Surgical prevention of paralytic dislocation of the hip in cerebral palsy

Summary Paralytic dislocation of the hip in cerebral palsy may be prevented by soft tissue surgery and the results of two procedures are reported. Twenty hips were treated by adductor tenotomy alone and this was unsuccessful in every case. An alternative method was carried out in 42 hips in 25 patients. The procedure combined adductor tenotomy with release of the hip muscles including iliac crest resection, tenotomy of the rectus femoris, recession of the iliopsoas and, when necessary, either release or transposition of the knee flexors. This was much more successful in decreasing migration of the femoral head.

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Résumé Dans la paralysie cérébrale la luxation de la hanche peut être efficacement évitée grâce à des interventions chirurgicales portant sur les parties molles. Nous avons étudié les résultats de deux types d'opération: la ténotomie des adducteurs et cette même opération associée à la désinsertion de la hanche (avec transposition du psoas sur la partie proximale de la capsule) et éventuellement avec allongement des fléchisseurs du genou ou transposition de ceux-ci sur la partie distale du fémur. Soixante-deux hanches ont été opérées chez 45 malades. Les résultats de la ténotomie isolée des adducteurs ont été insuffisants dans les 20 cas opérés (âge moyen au moment de l'opération, 4, 5, ans, recul 6,5 ans). Les résultats du deuxième type d'intervention ont été meilleurs dans les 42 hanches opérées, le pourcentage migratoire de la tête fémorale a été réduit de 45% (âge moyen lors de l'opération 7 ans, recul 5 ans). Plus de la moitié des malades étaient capables de se déplacer.

     

Incidence of IDDM during 1988–1992 in Zagreb,Croatia

Summary The objective of this study was to determine the incidence of insulin-dependent diabetes mellitus (IDDM) in the population of Zagreb, Croatia, during 1988–1992. A centralized diabetes registry was the primary source of data, while secondary sources were used to assess ascertainment. A total of 282 new cases of IDDM were diagnosed in the study period, the primary and secondary sources identifying annually 93–100% of the cases. The annual incidence rate ranged from 5.6 per 100,000 to 6.6 per 100,000. Early fatality in persons older than 50 years was the major cause of underascertainment. The incidence peaked in the 10–14 years age group (12.4 per 100,000), and remained stable after age 24 years. Males had a significantly higher incidence in the 5–9 and 24–44 years age groups. In the 45–54 years age group, females had a significantly higher incidence. No seasonality was observed. Despite the war conditions in Croatia, the low overall IDDM incidence rates did not change significantly during the study period.Abbreviations IDDM Insulin-dependent diabetes mellitus - DKA diabetic ketoacidosis     

An external approach without tracheotomy for submucosal cordectomy with laterofixation for bilateral abductor paralysis of the vocal folds

There are numerous surgical procedures now available to manage bilateral abductor paralyses of the vocal folds. These procedures have various success rates but mostly do not offer reliable and predictable postoperative results, and usually require ,tracheotomy. The technique described in this report is based on a trial study to obtain a safe airway for an affected patient and avoid tracheotomy, if possible. Submucosal cordectomy was used with lateral fixation of one vocal fold and preservation of the arytenoid. The procedure was performed by using continuous intravenous anesthesia, which does not require intubation of the patient's airway. Seven patients were operated with this technique with excellent postoperative results. The glottal airway was largely improved in all patients, with only minor temporary complications.     

Isolated hydatid cyst of the adrenal gland

Hydatide disease of the adrenal gland is extremely rare, even in disseminated disease. Isolated cyst of the gland is even more rare. Only 9 of such cases seem to have been described so far. We present a 49 year old woman in whom a hydatide cyst of the right gland was found during the investigation for the dull pain in the area. She was successfully operated. Hydatide etiology was confirmed at operation and by histology. She had an uneventful recovery. The preoperative pain disappeared postoperatively.     

Diverticulum of the stomach

Gastric diverticula are very rare and usually asymptomatic diseases. Clinical symptoms may include haemorrhage, mild discomfort and pain in upper abdomen. They are most frequently diagnosed incidentally during X-Ray examinations. In symptomatic diverticulum of gastric fundus was diagnosed roentgenographically and endoscopically and was successfully cured surgically.     

Vaginoplasty in male to female sex change operations

Vaginoplasty presents the main procedure in one-stage male to female sex reassignment surgery. Our new vagina consist of two parts: a long vascularized urethral flap and a pedicled island tube skin flap serrated from the penile skin. The urethral segment of the vagina plays a major role, giving the vagina depth, width and providing moisture. In the period from January 1989 to August 1995, 89 patients aged 18 to 56 years underwent surgery. The follow-up ranged from 3 months to 6 years (mean 4.1 years). Satisfactory cosmetic and functional results were obtained in 86% of cases.     

Angiographic analysis of the tensor fascia lata vascularized flap

Vascularisation of the flap of tensor fasciae latae originates from the ascending branch of the lateral circumflex femoral artery which enters through the medial side of fascia lata tensor as a dominant branch. Knowing the vascular and characteristics of a vascular peduncle is of great importance while taking the flap, so knowing the site of the source of lateral circumflex femoral artery diameter at the source, the number of the terminal branches and the number of ascending branch anastomoses of lateral circumflex femoral artery are the basic significance for successful taking of the flap and its clinical application. Our investigations were done on clinical material, and the study was based on investigations of angiographies of the femoral artery. Measuring the diameter in the source of ascending branch we found that it was 33 mm while the diameter in the bifurcation of the terminal branches of ascending branch was 2.41 mm in average. The length of vascular peduncle of ascending branch was 68.88 mm in average. Vascular peduncle of the flap of tensor fasciae latae has appropriate length and diameter for microvascular anastomosis.     

Surgical treatment of toxic adenoma

In the period ranging from 1985. to 1994. a total number of 86 patients have been treated for toxic adenoma (TA). Hyperthyroidism was more often present in males (70.83% versus 51.61%) and in enlarged adenomas (more then 2 cm in diameter). Pathohistologic type of adenoma influenced degenerative changes. Three carcinoma have been observed, two papillary and one follicular. Surgical treatment is the method of choice. Complications are rare (3.49%) and mild.     

Overview of the surgical importance of variations in the hepatic artery

Hepatobiliary and gastric surgery greatly depend upon knowledge and recognition of origin, relations and course of the hepatic artery. This paper presents the main variants of the arterial vessels in the hepatoduodenal ligament, with a concise review on their clinical relevance. Special attention was drawn to the aberrant hepatic arteries, which are found in nearly half of the cases, and to the macro- and microvasculature of the common bile duct.     

Local interferon therapy for lip carcinoma

In a prospective non-randomized study 21 patients with lower lip squamous cell carcinoma were treated with human natural leukocyte interferon (HNLI). The response rate was measured by a size reduction of more than 25% and was 81%. A complete response rate was considered to be a cure according to histopathological and clinical findings and was 48%. The response rate of six lower lip squamous cell carcinoma cases treated with recombinant interferon alpha 2c was 67% and the complete response rate was 17%. Three patients with basal cell carcinoma of the upper lip were also treated with HNLI. All three patients were cured, as determined by histopathological and clinical findings. These findings indicate that interferon can be a useful alternative therapy for lip carcinoma either with or without surgery.