Clear cell renal carcinoma metastases to the pancreas.

INTRODUCTION: To date, clear cell renal carcinoma (Grawitz tumour) remains the most frequent malignant tumour of the kidney in adults. It metastasises in more than 25% of cases, most frequently to the bones (osteolytic metastases), lungs, brain, liver, adrenal glands and the contralateral kidney. Metastases to the pancreas are rare and represent 1-4% of all malignant tumours of the pancreas. METHODS: This is a retrospective analysis of patients who were operated at the Department of Surgery in Pilsen between 2010 and 2018 for histologi-cally verified metastasis of clear cell carcinoma (Grawitz tumour) to the pancreas. RESULTS: We operated 12 patients (8 men and 4 women). The metastases appeared on average 8 years and 8 months following the primary urolo-gical surgery. The mean age of the male patients was 66.5 years and that of the female patients was 67.4 years. In our sample, the diagnostic specificity of the CT scan was 50%, the diagnostic specificity of endoscopic ultrasound (EUS) was 75% and subsequent EUS-guided fine needle aspiration biopsy performed in 100% of cases yielded a specificity of 75%. Resectability was 92%. The average length of hospitalisation was 11.5 days. Post-operative complications according to Clavien-Dindo were grade 1 in 66%, grade 2 in 1.25% and grade 5 in 8.3% of the cases. The 30-day post-operative mortality was 8.3% (one patient).  Conclusion: Clear cell renal carcinoma metastases to the pancreas are very rare. However, if radically removed, the patient has a good prognosis with regards to long-term survival.

Regeneration of ischemic tissue and improvement of blood supply using stem cells up-to-date knowledge and potential use in no-option critical limb ischemia.

INTRODUCTION: Cardiovascular disorders and their complications are the leading causes of death all over the world. The number of patients with critical limb ischemia and in risk of amputation is increasing together with increased incidence of cardiovascular diseases. In comparison with comparable population, the prognosis of patients after limb amputation is much worse. In case with no possible revascularisation, stem cell therapy offers a possible option for limb salvage. METHODS: We collected relevant informations from published and accessible studies available on internet database Pubmed in period of 2007-2017. The key words stem cell and critical limb ischemia were used. CONCLUSION: Available informations show promising results in the use of stem cells in the treatment of no-option limb ischemia. Multicenter randomized clinical trials and unified recommendations and guidelines are needed to accept this method as available option for treatment. This article is presenting a short rewiev of circumstancies and conditions of this evolving method of treatment. Key words: stem cell - limb ischemia.

Hypogastric artery aneurysm - a case report.

Isolated hypogastric artery aneurysm (internal iliac artery aneurysm) is a rare disease, more often associated with the occurrence of aneurysms in other localities. It typically occurs in older men. Rupture as the most serious complication is associated with high mortality, which is many times higher than the mortality in case of elective repair. Nearly half of the patients are asymptomatic and eventual symptoms tend to be very diverse. Therefore, in the diagnostic process, it is necessary to consider this disease even in case of symptoms apparently unrelated to the arterial system. Treatment is surgical or endovascular. The report presents the case of a female patient with an isolated aneurysm of the hypogastric artery treated endovascularly. Key words: aneurysm hypogastric artery - stentgraft diagnosis.

[Popliteal vein aneurysm]. / Aneuryzma vena poplitea.

Popliteal vein aneurysm is a rare disease of the lower limb venous system. Massive pulmonary embolism may be a clinically serious presentation of the disease. The authors present surgical management of the popliteal vein aneurysm in two case reports.Key words: popliteal vein aneurysm surgical management.

[Thyroid carcinoma, ten-years file]. / Karcinom stítné zlázy, desetiletý soubor.

INTRODUCTION: Even though thyroid carcinoma has, in general, a good prognosis and low mortality rate, its incidence, especially the incidence of early forms of the disease has been growing. METHOD: Retrospective analysis of the file of surgeries of documented thyroid carcinoma within the years of 2006-2015. RESULTS: Thyroid carcinoma was recorded in 145 of 1820 patients operated for thyreopathy (8%); microcarcinoma (<10mm) was recorded in 64 cases (44.1%). The carcinoma was mostly detected accidentally during total thyroidectomy, which was in 70 cases (48.3%). The carcinoma was expected in 35 cases (24.1%) on the basis of prior puncture and total thyroidectomy was carried out straight away. Perioperative histology after hemithyroidectomy was requested in 31 cases (21.4%), and it was found positive only in 13 cases; thyroidectomy was finished in the second period in the other cases. Due to advanced carcinoma, tumour exploration/debulking was performed in 3 cases (2.1%) - for anaplastic carcinoma in all these cases. A permanent unilateral lesion - n. laryngeus recurrens - occurred in 3 cases (2.1%); a permanent bilateral lesion was recorded twice (1.4%).The most frequently manifested carcinoma was the papillary carcinoma in 114 patients (78.6%; 83 women/31 men; age of 1284 years; mean age of 50.6), the second most frequent carcinoma was the follicular carcinoma in 16 patients (11.0%; 15/1; 1969; 55.3), followed by the medullary carcinoma in 10 patients (6.9%; 6/4; 2576; 58.1). Anaplastic carcinoma was detected only in 4 cases (2.8%; 2/2; 6487; 75.5), and lymphoma of the thyroid gland occurred twice as well as Hürtle cell carcinoma. CONCLUSION: Thyroid carcinoma is mostly found accidentally during surgery in the early phase of the disease. This proves the high quality of endocrinology care and the correctness of the tendency to indicate early surgical treatment of thyroidal pathology.Key words: thyroid carcinoma - thyroidectomy complications.

[Choledochal cyst]. / Cysta ductus choledochus.

Choledochal cyst is a rare disease with a considerably higher incidence found in the Asian population. Although its etiology is not completely known, the disease is believed to be associated with anomalies in the anatomy of the biliary tract. While being a benign unit, it is considered as a precancerosis with the risk of conversion to the biliary tract carcinoma. Radical surgical removal with biliary tract reconstruction is the only curative solution. The authors present the case report of a patient with choledochal cyst type I according to Todani