Hepatocellular carcinoma--evaluation of a group of 74 patients treated at the surgical department.

The authors present their experience with treatment of 74 patients operated on for hepatocellular carcinoma. Resection could be performed only in 44 patients. In 19 cases, a catheter for regional chemotherapy was implanted. Tumor destruction with alcohol was performed 4 times and radiofrequency thermal ablation 5 times either as a single intervention or in addition to the resection. Liver cirrhosis was verified by histology in 29 operated patients. Hospital mortality: 2 operated patients. Median survival after the liver resection: 42 months, mean survival: 72 months. The importance of preoperative indocyanine green elimination test for the exact determination of functional capacity of the liver and the priority of radical resection as compared to the other treatment modalities are emphasized (Tab. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

[Interdisciplinary approach to treatment of multiple arterial aneurysms in patient with eighth recurrence of incisional hernia--a case report]. / Interdisciplinární prístup k riesení mnohocetných tepenných aneuryzmat u pacienta s osmou recidivou incizionální kýly--kazuistika.

Vascular surgery is not the only option for arterial aneurysm treatment. Minimally invasive techniques are being increasingly used, especially methods of interventional radiology. We present a case of a 51-year-old man who came to our department in July 2005 because of sonographically diagnosed popliteal artery aneurysm. Simultaneous presence of subrenal abdominal aortic aneurysm, bilateral iliac and femoral artery aneurysms and left popliteal artery aneurysm was found. This patient was operated on for pancreatic pseudocyst in 2000 and then during next three years eight times for incisional hernia and its recurrences. The operations were carried out in other surgical departments. Eighth recurrence of incisional hernia was already present. Because of these facts, the risk of resection was deemed too high. Therefore, we chose stent graft implantation for abdominal aortic aneurysm treatment. The endovascular approach was also used to treat some complications that occurred. In this case report, we would like to present a combination of surgical and interventional radiological approaches to treatment of arterial aneurysms as a typical example of interdisciplinary cooperation.

[Infection in vascular reconstructive surgery]. / Infekce v rekonstrukcní cévní chirurgii.

PURPOSE: Infection is one of the most serious complications in vascular surgery. METHODS: We summarize the patients operated on in our clinic during a 3-year period for infection of the arterial reconstruction. RESULTS: 577 primary arterial reconstructions were performed in the region of abdominal aorta and lower limb arteries during the years 2003-2005. In the same period 17 patients were operated on for infection of the arterial reconstruction grade III of Szilagyi (13x aortofemoral, 4x femoropopliteal region). The main agent of infection was Staphylococcus aureus (47.1%). In most cases the therapy involved revision of the infected groin (10x) with subsequent explantation of the reconstruction (7 patients). Eight extraanatomic reconstructions were performed. Three patients died during the follow-up (2 within 30 days of an operation). The one year mortality rate is 17.6%. Amputation was necessary in 6 patients (i.e. 35.3%) CONCLUSIONS: Handling vascular infection still remains a challenging diagnostic and therapeutic problem.

[Assessment of functional capability of liver parenchyma using indocyanine green before liver resection]. / Vysetrení funkcní zdatnosti jaterního parenchymu s pomocí indocyaninové zelene pred resekcí jater.

During the period from 1997 to 2000, the total of 129 liver operations were performed at the 2nd Surgical Department of the Masaryk's University in Brno. Malignant tumours were present in 91 cases. In-hospital mortality in patients operated on for malignant liver tumours was 2.1%. No case of death was caused by liver insufficiency. Examination of liver function by use of indocyanine green (ICG) enabling the determination of the extent of possible resection, contributes to the lowering of postoperative morbidity and mortality. The rate of indocyanine green retention up to 6% does not limit the extent of resection, the retention rate up to 15% allows bisegmentectomy or a minor surgery, the retention rate up to 20% allows segmentectomy at the most, and the retention rate up to 30% enables superficial excisions only.

[Distal crural bypass as a limb salvage procedure--case report]. / Distální krurální bypass jako koncetinu zachranující výkon--klinický prípad.

The authors present a case of a patient with a progredient moist gangrene of the right foot. In this patient, amputation of the lower limb was indicated because of an unfavourable angiographic finding, after unsuccessful conservative treatment. With regard to the fact, that the patient had undergone amputation of the other lower limb in the crus, revision of the posterior tibial artery was decided. Preoperative angiography did not confirm the previous unfavourable angiographic finding. After the implantation of a distal crural venous bypass (posterior tibial artery--supramalleolar part), healing of the extremity occurred in a relatively short time period. The authors agree with the opinion that distal crural and pedal bypasses cannot be always indicated on the basis of routinely performed angiography. Revision of crural arteries and possible preoperative angiography can change the situation and lead to the salvage of the limb.

Our experience in the surgical treatment of liver tumors in the years 1994-1996.

The study is based on the evaluation of a study group consisting of 61 patients who underwent surgery for liver tumors in the 2nd Surgical Clinic in Brno between 1994 and 1996. Liver resections were carried out in 39 patients, port-systems for regional chemotherapy were implanted in 29 patients. In recent years, port-systems have been inserted even in liver resections in indicated cases. The median survival after liver resection for hepatocellular carcinoma was 43 months, for colorectal carcinoma metastases it was 32 months. The in-hospital mortality was 3.4%.

[Peroperative endoscopic papillosphincterotomy]. / Peroperacní endoskopická papilosfinkterotomie.

The authors describe their experience with combinations of endoscopic and surgical procedures when dealing with stenoses of the papilla Vateri. They give a detailed account of the endoscopic phase of surgical intervention. In their opinion the most important thing is exclusion of duodenotomy which should reduce the risk of a duodenal fistula. Another important advantage is more rapid convalescence and a shorter hospitalization period as well as a shorter time required for the intervention. Next the authors discuss possible complications described in the literature and their relationship to endoscopic papillotomy. The authors evaluate contemporary possibilities of endoscopic treatment and emphasize the necessity to extend the use of endoscopic methods in everyday surgical practice.

[Endoscopic bipolar coagulation of acute gastroduodenal hemorrhage]. / Endoskopická bipolární koagulace akutního gastroduodenálního kravácení.

The authors describe one possible way of endoscopic haemostasis, i.e. by bipolar coagulation. First they give an account of the principle of the method and technique of coagulation. Then they demonstrate on their own group of patients with haemorrhage into the gastroduodenum a 71% effectiveness of haemostasis by this method. In another 10% a temporary effect was achieved with the possibility of effective supplementation of the blood volume and thus an improved prognosis of surgery. In case of failure, in particular haemorrhage according to Forest Ia, they warn against any delay of surgery.

[Hemostatsis during liver resection using the Leister Hot-Jet coagulator]. / Stavení krvácení pri resekci jater pomocí Leister Hot-Jet koagulátoru.

The authors present their own experience with the use of a hot-jet coagulator in resections of the liver. The principle is based on contact-free transmission of thermal energy by means of a current of hot air to achieve haemostasis and tissue coagulation. They mention the use of the apparatus in animal experiments and in resections of the liver in nine patients. They recommend the procedure as one possibility of haemostasis where conventional methods do not affect haemostasis.

[Scanning electron microscopic pattern on normal and pathological nasal mucosa (author's transl)]. / Die normale und pathologische Nasenschleimhaut im rasterelektronenmikroskopischen Bild.

Nasal mucosa from animals and men were investigated by scanning electron microscopy. The findings resulting from normal nasal mucosa and mucosa chronically alterated by inflammation (rhinitis chronica hyperplastica, rhinitis allergica, rhinitis chronica atrophicans, and nasal polyps) were compared. The patterns of the surface-behavior of the mucociliary apparatus and the structure of the epithelium--as well as the findings were discussed. The three-dimensional observation of mucosal surface structure completes the light and electron microscopic examination procedures allowing further insights into morphology and physiological function of the mucosa in the upper respiratory tract.