Thyroid tumors at the limit of operability.

Comprehensive information about current thyroid carcinoma treatment options depending on its histology and extent of the disease, focusing on locally advanced findings at the limit of operability. Treatment of such a heterogeneous group requires interdisciplinary cooperation. We provide 6 unique case reports including imaging scans, description of the therapy and description of development of the condition.

[Surprising findings during thoracic revision due to gunshot injury - a case report]. / Prekvapivý nález pri revizi hrudníku pro strelné poranení - kazuistika.

INTRODUCTION: Gunshot thoracic injuries are not very common in our geographical location, occurring most frequently in the context of criminal activity or as a result of suicidal behavior. CASE REPORT: The authors report the case of a patient who, in a suicidal attempt, caused himself a combined penetrating gunshot injury of the chest with laceration of the lung and a heart gunshot hole, which was diagnosed peroperatively. CONCLUSION: Therapy of gunshot injuries in the era of modern medicine should be comprehensive in multidisciplinary cooperation.Key words: thoracic trauma gunshot injury lung injury heart injury thoracotomy.

[The first lung re-transplantation in the Czech Republic]. / První retransplantace plic v Ceské republice.

Nowadays, lung re-transplantation is an acceptable method of treatment in patients with graft failure after lung transplantation. During the 15-year duration of the lung transplant program in the Czech Republic, the first re-transplantation was performed on 1. 8. 2012. This article presents the case report of a female patient with lymphangioleiomyomatosis who underwent single lung transplantation on the left side on 4. 10. 1998. Over 12 years, based on bronchiolitis obliterans syndrome, she developed chronic respiratory insufficiency again. The patient was re-listed on the waiting list and on 1. 8. 2012, successful single-lung transplantation on the right side was performed.Key words: lung re-transplantation bronchiolitis obliterans syndrome organ allocation.

[Thoracic sarcoma, is indication for surgery sensible? case reports]. / Sarkomy hrudníku, má operacní indikace smysl? soubor kazuistik.

Sarcomas form a heterogenous group of diseases. They often affect young patients and their prognosis is uncertain. The only hope for curative treatment of these patients is a surgical R0 resection. Chemotherapy is only indicated for certain types of sarcomas and is often only recommended as part of clinical trials. The article describes 4 different case reports of patients with sarcomas and reflects on the justification of indicating surgical treatment. resection.

[Reexpansion pulmonary oedema after drainage of a long-term spontaneous pneumothorax - a case report]. / Reexpanzní edém plíce po drenázi dlouhotrvajícího spontánního pneumotoraxu - kazuistika.

Reexpansion pulmonary oedema is a rare but possibly lethal complication of thoracic drainage for pneumothorax. Morbidity and mortality of this complication remains high (up to 20% of lethal cases) and as such deserves our attention. We report a case of ipsilateral left-sided pulmonary oedema following chest tube insertion in a 42-year-old male patient with spontaneous pneumothorax. Pneumothorax can be expected to last for up to 3 weeks (from the first presentation of sudden dyspnoea and chest pain). The pathophysiology of this lung affection has not yet been completely elucidated; the crucial role is probably played by damage to the endothelium which is followed by increased endothelial permeability during ischemia-reperfusion injury in a rapidly reexpanding lung. The main risk factors for the development of RPE are young age (the younger the patient, the higher the risk), the female sex, the degree of lung collapse, a pneumothorax that lasts more than 24 hours, a reexpansion of the lung in less than ten minutes, the use of a suction system, and - in cases of a pleural effusion - an evacuation volume of more than 2000 ml. Although in patients with these risk factors the administration of initial negative pressure should be avoided, this procedure remains common practice in pneumothorax treatment in the Czech Republic. Thoracic surgeons are more likely to use the suction system than pulmonologists (70% versus 52%). RPE manifestation ranges from benign clinical course (patients are free of complaints with only pathological chest radiography findings) to potentially lethal rapid respiratory failure with circulatory shock. Most patients develop RPE within 1 hour of expansion and the ipsilateral lung is affected. Only rarely can pulmonary oedema be bilateral, or in the contra-lateral lung. Treatment of RPE is supportive and depends on the individual patients condition, ranging from mere monitoring to mechanical ventilation for serious cases. Positive pressure mechanical ventilation and the utilization of positive end-expiratory pressure (PEEP) remains the gold standard of treatment.