Obturator nerve injury in laparoscopic inguinal hernia mesh repair.

Injury to pelvic nerves during laparoscopy mostly occurs in gynecological and urological procedures. In abdominal surgery, these complications are infrequent. We present a case report of a patient who suffered a rare obturator nerve injury during a laparoscopic hernioplasty caused by clipping the nerve to the edge of the mesh. After revision and release of nerve from the clip and scars tissue, the associated pain rapidly disappeared and thigh adduction strength improved. Now, 4 years later, MRI and EMG show no sign of nerve compression.

Study of Mn interstitials in (Ga, Mn)As using high-resolution x-ray diffraction.

We present a method for the determination of the concentration of Mn ions in nonequivalent interstitial positions in the lattice of (Ga, Mn)As. The Mn ions occupy substitutional and/or interstitial positions in the GaAs lattice and the dependence of the structure factor on their concentration differs for various diffractions and for different positions in the lattice. We measured several diffractions including weak diffractions, which are very sensitive to the Mn content. All measured diffraction curves were simultaneously fitted to a theoretical model and the densities of Mn ions, in particular interstitial positions, were obtained. The method reported here allows us to determine the amount of interstitial Mn which, according to current understanding, affects the ferromagnetic properties including the Curie temperature in (Ga, Mn)As.

[Rectal duplication cyst--case report]. / Cystická duplikatura rekta--kazuistika.

OBJECTIVE: The authors demonstrate a rare case of duplication anomaly of the rectum. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prague. SUBJECT AND METHOD: We present a rare case of cystic rectal duplication in adult, completely removed and histologically confirmed. A literature review was summarized. CONCLUSION: The case was complicated by delay in diagnosis, multiple operations, and by the association with endometriosis, as well. Mentioned anomaly is published in the Czech literature for the very first time.

[Comparison of various methods of body fat analysis in overweight and obese women]. / Srovnání ruzných meted pro stanovení mnozství tuku v tele u zen s nadváhou a obezitou.

INTRODUCTION: Body composition assessment and determination of the amount and distribution of body fat, respectively, form an essential part of the basic clinical assessment of an obese patient. However, there are no recommended methods to determine the amount of fat in obese population. The aim of our study was to compare the methods most frequently used to determine the amount of body fat in overweight and obese women in clinical practice (multi-frequency bio-electrical impedance analysis--BIA using the Bodystat, Omron and Tanita machines and the skinfold test using a calliper) with a reference method (DEXA). The study further aimed to compile prediction formulae enabling clinicians to calculate the percentage of body fat when using the available body fat measurement techniques. METHODS: The study included 61 overweight and obese women (mean age 48.6 years +/- 13.9 years). Four practice-based body fat assessment methods were used - bioimpedance technique with tetra-polar electrode arrangement (Bodystat machine), bioimpedance technique with bi-pedal electrode arrangement (Tanita machine), hand-held bioimpedance technique (Omron machine) and the anthropometry assessment--the skinfold calliper technique. These methods were compared to the method considered as the reference--the whole body densinometry (DEXA). RESULTS: The results obtained using the listed body fat assessment methods suggest that the resulting body fat measurements differ importantly depending on the method used. The highest correlation with DEXA was found for the Bodystat BIA (r = 0.9096, p < 0.001). Prediction formulae were constructed for a more accurate calculation of body fat content when using the techniques evaluated in the present study. CONCLUSION: When the newly compiled formulae are employed, the body fat assessment obtained with any of the methods applied in the present study will approximate DEXA. The BIA techniques were found to be particularly precise. Therefore, further evaluation of these techniques is recommendable to support their use as methods for monitoring the efficacy of weight reduction programmes in overweight and obese patients.

[Can the sacral spongiosa bleeding cause fatal complications of unstable pelvic fracture?]. / Muze být krvácení ze spongiózy sakra fatální komplikací nestabilní zlomeniny pánve?

The authors present the case of 36 years old woman, who suffered from unstable fracture of pelvis after she fell from the 5th floor. The spongiosa bleeding from both massae laterales sacri caused significant blood circuit destabilisation not only immediately after the injury but also in hours following the external fixation of pelvis. Due to persistent blood losses it was necessary to apply 38 RBC units, 48 FFP units, 1500 IU of antithrombin III, 1000 mg of fibrinogen and 6 platelet units within first 12 hospitalisation hours. With respect to ongoing bleeding and lack of accessible blood products it was decided to stop intensive hemotherapy and rationalize the treatment. The rationalization led to the hypotension (systolic blood pressure was 40-60 mm Hg), which along with gradual increase of body temperature caused unexpectable patient stabilisation. The systolic blood pressure was stabilized on 80 mm Hg and heart rate about 100/min. After 4 hours another 3 RBC units and 4 FFP units brought from the nearest reachable hospital were applied. The following blood pressure measurement was 120/80 and heart rate about 90/min. In the course of following 2 days it was possible to stop the catecholamine treatment. The authors are of opinion, that uncovered spongiosa caused by expresive dislocation of fragments may lead to massive bleeding that is difficult to stop by accessible means. The bleeding may be an essential risk for patients life and neither targeted intensive postoperative care can settle the matter.

[Clostridium difficile colitis]. / Kolitidy vyvolané Clostridium difficile.

The authors present a detailed study of Clostridium difficile-induced conditions and desribe their pathogenesis, diagnostics, and treatment. Considering the extensive use of antibiotics and increasing numbers of immunocompromized patients, it can be expected that surgeons will face this infection, which was practically unknown a few years ago, more often in future. Based on the above facts, the authors consider important to inform the surgical profession about the problematics.

Transrectal stent in endoscopic palliative therapy of malignant stenosis of the rectum.

BACKGROUND/AIMS: To check the feasibility and safety of endoscopic stent introduction in colorectal cancer therapy. METHODOLOGY: A total of 62 patients with inoperable tumors of the rectum and rectosigmoid were treated by introducing stents. Stents were also introduced in 3 patients with advanced prostate tumors obturating (narrowing) the rectum. In 3 cases, the stents were introduced under X-ray control. In all other cases, an endoscopic approach to the stent introduction was employed. RESULTS: Stents could not be introduced in 4 patients. In 1 case, the bowel was perforated above the malignant (tumorous) stenosis. In 4 patients, it was necessary to remove the stents because of dislocation. Growth of the tumor into the stent was not experienced. Experience with acute obstruction treatment was minimal as only two patients were treated for this indication. CONCLUSIONS: Endoscopic stent introduction is a safe palliative procedure making it possible to improve the quality of life of patients with inoperable tumors of the rectum and rectosigmoid.

[Infectious complications of surgically treatment pelvic fractures]. / Infekcní komplikace operacní lécby zlomenin pánve.

Based on case histories, the authors draw attention to important infectious complications in patients surgically treated for pelvic injuries. These complications were recorded in four out of 75 patients (5.3%) undergoing surgery for pelvic fracture in the period from 2001 to 2005. The chief risk factors for the development of infection included the poor state of health of a polytraumatized patient in combination with a long stay in an acute care unit, and severe trauma and bleeding of soft tissue structures in B and C types of pelvic injury. Bacteriological findings showed the presence of several pathogenic species (Enterobacter cloacae, Citrobacter koseri, Pseudomonas aeruginosa and Klebsiella oxytoca) or multi-resistant bacteria (methicillin-resistant Staphylococcus aureus).

[Leiomyoma of the abdomen wall. Case report]. / Leiomyom piední steny birisní.

Authors present the case report of the patient indicated to plastic of abdomen wall for large hernia. Per operation, tumor was found without communication with abdomen cavity and organs. Histopathologically, leiomyoma of the abdomen wall was identified.

Changes in small intestine permeability after radiotherapy of malignant tumor.

BACKGROUND/AIMS: Radiotherapy of the malignancy in the small pelvis causes different adverse events in normal tissues. The small intestine is the most sensitive organ in this region. Its wall performs the barrier function between internal and external environments. The damage to the intestinal barrier brings increase in the intestinal permeability. The aim of this study was to find out dependency of intestinal permeability disorder on certain factors such as age, radiation dose, target volume, dose per fraction, added chemotherapy etc. METHODOLOGY: We evaluated the intestinal permeability by the LAMA (lactulose-mannitol) test in a group of 31 patients with a diagnosis of malignant gynecological tumor (24), rectal cancer (6) and prostate cancer (1) who underwent radiotherapy of the small pelvis with doses of at lest 45.0Gy. Fourteen patients underwent adjuvant radiotherapy, and 17 patients underwent a primary radical radiotherapy. In the latter group there was a tumor at the time of radiotherapy. The measurement was performed 3x (before starting radiotherapy, after its completion, and 6 months after completion). Complications after radiotherapy were assessed according to RTOG classification. LAMA test resultswere statistically worked out. RESULTS: Early complications G1, G2 were observed in 22 patients, late complications G1 in 3 patients. No dependency has been proved between grade of complications and intestine permeability changes. No evidence has been found in dependency on the patients' age, target volume, added chemotherapy, size of fraction, energy of radiation or other factors either. Connection of intestine permeability changes and total dose was on the margin of statistical significance; the only statistically significant relation was between intestinal permeability change and presence of tumor in the organism which was very surprising and cannot yet be explained. CONCLUSIONS: More patients should be involved in the study and late postirradiation changes should be assessed at a longer time interval.

Comparison of photodynamic therapy with phthalocyanine and photofrin in human colorectal carcinoma.

Photodynamic therapy (PDT) has been developed in recent years as a new modality for the treatment of various neoplastic and non-neoplastic lesions. Although the method of combining light with photosensitizers for treatment has been around for a century, further understanding has been evolved over the past decades. The method is based on the phenomenon involving the combination of photosensitizer and light. Neither drug nor light alone are effective as therapeutic agents. The antitumour effects result from direct cell damage, destruction of tumor vasculature and activation of a nonspecific immune response. The more accepted use of PDT is still restricted for ophthalmology, dermatology and treatment of some stages of esophageal, lung and urinary bladder cancer. In our experiments, the effect of phototherapy with disulfonated hydroxyaluminium phthalocyanine (Al(OH)S2Pc) and photofrin (control group) on the growth of human colorectal carcinoma on nude mice was studied. We chose colorectal carcinoma, because the Czech population has the highest incidence and it is still increasing. We try to offer a new possibility of treatment for patients with this severe disease.

[NF-kappaB, colorectal carcinoma and radiotherapy: results of a clinical and experimental study]. / NF-kappaB, kolorektální karcinom a radioterapie: výsledky klinické a experimentální studie.

Resistance to radiotherapy often seen in rectal cancer patients requires intensive study of mechanisms taking part in this process. It seems that nuclear factor-kappaB (NF-kappaB), especially its subunit p65, could play an important role in radioresistance. The aims of this study were: 1. to assess expression of p65 in rectal cancer patients and to evaluate its possible predictive role; 2. to determine in in vitro experiments possibilities of p65 modulation and to evaluate, whether this modulation can result in enhacement of efficiency of radiation therapy. We found that the level of NF-kappaB expression may serve as a predictive marker of overall survival. Further we found that inhibition of NF-kappaB activity caused by radiation improves impact of radiation therapy.

Human papillomavirus infection and tumours of the anal canal: correlation of histology, PCR detection in paraffin sections and serology.

Human papillomavirus infection is an important etiological factor in squamous cell carcinoma of the anus (SCCA). Different histological variants of anal carcinomas displaying squamous differentiation, previously classified as separate tumours, were recently reclassified as SCCA by the WHO. In our recent study the presence of HPV was detected by PCR in biopsy specimens of 42 different anal tumours, including SCCA and its histological variants (n=22), adenocarcinomas (n=5), tubulovillous adenomas (n=5) and anal condylomas (n=10). HR HPV16 (high risk - HR) was detected in 18 of SCCA specimens (81.8%). All histological variants, i.e. tumours with basaloid, squamous and mixed histological patterns, were represented among the HPV-positive cancers. Four tumours (18.2%) were HPV negative. Low-risk (LR) HPV types were not detected within the SCCA group. HPV16 was identified in one adenocarcinoma, while four cases were HPV negative. Two adenomas showed presence of HPV16; one showed simultaneous positivity for HPV33. The remaining three tumours were HPV negative. Seven anal condylomas (70%) were LR HPV 6 and/or 11 positive, while three were HPV negative. The presence of HR HPV types was not observed in anal condylomas. Our results provide further evidence in support of the etiological role of HR HPV infection in the development of SCCA regardless of its histological appearance.

Re-fixation in a lymph node revealing solution is a powerful method for identifying lymph nodes in colorectal resection specimens.

AIM: To verify an impact of a lymph node revealing solution (LRS) on the number of lymph nodes (LN) revealed in colorectal resection specimens. MATERIAL AND METHOD: Fifty-nine cases of rectosigmoid carcinomas divided into two subgroups-stage pT2&3 (20 cases) and ypT2&3 (with pre-operative radiotherapy-39 cases)-were formalin fixed for 42-72 h, serially sectioned and re-fixed in LRS containing ethanol, diethyl ether, glacial acetic acid, and formalin for 24 h. The number of LNs was matched to a control group consisting of 34 cases of colorectal carcinoma, 14 pT2&3 and 20 ypT2&3 rectosigmoid carcinomas examined routinely. Results were statistically tested by Student's t-test. RESULTS: In the study group the total number of revealed LNs was 869, range 1-48, average 14.7 per specimen, median 15. In the control group the number of LNs was 200, range 0-13, average 5.9 per specimen, median 6. The difference between the study and the control group was statistically significant (P = 0.05). CONCLUSION: Using LRS leads to a significant increase in the number of revealed LNs in colorectal resection specimens and makes it possible to find more than 12 LNs in a majority of stage pT2 and pT3 adenocarcinomas.

[Complications of the Longo Procedure--rectal occlusion]. / Komplikace operace podle Longa--okluze rekta.

Longo Procedures on hemorrhoids are widely used and standard surgical procedures used in many surgical clinics. Extensive studies, describing benefits and possible complications of the method in a detail, are published in Czech and foreign literature. A wide range of complication rates (5-20%) is reported by individual clinics, however, the rates decrease proportionally to the surgeon's growing experience and mastering of the method. The complications reported are mostly non-serious, bleeding from stapled sutures is one of the commonest ones. However, more serious complications including suture dehiscence or rectovaginal fistules, are less common. Our case-review presents an unusual complication after the procedure, a blind closure of the rectum with a circular PPH stapler. No similar complication has been found in the available literature.

[The malignant melanoma metastasis into the stomach corpus]. / Metastáza maligního melanomu do tela zaludku.

Our case-review studies an unusual case of occult bleeding from the cephalad portion of the digestive tube, caused by a metastasis of the malignant melanoma in the gastric corpus. The worldwide rates of patients with confirmed metastatic affections of the abdominal cavity, reaches only 2%. On the contrary, in 60% patients who died in consequence with malignant melanoma generalization, sections revealed metastases to the gastrointestinal tract. Unspecific symptoms, most frequently general weakness, tiredness, unspecific pains, anaemia and sometimes difficult decision-making, are among the suspected causes of poor diagnostic outcomes. Our case-review and collected literature data have confirmed positive effects of surgery on condition of patients with metastatic affections of the gastrointestinal tract.

[Treatment of the agitated patient in surgical practice]. / Lécba agitovaného pacienta v chirurgické praxi.

The authors discuss in their paper treatment of amented delirious conditions as a complication after an urgent or elective surgical operation. Contrary to hitherto applied practice, where treatment is started only at the onset of the mental disorder, the authors administered treatment in selected patients immediately after surgery. The results revealed a marked decrease of amented delirious conditions in the group of patients where treatment was started immediately after surgery.

[Liver resection using the harmonic scalpel]. / Resekce jater s pouzitím harmonického skalpelu.

The authors present their initial experience with the use of a harmonious scalpel in resections of the liver. The harmonious scalpel was used as part of the resection technique in 24 patients operated in 1999. Indication for surgery was in five patients benign liver disease (inborn cysts, nodular hyperplasia, haemangioma, hepatocellular adenoma) and in 19 malignant disease (hepatocellular carcinoma and secondaries). Anatomical resection of the liver was performed in 15 patients and in 9 patients a wedge-shaped resection. During resection a combined technique with a harmonious scalpel was used (with coagulation scissors). As to postoperative complications two patients developed cholascos. According to the authors' experience introduction of a harmonious scalpel into the technique of liver resection is the method of choice in particular in non-anatomical resections because of the better control of haemorrhage and safer isolation of bile ducts and blood vessels.

[Surgical treatment of hepatic metastases]. / Chirurgická lécba jaterních metastáz.

The authors analysed the possibilities of surgical treatment of hepatic secondaries in a group of 69 patients where resection of the liver was performed. Most frequently secondaries of carcinoma of the large intestine and rectum were resected (40 patients). As to different operations in 12 patients left-sided lateral lobectomy; right-sided lateral lobectomy was performed in 8, segmentectomy in 26 and in 23 wedge-shaped resection. During the postoperative period local complications developed in 5 patients and two were treated on account of pneumonia. The mean period of survival in patients operated on account of secondaries of the large intestine and rectum was 19 months.