[Vascularization of the lateral heel in relation to extensive skin incisions in osteosynthesis of calcaneal fractures]. / Vaskularizace laterální strany paty ve vztahu k extenzivnímu koznímu rezu k osteosyntéze zlomeniny kalkanea.

The aim of the study was to document soft tissue vascularization of the lateral heel on cadavers and, therefore, to indirectly demonstrate the importance to perform perfectly precise incisions, in order to prevent ischemic complications. Sections of 8 human lower limb cadavers were performed in cooperation with the Anatomical Institute of the MU Medical Faculty in Brno, according to current common standards for anatomical preparations. In successive steps, cutaneous and subcutanous covers of the lateral ankle, malleolar and heel regions were preparated. Final branches of the individual arteries were followed and the authors aimed to demonstrate their vascular arcade consisting of anastomosis of the lateral calcaneal artery--LCA (a branch of a. peronea)--which is a clinical term for rami calcaneares laterales, ventrolateral tarsal arteries--LTA (a branch of a. dorsalis pedis) and lateral malleolar artery branching off medially--LMA (a branch of a. tibialis ant.). The course of the arteries and their location is related to a reference point--a lateral tip of the lateral ankle. The investigators found out that all three arteries, as well as the arterial arch, had standard courses. The course of the arch defines the outline of the lateral extensive incision during osteosynthesis in calcaneal fractures, which lies fairly close to the lateral outline of this vascular arcade. Incorrect performance of the incision results, invitably, in serious ischemic complications. Open reduction and internal fixation of intraarticular calcaneal fractures has become a standard surgical method. Correct indication, good timing and saving open reduction, internal fixation using arthroscopy and early mobilization are the prerequisites to prevent further postoperative complications and to achieve complete healing of the fracture. Considering the demandingness of these fractures treatment and their rare incidence, their management should be centred in specialized traumatological clinics.

[Fixation of the prolapse vagina to the sacrotuberal ligament]. / Fixace prolapsu vaginy k lig. sacrotuberale.

OBJECTIVE: To present personal experience in the fixation of the vaginal stump to the sacrotuberal ligament. METHOD: Description of the surgery including modified surgical instruments. RESULTS: 32 surgical procedures were performed during a 4-year period. Two relapses were recorded. DISCUSSION: Various surgical procedures including abdominal approach to the fixation are mentioned, complications and prevention of relapses are discussed. CONCLUSION: The method is appropriate for sexually active patients. It preserves the length, axis and volume of the vagina.

Structure of the coronary arteries during the prenatal period in man.

The coronary arteries of human foetuses from the 4th to 10th month of gestation were examined in the light and the electron microscope. Marked changes were demonstrated in the course of prenatal development, particularly in the media and adventitia (thickening, an increase in the number of collagen fibrils). In regions of coronary artery branching, here and there we found intimal pads or diffuse thickening of the intima, which were separated from the media by a mostly thin or discontinuous inner elastic membrane with an accumulation of smooth muscle cells and a smaller quantity of elastic fibrils. The intimal thickenings, which occurred mostly in the region of bifurcation of the left coronary artery and at sites where branches sprang from the r. ventricularis anterior of the left coronary artery, were already discernible at the beginning of the period in question (i.e. in the 4th month). In some cases, oedematous changes were found in the pads, where they were characterized by dilatation of the elastic membranes and smooth muscle cells by proliferating structureless matter.

[The role of calcium in the effect of stress hormones]. / Uloha kalcia v mechanismu pusobení stressogenních hormonu.

During administration of stressogenic substances an increased shift of calcium ions into smooth muscles of the aorta and heart muscle takes place. Administration of a high-fat diet supplemented by cholesterol enhances this process. The calcium blood level does not change significantly during this procedure. The amount of calcium in bones declined after administration of stresso-genic hormones although the values were not statistically significant. It may be assumed that calcium ions shifted into the cardiovascular system originate from osseous tissue. Calcium accumulation during repeated or prolonged stress contributes towards the interpretation of the mechanism of action of stressogenic substances on the cardiovascular system. The increased supply of calcium ions into the heart muscle and coronary arteries may influence also the development of ischaemic heart disease and cardiomyopathies. The increased amount of calcium ions in smooth muscles of the aorta after prolonged administration of stressogenic substances indicates a higher content of calcium ions also in smooth muscle cells of arterioles which leads to a higher peripheral vascular tension. Stress alone does not lead to the development of atherosclerosis but creates favourable conditions for its development.

Scanning electron microscopic observation of intimal surface of normal and atherosclerotic arteries.

A scanning electron microscopic study was made of the intimal surfaces of human normal and atherosclerotic thoracic aorta and rabbit normal thoracic aorta, and the thoracic aorta of rabbits with cholesterol atherosclerosis with consequential calciphylaxis. In normal human and rabbit arteries the intimal surface is smooth, the endothelial cells are clustered into regular mounds. In arteries affected by atherosclerosis at some sites the regular linear arrangement of endothelial cells disappears and the intimal surface is characterized by irregular protrusions of formations in the shape of scales or plates.