Therapy of gonadal stromal cell testicular tumours

At our regional centre, 504 patients with testicular tumour were treated from 1 January 1980 to 31 December 1993. In the course of the treatment, 10 patients (2%) with gonadal stromal cell testicular tumours were found. Histopathological examination identified Sertoli cells in 3 cases, granulosa cells in 1 case, and Leydig cell primary tumours in 6 cases. Leydig cell testicular tumours, the most significant clinically, should not be regarded as benign. In 3 of 6 cases metastatic processes developed. Three patients died in spite of the surgical and chemotherapeutic interventions. Analysis of these cases suggests that, following the semicastration of Leydig cell testicular tumours, a primary retroperitoneal lymph node dissection should be performed, and an exact identification of the pathological stage should be carried out.

[Family-centered obstetrics]

Family centralised delivery model program in the Department of Obstetrics of Borsod County Hospital in Miskolc is reviewed. This program has been started since 1986. Significance and positive emotional effects are emphasized. Preparation for the birth, the presence of the husband in the labour ward, the alternative delivery position and the rooming-in system are discussed in detail. The natural birth's behaviour, which is very important in the life of the family, would be realized with this program.

Prognosis of testicular tumour since the introduction of complex therapy

Change of approach in dealing with testicular carcinoma has made it necessary to set up a central organization covering a larger geographic area in Hungary where 242 patients had been treated since 1980. Progress in the development of therapy-oriented methods cleared the way for reliable and accurate stage determination. Data analysis seems to indicate that correct therapeutic principles combined with plenty of surgical, radiological and chemotherapeutic experience may contribute a lot to improving the pathologic prospects. The mortality rates for the pure seminoma group and for the non-seminomatous plus mixed-cell group of patients were 7.5% and 26.5%, respectively. The results promise additional chances--even with increasing morbidity--to reduce the mortality rate and the incidence of complications.

Infrared photoretinoscope

A modification of the technique of photoretinoscopy is presented which allows measurement of the refractive state of the eye in noncooperative subjects and in very small eyes. Infrared light provided by high-output infrared LEDs permits measurement at large pupil sizes and thereby better resolution. Arrangement of the IR LEDs at different eccentricities from the optical axis of the video camera markedly increases the range of measurement. The current sensitivity for a measurement distance of 1.5 m in a human eye is +/- 0.3 diopter or better over a range of +/-5 diopters. Higher amounts of defocus can be better determined at shorter distances.

Natural accommodation in the growing chicken

A new technique, Infrared Photoretinoscopy, has been employed for recording natural accommodation in the chicken. The illumination of the pupil by the fundus reflection of infrared light provided by high output light emitting diodes (I.R. LED's) was monitored on a video screen. The defocus of the eye could be calculated by evaluating the fraction of the pupil which was illuminated. It was found that: in the chick the full range of accommodation (about 17D) is present in the first day after hatching, accommodation acts completely independently in both eyes, the "near pupillary response" is weaker in younger chicks, the pupil constriction in response to light starts at higher luminance in the younger chicks the developmental decrease of the f/number is not sufficient to explain the change of the pupil reaction to light. Problems resulting from the use of drugs in order to measure the refractive state using normal retinoscopy are discussed.

Diagnostic accuracy of lymphangiography in the demonstration of histologically verified retroperitoneal lymph node metastases of testicular tumours

Bipedal lymphangiography was performed in 101 cases of testicular tumour for the detection of retroperitoneal lymph node deposits. The lymphangiograms of 51 patients have been checked against the results of microscopic study of lymphadenectomy specimens. The radiogram was false-positive in 3, false-negative in 7 cases. The lymphangiographic diagnosis was accurate in 81 per cent of the cases. The other diagnostic possibilities--computerized tomography, ultrasonography, isotope lymphangiography--are also discussed. The main advantage of bipedal lymphangiography is to provide information on the structures of the lymph nodes and on the lymphatic channels as well. Combination of several diagnostic methods provides for a high accuracy of staging.

Infection of the abdominal cavity and chronic peritoneal dialysis

Peritoneal dialyses have been performed in 1072 instances by the manual infusion technique in 16 patients with chronic renal failure, during a period of 2 years. Among the intraabdominal bacterial cultures done before each dialysis, 79 were positive, and peritonitis developed in 7 cases. As related to the total number of dialyses, these figures represent 7.37 and 0.65 per cent, respectively. Local intraabdominal applications has been found to reduce the hazard of peritonitis. Increased frequency of dialyses and combined antibiotic therapy proved curative to peritonitis. The results of the bacterial cultures indicate that in case of intraabdominal infections caused by Pseudomonas aeruginosa, acetate-containing dialysing fluids should be given preference.

Adaptation problems with nursing home application for elderly persons: an application of the Roy adaptation nursing model

This study sought to identify adaptation problems on the part of elderly persons and significant others that were associated with nursing home applications for elderly persons. Within the framework of the Roy Adaptation Nursing Model, an ex post facto research design was utilized to identify these adaptation problems. The four adaptive modes in this model are: physiological, self-concept, role function, and interdependence. The study group (n = 22) and a control group of elderly persons living in Calgary, as well as their significant others, were administered a structured questionnaire. Five hypotheses relating to overall adaptation problems, powerlessness, role reversal, guilt, and knowledge and utilization of services were formulated and tested. Only the hypothesis indicating role reversal on the part of the significant others was accepted. Adaptation problems encountered by the elderly which were associated with nursing home applications occurred in the self-concept and interdependence adaptive modes. The adaptation problems perceived by the significant others, which were associated with nursing home applications for their elderly, occurred in the self-concept, role function, and interdependence modes. Adaptation problems from the significant others' perception rather than from the elderly persons' perception appear to be more significantly associated with nursing home applications.

Satellite peritoneal dialysis

In 29 cases of chronic renal failure 1325 peritoneal dialyses were performed between January 1, 1976 and April 31, 1978. The technique of peritoneal dialysis, the general lines of supervision and follow-up, the results and shortcomings of the procedure are discussed. Peritoneal dialysis is regarded as an alternative to haemodialysis in chronic renal failure. On ground of the favourable observations, organization of satellite PD services on a large scale, parallel with the expansion of other services (haemodialysis, renal transplantation), is advocated.

Observations with the "Bi-flo" cannula (continuous, single-needle haemodialysis)

Observations with the double-lumen "Bi-flo" cannula in chronic intermittent haemodialysis are reported. On the evidence of urea and creatinine measurements, recirculation of blood corresponds to 7.9 and 6.1 per cent, respectively. In comparison with double-needle or single-needle dialysis, use of the double-lumen cannula does not affect the efficiency of dialysis to any notable degree. The advantages and shortcomings of the "Bi-flo" cannula with regard to the technique of dialysis are summed up.