Pulmonary arteriovenous malformation managed by VATS lobectomy.

Pulmonary arteriovenous malformation (PAVM) is formed by abnormal connections between pulmonary arteries and veins that bypass the pulmonary capillaries and transport deoxygenated blood through pulmonary veins to the left heart. This causes insufficient oxygenation of blood in the lungs. This condition remains symptomless for a long period of time. The most common symptoms include shortness of breath on exertion, nosebleeds, increased fatigue and a gradual development of cyanosis. Paradoxical embolism in the brain is a serious complication; it can present with a stroke or a brain abscess. Treatment of the disease consists of embolization of the pathological vascular connections, surgical resection of the affected pulmonary parenchyma and management of concomitant manifestations of the disease. PAVM in most common cases arises as a result of an autosomal dominant hereditary disorder referred to as hereditary hemorrhagic telangiectasia.  Case report: In our communication, we document the diagnostic and therapeutic management in a young patient diagnosed with PAVM after falling off his bicycle. Based on comprehensive assessments, AV malformations with a 40% shunt of the pulmonary circulation were detected. An angiographic procedure was not an appropriate option considering the type and extent of the condition. Therefore, video-assisted thoracic resection of the affected pulmonary lobe was indicated. Conclusion: PAVM is a rare finding. PAVM should be ruled out in all patients with hereditary hemorrhagic telangiectasia (HHT) signs in the oral cavity. Contrast sonography of the heart and contract CT of the chest are the methods of choice for the diagnosis. Conservative or pharmacological treat-ment fails to improve the patients status.  The condition is usually managed by embolization. Cases where PAVM is rather extensive or diffuse, where endovascular management would be inappropriate, can be well managed using endoscopic resection adequate to the extent of the condition.

[Descending Thoracic Aortic Injury in Flail Chest]. / Poranení sestupné hrudní aorty pri blokové zlomenine zeber.

The authors present a case of 74-year-old female patient who suffered a flail chest in motor vehicle accident. First day after injury a descending thoracic aorta was injured, most likely during manipulation with the patient. This injury was verified by operation, which was indicated 26 hours after the hospital admission, because of a sudden decrease of blood pressure with blood loss over 600 ml through the chest tube. The female patient died during surgery despite all efforts. Due to our experience with this rare case and after literature studying, we would recommend to consider early surgical revision. Based on the close contact of severely displaced sharp edges of ribs to the descending aorta, which was visible on the CT scan. Even through the absence of clear leak of contrast in the CT examination. We could resect these parts of ribs. Key words: flail chest, descending thoracic aortic injury.

Procalcitonin, neopterin and C-reactive protein in diagnostics of intrauterine infection and preterm delivery.

OBJECTIVE: The purpose of this study was to find out whether Procalcitoni, Neopterin and C-reactive protein are sensitive and specific markers of intrauterine infection. METHODS: We evaluated 155 patients from 26. to 41. week of pregnancy at the time of delivery. We measured serum concentrations of procalcitonin (PCT), neopterin and C-reactive protein (CRP) from mother's blood sample at the beginning of delivery and from umbilical cord blood after delivery. RESULTS: In first group occurred in higher percentage (27.41%) preterm delivery (26.-37. week of pregnancy), chorioamnionitis confirmed by histological examination (16.12%) and preterm premature rupture of membranes (24.19%). In this group occured perinatal infection of newborn in 61.29%. In the second group preterm delivery (6.31%) and perinatal infection of newborn (7.36%) occured in lower percentage. CONCLUSION: The results suggest that the simultaneous measurement of CRP, PCT and NPT in mother's blood sample before delivery and umbilical cord blood may provide an accurate early diagnosis of infection and then preterm delivery (Tab. 1, Fig. 3, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

[Retroperitoneal hemangioma--a case report]. / Hemangiom retroperitonea--kazuistika.

Localization of hemangioma in retroperineum causes late diagnosis of the disease. The tumour is usually detected only when the clinical symptoms caused by the pressure of the surrounding tissues occur. This article presents the case of retroperitoneal hemangioma preoperatively diagnosed as suspect feochromocytoma.

[Amoebic liver abscess--case report]. / Amébové abscesy jater--kazuistika.

The authors present a case of a young male, who suffered with extraintestinal form of amoebiasis-amoebic liver abscesses. The patient traveled to India two month before symptoms onset. The diagnosis based on ultrasonography and computed tomography was definetely confirmed by serological examination. Metronidazol treatment was given initially, followed by percutaneous drainage. Open surgical tretment was indicated due to failure of percutaneous treatment. Patient was discharged home in a good condition one month after surgery. At this time patient is doing well eight months after surgery.