Splenectomy in patients older than 65 years - a single-center experience.

INTRODUCTION: Despite current efforts at the most conservative approach possible to splenic injury, splenectomy remains a relatively common surgical procedure. Indications for splenectomy, however, are not limited to spleen injury. In senior patients in particular, non-traumatic reasons for splenectomy becomemore frequent. In addition, previous studies have indicated a relatively wide range of complications and lethality in splenectomized patients without taking into account the age aspect. Within the scope of geriatric surgery, this study deals with splenectomy in elderly patients and is based on retrospectively evaluated experience of our clinic. METHOD: We studied a group of patients older than 65 years having undergone splenectomy at our institutionover the past 11 years. For each patient, the demographics, the reason for splenectomy, the mechanism of injury (if any), the degree of spleen damage, co-morbidities, the length of hospital stay, complications and lethality were evaluated. A group of patients operated on due tospleen trauma and the other group operated on for other reasons were analysed separately. Attention was paid to the reasons leading to splenectomy in the non-traumatic patients. Complications and lethality rate were evaluated in relation to the individual patient groups. RESULTS: 269 splenectomies were performed in our clinic between 2006 and 2016. Of these, only 57 (21.2%) were carried out in patients older than 65 years (32 men and 25 women aged 6590, mean age 73.6). Splenectomy was even rarer in association with splenic trauma:it was performed in only 13 senior patients. Other causes leading to splenectomy in elderly patients were: perioperative spleen injury (17 patients), gangrene, septic activation or spontaneous rupture of the spleen (10 patients), splenectomy during an operation on another organ (8 patients), splenomegaly (5 patients) and splenic artery aneurysm (4 patients). Lethality in the entire group was 29.8%, the percentage of complications was 57.9%; however, circumstances leading to splenectomy and also potential co-morbidities played a significant role. The average length of hospitalization in the entire group was 20.3 days. CONCLUSIONS: Splenectomy in patients over 65 years of age is associated with a high risk of complications and very high lethality. However, senior patients after splenectomy for monotrauma and those after elective splenectomy have a very good prognosis. Key words: geriatric surgery splenic rupture - splenectomy.

A comparison of electrochemically pre-treated and spark-platinized carbon fiber microelectrode. Measurement of 8-oxo-7,8-dihydro-2'-deoxyguanosine in human urine and plasma.

A novel method of carbon fiber microelectrode activation using spark discharge was demonstrated and compared to conventional electrochemical pretreatment by potential cycling. The spark discharge was performed at 800 V between the microelectrode connected to positive pole of the power supply and platinum counter electrode. Spark discharge led both to trimming of the fiber tip into conical shape and to the modification of carbon fiber microelectrode with platinum, as proven by scanning electron microscopy and electron dispersive X-ray spectroscopy. After the characterization of electrochemical properties using ferricyanide voltammetry, the activated electrodes were used for electrochemical analysis of 8-oxo-7,8-dihydro-2'-deoxyguanosine, an oxidative stress marker. Subnanomolar detection limits (0.55 nmol L(-1)) in high-performance liquid chromatography were achieved for spark platinized electrodes incorporated into the flow detection cell.

[Pulmonary metastases - 12-year experience with surgical therapy]. / Plicní metastázy - dvanáctileté zkusenosti s chirurgickou lécbou.

INTRODUCTION: Nowadays, radical surgical therapy of selected secondary pulmonary tumours is a generally accepted therapeutic procedure that has been proven to extend long-term survival of the patients with acceptable perioperative morbidity and mortality. The authors present a retrospective analysis of a set of patients who underwent surgery for pulmonary metastases of various tumours in a 12-year period. MATERIAL AND METHODS: In 2001-2012, 159 patients with secondary pulmonary tumours were operated on at the authors department, of whom 80 were men; the median age was 65 years. Solitary metastases were present in 112 patients (70.4%); the other patients had multiple metastases; 24 patients (15.1 %) suffered from bilateral involvement, and 6 patients (3.8%) suffered from relapsed metastatic disease after previous radical surgery. Colorectal carcinoma metastases were diagnosed in most cases (75 people - 47.2%). The median disease-free period from the surgery of the primary tumour was 27 months in the patient set. RESULTS: In total, 166 unilateral (87.4%) and 24 bilateral surgeries were performed using one- or two-stage procedure (12.6%). Precise laser excisions represented the most common type of surgery (59 procedures - 31.1%). In total, 296 metastases were radically resected, and 13 were treated using radiofrequency ablation. Perioperative morbidity was 13.2% with a zero lethality rate. 90 operated patients (56.6%) still survive after the metastasectomy, with median survival of 44 months. The overall 3-year survival in the set was 59%, and 5-year survival was 39%. The number of metastases is a statistically significant factor affecting survival in the patient cohort with colorectal carcinoma metastases, the risk of death being 2.7 times higher in patients with 2 and more colorectal carcinoma metastases. 68 patients (42.8%) live without progression of the disease after the metastasectomy, with the median disease-free interval of 29 months. In total, 43% of the patients were free of any signs of relapse or disease progression for 3 years, and 27% for 5 years. The risk of disease progression is 2.1 times higher in patients with 2 and more metastases of any tumour, and for colorectal carcinoma this risk is 2.3 times higher. CONCLUSION: The achieved results confirm the positive role of pulmonary metastasectomy in disseminated tumour therapy. The number of metastases is the decisive prognostic factor affecting both long-term survival of operated patients and their DFI.

[Liver and pulmonary metastases of the colorectal carcinoma - the experience of the Department of Surgery, University Hospital in Pilsen]. / Jaterní a plicní metastázy kolorektálního karcinomu - zkusenosti Chirurgické kliniky FN v Plzni.

INTRODUCTION: Liver and pulmonary metastases of the colorectal carcinoma develop in about 20-70%, resp. in 10-22% patients with the colorectal carcinoma. Their treatment is still a matter of discussion. The aim of our study was to evaluate the results of surgical treatment as a part of the multimodal approach. MATERIAL AND METHODS: 30 patients with liver and pulmonary colorectal metastases were operated on between 2002 and 4/2013. The average age was 62.8 ± 10.7 years. 19 patients had metachronous and 11 synchronous metastases. The liver metastases preceded pulmonary in 14 cases, and vice versa in 5 patients. Both types of metastases developed in seven patients simultaneously. Liver resection was performed in 23, radiofrequency ablation (RFA) in 7 patients. Laser pulmonary metastasectomy was performed in 15, pulmonary resection in 14 and RFA in one patient. The liver procedure preceded pulmonary in 25 patients. 73.3% patients had adjuvant oncological treatment. RESULTS: 30 days mortality rate was 3.3% (N=1) for the actinomycotic sepsis complicated with MRSA infection. Morbidity rate was 10%. Recurrence of liver metastases developed in 6 patients. RFA was performed in all patients. The median of overall and disease free survival was 6.9, resp. 1.1 years. CONCLUSION: Surgical treatment as a part of the multimodal treatment is the only radical treatment for patients with liver and pulmonary metastases. It offers good long-term results.

[Combined procedure of pulmonary resection and radiofrequency ablation of lung tumours - case reports]. / Kombinovaný výkon plicní resekce a radiofrekvencní ablace nádoru plic - kazuistiky.

The authors present two case reports to describe the possibility of performing a combined procedure when dealing with lung cancer in patients who are not indicated for radical surgery. The combination of pulmonary resection and radiofrequency ablation thus opens a new possibility for a quality extension of active life.

Surgical therapy of pulmonary metastases - 10-year results.

INTRODUCTION: The surgical therapy of selected secondary pulmonary tumors, including both solitary and multiple or bilateral tumours, is currently a generally accepted therapeutic procedure demonstrably extending the long term survival of these patients. PURPOSE: The purpose of the present study is a ten-year retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors. METHODS: In 2000-2009, 87 patients (of which 44 were male with a median age of 64 years) with secondary pulmonary tumors underwent surgery at the departments of the authors of this study. Solitary metastases were found in 60 patients, multiple metastases in the remaining patients, while 13 patients had bilateral metastases. The median disease-free period from surgery of the primary tumor was 31 months. RESULTS: In total, 74 unilateral and 13 bilateral surgeries were performed in one or two periods. The most common type of surgery included anatomical pulmonary resections (32 procedures), wedge resections (29 procedures) and laser excisions (24 procedures). In total, the radical resection was performed in 156 metastases. Post-operative morbidity was 17.2 % with zero mortality. A proportion of 50.6 % of operated patients survived after resection of metastases with median survival of 39 months. The overall three-year and five-year survivals in the group were 57 % and 38 %, respectively. A proportion of 35.6 % of patients live after resection of metastases without disease progression, and the median is 15 months. CONCLUSION: The achieved results confirm the positive role of pulmonary metastasectomy in the therapy of disseminated cancer disease (Tab. 1, Fig. 5, Ref. 34).

[Catamenial pneumothorax - case studies from our department in a ten-year period]. / Katameniální pneumotorax - kazuistiky z vlastního pracoviste v období 10 let.

Catamenial pneumothorax is defined as spontaneous pneumothorax in women of reproductive age occurring in conjunction with the menstrual cycle. The authors present 4 cases of this condition treated in our department during the past ten years. The causes leading to the development of this condition and optimal treatment procedures are also discussed.

[Inveterate dislocation fracture of the sternoclavicular joint]. / "Inveterovaná" luxacní zlomenina sternoklavikulárního kloubu

We present the case report of a 21-year-old man with a late diagnosis of retrosternal dislocation of the sternoclavicular joint with a fractured sternal end of the clavicle. The first symptom leading to the diagnosis was dysphagia associated with physical activity. The diagnosis was based on computed tomography examination. In the first place, the fragment of the medial clavicular end was fixed with two screws. During surgery the sternoclavicular joint was wrongly identified; this fact was revealed by the following radiographic examination. On revision surgery, the sternoclaviculr ligament was reconstructed using a semitendinosus tendon graft. The reconstructed ligament was augmented with two Orthocord sutures running between the clavicle and the first rib. At 2 years after surgery the functional outcome and sternoclavicular joint stability were excellent.

[Surgical therapy of pulmonary metastases of colorectal cancer--ten-year results]. / Chirurgická léba plicních metastáz kolorektálního karcinomu--desetileté výsledky.

INTRODUCTION: Nowadays, surgical therapy of pulmonary metastases of colorectal cancer is a generally accepted therapeutic approach that has been proven to extend long term patient survival with acceptable perioperative morbidity and mortality rates. The aim of the study is to retrospectively analyse a group of patients who underwent surgery for pulmonary metastases of colorectal cancer over a period of ten years. MATERIALS AND METHODS: From 2000 to 2009, 39 patients with pulmonary metastases of colorectal cancer underwent surgical therapy at the site of the authors, out of whom 21 were males (53.8%), with a mean age of 60.4 years. Out of the total, 24 patients (61.5%) presented with solitary metastases, multiple metastases were found in the remaining patients. 8 patients (20.5%) bileral affection was detected. 34 patients (87.2%) underwent adjuvant oncological therapy of a radically surgically curable primary tumor before metastasectomy and 6 patients (15.4%) underwent surgery for liver metastases. Five patients in the group (12.8%) had both pulmonary and secondary liver affections at the same time. The median disease-free period after the primary tumor surgery was 27 months in the whole group. RESULTS: In total, we performed 31 unilateral (79.5%) and 8 bilateral (20.5%) one- or two- step surgeries. The most common type of surgery included anatomical pulmonary resections (18 procedures), laser excisions (13 procedures) and wedge resections (9 procedures). In total, we performed 73 radical resections of metastases and 5 metastases were treated by radiofrequency ablation (RFA). Metastatic affection of hilar lymph nodes was found in three patients (7.7%). Perioperative morbidity reached 12.8%, mortality was zero, and two re-operations were required because of complications (5.1%). 53.8% of patients with metastasectomy are still alive, the median survival time is 38 months. The three-year survival rate is 52% and the five-year survival rate is 41% five years. Pre-operatively increased value of tissue polypeptid specific antigen (TPS) was the only statistically significant factor that had a negative impact on the overall survival. 30.7% of patients with metastasectomy show no disease progression, the median disease- free interval is 14 months. There is a statistically significant correlation between DFI (Disease Free Interval) following metastasectomy and the type of surgery and the lowest value of DFI was achieved with radiofrequency ablation. The risk of disease progression is 3.4-times higher in patients with two and more metastases of colorectal cancer up to 3.9-times higher in subjects with three and more metastases. CONCLUSION: The positive effect of pulmonary metastasectomy on the long-term survival is evident. However, careful selection of patients with individual evaluation of each single case is required. In particular, indication for metastasectomy should be carefuly considered in cases of multiple affection, which are associated with higher risk of disease progression. The essential requirement is to achieve complete resection of the pathological focus, with a maximum effort aimed at sparing healthy pulmonary tissue, which allows for potential necessary reoperations in case of the disease recurrence. Systematic mediastinal lymphadenectomy (SMLA) should be an integral part of any pulmonary metastasectomy.

[Pulmonary metastases of the clear cell (conventional) renal cell carcinoma--options and results of surgical treatment]. / Moznosti a výsledky chirurgické lécby plicních metastáz svetlobunecného (konvencního) renálního karcinomu.

BACKGROUNDS: At the diagnosis, up to one third of patients with clear cell (conventional) renal cell carcinoma have metastases, and the disease will progress in a half of patients with localized disease; the lungs are the most frequently affected organ. Despite clear advances in targeted biological treatment, radical surgery of organ, mainly pulmonary, metastases is a justified treatment approach with good results. AIM: A nine-year retrospective analysis of patients with clear cell renal cell carcinoma undergoing surgical treatment of pulmonary metastases. MATERIALS AND METHODS: At our centre, 13 patients with the mean age of 65 years, 9 of which were men, underwent surgical treatment between 2001 and 2009. Surgery was only indicated in patients after renal tumour resection without extrapulmonary metastases in whom presurgical assessment suggested that the pulmonary metastases were resectable (with respect to their number and location) and in whom the benefits of performing the surgery outweighed any potential risks. Metastases were solitary in 9 patients and multiple in the rest, 2 patients had bilateral involvement. Median disease-free interval following nephrectomy was 28 months. RESULTS: A total of 11 unilateral and 2 bilateral resections were performed during one or two surgical operations. Most frequently, wedge resection was performed (7 patients). A total of 23 metastases were resected. Perisurgical morbidity was 15.4%, zero mortality. Of those undergoing metastasectomy, 53.8% are still surviving with a median survival of 24.3 months. Three-year survival in the sample was 66%, 5-year survival was 53%. Five patients (38.5%) have had no disease progression for a median of 8.8 months. CONCLUSION: Our results confirm the positive role of metastasectomy in the treatment of pulmonary metastases of clear cell (conventional) renal cell carcinoma. Long-term survival after pulmonary metastasectomy might be expected in patients with solitary metachrone small metastases with DFI after nephrectomy > 1 year, without tumour involvement of the relevant lymph nodes and R0 resection.

[Surgical treatment of pulmonary carcinoids - ten-year results]. / Chirurgische Behandlung von Lungenkarzinoiden - Zehnjahresergebnisse.

INTRODUCTION: Carcinoids are malignant neuro-endocrine tumours occurring in the bronchopulmonary location in about 25 %, and accounting for approximately 2 % of all pulmonary tumours. MATERIAL AND METHODS: Our retrospective analysis included 27  patients, 14  men and 13  women, mean age 58.4  years, treated from 2000 to 2009 for carcinoids in bronchopulmonary locations. The tumour manifested clinically in 52 % of the cases, the most common symptom being cough; one tumour manifested as carcinoid syndrome. All patients underwent fibrobronchoscopy that was positive in 20  cases (74.1 %). Pre-surgery histological diagnoses were made in 13  patients (48.1 %). Chest CT scans were carried out in 26  patients, and the investigation failed to detect the expected pathological process in 2  of the patients. Octreoscans were carried out in 12  patients, and were successful in identifying a primary neuroendocrine tumour in 75 %. RESULTS: All patients in the sample underwent rad-ical surgical therapy; the most common surgical procedure was lobectomy (70.4 %). Perioperative morbidity and mortality were zero. Typical carcinoids were found in 20  cases while 7  cases were atypical carcinoids, 20  tumours were located centrally. 74 % of the tumours were consistent with stage  I A disease. Mean follow-up period was 47 (range: 6-134)  months. Local recurrences were observed in 2  patients (7.4 %), but the tumour disseminated in 4  patients (14.8 %). Two patients (7.4 %) died during the follow-up period. Overall five-year survival in the sample was 92.3 %, 90.9 % in the typical carcinoid group and 100 % for atypical carcinoids. We found a statistically significant association between disease-free interval and histological type of the tumour; the risk of progression was 8  times higher in -patients with atypical carcinoids compared to patients with typical carcinoids (Log-Rank-Test: p-value = 0.0049). CONCLUSION: Radical surgical treatment of bronchopulmonary carcinoids is the optimum therapeutic approach that results in the best results both regarding perioperative morbidity and mortality and regarding long-term survival of the patients.

Chemical constituents of the different parts of Colchicum baytopiorum and their cytotoxic activities on K562 and HL60 cell lines.

The plant chemistry and cytotoxic activity of Colchicum baytopiorum CD Brickell (Liliaceae/Colchicaceae), an endemic species growing in Turkey, has been studied for the first time. Nine known alkaloids were isolated and their structures were identified by spectral methods (UV, IR, (1)H-NMR, and ESI/MS), and the presence of three alkaloids, which could not be isolated from the plant, was also detected by LC/MS/MS spectrometry. Phenolic acids were elaborated using LC/MS and 11 phenolic acids were identified. The presence of two flavonoids appeared to be valuable for chemotaxonomic purposes. Guided by the brine shrimp lethality test (BSLT), methanol extracts were tested for cytotoxic activity by colorimetric MTT test on K562 and HL60 cells. Except the seed extract, all methanol extracts showed more cytotoxic activity on HL60 cells (IC(50): 6.5- < 0.1 microg/mL) than on K562 cells (IC(50): > 500-44 microg/mL).

[Surgical treatment of liver and pulmonary metastases of colorectal carcinoma]. / Chirurgickái lécba jaterních a plicních metastáz kolorektálního karcinomu.

THE AIM: The aim of the work was to evaluate the set of 10 patients, who were operated on hepatic and pulmonary metastases of colorectal carcinoma at the Surgical Clinic of Medical Faculty of Charles University and Faculty Hospital in Plzen in years from 2005 till 2009. With regard to limited experience with the patients who underwent hepatic as well as pulmonary resection, we focused on the evaluation of a long-term survival of the patients and their mortality and morbidity. THE SET OF THE PATIENTS: In years from 2005 till 12/2009 we operated 10 patients during whose affection there occurred hepatic and pulmonary metastases of colorectal carcinoma and these were solved surgically. This concerned 5 men and 5 women at an average age of 62.4 years (42-71 years). In 10% it was hepatic resection in the first period after the operation of primary carcinoma, it was the first performance on the hepatic parenchyma in 90%. THE RESULTS: Morbidity of the set was 20.1% regarding hepatic resections and 5.6% regarding pulmonary resections. A 30-day postoperative mortality was 0%. In three cases a hepatic involvement was bilateral, in two cases in the left lung and 5 patients had an involvement of the right pulmonary lobe. In 4 cases primary carcinoma was in the rectum and in 6 cases in the large intestine. The period of three months was an average time between hepatic and pulmonary resection. Resection on liver parenchyma was the most often performance and metastasectomy with the help of laser on the pulmonary parenchyma. Rectal carcinoma spread into lungs in 50%. An average time of a 5-year survival in the patients after resection of hepatic and pulmonary metastases of colorectal carcinoma was 26%. THE CONCLUSION: Hepatic and pulmonary resection in the selected patients with generalized colorectal carcinoma extends the period of a survival and does not worsen the quality of the life. The patients after resection of both--hepatic and pulmonary metastases have got a worse long-term survival than the patients being only after hepatic resections.

Polyphenolic fraction of Lonicera caerulea L. fruits reduces oxidative stress and inflammatory markers induced by lipopolysaccharide in gingival fibroblasts.

The most common oral diseases have a microbial aetiology. Pathogenic bacteria liberate a number of irritating agents including a lipopolysaccharide (LPS) that activates pro-inflammatory cytokines promoting increased activity of polymorphonucleocytes (PMN). Release of PMN-derived free radicals into an infected gingival area affects gums, periodontal ligaments and alveolar bone. Berries of Lonicera caerulea L. (blue honeysuckle) are rich in phenolics, particularly phenolic acids, flavonoids and anthocyanins that have multiple biological activities in vitro and in vivo such as antiadherence, antioxidant and anti-inflammatory. Studies have shown that polyphenols suppress a number of LPS-induced signals and thus could be effective against gingivitis. Here we assessed effects of the polyphenolic fraction of L. caerulea fruits (PFLC; containing 77% anthocyanins) on LPS-induced oxidative damage and inflammation in human gingival fibroblasts. Application of PFLC (10-50mug/ml) reduced reactive oxygen species (ROS) production, intracellular glutathione (GSH) depletion as well as lipid peroxidation in LPS-treated cells. PFLC treatment also inhibited LPS-induced up-regulation of interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha) and it suppressed expression of cyclooxygenase-2 (COX-2). The effects are presumably linked to its antioxidant and anti-inflammatory activities and suggest its use in attenuating the inflammatory process, including periodontal disease.

[Use of the KLS Martin Nd:YAG laser MY 40 13 in lung parenchyma surgery]. / Vyuzití KLS Martin Nd: YAG laseru MY 40 13 v plicní chirurgii.

INTRODUCTION: Nd:YAG laser MY 40 1.3 has been developed to be employed in lung tumor resections. The method's principle is based on tissue absorption of light energy and its transformation into heat. The light beam wavelength is 1318 nm and its output power is 40 W. The beam even penetrates fluid media up to the depth of 6mm, and its hemostatic effect is much larger than in other models (obstruction of arteries of up to 2 mm in diameter, veins of up to 3 mm in diameter). The laser beam application to the lung parenchyma is continuous and non-contact. AIM: Analysis of our initial experience with the use of the instrument in surgical management of primary and secondary lung tumors. METHODOLOGY: From March 2008 to December 2008, the authors operated 12 male and 5 female patients, the average age was 60.7 years. In 12 subjects, lung metastases of malignant tumors were detected, 3 subjects suffered from primary lung carcinoma and two from benign lung lesions. 7 operated subjects had multiple secondary lung tumors in various lobes of a single lung or both lungs, in 5 subjects, the secondary tumors were solitary. Most commonly--in 7 cases, the subjects suffered from colorectal carcinoma metastases. All the above surgical procedures were performed under general anesthesia with selective lung ventilation via posterolateral thoracotomy. RESULTS: In the all 12 patients, the lung metastases were radically removed using parenchyma-saving laser metastasectomy. In 3 subjects with primary pulmonary carcinoma, the laser was used to perform limited resection for intraoperative biopsy purposes, which was followed by standard radical pulmonary resection. The two benign lesions were managed in a similar way. Perioperative morbidity and mortality was nil, no significant air leak was recorded in the subjects during the postoperative period. CONCLUSION: Nd:YAG laser MY 40 1.3 facilitates radical removals of secondary pulmonary neoplasms, in particular of the multiple and deeply located ones, with no need for extensive lung parenchyma resections and with minimum intraoperative morbidity and mortality rates. Furthermore, it can be successfully used in a numer of other surgical procedures, such as management of pleural adhesions, lung biopsies, resections of emphysematous bullae, resections of benign lung tumors, dissections of inerlobal fissures, etc., where the method can fully replace staplers. It has potential for its further application in miniinvasive pulmonary surgery in the near future.

[Acute mediastinitis--optimum diagnostic and therapeutic measures]. / Akutní mediastinitis --optimální diagnostická a lécebná opatrení.

The term of acute purulent mediastinitis (APM) is understood as a bacterial inflammatory process involving mediastinal tissue and organs. It is a group of clinical disorders originated primary or secondary as a complications another disease of different etiology. The definitive clinical picture is a combination of both pathologies. APM having obviously purulent character develops usually extremly fast and is objectively harming patient's life. In case of Descending Necrotizing Mediastinitis (DNM) the mortality is up to 25-40%. The only perfect and early stated diagnosis and choosen effective therapy mode can lead to patient life salvage and survival. The surgery share on therapy is substantional. During years 2004-2008 we have taken experience in this field by treatment of 18 patients with APM. Our conclusions after that most important condition for effective therapy is early and enough wide dissection of the involved area, mainly thoracocervical and mediastinal, their drainage and installation of the continual rinsing, eventually. There is no exception we indicate an operative repeated revision including rethoracotomy, if necessary.

[Late diagnosed rupture of the diaphragm --a case review]. / Pozdne diagnostikovaná ruptura bránice--kazuistika.

The authors describe a case of the patient with late diagnosis of the diaphragmatic rupture. There was a bowel obstruction found in X-ray scan. After endotracheal intubation was complicated of tension pneumotorax. Laparotomy was found rupture of the diaphragm.

Prunella vulgaris extract and rosmarinic acid suppress lipopolysaccharide-induced alteration in human gingival fibroblasts.

Periodontitis is a chronic disease associated with inflammation of the tooth-supporting tissues. The inflammation is initiated by a group of gram-negative anaerobic bacteria. These express a number of irritating factors including a lipopolysaccharide (LPS), which plays a key role in periodontal disease development. Plant extracts with anti-inflammatory and anti-microbial properties have been shown to inhibit bacterial plaque formation and thus prevent chronic gingivitis. In this study we tested effects of Prunella vulgaris L. extract (PVE; 5, 10, 25microg/ml) and its component rosmarinic acid (RA; 1microg/ml) on LPS-induced oxidative damage and inflammation in human gingival fibroblasts. PVE and RA reduced reactive oxygen species (ROS) production, intracellular glutathione (GSH) depletion as well as lipid peroxidation in LPS-treated cells. Treatment with PVE and RA also inhibited LPS-induced up-regulation of interleukin 1beta (IL-1beta), interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and suppressed expression of inducible nitric oxide synthase (iNOS). The results indicate that PVE and RA are able to suppress LPS-induced biological changes in gingival fibroblasts. The effects of PVE and RA are presumably linked to their anti-inflammatory activities and thus use of PVE and RA may be relevant in modulating the inflammation process, including periodontal disease.

[Incidence and management of prolonged air leak following pulmonary lobectomy]. / Výskyt a resení prolongovaného úniku vzduchu po plicní lobektomii.

INTRODUCTION: Prolonged air leak (prolonged air leak - PAL, an air leak for over 7 postoperative days) is a common complication following lung resections. It extends the period of thoracic drainage, duration of hospitalization, increases postoperative morbidity rates and the cost of the treatment. METHODOLOGY: The retrospective study included a group of 256 subjects with lung lobectomies, performed during 2002-2007, where active thoracic drainage was introduced postoperatively. The following parametres were assessed: gender, age, preoperative FEV1/FVC values, intraoperative detection of pleural adhesions, missing interlobar fissures (due to stapler resections), presence of distinct bullae, number of removed mediastinal lymph nodes, lobectomy types (upper vs. lower), use of staplers and insufficient lung inflation of 2cm, detectable on x-ray on the day of the procedure. RESULTS: PAL was recorded in 26 (10.1%) of the subjects and their thoracic drain was left in place for 8-34 days (the mean of 15.9 days). In 7 subjects, the active thoracic drainage was replaced by a passive one (on the 14.4th postoperative day, on average, the range: postoperative Day 11 to postoperative Day 22). In seven subjects, the drain's position was changed, and in a single subject, reoperation for PAL was required. In particular, the following subjects are more likely to develop PAL: patients with FEV1/FVC of 80% (p-value = 0.0066; odds ratio = 3.494), where stapler resections of interlobar fissures are required (p-value = 0.0118; odds ratio = 3.070) and males (p-value = 0.0471; odds ratio = 3.200). CONCLUSION: In patients, predisposed to develop PAL, saving techniques to optimalize surgical procedures, as well as approaches to optimalize their postoperative care, including early replacement of the active thoracic drainage for the passive method, should be employed.

[Elective videothoracoscopy--a tool for prevention of primary spontaneous pneumothorax?]. / Elektivní videotorakoskopie jako prevence vzniku primárního spontánního pneumotoraxu--ano ci ne?

AIM: Based on the retrospective analysis of the selected group of patients with primary spontaneous pneumothorax (PSP), the authors aim to demonstrate contribution of CT scan examinations and elective videothoracoscopic procedures in diagnostics and treatment of pulmonary conditions, predisposing the patient to the disorder. MATERIAL AND METHODOLOGY: During 2005-2007, 45 patients with PSPs underwent post-treatment CT lung examinations. Pathological findings potentially resulting in collapsed lung, were detected in nearly 25% of the subjects. All of the subjects (males, the mean age of 22.4 years) were then indicated for elective videothoracoscopy, in order to prevent potential PSP events. The procedure included peripheral endostapler lung lesion resection and mechanical pleurodesis (pleuroabrasion), resp. partial apical pleurectomy. RESULTS: Pathological changes of the lung tissue were detected with the same rate in the both, right and left lung apices. In miniinvasive procedures, they were always easily located, as anticipated. In all of the subjects, the changed tissue was removed using peripheral lung resections, with concomittant pleuroabrasion in a half of the subjects, while in the other half of the subject, the procedure was combined with partial apical pleurectomy. Intraoperative morbidity and mortality were nil. The mean period of postoperative drainage was 5.5 days, the mean duration of hospitalization was a week. During the study period, no further PSP events were recorded. CONCLUSION: CT examination-based detection of pneumothorax-predisposing pathological lung tissue changes and their subsequent removal using elective videothoracoscopy, is a valid and a patient-beneficial procedure.