[Epidemiology of severe injuries from the viewpoint of the trauma center]. / Epidemiologie tezkých poranení z pohledu trauma centra.

BACKGROUND: Injuries represent the major cause of mortality in the age group up to 45 years. In the Czech Republic, the majority of injuries is caused by traffic accidents. According of statistic data incidence of injuries is increasing. METHODS AND RESULTS: Traumatological Hospital Brno is Trauma Centre level I for two districts (2 mil. people). In 1999, the epidemiological prospective study was initiated, monitoring patients with injured at least two body structures and with Injury Severity Score higher than 16. After four years, the group includes 880 patients (75.7% of males). The average age was 39.3 years (14-97 years). The main cause of injury was a traffic accident (72%), the second cause was a downfall (20%). CONCLUSIONS: The average value of ISS is 27, the mortality decreased significantly from 22% in 1999 to 11% in 2002. Occurrence and types of injuries in traffic participants are analysed.

[Personal experience with injuries of the rectum and anus]. / Nase zkusenosti s poranením rekta a anu.

Authors analyze some new knowledge in treatment of rectal and anal injuries proceeded from own clinical experience in comparison with studies of a range of foreign authors published recently. During last ten years together 24 injured patients with this diagnose were operated in Traumatological Hospital Brno, primary reconstruction was performed in 10 patients, secondary reconstruction after precise examination of pelvic fundus pathophysiology in 14 patients, mostly transferred from other clinics. Authors prefer primary treatment in 3 hours after injury. This opinion is supported by control examinations after performed reconstructions.

[Devastating injuries--new therapeutic approaches]. / Devastující poranení--nové prístupy lécby.

Nowadays the number of devastating injuries is increasing, as a consequence of traffic accidents and criminal incidents, too. Patients are often admitted in a critical state, the mortality rate in these cases is very high (50% and more). To decrease this high mortality, new treatment approaches must be chosen incl. the method called damage control. Knowledge of leading foreign centres are evaluated together with our clinical experience.

[Injuries of the small intestine in polytrauma]. / Poranení tenkého streva pri polytraumatu.

The authors inform on the increasing number of penetrating abdominal injuries during the last five years, especially in the criminal injuries. Diagnostic methods in a stabilised patient are analysed, diagnostic and therapeutic laparoscopy is preferred to lavage of the abdominal cavity in indicated cases. Urgent surgical revision is recommended in patients in a critical state on account of quickly increasing compartment syndrome, although staged laparotomy is needed. The timing of surgical methods is emphasised in serious associated injuries. Conclusions are illustrated with surgical results.

[Does a pelvic compartment exist? Personal experience]. / Existuje pánevní kompartment? Nase zkusenosti.

The authors analyze a group of 7 patients transferred to their hospital for instable fractures of the pelvic circle and lumbar spine. The pelvic compartment was manifested 24-48 hours after injury. Early diagnostics are based on the use of new imaging techniques, spiral CT examination is preferred, and angiography in stabilized patients. Early surgical intervention is aimed at evacuation of haematomas, revision of vessels, release of the ureters and temporary nephrostomy.

[Surgical treatment of the ruptured achilles tendon.]. / Operacní lécba pretrzené Achillovy slachy.

The article deals with the issues of the rupture of Achilles tendon with a focus on its surgical treatment. On the group of 42 patients operated on between 1994 and 1999 with the average follow-up of 3 years and 9 months the authors analyze the epidemiology of this injury, i. e. its incidence by sex, age, causes etc. They also examine the influence of the presence of pretrauma complaints and the associated diseases. The results reflect both the subjective condition and the objective finding. Satisfaction of patients is expressed by a scale of seven subgroups. Achieved were 64,2 points out of the maximum number of 85. Clinical examination is focused mainly on the assessment of the standing on the toes or plan-tiflexion,Thompson test, range of motion and the presence of potential postoperative muscular hypotrophy. In the conclusion the authors discuss the influence of immobilization of the knee joint after the surgery on the strength of the regenerated tendon and mainly on the healing of the tendon in elongation which corresponds with the above mentioned clinical tests. Reduced plantiflexion was recorded in 26,2 % and the positive Thompson test in 21,4 % patients treated after the surgery by a foot-knee plaster fixation applied for 6 weeks. Key words: rupture of Achilles tendon, surgical treatment, results.

[Standardized spiral CT examination in polytrauma patients]. / Standardizovaná spirální CT vysetrení polytraumatizovaných pacientu.

The aim of this study was to develop a standardised spiral CT examination protocol including head, body and extremities to achieve good time efficiency and the diagnostic accuracy during initial radiological examination of polytraumatised patients. The precondition for this examination is circulatory stability of the patient. In instable patients the situation must be solved surgically without this examination. All 35 patients were examined according to a standardised CT protocol. After native examination of the head, the examination of the thorax, abdomen and pelvis was performed with administration of intravenous contrast medium (occasionally modified). All data in the medical report were completed and the outcome of the CT examination was compared with the final diagnosis. In total, 14 head injuries, 23 thoracic injuries, 17 abdominal and 20 pelvic injuries were examined, and 7 spinal fractures and 5 fractures of the extremities were found. The mean examination time was ca. 12 min. (range 8-15 min.). The spiral CT examination in comparison with the sequential CT examination is markedly quicker and its diagnostic accuracy is higher. For these reasons we recommend this examination as the method of choice for initial radiological examination in polytraumatised patients.

[Central rupture of the liver in multiple injuries]. / Centrální ruptury jater u polytraumatizovaných.

Authors evaluate clinical material of polytraumatized patients operated on account of liver injury during the last 15 years. The contribution of new imaging techniques is analyzed, especially of spiral computed tomography, for the diagnosis of liver injuries and associated injuries of the abdomen and retroperitoneum. These techniques enable in stabilized patients with the trauma I, II injuries and in some cases of grade III injuries to prefer conservative treatment. During the last 3 years the authors treated 5 polytraumatized patients with central liver rupture. Consistent with experience of major trauma centres in USA and Switzerland, criteria for conservative treatment are outlined, especially in patients of younger age groups.

[Loss injuries of the biliary tract in laparoscopic cholecystectomy-- possibilities of reconstruction]. / Ztrátová poranení zlucových cest pri laparoskopické cholecystektomii--moznosti rekonstrukcí.

Authors analyze occurrence of injuries of external biliary tract relating to the increasing number of laparoscopic cholecystectomies, especially of loss injuries, very demanding for its reconstruction. The early diagnosis of these injuries is emphasized and the necessity of their surgical revision as soon as possible, best still during the primary intervention. Authors present the own reconstruction method by high intrahepatic anastomoses in loss injuries of the common hepaticus and its branches.

[Laparoscopy in abdominal injuries]. / Laparoskopia pri úrazoch brucha.

Application of laparoscopy in trauma was studied in Traumatological Hospital in Brno, within a more widely concipated project of grant IGA, Ministry of Health in Czech Republic. In the series of 28 patients there was detected neither a single complication, nor a reoperation nor any significant damage to the patient in connection with the use of the endoscopic method detected. Results of the research and author's observations act as a guide for use of more precise indication criteria and adequate selection of patients and for the proper evaluation of the method. Provided that basic principles and priorities of the urgencies management are kept, the application of this minimally invasive method in the management of patients with selected both the blunt and the penetrating abdominal trauma is justified, including associated extraabdominal injuries and polytrauma. It's diagnostic contribution exceeds the therapeutic one.

[Injury of the extrahepatic bile ducts in multiple injuries]. / Poranení extrahepatických zlucových cest pri polytraumatu.

During the ten-year period between 1982-1991 the authors operated in the Institute 12 casualties after perforation and avulsion of the gallbladder, 8 patients on account of injuries of the hepatocholedochus and 15 patients where after injury posttraumatic acute cholecystitis developed. The authors evaluate critically the asset of new diagnostic preoperative procedures for assessment of early indication of surgery. In the surgical tactics they prefer reconstruction procedures which prevent such serious postoperative complications as relapsing cholangitis or stricture with cholestatic affection of the liver [1,3].

[Problems with continence after deep pelvic anastomoses in rectal carcinoma]. / Problematika kontinence po hlubokých pánevních anastomózách pri Ca recti.

Based on the complex evaluation of the continence by anorectal manometry, EMG examination of sphincters, transrectal sonography, defecography and Colonic Transit Time examination, the analysis of the group of 15 patients partially incontinent after operation of carcinoma of the lower part of the rectum has been done. In these patients the deep pelvic anastomosis or coloanal anastomosis was performed. In none of the patients any serious organic damage of sphincters was manifested, the causes were dominantly extrasphincteric and functional, solvable well by conservative methods.

[Acute surgical diseases in spinal injuries with spinal cord lesions]. / Výskyt akutních chirurgických onemocnení pri poranení pátere s mísní lézí.

Authors analyse the group of 22 operated patients admitted to the Spinal Centre of the Traumatological Hospital Brno for instable spinal fracture with the transversal lesion of the spinal cord, in whom the acutely affected abdomen and acute surgical disease manifested. The anamnestic and clinic examination of the abdomen is not reliable in patients with the transversal lesion of spinal cord for valid laws of the spinal cord. Authors evaluate the contribution of new diagnostic imaging techniques and endoscopic methods to determinate the early indication for surgical treatment.

[Problems with continence in rectal injuries]. / Problematika kontinence pri poranení rekta.

Authors analyse the group of 17 patients operated for rectal and anal injury. In this group 7 patients were operated primarily after injury and in 11 patients the secondary reconstruction was performed. Authors called the attention to the high diagnostic difficulty before the planned and indicated secondary reconstruction. Based on assessment of own clinical material and conforming with literature, authors conclude that secondary reconstruction are more difficult, and this difficulty is the higher, the less qualified the primary treatment was performed.

[Trauma and emergency thoracoscopy]. / Trauma a casná torakoskopie.

Authors present their first experience with urgent videothoracoscopy in polytraumatism and in isolated thoracic trauma patients. During the prospective study in 1993-1995 thoracoscopically was treated 41 (18%) from 229 multiple trauma patients including thorax trauma, hospitalised in our Institute. Thoracoscopy underwent 62 (4%) from 1452 patients with simple thoracic trauma. Thoracoscopy has been indicated above all for continued bleeding into peritoneal cavity, for suspected diafragmatic injury and for the diagnosis and treatment of posttraumatic complications. Authors suggest that thoracoscopy is in experienced hands and adequatelly equipped workplaces an accurate and safe method for the diagnosis and in some cases also for therapy of hemodynamic stabile patients with thoracic trauma.

[Associated injuries of the pelvis]. / Sdruzená poranení pánve.

In last three years 27 injured patients were operated in Traumatological hospital Brno for associated pelvic trauma. This trauma was associated with injury of urinary tract in 8 patients, with traumatic lesion in area of the colon in 6 cases and with injured big vessels of the retroperitoneum in 8 patients. The urgent operation was performed in 44%. Authors put stress in diagnostic analysis and early indication of surgical operation on careful anamnestic clinical examination, they utilize the contribution of the sonographic and CT examination with contrast, in indicated cases the selective angiography and retrograde urethrocystography, too. Authors prefer early reconstructional operations.

[Pitfalls of deep pelvic anastomoses in rectal carcinoma]. / Uskalí hlubokých pánevních anastomóz u karcinomu rekta.

Authors analyse a group of patients operated for colorectal carcinoma in their hospital during ten-years period 1982-1991. 421 patients were operated for ca recti, in more as 65% of cases the sphincter saving operation was preferred. The used method was elaborated by Hojo and Kaso from Japan. The contraindication of sphincter, and insufficiency of sphincter, objectively rectomanometrically detectable. The resection of urinary bladder was contemporary performed in 15 patients, the hysterectomy with adnexotomy in 8 patients, the vaginal resection in 5 cases and the resection of small intestine in 8 cases. The resection of os sacrum to S 3 was performed in 3 patients. The radical resection with establishment of the deep pelvic anastomosis is burdened by certain number of early and delayed complications, too. Authors analyse its causes, possible corrections, but also its prevention.

[Injuries of organs in the abdominal and retroperitoneal cavities]. / Poranení orgánu brisní dutiny a retroperitonea.

In the Traumatological Hospital Brno approx. 100 polytraumatised patients yearly are admitted with involvement of 2, 3 or 4 systems. During the period of years 1982-1991 authors operated 308 injured patients with increasing haemoperitoneum, 254 patients with profuse bleeding into retroperitoneum, 77 patients with traumatic perforative peritonitis and 61 patients with severe thoracoabdominal trauma. Mortality in this group was 26%. Authors evaluate the contribution of new diagnostic methods for the indication of early surgical treatment, and results of operations, complications and problems.

[Stress ulcers in patients with polytrauma]. / Výskyt stresového vredu u polytraumatizovaných.

Authors treat in their institution yearly 100-120 patients with polytrauma. In the Endoscopic Centre of the hospital approx. 20 gastroduodenal ulcers are diagnosed yearly in patients with supposed stress etiology. Authors analyze the pathophysiology of origin of stress ulcer, clinical symptoms and acute diagnostics. They evaluate results of early surgical treatment. Authors place the great importance on explicit treatment methods for prevention of stress ulcer origin.

[Early treatment of the unstable thorax in polytrauma]. / Vcasné osetrení instabilního hrudníku u polytraumatizovaných.

Thoracic trauma represents 12.8% of all trauma patients treated in author's evaluated the contribution of new diagnostic methods, in particular CT and sonography, to determinate the indication of conservative therapy or early surgical treatment. From 1992 in the framework of the grant project the early surgical treatment of instable thorax was performed in 29 patients with polytrauma or severe associated thoracoabdominal trauma. Authors determined indications for thorax stabilisation after serious consideration, and stated contemporary contraindications of this treatment. They evaluated the therapeutic contribution of these methods and prepared in cooperation with the company Medin Nové Mesto the set of osteosynthetic material with accessories for treatment of instable thorax.