Retroperitoneal tumour resection in fifteen consecutive cases: Single centre experience.

INTRODUCTION: Retroperitoneal tumours (RTs) in adults are a rare heterogeneous group of neoplasms arising from the retroperitoneal space. RTs'clinical manifestations are nonspecific and depend on their anatomical positioning and relation with bordering structures. Our study aimed to retrospectively evaluate our patients' diagnosis, length of hospital stay, disease-free period and postoperative metastasis occurrence. METHODS: From 2011 to 2019, fifteen suspected RT resections were performed at our centre. Retrospective analysis of patients' hospital stays, follow-up, histological and immunological tumour profile, and metastasis occurrence/ re-occurrence was performed. RESULT: All of the 15 (100%) patients were males. The average age of our patients was 44 years (SD ± 11.2 years), average hospital stay was 7.4 days (SD±3.4 days) (Tab.1). All resected tumours underwent histological and immunological evaluation. Based on histological examination of the resected tumours, nonseminomatous germ cell tumours were present in 12 (80%) patients - including teratoma in 4 (26.6%) patients, seminoma in 2 (13.3%) patients, and malignant B-cell lymphoma in 1 (6.6%) patient. The average patient follow-up was 42.7 months (SD±31.4.9 months). Complete remission after the surgery was achieved in 11 (76.9%) patients, and 2 (13.3%) patients were lost in follow-up. CONCLUSION: RT is a rare heterogeneous group of neoplasm. The patient's prognosis dramatically depends on the type of tumour, metastasis occurrence and re-occurrence, and the surgeons' ability to resect the tumour completely.

Giant aggressive intra-abdominal desmoid-type fibromatosis - case report.

INTRODUCTION: Aggressive fibromatosis, also known as desmoid tumour (DT), is a locally invasive soft tissue malignancy originating from fascial planes, connective tissue, and musculoaponeurotic structures of the muscles. The symptoms greatly depend on the location and size of the tumour. CASE REPORT: A 68-year-old male patient without any comorbidities with a large, palpable mass in the abdomen underwent computed tomography (CT) of the abdomen during diagnostic examination in September 2017 in another centre. The CT scan revealed a giant intraperitoneal 30×40cm tumour without signs of infiltrating the surrounding organs and large vessels. The tumour biopsy revealed an aggressive DT. The patient was scheduled for tumour resection. Midline laparotomy was performed in the supine position under general anaesthesia. After gaining access to the abdominal cavity, 8 litres of clear ascites were evacuated. The tumour was not attached to the abdominal wall. Large omentum was freed from the DT. The perioperative finding confirmed the CT images of DT encapsulation of the medial colic artery, part of the small intestine, and transverse colon. The tumour was resected with part of the mesenteric radix, 30 cm of small intestine, and 2/3 of the transverse colon. After the DT was removed entirely, the small intestine was re-anastomosed end to end. The abdominal cavity and the liver were carefully checked for bleeding. The abdominal cavity was closed in a standard manner. RESULTS: The postoperative hospital stay was uneventful. The patient was discharged on the 7th postoperative day with prophylactic low weight molecular heparin for one month. Currently, we have five months of follow-up with no signs of DT recurrence based on CT examination. The histology of the resected tumour confirmed the diagnosis of a desmoid tumour (aggressive abdominal fibromatosis). CONCLUSION: Desmoid tumours are benign neoplasms with no metastatic potential. However, their treatment is challenging due to their aggressive growth, infiltrative behaviour, and a high tendency to recur.

Early Uterine Transplant Graft Loss Due to Thrombosis: Single-Center Experience With Causes, Prevention, Diagnosis, and Treatment.

Uterus transplantation (UTx) is a promising treatment option for women who wish to give birth but suffer from absolute uterine factor infertility. This paper presents an interim analysis of a trial focusing on the causes, prevention, diagnosis, and management of graft thrombosis. Our team analyzed 10 cases of UTx (recipients numbered 1 to 10). Early thrombosis developed in 2 of 10 (20 %) recipients, and thrombectomy and temporary viability preservation were achieved in both cases. However, re-thrombosis developed in both cases, and a graft hysterectomy was carried out. In recipient number 2, vascular changes might have contributed to graft thrombosis. The histopathological finding of the explant revealed subintimal excentric fibrosis with focal sclerotic changes. In recipient number 8, thrombosis was facilitated by external compression of the vascular pedicles by the hematoma as well as production of de novo donor-specific antibodies. Thrombosis led to graft loss in both cases despite an attempt at a thrombectomy. Therefore, the focus must be on prevention including a thorough evaluation of the donor candidate. In the postoperative course, perfusion is closely followed-up with an ultrasound, Doppler flow monitoring, and macroscopic evaluation of the cervix. In the event that findings are unclear, a relaparotomy should be promptly indicated. If thrombosis is revealed, a thrombectomy and an attempt to salvage the graft are indicated; however, the role of this strategy is questionable due to the low chance of long-term success. The indication of upfront graft removal and early re-transplantation in the treatment of uterine graft remains debatable.

Contralateral and Ipsilateral Arterial Vasculature of the Human Uterus: The Pilot Results of an Anatomical Study.

Arterial blood to the human uterus is provided by a pair of uterine arteries (UA) and supported by terminal branches of ovarian (OA) and vaginal arteries (VA). Literature reports the existence of ipsilateral and contralateral anastomoses between these arteries and the UA, but data on the prevalence of such anastomoses are discrepant. The aim of this trial is to study whether contralateral and ipsilateral anastomoses exist. We studied nine human uterine specimens, which were obtained from (i) human cadavers (n = 6), (ii) uterine transplant recipients (n = 2), and (iii) one altruistic uterine donor (n = 1). We injected India ink into the graft through the UA of each specimen (n = 8) or OA (n = 1). We semiquantitatively observed and evaluated the extent of the injection on horizontal, vertical, and transmural levels. The dye permeated beyond the midline in 9/9 (100 %) cases. Near-complete/complete permeation to the contralateral side was observed in 6/9 (66 %) cases. The dye permeated ipsilaterally throughout all uterine levels in 8/8 cases (100 %) of UA injection. The entire wall of the myometrium was permeated in 2/9 (22 %) cases. In 7/9 (78 %) cases, the wall of the myometrium was permeated less than halfway through. In conclusion, the preliminary results of this study prove the existence of ipsilateral and contralateral anastomoses. Complete transmural injection was observed in only 22 % of cases; however, this finding does not provide information about the functional capacity of these anastomoses. More data and studies are necessary to make definitive conclusions.

Thrombolysis as a treatment for transplant renal artery thrombosis - a report of three unsuccessful cases and an overview of reported cases.

INTRODUCTION: Thrombolysis has been suggested as a feasible method to treat arterial renal transplant thrombosis under conditions of short duration of ischemia. Data on maximal duration of ischemia that are still feasible to treat are scarce. METHODS: We retrospectively analysed our experience involving three attempts to utilize thrombolysis to treat transplant renal artery thrombosis. We searched through literature on PubMed and compared the data we found with our own experience. RESULTS: In case number 1 of our cohort, thrombolysis was initiated 12 hours after the onset of thrombosis and had to be ceased after five hours due to the formation of a haematoma. Perfusion of the graft was restored but it did not regain function, most likely due to long ischemia time. In case number 2, an attempt to use thrombolysis was unsuccessful due to failure to cross the graft artery occlusion with a guidewire. Thrombosis was most likely caused by chronic rejection of the graft. In case number 3, thrombolysis restored arterial patency but, due to an onset of ischemia, which lasted 2 to 3 days, did not lead to restoration of graft function. The prolonged ischemia period in case three occurred, at least in part, due to failure to perform an ultrasound scan when the patient was first admitted. CONCLUSION: We can confirm that thrombolysis for transplant renal artery thrombosis seems to be feasible only when the condition has a short duration. In the event of sudden deterioration of graft function, the absence of perfusion must always be ruled out by ultrasound scan.

Migration of a mesh into the colon after inguinal hernia repair - a case report.

INTRODUCTION: Mesh migration is one of the least common complications that arise after inguinal hernia repair with a mesh. Only small case series have been reported, and an understanding of this issue is limited due to a lack of data. Most of the cases were treated surgically. In this paper, we wish to present the potential of treating this condition using endoscopic techniques. CASE REPORT: A male patient underwent transabdominal preperitoneal repair of a primary inguinal hernia in 1999. In 2003, the patient required the same procedure for a recurrent inguinal hernia. Twenty years after the primary hernia repair, the patient had a positive faecal occult blood test but was completely asymptomatic. A colonoscopy revealed mesh migration into the sigmoid colon. Despite multiple attempts to remove the mesh endoscopically, endoscopic treatment was unsuccessful. The migrated mesh was surgically removed and obligatory resection of the sigmoid colon was carried out. Apart from wound infection (Clavien-Dindo IIIb), the postoperative course was uneventful. CONCLUSION: In our case, the mesh that had penetrated the colon could not be removed endoscopically. Despite our experience, it is advisable to attempt endoscopic removal of mesh that has migrated into a hollow intra-abdominal viscus.

Orthotopic liver transplantation with reduced and rotated graft in adult situs inversus recipient: a case report and a review of reported cases.

INTRODUCTION: Situs inversus is a rare congenital anomaly characterized by a mirror-image orientation of abdominal and mostly also thoracic organs. Liver transplantation in these patients is a demanding procedure due to the difficulties pertaining to positioning of the graft and the presence of frequently associated vascular abnormalities. Several reports have been published regarding successful liver transplantation in adult situs inversus recipients with different proposed positions of the graft. Relevant experience remains limited. CASE REPORT: In this paper we present a case of successful transplantation of a reduced-size cadaverous left hemi-liver graft to an adult situs inversus recipient in a 90-degree clockwise rotation. A complex arterial reconstruction was established. A review of published liver transplantations in adult situs inversus recipients along with the techniques employed is provided. RESULTS: No vascular or spatial problems were encountered using this technique. The graft function is perfect at 27 months from the transplant procedure. The first liver transplantation with a reduced-size left hemi-liver graft from a situs solitus cadaveric donor to the situs inversus adult recipient is presented. CONCLUSION: The devised method of 90-degree clockwise rotation provides perfect spatial adjustment. Relatively smaller grafts are to be preferred as they allow maximum flexibility. Vascular conduits should be readily available.

Two-stage surgical treatment of inferior vena cava traumatic rupture including urgent transport to a specialized unit.

Inferior vena cava injury as well as major liver injury remains a formidable treatment challenge. The most imminent danger is life-threatening bleeding. In this report, we present a case of polytrauma (Injury Severity Score 35) with arupture of the juxtahepatic inferior vena cava which was successfully treated using two-stage approach. The first part of the treatment consisted of damage control laparotomy at a level I trauma center. After stabilization, the patient was air-transported to receive the definitive treatment at a tertiary care facility experienced in hepatopancreatobiliary and transplantation surgery. As the level of injury was not clear prior to the second stage surgery, a cardiac team also assisted the operation. The second stage procedure was uneventful. The patient is doing well and is preparing to return to work. We believe that experience with major abdominal, thoracic and liver transplantation surgery is beneficial in such cases.

[Interventional radiology options to address certain complications of the orthotopic liver transplant]. / Moznosti intervencní radiologie pri resení ne-kte-rých komplikací ortotopické transplantace jater.

At the clinic of imaging method St. Annas University Hospital solved complications arising after ortotopic liver transplantation. For more than 15 years of cooperation with CKTCH Brno intervention was performed on both the arterial and venous system, but most on the biliary tract. The order was a unit patients, which correlates with other comparable work. In the years 1998- 2013 we conducted one intervention on arterial bed, 3× intervention in hepatic venous system and we solved biliary complications in 7 transplant. .

Components of type A behavior and two-year prognosis of patients with acute coronary syndrome.

We investigated prospectively the relationship of Type A behavior and its subcomponents with cardiac mortality and recurrent nonfatal cardiac events in a 2-yr. follow-up of 90 patients [69 men and 21 women, M age=56.4 yr., SD=8.4] after acute coronary syndrome. Type A behavior was assessed via the general Bortner Type A Index. Each patient completed the Bortner's scale before hospital discharge. During the first 2-yr. follow-up, there were 14 cardiac deaths among patients with myocardial infarction. 8 patients had recurrent cardiac events and were hospitalized, and 19 patients had an effort-induced angina pectoris. Patients with acute myocardial infarction who died during follow-up had a significantly lower Bortner score than patients with a secondary cardiac event. Bortner scores of patients with acute myocardial infarction who died indicated Type B behavioral patterns. Mortality was significantly higher in the patients classified as showing Type B (21.8%) behavior than in the patients classified as showing Type A (12.0%) behavior. Patients with a secondary cardiac event had more common Type A behavior patterns and higher Bortner scores than patients without a secondary cardiac event. The items on Bortner's scale "very competitive, ever rushed, tries to do too many things at once, fast in daily activities and expresses feelings" were inversely associated with cardiac deaths. These findings suggest that patients with acute coronary syndrome classified by scores on the Bortner scale as Type B behavior have a greater probability of death, and patients classified on the Bortner scale as Type A behavior have a greater probability of secondary cardiac events during follow-up. This finding may have implications for the treatment of patients with acute coronary syndrome. The inferior survival of patients with Type B personalities argues against attempts to modify Type A behavior in postinfarction patients.

[Structural Bone Grafting in THR with Cup for Dysplastic Hip.]. / Strukturální kostní step a CLS jamka u postdysplastické artrózy kycle.

The authors present results of THR with cementless CLS cup and massive structural bone grafting for dysplastic hip in 42 patients at the average 7,3 years after surgery. They used an autogenous graft from the femoral head in all cases. Crowe type of dysplasia: group I. 14 patients, group II. 20, group III. 5 and group IV. 3 patients. Harris hips score has improved from 37 to 79 points.The cup was placed into anatomic hip centre in 14 patients. There was proximal position up to 15 mm from the hip centre in 27 patients and lateral position up to 10 mm from the hip centre in 18 patients. Osteointegration of the CLS cup has occured in all cases. Clinical survivorship was 100 percent. There was no definite or probable aseptic loosening of the cup. There was no revision. The average of the support of the cup by the structural graft was 30 percent. All grafts have healed to the iliac bone. There was bridging trabeculisation, remodelling and trabecular reorientation at the interface between the iliac bone and the graft. Key words: developmental dislocation of the hip, total endoprosthesis.

Penetrating heart wounds repaired without cardiopulmonary bypass. Evaluation and follow-up of recent war injuries.

Penetrating cardiac injuries requires urgent management. Between September 1991 and June 1992, 10 patients with penetrating cardiac injuries sustained in war were treated at our hospital in Croatia, which does not have cardiopulmonary bypass facilities. Seven of these patients survived cardiorrhaphy and were discharged from the hospital, subject to follow-up. In 5 of the survivors, the injuries were inflicted by fragments from explosive devices; in 1 survivor, by a bullet; and in 1 survivor, by a rib fragment. The left ventricle was lacerated in 4 patients, the right ventricle in 2, the left atrium in 1, and the right atrium in 2. One patient had sustained laceration of the left anterior descending coronary artery in addition to a left ventricular laceration. During early post-cardiorrhaphy evaluation, all patients showed ST segment changes on electrocardiography. The most common echocardiographic findings were pericardial effusion in 5 patients (71%) and intramyocardial foreign bodies in 3 patients (43%). After 5 to 10 months of follow-up, the most common echocardiographic findings were enlargement of the injured chamber in 6 patients (86%), intramyocardial foreign bodies in 3 patients (43%), and hypokinesis of the injured wall in 2 patients (29%). Resting electrocardiographic results and exercise testing results were normal in all patients. One patient had arrhythmias during 24-hour Holter monitoring. Patients surviving operation had a rapid recovery, and were asymptomatic when last seen at follow-up. This demonstrates that treatment of penetrating injuries of the heart can be very successful, at least in the short term, even in hospitals without cardiopulmonary bypass facilities.

[Vesico-uterine fistula]. / Vesiko-uterine Fisteln.

The incidence of vesico-uterine fistulas is very low; they can develop from normal delivery, malignant tumors, inflammations and iatrogenic lesions. The increased number of cesarean sections during the past years should also be considered. Two patients are presented. Symptoms, diagnostic and therapy are discussed.

Antiarrhythmic effects of stirocainide in acute myocardial infarction.

Ventricular arrhythmias, especially ventricular fibrillation, are assumed to be a main cause of sudden death during the first 24 h of acute myocardial infarction. Effective prophylaxis and acute suppression of these life-threatening rhythm disturbances are a major therapeutic problem. The present study was undertaken to investigate the efficacy of the new antiarrhythmic compound stirocainide (2-(1-benzylidene)cycloheptenimino-oxyethyl-diisopropylamine -2-butenedionate, Th 494) in suppressing "2nd phase arrhythmias" arising from large anteroseptal myocardial infarctions using a standardized experimental canine preparation. Our results demonstrate that "2nd phase arrhythmias"--i.e. frequent ventricular ectopics, tachycardias, salvos, and R-on-T phenomena--are reduced by 80-90% (sometimes even completely abolished) by stirocainide (dose: 4 mg/kg within 3 min, followed by 300 micrograms/kg X min over a 20-min period). The administration of the drug at the dose used does not produce severe cardiodepression, but intraventricular conduction time is significantly prolonged. Thus, Th 494 is a highly effective antiarrhythmic agent in acute myocardial infarction, and further experimental and clinical investigations on its antiarrhythmic and antifibrillatory properties may lead to beneficial therapeutic results.

Characterization of a mutant of the Prague strain of Rous sarcoma virus inducing fusiform transformation of avian fibroblasts in vitro.

The DNA as isolated from duck fibroblasts transformed by a duck-adapted Prague strain of Rous sarcoma virus and used for transfection. Transformed recipient BLEF and DEF cultures exhibited considerable morphological variability. The virus designated daPR-RSV-C morphf was obtained from the culture with fusiform transformation and cloned. The virus retained the ability to induce fusiform transformation, even after 20 passages on chicken fibroblasts. There was a good correlation between focus forming activity of the virus and its tumorigenicity in chickens. The frequency of morphf mutation to another phenotype was less than 10(-3) in cloned virus. Foreign avian embryonic cells transformed by this virus clone had a similar morphological appearance as transformed chicken cells. The clone also retained two additional non-conditional markers - subgroup C specificity and the ability to replicate efficiently in duck cells ("duck adaptation"). Freshly obtained cloned virus was found not to contain a transformation-defective mutant. Such a mutant occurred in the second passage of the virus of DEF where the mutant was isolated. Inoculation of the td mutant into Brown Leghorn embryos gave rise to a sarcoma in one of the 36 examined chickens. However, no transforming virus was detected in the sarcoma. SDS-polyacrylamide gel electrophoresis showed that cloned daPR-RSV-C morphf contained only genomic RNA; its molecular weight 3.08 X 10(6) daltons corresponded to the molecular weight of a non-defective PR-RSV-C used as control.

[Antiarrhythmic therapy with flecainide in acute experimental myocardial infarction (author's transl)]. / Behandlung akuter experimenteller Infarktarrhythmien mit Flecainid.

Clinical and experimental studies indicate that ventricular arrhythmias, especially ventricular fibrillation, are in almost all cases the mechanism for sudden death occurring during the first 24 hours after the onset of an ischaemic myocardial event. Therefore a higher survival rate seems to depend on advances in antiarrhythmic therapy. The present study investigates the efficacy of the new local anaesthetic compound Flecainide in reducing or preventing ventricular arrhythmias and primary ventricular fibrillation, using a standardized experimental canine preparation. Our findings demonstrate that ventricular arrhythmias due to severe transmural myocardial infarction are reduced by 80-90% following the application of Flecainide. In some cases a complete abolition of the arrhythmias can be observed. The striking reduction in ventricular ectopics includes decreases in ventricular salves and R-on-T phenomena, which may lead to sudden death by precipitating ventricular fibrillation. The beneficial antiarrhythmic and antifibrillatory actions of Flecainide affect only the arrhythmias resulting from transmural necrosis of the myocardium ("in-hospital arrhythmias", 2nd-phase arrhythmias"), whereas the incidence of early ventricular arrhythmias, especially ventricular fibrillation occurring in the very inception of myocardial ischaemia ("pre-hospital arrhythmias", "1st-phase arrhythmias") is not prevented. Changes in hemodynamics and contractility due to Flecainide are not severe, even in myocardial infarction. Thus, our results indicate that the application of Flecainide in acute myocardial infarction in man may be successful in reducing therapy-resistant ventricular dysrhythmias.

Sympathomimetic and cardiodepressant effects of acebutolol, oxprenolol, pindolol, and propranolol. A comparative study on changes in hemodynamics, contractility, heart rate, and AV-conduction time at therapeutic doses.

The present study was undertaken in order to obtain further informations on non-beta-antiadrenergic properties of the four beta-sympatholytic agents acebutolol, oxprenolol, pindolol, and propranolol. Standardized experiments were performed using a chronically reserpinized canine preparation for the assessment of dose-response curves of changes in hemodynamics, left ventricular contractility, heart rate, AV-conduction time, and myocardial oxygen consumption especially at therapeutic doses. Our results show that acebutolol and oxprenolol, at doses clinically recommended, exert moderate positive inotropic effects but do not influence heart rate significantly. Pindolol has a strong both positive chronotropic and inotropic efficacy, even at small therapeutic doses. Propranolol produces neither chronotropic nor inotropic effects. In contrast to the literature acebutolol exerts direct cardiodepression at doses clinically used, whereas oxprenolol, pindolol, at propranolol have no direct cardiodepressant properties at those doses. Thus the relationship between the dose requirements for chronotropic and inotropic sympathomimetic effects differs for each beta-sympatholytic agents, and in may prove impossible to get an order of intrinsic sympathomimetic potency of beta-blockers comparing dose-response curves of heart rate changes only. As shown in the case of acebutolol, direct cardiodepression of beta-sympatholytic agents may occur at therapeutic doses.

[Effects of sulfinpyrazone on early ventricular fibrillation and 2d-phase arrhythmias in acute myocardial infarction (author's transl)]. / Untersuchunger zur Wirkung von Sulfinpyrazon auf das frühe Kammerflimmern und die Arrhythmien der Spätphase bei akutem Herzinfarkt.

Clinical and experimental studies indicate that ventricular arrhythmias, mainly ventricular fibrillation, are responsible for sudden cardiac death. A recent double-blind multicenter trial ("Anturane Reinfarction Trial") showed that the incidence of sudden cardiac death was reduced in Sulfinpyrazone-treated patients after acute myocardial infarction compared with the placebo group, although the rate of reinfarctions was not diminished. We investigated the efficacy of Sulfinpyrazone on the reduction and prevention of ventricular arrhythmias and primary ventricular fibrillation, utilizing a standardized experimental canine preparation. At normal therapeutic and at high cumulative doses of the drug, a reduction in ventricular arrhythmias within the first 24 hours after coronary occlusion could not be observed. Sulfinpyrazone failed also to alter the ventricular vulnerability to fibrillation in the very early myocardial infarction period. Furthermore, haemodynamics, contractility and oxygen consumption of the heart were not changed. These experimental findings show that the reduction in sudden cardiac deaths in Sulfinpyrazone-treated patients cannot be attributed to antiarrhythmic effects of the drug. Further research is needed to delineate the mechanism of action of Sulfinpyrazone as reported by the Anturane Reinfarction Trial Research Group.