapy. This combination of therapeutic modalities appears to be very effective and efficient (Fig. 2, Ref. 16).

The results of 1 day surgery in proctological practice

Abstract In the last 9 years the authors have operated on 745 patients with proctological problems in the out-patient department under local regional or caudal peridural anaesthesia. These included 432 haemorrhoidectomies, 29 lateral internal sphincterotomies, 166 anal stretches, 56 trans-sphincteric fistulas, 41 ischiorectal abscesses and 21 rectal prolapses. Patients were discharged home after a mean stay of 5.3 h. About 6.4% (48) of operated patients had some problems in the first 24 h (bleeding, pain, discharge, retention of urine). All patients were checked after 3, 7 and 14 days. About 87% of patients were satisfied with their surgical treatment. Most proctological diseases could be operated on as 1 day surgery cases safely. Day surgery is an attractive alternative to impatient surgery as it lowers cost without increasing morbidity.

Transoral application of EEA stapler after subtotal oesophagectomy.

OBJECTIVE To describe a new transoral technique of cervical oesophagogastric and oesophagojejunal anastomoses using the EEA stapler. DESIGN Prospective clinical study. SETTING University Hospital, Bratislava, Slovakia. SUBJECTS Two patients with squamous cell carcinoma of the middle and distal third of the oesophagus. INTERVENTIONS Transhiatal subtotal oesophagectomy without thoracotomy, and cervical oesophageal anastomosis by transoral EEA stapling. MAIN OUTCOME MEASURES Morbidity and mortality. RESULTS Transoral stapling was successful in both patients with no anastomotic leaks. The patients were discharged on the 14th and 21st postoperative days, respectively. CONCLUSIONS Transoral stapling of the cervical anastomosis gave good results in two patients. More development and evaluation are needed.

Reccurent bleeding from Meckel's diverticulum - surgeon's challenge.

The authors of this paper want to share their experience with diagnostic and therapeutic problems in case of chronic small intestinal bleeding from Meckels diverticulum, which ended with acute episode of massive gastrointestinal bleeding requiring emergent surgery.Despite the progress achieved in diagnosing the sources of gastrointestinal bleeding, the diagnosis of small intestinal bleeding is very frequently beyond the ability of making it right, and thus emergent surgery is often the only possibility of saving the patients life on the one hand, and allowing stating the correct diagnosis on the other (Fig. 1, Ref. 6).

Role of human papilloma virus infection and oral-genital contact in oral cancer ethiopathogenesis.

Head and neck squamous cell carcinoma and especially oropharyngeal squamous cell carcinoma is a very significant cause of morbidity and mortality. The majors risk factors of these tumors are tobacco smoking, chewing and alcohol consumption. But there is a group, non-drinking and non-smoking, patients with oropharyngeal squamous cell carcinoma. In these patients may be oral-genital contact and human papillomavirus infection the major risk factor for oral carcinogenesis. Aim of this review is to point out this fact in correlation with clinical studies and clinical conclusion for medical practice (Fig. 1, Ref. 32).

Rare conditions of gastrointestinal bleeding.

The aim of this paper is to analyze and discuss an infrequent topic, i. e. rare conditions of gastrointestinal bleeding.Bleeding from gastrointestinal system is a common cause of acute abdomen and the most frequent causes are generally known.Clinicians, first of all emergency medicine staff, surgeons and internists (gastroenterology specialists), general practitioners, or less frequently other specialists, sometimes meet with less common causes of acute or chronic bleeding from gastrointestinal organs. It is quite important to be aware of the possibility the bleeding being caused by some rare condition, which is not so often met in medical practice, because of their great diagnostic and therapeutic problem. The low index of expectation of such a rare etiological unit could be the reason why destiny of such patients can be extremely problematic and why clinicians may fail at management of these patients (Fig. 4, Ref. 8).