Investigation of association between genetic polymorphisms of MMP2, MMP8, MMP9 and TIMP2 and development of varicose veins in the Slovak Population - pilot study.

Matrix metalloproteinases (MMPs) are a family of zinc-dependent metalloendopeptidases that degrades extracellular matrix (ECM) components. MMPs are associated with venous wall remodelling, proliferation, migration, phenotypic and functional transformation of vascular smooth muscle cells and ECM organization under the physiological and pathophysiological conditions. We investigated possible association of genetic promoter polymorphisms of MMP2 (rs243866), MMP8 (rs11225395), MMP9 (rs3918242) and TIMP2 (rs8179090) to varicose veins development in the Slovak population. Genomic DNA from 276 Slovak individuals (138 cases, 138 controls) was genotyped for selected SNPs (rs243866, rs11225395, rs3918242 and rs8179090) using the PCR-RFLP analysis. The data were analysed by chi-squared (chi2) test, logistic regression, and Mann-Whitney test. The risk of varicose veins development was evaluated in dominant, codominant and recessive genetic models. The statistical evaluation of selected polymorphisms in patients in all three genetic models has not shown a significant risk of varicose veins development. Our study has not shown the association between selected polymorphisms and increased risk of varicose veins development in Slovak population. More evidence with broaden sample size is needed.

[Review of revascularization and arterial reconstructive procedures in arteriosclerosis performed at the Hospital in Lucenec]. / Prehl'ad revaskularizacných a rekonstrukcných arteriálnych výkonov pre artériosklerózu v NsP v Lucenci.

The authors present a review of revascularisation and reconstruction operations for arteriosclerosis in a group of 2341 patients (1754 (75%) operations). Direct reconstruction operations were made 825 times (47%), indirect operations--sympathectomy 598 times (34.1%) and endovascular intervention 331 times (18.9%). Intervention vascular radiology significantly changes the indication, the strategy and the tactics of surgical treatment of arteriosclerosis and its complications.

[Transhiatal esophagectomy in esophageal carcinoma and subsequent lung carcinoma 6 years later]. / Transhiatálna ezofagektómia pre karcinóm pazeráka a následný karcinóm pl'úc po 6 rokoch.

The author describes an interesting case primary oesophageal carcinoma. Well differentiated spinocellular carcinoma of the middle third of the oesophagus (T1 N0 MX stage) was diagnosed in a 42-year-old male. He underwent transhiatal oesophagectomy without thoracotomy with a survival period of over 6 year with no relapse. During the last 2 months he developed serious psychiatric and neurological symptoms and neurosurgical craniotomy was performed. The operation presented a metastases of alveolar lung carcinoma in the cerebrum. The primary source was not localised but autopsy revealed a small carcinoma of the left lung with metastases in the cerebellum and basal brain structures causing death. There were no signs of relapse of oesophageal carcinoma during the period after oesophagectomy verified by autopsy. Survival the period after operation was 6 years, 2 months and 2 weeks. Death was caused by subsequent lung carcinoma.

[Laparoscopic cholecystectomy versus classical cholecystectomy]. / Laparoskopická cholecystektómia versus klasická cholecystektómia.

The authors evaluated the results after classical (CCHE) and laparoscopic cholecystectomies (LCHE) in the period from March 16 1994 to June 30 1995. In this period they operated on 408 patients, out of which 208 were operated by the laparoscopic technique. There were no differences in postoperative morbidity. The mortality after laparoscopic surgery was 0% and the classical cholecystectomy reached the morbidity of 1.4%. Complicated patients were usually operated in the classical way. The time of hospitalisation after LCHE was 5.2 days and after CCHE 8.3 days. The results of LCHE were as follows: morbidity 10.5%, conversions 2.4%, reoperations 1.4%, and no leakage of the bile duct. We saved 40% of costs using LCHE. All these facts show that LCHE is advantageous, secure and well tolerated by patients. The patients prefer comfort after the operation, good cosmetic effect and a short hospital isation. CCHE did not lose its position, especially in complicated cases. (Tab. 5, Ref. 21.)

[Diverticulosis of the small intestine]. / Divertikulóza tenkého creva.

Small bowel diverticulosis is a rare disease of gastrointestinal tract that occurs most frequently in older patients. Since this disease can be asymptomatic, for a long time, the diagnosis rarely is made in the preoperative period. In 40% of cases there are acute or chronic complications, most frequently diverticulitis either with or without perforation, bowel obstruction and massive haemorrhage clinically manifested as bleeding from the lower part of the gastrointestinal tract. Abdominal pain, pseudoobstructive and malabsorption syndrome, expressive weight loss, steatorrhea and anemia are common chronic complications. In these cases a surgical treatment is necessary. Resection of the affected part of the small bowel is usually performed with end-to-end anastomosis. The authors present 4 cases with diverticulosis of the small bowel, two cases of which were manifested by diverticulitis and one of them was perforated. Pseudoobstructive syndrome, malabsorption and expressive weight loss were presented in other two cases. All four cases were dominated by severe abdominal pain. The surgical treatment was based upon radical resection of the small bowel with end-to-end anastomosis. (Fig. 4, Ref. 28.)

[Long-term results of revascularization surgery in oblitertive arteriosclerosis of the lower extremities]. / Dlhodobé výsledky revaskularizacných operácií pre obliterujúcu artériosklerózu dolných koncatín.

The authors evaluated their 15-year experience with revascularization operations for atherosclerosis obliterans (ASO) of the lower extremities. Over the period from 1975 to 1990, 1112 patients with ASO were admitted to their department and in 674 (60.6%) of them revascularization operation was performed. Direct revascularization surgery (bypass, desobliteration, angioplasty) was performed in 318 (47.2%) patients and indirect revascularization, sympathectomy in 326 (52.8%) patients. On evaluating the long-term results of aortobifemoral (AF2), femoropopliteal (FP) and femorocrural (FC) bypasses the following long-term patency was established: AF2 bypass--patency up to 2 years 92%, up to 5 years 90%, up to 10 years 76%, up to 15 years 75%; FP bypass--patency up to 2 years 90%, up to 5 years 84%, up to 10 years 62%, up to 15 years 46%; FC bypass--patency up to 2 years 63%, up to 5 years 50%, up to 10 years 25%. Complications developed in 10%, the mortality rate was 2.5% and 8% in FP and AF2, respectively. The obtained results are comparable with the data published in the literature. The authors achieved the best results in the suprainguinal region with AF2 bypasses on using mostly dacron prostheses and in the infrainguinal region FP bypasses on using the autologous great saphenous vein. (Tab. 3, Fig. 4, Ref. 17.)

[History of the surgical treatment of lower extremity varices]. / História chirurgickej liecby varixov dolných koncatín.

The authors presents a historical review of different surgical procedures and methods up to the present time. Surgical operations were at first focused on the superficial venous system. With advancing knowledge of the pathophysiology of the venous system the operations were gradually focused on the anastomosing and later also on the deep venous system.

[Traumatic rupture of the diaphragm]. / Traumatická ruptúra bránice.

Traumatic ruptures of the diaphragm occur most frequently at blunt injuries of the abdomen or thorax as a component of polytraumatism. At the acute stage they present a serious diagnostic problem since signs of polytrauma are predominant. The authors report 3 cases of traumatic rupture of the diaphragm with thoracotomy as the therapeutic approach. The first patient presented with severe polytraumatism and shock, rupture of the diaphragm, pericardium and lungs, along with serial fracture of the left ribs. The second patient was not in shock, he had suffered serial fracture of the left ribs and fracture of the pelvis. In both these cases of blunt injury to the thorax, careful examination of the patients resulted in early diagnosis and surgery. The third patient presented with open injury of the right side of the thorax, injured diaphragm and liver, serial fracture of the ribs, fractured sternum, and was in a state of deep shock. There was no mortality, all three patients recovered.

[The present state of surgical treatment of primary varices of the lower extremities]. / Súcasný stav chirurgickej liecby primárnych varixov dolných koncatín.

Surgical treatment holds the chief place in treatment of varicosities of the lower extremities. Surgical treatment of varicosities of the lower extremities should be pathogenetic and based on pathophysiological findings and disorders of the venous system. The main principle of contemporary surgical treatment of varicosities is elimination of chronic venous insufficiency, elimination of the pathological venous reflux between the deep and superficial venous system and elimination of the altered insufficient superficial and connecting venous system.

[Spontaneous rupture of a renal liposarcoma]. / Spontánna ruptúra liposarkómu oblicky.

The authors describe a rare case of spontaneous rupture of a renal liposarcoma which imitated the clinical picture of an acute abdomen. Urgent transabdominal left nephrectomy was performed. The entire lower half of the kidney was altered by the tumour and ruptured and there was an extensive perirenal and retroperitoneal haematoma. The histological finding confirmed the presence of a primary renal liposarcoma. This is the first case of spontaneous rupture of a liposarcoma of the kidneys described in our literature and the second case in the world literature. The patient survives now for eight years after operation and is in a good condition.

[Ruptured aneurysm of the abdominal aorta]. / Ruptúra aneuryzmy abdominálnej aorty.

Rupture of an aneurysm of the abdominal aorta is a severe abdominal emergency requiring urgent surgical intervention. The mortality rate is high since mostly elderly patients are involved with associated cardiovascular diseases and the presence of hemorrhagic shock. Prolonged hypotension may lead to renal and cardiovascular failure. The authors treated three cases of abdominal aortic aneurysm rupture under field conditions. One of the patients survived. Surgical procedure is indicated in each case of abdominal aortic rupture and the operation has to be performed early and with technical perfection. Neither advanced age nor other risk factors are contraindications to surgical intervention, since without operation the condition is inevitably fatal.

[Results of surgical treatment of varices of the lower extremities and the problem of recurrence]. / Výsledky chirurgickej liecby varixov dolných koncatín a otázky recidív.

The authors evaluated the results of surgical treatment of variostities of the lower extremities in 466 operations made in 436 patients after an average interval of 8.76 years after operation. Excellent results were recorded in 390 (83.69%) of the patients, improvement in 46 (9.87%) where in the majority a varicose complex was involved. On the whole it may be stated that favourable results with a very good functional and cosmetic effect were achieved in 93.56% of the patients. Relapses were recorded in 29 (6.23%) of the patients. A pathogenetic approach to surgical treatment and a radical operation are the basic prerequisites of satisfactory long-term results.

Spontaneous rupture of the kidney.

Two cases of spontaneous rupture of the kidney manifesting as acute abdomen are described. In both cases urgent transabdominal nephrectomy was carried out. The whole distal half of the kidney was tumorous and rupture, with extensive perirenal and retroperitoneal haemorrhage. Histological findings showed in the first instance renal liposarcoma, in the second instance an atypical lipoma of the kidney. The first patient survives 4 years, the second one year, after the operation both are in a good condition.