Spontaneous retroperitoneal hematoma - our experience with surgical approach.

Spontaneous retroperitoneal hematoma is a serious complication of anticoagulation and antiplatelet therapy. Its incidence has increased in recent years due to an increasing number of patients on this treatment. A number of case series have been described in the literature. In the vast majority of cases, the hemodynamically stable patients were treated either conservatively or by selective radiological embolization of the bleeding source. A surgical approach is reported as a last choice in the cases where the conservative therapy fails, radiological intervention is unavailable, in patients with continuous bleeding or in patients who develop abdominal compartment syndrome. In our case report, we present a patient on anticoagulation therapy for deep venous thrombosis complicated by massive retroperitoneal bleeding: surgery was used as the method of first choice and the treatment was successful. Key words: retroperitoneal hematoma bleeding anticoagulation treatment surgery.

The role of the NOD2/CARD15 gene in surgical treatment prediction in patients with Crohn's disease.

PURPOSE: Crohn's disease (CD) belongs to chronic disorders with unpredictable disease course. The aim of this study was to identify how genetic testing (NOD2/CARD15) can be used in patients with CD to predict the need for surgical treatment (to define an aggressive type of disease where the patient can profit from early surgery). METHODS: The patients who were tested genetically had undergone a surgery due to CD at the Department of Surgery University Hospital Brno Bohunice between 2010 and 2016. The control group consisted of patients with CD who had been diagnosed with CD at least 5 years prior to the testing and had not required any surgical intervention. The second control group was healthy subjects. RESULTS: In total, there were 117 operated patients for CD, 77 patients with CD that had not undergone surgery for CD and 30 healthy subjects. For patients with at least one genetic mutation, the risk of the necessity of surgical treatment of CD is 1.96 times higher than for patients with no mutation. Patients with two or more mutations were generally operated on at a younger age, in a shorter time after being diagnosed and each patient had a partial resection of the ileum. CONCLUSION: The group of operated patients with CD had a significantly higher distribution of at least one genetic mutation as opposed to the non-operated group. In patients with two or more mutations, the disease course was more aggressive. This group of patients might profit from the conservative top-down or early surgical therapy.

Rare cases imitating acute appendicitis: Three case reports and a review of literature.

Acute appendicitis with its characteristic clinical course is one of the most common diagnoses that require urgent surgery. The following three case reports present patients with symptoms typical of acute appendicitis which was, however, not confirmed intraoperatively. Preoperative CT or MRI were not requested because symptoms clearly indicated acute appendicitis. The first case describes a male patient with right-sided diverticulitis, the second case report involves a pregnant woman in 33rd week of gestation with right adnexal torsion due to a dermoid cyst, and in the last report, a case of spontaneous perforation of appendiceal mucinous neoplasm is presented.Key words: right-sided diverticulitis - dermoid cyst - adnexal torsion - mucinous neoplasm - pseudomyxoma peritonei - appendicitis.

Charged vanadium-benzene multidecker clusters: DFT and quantum Monte Carlo study.

Using explicitly correlated fixed-node quantum Monte Carlo and density functional theory (DFT) methods, we study electronic properties, ground-state multiplets, ionization potentials, electron affinities, and low-energy fragmentation channels of charged half-sandwich and multidecker vanadium-benzene systems with up to 3 vanadium atoms, including both anions and cations. It is shown that, particularly in anions, electronic correlations play a crucial role; these effects are not systematically captured with any commonly used DFT functionals such as gradient corrected, hybrids, and range-separated hybrids. On the other hand, tightly bound cations can be described qualitatively by DFT. A comparison of DFT and quantum Monte Carlo provides an in-depth understanding of the electronic structure and properties of these correlated systems. The calculations also serve as a benchmark study of 3d molecular anions that require a balanced many-body description of correlations at both short- and long-range distances.

Quality of life after bowel resection for Crohn´s disease - first results.

INTRODUCTION: Crohn´s disease (CD) highly affects a patient´s quality of life. The aim of the study was to find out the impact of surgery on the quality of life (QoL) in CD patients and factors affecting their postoperative QoL. METHODS: 90 patients with CD who underwent surgery (bowel resection) filled out an EORTC QLQ-CR29 questionnaire preoperatively and again after the surgical procedure. RESULTS: 77% of the patients experienced a positive change (p<0.001), 22% negative and 11% no change. CONCLUSION: In this cohort, we proved that surgical treatment improves the overall QoL in patients with CD. To determine factors which affect postoperative QoL, more patients need to be enrolled in future studies.Key words: Crohn´s disease - quality of life - surgery - bowel resection - Czech cohort.

[Rare case of a giant parathyroid adenoma]. / Raritní prípad obrovského adenomu prístítného telíska.

Currently, primary hyperparathyroidism is the third most common endocrine disorder worldwide. In the last years, though, the numbers of patients with this diagnosis have been clearly increasing. Females are affected more often, and the age of patients is usually over 50 years. The diagnosis is guided by clinical symptoms of the patient and by biochemical and imaging methods results. [1] When parathyroid adenoma is identified as the source of primary hyperparathyroidism, the necessary extent of resection is performed. The present case involved a rapid diagnostic process necessary to stabilize the patient, together with localization of the adenoma for the indicated surgery. Ultrasound-guided exploration found a surprisingly large tumour of the parathyroid gland causing the acute clinical condition with symptoms suggestive of primary hyperparathyroidism with discrete mechanical compression of the upper mediastinum.Key words: critical diagnosis of hyperparathyroidism acute-active parathyroid adenoma extirpation of a huge parathyroid tumour - normalization of the clinical condition.

Quantum Monte Carlo Study of π-Bonded Transition Metal Organometallics: Neutral and Cationic Vanadium-Benzene and Cobalt-Benzene Half Sandwiches.

We present accurate quantum Monte Carlo (QMC) calculations that enabled us to determine the structure, spin multiplicity, ionization energy, dissociation energy, and spin-dependent electronic gaps of neutral and positively charged vanadium-benzene and cobalt-benzene systems. From total/ionization energy, we deduce a sextet (quintet) state of neutral (cationic) vanadium-benzene systems and quartet (triplet) state of the neutral (cationic) cobalt-benzene systems. Vastly different energy gaps for the two spin channels are predicted for the vanadium-benzene system and broadly similar energy gaps for the cobalt-benzene system. For this purpose, we have used a multistage combination of techniques with consecutive elimination of systematic biases except for the fixed-node approximation in QMC. Our results significantly differ from the established picture based on previous less accurate calculations and point out the importance of high-level many-body methods for predictive calculations of similar transition metal-based organometallic systems.

Spin multiplicity and symmetry breaking in vanadium-benzene complexes.

We present accurate quantum Monte Carlo (QMC) calculations which enabled us to determine the structure, spin multiplicity, ionization energy, dissociation energy, and spin-dependent electronic gaps of the vanadium-benzene system. From total and ionization energy we deduce a high-spin state with vastly different energy gaps for the two spin channels. For this purpose we have used a multistage combination of techniques with consecutive elimination of systematic biases except for the fixed-node approximation in QMC calculations. Our results significantly differ from the established picture based on previous less accurate calculations and point out the importance of high-level many-body methods for predictive calculations of similar transition metal-based organometallic systems.

[The value of intraoperative ultrasonography in parathyroid surgery]. / Výteznost peroperacní ultrasonografi v chirurgii prístítných telísek.

INTRODUCTION: Ultrasound of the neck is a sovereign complementary imaging method suitable for determining morphological changes in thyroidology which uses the so-called B-mode two-dimensional images for the neck area that are complemented by duplex Doppler imaging. Diagnostic verification is performed by sonographists from among radiologists and endocrinologists providing regular outpatient care; the surgeon uses ultrasound for navigation to attain the focus to be operated on. Sonography will provide information on the structure of the thyroid, of the parathyroids, their relationship to the surrounding organs (location, size, relationship to breathing and swallowing pathways). We search for the presence of any pathological abnormalities such as the affection of other organs, tumour invasion into surrounding tissue; it is also important to assess the size and nature of the cervical lymph nodes pretracheally, prelaryngeally, paratracheally, along the vascular plexus and supraclavicularly, where thyroid tumours may form metastases. USG assessment of the regional lymph nodes should not be forgotten before surgical management of thyroid nodules or the parathyroids. Thanks to the introduction of ultrasound as an additional screening method in parathyroid surgery we have gained the opportunity of more precise and successful localisation of pathological parathyroid lesions, which is beneficial for patients with hyperparathyroidism. MATERIAL AND METHODS: We worked with a group of patients from 2002 to 2010 when we selected 370 prospectively followed patients operated on for endocrine disease of the thyroid and parathyroid glands. The group consisted of 77 men and 293 women. This group was further selected according to the required criteria specified in the text. Since we are focusing on peroperative ultrasound and on the detection and specification of the position of the parathyroid glands for the surgeon, we are concentrating chiefly on pathological parathyroid glands. These are imaged as circumscribed hypoechoic lesions with hyperechoic margin. Ultrasonography is considered both a sovereign standard diagnostic method and a very valuable navigational method used to localise pathological glands. We use a linear as well as a special "hockey stick" probe which has a higher resolution. RESULTS: For comparison, both detection methods - gamma navigation and ultrasound - are dealt with. We are fully aware of the small number of patients in the selected groups. The results of the statistical analysis show that the use of ultrasound and gamma navigation shortens the overall operation time. More interesting, however, is the indicator of the range of variation, i.e. the difference between the maximum and minimum length of operation. When using one or the other detection method, the variation range is significantly lower and it is apparent that using the gamma-ray or ultrasound navigation system, the detection of the parathyroid gland, particularly when unusually located, is much simpler and thus faster. This finding is also supported by an additional parameter, variance, which expresses the variability of the distribution of values - around the average length of operation. CONCLUSION: Preoperative and intraoperative detection of hyperactive parathyroid glands is useful for minimizing the extent of surgical intervention, reducing operation time and decreasing the risk of perioperative complications. It is not necessary to use a radionuclide and therefore the method can be used even where there is no nuclear medicine station. It is also possible to detect glands which do not accumulate radionuclides and thus cannot be imaged with MIBI scintigraphy/SPECT CT. Still, an experienced surgeon remains irreplaceable. We dare say that if such a surgeon can make use of the above mentioned auxiliary methods in addition, the rate of success in this field of surgery increases substantially.

[Pneumosurgery in the management of colorectal carcinomas]. / Pneumochirurgie v resení karcinomu kolorekta.

OBJECTIVE: Surgically solved lung involvement in patients after surgery of colorectal cancer. MATERIALS AND METHODS: Altogether 15 patients, 9 men (median age in the time of lung diagnosis 67 years) and 6 women (median age 59 years) underwent classical open pulmonary surgery during 2003-2008 years from the follow-up cohort of 836 persons after operation due to colorectal cancer in the time period of 1996-2008 years. The indication for lung surgery: solitary pulmonary lesion. Procedures distribution: pulmonary lobectomy 7, bilobectomy 2, segmentectomy 4, wedge resection 2. The requirement of the European Society of Thoracic Surgeons (ESTS) guidelines of complete pulmonary resection has been met by 10 operations (66.7%) with lobe specific lymphadenectomy. Histopathology investigation: Formalin fixed, paraffin embedded samples were investigated after hematoxylin-and-eosin staining, supplemented in case of need by immunohistochemistry of CK7, CK20 and TTF1. RESULTS: Eleven pulmonary metastases were found, in two cases with interlobar lymfatics involvement. Two metachronous primary adenocarcinomas of the lung (ADL) were diagnosed, one of them with metastases into hilar lymphatics. In remaining two patients pulmonary chondrohamartoma was discovered. CONCLUSION: Solitary pulmonary opacity in patient after colorectal surgery might not represent simple metastasis explicitly. Complete resection is needed.

[Complications in patients undergoing pulmonary oncological surgery]. / Komplikace u pacientu po operaci pro plicní malignitu.

AIM: A survey evaluating incidence and risk factors of complications in persons underwent complete open lung resection because of primary or secondary lung malignancy. MATERIAL AND METHODS: Retrospective study of 189 open surgery procedures in 128 males and 61 females, mean age males 61 years (range 21-78), females 64 years (range 33-80) during a five-years period (2003-2007). Data processing and analysis were performed with the statistical software system Statistica and compared by parametres odds ratio a chi2 test. RESULTS: Complications were divided into five groups. First group was defined as complications in perioperative period and was composed of three events 1.5%: endotracheal tube dysfunction (i.e. 0.5%), heavy cardiac arrhytmia 0.5% and serious haemorrhage, that occurred immediately after operation 0.5%. Second group includes complications within period of 7 days after surgery: prolonged air leak (PAL > 7 days) 7.4%, bronchopneumonia 6.9%, cardiac arrhythmia 6.9%, postoperative delirium 4.2%, atelectasis 2.6%, wound infection 1.1%, bleeding 1.1% and chylothorax 0.5%. Third group contains events between 8th and 30th postoperative days: thoracic empyema 2.1%, dysphonia 2.1%, painfull shoulder 1.1%, alimentary tract infection 0.5% and bronchial closure insufficiency 0.5%. Fourth group contains patients with severe complications, that led to death during 30 days after operation: ischemic stroke 0.5% and pulmonary embolism 0.5%. Patients without any complication formed the fifth group of 60.5%. CONCLUSION: Main risk factors for complications in postoperative period after lung resection due to primary or secondary lung malignancy in our group of patients are COPD, corticotherapy, time of operation over 3 hours, BMI over 25, left side tumor localization and bronchoplastic procedure. For cardiac arrhytmia seems to be risk factor pneumonectomy and previous neoadjuvant radiochemotherapy.

Ground and excited electronic states of azobenzene: a quantum Monte Carlo study.

Large-scale quantum Monte Carlo (QMC) calculations of ground and excited singlet states of both conformers of azobenzene are presented. Remarkable accuracy is achieved by combining medium accuracy quantum chemistry methods with QMC. The results not only reproduce measured values with chemical accuracy but the accuracy is sufficient to identify part of experimental results which appear to be biased. Novel analysis of nodal surface structure yields new insights and control over their convergence, providing boost to the chemical accuracy electronic structure methods of large molecular systems.

[Spontaneous pneumothorax--management, therapy]. / Spontáinní pneumotorax--management, terapie.

OBJECTIVE: Spontaneous pneumothorax (SPNO) is a surgical disease, which belongs to surgical emergencies. It is divided into a primary, secundary, katamenial and neonatal. A young and healthy men are affected by primary SPNO, usually on the right side of the thorax, recurrence is common. A secondary SPNO typically occurs in patients between the 5th and 7th decenium. These patients usually suffer from some lung disease. A major complications are more common in this type of pneumothorax. METHODS: At Department of surgery, University Hospital Brno, 73 patients were treated for spontaneous pneumothorax from the January, 2006 till August, 2008. We divided patients in two groups. The first one with primary SPNO, and the second one with secondary SPNO. Hospital stay, age distribution, type of operation, duration of drainage, postoperative complication, histological findings and laterality were followed up retrospectively. RESULTS: In group of primary SPNO, 24 patients were operated without major complication. The most frequent cause was bullate emphysema, hospital stay was 8 days, duration of drainage 6 days. The second group with secondary SPNO, five patients were operated, hospital stay was 16.5 days, duration of drainage 10 days. Haemothorax as a postoperative complication occured in one case. In both groups we proved the bullate emphysema as the most frequent cause, as well as a right - sided involvement. CONCLUSION: Spontaneous pneumothorax is a surgical disease. It's treatment has to be provided by surgeon, if possible by a thoracic specialist. The first occurrence of spontaneous pneumothorax is treated by drainage, the recurrence by operation. The principal is to combine an atypical resection of affected lung with a mechanical pleurodesis. Postoperative complications are not frequent.

Pfaffian pairing wave functions in electronic-structure quantum Monte Carlo simulations.

We investigate the accuracy of trial wave functions for quantum Monte Carlo based on Pfaffian functional form with singlet and triplet pairing. Using a set of first row atoms and molecules we find that these wave functions provide very consistent and systematic behavior in recovering the correlation energies on the level of 95%. In order to get beyond this limit we explore the possibilities of multi-Pfaffian pairing wave functions. We show that a small number of Pfaffians recovers another large fraction of the missing correlation energy comparable to the larger-scale configuration interaction wave functions. We also find that Pfaffians lead to substantial improvements in fermion nodes when compared to Hartree-Fock wave functions.

High accuracy many-body calculational approaches for excitations in molecules.

Two state-of-the-art computational approaches: quantum Monte Carlo and GW with exciton effects [GW-BSE (Bethe-Salpeter equation)] are employed to calculate ionization potentials, electron affinities, and first excited singlet and triplet energies for the silane and methane molecules. Results are in excellent agreement between these dramatically different approaches and with available experiment. The optically forbidden triplet excitation in silane is predicted to lie roughly 1 eV higher than previously reported. In the GW-BSE method, we demonstrate that inclusion of off-diagonal matrix elements in the self-energy operator is crucial for an accurate picture.

Silicon clusters of intermediate size: energetics, dynamics, and thermal effects

A combination of the best available theoretical techniques for energetics, dynamics, and thermodynamics is employed in an extensive study of Si(n) ( n = 20,25) clusters. For T = 0 we solve the electronic structure by the density functional and the highly accurate quantum Monte Carlo approaches. Finite temperature and dynamical effects are investigated by the ab initio molecular dynamics method. This combination of methods enables us to find several new low-energy isomers and to explain the differences in properties, behavior, and stability of elongated versus compact types of structures and to elucidate the origin of the existing discrepancies between theory and experiments.

Electron correlation in C(4N+2) carbon rings: aromatic versus dimerized structures

The electronic structure of C(4N+2) carbon rings exhibits competing many-body effects of Huckel aromaticity, second-order Jahn-Teller (SOJT), and Peierls instability at large sizes. This leads to possible ground state structures with aromatic, bond angle, or bond length alternated geometry. Highly accurate quantum Monte Carlo results indicate the existence of a crossover between C10 and C14 from bond angle to bond length alternation. The aromatic isomer is always a transition state. The gap opening mechanism is the SOJT effect, which coalesces with the Peierls regime as N-->infinity.