[Thoracoscopic thymectomy--initial experience]. / Torakoskopická tymektomie--iniciální zkusenosti.

Video-assisted thymectomy and its variations is not generally accepted approach in surgical treatment of myasthenia gravis yet. Authors present their initial experience with videothoracoscopic technique in surgery for thymic cysts and myasthenia gravis. Authors prefer left thoracoscopic approach which allows good view to the thymus in mediastinum and neck. Recent studies confirm generally known advantages of miniinvasive surgery and show no differences between open and thoracoscopic thymectomy in terms of treatment outcome of myasthenia gravis. Nevertheless, prospective randomized study comparing open and thoracoscopic thymectomy in myasthenia gravis is not known.

[Spontaneous pneumomediastinum]. / Spontáinní pneumomediastinum.

Spontaneous pneumomediastinum is a presence of free air in the mediastinum without previous injury and without previously known lung disease. Spontaneous pneumomediastinum is infrequent and little known by physicians. Authors present a case report of three young men with spontaneous pneumomediastinum. There was no evident causation in two cases. In one case there was previous excessive sport activity. Main presenting symptoms were chest and neck pain, odynophagia, dysphonia, vomiting, and neck subcutaneous emphysema. Esophageal perforation was ruled out. All patients recovered spontaneously. Spontaneous pneumomediastinum is the benign disease. Its main importace is in differential diagnosis concerning especially esophageal perforation.

[Comparison various types of artificial nutrition on postoperative complications after major surgery]. / Porovnání vlivu ruzných druhu umelé výzivy na pooperacní komplikace po velkých chirurgických výkonech.

BACKGROUND: The present rationale appears to prefer early postoperative enteral nutrition to total parenteral nutrition. But no clear conclusions exist for demonstrating the clinical benefit of early postoperative enteral nutrition in patients after the major surgical resections of upper gastrointestinal tract. AIM: To compare the clinical impact of various types of the artificial nutrition by comparison of the postoperative complications. METHODS: Prospective, randomized, controlled clinical trial. Sixty-two patients were analyzed. In the group I (21 patients) the total parenteral nutrition was received, in the group II (20 patients) the standard enteral nutrition was received, in the group III (21 patients) the enteral nutrition enriched with glutamin, arginin and omega-3 fatty acids was received. Both enteral feedings were given early. All three nutritional regiments were isocaloric and isoproteinaceus. RESULTS: The postoperative complications were in 31 patients overall (11, 11, 9 patients in the each group I, II, III). Three patients died in the group I, 2 patients in the group II, and 1 patient in the group III. There were no significance differences (p < 0,05) in postoperative complications, both infectious and non-infectious reasons. CONCLUSION: The study has shown no impact of various type of artificial nutrition on clinical outcome in patients after major resections of upper gastrointestinal tract. There was no significant difference in infectious complications in the groups with enteral feeding. The combination of enteral and parenteral nutrition appears as optimum after major surgery of the upper gastrointestinal tract. It is necessary to realize more extensive studies of homogenous patients to find out the benefit of various types of arteficial nutrition in postoperative period.