[Improving of treatment safety in emergency thoracic surgery]. / Zvýsení bezpecnosti lécby v emergentní hrudní chirurgii.

Authors point out a possibility of improving operative results in thoracic surgery with acute state. They prove it with two groups of patients, where preoperative complications are anticipated. The first group consists of the patients with thorax injury and the second group consists of the patients with relapsing pneumothorax. With a blunt thorax injury is the surgical treatment often performed on blood-soaked pulmonary tissue or on parenchyma affected by ARDS. A necessary stapler suture during an atypical reaction is accompanied by bleeding or air-leak from the resected area. To reinforce the suture, there are used various materials for staplers to utilize a padding effect. Sometimes is necessary to use tissue sealants to prevent the air-leak. Traumacel Stapler Seam Protection meets requirements on the stapler suture reinforcement and, moreover, due to its bactericidal and haemostatic effects helps the tissue healing.

[Monitoring the effectiveness of surgical treatment of malignant pleural effusions]. / Monitorace efektivity chirurgické lécby maligních pleurálních výpotku.

BACKGROUNDS: Recurrent pleural effusion occured in 10% of cancer patients. Repeated thoracocentesis or drainage may be complicated by pneumothorax, haemothorax or pleural cavity infection. Thoracoscopic talc poudrage is one of the most effective pleurodesis technique in patients with malignant pleural effusions. The effectiveness of such pleurodesis is reaching the 70 to 90%. This surgical approach also allows to take a biopsy for histological verification of the process. An effort to predict the success rate of chemical pleurodesis on the basis of the body's general inflammatory reaction rate, which is determined by the dynamics of values of humoral and cellular inflammatory parameters in both serum and in pleural effusion. PATIENTS: In the period 6/2008-12/2009 we applied biotalcum to 14 patients with malignant pleural effusions. The group of patients consisted of 10 male patients and 4 female patients of average age 71 years. Indication to include patients in the group was a second or further thoracic puncture, shortening of the interval between interventions, estimated time of survival > 3 months and the possibility of operation under selective pulmonary ventilation. METHOD: We performed the collection of pleural effusion and blood serum at 12-hour intervals. The first collection was performed preoperatively before biotalcum application, and then during the time of losses from thoracic drainage bigger than 150 ml in 24 hours. The duration of thoracic drainage was 4 days +/- 1 day. The success of the treatment was observed by ultrasound scan before drainage removal; during the first three months always at intervals of 1 month and then after 3 and 6 months, depending on the progression of a disease. RESULTS: No reccurence occured when the P-CRP (pleural) and S-CRP (serum) ratio exceeded 60% during the first 48 hours after pleurodesis. On the other hand, when the ratio fall bellow 30-35%, the effusion relapsed frequently. CONCLUSION: The P-CRP/S-CRP ratio as a promising marker of talc pleurodesis effectiveness and monitoring both P-CRP and S-CRP levels is inexpensive and acceptable method for clinical practice. The pleural effusion caused by malignant mesothelioma appeares to be resistant to talc pleurodesis.

[Long-term results of surgical treatment in lung cancer]. / Dlouhodobé výsledky chirurgické lécby plicní rakoviny.

The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,857 patients from the years 1948-1997. The special analysis has been performed of the group of 1572 patients from the years 1974-1997 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 33% of patients in whom the lung resection was performed during the period 1974-1997. The operative hospital mortality has been substantially reduced to 1.7%. Even though it is our duty to provided the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.

[Control of blood loss with topical administration of aprotinin after pulmonary tissue decortication and pleurectomy]. / Ovlivnení krevních ztrát po dekortikaci plicní tkáne a pleurektomii lokální aplikací aprotininu.

The authors were prospectively monitoring postoperative blood loss in 23 patients, in which decortication of the lung tissue and pleurectomy was performed and in which 500,000 KIU of aprotinin was applicated locally to the operating field before closing chest. The study was performed between the years 1998 and 2001. The amount of blood loss was compared to that of a group of 23 patients who underwent the same type of surgery between 1991 and 1998 without use of aprotinin. The postoperative blood loss was monitored 6, 12 and 24 hours after completing the surgery. Postoperative blood loss was lower in the group of patients in which aprotinin was used which was found to be statistically significant compared to the group of nonaprotinin patients.

[Early surgical stabilization of the thorax]. / Casná chirurgická stabilizace hrudníku.

Patients with non-penetrating chest trauma are encountered with increasing frequency. Car crash is the main cause of blunt chest trauma. Despite their nature these lesions may be life-threatening. The mortality rate of chest injuries varies from 20 to 50%. In the last 3 years 86 patients with blunt chest injuries were treated in our institution. 24 patients underwent surgical repair. We compared the outcome of surgical and conservative treatment. Early diagnosis and proper treatment reduce morbidity and mortality.

[Surgical treatment of lung cancer]. / Chirurgická lécba plicní rakoviny.

The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,727 patients from the years 1948-1995. The special analysis has been performed of the group of 1,456 patients from the years 1974-1995 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 32% of patients in whom the lung resection was performed during the period 1974-1995. The operative hospital mortality has been substantially reduced to 2%. Even though it is our duty to provide the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.

Congenital absence of the left pericardium in combination with left pulmonary artery hypoplasia, right aortic arch, and secundum atrial septal defect.

The authors describe a rare congenital anomaly--absence of the left pericardium--in one patient who was operated on for a secundum atrial septal defect. The symptomatology, diagnostic, and therapeutic possibilities are discussed.

[Injuries of the diaphragm]. / Urazová poranení bránice.

The authors submit a group of 11 patients treated in 1977-1988 on account of traumatic injury of the diaphragm. The group comprised 9 adults and two children. The authors analyzed the causes of injury, the condition of the patients on admission to hospital, the interval between admission and surgical treatment of the diaphragm, the diagnostic approach, the surgical approach and its results.

[An unusual complication of myxoma of the left atrium]. / Neobvyklá komplikace myxomu levé srdecní predsíne.

The authors give an account of a 59-year-old female patient with a myxoma of the left atrium which was complicated by repeated multiple embolizations into the systemic circulation. The cause of death after a successful operation was haemorrhage into the abdominal cavity from a ruptured spleen, as a result of a new lienal infarction after embolization of a portion of the myxoma into the lienal artery, 24 before the operation. The authors emphasize the necessity of immediate removal of an intracardiac formation as soon as it is detected.

[Mediastinal inflammation as a complication of heart surgery under extracorporeal circulation]. / Zánet mezihrudí jako komplikace srdecních operací v mimotelním obehu.

The authors describe mediastinitis in two patients operated on account of ischaemic heart disease. In both patients they used the closed approach which involved suture of the sternum and surgical wound, perfect drainage and the administration of antibiotics (general and local). They describe the applied method of fixation of the sternum. In both patients the sternum and surgical wound healed.