[Cryolization in the inoperable breast carcinoma treatment]. / Kryolizace v lécbe inoperabilního nádoru prsu.

The authors present a case review describing a method of cryolization. They employed this method in the case of a patient with an extensive advanced breast carcinoma with multiple metastases located in the thoracic wall, in order to make the patient's state surgically manageable.

[Torsion of the spleen--an unusual cause of sudden acute abdomen]. / Torze sleziny--neobvyklá prícina náhlé príhody brisní.

Torsion of a wandering spleen is rare and has been diagnosed in about 0.2%-0.3% of a large group of patients who required splenectomy. Abnormalities in the ligamentous structures that fix the spleen are thought to be responsible for its abnormal position and for its torsion. Patients may present with various symptoms ranging from mild intermittent abdominal pain to an acute abdomen. Computed tomography leads to correct diagnosis.

[Synovial metaplasia around breast implants]. / Synoviální metaplazie kolem mamárních implantátu.

Three cases of the periprosthetic breast capsules showing typical features of synovial metaplasia are presented. The histological picture is characterized by the presence of cellular layer mimicking synovial membrane. These elements are devoid of basement membrane, otherwise, nevertheless, they strongly resemble single- or multilayered epithelium. Focally, the differentiation towards giant multinucleated cells is noted. Immunohistochemical profile, as well as the ultrastructure of the cells, confirms their histiocytic origin with advanced differentiation towards elements of the synovial membrane. These histological features are referred to as synovial or synovial-like metaplasia. They are found in considerable fraction of textured breast implant capsules. The pathogenesis remains uncertain; however, similar picture was observed in other locations in association with prolonged or repeated action of mechanical forces. Thus, movement of the implant in situ is the most probable trigger of synovial metaplasia.

Biological skin covers in treatment of two cases of the Lyell's syndrome.

The treatment of two cases of toxic epidermal necrolysis (Lyell's syndrome) is described. Although some features were common for both ones (young men practically of the same age, reaction after using the same drug) the clinical course of illness was very different. Spontaneous epithelisation of partial-thickness lesions and definitive healing under the xenografts in one patient and full-thickness skin-loss on 12% of body surface with severe septic complications requiring application of cultured keratinocytes and/or skin autografting in the other patient were the main differences. The interdisciplinary approach using a burns treatment protocol in non-burned patient including the close co-operation with the tissue bank in preparing different types of biological covers has been applied.

The use of fasciocutaneous flaps on perforating vessels.

The distally based fasciocutaneous flaps on perforating vessels are mobile, well shapable and cosmetically satisfactory ones. In soft tissue defects of the lower third of the leg the above flaps should be a method of choice for their simple applicability and shapability of tissues. Pedicular fasciocutaneous flaps enable us to enlarge the possibilities of reconstructive surgery in this field. Microsurgical flaps may then be reserved for more important losses of soft tissues.

[The brachial flap in reconstructive surgery]. / Pazní lalok v rekonstrukcní chirurgii.

Radical treatment of tumours in the region of the shoulder joint is a problem. For reconstruction we can use local shifts, microsurgical methods and free skin transplants, unless the surgical operation involves resection of the skeleton. Less frequently a brachial flap is used, calling for amputation of the upper extremity to use the soft tissues of the arm. In the described patient a radical approach to a tumour in the area of the left shoulder with the use of a total brachial flap was involved. The authors draw attention to the importance of the surgical decision to apply this mutilating operation where it is necessary to take into account the clinical finding, subjective complaints as well as possibilities of reconstructive surgery.