[Rare discovery of metastasis of renal cell carcinoma in location of struma polynodosa]. / Raritní nález metastázy svetlobunecného karcinomu z renálních bunek v terénu polynodózní strumy.

Renal carcinoma metastasis to the thyroid gland is not particularly rare; the interval since the initial diagnosis in the case presented, that is, nephrectomy, is more of a rarity. We present the case of a 58-year-old man admitted to our hospital with the diagnosis of polynodular retrosternal goitre. Complete thyroidectomy by cervical approach was performed. Histological examination showed multiple metastases of conventional renal carcinoma located within colloid struma polynodosa. Postoperative progress was uneventful, the surgical wound healed per primam. Renal carcinoma metastasing to the thyroid gland is rather unusual and is often found only postoperatively.Key words: renal carcinoma - metastasis - thyroid gland.

[Pathologic fluid collection of mesentery, differential diagnosis of mesenteric cysts - case report]. / Patologická tekutinová kolekce mezenteria, diferenciální diagnostika mezenteriální cysty - kazuistika.

Mesenteric cyst is a pathologic fluid collection that very rarely occurs anywhere in the mesentery of the gastrointestinal tract from the duodenum to the rectum. The etiology of mesenteric cysts has not yet been completely understood. It ranges from tumorous, infectious, lymphatic and embryological to post-traumatic or post-operative origin. Symptoms of the illness are usually non-specific, caused mainly by intestinal obstruction. Diagnosis is often accidental. Therapy is exclusively surgical. In the following text, the authors present a case report of a 50-year-old patient operated on due to a mesenteric cyst. The patient had undergone bilateral nephrectomy for polycystic kidney disease and was followed up for polycystic liver disease. CT accidentally revealed a mesenteric cyst around 14 cm in size in the right meso-hypogastrium. It was necessary to perform its histological verification before the planned renal transplantation.

[Buried bumper syndrome (BBS) as a complication of percutaneous endoscopic gastrostomy]. / Buried bumper syndrom (BBS) jako komplikace perkutánní endoskopické gastrostomie.

"Buried bumper syndrome" is a less frequent but potentially serious complication of percutaneous endoscopic gastrostomy. We present case reports of two patients in whom buried bumper syndrome was diagnosed by means of X-ray examination and endoscopic examination. In both cases the original gastrostomy was surgically removed and classical gastrostomy was performed.

[Laparoscopic liver resection]. / Laparoskopická resekce jater.

Rapid development of liver surgery in the last 25 years results from introduction of new procedures entailing an increase in the number of operated patients, and simultaneously a reduction in risk of the surgery and subsequent postoperative morbidity and mortality. They include standard preoperative examination completed by new high-resolution diagnostic methods (duplex ultrasound, spiral CT, liver scintigraphy, PET) which can better reveal the pathological focus in relation to liver anatomy and largely contribute to the consideration of resecability of the liver affection . Standard resection technique is, in addition to the advantage of an anatomical resection, completed with modern technology which helps to reduce the blood loss and ischemic damage to the remaining liver parenchyma especially in non-anatomical resections. Nowadays, liver resections are performed by a combination of various techniques. One of them is a liver parenchyma resection using a harmonic scalpel in the classical surgical procedure. There are also mini-invasive laparoscopic operations, and recently robotic resections which can't be done without the harmonic scalpel. The authors present a case report of a 25-year-old woman who developed spastic pain in the epigastrium three years ago. Sonography, CT, MR, liver scintigraphy and, last but not least, diagnostic laparoscopy were used for accurate diagnostics. Diagnostic laparoscopy was performed in order to confirm the diagnosis, extent of surgery and especially the possibility of performing laparoscopic liver resection. This was carried out using the harmonic scalpel which is the method of choice especially in non-anatomical resection for better control of bleeding and safer isolation of bile ducts and vessels.

The laparoscopic ventral and incisional hernia repair.

We retrospectively reviewed the first twenty laparoscopic ventral and incisional hernia repairs performed at the 2nd Department of Surgery, St. Anne's Teaching Hospital, Brno from March 2003 till April 2004. Laparoscopic repairs were performed using Biomesh mesh (Cousin Biotech, France) with a minimum of 3 cm overlap circumferentially with normal fascia and secured with spiraltacks every 3-4 cm and transparietal sutures. All adhesions on the parietal defect are released, using scissors, and whenever possible we attempted to reduce the hernia sac. The mean follow-up period was 7 months with a range of 2 to 13 months. There was no recurrence in the group. There were two hematomas and one seroma in our group, which disappeared without treatment. Two patients experienced transient pain, which was resolved by analgesic treatment over time. By this date, no chronic infection, bowel obstruction, or enterocutaneous fistula have been reported. In conclusion our results are encouraging and suggest that laparoscopic ventral and incisional hernia repair is a safe, feasible, and effective alternative to open techniques. (Ref. 10.)

Patient with percutaneous endoscopic gastrostomy.

INTRODUCTION: Since 1980, when percutaneous endoscopic gastrostomy was described and performed for the first time, the number of patients with this way of nutrition has been growing. At present, however, these patients are treated not only in intensive care units, but also in follow-up care institutions or in home care. AIM: We want to explain the problems of nutrition via endoscopic gastrostomy to those physicians who take long-term care of these patients. METHODS: In our department we introduced percutaneous endoscopic gastrostomy in 1994. A total of 78 PEGs were performed. In all cases the pull technique was used. A condition for percutaneous endoscopic gastrostomy insertion was an unaffected gastrointestinal tract from the stomach in aboral direction. The most frequent indications were: necessity of long-term enteral nutrition in patients during artificial ventilation, neurological patients with lost swallowing reflex, and patients with a tumor in the ENT area with preserved patency for the endoscope. RESULTS: In all cases, the intervention itself was without major complications and no death occurred relating to the intervention. Subsequently, mainly local complications such as decubitus ulcers or maceration around the tube and its accidental removal by a restless patient were noticed. CONCLUSION: In cases of more than 6-week inability to ingest food per os with otherwise unaffected gastrointestinal tract, it is appropriate to consider the nutrition via PEG. Using this method, it is possible to ensure an adequate access for enteral nutrition for a longer time without risk of complications associated with the nasoenteric tube, with minimum trouble to the patient. (Fig. 1, Ref. 9.).

[Endoscopic gastric polypectomy--personal experience]. / Endoskopická polypektomie zaludku--nase zkusenosti.

In the time period from August 1986 to August 2001, a total of 10,260 gastrofibroscopic examinations were performed in our department. Gastric polyps were found in 28 patients--in 15 men and 13 women. Polypoid foveolar hyperplasia was present in 67.8% patients, hyperplasiogenic polyps in 21.5%, and adenomatous polyps in 10.7% of patients. Multiple gastric polyposis was found in 3 patients: in two of them all polyps were removed and one patient has regular gastrofibroscopic checkups. We did not encounter complications after endoscopic polypectomy of the stomach in our study group. Polypectomy via gastrotomy was not performed in any of our patients.

[Emergency ERCP and acute biliary pancreatitis]. / Urgentní ERCP a akutní biliární pankreatitida.

In the period from 1992 to 1997, a total of 130 urgent therapeutic ERCPs were performed at the 2nd Department of Surgery of the Faculty of Medicine in Brno. The examination was indicated because of acute pancreatitis, acute septic cholangitis, and papillary ileus. Fifty nine patients with proven acute biliary pancreatitis and successful endoscopic papillosphincterotomy were followed up subsequently. Information on 44 patients could be retrieved (75%). The results were evaluated and compared with a group of patients treated for acute biliary pancreatitis at the 2nd Department of Surgery in Brno before introduction of urgent therapeutic ERCPs. In addition to lower mortality, in the group of patients who underwent endoscopy a decrease in the percentage of surgical revisions needed was reached, and in the group with conservative treatment, statistically significant reduction of hospitalization was duration achieved. (Tab. 3, Fig. 1, Ref. 14.)

[Initial experience with percutaneous endoscopic gastrostomy in a surgery department]. / První zkusenosti chirurgického pracoviste s perkutánní endoskopickou gastrostomií.

The authors present their initial experience with percutaneous endoscopic gastrostomy and draw attention to its advantages and risks. As a basis they use their own group of patients, most of them in a very poor condition where it proved possible to ensure by this method enteral nutrition on a long-term basis.

[Thyroid gland surgery--principles of surgical technique and postoperative care in our department]. / Operace na stítné zláze--zásady operacní techniky a pooperacní péce na nasem pracovisti.

Views on the surgical procedure are not uniform. The authors summarise the basic principles of surgical technique and postoperative care in thyroid surgery, as used in their department. Attention is drawn to the possibility to use epidural anaesthesia in indicated cases. The most frequent causes of complications and their prevention are emphasised.

[Surgical endoscopy--analysis of 6 years' activity]. / Chirurgická endoskopie--rozbor sestileté cinnosti.

Fibroscopy of the digestive system which in the majority of developed countries is quite common is in our country still not available in an adequate extent. The authors evaluate their experience in a surgical department covering a six-year period. A total of 4436 fibroscopic examinations were made incl. 3821 gastroscopies 615 ERCP and examinations of the papilla Vateri. They describe their experience with urgent endoscopy on account of haemorrhage into the GIT, pancreatitis or cholangitis. They emphasize the advantages of a maximal extension of endoscopic methods and their advantages, as compared with classical examination methods.