Rozhledy v Chirurgii最新文献

Fractures of the proximal femur, i.e., femoral neck fractures and trochanteric fractures, may be associated with a number of late complications. The most frequent of them in-clude non-union, varus malunion, unequal limb length, avascular necrosis of the femoral head, malrotation of the extremity and osteoarthritis of the hip joint. Individual affections are very often combined, for example, varus malunion, short-ening of the limb and its malrotation. This may result in pain, limp and, later, in dis-orders of other joints, especially the knee, and the lumbar spine. In the past, many of these complications were treated with intertrochanteric osteotomy. Currently, however, the indications for osteotomies have significantly decreased due to advances in internal fixation of proximal femur fractures and the introduction of THA. Nevertheless, intertrochanteric osteotomy remains the method of choice in management of certain complications of proximal femur fractures. Not every orthopedist or traumatologist has the capacity to perform these surgeries, but everyone should know about them and their indications. The aim of this article is therefore to give a brief overview of the current possibilities of valgus intertrochanteric osteotomy in the management of posttraumatic -non-unions of the femoral neck.

Introduction: Liver resection ranks among the most technically demanding abdominal procedures, requiring detailed knowledge of complex three-dimensional anatomy. Augmented reality (AR) represents an innovative technology that overlays digital information on the surgical field and may serve as a tool for perioperative navigation.

Methods: A systematic search of PubMed, MEDLINE, and Cochrane databases was conducted for studies published between January 2022 and August 2025. Only articles in En-glish focusing on human subjects and describing the use of AR during liver resection were included. A total of 133 studies were identified; after removing duplicates, 67 remained. Based on predefined criteria, 10 studies were finally considered relevant for analysis.

Results: The analyzed studies involved 649 patients, of whom 245 underwent liver resection with AR assistance. Five were retrospective with control groups, three were single-arm, and one was prospective. Most studies demonstrated that AR improved intraoperative orientation, facilitated lesion localization, and could reduce blood loss and operative time. In cases of deep-seated lesions, AR was associated with wider resection margins, higher R0 resection rates, and fewer conversions. Conversely, long-term oncologic outcomes and postoperative complication rates were not consistently affected.

Conclusion: AR appears to be a safe technique with the potential to enhance the precision of liver resections and support intraoperative decision-making. Nevertheless, large prospective trials and further technological advances in registration and tissue deformation correction are required before routine clinical implementation.

Introduction: Managing a large number of seriously injured patients (massive casualties - MASCAL) is a situation faced by medical teams in war conflicts and during disasters. MASCAL is an incident with a mass receive of injured patients, where the number of casualties exceeds the capacity and capabilities of the healthcare facility, placing enormous demands on the work of medical teams and effective management of limited human and material resources.

Case report: In this communication, we describe a burn-related MASCAL that occurred in Kabul following a gas cylinder explosion. Within a 72-hour period, a ROLE 3 field hospital at the Kabul base received and treated 71 patients with deep burns covering 5-90% of their body surface area. Despite the exceptional scale of this tragedy, it was managed successfully through a staged system of care delivery and subsequent redistribution of burn patients to other alliance healthcare facilities.

Conclusion: Receiving a mass influx of patients with extensive burns is one of the most medically, organizationally, and logistically challenging situations, placing extreme demands on the healthcare delivery system. MASCAL situations require a rapid and coordinated response with established treatment priorities and a prepared strategy for the efficient distribution of personnel, supplies, and equipment.

Pancreatic pseudocysts, as one of the many complications of pancreatitis, are usually asymptomatic and are not commonly considered in the differential diagnosis of acute abdominal events. A pancreatic pseudocyst with its aggressive juices tends to damage nearby organs, leading to their fibrotic changes and low-quality healing. Such organ changes are more prone to follow up complications. The most dangerous bleeding source in pancreatic pseudocyst patients is splenic artery aneurysm, often solved by endovascular interventions. In other cases, mainly in haemodynamic stable patients, maximum conservative approach is preferred. In this case report, we present hemorrhage into a pancreatic pseudocyst in a gastric serosa rupture as a rare cause of sudden-onset abdominal pain and hemoperitoneum, which led to urgent surgical exploration and necessitated a more extensive resection of organs damaged during the rupture of the pancreatic pseudocyst.

This narrative review article describes the possibilities and limitations of using the -ChatGPT-4o language model in pediatric surgery and urology in Czech hospitals. -Based on a review of 45 research and media sources published between 2023 and 2025, the article explains the basic principles of how the chatbot works and divides the possibilities of using ChatGPT-4o into those that are realistic in current practice and those that are potential in the near future. The model can serve as a tool in the education of medical students and doctors preparing for specialization or as a useful assistant in writing academic papers. ChatGPT-4o can be used in communication with children and their parents as an understandable source of information and answers to lay questions in preparation for investigations and operations. It can be used as a data collection tool in monitoring long-term complications, quality of life, and subjective perception of the perioperative period. It can help doctors as a consultation tool in the diagnostic and investigation process or when writing outpatient reports and surgical protocols. Potential future uses of the chatbot include the integration of all clinical data about the patient, generating admission and discharge reports or the role of an intraoperative multimodal AI assistant. Ethical risks are discussed, particularly in the areas of authorship, reli-ability of chatbot outputs, and personal data protection. The introduction of European legislation on the use of AI, not only in healthcare, is mentioned. Based on personal experience, the authors recommend the use of the latest ChatGPT model as a useful support tool in the daily practice of pediatric surgeons and believe that the practical usefulness of chatbots will continue to grow over time.

In this case report, we present the management of an uncommon case of genital burns in a patient with pre-existing phimosis. Generally, a burn wound on the prepuce is -treated with a standard burn wound care strategy; however, in this case, circumcision was performed to address both the phimosis and the genital burns simultaneously. To the best of our knowledge, no similar cases have been reported in the literature. Genital burns are not often encountered due to their protected anatomic location and the additional coverage provided by clothing. Thus, genital burns are usually associated with extensive total body surface area (TBSA) burn injuries. Currently, there is no available standardized algorithm or treatment guideline for genital burn injuries. The treatment of burns in this region is primarily conservative. In this case, a 55-year-old male patient presented with extensive scald burn injury, including genital burns. He was diagnosed with third-degree scald burns on both upper extremities and deep second-degree burns on the lower extremities, abdomen, perineum and genitals, covering 46% of the TBSA. However, his penis was protected by native phimosis. We performed fluid resuscitation and burn wound management, including circumcision. The use of circumcision as a simultaneous treatment for genital burns and phimosis led to a highly favorable outcome, including good wound healing, effective pain control, satisfactory prognosis, and excellent cosmetic appearance.

Immediate breast reconstruction (IBR) with implants has become an integral part of comprehensive care for patients undergoing mastectomy for breast cancer. This review summarizes current evidence on indications, contraindications, surgical techniques, complications, and clinical outcomes of IBR with an implant. Properly selected pa-tients benefit from enhanced psychological well-being, shorter recovery, and improved cosmetic results. IBR is primarily indicated in women with stage T1-T2 tumors without metastases. Contraindications include advanced disease, the requirement for adjuvant radiotherapy, comorbidities such as diabetes mellitus, obesity, or smoking, and poor skin flap qual-ity. The most widely used surgical approach is the direct-to-implant (DTI) technique, allowing definitive reconstruction in a single operation. Potential complications include infection, seroma, capsular contracture, skin necrosis, and implant exposure. Their incidence depends on tissue quality, surgical exper-tise, and patient-related risk factors. Current studies demonstrate that IBR does not adversely affect oncologic safety nor delay adjuvant treatment. In addition, IBR has been shown to be cost-effective and to yield high patient satisfaction, particularly in domains of body image, sexuality, and psychosocial adjustment. In conclusion, IBR with implants represents a safe and effective reconstructive option for appropriately selected patients.

Introduction: Sexual and reproductive health remains under-recognized in surgical care despite its decisive impact on quality of life and overall outcomes.

Methods: Narrative synthesis of recent guidance (EAU 2025, AUA 2024, ISSM/ESSM, NCCN/ASCO) and clinical evidence on sexual and reproductive sequelae after colorectal, vascular, and spinal procedures.

Key findings: Core mechanisms include autonomic denervation, vascular/hormonal factors, pain/scarring, and altered body image.  Pelvic oncologic surgeries (low anterior resection, radical prostatectomy/cystectomy) are high-risk procedures. High-value interventions include early penile rehabilitation (PDE5 inhibitors ± vacuum device) and fertility preservation (gamete cryopreservation), local estrogens/lubricants and pelvic-floor physiother-apy in women, and psychosexual support within coordinated multidisciplinary care across both sexes.

Conclusion: Embedding sexual and reproductive health into standard perioperative pathways (six-step algorithm: education, risk stratification, fertility preservation, nerve-sparing, discharge instructions, 6-12-week follow-up) is feasible in Czech practice and improves functional outcomes and patient satisfaction.

Continuous improvement in imaging techniques plays an integral part of the evolvement in liver surgery. Accurate imaging is necessary for the diagnostics and surgeon's preop-erative preparation, specifically for learning the individual anatomy, which is often var-iable in the liver, and for understanding the precise extent of pathology. A compelling area in preoperative evaluation is the assessment of the liver parenchyma function, for which the official guidelines have been published, specifying the precise indications, among other things. An upcoming method for assessing liver parenchyma function is magnetic resonance, which has the potential to evaluate both the volume and the func-tion of the future liver remnant. Beyond preoperative imaging, the real-time imaging directly in the operating room enables surgeons to perform the most complex procedures. With the growing establishment of minimally invasive approaches, fluorescent imaging using indocyanine green is increasingly utilized, presenting the main substitution of tactile perception during open resections in combination with ultrasound. The future potentially lies in targeted molecular imaging, which has the potential to eliminate the current shortcomings of imaging methods. We present an overview of current trends in liver imaging and a relevant literature.

This article focuses on gynecological causes of acute abdominal emergencies, which represent serious conditions requiring prompt diagnosis and treatment. It describes their pathogenesis, clinical presentation, diagnostic procedures, and therapeutic options. As a review paper, its aim is to identify the most common indications for urgent gynecological intervention and to facilitate differential diagnosis in acute zone, particularly within surgical outpatient departments. Gynecological causes are categorized into three main groups: non-infectious, infectious, and emergencies associated with early pregnancy. The article provides a detailed overview of expected findings from lab-oratory tests and transvaginal gynecological ultrasound examination. For each condition, surgical management is described, with laparoscopy being the preferred ap-proach in gynecological cases.