Pneumatosis cystoides intestinalis as a rare cause of non-surgical pneumoperitoneum.

Pneumoperitoneum as a finding on imaging examinations is not always a sign of acute abdomen due to gastrointestinal perforation. These findings must be viewed in connection with the clinical condition and personal history of each patient because they may also indicate a non-surgical or spontaneous pneumoperitoneum. This condition is repeatedly described but very often neglected. This paper presents the case report of a patient with non-surgical pneumoperitoneum where, despite proceeding according to the guidelines, no expected intra-abdominal pathology explaining the patient's problems was found.

[Perilunar dislocation of the corpus in a patient with aplasia of the scaphoid]. / Perilunátní luxace karpu u pacienta s aplazií skafoidea.

Congenital aplasia of the scaphoid is a rare abnormality arising when the distal row of carpal bones is dislocated radially and proximally, the capitate replaces the scaphoid, and the lunate is triangular instead of quadrilateral in shape. The scaphoid bone which makes a functional bridge between the proximal and the distal row is a stabilising element under normal anatomical conditions. If it is absent, the carpus structure is disturbed and its radial part is prone to perilunar dislocation, because stability is provided only by the ligaments. However, a perilunar dislocation associated with aplasia of the scaphoid has not been described in the literature yet. In the case reported here, after arthroscopic examination ascertaining that the capsular ligaments are not interposed between the joints, the dislocation was managed by closed reduction and Kirschner wire transfixation for 8 weeks, and the wrist was immobilised with a below-elbow plaster splint for the same period. A 22-month follow-up did not show any signs of wrist instability or restriction in hand function.

[Open vs. percutaneous suture repair of the subcutaneous Achilles tendon rupture]. / Perkutánni vs. otevrená sutura subkutánní ruptury Achillovy slachy.

INTRODUCTION: The authors assess and compare results of percutaneous and open repair of closed Achilles tendon rupture METHOD AND CLINICAL MATERIAL: The authors retrospectively examined 115 patients with subcutaneous Achilles tendon rupture who were treated in the Regional Hospital of Pardubice during the years 2000-2005. They used the 100 point Hannover Achilles Tendon Score. 42 patients were operated on exclusively with percutaneous technique and 73 patients with open repair of Achilles tendon. Duration of the rehabilitation, post-operative complications and using of alternative fixation system in a post-operative treatment of Achilles tendon rupture were also assessed. RESULTS: 62 % of evaluated patients achieved good or excellent results. There was no significant difference between the open and percutaneous repair. In a case of percutaneous repair there was achieved a shortening of post-fixation rehabilitation time in compare with open repair about two weeks. Eighteen postoperative complications were identified after open Achilles tendon repair, resulting in institutional complication rate of 24.7 %. The complications included 6 (8.2%) superficial wound infections. 7 (9.6%) deep crural flebothromboses, 4 (5.5%) re-ruptures and 1 (1.4%) sural nerve injury. Seven postoperative complications were identified after percuaneous Achilles tendon repair, resulting in institutional complication rate of 11.8%. The complications included 3 (7.1%) sural nerve injury and 2 (4.7%) deep crural flebothromboses. The vacuum brace system VacoAchill was used in 23 patients and involved in shortening of duration of rehabilitation about 20%. CONCLUSION: Percutaneous suture of Achilles tendon rupture is a simple and safety method, that brings comparable functional results to open repair with the same time of post-operative fixation and with a significantly lower rate of complications. The vacuum brace system VacoAchill is an alternative method of post-operative fixation allowing earlier mobilization and shortening patient's disability.