Annales chirurgiae et gynaecologiae
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105 valve replacements with the Björk-Shiley tilting-disc prosthesis have been performed in 99 patients with an overall mortality of 12%. The hospital mortality for 73 single aortic valve replacements was 10%, for 24 single mitral valve replacements 13%, and for 5 double valve operations 20%. ⋯ The follow-up period of the first patients with aortic valve replacement is 4 1/2 years, and that of those with mitral valve replacement over 2 1/2 years. The most common late complication in patients with mitral valve replacement was a paravalvular leak (19%), whereas in patients with aortic valve replacement slight haemolytic anaemia (4%) and late thromboembolism (3%) occurred most frequently. 84 of the 87 survivors showed manifest clinical improvement in their preoperative status and increased exercise tolerance.
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One case of an ulcerating paraffinoma of the male mammary gland and another of the penis are reported. The former is the third and the latter the eighth of its kind described in the literature. Psychopathological features were associated with both cases, and additionally impotence with the latter. ⋯ Re-injection of paraffin later required total excision of the entire anterior thoracic skin and subcutaneous tissues and skin grafting. The penile paraffinoma was treated by complete excision and again subsequent skin grafting. Both the functional and cosmetic results of the latter were good.
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Children between the ages 1 to 3 years are particularly prone to burns by their constant desire to pull down containers of hot fluids. The resulting burns produce serious complications such as hypertrophic scars and scar contractures, which can be severe enough to cause growth disturbances. A series of 31 cases of these accidents resulting in the above sequelae was investigated. ⋯ Usually the scald could have been prevented by greater vigilance on the part of the parents. Once late complications have developed, excision of the scar tissue and subsequent skin grafting or other reconstructive procedure should be performed. However, in spite of satisfactory results, these complications have a tendency to recur during the growth period.
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A case of intussusception of the appendix caused by an adenovillous papilloma in the appendix is reported. The condition was combined with acute appendicitis. ⋯ The aetiology is briefly discussed. The treatment is operative with removal of the appendix or an appropriate resection.
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A review is given of a 15 year experience of valve replacement with Teflon cusps, pericardial cusps, Starr-Edwards, Key-Shiley, Wada-Cutter and Björk-Shiley artificial valve prosthesis. The Björk-Shiley tilting disc valves have shown the lowest gradient and blood trauma and excellent durability in more than 1 000 implantations during a 7 year period. Anticoagulation therapy is considered necessary with all types of artificial heart valves. Thrombo-embolism is negligible after aortic valve replacement (1 episode in 4 000 patient months) but still a problem in the mitral position (4 episodes in 1 000 patient months).