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Biomedical subjects

I Rozsos

Publications and source records attributed to I Rozsos.

At least 19 recordsLinked to original sources
PubMed2000

[Cholecystectomy with microlaparotomy and innovation of the ROMICRO R-set].

Gallstone disease is a major health problem, 10-15% of the adult population of Hungary are afflicted, and each year about 20,000 cholecystectomies are undertaken. There are two essential and widely accepted methods for the removal of gallbladder: conventional open cholecystectomy and laparoscopic cholecystectomy. Since 1988 the authors worked on a new surgical technique and equipment (ROMICRO R-set) for cholecystectomy using a single 2-4 cm microlaparotomy inside the infrasternal triangle. They demonstrate the innovation's phases of this new technique and ROMICRO R-set. Till 1999 more than 7000 microlaparotomy cholecystectomy were undertaken in Hungary. The benefits of laparoscopic cholecystectomy can be achieved with less expense and risk by microlaparotomy cholecystectomy. Most patients are often not willing to accept conventional open cholecystectomy, but the microlaparotomy cholecystectomy alternative is unknown to the public and to most physicians. All countries have experienced a fast growth in their health care expenses over the last decades which will continue in the future. But spending an ever larger share of our nation's resources on health care cannot be afforded. As a consequence, making choices will became more and more unavoidable, also in galltree surgery. Therefore economic evaluation compares the different techniques of cholecystectomy necessary not only in terms on surgical and on patients aspect, but also in term of costs.

Adult↗
PubMed1998

[Common abdominal emergency cases a the end of the 20th century].

Despite the marked decline in mortality of acute appendicitis over the past 50 years, the rate of perforation and negative appendectomy remains unchanged. The most effective means of controlling human suffering and economic cost associated with appendicitis is the identification and correction of factors responsible for perforation. Negative appendectomy rates have been relatively stable over the decades. Progress in diagnosis and diagnostic imaging still has not provided a foolproof non-invasive test to rule out the presence of appendicitis accurately. Clinical assessment determines the treatment and the clinical observation should be done by the surgeon. The use of H2-receptor antagonists has not reduced emergency admission of patients with duodenal ulcer. Mortality associated with perforated peptic ulcer remains high in spite of advances in surgical management. The patients with acute obstructed cholecystitis usually reach the surgeon with more advanced stage of the disease which results in increased morbidity and subsequently increased cost for undergoing cholecystectomy. If the patient develops severe diffuse peritonitis, the mortality could reach 30%. This is in spite of aggressive surgical treatment, potent antibiotics, modern intensive care and diagnostic procedures. To improve the results, more advanced treatment to avoid the development of peritonitis and more effective antibiotics to control the inflammation will be needed.

Abdomen, Acute↗
PubMed1998

[A case of spontaneous rupture of a cervical hematoma causing respiratory insufficiency].

The authors review a case of a patient with spontaneous cervical hematoma without trauma. The similar cases of the international literature, the causes (local and systemic vascular disorders, inflammatory and neoplastic disease of the surrounding tissues) are summarized and the importance of the computerized tomography in connection with the described case is emphasized.

Aged↗
PubMed1998

[Minimally invasive surgery in the management of Mirizzi syndrome].

An impacted gallstone in the cystic duct or in the Hartman's pouch with subsequent inflammation and edema resulting in extrinsic compression of the common hepatic or common bile duct with obstructive jaundice is known as Mirizzi's syndrome. The Mirizzi syndrome presents a difficult surgical challenge because of the dense adhesions and edematous inflammatory tissue cause distortion of the normal anatomy in Calot's triangle, leading to a great risk of bile duct injury. Therefore, a controversial issue the surgical strategy for the treatment of Mirizzi's syndrome since the introduction of laparoscopic cholecystectomy. The present study was undertaken to elucidate the applicability of microlaparotomy cholecystectomy in the management of Mirizzi's syndrome. Between December 1990 and December 1996 we operated on 16 patients for Mirizzi's syndrome. In 14 of these patients had type I of Mirizzi's syndrome, the remaining 2 had type II of this syndrome. In 13 of these patients the gallbladder were removed using 3-4 cm single microlaparotomy incisions. In the remaining 3 patients using 5.5 cm, 8 cm as well as 12 cm long incisions for the removal of the gallbladder, and placement T tube because of stenosis of the common hepatic duct, suture repair of the choledochal defect as well as choledochoplasty. In 12 of these patients the microlaparotomy cholecystectomy were done within 7 days of the onset of the obstructive cholecystitis. The postoperative stay of these patients were uneventful and they were discharged home 3 days after surgery. We conclude that early operation of the obstructive cholecystitis with Mirizzi's syndrome eliminates the serious stricture and fistula formation of Mirizzi's syndrome.

Adult↗
PubMed1998

Subacute ischemic lesions in jejunal loops used for esophageal reconstruction.

Subacute, postoperative ischemic lesion in small bowel loops is a poorly defined phenomenon. The authors observed this rare complication with full or partial regeneration in jejunal loops used for esophageal reconstruction. Beside the case reports, they discuss the cause, the mechanism, the possible prevention and correction of this rarely reported complication.

Aged↗
PubMed1997

[Cystic duct syndrome and minimally invasive surgery].

Cholecystectomy is an established successful operation which provides total relief of presurgical symptoms in up to 85% of patients. About 5% of patients after cholecystectomy experience severe episodes of upper abdominal pain, similar to those that they had prior to cholecystectomy. These so called postcholecystectomy syndromes may be due to biliary strictures, retained biliary calculi, cystic duct stump syndrome, stenosis or dyskinesis of the sphincter of Oddi. Postcholecystectomy symptoms caused by cystic stump and gallbladder remnant had been described early in this century and several papers have been published on the topic. During recent years laparoscopic cholecystectomy became popular but we have not found in the literature the mention of either that it could cause cystic duct stump syndrome or it could be used for its treatment. During the last seven years in 8 patients we found gallbladder remnants or cystic duct stumps causing their symptoms. Among the 8 patients 3 had laparoscopic and 5 classic cholecystectomies. After incomplete cholecystectomy we usually find that the cystic duct stump and the Calot triangle embedded in inflamed scar tissue. For this reason the surgical risk is to high with laparoscopic surgery to reoperate for these pathological changes. In all 8 cases the pathological cystic duct stumps and gallbladder remnants were removed using 3-4 cm single microlaparotomy incisions. The postoperative stay of these patients were uneventful and they were discharged home 2-3 days after surgery.

Adult↗
PubMed1997

Internal carotid stent implantation with angioscopic control.

Stent implantation is a method, which is being used more and more often, mainly in the field of peripheral arteries, but coronary stent implantation is also well-known. The authors apply this procedure for patients, who besides the carotid bifurcation stenosis also suffer from the internal carotid stenosis in a longer section of the artery. The indication are as follows: 1 in the case of internal carotid stenosis in a longer section we assure the flow with the help of carotid thrombendarterectomy and slove the run-off with balloon catheter dilatation and stent implantation. 2. in the case of a stenosis in a short section we use stent implantation to avoid dissection of the intima. With each intervention we perform the carotid bifurcation thrombendarterectomy. The authors made the first intervention 15 months ago, since then we have performed 17 stent implantations. One of the 17 patients developed a temporary stroke (TIA). This is a new method, further cases are needed for long-term experiences. Intervention under eye-control can be carried out with more confidence. As regards to the post-operative medicinal treatment, the administration of thrombocyte aggregation-blockers or heparinoid preparation (e.g.: PPS-SP 54) after the stent implantation has become a routine therapy. Summarized the foregoing, these cases constitute about 10-15% of all carotid operations, therefore the authors would like to make it clear, that this is not a routine method, but a possibility, strictly respecting the above-mentioned indications.

Aortic Dissection↗
PubMed1997

Micro and minilaparotomy surgery in the treatment of Mirizzi's syndrome.

The Mirizzi's syndrome presents a difficult surgical challenge because the dense adhesions and edematous inflammatory tissue cause distorsion of the normal anatomy in Calot's triangle, leading to a great risk of bile duct injury. Therefore, a controversial issue the surgical strategy for treatment of Mirizzi's syndrome since the introduction of laparoscopic cholecystectomy. The present study was undertaken to elucidate the applicability of microlaparotomy cholecystectomy in the management of Mirizzi's syndrome.

Bile Duct Diseases↗
PubMed1997

The surgical technique of microlaparotomy cholecystectomy.

The authors are demonstrating the surgical technique of microlaparotomy cholecystectomy and the categorisation of minilaparotomy. In their 1575 unselected cases operated for cholelithiasis and their complications, 94% had microlaparotomy cholecystectomy (MLC: less than 4 cm single skin incision). 5.4% required modern minilaparotomy (4 to 6 cm incision) because of choledocholithotomy or bilioenteric fistula: and 0.3% had classical minilaparotomy (6 to 8 cm incision). In only 0.3% they converted into an incision longer than 8 cm.

Arteries↗
PubMed1997

The removal of cystic duct and gallbladder remnant by microlaparotomy.

The so called "Postcholecystectomy Syndrome" may be due to various pathological biliary causes. While a very small number of patients may have symptoms attributable to problems related to cholecystectomy. Twenty five patients underwent a second operation on the bile ducts after cholecystectomy, cholecystostomy and choledocho-duodenostomy by micro and minilaparotomy between December 1990 and December 1996. The second most common causes for reexploration were cystic duct and gallbladder remnants (16%). After incomplete cholecystectomy they usually find that the cystic duct stump and the alot triangle embedded in inflamed scar tissue. For this reason the surgical risk is to high with laparoscopic surgery to reoperate for these pathological changes.

Bile Ducts↗
PubMed1997

The basic and the practical way of treating of diabetic foot.

Developed atrophic ulcer and infected alterations of the foot, as a result of complications of DM, according to the available literature, 40-80% of the performed amputations are not necessary even though in practice they do occur. In our practice even the severely altered and infected extremities which look serious are considered as primarily a savable extremity if the conditions are present. The state of circulation of the extremity and the condition of the limb are evaluated carefully, and the sugar level is monitored continuously. According to our experience, every progressing process, the alteration of the host sugar level can be held as responsible. That is why after the early therapeutic period, careful monitoring of the insulin level is a priority. At our out-patient department we are daily confronted during routine wound inspections by cases of necrotizing osteomyelitis which to our experience are doomed for removal. In 1995 at the out-patient section of the vascular surgery ward we saw over 9000 patients, more than 500 of which included patients with diabetic angio/neuropathy complications. The nursing of this group of patients during that year only to 33 large vessel reconstructive operations and 26 cases of amputations. We conclude from the above statistics that not all cases of osteomyelitis cases should lead to limb amputation. Due to the nature of the condition, careful monitoring with early preventive measures, plus family support play a crucial role in the outcome of the condition. This complex process is better handled if special diabetic centres were set-up to monitor patients progress.

Ambulatory Care↗
PubMed1996

[Micro- and modern minilaparotomy in biliary tract surgery. (Remembering János Balassa)].

The author remembering "János Balassa" points out how his legacy can be used as a moulding energy for surgery in our present time. After analysing the personality and values of Balassa the results of 1357 consecutive unselected cholecyatectomies and choledocholithotomies performed in micro- and modern minilaparotomy are analyzed. The issue of mini laparotomy has not been defined yet, so that abdominal incisions from 3 to 10 cm are also called mini laparotomy. The author suggested in 1992 that the term microlaparotomy be applied to incisions less than 4 cm, modern mini laparotomy from 4 to 6 cm, and conventional mini laparotomy from 6 to 10 cm. In contrast to other mini laparotomies he uses a vertical incision in the infrasternal triangle. From the functional anatomical point of view this approach is advantageous because it is situated above Calot's Triangle and Moosman's area and results in reduced postoperative pain. Special lighting retractors have been developed for excellent exposure and illumination of the surgical field to make the operation safe. Micro and mini laparotomies can be used for both early and late reoperations on the biliary system and also for the conversion of laparoscopic cholecystectomy. At our department conventional, laparoscopic and micro laparotomy cholecystectomy are used. Considering both surgical and economic factors, the author has found that micro laparotomy cholecystectomy offers better results than conventional and laparoscopic cholecystectomy.

Biliary Tract Diseases↗
PubMed1995

[Special complications of cholecystectomy performed by micro- and modern mini-laparotomy].

There is no data on the special complications of micro (less than 4 cm incision) and modern mini laparotomy cholecystectomies (4.1-6 cm incision). Out of 710 non selected patients, 643 micro laparotomy cholecystectomies were performed and 61 modern mini laparotomies due to choledocholithiasis. On three occasions, conventional mini (6.1-10 cm) laparotomy was performed and in another three, conventional laparotomy (over 10 cm incision) was executed. Intraoperative bleeding was encountered in 15 cases (2.1%) while accidental hepatic duct clipping occurred in one case (0.1%). Damage to the bile duct did not occur in any case reported. Postoperative bleeding was reported in 8 cases (1.1%) and delayed bile leakage was reported in 10 cases (1.4%). Special complications reported as a result of pathological alteration in the bile tract as follows: Intraoperative bleeding encountered during simple cholecystectomy-1% but cholecystectomy due to obstructive cholecystitis 3.8%, also caused by intraoperative bleeding. Delayed bile leakage in simple cholecystectomy was not observed, but after cholecystectomy for obstructive cholecystitis it encountered in 3.4%. Special complications resulted in four early reoperations (0.5%). Two other patients were re-operated within three weeks, independent of special complications. The percentage of both intra and postoperative complication was significantly higher in obstructive cholecystitis with an operative delay of 11 or more days.

Adolescent↗
PubMed1995

[Cholecystectomy performed by macro- and modern mini-laparotomy].

The conventional and laparoscopic cholecystectomy is as already every day utilized method, the operation procedure is well developed and the instruments used allow a reliable operation. The cholecystectomy performed by minilaparotomy is not yet a widespread procedure, since there is no established method and the instruments needed are not readily available, as well as the fact that special complications' rates is not yet well known. In order to further elaborate on the procedure and to demonstrate it's true value, 710 micro- and modern minilaparotomies, without exclusion or selection, were analyzed and the operation procedures were then summarized. The operations were completed with microlaparotomy (smaller than 4 cm incisions) in 643 cases (90.6%) with modern minilaparotomies (4.1-6 cm) in 61 cases (8.6%), with conventional mini (6.1-10 cm), and the incisions longer than 10 cm with conventional laparotomies in 3-3 instances (0.4-0.4%). We performed a complete cholecystectomy in 97.2%, a longer cystic stumps was left in 1.7%, subtotal and partial cholecystectomies in 0.7% and 0.3% respectively. In 69 of the cases (9.7%) simultaneous choledocholithiasis was discovered and resolved. 21.2% of the operations were termed as difficult. 2/3 of the intra and postoperative complications as well as early reoperations occured in cases where they followed a delayed operation of obstructive cholecystitis. One patient was lost (0.14%) due to non-surgical complication. These experiences show that cholecystectomy performed by micro and modern minilaparotomy is a realistic alternatives to the conventional and laparoscopic cholecystectomies.

Adolescent↗