[Role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to Save Life in Bleeding in a Patient with a Pelvic Ring Injury]. / Role balonové endovaskulární okluze aorty (REBOA) pri záchrane zivota u pacientu s krvácením z pánve.

The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience.

PURPOSE: Retrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS: From 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised. RESULTS: We achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %. CONCLUSION: Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

[Femoropopliteal deep vein thrombosis and popliteal artery pseudoaneurysm as a complication of multiple hereditary osteochondromatosis]. / Femoropopliteální zilní trombóza a pseudoaneuryzma popliteální tepny jako komplikace mnohocetné hereditární osteochondromatózy.

Osteochondromas (exostoses) are the most common benign bone tumours. In most cases, osteochondroma occurs as a solitary lesion. Hereditary multiple osteochondromatosis is an autosomal dominant disorder manifested by multiple exostoses most commonly located at the metaphyses of long bones, the iliac crest, the ribs, the vertebral borders, and scapulas. Vascular complications of multiple osteochondromatosis are very rare, most frequently affecting the popliteal artery. The authors report the case of a 27-year-old female patient with hereditary multiple osteochondromatosis that was complicated by femoropopliteal deep vein thrombosis and giant popliteal artery pseudoaneurysm.

[Endovascular treatment of obstetric hemorrhage]. / Endovaskulární lécba krvácení v souvislostis porodem a tehotenstvím.

PURPOSE: To evaluate effectiveness and safety of hypogastric artery branches embolization in the treatment of postpartum hemorrhage, hemorrhage associated with cesarean section and termination of pregnancy. MATERIALS AND METHODS: All women with intractable bleeding and who were treated by embolization, were included from the period between 1996 to 2010. The retrospective study included 16 women of mean age 30.5 years. RESULTS: Intractable hemorrhage related to regular delivery occurred 7 times, five times after cesarean section and four times after termination of pregnancy. Seven women (44%) were in hemorrhagic shock during therapeutic embolization. Extravazation was angiographically proved in 50% cases. Embolization was successful in hemorrhage control in 87,5% of women, in two women embolization was repeated for persistent bleeding. There were 21 additional surgical procedures performed in 13 women before embolization including 2 hysterectomies. Two hysterectomies were done after embolization because of infection. In remaining 3 women embolization was done as a primary method of bleeding control. No patient died. In the group of 10 women with maximally 1 surgery before embolization length of hospital stay was 10.1 days in average, while in a group of six women having 2 to 3 surgeries before embolization the hospital stay was 21.2 days in average (p = 0.03). CONCLUSION: Embolization of hypogastric arteries decreases length of hospital stay in patients with obstetric hemorrhage and should be done soon if routine methods of bleeding control fail.

[Survival of patients after TIPS in the University Hospital Hradec Kralove]. / Prezívání nemocných po TIPS ve Fakultní nemocnici Hradec Králové.

AIM: To analyze survival of patients after TIPS (transjugular intrahepatic portosystemic shunt). PATIENT SAMPLE AND METHODOLOGY: Between September 1992 and August 2010, TIPS was created in 848 patients of the University Hospital Hradec Kralove. These patients were divided into groups. Survival was analyzed using Kaplan-Meier survival curves. Differences between groups were evaluated using log-rank test. RESULTS: Ten percent of patients do not survive one month after TIPS, 40% of patients survive 5 years and 20% of patients survive 10 years. There were statistically significant differences between groups divided according to Child-Pugh classification (A vs B p = 0.0053; B vs. C p < 0.0001), indication for surgery [prevention of bleeding recurrence differed from refractory ascites (p = 0.0001) and the indication to stop acute bleeding (p = 0.026)]; aetiology of the liver disease [patients with alcoholic cirrhosis differed from patients with Budd-Chiari syndrome (p < 0.0001) and from patients with chronic viral hepatitis (p = 0.024)]. CONCLUSION: Survival of patients after TIPS is influenced by Child-Pugh score, indication and aetiology of the liver disease.

[Endovascular treatment of spontaneous hemothorax in patient with neurofibromatosis type I]. / Endovaskulárni lécba spontánního hemotoraxu u neurofibromatózy I. typu.

Authors present possibility of endovascular treatment of spontaneous hemothorax in the patient with neurofibromatosis type I. CT angiography was crucial in diagnostic algorithm because revealed false aneurysm of the thyreocervical artery. This artery was embolised with acrylic glue. The patient has been without signs of recurrent bleeding.

[Wegener's granulomatosis--a case report]. / Wegenerova granulomatóza (WG) --kazuistické sdelení.

UNLABELLED: Authors present an unusual eye finding in a 56 years old patient with Wegener's granulomatosis, who was followed up at the Department of Pulmonary Diseases, School of Medicine Hospital, Hradec Králové (Königgrätz), Czech Republic. From the point of view of the internal medicine, there are granulomas of the upper and lower airways and renal affection (minimally LK form). It consists of the affections of lungs and bronchi (histologically verified), kidneys (erytrocytouria with normal functions), eyes (ophthalmoscopically verified), weight loss about 10%, and possible nose involvement (suspect). The eye finding consists of severe anterior and posterior scleritis bilaterally, protrusion of the eyeball, and restricted movement of the left eye temporally with diplopia, and changing retinal findings bilaterally with the final improvement of consequently appearing foci of the serous retinal detachment. CONCLUSION: The paper demonstrates variety of ocular findings in Wegener's granulomatosis, and simultaneously emphasizes the importance of multidisciplinary collaboration in diagnosis and treatment of this serious disease.

[Role of percutaneous vertebroplasty and kyphoplasty in the treatment of oncology disorders of the spine]. / Postavení perkutánní vertebroplastiky a kyfoplastiky v lécbe onkologického onemocnení pátere.

BACKGROUND: The aim of the study is to present results of a prospective uncontrolled clinical study. Percutaneous vertebroplasty or kyphoplasty are minimally invasive methods based on polymethylmethacrylate (PMMA) bone cement application into the damaged vertebra. This leads to decrease of the pain and vertebral body stabilisation. Oncology disorders of the spine are relatively common, having a wide alternative of various methods of treatment. Patients, according to their findings and indication criteria, are treated surgically or conservatively, oncological treatment is usually based on radiotherapy. Authors discuss the role of these invasive procedures in the treating algorithm of patients with spinal metasthases and multiple myeloma. METHODS AND RESULTS: From September 2003 to December 2005, 21 percutaneous vertebroplasties in 14 patients, mean age 68.7 (47-80) year, were performed in our department. During one treatment session 1-2 vertebrae (total of 21 vertebrae) in level Th9 - L5 were treated. Vertebroplasties and kyphoplasty were performed under fluoroscopy guidance. Transpedicular acces was used. Totally, 3 asymptomatic complications were proved. As first, a bone cement leaked paravertebrally during L5 body treatment, as second, a bone cement leaked into paravertebral veins, and as third, a bone cement leaked into the intervertebral space. Visual analog scale (VAS) was 8.9 points before procedure, 1.9 point 3 months after procedure and 2.6 points 6 months after procedure. We did not prove a symptomatic or total complication. CONCLUSIONS: According to our experience, percutaneous vertebroplasty is an effective alternative treatment of painful oncologic spine disease.

[Percutaneous sacroplasty in sacral insufficiency fracture treatment]. / Perkutánní sakroplastika v lécbe insuficientní fraktury krizové kosti.

Stress (insufficient) sacral bone fracture is a seriously painful disease with discussed and disunited therapy. Older women sufferig from osteoporosis create the main group in which this fracture occurs. Clinically, serious pain in sacral area is the most common symptome. This pain may last for a long time when treated conservatively and it can lead to pacient's immobilization with related comorbidity. In 2% of patients, neurological complications can be observed. Authors present summary of published studies and demonstrate an own case treated using percutaneous sacroplasty.