[Management of groin wound infection after arterial surgery using negative-pressure wound therapy]. / Lécba infekce v trísle po tepenné rekonstrukci pomocí podtlakové terapie.

INTRODUCTION: Infection is a serious complication in vascular reconstructive surgery. When the entire graft is infected, its excision and subsequent replacement is the only option of treatment. In case of localised graft infection in the groin, the vascular reconstruction can be saved using negative-pressure wound therapy (NPWT). METHODS: Retrospective study design was used to evaluate the efficiency of NPWT in the treatment of infected inguinal wounds following arterial reconstructive surgery. The assessments included demographic patient characteristics, causative agents, type of reconstruction and NPWT outcome. Wound infection was graded based on the Szilagyi classification. Patients were followed-up for 12 months after the therapy. Complete wound healing, retained graft patency, and no clinical signs or laboratory evidence of infection were regarded as successful results of treatment. RESULTS: Between 2009 and 2012, 20 patients with deep groin infection (Szilagyi II and III) following arterial reconstructive surgery were treated by NPWT. The patient group included 12 men and 8 women; mean age was 68.1 years. Nine patients underwent aorto-femoral arterial reconstructions (with vascular prosthesis in 8 cases), and surgery below the inguinal ligament was done in 11 patients (with vascular prosthesis in 7 cases). Of the 20 patients, early infection within 30 days of surgery was recorded in 17 (85%) patients; Szilagyi grade III groin infection with exposed prosthetic graft was found in 5 (25 %) patients (infection: early, 4; late, 1). The causative agents isolated from the wound included Staphylococcus aureus (n=8), Pseudomonas aeruginosa (n=5) and Escherichia coli (n=5). Mean NPWT duration was 12.7 days. Wound healing was achieved in 17 patients (success rate, 85 %). Patients with early Szilagyi II infection showed the best outcomes (92.3%). CONCLUSION: Localised wound infection in the groin after arterial surgery is a serious complication of arterial reconstruction procedures. In eligible patients, such an infection can be treated conservatively using NPWT. The method is most efficient in the management of early infections. Wounds infected with P. aeruginosa or those with suture line exposure require special treatment. Long-term follow-up is necessary due to the risk of recurrent infection.

[Urgent thyroidectomy for a mechanical syndrome caused by a toxic nodular goiter--a case report]. / Akutní tyroidektomie pro mechanický syndrom pri toxické nodózní strume--kazuistika.

We present a case of emergency surgery of an 86-year-old patient with an extensive cevicomediastinal toxic nodular goiter. Acutely onset mechanical syndrome during hospitalization of the patient in another department for a different diagnosis (vertebrogenic algic syndrome of Th-L spine) warranted acute intubation and mechanical ventilation. After the transfer of the patient to our department, we performed total thyroidectomy. All published cases of acute compression syndrome with respiratory insufficiency involve anaplastic carcinoma transformation, fast growing lymphoma, injuries with an intraglandular haemorrhage or infected cysts. In this case the reason was the benign disease of the thyroid gland.

[The use of V.A.C. system for the treatment of infected vascular prosthesis--a case report]. / Pouzití V.A.C. systému pri lécbe infikované cévní protézy--kazuistika.

Infected vascular prosthesis is a serious therapeutic issue and a dreaded complication in vascular surgery. We present a case of an 87-year-old man with an infected femoroprofundal crossover PTFE bypass. In this case of a high-risk patient not suitable for surgery, we used a conservative approach using a V.A.C. system. After 4 weeks of conservative therapy the inflammation markers went down and the groin, where the vascular prosthesis was exposed in the beginning, had fully healed up. Follow-up CT scan of both regions of the groin and hypogastria is without fluid collection or other signs of infection of the crossover bypass.

[Ruptured mycotic aneurysm of the abdominal aorta managed using a superficial femoral vein graft--a case review]. / Rupturované mykotické aneuryzma brisní aorty resené graftem z vena femoralis superficialis--kazuistika.

Mycotic aneurysm of the abdominal aorta is a rare, but potentially lethal disorder because of the risk of rupture. It presents a permanent problem in vascular surgery. Despite recent advances in endovascular procedures, one of the available surgical interventions generally remains the method of choice. The authors present the case of a patient with a ruptured mycotic aneurysm of the abdominal aorta who urgently underwent aorto-biiliac reconstruction by an autologous superficial femoral vein graft. The patient's post-operative condition with the absence of complications is in agreement with the good results achieved with this technique by surgeons abroad, and gives support to the notion that this approach is superior to other surgical treatments of mycotic aneurysms.

[Infection in vascular reconstructive surgery]. / Infekce v rekonstrukcní cévní chirurgii.

PURPOSE: Infection is one of the most serious complications in vascular surgery. METHODS: We summarize the patients operated on in our clinic during a 3-year period for infection of the arterial reconstruction. RESULTS: 577 primary arterial reconstructions were performed in the region of abdominal aorta and lower limb arteries during the years 2003-2005. In the same period 17 patients were operated on for infection of the arterial reconstruction grade III of Szilagyi (13x aortofemoral, 4x femoropopliteal region). The main agent of infection was Staphylococcus aureus (47.1%). In most cases the therapy involved revision of the infected groin (10x) with subsequent explantation of the reconstruction (7 patients). Eight extraanatomic reconstructions were performed. Three patients died during the follow-up (2 within 30 days of an operation). The one year mortality rate is 17.6%. Amputation was necessary in 6 patients (i.e. 35.3%) CONCLUSIONS: Handling vascular infection still remains a challenging diagnostic and therapeutic problem.

[Total thyroidectomy as the most frequent surgical procedure on the thyroid gland]. / Totální tyreoidektomie jako nejcastejsí operacní výkon na stítné zláze.

In 1997 and 1999 at the Second Surgical Clinic 35 patients with thyroid disease were operated. The authors reflect on the increasing radicality of operations from the aspect of the endocrinologist and surgeon. Extended surgical operations in relation to the original endocrinological indications are explained by the surgical finding and results of the histological examination.

[Incidence of carcinomas in goiters and their combination with Hashimoto's thyroiditis]. / Incidence karcinomu ve strumách a jejich kombinace s Hashimotovou tyroiditidou.

In the investigated group 300 patients were operated for a thyropathy mostly struma nodosa, tumours were proved in 69 cases; 38 of them were carcinomas of various extent and 3 of them were combined with Hashinoto's lymphomatous goitre. The overwhelming majority of the carcinomas were papillary carcinomas (22 cases). The incidence of papillary carcinoma in Hashimoto's goitre was about 8%; this fact calls for more attention to autoaggressive thyroiditis both in examination of surgical material, and during autopsies in middle-aged women, where this thyroiditis is often clinically silent. Our results suggest an increase in the incidence of carcinoma in Hashimoto's goitre and the generally accepted rarity of this coincidence is questioned. We recorded also a lower incidence of medullary carcinoma than the worldwide average and a more frequent incidence of mixed-type carcinoma.