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The acute abdomen is a life threatening condition, its proper diagnosis and treatment is a great challenge until today in surgery. The authors aim to present the diagnostic difficulties in four cases of acute abdomen caused by large benign ovarian tumors. Vast majority of benign ovarian tumors are recognized accidentally through physical examination, X-ray and ultrasonography of the pelvis, abdominal operation is carried out for other reasons or investigations for acute abdominal pain. The case history, physical examination and radiological procedures do not always lead to the correct diagnosis. The authors diagnosed the disease through laparotomy, and an adequate operation was carried out subsequently. Following the operation, all four patients left the hospital in good condition.

Primary malignancies in the small intestine are relatively rare. There are no specific methods to find these tumours in early stage. The authors report a case of a primary T-cell lymphoma in the small bowel that caused diagnostic challenges. A 66-year-old woman presenting with abdominal pain and and a palpable mass in the left upper quadrant of her abdomen was admitted into the hospital. Blood tests, endoscopic examinations, ultrasonography and CT scan could not reveal a definitive diagnosis. While a small bowel follow through examination demonstrated an entero-enteral fistula, its exact position could not have been determined. Consequently, an exploratory laparotomy was carried out, and a tumour was found involving the small bowel loops. The involved portion of the small intestine (with the fistula) was resected, and a side-to-side small bowel anastomosis was performed. Histological and immunohistochemical analyses revealed a primary T-cell lymphoma of the small bowel. There was no evidence of metastatic disease at the time of surgery. The patient received adjuvant chemotherapy, but three months later multiple lung metastases were detected. Small bowel malignant tumours cause significant diagnostic difficulties. Therefore, diagnosis and adequate treatment are usually delayed for some weeks. In the future, capsule endoscopy could help in the diagnostic work-up. Nevertheless, surgical exploration and resection of the tumour will be necessary for the correct diagnosis and treatment.

The posterior mediastinum is the usual location of enteric cysts. They can be located at any part of the posterior mediastinum adjacent to the oesophagus, but communication with that structure is rare. Approximately 60 percent of the cysts occur in infants less than one year of age, and symptoms of tracheal or oesophageal obstruction are common. The cysts usually contain clear, colorless mucoid fluid. The authors describe here a successfully treated enteric cyst with an unusual, retroperitoneal location, which presented in an adult.

247 elective rectal operations were performed between 1st of Jan., 1996 till 31st of Dec., 2001 in our surgical department. The observation period was divided into one 4-year and one 2-year period. 148 operations were performed in the first and 99 in the second period. In the second period some personal, methodical and technical changes occurred. Age and sex distributions were similar, and the groups were comparable. The early postoperative mortality rate decreased from 9% to 4%. Due to the double stapling technique the rate of anterior rectal resections increased from 40% to 69% and the rate of abdomino-perineal rectal extirpation decreased from 43% to 23% in the same time. Large differences were found in the rate of palliative stoma performing operations, the rate decreased from 16% to 8% in the second period, so the quality of life of the patients improved. The operative time, the length of hospital stay and the rate of blood transfusions decreased as did the rate of postoperative infections. The new quality program improved the results significantly.

The authors present that 247 elective rectal operations were performed between 1 January, 1996 and 31 December, 2001 in their surgical department. The examined 6 years were divided into a 4-year and a 2-year period. 148 operations were performed in the first and 99 in the second period. Beside personal changes, methodical and technical modifications were introduced in the second period. Distribution of age and sex was similar, and the groups were comparable. The early postoperative mortality rate decreased from 9% to 4% during the examined time. Due to the double stapling technique, the rate of anterior rectal resections has increased from 40% to 69%, and the rate of abdomino-perineal rectal extirpation has decreased from 43% to 23%. Considerable difference was found in the rate of palliative stoma-creation operations, since the 16% decreased to 8% in the second period, so the quality of life of patients has improved. The operative time, the hospital stay of the patients and the rate of operations with blood transfusion decreased. The different types of postoperative infections decreased due to the new methods.

Aim: Subtotal colectomy (STC) involves an extended resection of the large bowel over the splenic flexure. In a period of 8 years, a total of 72 subtotal colectomies (STC) were performed for the treatment of large bowel obstructions or symptomatic stenosis caused by cancer of the left colon. A primary ileocolic latero-terminal anastomosis was made in each case. The aim of study was to evaluate the late results of procedure., Patients and Methods: In a non-prospective, non-randomized study of 23 of the total of 72 STC cases, authors investigated the postoperative quality of life, the changes in the intestinal bacterial flora, and signs of a nutritional deficiency or of an accelerated bowel transit., Methods: 1) H2 excretion test, 2) UDCA-PABA and 3) Schilling test for contaminated small bowel syndrome and bowel transit time, studied by means of a 4) barium meal and 5) radiopaque marker passage, and 6) registration of the number of defecations/day., Results: The laboratory findings were in the normal range in each case. The daily number of defecations gradually decreased during the 3 months after the operation (mean 1.9/day). The lack of an ileocoecal valve did not result in bacterial overgrowth in the small bowel and the investigations did not reveal contaminated bowel syndrome. The oro-anal transit time was reduced in only four cases. Three months postoperatively, no patient had a deteriorated quality of life., Conclusions: STC offers 1) one-stage treatment for colonic obstruction in emergency surgery, 2) tumour removal with sufficient oncological radicality, and 3) primary reconstruction of the digestive tract, with a safe ileocolic anastomosis even in emergency cases. The follow-up study of 23 of the patients proved that loss of 60-80% of the colon did not cause any symptomatic disturbance of the digestive functions. The quality of life after surgery was normal, the slightly increased number (mean 1.9) of daily defecations was acceptable, and bacterial colonization of the small bowel did not occur.

Method: Between 1997 and 2000 the authors performed 110 fine-wire localized breast biopsies in patients with nonpalpable suspicious lesions., Results: 108 target lesions (98.1%) were accurately excised during the initial surgery. Overall, 56 lesions were malignant, among these cases 50 invasive carcinomas and 6 DCIS were found. Breast conservation was achieved in 48 patients (88.5%), simple mastectomy with axillary lymph node sampling was performed in 8 cases. 86% of the invasive malignant lesions belonged to the good prognostic subgroup of the Nottingham Prognostic Index., Conclusion: There in an importance of the close cooperation between radiologist, surgeon, pathologist and oncologist in the treatment of nonpalpable preclinical breast carcinomas.

Background: Acetylsalicylic acid (ASA)-induced gastric injury is reduced when ASA is administered along with phosphatidylcholine. The hydrolysis of endogenous phosphatidylcholine leads to the production of betaine, which may participate in the maintenance of cellular homeostasis. The present aims were to investigate the effects of exogenous betaine and its palmitic acid complex (betaine-palmitate) in the protection of the gastric mucosa in ASA-induced subacute damage., Methods: Repeated doses of ASA were given intragastrically to male Wistar rats. Control rats were given vehicle only, while treated animals were challenged with ASA or with ASA along with betaine, palmitic acid or betaine-palmitate. The gastric mucosa was examined after 3 days and the nature of any microscopic mucosal injury was assessed by histology. The extent of macroscopic damage, changes in permeability (assessed by Evans blue method) and tissue ATP concentrations were determined in separate series., Results: ASA induced a significant fall in the ATP content of the mucosa, which was not affected by the other drugs used in the study. However, the ASA-induced mucosal permeability increase could be completely reversed by betaine-palmitate supplementation. The extent of severity of the macroscopic and microscopic lesions was 33% and 2.45, respectively, for ASA, as compared with 15% and 2.2 for betaine, 14% and 1.9 for palmitic acid and 3% and 1.4 for betaine-palmitate., Conclusions: Betaine-palmitate affords a significant protective effect against ASA-induced injury, without influencing the ATP synthesis, and this suggests that the defence is due to its ability to prevent secondary damage.

The authors report a total of 62 middle and low third rectal cancer cases operated on by total mesorectal excision by the method of Heald. The oncological basis of this procedure is the horizontal regional metastatization of rectal cancer. The total mesorectal excision facilitates, the low anterior resections and preservation of sphincter with an ultra-low colorectal, or coloanal anastomosis using the double stapling technique. In the authors' experience, the "UltraCision" cutting-coagulating device permits an atraumatic, bloodless and oncologically correct dissection. Using the double stapling technique, we succeeded in 60% of our middle- and low-third rectal cancer patients to perform a sphincter preserving low anterior resection. In 9 (28%) of the low third rectal cancer patients, preservation of the sphincter was possible with oncologically correct anterior resection and an ultra-low colo-anal anastomosis. Three anastomotic insufficiencies occurred, two of them healed on lotion-suction drainage, and one on the application of transient protective ileostomy. The literature data suggest a lower local recurrency rate after radical rectal cancer surgery, if total mesorectal excision is performed.

This study was designed to determine whether oxygen-derived free radicals play a role in the pathogenesis of gastric mucosal lesions produced by haemorrhagic shock and reperfusion experimental model in the rat. Ranitidine (H2-receptor blocker) in different doses, allopurinol, an inhibitor of xanthine oxidase and SOD (superoxide dysmutase) pre-treatment were used against haemorrhagic shock and reperfusion induced gastric mucosal lesions. Altogether 67 rats were divided into seven different groups. The area of gastric mucosal lesions was measured, the activity of endogenous peroxidase was examined histochemically and histological grading was made. Evans blue was used to demonstrate the improved permeability of gastric mucosal membranes. Ranitidine, in high dose, allopurinol and superoxide dysmutase significantly protected against haemorrhagic shock-induced gastric mucosal lesions, against improved membrane permeability and peroxidation.

Primary malignant tumors of small bowels are relatively rare among the GIA-tumors. There are no specific methods to find these tumors in an early stage. Only the specific radiological examination (double contrast method or CT-scan) or sometimes the specific jejunoscopy can prove the correct diagnosis before the operation. Usually surgeons have to operate because of the emergency situation caused by primary malignant tumors of small bowel. A total of 21 patients were operated on for malignant tumors of small bowels since 1st January, 1986 till 31st December, 1995 (during 10 years). 13 of the 21 were urgent cases. 3 perforations and 10 mechanical bowel obstructions were the indications of the acute surgical procedures. The preoperative diagnoses were correct in the eight elective operations. Types of operations: 8 jejunal-resection, 11 ileal-resection, 1 Whipple-operation, 1 ileal-resection with right hemicolectomy. Peri-operative mortality rate was zero. Histological reports: 13 adenocancers, 2 leiomyosarcomas, 5 malignant carcinoids, 1 anaplastic cancer. Lymphomas and tumors of papilla Vateri were excluded from this study. Most of the patients had abdominal symptoms earlier than 8 months before the operations. Earlier diagnosis may give a better chance to operate these tumors in earlier stages, and it can give a better chance for the patients for longer survival.

Histamine release have been demonstrated in haemorrhagic shock. There are some observations that oxygen free radicals can cause histamine release. Oxygen free radicals play a role in the pathogenesis of gastric mucosal lesions. The goal of this study was to determine whether ranitidine or SOD and allopurinol pretreatment modify the histamine release during and after the haemorrhagic shock in the rat. In the anaesthetized rat 0.1 N HCl was instilled into the stomach and the rat was bled to reduce the blood pressure to 30 mmHg for 20 min. The shed blood was reinfused. Twenty min later the stomach was removed. The area of gastric mucosal lesions were measured, histological grading was made. Blood samples taken from the carotid artery were examined by radioimmunoassay (IMMUNOTECH) to determine the plasma histamine level. Plasma histamine level did not change significantly during the preparative surgery, but there was a significant increase of histamine level by the end of shock period. After the reinfusion of the blood the plasma histamine remained essentially at the same level for five min. Oxygen free radicals did not cause an important histamine release. By the end of the experiment the histamine level decreased dramatically. Ranitidine, allopurinol and SOD pretreatment provided significant protection against the gastric mucosal lesions. Allopurinol and SOD did not influence significantly the histamine level. Ranitidine caused significant histamine release immediately after the injection and every histamine value was significantly higher in this group except for the final value which was lower than the control one. The oxygen free radicals were not found as endogenous histamine releasers in this study.

The patients immuno-activity has a well-known importance for the outcome of postoperative complications. The authors evaluated the immuno-activity of 95 patients before selective, radical colorectal surgery: 1) 40% of the patients were anergic compared to healthy controls. 2) The incidence of wound infections was significantly higher in the anergic groups than in normal or hyperergic ones. 3) 25% and 50% decrease in wound sepsis has been observed in anergic and normal or hyperergic groups respectively after vaccination 7 to 10 days before operation with vaccine made of E. coli, Proteus, Klebsiella and Pseudomonas strains. The difference indicates the lowered immuno-reactivity on anergic patients.

Out of 279 cases of elective radical colonic surgery 109 complicated cases are dealt with. Most of them (66%) were caused by infection. The postoperative mortality came up to 10%. Three quarters of the postoperative deaths were caused by septicaemia and gastrointestinal bleeding. Some of the complications can be effectively cured. Others like peritonitis, anaerobic septicaemia, pulmonary embolism and uraemia have a high mortality rate and will in future require better methods of prevention and therapy.

This study was designed to determine whether oxygen-derived free radicals play a role in the pathogenesis of gastric lesions produced by hemorrhagic shock in the rat. Allopurinol (Zyloric), an inhibitor of xanthine oxidase (responsible for the formation of superoxide radicals) and MTDQ-DA (Kontrad), a synthetic antioxidant of dihydroquinoline type were used. In the anesthetized rat 0.1 N HCl was instilled into the stomach and the rat was bled to reduce the blood pressure to 30 mmHg for 20 min. The blood shed was retransfused. Twenty min later the stomach was removed. The area of gastric mucosal lesions were measured, the activity of endogenous peroxidase was examined histochemically and a histological grading was made. Both allopurinol and MTDQ-DA significantly protected against hemorrhagic shock-induced gastric lesions and peroxidation. These results suggest that oxygen-derived free radicals play an important role in the formation of gastric lesions produced by ischemia plus 0.1 N HCl.

From 1970-1982, 96 rectal and colonic anastomoses were performed by the stapler device SPTU. The results obtained were at least as good as anastomotic sutures made by hand.