[Stabilisation of the dislocated acromioclavicular joint and lateral fractures of the clavicle using a hook plate]. / Stabilizace luxace AC skloubení a zlomenin akromiálního konce klícku pomocí háckové dlahy.

INTRODUCTION: The aim of this study was to verify the hypothesis that the technique of stabilizing the acromioclavicular joint and lateral fractures of the clavicle using a clavicular hook plate can be considered a method of choice in the given types of injury. MATERIAL AND METHODS: The clinical part of the study included a total of 40 patients. The indication group was formed by patients with type III acromioclavicular joint dislocation, according to Tossy. As for lateral fractures of the clavicle, the patients of group II and types IIa, IIb according to revised Allman and Neers classification, underwent surgery. 40 patients with type III acromioclavicular luxation, operated on at the same clinic, were chosen as the control group; however, the technique of traction cerclage was used here. RESULTS: When evaluating our results, we recorded a lower occurrence of infectious complications in patients with a hook plate. No method failure or joint redislocation was observed in the hook plate group. There was no change in position even after the implant was removed. On the other hand, where traction cerclage was used, redislocation in the acromioclavicular joint occurred due to mechanical failure in 5 cases, in 15 cases mechanical implant failure was seen. As for patients with a hook plate, 11 cases showed irritation of the lower surface of the acromion. Statistical evaluation of parameters of the main set of patients was carried out in cooperation with the Institute of Biostatistics and Analyses of Masaryk University in Brno. CONCLUSION: Based on our results, the stabilisation of complete acromioclavicular separation and lateral end clavicle fractures using clavicle hook plate can be regarded as a suitable method for treating these lesions. Timely removal of the implant within 12 weeks of the intervention is needed to prevent irritation of the lower surface of the acromion.

Current multidisciplinary treatment of gastric cancer.

The aim of our study was to optimise current therapy of gastric tumours. The studied population consisted of 92 patients treated at the 1st Department of Surgery, St. Anne's Teaching Hospital, Brno, Czech Republic, and at the Department of Radiation Oncology of the same hospital during 1994-2000. We have proven that, nowadays, a radical surgical procedure still remains the best method used for the treatment of malignant illnesses of the stomach. Results from clinical studies show that preoperative chemotherapy is effective and that postponed surgical therapy has no impact on survival (Fig. 4, Ref. 21). Full Text (Free, PDF) www.bmj.sk.

Combination therapy of colorectal carcinoma.

The aim of the study was to optimise the present therapy for colorectal carcinoma according to the standard therapeutic protocol. At the Ist Department of Surgery of the LF MU St. Anna Hospital in Brno and at the Department of Radiation Oncology of the same hospital, 262 patients with colorectal carcinoma were treated in period 2000-2002. Neoadjuvant radiotherapy concomitant with chemotherapy was applied for 5-6 weeks. After this procedure, a 5-6-week break, the restaging and the surgical intervention have followed. A radical surgical operation was carried out in 74.1% cases. The survival of stage IV patients was worse compared to other stages, and the presence of organ metastases markedly impaired the prognosis. We have shown in our study, that radical surgery is still the best therapeutic method for colorectal tumors. Within the surgical technique, the use of a harmonic scalpel has proved beneficial, as it enables a bloodless operative field while ensuring the necessary radicality and preserving the nerve plexuses. Neoadjuvant chemo-radiotherapy is considered a method of choice in rectal tumors surgery; it shows better results than radiotherapy only. Its inclusion into standard protocols has been still hindered by the lacking evidence of effectiveness at the II or I level. The possibility of administering oral fluoropyrimidines makes these studies even more attractive (Fig. 6, Ref. 30).

Stage IIb, IIIb, and IVa carcinoma of the uterine cervix--results of treatment by radiotherapy in 649 patients.

During the period of January 1969 to December 1980, 649 patients have been treated by radical radiotherapy for Stage IIb, IIIb, and IVa carcinoma of the cervix uteri. This retrospective study was performed to assess therapeutical results in two groups of patients. Clinical staging and the methods of treatment were standard in both groups. Group I was treated by external irradiation of the pelvis minor with 60Co in combination with intracavitary radium administration. Group II patients were irradiated with a 42 MeV betatron according to the findings of lymphography, again in combination with radium brachytherapy. In Group I the 5-year survival rate was 59.2%, that in Group II was 66.7%. There was a statistically significant difference in the 5-year survival rate in Stage IIb patients of Group II (85.5%) against that in Group I (75.6%). The incidence of serious complications elicited by radiotherapy increased from 4.8% in Group I patients to 7.5% in Group II. Clinical stage, age at the time of diagnosis, findings of lymphography and tolerance to irradiation are prognostically important factors that influence the cure of the patients. On the basis of these findings, the possibilities of further therapeutic improvements are discussed.

Carcinoma cervicis uteri. Long-term follow-up therapeutic results.

The principle of the therapy of carcinoma cervicis uteri in the Research Institute of Clinical and Experimental Oncology in Brno is the combination of betatron megavoltage irradiation and cobalt 60 irradiation with intracavital radium irradiation. On the basis of many years' study concerning the therapy and therapeutic results of this tumor accurate directions of total therapy were elaborated. Carcinoma is diagnosed and classified precisely according to valid international directions. In addition to basic examination, limb lymphography was introduced giving the strategy of irradiation when lymphatic system is involved and in early stages of the disease. By preliminary evaluation of the obtained data a certain improvement of therapeutic results is proven. About 15% more patients are alive till 5 years without any signs of the disease than in precedent years. In spite of a high dose summation given by the extent of megavoltage irradiation the number of postirradiation reaction, nor early late, is increased to much. Complex therapy of this tumor is performed by a team of physicians composed of gynecologist, radiologist, rentgendiagnosticist, pathologist, and radiation physicist. By increasing the number of cured patients and their return and enclosure into further working process the savings in state budget are achieved. The effectiveness of the carcinoma cervicis uteri therapy is therefore dependent not only on earlier diagnosis and modern irradiation technique, but also on the cooperation of a team of physicians who plan, perform and follow the therapy.

Use of 42 MeV betatron bremsstrahlung irradiation in the therapy combined with radium in carcinoma of the cervix.

The article deals with the therapy of cancer of the cervix with external 42 MeV betatron bremsstrahlung irradiation in combination with intracavitary applicated radium. The described irradiation technique using special shielding blocks extends the dose distribution till to the region of paraaortic nodes in an extended field. The extended irradiation field is used on the basis of lymphographic examination. In the region of pelvis minor, sufficiently uniform dose distribution is attained with lethal tumor effect. The dose variability with betatron or cobalt external irradiation was also studied.

Does lymphography promote dissemination of tumorous disease?

In two groups of patients with malignant melanoma on the lower limb and with metastases in the inguinal lymph nodes the authors followed the time of appearance of lung metastases and the survival time. In one group lymphography of the extremity was performed, the other one served as a control. Tabulated time data were mutually evaluated between the two groups by the parametric T-test and with the aid of the nonparametric Me-test. No significant difference was found between the two groups, not even with 20% probability. Thus, lymphography is not likely to have an influence on deissemination of malignant melanoma.