Incarcerated lumbar hernia in the Petit´s triangle as a cause of large bowel obstruction.

Petits hernia is a rare defect in the abdominal wall located in the lower lumbar triangle. The herniation in the Petiti trigonum is complicated by bowel incarceration in about 9% of cases, most often of the large bowel. We present a case report of a 73-year-old patient with clinical manifestations of large bowel obstrution. The patient was admitted and indicated for urgent surgery. Incarcerated left lumbar hernia in the Petits triangle with herniation of sigmoid colon that showed no signs of ischemia was found. Reposition of the sigmoid colon and hernioplasty of the lumbar hernia was performed. There were no postoperative complications and the patient was discharged on postoperative day 9. The presented case report shows that the lumbar hernia (Petit) may result in bowel obstruction and thus may cause a life-threatening condition that requires urgent surgical intervention.

Inflammatory pseudotumour of urinary bladder - a rare cause of massive macroscopic haematuria.

PURPOSE: Authors analyzed their experience with urinary bladder tumours. This article discusses clinical and histopathological diagnostics and treatment procedures, and follow up of patients with rare benign urinary bladder tumours. METHODS: 406 patients with bladder tumours were treated in our department between January 2000 and December 2008. 322 patients had superficial tumours and 84 had primary invasive tumours. All patients who underwent transurethral resections of these tumours were operated under general or spinal anaesthesia. The resected specimens were histologically examined in the department of Pathology. RESULTS: 399 of the 406 patients had urothelial bladder cancer, 7 patients had a histologically uncommon type of bladder tumour, one female was diagnosed with sarcomatoid bladder cancer, one patient had a histologically confirmed feochromocytoma of the urinary bladder. Two males had epidermoid carcinoma. One female had a histologically described uncommon benign pseudoneoplastic lesion, chararacteristic for endosalpingiosis. Another two patients were diagnosed with inflammatory myofibroblastic tumour of the urinary bladder. Both patients presented with gross macroscopic haematuria. Authors performed complete transurethral tumour resections, which required several sessions and the deliberation of a blocked ureter through nephrostomy in one case. CONCLUSION: More than 98 % of all treated patients had urothelial bladder cancer in different stages and grades. Two patients had rare benign inflammatory proliferation of the bladder wall which formed large tumorous bleeding masses obstructing the ureter in one case. These types of bladder tumour could be treated conservatively with meticulous long term follow up similarly to patients with bladder cancer (Tab. 1, Fig. 4, Ref. 15). .

Malignant tumours of colon and rectum from the blood clotting view.

OBJECTIVES: The relationship between malignant tumours and blood coagulation disorders is generally well known. BACKGROUND: The authors notice blood coagulation in patients with colorectal cancer and evaluate prothrombotic markers. METHODS: The authors analyzed a group of 137 patients with malignant tumour of colon and rectum, drew attention to the relationship between level of D-dimer, PAI-1, F 1+2, Protein C and the progress of malignant tumour, its localization, clinical stage, histopathology type, method of surgery considering the stapling use. RESULTS: Very aggressive and advance tumours have high level of D dimer, plasminogen activator inhibitor I (PAI-1). Prothrombotic fragments 1+2 were significantly higher by anastomotic dehiscence. Protein C level was lower by age from sixty to seventy and in advanced clinical stage. CONCLUSION: Pre-operative surveys of D dimer, PAI-1, prothrombotic fragments and Protein C give informations abaout risk of thrombosis, far gone of malignant diseases, they clinical stage and histological type. D dimer and PAI-1 have the most clinical value (Fig. 5, Ref. 11).

[Benefits of sentinel lymph node examination in early breast carcinoma]. / Prínos vysetrenia sentinelovej uzliny pri vcasnom karcinóme prsníka.

INTRODUCTION: Sentinel lymph node biopsy improves staging of disease, saves the axilla, and significantly reduces the risk of complications. MATERIAL AND METHODS: The authors compare the two groups of surgical treatment of breast cancer patients--after conventional surgery with axillary exenteration with a group of patients with sentinel node biopsy using gamma probe with limited power. RESULTS: In group of 42 patients after axillary exenteration authors observed: hematoma in 2 patients, 1 postoperative bleeding that need for surgical revision, 2 patients had paresthesia and 1 patient had lymphedema, which represents 11.5% of complications. In the group of 54 patients after limited exercise with the use of sentinel biopsy and gamma probe authors reported only one complication--an infected surgical wound seroma in the axilla (1.8% complications). CONCLUSION: Examination of sentinel node biopsy in combination with exact measurement of gamma probe allows friendly operating performance in the axilla and significantly reduces the incidence of postoperative complications.

[Coagulation disorder and its uncommon complication in a patient with obturating sigmoid carcinoma]. / Hypokoagulacný stav a jeho neobvyklá komplikácia u pacienta s obturujúcim karcinómom c. sigmoideum.

AIM: The authors point to the risk of hypocoagulation by patients with colorectal carcinoma, who use warfarin. MATERIAL AND METHODS: 185 patients with colorectal cancer were examined for plattellets, prothrombin time and D-dimer. RESULTS: Only 64 patients (35%) had haemocoagulation in the standard, 114 patients (61%) were hypercoagulable and only 7 patients (3.7%) were hypocoagulable. The authors present an interesting case report of a patient who used warfarin. This patient has ileos state by sigmoideal cancer, and in parallel a progressive intramural haematoma in the hepatic flexure of the colon. CONCLUSION: Hypocoagulation state with an intramural haematoma of colon may be very dangerous complication for patients with colorectal cancer and ileos state. Very careful choice of surgical strategy is necessary.

D-dimer, plasminogen activator inhibitor-1, prothrombin fragments and protein C - role in prothrombotic state of colorectal cancer.

The relationship between malignant tumors and blood coagulation disorders is generally well known. The authors studied blood coagulation in patients with colorectal cancer and evaluated some prothrombotic markers. The authors analyzed by latex-aglutination method, ProC Global test, Asserachrom PAI-1 test and Enzygnost F 1+2 test the group of 137 patients with malignant tumor of colon and rectum, drew attention to the relationship between level of D-dimer, PAI-1, F 1+2, Protein C and the progress of malignant tumor, its localization, clinical stage, histopathology type, method of surgery considering the stapling use. Very aggressive and advanced tumors have significantly higher level of D-dimer, plasminogen activator inhibitor I (PAI-1). Prothrombotic fragments 1+2 were significantly higher by anastomosis dehiscence. Protein C level was lower in the age from sixty to seventy and in advanced clinical stage. Pre-operative surveys of D-dimer, PAI-1, prothrombotic fragments and Protein C give informations about risk of thrombosis of malignant diseases, their clinical stage and histological type. D-dimer and PAI-1 have a real clinical value and can be reliable prothrombotic marker.

Ileus, pregnancy or leiomyoma? A case of a large intraabdominal tumor.

OBJECTIVE: Authors evaluate a case of an extremely large leiomyoma, its symptomatology, diagnosis and surgical treatment. They present the possible peroperative complications and emphasize the necessity of the interdisciplinary approach. METHODS: The set of patients consists of 21 patients with leiomyomas of various localizations. All patients were operated by means of conventional operation. The material was sent for classical bioptic examination with the use of immuno-histochemical analysis. RESULTS: Unlike found in literature, the most common appearance of leiomyoma in our set of patients was on small bowel, namely 10 of 21 patients had tumors in this localization. Furthermore there were three tumors of gynecological origin. Two of them had acute abdominal disease (AAD) while in these cases, ileus was a reason for urgent operations. In all three gynecological cases it was difficult to diagnose preoperatively the origin of tumors. In one patient, the preparation led to partial iatrogenic lesion of left ureter which was subsequently treated with primary suture. The authors describe zero mortality. CONCLUSION: Despite the relatively simple diagnosis of leiomyomas, in some cases of extreme size of the tumor combined with its localization in the small pelvis makes it difficult to distinguish it from other mesenchymal tumors. In order eliminate the peroperative complications it is possible to introduce a urethral catheter and to set up a multidisciplinary operation team to achieve combined experience (Fig. 5, Ref. 14).

[Laparoscopic splenectomy--our experience]. / Laparoskopická splenektómia--nase skúsenosti.

AIM: Comparison laparoscopic (LS) and conventional splenectomy (OS). MATERIAL AND METHODS: Evaluation results of 22 patients after LS and 22 patients after open splenectomy for idiopathic trombocythopenic purpura (ITP)--complications, operational time, hospital stay, dynamics of coagulating parameters, mainly plattelets. RESULTS: We provided longer operational time, shorter hospital stay, earlier regression of trombocytopenia at patients after laparoscopic splenectomy and all at once the same complications then at patients after open splenectomy. CONCLUSION: The laparoscopic splenectomy is considere for advantages of miniinvasive approach as appropriate alternative of surgical treatment of ITP.

[Colorectal malignancies with respect to hemocoagulation]. / Malignómy kólonu a rekta z pohl'adu hemokoagulácie.

AIM: Relationship between malignants tumors and damage of hemocoagulation is known. The aim is analyse this damage and evaluate the thrombotic markers. MATERIAL AND METHODICS: Authors analyses group of 137 patients with colorectal malignants tumors. They notifyes to relationship between plasmatic preoperative D dimer, PAI-1, F 1+2, Protein C level with controll group. RESULTS: Especially aggressive forms of colorectal tumours have increased levels of D dimer and PAI-1. Protrombin fragments 1+2 were enhanced in the course of anastomotic dehiscence. Protein C level was reduced in 6.-7. decade and in advanced clinical stage. CONCLUSION: Praeoperative thrombotic markers assays inform about risk of thrombosis and clinical diseases stage. They prefere mini-invasive operations procedures. The maximall validity provides D dimer and PAI-1.