[Optimizing the treatment procedure in crural ulcers - a pilot study of the surgical method]. / Optimalizace lécebného postupu u kozního trofického defektu bérce pilotní studie chirurgické metody.

INTRODUCTION: Current medical knowledge has provided us with a wide range of possibilities of treating chronic wounds. Over the recent decades, in particular, significant progress has been made in this field. The authors present an overview of current knowledge of chronic wound healing, pointing out the surgeons role in the process of chronic wound management. Using surgical therapy, we are able to heal a chronic wound in a shorter period of time, particularly if the treatment is accelerated by the application of platelet-rich plasma (PRP) as a source of growth factors. METHODS: The pilot randomized prospective study included four patients with chronic wounds of the lower leg after previous failure of conservative therapy who were indicated for skin transplantation. Following previous vacuum-assisted closure therapy, the patients undergoing skin transplantation were prospectively randomized into two groups. Autologous PRP was used in one of the groups and standard skin transplantation without PRP was performed in the other one. RESULTS: In the PRP group, 99% of the wound areas were healed on the 15th day after the operation. In the other group, 90% of the areas were healed on the 15th day following the operation. In the PRP group, complete healing of the defect occurred in both patients at 15 and 20 days post-surgery. In the second group, one patient completely healed within 28 days; the other one was not fully healed even at 3 months post-surgery. CONCLUSIONS: Most patient groups at great risk may benefit from the method using PRP, as well as patients with chronic wounds who have failed conventional methods available for both general and local therapy. This fact has been confirmed by the authors initial experience presented.Key words: platelet-rich plasma (PRP) - platelets wound healing chronic wound.

[Clostridial myonecrosis of the abdominal wall - case report]. / Klostridiová myonekróza brisní steny - kazuistika.

The authors present a case report of a forty-five-year-old patient operated on for acute appendicitis who developed gas gangrene of the abdominal wall within 48 hours after an appendectomy and subsequently also clostridial sepsis. Due to early diagnosis and intensive care, the patient survived. Clostridial myonecrosis is a rare complication after abdominal surgery and may be fatal in many cases. In our literature, there are only a few publications describing cases of patients who survived this rare postoperative complication.

Laceration and degloving injury of a child's foot--a case report.

Laceration and degloving injury to a child's foot is quite a rare occurence, mostly resulting in persistent consequences. Treatment options for such an injury depend on the specific type of injury and the customary practice of each surgical department. The authors present the interesting case of 4-year-old boy with laceration and degloving injury to his right foot after a collision with a truck, suggesting simple treatment using skin graft which has an excellent functional and cosmetic effect. Several methods have been described in management of this kind of injury, such as microvascular free tissue transfer, free or local flap and skin graft. A full-thickness skin graft was used in this case with good result, and in our opinion this treatment option need not be reserved for plastic surgeons.

[Clostridial sepsis and gas gangrene of the abdominal wall after cholecystectomy]. / Klostridiová sepse a plynatá snet' brisní steny po cholecystektomii.

Clostridial sepsis is a rare complication after intraabdominal operations, mostly fatal. According to our knowledge only two papers describing clostridial sepsis as postoperative complication in 4 patients were published in the Czech literature, only one of them survived. Authors present a case report of patient operated on for cholecystolithiasis and obstructive icterus where within 48 hours after cholecystectomy the clostridial sepsis and gas gangrene of the abdominal wall developed and that were successfuly managed.

Testing intestinal permeability in rats with burns and administration of early enteral nutrition.

Damaged intestinal mucosa in patients with extensive burns is one of the causes of the development of SIRS and MOFS. No unequivocal method has been established so far for assessment of the extent of damage of the intestinal mucosa. In the presented work the authors focus their attention on assessment of intestinal permeability in rats with burns. As their experimental method they used the lactulose-mannitol test (LAMA test). The animals were subjected to a deep burn with an extent of 20% body surface (TBSA). Then the LAMA test was performed 24, 48 and 72 hours after the burn. The rats were divided into groups: the first with a burn without enteral nutrition, the second with a burn and polymeric enteral nutrition and the last with oligomeric enteral nutrition. From the conclusions it is evident that a burn extending over 20% TBSA causes in the laboratory rat to experience impaired intestinal permeability. The work did not prove a significant difference between groups with and without enteral nutrition. Due to its simplicity speed, repeatability and high yield the LAMA test is a method which can be used in patients with burns in departments for the treatment of burns.

[Pregnancy in diabetes insipidus--a case report with review of the literature]. / Schwangerschaft bei Diabetes Insipidus--ein Fallbericht mit Literaturübersicht.

A 32 year old I P II G with preexisting diabetes insipidus was treated with 1-(3-mercaptopropionic acid)-8-d-arginine vasopressin (DDAVP) during pregnancy. An otherwise normal pregnancy was marked only with an excessive weight increase. A healthy girl was delivered by secondary cesarean section at term. Postoperative the mother developed a water intoxication accompanying oxytocin-infusion. During nursing the diabetes insipidus improved significantly whereby DDAVP doses could be reduced to 20-10 percent. We suppose an overreaction to endogene oxytocin with an antidiuretic effect.