Posttraumatic hydrocephalus.

Posttraumatic hydrocephalus (PH) is a common complication of craniocerebral trauma. It is necessary to bear this entity in mind, especially when managing craniocerebral trauma patients, because if not detected in time, it can significantly affect morbidity and mortality. It needs to be distinguished from brain atrophy with axonal degeneration, a condition requiring an entirely different treatment approach. Key words: hydrocephalus - posttraumatic - VP shunt - brain CT - progression of neurological status.

Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study.

BACKGROUND: Prospective randomized data is currently lacking which compares endoscopically assisted surgery with open surgical techniques in the treatment of cubital tunnel syndrome (CUTS). The aim of this study is to compare patient outcome in both techniques. METHOD: This prospective study comprised of 45 patients who, between October 2014 and February 2017, were randomly assigned to undergo either endoscopic or open surgery (22 and 23 patients respectively) for decompression of the ulnar nerve. Patients were followed up at 3 and 12 months postoperation. McGowan classification was used to determine the severity of symptoms. Surgical outcome was evaluated by Bishop classification. Pain levels were monitored according to gender from 0 to 10 days postoperation. Other factors investigated were chronic scar pain, working status, operation duration, and patient satisfaction regarding postoperative scarring and the procedure itself. RESULTS: Both methods are equally effective in the treatment of CUTS (Bishop score excellent or good 90% vs 96%). Postoperative pain is significant particularly in the first few days following surgery, but with no significant difference depending on procedure. In the open group, postoperative pain was significantly higher in women than in men; pain did not differ between the sexes in the endoscopic group. The tendency to lower levels of pain among endoscopically operated women in comparison with women in the open group was not statistically notable. Patients who underwent open decompression experienced notably higher levels of postoperative chronic scar pain. Although working status and satisfaction with the surgical outcome were the same in both groups, satisfaction with scarring was higher in the endoscopy group. Operation time was significantly longer by endoscopy. CONCLUSIONS: Both studied methods produced equal satisfactory outcomes in the treatment of CUTS. Endoscopy has the potential to minimize chronic scar pain and improve scarring esthetics, at the expense of longer operating time. CLINICAL TRIAL REGISTRATION NUMBER: Supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNOs/2014, project number 20). Graphical abstract Median postoperative pain from 0 to 10 days by group.

[Rupture of focal nodular hyperplasia in the 37th week of pregnanacy - case report]. / Ruptura jater u pacientky s fokální nodulární hyperplazií ve 37. týdnu tehotenství - kazuistika.

OBJECTIVE: We describe a case of spontaneous hepatic rupture associated with undiagnosed focal nodular hyperplasia of a patient in the third trimester of pregnancy. Additionally, we provide a brief review of literature. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague. RESULTS: We report the case of a 29 year old patient with otherwise physiological pregnancy, who was hospitalized with pain in left hypochondrium. The patient experienced painful respiration, increasing in intensity in supine position. The possibility of lung embolism was considered and ruled out. Based on a suspected haemoperitoneum, caesarean section was performed. During the inspection of peritoneal cavity a ruptured tumor on the liver was identified. Histological examination showed focal nodular hyperplasia. CONCLUSION: Focal nodular hyperplasia is a benign liver lesion. Complications involving rupture or bleeding are very rare. 17 cases of hepatic rupture associated with focal nodular hyperplasia were described in published reports with only one case related to pregnancy. Our case emphasizes the importance of a close cooperation between a gynaecologist, radiologist and surgeon.

[Current status regarding surgical treatment of pancreatic cancer in the Czech Republic]. / Aktuální stav chirurgické lécby karcinomu pankreatu v Ceské republice.

INTRODUCTION: The aim is to map the current situation in the surgical treatment of pancreatic cancer in the Czech Republic. This information has been obtained from surgical treatment providers using a simple questionnaire and by identifying the so called high volume centres. The information has been collected in the interest of organizing and planning research projects in the field of pancreatic cancer treatment. METHOD: We addressed centres known to provide surgical treatment of pancreatic cancer. A simple questionnaire formulated one question about the total number of pancreatic resections, also separately for the diagnoses PDAC - C25, in the last two years (2014 and 2015). Other questions focused on the use of diagnostic methods, neoadjuvant therapy, preoperative assessment of risks, the possibility of rapid intraoperative histopathology examination, Leeds protocol, monitoring of morbidity and mortality including long-term results, and the method of postoperative follow-up and treatment. ÚZIS (Institute of Health Information and Statistics of the Czech Republic) was addressed with a request to analyze the frequency of reported total numbers for DPE, LPE, TPE and to do the same with respect to diagnosis C 25 for the last two years, available for the entire Czech Republic (2013, 2014). RESULTS: Altogether 19 institutions were identified by the preceding audit, which reported more than 10 pancreatic resections annually; these institutions were addressed with the questionnaire. Sixteen institutions responded to the questions, 13 of them completely. CONCLUSION: The majority of potentially radical surgeries for PDAC in the Czech Republic are carried out at 6 institutions. All of the institutions that participated in the survey collect data about morbidity and mortality and monitor their results. KEY WORDS: pancreas cancer outcomes surgery.

[Delayed gastric emptying after partial duodenopancreatectomy]. / Porucha evakuace zaludku po parciální duodenopankreatektomii.

INTRODUCTION: Delayed gastric emptying (DGE) is a relatively common complication in patients after partial duodenopancreatectomy (PDPE) and significantly contributes to their postoperative morbidity. There has only been a small amount of interest attributed to DGE in Czech literature. The aim of this article is to present and analyze our own experience with the occurrence of DGE after PDPE. MATERIALS AND METHODS: Retrospective analysis of prospectively collected data from 106 patients who underwent a PDPE at the Department of Surgery, University Hospital Motol and 2nd Medical Faculty, between 2001 and 2011. The data were statistically analyzed using the Chi-square test with statistical significance set at 5% of probability value (p < 0.05). RESULTS: During the reporting period, PDPE was performed in 106 patients with a pathological process in the pancreatic head. 4 patients died in the postoperative period (30-day mortality 3.8%). Major postoperative complications occurred in 31 patients (morbidity 29%), with clinically significant DGE (grade B and C) in almost half of them (16 patients). Along with the DGE, 4 patients suffered from other major complications (2 pancreatic anastomotic insufficiency, 1 bile fistula and 1 external pancreatic fistula). We did not prove a statistically significant difference in the incidence of DGE depending either on the type of resection or pancreatic anastomosis type. CONCLUSION: DGE contributes significantly to postoperative morbidity in patients after PDPE and is associated with other serious postoperative complications in a considerable number of cases.

[Transnasal endoscopic surgery approach in intraorbital tumors]. / Transnazální endoskopická chirurgie nádoru ocnice.

OBJECTIVES: To determine the role of transnasal endoscopic approach to orbital lesions. METHODS: Retrospective case series. RESULTS: Three patients underwent endoscopic diagnostic surgery for orbital lesions. In all three patients was successfully finded out the diagnosis, the orbita was decompressed. In two cases it resulted to visual recovery, in one case was determine a diagnosis of metastatic adenocarcinoma. In one case the tumor was removed totally. CONCLUSION: Using endoscopic approach to the orbit allowed good approach to the biopsy of orbital lesions, allowed decompression an in limited count of cases this access allowed a complete tumour removal. On the other hand, generally endoscopic approach is useful only for limited lesions (extraconal), usually it allowed only debunking, not the complete resection of orbital pathology.

[Cystic neoplasms of the pancreas]. / Cystické neoplazie slinivky brisní.

INTRODUCTION: Neoplastic changes represent an important part of cystic deposits in pancreas. It is morphologically non-homogenous group of neoplasms with different occurrence depending on sex and age, different localization and different biologic properties. The aim of the paper is to remind current knowledge of this topic and confront it with our own experience. MATERIAL AND METHODS: Together 13 patients with histologically proved cystic neoplasm of pancreas underwent surgery during the period of ten years from 1997 to 2007. They represent 6% of all patients operated for pancreatic tumor (213 patients). Women (9 patients) represented more than two thirds of all operated patients and deposits were more often localized in the head of pancreas (8). RESULTS: The most frequent operation was partial duodenopancreatectomy (7) and most frequently cystadenocarcinoma was identified histologically (5 times). Median survival of these patients is 54 months. Left sided resection, done in 5 cases, identified benign tumor in all patients; no recurrence was found in 2 years follow-up. CONCLUSION: Cystic neoplasms localized in the pancreatic head are more frequent in men than in women and predominantly malignant, on the contrary localization in the tail of pancreas is particularly in younger women linked with benign tumor. Prognosis after resection is markedly better in malignant processes even in comparison with ductal carcinoma.

[Long-term results after radical resections for pancreatic ductal adenocarcinoma--10 years experience]. / Dlouhodobé výsledky po radikálních resekcích pro duktální adenokarcinom pankreatu--desetileté zkusenosti.

INTRODUCTION: Pancreatic ductal adenocarcinoma is the most often and the most malignant type of pancreatic tumor. Effective systemic anticancer treatment is still missing and only radical resection can potentially lead to the life prolongation. TARGET: Long-term therapeutic outcomes evaluation in patients after radical resections due to the pancreatic ductal adenocarcinoma during the 10 years period. MATERIAL AND METHODS: Population included 42 patients after resection of pancreas due to ductal adenocarcinoma realized during the period from 1995 to 2005. Therapeutic outcomes including long-term survival in different stages of the disease were compared with data collected from patients with another histological type of periampullar tumor by statistical analysis. RESULTS: 48 radical resections of pancreas due to ductal adenocarcinoma were realized during the 10 years period. Six patients were excluded from the follow up. Median of survival with the minimum 6 months of follow up has reached 14 months and the maximal survival time was 35 months. None of the patients has survived 5 years. Five patients were alive after the end of follow up period. There were no statistical difference in survival when particular disease stages were compared (p = 0.3226). Survival of female patients in this population was statistically lower in comparison to male patients (p = 0.0222). Significantly lower survival of patients with ductal adenocarcinoma in comparison to the patients with other types of carcinoma in periampullar localization was demonstrated (p = 0.0234). CONCLUSION: Achieved results proved that pancreatic carcinoma is solid tumor with the worst long-term prognosis. Long-term survival in this population did not exceed 35 months and was independent on per-operative staging. Long-term prognosis of ductale adenocarcinoma is significantly worse in comparison to other types of carcinoma in periampullar localization.

Strictures of the terminal bile duct--who profits from the surgery?

BACKGROUND: Elucidation of the etiology of terminal bile duct strictures is oftentimes challenging. In choosing the optimal treatment method, a multidisciplinary approach is necessary. AIMS AND METHODS: To demonstrate the advantages and indications of surgical management, 153 patients with terminal bile duct strictures were retrospectively analysed. All patients had been treated during a period of eight years (1st January 1995 - 31st December 2002) in same department. The principal datas studied were surgical morbidity, thirty-days' mortality rates and recurrence of jaundice. RESULTS: During a period of eight years, 153 patients (100%) underwent laparotomy. Radical surgery (duodenopancreatectomy) was performed in 79 patients (51.6%), while 74 others (48.4%) benefited from bypass procedures. Postoperative morbidity reached 13.1%; nine patients (5.9%) died within the thirty days of surgery. Recurrence of jaundice was observed in three patients (1.9%). CONCLUSION: Surgical management of terminal bile duct strictures is indicated in most patients with benign strictures, strictures of unknown origin and with malignant strictures, where the patients are in a reasonably satisfactory clinical condition. The surgical approach provides the potential advantage to obtain a definite histological diagnosiscare and to remove the tumour in many patients. Patients with non resectable tumours could benefit from bypass procedures ensuring long-term and effective drainage of the bile.

[Carcinoma of the pancreatic head and periampular carcinomas. 10-year results of their resection management]. / Karcinom hlavy pankreatu a periampulární karcinomy. Výsledky resekcní lécby za 10 let.

INTRODUCTION: Parcial duodenopancreatectomy (DPE) remains the principal treatment method of carcinomas located in the region of the pancreatic head. Although several surgical clinics use this method, assessment of, mainly the long-term, treatment results is virtually absent in our literature. AIM: Presentation of early and late results of the procedure collected in a clinic, managing the procedures with "medium frequency". The study is aimed at patients with histologically confirmed carcinomas of the pancreatic head. MATERIAL AND METHODS: Prospective data from a group of patients who had undergone the DPE during the 10-year study in the Surgical Clinic of the IInd Medical Faculty of the Charles University in Prague-Motol, have been collected. RESULTS: From January 1995 to the end of 2004, 121 DPEs were completed, the 30-day mortality rate was 4.9% and the morbidity rate reached 17.5%. The long-term results were assessed in 71 cancer patients - the median survival rate was 18 months following the procedure (1-121 months), depending on the tumor type. CONCLUSIONS: The collected results are similar to those presented by foreign clinics (but conducted with lower frequencies here) and fall within a European better average.

[Massive hemorrhage from a pancreatic pseudocyst into the duodenum]. / Masivní krvácení z pseudocysty pankreatu do duodena.

Pancreatic pseudocyst or pseudoaneurysm bleeding related to chronic pancreatitis is associated with high mortality. Diagnostics includes angiography and contrast CT; therapy is based mainly on percutaneous transvascular embolisation (PTE) and surgery. Mortality burden related to conservative approach is up to 90%. Case report describes massive pancreas pseudocyst bleeding from erosion-affected arteria gastroduodenalis in 44-years-old patient with chronic pancreatitis. Spontaneous pseudocyst perforation into the duodenum caused hemorrhagic shock with necessity of urgent surgery. Identification of bleeding vessel was enabled thanks to longitudinal gastroduodenotomy and pseudocyst dissection through duodenum wall. Article reminds some diagnostics and therapeutics issues related to chronic pancreatitis complications with bleeding as well as information published in recent literature.

[Stenoses of the terminal choledochus--surgical treatment]. / Stenózy terminálního choledochu--chirurgické lécení.

INTRODUCTION: Obstructive jaundice caused by stenosis of the terminal choledochus remains even nowadays a serious differential diagnostic and therapeutic problem. OBJECTIVE: The objective is to draw attention to possible contemporary treatment and its indications. MATERIAL AND METHODS: The authors evaluated retrospectively the results achieved by surgical treatment in 145 patients operated during the last 8 years on account of benign or malignant obstruction of the terminal choledochus. RESULTS: Within 30 days after surgery 9 patients (6%) died. A relapse of the obstructive jaundice occurred in three instances (2%). The morbidity amounted to a total of 14% and is comparable with data in the contemporary literature. CONCLUSIONS: The presented results support the inclusion of surgical treatment as the method of first choice in patients with stenosis of the terminal choledochus of uncertain biological nature. For surgery also patients are indicated with obstruction of malignant origin who cannot be treated radically (M1), provided they are in a satisfactory general condition (ASA I-III). Surgical therapy is suitable also for treatment of the majority of patients with a benign stenosis or stricture of the terminal choledochus.

[Surgical approaches to treatment of chronic pancreatitis]. / Chirurgické prístupy v terapii chronické pankreatitidy.

In the treatment of pancreatitis in recent decades various surgical methods are used. Essentially we can divide them into resection and drainage methods. In the submitted paper the authors review possible surgical treatment of chronic pancreatitis and indications of optimal surgical methods in different forms of chronic pancreatitis. The application of these surgical procedures is demonstrated on a group of patients operated by the authors in 1985-2001. The authors discuss the problem of indication of patients for surgical treatment and selection of the optimal surgical methods for the treatment of chronic pancreatitis.

[Benign tumors of the pancreas]. / Benigní nádory pankreatu.

The contemporary incidence of the tumours of the pancreas is approximately 3.5% in the Czech Republic. Benign tumours represent only about 2% of them. We have found 7 such patients (2.3%) in our population of 303 patients operated for pancreatic tumours. This paper summarizes our experience with the diagnostics and surgical treatment of these patients.

[Complications of esophageal stents used in benign esophageal stenoses]. / Komplikace jícnových stentu uzitých u benigních stenóz jícnu.

Oesophageal stents are used in the treatment of stenosis of the oesophagus in the last 10 years. The application of the stent in benign stenosis should be exceptional because it is associated with high morbidity and mortality. Two cases with severe complications treated by operation are demonstrated. Types of stents for the treatment of the oesophageal stenosis are presented.