[Pelvic infiltrations following amputation procedures for rectal carcinomas]. / Infiltráty v pánvi po amputacních výkonech pro karcinom rekta.

INTRODUCTION: The authors present anatomical division of the rectum and then give a short overview of the rectal surgery development. Currently, even in departments specialized in colorectal surgery, 25-30% of the rectal carcinoma cases must be managed by abdominoperineal amputations. COMPLICATIONS OF AMPUTATION PROCEDURES: The study deals with complications following extirpation of the rectum, like bleeding and its management, inflammatory complications during the healing process or following healing of the perineum. However, pelvic relapses, which in most cases cannot be managed surgically, remain the major therapeutic problem. These cases are indicated for systemic treatment with combinations of cytostatic drugs, eventually for radiotherapy. RESULTS: 324 patients with rectal carcinomas were operated at the 1st Surgical Clinic of the VFN in Prague. In 230 cases, resection was completed, in 94 cases, the rectum was amputated. In 78 cases, sutures of the pelvic floor was conducted, 64 cases healed per primam within 3 weeks, 11 healed per secundam within 3 months. In 16 cases, tamponade with surgical cover sheets and longettes was applied. 70% of these patients healed within 12 weeks of the surgery. In 3 cases, chronic fistules persisted for over 6 months. In 11 cases, locoregional relapses occurred. In 2 cases, radical excision was conducted, the other underwent systemic chemotherapy. CONCLUSION: Good preoperative care of the intestine, ATB prophylaxis and saving surgical technique were the precautions taken with the aim to prevent inflammatory complications. With respect to management difficulties of local relapses following amputations of the rectum, a requirement for total excisioning of the mesorectum on the first operation is substantial.

[A fistule of the anus in the Crohn's disease]. / Anální pístel u Crohnovy choroby.

A fistule is defined as a canal or a cavity, created by necrotic degradation of the tissue, which may, (but not necessarily has to) communicate directly with the digestive tract via an internal orifice. In case of the Crohn's disease, the abscesi and fistules result from the same pathological process and are caused by penetration of the inflammatory process through the wall of the digestive tube and to its outer side. The authors, having initially described the types and the pathogenesis of the anal fistules in the Crohn's disease, present a brief examination algorithm including examination of the whole digestive tract, based on the pan-entero-colitic character of the disorder. Sound diagnostics and establishment of the disease activity is very important, beacuse the treatment strategy differs from that of other perianal inflammatory affections. Furthermore, options for both the surgical and conservative treatment are listed in this work, including experience with use of the advancement flap. According to some authors, the success-rate of this treatment reaches up to 80%.

[Results of the large intestine resection in elderly patients]. / Výsledky resekce tlustého streva u nemocných ve vysokém véku.

The colorectal carcinoma incidence increases with age. The radical resection procedure significantly extends the survival period, when compared with other therapeutic approaches. The tissue damage may exceed the organ reserve capacity in cases of the elderly patients and may result in higher postoperative morbidity and mortality rates. The aim of this study was to compare the results and the surgical risks of the large intestine carcinoma resection procedure in elderly patients, compared to younger patients with the same diagnosis. THE PATIENT GROUP AND METHODOLOGY: The retrospective study summons up the clinical results of 3778 patients from all over the Czech Republic, who underwent primeoperations for the following diagnoses: C18--a malignant neoplasm of the large intestine, and C19--a malignant neoplasm of the rectosigmoideal junction, in 2001. The results are compared with our own patient group in the same time-period. The results were assessed according to the following age-group criteria: 21-59 yrs., 60-69 yrs. and over 70 yrs. of age. We assessed the following factors: age, diagnosis, incidence of early postoperative complications and duration of patients hospitalization. RESULTS: The patients in the 21-59 year-group and in the group over 70 years of age, had significantly different rates of early postoperative complications (12.3% vs 17.6%, p < 0.001). The rate of complications was twice as high in urgent procedures compared to planned procedures in all age groups (p < 0.001). The average hospitalization lasted 14.8 +/- 10.9 days. We discovered statistically significant differences in the duration of hospitalization among all three age groups respectively (p < 0.01). CONCLUSION: Based on our results, we believe the age itself not be an indication-limiting factor for the radical resection procedure for the large intestine carcinoma. The elderly patients benefit from its oncological radicality with acceptable rates of the postoperative complications risks. We believe even extensive surgical procedures to be feasible in cases of appropriately indicated elderly patients, and their surgical risks to be acceptable considering the expected benefits for the respective patient.

Surgical treatment of haemorrhoids according to Longo and Milligan Morgan: an evaluation of postoperative tissue response.

OBJECTIVES: To compare by prospective randomised trial the postoperative tissue reaction of stapled vs. conventional haemorrhoidectomy. PATIENTS AND METHODS: Fifty patients with stage III haemorrhoids underwent surgery for haemorrhoids. Group 1 (n = 25) had the Milligan-Morgan procedure; Group 2 (n = 25) had a stapled haemorrhoidectomy. All patients underwent measurements of endothelial dysfunction markers including E-selectin, P-selectin and intercellular adhesion molecule (ICAM). Acute-phase proteins including C-reactive protein, orosomucoid and fibrinogen were also measured. Estimations were made prior to surgery, immediately afterward surgery and on the first and fifth postoperative days. Assessment of clinical outcome was made one month after the surgery. RESULTS: There was a postoperative increase of acute-phase reactants in both groups. The patterns of the cures of the monitored parameters appeared similar in both groups. Lower values were found in Group 1, but the difference was not statistically significant except the level of fibrinogen on day 5, which was significantly higher in Group 2. E-selectin, P-selectin and ICAM showed similar time curves. Statistical analysis found the differences to be significant only when individual days were compared and not for the types of surgery. Raised ICAM and P-selectin on the fifth postoperative day was found in both groups. In Group 1, pain assessment by patients remained in the lower part of the pain rating scale, while in Group 2 it did not start declining until one week after surgery and became normal in the third to fourth weeks. In Group 1, the duration of hospitalization and the duration of incapacity for work were 50% of the values in Group 2. CONCLUSION: Patients having stapled haemorrhoidectomy have less pain and experience more rapid recovery when compared to classical haemorroidectomy. This was mirrored by the acute-phase protein CRP and fibrinogen levels postoperatively. There was no significant difference in other acute-phase reactants monitored, nor was there any difference in parameters of endothelial dysfunction. The techniques differ in extent of pain and duration of hospital stay and incapacity for work.

[Results of rectal resection procedures at the First Surgical Clinic of the First Medical Faculty of Charles University]. / Výsledky resekcních výkonu rekta na I. chirurgické klinice 1. lékarské fakulty Univerzity Karlovy.

Conventional surgical techniques play an important role in rectal cancer. Dehiscence of the anastomosis after low anterior resection of the rectum is a serious complication. The incidence of dehiscences can be reduced when known principles of preoperative care are respected but in particular by correct surgical technique. In 92 patients operated for rectal cancer at First Surgical Clinic of Charles University we had six patients (6.5%) with dehiscences of anastomosis. The serious character of this surgical complication can be reduced by a primary derivative stomy. Authors recommend implementing a preventive ileostomy in low resection of the rectum in high-risk patients.

[Results of laparoscopic implantation of peritoneal catheters]]. / Výsledky laparoskopické implantace peritoneálního katétru.

The advantages of miniinvasive surgical techniques were proved in a number of surgical operations. In the submitted article the authors evaluate five years' experience with laparoscopic implantation of Tenckhoff's catheter for peritoneal dialysis. The authors implanted in 1995-1999 catheters by the laparoscopic route in 34 patients. The most frequent complication was early leak of the dialysate along the catheter (41%). After modification of the surgical technique early leak was observed in 11% of the patients. Escape of the catheter from the lesser pelvis was observed in 14.8% patients. The authors did not observe early infection of the tunnel along the catheter. It may be concluded that the laparoscopic technique of implantation of a peritoneal catheter was not associated with a higher incidence of complications than the laparotomy. The advantage of laparoscopic operation is earlier mobilisation and shorter hospitalization of the patient. Another advantage of this technique, tested by the authors, is the possibility of exact diagnosis possibly with an immediate single-stage plastic operation of hernias in the abdominal region.

[A preventive ostomy in low rectal resections]. / Pojistná stomie u nízkých resekcí rekta.

Dehiscence of the anastomosis after low resection of the rectum is a serious complication with the possible development of sepsis and multiorgan failure. This complication is reported in 10-20% of operations. The incidence of dehiscences can be reduced when known principles of preoperative care are respected but in particular by correct surgical technique. The serious character of this surgical complication can be reduced by a primary derivative stomy. Based on their experience the authors recommend to implement a preventive ileostomy in low resections of the rectum which can be closed already two weeks after the primary operation.

[Acute resection of the large intestine]. / Akutní resekce tlustého streva.

The authors evaluate the results of 32 acute resections of the large intestine on account of a malignant process or an inflammatory aetiology causing obstruction. They recommend to prefer this method to multi-stage operations even in patients of advanced age, if their general condition permits it.

[Herbal drugs in Kampo preparations]. / Rostlinné drogy v Kampo prípravcích.

Medicaments of the Kampo medicine are composed from vegetable drugs. This article describes drugs unknown in European medicine and used in Kampo preparations--Radix bupleuri, Tuber pinelliae, Hoelen, Radix scutellariae, Cortex magnoliae, Fructus zizyphi, Herba perillae, Radix paeoniae, Rhizoma atractylodis, Rhizoma alismatis, Radix alismae, Rhizoma cnidii, Radix angelicae, Rhizoma coptidis, Fructus gardeniae, Cortex phellodendri, Polyporus, Radix ginseng.

[Treatment of hemorrhoids with elastic ligature]. / Lécení hemoroidu elastickou ligaturou.

The authors present a report on the treatment of haemorrhoids by elastic ligature at the Second Surgical Clinic in Prague in 93 patients. In 75% they evaluate the results as excellent, in 22% as very good, only two patients, i.e. 3%, did not improve. The method is reliable, provides very good results and involves a low risk.