Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a 10-year experience.

INTRODUCTION: Bipolar radiofrequency-induced thermotherapy of advanced stage haemorrhoid disease has been used successfully at the Atlas Hospital in Zlin for ten years. The aim of this study was to evaluate long-term outcomes of the method. METHOD: RFITTH is bipolar radiofrequency-induced thermotherapy of haemorrhoidal diseases. High frequency electric current causes thermal coagulation of tissue. The procedure results in the elimination or significant reduction of prolapse and bleeding of hemorrhoids. RESULTS: 228 RFITTH procedures were performed in 217 patients at the Department of Surgery at the Atlas Hospital from 9/2007 to 1/2017. The group consisted of 134 men and 94 women, the average age was 51 years. 107 operations were performed in stage III and 121 in stage IV. Complications of the procedure involved postoperative fissure occurring in 20 patients (8.7 %). Thrombotic haemorrhoid developed in 6 patients (2.6 %), hyperspasm of the sphincters in 9 patients (3.9 %). Prolapse of the rectal mucosa was diagnosed in 4 patients (1.7 %). The disease recurred in 9 patients and 10 reoperations were performed (3.9 %). CONCLUSION: The method is a safe miniinvasive therapeutic option for advanced stage haemorrhoidal disease. Key words: RFITTH - haemorrhoidal disease - radiofrequency coagulation.

Radiofrequency-induced thermal therapy: results of a European multicentre study of resistive ablation of incompetent truncal varicose veins.

OBJECTIVES: To investigate the effectiveness of bipolar radiofrequency-induced thermal therapy (RFITT) in a multicentre non-randomized study. METHODS: Some 672 incompetent saphenous veins (85% great saphenous varicose vein, 15% short saphenous vein) in 462 patients (56.5% CEAP [clinical, aetiological, anatomical and pathological elements] class 3 or worse) were treated in eight European centres. Patients were assessed between 180 and 360 days postoperatively. Occlusion rates were determined by duplex ultrasound and compared with the power used for treatment, pull back rate and experience of the operating surgeon. RESULTS: Complete occlusion rates of 98.4% were achieved when treatments were performed by an experienced operator (more than 20 cases), when the maximum power setting on the RFITT generator was between 18 and 20 W and the applicator was withdrawn at a rate slower than 1.5 second/cm CONCLUSIONS: RFITT is efficacious, well tolerated by patients and has a low incidence of procedure-related post-operative complications.

Significance of the resection margin and risk factors for close or positive resection margin in patients undergoing breast-conserving surgery.

PURPOSE: While positive resection margin (RM) in women undergoing breast-conserving surgery (BCS) represents a clear indication for re-resection, there is no unequivocal recommendation regarding the extent of the clear RM. The aim of this study was to define the optimal extent of the RM and the risk factors for close or positive RM. METHODS: Patients scheduled for BCS had diagnosis confirmed before BCS (lumpectomy and quadrantectomy) by core biopsy. Sentinel lymph node biopsy followed BCS, and in case of positive findings axillary lymph node dissection followed. According to RM patients were categorized into 4 groups: 1) Patients with positive RM; 2) Clear RM < 2 mm; 3) Clear RM of 2-5 mm; and 4) RM > 5 mm. In the first 3 groups where re-resection was indicated, the presence of tumor cells in the re-resection specimen was determined. All patients were followed for local recurrence. RESULTS: 330 patients undergoing BCS were studied. Median follow up was 39.6 months (range 12-70). Lumpectomy was performed in 111 cases and quadrantectomy in 219. In 19 cases the final procedure was mastectomy due to the impossibility to achieve negative RM. In 78 cases re-resection followed the primary procedure due to close or positive RM. Clear RM was < 2 mm in 12 cases (15%), 2-5 mm in 56 (72%) and positive margin in 10 (13%). Positive re-resection specimen was detected in 31 cases (39.7%) (in 10 cases with positive RM after primary procedure, in 3 with negative margin < 2 mm and in 18 with 2-5 mm margin). The re-resection rate according to the location of the primary tumor was 77% (n=60) in the upper outer quadrant, 8% (n=6) in the lower outer quadrant, 6% (n=5) in the upper inner quadrant, 4% (n=3) in the lower inner quadrant, and 5% (n=4) in centrally located tumors. Multicentric/ multifocal tumor was diagnosed in 16 cases from which re-resection was indicated in 12 cases (75%). The number of re-resection according to tumor size was as follows: Tis 8 cases (30.7%), T1a none, T1b 14 (20.2%), T1c 34 (22.5%), T2 22 (28%). Re-resection was performed in 8 cases (31%) of ductal carcinoma in situ (DCIS), in 53 (22%) of ductal carcinoma, in 10 (37%) of lobular carcinoma, and in 7 (15%) of other histology. Five cases with local relapse were detected during follow up. CONCLUSION: The generally recommended clear RM of 1-5 mm is not sufficient because of the high number of positive specimens in the case of clear RM of 2-5 mm. The risk factors for close or positive RM are multicentric tumors and upper outer location of the primary tumor. Longer follow up will be needed to analyze local relapse rate according to RM status.

Sentinel node biopsy and neoadjuvant chemotherapy in the treatment of breast cancer.

PURPOSE: Sentinel lymph node biopsy (SLNB) has become a safe and accurate alternative to axillary lymph node dissection (ALND) in the surgical management of early breast cancer. The aim of this study was to determine the false negative rate of SLNB in patients with advanced breast cancer after neoadjuvant chemotherapy. METHODS: Forty-eight patients with 49 advanced breast cancers (one patient had bilateral disease) underwent neoadjuvant chemotherapy. All of them had SLNB, followed by standard level I/II ALND. SLNs were identified in 47 out of 49 tumors (detection rate 95.9%). RESULTS: Axillary nodal metastases were detected in 28 patients; SLNs were positive only in 14 patients. Four sentinel internal mammary nodes were removed in 4 patients, while one of them was positive with micrometastasis but axillary nodes were negative. False-negative results occurred in 2 (7.14%) patients. The results of our study confirm that SLNB in patients with advanced breast cancer is not significantly altered by the preoperative chemotherapy. Biopsy results were very similar to those without any neoadjuvant chemotherapy. CONCLUSION: ALND, known for its serious complications, can be replaced in some cases by SLNB.

[Lymphadenectomy in papillary thyroid cancer]. / Lymfadenektomie u papilárního karcinomu stítné zlázy.

INTRODUCTION: Papillary carcinoma is the most frequent malign tumour of the thyroid with rising incidence and metastasising in lymphatic veins. AIM: Diagnosing our patients and comparing the TNM stages to metastases found in lymphatic nodes. MATERIALS, METHODS: A retrospective study of 1,353 patients treated at our department between 2005 and 2008. RESULTS: 220 (16.3%) malign thyroid tumours have been found among 1,353 patients. Papillary carcinoma has been found in 180 cases, according to the TNM classification T1 mic 80x (44.4%), T1 58x (32.2%), T2 29x (16.1%), T3 8x (4.4%), T4 5x (2.8%). Multifocal incidence of papillary carcinoma has been observed in 42 patients (23.3%). Lymphadenectomy cervicocentral 18x, ipsicervicolateral 52x, contracervicolateral 1x. In total, 351 nodes were removed and 113 nodes had metastasis of papillary carcinoma. 2 patients had permanent paresis of the NLR (1.11%), nerve at risk 0.56%, transitory paresis 5.56%. CONCLUSION: The basic surgical treatment of the thyroid with papillary carcinoma is total thyroidectomy with cervicocentral lymphadenectomy. Ipsilateral lympadenectomy is indicated in the case of nodes found sonographically or tumour size T2.

[Locoregional recurrences after conservative surgery in early breast cancer]. / Lokoregionální recidivy po konzervativních výkonech u casného karcinomu prsu.

INTRODUCTION: Conservative surgery is considered as standard and alternative mastectomy in early stage breast cancer but number of local recurrence is higher. Aim of the study was to detect number of local recurrences after conservative surgery and to identify risk factors of local recurrence especially importance of resection margins. MATERIALS AND METHODS: Local recurrences were evaluated in patients after conservative surgery in early breast cancer at department of surgery Atlas hospital in Zlin between January 2004 and December 2008. T1-2 (only one T3) breast cancers were included in study. Diagnostic biopsy, lumpectomy and quadrantectomy were performed. In all patients axillary nodes were examined. Study guidelines required microscopic distance between resection line and tumor margin 5mm. Specimen after surgery was marked with black ink and from June 2006 with six colors ink. Radiotherapy and chemotherapy in additions to character of cancer followed surgery. RESULTS: Conservative surgery was performed in 330 patients. Mean age was 59 years. Follow-up was 39.6 month. Stage of the tumor: 0 19x, I 101x, IIA 163x, IIB 33x, IIIA 5, IIIB 0, IIIC 9. Lumpectomy was made 11 lx including 11 diagnostic biopsies and quadrantectomy 219x. Final conservative surgery was 331x and mastectomy 19x. Positive axillary nodes were 98x. In breast local recurrence appeared in 5 (3.6%) patients and one had regional recurrence without in breast recurrence. Distant metastases were 8x (2.4%) and ten patient died on primary disease without locoregional recurrence. CONCLUSION: Local recurrence appeared only 5x. Clear margins after breast conserving surgery are very important factor in prevention local recurrence. We recommend keeping 5 mm resection distance.

[Lymphatic mapping and biopsy of sentinel lymph nodes using combined methodology of in vivo application of Patentblue and radionuclide and ex vivo detection of metastatic affection of lymph nodes in colorectal carcinoma]. / Lymfatické mapování a biopsie sentinelových uzlin s pouzitím kombinované metodiky in vivo aplikace Patentblue a radiokoloidu a ex vivo detekce metastatického postizení lymfatických uzlin u kolorektálního karcinomu.

AIM OF THE STUDY: to check the new technique of lymphatic mapping and sentinel node biopsy by colorectal cancer surgery and to improve the lymphatic staging. METHOD: combined technique of lymphatic mapping via Patentblue and the radiocolloid in vivo applied in the rectal cancer surgery. The lymphatic-mapping technique with Patentblue in the colon cancer surgery. Radically or palliative tumour resection. Ex vivo detection of sentinel and non-sentinel lymph nodes in the specimen and their division into peritumoral, intermedial and central level. Serial sectioning examination and immunohistochemistry examination of detected lymph nodes. Statistic process. RESULTS: The methods were used for 107 patients. 1985 lymph nodes were examined, out of which 208 was with metastasis. Positive nodes were detected in 56 patients. In average there were 18.5 nodes per patient. 966 sentinel nodes were detected by colouring and radiocolloid marking. Sentinel nodes showed in 97 patients. In 10 patients, the method failed. In 44 patients, sentinel nodes were positive; 117 positive nodes in total. Skip metastases were detected in 6 percent of the patients. The upstaging of metastatic detection was in 3.7 percent. CONCLUSION: The technique of lymphatic mapping and sentinel node detection significantly increases the number of detected nodes and selects the marks the sentinel ones for further examination. The greatest amount of findings of nodal metastases is in the area closest to the tumour, therefore, when sentinel nodes are negative there, these can be examined more closely, by the method of serial insections or immunohistochemically, and staging of the disease can be made more accurate.

[Mapping of the superficial venous system on the lower extremities before and after the varicose veins surgery--summarizing paper of specific aspects during the duplex ultrasound imaging]. / Mapováiní povrchového zilního systému preed a po operaci varixu--literární souhrn specifických aspektu pri vysetrrování duplexní sonografií.

INTRODUCTION: Duplex ultrasound examination is a gold standard for the investigation of venous system of lower extremities. Its importance is often undervalued especially by surgeons before the intervention itself. The necessity of mapping of the superficial venous system on lower extremities became more important with the progress of endovenous techniques. GOAL: The goal of this summarizing paper is to focus on anatomical and topographical situations of significant anatomical structures during the ultrasound mapping of venous system on lower extremities. MATERIAL AND METHOD: There is described the course of great and small saphenus veins and their junction into the deep venous system including all the other tributaries in the described region there. The description of perforating veins is not left out in the paper, too. The emphasis is put on display of anatomical structures in B-mode of the ultrasound imaging and their relationship to the surrounding anatomical structures. CONCLUSION: It is necessary to keep the guidelines for investigation and consecutively the guidelines for intervention of venous system. This is the only way to eliminate the pathological reflux and insufficient inter- and epifastial veins. This is the chance how to avoid the early recurrence or progression of the disease.

[Local recurrences after conservative surgery in breast carcinoma]. / Lokální recidivy po konzervativních výkonech u karcinomu prsu.

BACKGROUND: Local recurrences in breast after conservative surgery are failure of primary therapy. The aim of the study was monitoring of local recurrences after conservative surgery and also relationships of local recurrences with disease free interval and survival. MATERIALS AND METHODS: Between 1.12.1998 and 30.06.2004, 143 patients with breast carcinoma were treated at Department of Surgery Atlas Hospital Zlin by conservative surgery. All patients received radiotherapy and boost in breast. Macroscopic free margins were 10 mm and reexcision were done in all patients with free margins less than 5 mm. Dose of the radiotherapy whole breast and cavity were 50 Gy, interval 5-6 weeks, daily 2Gy. Brachytherapy received all patients, combination of chemotherapy and hormonal therapy were 56x, only chemotherapy 31x, only hormonal therapy 31x and without adjuvant therapy 25x. RESULTS: Median follow-up was 32 month. Tumor size according to TNM classification: TIS 10, pT1a 1x, pTb 28x, pTc 55x, pT2 44x, pT3 5x. Stage: 0 1x, I 58x, IIA 56x, IIB 24x, IIIA 4x. Local recurrences in breast were 5x, (3.49%), distant metastases 6x, (4.1%) and 3x (2.09%) appeared distant metastases and death at breast carcinoma without local recurrence. Only in one patient local recurrence were followed by distant metastases and death. Interval from local recurrence and death was 12 month. Size of the original tumor with local recurrences was from 10mm to 45 mm. Interval from the time of initial treatment to local recurrences was from 12 to 42 month. Surgical treatment of local recurrences included mastectomy 4x and conservative surgery 1x. CONCLUSION: Number of local recurrences is in correspondence with international guideline and results of modern multimodal therapy.

[Sentinel lymph node biopsy in the breast carcinoma in clinical practice]. / Biopsie sentinelové uzliny u karcinomu prsu v klinické praxi.

AIM: In the management of early breast carcinoma, biopsy of sentinel lymph nodes has gradually replaced dissection of Level I and II axillary nodes. The aim of the study is to assess feasability and reliability of the method in our conditions. METHOD: From June 1998 to June 2007, a total of 458 sentinel node biopsies (SLNB) were performed. Originally, patent blue sentinel node mapping was used. Since 2000, a combination of radiocolloid application and a gamma- probe (detector), as well as the patent blue, has been used. Originally, SLNBs were followed by axillary dissections, however, in 2002, the procedure was waived in cases of negative sentinel nodes findings. RESULTS: Out of the total of 458 SLNB patients, 382 female patients were included in the study. SLNB, without concomitant axillary dissection, was performed in 170 subjects. In 70 subjects, the sentinel node was positive and they were indicated for axillary dissections. Positive non-sentinel nodes were detected 17 times. In total, 899 sentinel nodes were examined in the study group of 382 biopsies. The mean was 2.35. False negative nodes were recorded in three cases in female patients with SLNB and axillary dissection (4.6%). No local relapses in the axilla were recorded in negative sentinel node findings without subsequent axillary dissections. CONCLUSION: Sentinel node biopsy is a safe alternative to axillary dissection in the surgical management of early breast carcinoma.

[Benefits of intraoperative n. laryngeus recurrens neuromonitoring in thyroid surgery]. / Prínos peroperacního neuromonitoringu n. laryngeus recurrens v tyreoidální chirurgii.

INTRODUCTION: N. laryngeus reccurens injury is a serious complication in thyroid surgery. Nerve visualization is a procedure preventing its traumatization. The visualization with additional intraopertive neuromonitoring results in further reduction of the n. laryngeus reccurens injury rates. AIM: Verification of the intraoperative neuromonitoring effects on reduction of the n. laryngeus reccurens injury rates. MATERIAL, METHODOLOGY: 309 operated patients were included in the intraoperative neuromonitoring prospective study. A total of 295 patients were included in the study and intraoperative monitoring was performed per protocol. RESULTS: Out of the total of 295 subjects, 1 patient sufferred from permanent paresis, ie. 0.33%, nerves at risk 0.2%. 6 subjects sufferred from transient pareses, i.e. 2.03%, nerves at risk 1.2%, with a prevailing 8-week recovery period of the ORL findings. CONCLUSION: Intraoperative neuromonitoring in thyroid surgery is yet another option for reduction of the n. laryngeus reccurens intraoperative injury rates.

[Initial results of the bipolar RFITT coagulation in advanced stages of hemorrhoidal disorder study]. / První výsledky studie bipolární RFITT koagulace vyssích stadií hemoroidální nemoci.

AIM OF THE STUDY: The aim is to verify a new methodology of radiofrequency bipolar coagulation for treatment of hemorrhoids in practice. USED METHODS: The method of bipolar radiofrequency-induced thermotherapy of internal and external hemorrhoids using the Olympus Celon apparatus. Radiofrequency bipolar electrode was applied to perform coagulation of internal and external hemorrhoids under visual control and feedback. RF energy was applied, on average, at 12 sites above the dentate line to treat internal, stage III hemorroids. In stage IV hemorrhoids, based on the prolapse extent, it was applied to external hemorrhoids, as well. In four subjects, the method was used in combination with a standard Parks management to perform excision of perianal fibromas. RESULTS: From September 2007 to June 2008, the method was used in 18 patients with stage III and IV hemorrhoids. 15 patients underwent a per- protocol follow up on postoperative Day 7 and Day 21. Then, the first 5 subjects were checked in a 6- month interval and will be re-assessed in 12 months. The average duration of the procedure was 20 minutes and duration of hospitalization was 24 hours. Postoperative bleeding lasted for average 0-10 days. Major postoperative edema occured in 2 subjects. The average pain intensity (on 0-10 scale) was 1.5 on Day 7; 0.46 on Day 21. The postoperative complications included anal fissures with increased pain intensity in 2 subjects with a preoperative history of anal procedures. Transient edema of external hemorrhoids occured upon management of the stage IV hemorrhoidal disorder. CONCLUSION: Bipolar radiofrequency-induced thermotherapy of hemorrhoids is a new, semiinvasive method of the management of hemorrhoids. It is safe, with minimal rates of early postoperative complications. It is well-tolerated and evaluated by patients. Long-term results will be published further.

[Endoluminal radiofrequency ablation of varices]. / Endoluminální radiofrekvencní ablace krecových zil.

INTRODUCTION: Chronic venous insufficiency affects a considerable proportion of the population and, commonly, is not considered a disease, but a disease process presenting as a wide range of clinical findings. The commonest findings include stages C2 and C3 according to the CEAP classification. Recently, modern miniinvasive surgical methods have come forth. AIM: The aim is to present the authors intitial experience with endoluminal bipolar radiofrequency thermotherapy of varices (RFITT). MATERIAL, METHODOLOGY: 48 extremities operated in 35 subjects from January to June 2007. VSM (Vena saphaena magna) was operated in 47 cases and VSP (Vena saphaena parva) in a single case. Where terminal VSM valve insufficiency was detected, additional crossectomy was performed. In all subjects, the procedure was followed by mimiphlebectomy and foam sclerotherapy. RESULTS: Obliteration of the operated vein using RFITT immediately after the procedure rated 100%. Subsequent recanalization was performed in a single subject after Day 140. Complications included irritation of the saphenous nerve in three subjects, in one case following miniphlegectomy and in the other two cases following RFITT. In all the subjects, the clinical findings recovered spontaneously within 14 days. Duration of their hospitalization was 5-24 hours. CONCLUSION: RFITT is a safe and effective miniinvasive surgical technique in the varicose veins management. It can be considered another alternative to other miinvasive procedures, such as laser endoluminal photocoagulation or conventional procedures, including stripping.

[Cavernous haemangioma of the small intestine leading to haemoperitoneum]. / Kavernózní hemangiom tenkého streva jako prícna hemoperitonea.

The authors present a case-review of a cavernous haemangioma of the small intestine as a cause of haemoperitoneum in a young female. The authors discuss the patient's history, completed examinations and surgical management of the case including a detailed histological examination of the intestinal resecate with cavernous haemangioma. Discussion includes literature data of the published case-reviews.

[Crossectomy--the most important step in varices surgery]. / Crossectomia - nejdulezitejsí krok v operaci krecových zil.

The authors present ethiology and aethilogy-based surgical techniques of the disorder on a group of 3458 patients operated for varices of lower extremities. Crossectomy is flashed out as a key moment of the procedure in cases of sapheno-phemoral junction insufficiencies. The results are presented on two patient groups comparing relaps rates of the disorder following completion of partial selective and radical complete crossectomies. A subject of neovascularization and its relation to the procedure and relapses is discussed.

[Distribution of metastatic affection in colorectal carcinoma using lymphatic mapping and radiation-navigated biopsy of the sentinel lymph node]. / Distribuce metastatického postiienif u kolorektálního karcinomu s pouzitím metody lymfatického mapování a radiacne navigované biopsie sentinelové uzliny.

AIM: The aim is to define distribution of the lymphonode metastatic affection in colorectal carcinoma and to evaluate a new methodology of lymphatic mapping and the sentinel lymphonode detection during colorectal carcinoma procedures in practice. USED METHODS: A method of peroperative lymphatic mapping using a Patentblue method in vivo. Rectoscopic peritumoral application of a radiocoloid in a two-day or a single-day protocol, scintigraphy, peroperative quants of radioactivity detection using a gamma probe. Radical or paliative tumor resection. Detection of the sentinel and non-sentinel nodes on a preparation ex vivo, divided according to levels. The metastatic affection distribution is assessed in three levels, marked U1 - U3, a S1 - S3. Histopathological examination of the nodes on series sections and, event, immunohistochemistry. RESULTS: The methods were used in 66 patients. A total of 970 nodes have been examined, with an average of 14.6 nodes/ patient. The metastases quantity decreases with distance from the tumor. The peritumoral levels (U1a S1) record the highest rates of metastases. In our patient group, 92% of the metastases were recorded in the S1 level, 4% in the S2 level and 4 % in the S3 level. CONCLUSIONS: The highest rate of metastases was recorded in the levels, closest to the tumor, therefore, in case of negative findings of sentinel nodes in the S1 level, the nodes from this level may be closely examined (using the method of series sections and immunhistochemistry) and the staging be established more precisely.

[Lymphadenectomy in the early gastric carcinoma]. / Lymfadenektomie u casného karcinomu zaludku.

AIM: The method of extended lymphadenectomy in the early gastric carcinoma treatment remains controversial. The aim of this prospective study is to assess the above method feasibility with acceptable rates of complications, in our conditions. METHODOLOGY: From 2000 to 2003, 11 patients with early carcinomas of the stomach were treated using the method of extended lymphadenectomy. The study group included 7 males and 4 females. RESULTS: In 6 cases, the tumors were located in the distal, in 4 cases in the middle and once in the proximal third of the stomach. In a single case, the IIIA stadium was concerned, the other cases were rated lower. In total, 205 lymphonodes measuring 18.6 on average (median of 16) were examined. The total of 5 lymphonodes were malignant, all of them were found in one patient. The method of the sentinel lymphonode biopsy was applied once. A cardiopulmonary complication was reported once, a punction of the subphrenic absces was reported once, a primary disorder causing a death was reported once and the patient concerned exited after a 14-month-period of his follow-up. Once, a local relaps of the disorder was reported 43 months after the procedure. The follow-up median was 27 months. CONCLUSION: The method of extended lymphadenectomy can be conducted even in our conditions with acceptable rates of complications.

[Advances in lymphadenectomy in colorectal carcinoma--lymphatic mapping]. / Pokroky v lymfadenektomii u kolorektálního karcinomu--lymfatické mapování.

AIM: The aim of this study is to evaluate the lymphatic mapping method during the colorectal carcinoma surgery and to increase a number of the detected lymphonodes up to the level of the internationally recommended standards. METHODOLOGY: In the group collected in 2002 and 2003, the lymphatic mapping method was applied in cases of 32 patients suffering from the colorectal carcinoma, according to the protocol. RESULTS: In the group of 32 patients suffering from all stages of the colorectal carcinoma, a total number of 408 lymhonodes was examined, which is 12.75 lymphonodes per patient, on average. Out of this, in the rectal carcinoma cases--7.85 lymphonodes per patient were detected on average, and in the group of the colon tumors--13.72 lymphonodes per patient. CONCLUSIONS: The retrospective evaluation of the patients who underwent surgery for the colorectal carcinoma proved the method of the lymphatic mapping to increase the number of the detected lymphonodes from 6-8 up to nearly 13. Thus, the average number of the examined lymphonodes already complied with the international oncosurgical criteria. The lymphatic mapping technique proved to significantly increase the number of the examined lymphonodes and to improve the colorectal carcinoma patients staging.

[Surgical therapy of the ductal carcinoma in situ]. / Chirurgická terapie duktáilního karcinomu in situ.

AIM: Rates of the newly-detected DCIS reach up to 20% in developed countries. There is no unified therapeutic scheme to deal with the disorder. The aim of this work is to assess the author's own therapeutic results. METHODOLOGY: From 1999 until 2003, 11 female patients suffering from the DCIS were treated and 2 DCIS female patients were treated using microinvasion. The diagnosis was established 5x by the core-cut and 8x by the surgical excision. RESULTS: The size of the tumors varied from 0.5 cm to 6.0 cm. Conservative procedures were performed 11 times, a simple mastectomy once and a mastectomy with reconstruction once, as well. The sentinel lymphonodes were examined in all cases and once the examination was accompanied by the axilla dissection. The number of the sentinel lymphonodes was 29. All of the lymphonodes were negative. Seven female patients were given a complementary therapy. All female patients have had no local relapse in the breast and have had no signs of the disease process since. The average follow-up time is 13.5 months. CONCLUSION: The conservative procedures sufficiently provide treatment of early forms of the DCIS of the breast. The sentinel lymphonode biopsy is a patient- kind method, giving exact information on the status of the axillary lymphonodes and it is considered a suitable part of the DCIS therapy.

[Mini-invasive radiation-navigated parathyreoidectomy--MIRP]. / Miniinvazivní radiacne navigovaná paratyreoidektomie--MIRP.

AIM: The aim was to introduce a new surgical method and to verify its validity. METHODOLOGY: In 20 patients whose ultrasound findings correlated with the MIBI scintigraphic results, a radiation-navigated parathyreoidectomy using a C-Track was conducted, following a radionucleotide application. RESULTS: From 2001 to 2003, 20 patients with hyperparathyreosis were operated. In all cases, an altered parathyroid gland with increased activity was detected using radionavigation. After the surgery, the calcium and the parathormone blood levels decreased. CONCLUSION: The MIRP is a miniinvasive surgical method indicated for the use in cases when hyperparathyreosis is confirmed and the ultrasound findings correlate with the MIBI-scintigraphic findings.