Our local experience with the surgical treatment of ampullary cancer

Background

The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999.

Methods

Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery.

Results

When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%.

Conclusion

In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates.

     

Our experience with surgical treatment of primary cancer of the gallbladder

Witkin 1980-1988, 42 patients (4 males and 38 females) were operated for the gall-bladder cancer; it makes 2.9% of the patients who underwent cholecystectomies. Average age of female patients was 65 and males--71 years. No typical complaints were revealed making possible an early diagnosing of the gall-bladder cancer. The far advanced stages of this cancer were found in 41 cases. In i case no macroscopic features of the cancer were found. Cancer was diagnosed by means of histopathological examination. One patient (woman) survived more than 3 years after operation; 3 women survived more than 1 year. Average survival is 4 months.     

Long-term treatment with clozapine on aging mice.

To further clarify the relationship between central neurotransmitter systems, organ function and aging, we used mice to study the effects of long-term administration of the antipsychotic agent clozapine (10 and 20 mg/kg) on some age-related behavioral and organ-function tests. Compared to controls, clozapine-treated mice weighed less, had lower white-cell counts in peripheral blood, and had a shorter lifespan. Hexobarbital sleeping time of the clozapine-treated mice was elevated at 12, 16, and 20 months and decreased at 24, 28, and 32 months of age. Clozapine-treated mice had higher locomotor-activity scores (behavioral supersensitivity) at varying intervals from 12 to 24 months of age, but not at 28 and 32 months. A significant change in the total white-cell number in drug-treated mice compared to controls was also first noted at 24 months and the difference progressively increased at 28 and 32 months. These observations indicate that age may be a major factor in the level and even direction of responsiveness to longterm administration of antipsychotic agents like clozapine.     

Our clinical experience with fibula free flap

Oral cancer incidence in Hungary is strikingly high, even by international standards. In most cases the tumours are to be treated in advanced stage. Hence it follows that we are often forced to remove a part of the mandible, too. We usually use a fibula free flap to reconstruct the bone deficiency. In this paper we report on our clinical experience with fibula free flap.     

Our experience with reconstruction of the breast

Breast reconstruction in female patients undergoing mastectomy for breast cancer (17 patients) or benign breast disease (2 patients), and malformation of breast due to asymmetry (19 patients) was started in 1983. Mastectomy in 10 patients was performed because of the cancer, and in 17 patients due to benign breast disease. Age of patients ranged from 15 to 58 years. Breast reconstruction was performed within 1-12 years following mastectomy. Two different methods of reconstruction were applied: a) flap graft of patient's own skin and muscle from latissimus muscle of the back with silastic prosthesis implanted under graft (12 breasts), and b) implantation of the prosthesis only (28 breasts). Correction of the opposite breast was also made in 3 patients. No complications are seen up-to-date. Esthetic results are also satisfactory.     

Our experience with virtual endoscopy of paranasal sinuses

The main goal of our work was to evaluate advantages and disadvantages of virtual endoscopy (VE) techniques in routinely diagnostic and preoperative management of patients with various sinus diseases or head traumas in our practice. Fly-through algorithm was performed using an Xeon based workstation on data sets created from axial CT images acquired from 320 patients with various paranasal sinus disorders. Images were created using Siemens Somatom Emotion 16 continiously rotating helical CT scanner and archived in DICOM format. In comparison with real endoscopy, the VE has several advantages. It is completely non-invasive. It is possible to repeat the same procedure several times, therefore it may be a valuable tool for training. Interactive control of all virtual camera parameters, including the field-of-view is possible. Endoscopic viewing as opposed to real endoscopy is not restricted to the spaces defined by inner surfaces. The viewer may penetrate the walls and see the extent of lesions within and beyond the wall as well as the adjacent anatomic structures. Virtual endoscopy also has a potential to stage tumors by determining the location and the extent of transmural extension.     

Our experience with combined procedures in aesthetic plastic surgery

The instep flap needs neither muscle nor a transposition base for survival or innervation. It can be transposed as an island fasciocutaneous flap either on the medial or lateral plantar neurovascular bundles or both, and it can be transferred also as a free flap from the opposite foot. Four cases demonstrating the use of the flap as an island and free flap are presented with follow-up ranging from 1 to 2 years. The absence of muscle in the flap provides greater stability of the heel reconstruction and results in a lesser secondary defect. Sensation in the flaps is diminished but adequate for long-term function, but hyperkeratotic reaction remains an unpredictable problem. The ability to transfer the flap as a free transfer widens the scope of the flap to reconstruct both heel and forefoot defects where local instep tissue or vascularity are inadequate for local reconstruction. The secondary defect, particularly when no muscle is included in the flap, has been minimal.