[Our experience with chest wall stabilization]. / Nase zkusenosti se stabilizací hrudníku.

INTRODUCTION: An unstable chest wall is defined as a fracture of at least three adjacent ribs broken at least in two planes. As a result of impaired mechanical strength of the chest wall, paradoxical movements occur, resulting in insufficient pulmonary ventilation with the development of respiratory insufficiency with typical consequences - hypoxia, hypercapnia and acidosis. METHODS: In this paper we describe a group of 16 patients who underwent stabilization of the chest wall. The average age of the group was 56 years, the youngest patient was 23 and the oldest one 76 years old. There was an average of 6.1 broken ribs per patient, individually ranging from 4 to 8. In 11 cases, the stabilization was performed for a block fracture, in 5 cases for a serial fracture with a thoracic wall deformity. RESULTS: The average length of hospital stay was 19 days, the time from admission to surgery was 4.46 days, and the average duration of mechanical ventilation was 2.63 days. In our group, we had only one deep wound infection that was healed using vacuum therapy. Concerning other complications, there was one case of bronchopneumonia and one patient developed delirium. No redrainage for fluido- or pneumothorax was necessary. CONCLUSION: The main focus of this paper is on the active surgical approach to treatment of serial and block fractures of ribs with deformation or manifest instability of the chest wall. Not all patients with block fracture required stabilization, whereas 5 patients with serial fracture of the ribs were indicated for surgical revision for chest wall deformity and other complications.Key words: flail chest treatment indications.

[Initial experience with using uniportal VATS (SITS) to treat the implications of thoracic trauma in the 1st Department of Surgery of the Faculty of Medicine at Masaryk University and St. Annes Teaching Hospital in Brno]. / Iniciální zkusenosti s pouzitím "uniportal VATS (SITS)" prístupu pri osetrování dusledku hrudních traumat na I. chirurgické klinice LFMU a FNUSA v Brne.

Thoracic trauma represents a multidisciplinary therapeutic challenge requiring individualized approach to every patient. Continuous development and implementation of mini-invasive techniques in thoracic surgery pave way to so far unique attempts to establish video-assisted thoracic surgery for thoracic trauma as well. The indication is limited by hemodynamic stability of the patient, extent of the trauma, as well as by time required for the treatment. However, proper indication provides an unequivocal benefit in terms of postoperative pain, early mobilization and excellent cosmetic effect. Continuous reduction of the number of incisions down to monoportal approach is currently the peak of mini-invasive approach in thoracic trauma management. The aim of this work is to provide 3 case reports documenting the current spectrum of monoportal video-assisted surgery indication for thoracic trauma.Key words: uniportal VATS thoracic trauma.

[Assessment of thoracic trauma at the 1st Department of Surgery in Brno (1 January 2011 - 31 December 2015)]. / Poranení hrudníku na I. chirurgické klinice LF MU a FN USA v Brne (vyhodnocené období 1. 1. 2011 az 31. 12. 2015).

INTRODUCTION: The number of cases of thorax injury increased steadily between 2011 and 2015. This is probably related to a more active lifestyle of the younger generations and also to the increasing average age of citizens. The aim of the study was to show problems connected with thorax injury. METHOD: Our retrospective study evaluated a group of patients with thoracic injury (diagnosis codes S20-S29) in the period from 1 January 2011 to 31 December 2015 who were treated in our Department. RESULTS: We evaluated a group of 1,697 patients with thoracic injury were divided into five subgroups: 1) simple contusion of the thorax, 2) simple rib fractures, 3) contusion of the thorax with vertebral fractures, 4) serial, multiple rib fractures, 5) stab and gunshot injuries of the thorax. Each subgroup was analyzed independently and in detail. The number of thoracic injuries increased steadily, year on year. More than 40% of the patients were older than 60 years. In the group with simple rib fractures, the authors found 14 cases of pneumothorax (5.1%), which was drained in only 8 cases. The most common complications in the serial rib fractures group included pneumothorax (33 cases, 20%), hemothorax (28 cases, 16.9%) and lung contusion (15 cases, 9%). Stabilization of the thoracic wall was performed 16 times, out of the total of 26 multiple rib fracture cases (61.5%). CONCLUSIONS: Thorax injury is routinely encountered by surgeons. The authors recommend to pay particular attention not only to serious, but also to simple thorax injuries in very old patients, for instance those on anticoagulation therapy. Adequate caution also needs to be taken with serial rib fractures and flail chest and their treatment.Key words: thorax injury - rib fractures - hemothorax - pneumothorax.

[Multiple Primary Lung Cancer - a  Case Report and Literature Review]. / Vícenásobné nádorové onemocnení plic -  kazuistika a prehled literatury.

BACKGROUND: Multiple primary lung cancer is a relatively rare nosological entity. This case report is a reminder and points out the pitfalls of its diagnosis and therapy. CASE REPORT: A 62-year-old patient was indicated for surgical therapy for non-small cell lung cancer of the middle lobe and right lung, which were diagnosed during a screening investigation after the patient had undergone previous mastectomy of the right breast with axillary dissection for invasive ductal adenocarcinoma. Another infiltration in the lower lobe of the same lung was removed at the same time and was classified as a primary lung carcinoma; it was a synchronous lung cancer. CONCLUSION: Lung cancer presenting with more than one primary lesion in the lung is a rare nosological entity that can be classified into two types; synchronous and metachronous. Whereas synchronous cancers arise in the lung at the same time, metachronous cancers develop after treatment of the initial lesion. The incidence of multiple lung cancer is increasing due to earlier diagnosis and because successful treatment of the initial cancer at an early stage has led to an increase in patient survival, resulting in an increase in the interval between detection of the initial cancer and detection of the second. Smoking is one of the main risk factors. Diagnosis is made difficult because metastatic disease must be excluded. Basic information is obtained from a biopsy of the tumor. The staging of more than one primary lung cancer is complex and needs to be meticulous if curative resection is being contemplated. Magnetic resonance imaging of the brain and fluorodeoxyglucose positron emission tomography should be performed to evaluate for extra-thoracic metastases. KEY WORDS: lung carcinoma - multiple cancer disease - synchronous - metachronous - diagnosis - therapyThe authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 22. 2. 2016Accepted: 20. 4. 2016.