[Ten years of endovenous ablation - achievements, failures and future]. / Deset let endovenózní ablace varixu, úspechy, neúspechy a budoucnost.

Endovenous ablation of varicose veins is a very frequent treatment method which has more or less replaced the classic stripping method. It has its limitations, advantages as well as disadvantages. The authors present a summarizing article and their own experience with these methods. Histology examinations performed prove differences in the reaction of the endothelium to the individual types of endovenous therapy. Causes of varicose veins treatment failures are discussed.

The anatomical relationship between the saphenous nerve and the great saphenous vein.

OBJECTIVE: Damage to the saphenous nerve (SN) has been a known complication during varicose vein surgeries. We tested whether a better knowledge of the anatomy of the SN and the great saphenous vein (GSV) can prevent such damage. METHODS: We conducted a morphological and histological examination on 86 limbs from 43 cadavers in order to analyse the anatomical interrelation between the SN and the GSV in the lower leg and we also measured the distance between the nerve and the vein in a sample of 42 sections from three parts of the lower leg. RESULTS: The anatomical relationship between the SN and the GSV is varied and the two structures run close to each other so a better knowledge of their anatomy in itself proved insufficient in preventing damage to the SN. CONCLUSION: However, in the case of endovenous laser therapy and radiofrequency ablation tumescent anaesthesia decreases the risk of damage to the SN.

[Buried bumper syndrome (BBS) as a complication of percutaneous endoscopic gastrostomy]. / Buried bumper syndrom (BBS) jako komplikace perkutánní endoskopické gastrostomie.

"Buried bumper syndrome" is a less frequent but potentially serious complication of percutaneous endoscopic gastrostomy. We present case reports of two patients in whom buried bumper syndrome was diagnosed by means of X-ray examination and endoscopic examination. In both cases the original gastrostomy was surgically removed and classical gastrostomy was performed.

[Rare tumors of the gallbladder and bile ducts. A case review]. / Vzácné tumory zlucníku a zlucových cest. Kazuistika.

The authors deal with the problem of benigh tumours of the bile duct which might occur as a very suprising intraoperative finding instead of preoperatively diagnosed "gallstones". This situation can happen because of possible mistakes that might accompany today's modern practical investigative techniques. The presented report is an example of the pre-operatirely assumed choledocholithiasis which was not confirmed during the operation. Instead a rare bile duct tumour was found.

[Neurogenous cervical tumors]. / Neurogenní tumory krku.

The authors describe a case of the patient with collapse condition where there were some investigations made which excluded any internal cause. There was a neck infiltration found out during the post-examination, the lymfadenopatia was set down as the pre-diagnosis. After the preparation and the extirpation of the resistance the schwannom was approved via the histological examination.

Laser-tissue interaction in endovenous laser treatment.

The authors present the results of recorded changes in the endothelium in rabbit's veins following photocoagulation by laser diode. This study concentrates mainly on the detailed description of individual changes in the rabbit's venous system in the area of pelvis following laser therapy. The aim of our experiments was to reach the obliteration of rabbits' lateral saphenous vein using 980 nm laser diode with 200 micron fibre. The intensity of discharge was 3, 5, 6 and 7 watts. We examined the relationship between changes and the amount of joules that affect the endothelium of the rabbit's veins. The operation was conducted under general anaesthesia. All animals survived treatment and were returned to breeders. Within the time span of one, three, six and eight weeks the laser treated veins were removed. They were fixed in formaldehyde and sent for microscopic examination. We were interested in how long it will take for fibrous changes to occur in the endothelium of the vein and thus also the subsequent occlusion of the vein depending on the amount of joules applied per one centimetre of the vein (Tab. 1, Fig. 4, Ref 6).

[Analysis of surgical procedures on the vena saphena magna in the Czech Republic and an effect of Detralex during its stripping]. / Analýza operacních výkonu na vena saphena magna v Ceské republice a efekt Detralexu pri jejím strippingu.

The aim of this clinical study was to compare the degree of postoperative pain (VAS--10 cm, quality of life questionnaire CIVIQ and patient diary) between two groups of patients: patients treated with Detralex 14 days before and 14 days after the stripping of greater saphenous vein (GSV) and patients not treated with Detralex. In addition, the two groups were also compared for the incidence of symptoms associated with chronic venous insufficiency (CVI) (using the VAS scale: edema, tired and heavy legs, cramps, itching sensation), size of hematoma, use of analgesics and overall efficacy of the treatment. Clinical study included 181 patients from 15 medical centers throughout the Czech Republic. High ligation and partial stripping of greater saphenous vein on one lower extremity was performed in all patients (short stripping from groin to knee). Patients were randomly assigned in two groups: patients treated with Detralex (92) and patients not treated with Detralex (89). Patients in the first group were treated with Detralex for the period of 1 month. Degree of pain and patient's health condition were evaluated by the physician during D-14 (14 days prior to the surgery), D7 and D14 (7 and 14 days after the surgery) visits using the 10-cm visual analog scale VAS. The results indicate that Detralex reduced the intensity of postoperative pain, which resulted in decreased consumption of analgesics. Hematoma was smaller in patients already using Detralex 14 days prior to the scheduled stripping procedure. These patients also showed significant improvement of CVI symptoms and the quality of life of patients with CVI. High quality venoactive drugs administered 14 days prior to the surgery improve postoperative course in patients indicated for surgical treatment of varices.

Venous thrombosis in the surgical department.

Currently, there are no standardized guidelines aimed to the prevention of DVT. Thus we recommend the introduction of a standardized scoring system that would ensure the effective prevention of DVT. (Tab. 6, Ref. 5.).

[An unusual contraindication for vascular reconstruction--case report]. / Neobvyklá kontraindikace cévní rekonstrukce--kazuistika.

The authors report on an unusual cause of interruption of a planned vascular operation. The authors detected an anomalous biliary duct at the beginning of the vascular reconstruction operation. This duct was situated between the peritoneum and the abdominal fascia, and was unintentionally opened during the operation. Thus the laparotomy wound was contaminated by bile. To prevent contamination of the vascular prosthesis, which was planned for the reconstruction (bifurcation prosthesis), the operation had to be interrupted.

[Peritonism]. / Peritonismus.

The authors discuss clinic symptoms, reminding of acute abdomen, which called peritonism. Two patients admitted and treated at the 1st Department of Surgery are presented. These patients meet the criteria of the category of peritonism.