[Extensive defect in the inguinal region and damaged femoral arteries. Single stage reconstruction of the arterial supply and skin coverage. Case Report]. / Rozsiahly defekt inguinálnej oblasti s poskodením stehenných ciev. Rekonstrukcia arteriálneho zásobenia a kozného krytu v jednej dobe. Kazuistika.

The authors present an account on a patient with extensive damage of the tissue in the area of the right groin with complete severing of the artery and vein. After control of the infections they reconstructed the arterial supply and skin cover in one stage. They used a PTFE prosthesis with an extraanatomical localization and a muculocutaneous flap formed from the musculus rectus abdominis on a caudal stalk.

[Pedal bypass in the treatment of arterial occlusive disease of the lower extremities in diabetics]. / Pedálny bypass v liecbe uzáverovej choroby artérií dolných koncatín u diabetikov.

BACKGROUND: The increase of the number of diabetics in the population and prolongation of their survival increases also the number of patients suffering from diabetic foot syndrome. Terminal complication of diabetic foot syndrome is diabetic gangrene, which is the cause of 50% of major amputations performed in Slovak republic. The problem of major amputations is not only medical, but also economic one. Adequate treatment can reduce the number of amputations by 50%. One of the possibilities to improve the prognosis of a diabetic suffering from obliterative macroangiopathy is the treatment by distal bypass, because with the regard to the characteristic distribution of the lesions to leg arteries is the classic vessel surgery (aortofemoral and femoropopliteal/femorocrural bypasses) inefficient. After the introduction of this treatment at our department preliminary results and some prognostic factors of the surgery success were evaluated. AIM OF THE STUDY: To evaluate the efficiency of pedal bypass as a method of treatment for peripheral obliterative atherosclerosis in diabetics and to determine the predictive value of paraclinical investigations and angiography. METHODS: Retrospective analysis of clinical, paraclinical and functional parameters of patients in whom pedal bypass was indicated, focused on the analysis of angiography. RESULTS: Of the 142 patients hospitalised with diabetic foot complications 32 were indicated for pedal bypass. All the patients were in the IV stage according to Fontain, the range of gangrene reached in average 2.7 grades of Wagners scale. Early success--i.e. functional artery reconstruction after hospital discharge was achieved in 18 patients (56%). Positive criteria for early success of the surgery involve short interval from gangrene development and serum albumin level above 26 g/l as an indicator of the nutritional state. Favourable angiographic criteria were: passage free arteries of dorsum pedis (ADP, ATP, a. plantaris, ATA) in the length of 10 cm free from focal stenoses, presence of numerous collaterals of legs and dorsum pedis, opacification of metatarsal and digital arteries. CONCLUSION: Pedal bypass is an efficient method of treatment for obliterative processes of lower extremities in diabetics with involvement of leg arteries. On the basis of our results this procedure can be recommended after careful preoperative staging and analysis of angiography as the method of treatment. It is necessary to perform the operation as soon as possible regarding the worsened nutritional and healing potential of the organism in the case of gangrene. Providing the surgery is properly indicated and performed it significantly improves the life quality of the patient. (Tab. 5, Fig. 1, Ref. 22.)

[Hernias in scars]. / Hernie v jazve.

The authors evaluated a group of patients operated at the Surgical Clinic in 1992-1996 on account of a hernia in a scar by the Mayo plastic operation. During a mean follow-up period of 33 months 44% patients were re-operated or had a relapse. The results confirmed data reported in the literature of 30-50% relapses of hernias in scars when synthetic nets are not used. With regard to the unfavourable results the authors use since November 1997 synthetic nets in plastic operations of hernias.

[Care of the diabetic foot]. / Koncepcia staroslivosti o diabetickú nohu.

BACKGROUND: The diabetic foot is the most frequent complication of diabetes requiring hospitalization. According to large sets of patients, as many as 25% of diabetic patients develop damage to their feet during their life. Regarding the growing number of diabetic patients it is necessary to elaborate a prospective conception of the treatment of patients afflicted by this complication. OBJECTIVE: The study's aim is to respond to the question of differentiation of treatment of patients with the diabetic foot. METHODS: A retrospective analysis of two sets of patients hospitalized at the surgical clinic. RESULTS: The group I (1989-1993) included 264 patients treated by "classical surgical management". The group II (October 1994-January 1996) included 142 patients subdued to "intensified therapy" with maximum possible use of revascularization procedures, 52-57% of patients were admitted with extensive gangrene, 65-68% with ischaemic disease of the lower extremities in the stage of CLI. The proportion of revascularizations was 26% vs 68%, the proportion of large amputations was 60% vs 38%. Despite maximum surgical forcefullness, a large proportion of large amputations reaching 38%, perseveres. The authors additionally surveyed the patients of group II as to the degree of their knowledge on the possible chronic complications of diabetes. The predominant majority of patients (63%) had insufficient knowledge about the prevention of the diabetic foot. CONCLUSIONS: Even a maximum use of surgical procedures is not sufficient in procuring a decrease in the proportion of large amputations of lower limbs in diabetic patients who have been hospitalized with their disease being in a progressed stage caused by neglection. Therefore it is necessary to transfer the emphasis of treatment of the diabetic foot into the period preceding the stage of manifestant infectious and necrotic complications. It would be most appropriate to delegate this "frontman" task to diabetologists. USE IN PRACTICE: Even though the only definitive solution of this dissatisfying situation resides in the establishment of specialized centres focused on the therapy of the diabetic foot, certain progress can be achieved also under current conditions by a consequent use of the existing net of diabetologic out-patients clinics, improvement of the quality of the diagnostic process and enhancement of educational activities. (Tab. 5, Ref. 18.)

[Atypical abdominal abscesses]. / Atypické abscesy brucha.

In case-histories of four patients the authors present an account on atypical abdominal abscesses which are late symptoms of advanced malignity of the large bowel or inflammatory intestinal disease. They discuss whether it is suitable to use percutaneous drainage or surgery. The latter holds despite the higher mortality a permanent place in the solution of serious intraabdominal infections, in particular if combined with malignity.

[Sclerotherapy of varicosities of the lower extremities]. / Skleroterapia varixov dolných koncatín.

The authors used ambulatory sclerotherapeutic treatment in 910 patients whom they also followed up. All these patients suffered from primary and relapsing varicosities of the lower extremities. A favourable effect was recorded in 82% of the patients. A relapse was recorded in 13.2% of patients, where subsequent operation was recommended. Complications after sclerotherapy were recorded in 4.5% patients.

[Procedure for multiorgan procurement (heart, liver, kidneys)]. / Postup pri multiorgánových odberoch (srdce, pecen, oblicky).

A significant growth in transplantation activity has been recorded in the past decade, namely in transplantations of the heart and liver. The numbers of transplantations of the lungs, and of the combination of pancreas with kidneys have increased to a smaller extent. The number of transplanted kidneys has become stabilized during the past several years. The development of organ transplantations led to a change of conception in the procurement of cadaveric organs from the until now performed procurement of a single organ to multiorgan procurements where in addition to the kidneys at least one other organ is procured. In countries with the highest number of multiorgan procurements the latter form as many as 80% of the total number of cadaveric procurements. Since January 1, 1995 a principle has been officially recognized in the Slovak Republic where an agreement with organ donation is presumed. Procurements of organs do not take place in cases when the donors have made during their lives a written or any other kind of declaration disapproving any intervention into their corporal integrity. Organs are also not procured in cases of foreigners, persons under legal sentence and those whose identities cannot be proved. The authors describe the technique of multiorgan procurement (heart, liver, kidneys) as well as contraindications to procurements of individual organs. (Fig. 2, Tab. 1, Ref. 12.).

[Surgical treatment of hyperparathyroidism]. / Chirurgická liecba hyperparatyreoidizmu.

The authors present their experience with the diagnosis and treatment of hyperparathyroidism in a group of eight patients operated between June 1993 and November 1993 at the Surgical Clinic of Dérer's Hospital in Bratislava-Kramáre. They summarize the findings on the disease from the literature and compare them with their own clinical observations, which confirm the indication of surgical revision as a useful localizing method, and the necessity of perioperative histological diagnosis to determine the extent of surgery.

[Inguinal hernia surgery in 1993 in Slovakia]. / Operácie inguinálnych hernií v roku 1993 na Slovensku.

The authors present an account of a survey (by questionnaires) focused on surgery of inguinal hernias. The recovery rate of questionnaires was 84%. The standard techniques in surgery of child hernias are Gross (29%) and Girard (29%). In primary hernias more than 50% are made by Bassini's and Girard's plastic operation. So far the worldwide accepted plastic operation of Shouldice is rarely used 14%. In the techniques of relapsing hernias also inadequate plastic operations are used; the ratio of Lichtenstein's plastic operation which has the lowest relapse rate is only 4.5%.