[Rare injury of perineum and anorectum - case report]. / Raritní poranení hráze a anorekta kazuistika.

UNLABELLED: Anorectal injuries, with the exception of iatrogenic damage, are rare. Considering the extensive range of causes and potential extent of damage, the diagnosis and treatment of these injuries requires an individual approach to every patient. Based on the extent of damage, the best way of treatment strategy has to be selected for successful treatment of the primary injury and elimination of frequent complications, especially fecal incontinence. The authors present a rare injury of the perineum and anorectum with anorectal sphincter damage in an elderly man after falling down from a stepladder. KEY WORDS: anorectum - anorectal trauma - anal sphincter.

[Laparoscopic resection rectopexy in the treatment of obstructive defecation syndrome]. / Laparoskopická resekcní rektopexe v lécbe obstrukcního defekacního syndromu.

INTRODUCTION: Obstructive defecation syndrome (ODS) presents a common medical problem, which can be caused by various pelvic disorders; multiple disorders are frequently diagnosed. At the present, a high number of corrective techniques are available via various surgical approaches. Laparoscopic resection rectopexy is a minimally invasive technique, which comprises redundant sigmoidal resection with rectal mobilisation and fixation. METHODS: The aim of this paper was to evaluate the safety and effectiveness of laparoscopic resection rectopexy in the treatment of patients with ODS. The evaluation was performed via our own patients data analysis and via literature search focused on laparoscopic resection rectopexy. RESULTS: In total, 12 patients with ODS undergoing laparoscopic resection rectopexy in University Hospital Ostrava during the study period (2012-2015) were included in the study. In our study group, mean age was 64.5 years and mean BMI was 21.9; the group included 11 women (91.6%). ODS was caused by multiple pelvic disorders in all patients. Dolichosigmoideum and rectal prolapse (internal or external) were diagnosed in all included patients. On top of that, rectocoele and enterocoele were diagnosed in several patients. Laparoscopic resection rectopexy was performed without intraoperative complications; mean operative time was 144 minutes. Mean postoperative length of hospital stay was 7 days. Postoperative 30-day morbidity was 16.6%. All postoperative complications were classified as grade II according to Clavien-Dindo classification. Mean preoperative Wexner score was 23.6 points; mean score 6 months after the surgery was 11.3 points. Significant improvement in ODS symptoms was noted in 58.3% of patients, and a slight improvement in 16.6% of patients; resection rectopexy provided no clinical effect in 25% of patients. CONCLUSION: It is fundamental to carefully select those patients with ODS who could possibly profit from the surgery. Our results, in accordance with published data, suggest that laparoscopic resection rectopexy is a valuable surgical technique in the treatment of patients with ODS caused by multiple pelvic disorders. KEY WORDS: obstructive defecation syndrome - constipation - resection rectopexy - operative techniques - pelvic floor disorders.

[Hepatic pseudolesions adjacent to the falciform ligament]. / Hepatální pseudoléze v blízkosti falciformního ligamenta.

INTRODUCTION: Accurate detection of hepatic pseudolesions using multi-detector CT and MRI examinations is crucial for the differentiation of benign alterations from primary and secondary malignant lesions in hepatic parenchyma. METHOD: The authors conducted a systematic literature review in PubMed. "Liver" and "pseudolesion" were used as keywords in English and Czech, and papers/articles published from 2000 to 2014 were retrieved. RESULTS: The authors presented a literature review. In addition, the authors performed a retrospective evaluation of a group of patients treated for liver disease at University Hospital Ostrava where this anomaly was encountered in 7 cases.In 3 of the patients, diagnostic laparoscopy was done, with visual examination of the lesion accompanied by intraoperative ultrasound exam (IOUS) and partial excision, to establish the diagnosis. Subsequent histological assessment of the specimens confirmed the diagnosis of a steatotic lesion in each of these 3 patients. Additional 2 of the 7 patients underwent liver surgery for concurrent metastatic lesions of colorectal cancer and an open-access revision of the suspected lesions was performed. Visual inspection and intraoperative ultrasound (IOUS) was followed by excisional biopsy. The histology revealed macro- and micro-vesicular steatosis and excluded malignant changes. The last 2 patients still continue to be followed-up regularly on a 6-month routine check-up basis at our hepatology unit. CONCLUSION: The authors presented their own experience gained through inter-disciplinary cooperation at Multidisciplinary conferences. A literature overview of this unusual subject is also included. Particularly in oncologic patients, correct interpretation of these pseudolesions may help to avoid unnecessary biopsies, further imaging examinations and diagnostic laparoscopies and/or explorative laparotomies.

3D high resolution anorectal manometry in functional anorectal evaluation.

INTRODUCTION: Anorectal manometry is a diagnostic tool designed for the evaluation of functional parameters and assessment of anorectal activity coordination. In the last decade, the development of 3D high-resolution (HR) manometry and its expansion in experimental and clinical settings has been evident. Literature search (in the MEDLINE and PubMed databases) focusing on studies about 3-dimensional HR manometry was performed. The aim of this paper is to offer an overview of the current state of the art of manometry while concentrating on indications, protocol of the procedure and applicability of this examination in clinical practice. RESULTS: Development of solid catheters with miniaturized semiconductor sensors has enabled very precise measurement (high resolution) and creation of anorectal 3D pressure models. In comparison with water-perfused manometry systems, this method offers more accurate and more detailed data that can be employed in functional disorders assessment. The indications for anorectal manomery are symptoms of faecal incontinence and functional constipation. This modality can also be used in biofeedback therapy, in functional anorectal pain and when assessing patients undergoing continent rectal resection. The HR manometry protocol should comprise the measurement of anorectal resting pressures, the squeeze manoeuvre, the bear down manoeuvre, the cough reflex test, the rectoanal inhibitory reflex examination, rectal sensitivity testing and rectal compliance measurement. Processed data are fundamental in determining an individually tailored treatment plan for patients suffering from anorectal functional disorders. CONCLUSION: Anorectal 3D HR manometry presents a valuable diagnostic modality offering a new dimension in anorectal function understanding and can reveal new pathophysiologic mechanisms of anorectal functional disorders.

[Improving the quality of histopathological examination of colorectal cancer specimens through standard protocol implementation]. / Zvýsení kvality histopatologického hodnocení preparátu kolorektálního karcinomu prostrednictvím zavedení standardního protokolu.

INTRODUCTION: Detailed, high-quality histopathological examination of colorectal carcinoma is an essential component of accurate disease staging. The aim of this study was to evaluate the influence of standard pathological protocol implementation on the quality of colorectal cancer specimen evaluation. MATERIAL AND METHODS: The standard protocol for colorectal cancer specimens evaluation was created on the basis of the NCCN guidelines for colorectal carcinoma and in accordance with the American Joint Committee on Cancer (AJCC) recommendations. The protocol has been implemented into the practice of University Hospital Ostrava since 1 January 2013. All patients who underwent resection for colorectal cancer in University Hospital Ostrava between 1 January 2011 and 30 June 2013 were included into the study. Histopathological reports (before and after protocol implementation) were analysed with a focus on the presence of the parameters being monitored; the differences underwent statistical analysis. RESULTS: In total, 235 patients who underwent resection of colorectal cancer (184 patients before and 51 patients after protocol implementation) were included into the study. The mean number of investigated lymph nodes was 12.5±6.3 (colon) and 12.6±6.2 (rectum) before protocol implementation. The mean number of lymph nodes was 15.0±4.6 (colon) and 16.8±6.7 (rectum) after protocol implementation; the differences are statistically significant. Before protocol implementation, the limit of 12 investigated lymph nodes was not reached in 49 patients with colon carcinoma (43.8%) and in 32 patients with rectal carcinoma (44.4%). Statistically significant improvement was noted after protocol implementation - the limit of 12 lymph nodes was not reached in 5 patients (18.5%) with colon and 4 patients (16.7%) with rectal carcinoma. There were also differences in the number of macroscopic mesorectal excision quality evaluation, circumferential resection margin reports and signs of microscopic tumour aggressiveness, in favour of histopathological reports after standard protocol implementation. CONCLUSIONS: Our retrospective study proved that the implementation of the standard protocol for colorectal cancer resection specimens leads to an improved quality of definitive histopathological reports.

Determination of 239Pu/240Pu isotopic ratio by high-resolution alpha-particle spectrometry using the ADAM program.

A novel analysis program to unfold alpha-particle energy spectra was introduced, demonstrated and validated using radiochemically processed test sources, which contained different amounts of (239)Pu and (240)Pu. A high-resolution alpha spectrometer was used for data acquisition. The software known as ADAM unfolds the spectra using nuclide-specific decay data as a constraint. The peaks can have different shapes and the software can also cope with the coincidences between alpha particles and electrons/photons. In the present paper, the (239)Pu/(240)Pu activity ratios from alpha spectrometry agreed, within the stated uncertainties, with the reference values. Number of counts in the (239,240)Pu peak group must be larger than 100 to obtain reliable values when using semiconductor detector of energy resolution FWHM=10.6 keV.

Routine pathological analysis of appendicectomy specimens--is it justified?

Appendicectomy for acute appendicitis is one of the most commonly performed surgical procedures. Our unit policy has been to conduct pathological examination of all resected specimens, however this practice has recently been questioned. We therefore sought to analyse the utility of routine histological examination of appendicectomy specimens. A consecutive series of 236 patients who underwent open appendicectomy for clinically suspected appendicitis was reviewed. Examination of the specimens revealed inflammation or necrosis in 175 (74%) of the cases-however unexpected histological findings were seen in 10 (4.2%) specimens. In five of these cases (2.1%), these findings resulted in a change in medical therapy. We conclude that appendicectomy specimens from patients with clinically suspected appendicitis show diversity in their histological characteristics; and that routine histological examination can yield clinically significant information in a significant minority of patients.

[Ten-year experience with Barron ligature in the Ostrava surgical clinic]. / 10 let zkuseností s Barronovou ligaturou na chirurgické klinice Ostrava.

The authors aim to present the problematics of hemorrhoid treatment using the Barron ligature semiinvasive method, to healthcare professionals.

[False acute large bowel obstruction]. / Falesná akutní pseudoobstrukce tlustého streva.

Acute pseudobstruction of the large intestine is also termed the "Ogilvie" syndrome. The life- threatening condition without obvious mecha nical obstruction of the intestine, results from a major enlargement of the large intestine, which, if no therapy is initiated on time, may result in perforation of the right- sided colon, most commonly of the caecum. In this case study, the patient underwent urgent surgery for incipient caecal perforation. Nor the preoperative plain abdominal x- ray examination, abdominal CT, nor the laparotomy procedure detected any mechanical bowel obstruction. The condition was diagnosed as the Ogilvie syndrome in a chronic renal disorder of the patient. The procedure included transversostomy, drainage of the peritoneal cavity and complex management, and the patient was discharged to homecare on the ninth postoperative day. However, two weeks later, the patient was rehospitalized for bleeding from the stoma site. Colonoscopy detected a small stenosing tumor in the lienal flexure of the large intestine. The case study highlights failure of both the CT and x-ray abdominal examinations (air up to the sigmoid), as well as of the surgical exploration. Therefore, it may be concluded that not all pseudoobstructions are truely "pseudo".

[The rectal carcinoma treatment history]. / Historie lécby karcinomu rekta.

The authors demonstrate a history of the rectal carcinoma surgical therapy, based on the available literature data or on oral information. Furthermore, they add their own experience with treatment of the rectal carcinoma, the disorder, which in the Czech Republic and, namely, in the Northern Moravian region, has one of the highest worldwide incidence rates.

[A contribution of the anorectal angle measurement according to Schiessel to assessment of the safe distance of the inferior resection line in the rectal carcinomas surgical procedures]. / Prínos meiení anorektálního úhlu podle Schiessela pro urcení bezpecné vzdálenosti dolní resekcní linie pil operaci karcinomu rekta.

Surgical procedures of the anus for rectal malignancies are amongst the most difficult procedures within abdominal surgery. Especially when the tumor is located in the middle and distal third of the rectum and the surgeons aim to conduct a sphincter-saving procedure, the pre-operative diagnostics is a pre-requisite for a successful treatment. The authors aim to inform the medical community on a non-traditional and rarely used examination method of the anorectal angle prior to surgical procedures of the rectal carcinomas.

[The first case of management of the rectovaginal fistule using transanal endocsopic microsurgery]. / První prípad resení rektovaginální pístele pomocí transanální endoskopické mikrochirurgie.

The authors present an unusual and, according to the available literature data, so far unused method--management of the rectovaginal fistule, using a T.E.M. technique (transanal endoscopic microsurgery). In their case-review of a female patient, they present advantages of this technique in a case of a rare disorder - a benign rectovaginal fistule. All of the following employment of a harmonic scalpel in the T.E.M. method, as well as of a tissue adhesive Tissucol and of a surgical rectoscope in the vaginal phase of the procedure, deserve attention of surgeons and gynaecologists.

[Safe distance of the inferior resection line in the rectal carcinoma surgery]. / Bezpecná vzdálenost dolní resekcní linie pri operaci karcinomu rekta.

The authors present results of a study of a distal intramural spread of the rectal carcinoma beneath its aboral margin, which was conducted over several years. The authors closely cooperated with the Pathological Anatomy Institute of the Faculty Hospital in Ostrava, where each preparation was examined not only macro- and microscopically, but also the tumor's microscopic spread beneath its macroscopic margin was assessed in standard distances of 2 mm, 5 mm, 1 cm, 2 cm and 5 cm. The study did not record tumorous spread at the distance of 5 cm from the aboral margin of the tumor. The authors also confirmed that the distal intramural spread of the tumor is fairly rare and, at the same time, it signifies a highly advanced and aggressive disorder with a poor prognosis. Therefore, the authors favor management with a maximum quantity of the sphincter- saving procedures, with a sufficiently radical mesorectal excision, which they consider the essential method of the radical surgical treatment. Furthermore, the authors have not recorded cases of the differenciated adenocarcinoma spread, even at the distance of 2 mm from the aboral margin of the tumor. All positive findings of the distal intramural spread have been recorded in medium- low differenciated adenocarcinomas.

[Laparoscopic resection of the rectum: a fashionable extreme or a golden standard?]. / Laparoskopická resekce rekta: módní výstrelek ci zlatý standard?

The authors point out advantages of the laparoscopic approach in colorectal surgery. The laparoscopic approach is not commonly used in a number of our clinics, therefore, the authors would like to present a rectal resection procedure used in the Surgical Clinic of the Faculty Hospital in Ostrava.

The highest incidence in the world of rectal cancer is in Czech Republic.

Czech Republic is among the countries with the highest incidence of rectal cancer. The aim of the prospective study was to monitor the surgical treatment of patients with the diagnosis of rectal cancer. Certain aspects were examined: mainly the safety distance of the lower resection line during the operation of rectal cancer, the types of operations carried out, the amount of lymphatic nodes spotted in mesorectum and the possibility of laparoscopic utilization. In our study we focused on patients with rectal cancer who were operated within the three-year period (2000-2002) at the Department of Surgery at University Hospital of Ostrava. During this time there were 188 patients with rectal cancer treated. In the trial we shaved proved that in the direction from aboral margin of tumour the possibility of submucosal spread decreases in accordance with the literature. The submucosal spread of tumour occurs in 11.8% of cases. The spread of the tumour was not found at a distance of 5 cm below the bottom margin of tumour. In cases of microscopical positivity below the bottom margin of tumour there was a middle or low differentiated adenocarcinoma. The spread of well differentiated adenocarcinoma was not found. (Tab. 4, Fig. 5, Ref. 18.)

[Virtual colonoscopy as a part of the algorithm of the facultative examinations prior to the colorectal carcinoma procedure]. / Virtuální kolonoskopie jako souciást algoritmu fakultativních vysetriení pred operací kolorektálního karcinomu.

The authors present their own initial experience with virtual colonoscopy. Both benign and malignant stenosing processes of the colon and rectum, which make examining oral parts of the colon using colonoscopy or irrigography impossible, are the main indication for the procedure described. The authors' first experience with this method is totally positive. The more experienced the examiners, the better interpretation of the findings not only by radiologists but also by operating surgeons. In certain indications, the examination has its firm place in the algorithm of the facultative examinations prior to the colorectal carcinoma surgical procedures.

[Surgical management of advanced stages of rectal carcinomas]. / Chirurgická lécba pokrocilých stadií rektálního karcinomu.

The authors present a summary of literature data and their own experience with management of locally advanced rectal carcinomas. They prefer advanced surgical procedures, such as pelvic exenterations, and urge for preserving "quality of life".

[A new method of therapy of hemorrhoids using the PPH stapler and the Longo technique]. / Nová metoda v lécbe hemoroidálních uzlu pomocí stapleru PPH podle Longo.

The author wish to submit information on the use of a new method of surgical therapy of haemorrhoids about which they acquired information at a workshop of Ethicon Co. in Ljubljana (Slovenia). At the same time they want to demonstrate their first experience with introduction of the new method into practice.