[Delayed laparotomies in blunt injuries of the abdomen: incidence rates, causes, mortality rates and hospitalization times in a group of 139 operated patients. A retrospective study]. / Opozdené laparotomie u tupých úrazu bricha: výskyt, príciny, mortalita a doba hospitalizace v souboru 139 operovaných pacientfu. Retrospektivní studie.

INTRODUCTION: Employment of visualizing methods and achievements of conservative treatment methods have a major influence on the management of blunt abdominal injuries. The aim of the study is to assess incidence rates of, possibly, delayed surgeries and complications. PATIENTS AND METHODS: The authors conducted a retrospective analysis in a group of 139 operated patients. A common algorithm was followed on their admission. The following parameters were assessed in patients operated later than 24 hours following their admission (GROUP A): a cause of the delay, a mortality rate and duration of their intensive care unit (ICU) hospitalization. The parameters were compared to those of a corresponding patient group operated no later than 4 hours after their admission (GROUP B). RESULTS: The GROUP A included 17 (12.23%) patients. The delay median was 4 days (1-48). The diagnostics failed in 9 (52.94%), the conservative care failed in 8 (47.06%) subjects. The mortality rate was 29.41%. The GROUP B had significantly higher survival rates (p-value 0.0445). There was no statistically significant difference in the parameters of the ICU hospitalization duration. CONCLUSION: Diagnostic conclusions of visualizing methods, including CT scans, cannot be fully relied on in blunt abdominal injuries, mainly in cases of intestinal and diaphragmatic injuries. When a conservative treatment is indicated, the patient has to be closely monitored while sustaining an active surgical approach.

[Surgical treatment of thyreopathies. Retrospective assessment of the authors' study group]. / Chirurgická lécba tyreopatií. Retrospektivní rozbor vlastní sestavy.

The aim of this study is to expose the change in the access to thyroid gland operations during last 10-15 years when increasing radicality of the operations means any more specific complications in condition of routine detection and visualisation of recurrent laryngeal nerve and sparing of parathyroid glands. Authors analyse 458 patients with thyroid gland disease operated during years 2000-2004. Overall incidence of temporary and permanent paresis of recurrent laryngeal nerve was 2.5% and 1.5% respectively (nerves at risk). There was no permanent bilateral paresis in this study. Persistent hypoparathyroidism occurred after 0.2% of all the operations, and temporary hypoparathyroidism was noted in 10.7%. Results prove that even with increased radicality of performed operations the number of complications is in accordance with values quoted in world literature.

Increasing occurrence of oropharyngeal cancers among males in Slovakia.

The gradual decline of oropharyngeal cancers in postwar period was followed by their rapid increase during recent two decades among males in Slovakia. Overall age-adjusted incidence rates of cancers of oral cavity and pharynx increased from 4.5 in 1968-1970 to 20.7 in 1990-1992 and corresponding mortality rates from 2.8 to 14.0 per 100,000 males. Oropharyngeal cancers have recently accounted for 6.5% of all newly diagnosed cancers yearly and present the fourth most frequent cancer site among males in this country. The cancers of tongue, floor of mouth, oropharynx and hypopharynx are responsible for the dramatic increase of this combined site in males. The culmination of the age-specific incidence and mortality rates of these cancers in the age groups 40-59 confirms the leading role of middle-aged men in their increase and dominant position. The occurrence of cancers of major salivary glands and nasopharynx in males, as well as the incidence and mortality rates of all oropharyngeal cancers in females remained very low and an unchanged (less than 1% of total). Increasing and extremely high incidence and mortality rates from oropharyngeal cancers among males in Slovakia require more effective primary prevention, above all substantial reduction of smoking.

[Personal experience with treatment of primary hyperparathyroidism]. / Nase zkusenosti s lécením primárního hyperparatyreoidismu.

The primary hyperparathyreosis needs the interdisciplinary approach. The ideal term for surgical intervention is the period of the latent HPT, that means the time, when the signs of irreversibly damaged organs are not yet present. In the Czech Republic they are approximately 100-300 such cases per year with the primary diagnosed HPT. These patients should be sent to the departments, specialized for this type of surgery.

[Personal experience with surgery of retrosternal goiter]. / Nase zkusenosti s operacemi retrosternálních strum.

BACKGROUND: Retrosternal goitre has its specific features: a clinical picture with elements of compression, an increased percentage of malignant conversion, a technically more pretentious operation with an increased number of complications etc. Data in the literature are not uniform. The objective of the presented work was to assemble information in a large group of operated patients. METHODS AND RESULTS: The authors evaluated retrospectively operations of retrosternal goitres from two clinical departments. Of 716 patients operated on account of goitre 87 (21.1%) had retrosternal goitre. Women were affected more frequently (84%) than men (16%), ratio 5.2:1; the mean age of women was 66 years, of men 56 years. A malignant finding was confirmed in 4.6% of the operated patients. The most frequent finding was benign adenomatous colloid goitre (8.5%) and Hashimoto's thyroiditis (80.4%). Hyperthyroidism of the Graves-Basedow type (4.6%) and benign hyperthyroidism of the Plummer type (2.3%) were not frequent. Type of malignity: papillary carcinoma (3.45%) and follicular carcinoma (1.15%); medullary carcinoma, anaplastic carcinoma or lymphoma were not found. The most frequent surgical approach was cervical incision (Kocher) in 95.4%; it had to be supplemented by sternotomy only in 4.6% of the operated patients. As far as the extent of surgery is concerned, almost total thyroidectomy was performed in 60.9%, total lobectomy in 2.3%, subtotal thyroidectomy in 32.2% and subtotal lobectomy in 4.6% of the patients. 24.1% of the patients developed complications, only in 5.7% they were permanent. One female patient died (1.2%). CONCLUSIONS: Retrosternal goitre accounted for cca 20% of patients operated on account of goitre. In cca 5% histology confirmed a malignant form (papillary and follicular carcinoma). Sternotomy was necessary only in less than 5% of the operated patients. The results of surgery are very good.

Thyroid cancer in Slovakia, 1968-1990: incidence, mortality and histological types.

Data on thyroid cancer incidence and mortality from the national cancer registry in Slovakia have been analysed for 1968-90, representing one of the first such descriptive epidemiological studies from Eastern Europe. The incidence of thyroid cancer has increased over this period, particularly among women, from approximately 1.5 to 2.5 per 100,000. These increases occurred primarily in papillary carcinomas, and to a lesser extent follicular carcinomas; the greatest proportional increase was in the younger age groups. In contrast to data reported from other areas, mortality also increased over the same period. The reasons for such increases are not evident, but the increases in mortality certainly indicate the potential for improvements in the treatment of thyroid cancer in Slovakia, as well as further study on the aetiological factors involved in the disease.

The role of the registry in the study of relation between cancer and environment experiences from Slovakia.

Highly complete and detailed data on cancer incidence collected in National Cancer Registry of Slovakia in the years 1968-1988 contributed largely to the study of the relations between cancer occurrence and environment. The study of temporal trends of age-adjusted rates revealed the rapid increase of overall cancer incidence and mortality rates in males influenced mainly by extreme increase and high proportion of lung cancer. The lower but increasing overall incidence rates in females could be related to the increase in breast, other skin and genital organs cancers, while the stabilized mortality trends were caused by improving prognosis of these major cancers in females. The possible role of environmental factors in adults could be stressed also by the temporal trends of childhood malignancies which remained fairly stable during the same period. The role of environmental factors in cancer etiology is further documented with the dramatically increasing incidence of malignant skin melanoma caused probably by the overexposition to the sunlight and with prevailing incidence of the majority of cancer sites in urban areas. Finally, the significantly increased incidence rates of other skin cancers are shown in two districts and in both sexes in relation to the environment, highly polluted with arsenic.

[Incidence of malignant tumors in Slovakia. I. Levels and trends 1968-1989]. / Incidencia zhubných nádorov na Slovensku. I. Hodnoty a trendy v rokoch 1968-1989.

In the period from 1968-1989 an increase in the overall incidence of malignant tumors was recorded in men. Of the individual localizations a particularly marked increase was recorded in tumors of the lung, followed by tumors of the oral cavity, pharynx, esophagus, pancreas, urinary bladder, kidney (related to smoking), as well as of the testis and prostate gland. In women the values of overall incidence were lower and the trends were relatively stabilized. This is due to the relatively slow increase in the incidence in cancer of the breast and female reproductive organs and to the slight increase in cancer of the lung. Cancer of the kidney, urinary bladder and pancreas exhibited increased incidence. Low values, stabilized and even decreasing trends were recorded in the incidence of cancer of the oral cavity, pharynx, esophagus, and larynx, as compared to values found in men. In both sexes the incidence of cancer of the stomach showed a pronounced decrease, while the incidence of cancer of the colon and rectum was increasing. A smaller or greater rise was found also in the incidence of tumors of the hematopoietic and lymphatic tissues (except Hodgkins's disease). The trends observed in the incidence of malignant tumors in Slovakia are suggestive of their uncontrolled course, not affected by preventive measures. Yet the findings provide important information for directing the measures so as to aim at localizations of priority. (Tab. 2, Fig. 7, Ref. 20.)

[Intensive care in patients with intra-abdominal septic complications]. / Intenzívní péce o nemocné s nitrobrisními septickými komplikacemi.

The authors investigated diagnostic and therapeutic possibilities of intensive care units when treating septic conditions in intraabdominal surgery. The authors emphasize the comprehensive and systematic character of the follow up of patients who are threatened by sepsis. Care involves in particular aimed antimicrobial therapy, immunotherapy, normalization of haemodynamics and the acid-base balance and rational parenteral nutrition. Only a thus conceived therapeutic regime makes it possible to control such serious conditions as sepsis.

Recent trends in uterine cervix cancer in Slovakia, 1968-1987.

The temporal trends in the incidence and mortality of uterine cervix cancer in Slovakia were evaluated. Only highly reliable and complete data from 1968-1987 derived from the National Cancer Registry of Slovakia were used. Incidence rates have fallen in the first part of the period studied, but this trend has reversed and the incidence rates of this cancer site have risen since about 1976. The mortality rates showed continuous and unchanged increase over the whole mentioned period. The analysis of the age specific incidence rates indicated the responsibility of the youngest age groups of women for the overall recent increase of the uterine cervix cancer incidence in this country, while the age specific mortality rates increased in nearly all age groups. The relatively high incidence and mortality rates of uterine cervix cancer in Slovakia in comparison with the same rates in other countries as well as the recent increase of both indicators, together with low proportion of the in situ forms could be attributed mainly to the deficiencies in the organization and performance of the cervical screening.

Development of registration and cancer incidence rates and trends in Slovakia.

The development of cancer registration, from the introduction of obligatory notification and the establishment of National Cancer Registry of Slovakia, is described. The activity of the registry is illustrated by the list of publications which have emanated from this institution in recent years. The survey is completed by the analysis of the incidence rates of individual cancer sites in the last 5-year period (1984-1988) and by their trends in the decade 1979-1988. The positive role of the registry in the establishment of a cancer control programme and the investigation of cancer epidemiology is stressed.

Epidemiological features of biliary tract cancer incidence in Slovakia.

This descriptive study is based on detailed data of biliary tract cancer incidence in Slovakia in the period 1968-1977. Age-adjusted incidence rates of biliary tract cancer in the given decade decreased in females while in males they showed a slight increase. The study of geographic distribution revealed diminishing incidence rates from west to the east in both sexes with extremely elevated rates in towns and suburban districts in males. Different shapes of age-specific incidence curves together with the identified histological types suggested different epidemiological characteristics of individual subsites within this site. Relatively high incidence rates of biliary tract cancer in Slovakia as well as in whole Czechoslovakia, in comparison with other countries or areas of Europe, could be related to the excessive prevalence of gallstones and high number of surgical interventions upon biliary tract in this country while the decreasing incidence rates in women coincided with elevated number of cholecystectomies. The significance of detailed descriptive data from cancer registries for further analytic and etiologic study of biliary tract cancer according to subsites for a better delimitation of high risk groups and primary prevention strategies is stressed.

The role of registration in a nationwide cancer control program in Slovakia.

In comparison with the official statistics substantially higher, more reliable and more detailed cancer incidence and mortality rates were ascertained by the National Cancer Registry of Slovakia established in the frame work of a complex cancer control program initiated in Slovakia in 1976. The role of the registry in the evaluation of treatment, planning for material and personal resources, orientation of public education, improved classification of malignancies in childhood, in planning and evaluation of preventive measures as well as its experience with the use of the standard WHO system for cancer registries are described. A more important position for the registry in the continuous evaluation and current orientation of the cancer control program is suggested for the future.