Rozhledy v Chirurgii最新文献

Pediatric surgery is a medical specialty focused on the diagnosis, treatment, and postoperative care of children with congenital and acquired anomalies and diseases. The goal of pediatric surgeons is to ensure that children receive the best possible care while minimizing the risks and complications associated with surgical procedures. Contemporary pediatric surgeons face many challenges, including a decline in the number of children with congenital developmental defects, economic pressures, and efforts to increase efficiency, leading to reduced time spent on individual surgeries. This can limit the opportunity for thorough training of young surgeons. These challenges require innovative approaches and continuous improvement in educational and training methods. Minimally invasive surgery has become a significant part of pediatric surgery, offering benefits such as faster recovery, smaller surgical wounds, and lower risk of infection. However, minimally invasive pediatric surgery is technically demanding and requires excellent technical skills. The need to maintain and improve surgical skills demands ongoing training. Current educational methods increasingly rely on simulation technologies to enhance the quality and safety of training without risk to patients. The integration of 3D printing technology and imaging data from CT and MRI scans has opened new possibilities for creating highly realistic simulation models for minimally invasive surgery. These models accurately replicate the environment encountered in procedures like neonatal surgery. In this article, we present our experience with the development and creation of 3D-printed synthetic models designed for training thoracoscopic surgery of esophageal atresia with tracheoesophageal fistula. The aim of this review article is to provide an up-to-date overview of the literature on synthetic 3D-printed models designed for training in minimally invasive pediatric surgery.

The duodenum is the second most common diverticula origin after the colon. 1-5% of duodenal diverticula develop complications, such as inflammation, perforation, or bleeding. The key points in the diagnosis of complications of duodenal diverticulosis are a good medical history, often with reference to upper endoscopy, CT scan, and a generally altered patient condition with a poor physical examination of the abdomen. Treatment of the complications of duodenal diverticulosis is conservative, endoscopic and surgical. Due to the high lethality of undiagnosed complications, an energetic approach is essential, especially in the case of perforation events. The patient clearly benefits from the procedure performed within 12 hours of the start of the clinical symptoms. The text presents a general overview of duodenal diverticulosis and the issue is documented on two case reports of the complications of duodenal diverticulosis from 2022 from our surgical department.

The patient suddenly experienced shortness of breath, collapse, and loss of consciousness at home. Layperson-performed, telephone-guided cardiopulmonary resuscitation was initiated, and upon the arrival of the emergency medical team, suc-cessful extended CPR was performed, after which the patient was transported to the emergency department at Hospital of České Budějovice. Basic stabilization of the clinical condition was carried out, the patient was secured, intubated, and transported to the CT scanner. A massive bilateral pulmonary embolism was verified byCT. Thrombolysis was immediately performed in the emergency room, circulation was stabilized, and the patient was transferred to the ICU. An hour later, the patient experienced severe circulatory instability in the ICU, requiring high-dose norepinephrine support. Ultrasound was performed, followed by a CT scan of the abdomen, which revealed massive hemoperitoneum. An urgent surgical consultation was performed, and surgery was recommended on a vital indication. An urgent laparotomy was performed on a hemodynamically unstable patient with the blood pressure 60/30 and the pulse 180/min. Despite massive circulatory support and erythrocyte transfusion, 4 liters of noncoagulable blood were drained from the hepatic region. The liver was torn in several places due to fractured ribs, most severely in the left lobe at the hepatic veins. Due to severe circulatory instability, the injury was -deemed inoperable, and it was decided to stabilize the condition with perihepatic packing, after which the patient was transferred to the ICU. The ICU continued conservative therapy, and there was a gradual reduction in the drainage output. A second-look operation was performed after 48 hours - revision of the original wound and removal of the drapes. Multiple fissures were found in the -right lobe, caused by broken ribs, with heavy bleeding from the dorsal hepatic veins. A combination of selective suturing and electrocoagulation of the fissures was performed. Due to ongoing circulatory instability, the decision was made to use perihepatic packing once again. The patient was left in the ICU for further circulatory stabilization, with a plan to do another surgical revision after stabilization in 48 hours. Another surgical revision was performed, revisiting the perihepatic space and performing an anatomical resection of liver segments II and III, followed by selective ligation of the hepatic vein. Hemodynamic stabilization was achieved. Postoperatively, a fluidothorax developed, which was managed by thoracic drainage, and acute acalculous cholecystitis, which was treated with puncture cholecystostomy. The patient is now primarily healed and has been started on long-term anticoagulation therapy by the angiologist. The cause of the pulmonary embolism was not determined.

A population-based pilot screening programme for abdominal aortic aneurysm was launched in the Czech Republic on January 1, 2025. Its goal is not only early diagnosis of the disease, but also the collection of key data that will make health statistics more accurate. The target population includes all men aged 65-67. Men are referred by their general practitioner for ultrasound examination to accredited ultrasound centers. With the findings, they return to the general practitioner, who will perform basic triage based on the results of the ultrasound examination. Patients with a positive finding are then dispensarized and treated in cardiovascular centers across the Czech Republic. The pilot programme will last for 5 years. This period will serve to evaluate the benefits and effectiveness of the programme. Major statement: A population-based pilot screening programme for abdominal aortic aneurysm in the Czech Republic has been launched.

We report three patients who were operated on at the Centre for Thoracic Surgery of the National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery in Vyšné Hágy for primary malignant tumour of the cervical segment of the trachea during the last seven years. The first patient had an extremely rare primary chondrosarcoma of the trachea, the other two cases were patients with primary adenoid cystic carcinoma of the trachea. We discuss the clinical presentation as well as the strategy and outcome of surgical and nonsurgical oncological treatment. We consider the presented topic important because primary malignant tracheal tumors are rare and their symptoms may mimic common benign airway diseases. This fact may slow down their diagnosis and delay or exclude their treatment.

Introduction: A carotid web is a rare but clinically important cause of cryptogenic ischemic stroke. It is an atypical form of fibromuscular dysplasia localized at the carotid bulb. The aim of this paper is to present this less-known cause of ischemic stroke based on a case study.

Case report: In a 55-year-old female patient with acute ischemic strok in the left carotid territory, a carotid web was diagnosed on CT angiography. Other extracranial or intracranial cerebral arteries showed no stenoses or occlusions. The patient was initially treated effectively with intravenous thrombolysis. A follow-up brain MRI revealed a small cortical ischemia and a detailed cardiological evaluation excluded the cardioembolic etiology of the stroke. As part of the secondary stroke prevention, the patient was managed with antiplatelet therapy and underwent an uncomplicated carotid endarterectomy. During a 10-month follow-up period, there was no recurrence of cerebral ischemia.

Conclusion: Carotid endarterectomy represents a safe and effective method for treating symptomatic carotid web.

Significant changes have recently occurred in the treatment of locally advanced rectal cancer. These include a complete administration of systemic therapy in the neoadjuvant phase of treatment, nonsurgical interventions in case of clinically complete response and using of immunotherapy in patients with the deficiency ofmismatch repair. Although there is no universally accepted treatment standard, the concept of total neoadjuvant therapy, immunotherapy and non-operative management is widely accepted in clinical practice. The care of patients with rectal cancer is multimodal, comprehensive and should be based on consensual recommendations. A uniform approach in diagnostic and therapeutic procedures within the individual departments of the oncology center is a condition for high quality standard care. At the same time, unusual clinical situations and the specific wishes of patients should be taken into account. The listed recommended treatment procedures are a reflection of the efforts to unify patient care with rectal cancer at individual workplaces of the comprehensive oncology center in Brno. Defining general recommendations is not the goal.

Introduction: Non-palpable breast lesions that are eligible for breast-conserving surgery require precise preoperative localization of the pathological site. Mammographic screening and modern diagnostic methods contribute to the increasingly early detection of these lesions.

Methods: We present our two-year practical experience with the marking of non-palpa-ble breast lesions using the Advantage™ I-125 radioactive seed. This method was applied to 116 patients, 34 of whom had undergone successful neoadjuvant systemic therapy. The first 13 patients were marked using both the Frank wire method and radioactive seed application. The aim of our study was to evaluate the advantages and disadvantages of this method for both the patients and the entire multidisciplinary team.

Results: All pathological lesions were successfully removed during the primary procedure. In four patients, we observed seed displacement; however, the pathological lesion and the seed were always identified within the surgical field. Among the total number of patients, 73 underwent surgery for ductal carcinoma, 20 for lobular carcinoma, 8 for carcinoma associated with microcalcifications, 2 for invasive papillary carcinoma, and 13 for ambiguous biopsy findings. The method enables precise targeting of non-palpa-ble lesions with minimal radiation exposure for both the patients and the surgical team. Additionally, the cosmetic outcomes of this method were assessed as clearly positive.

Conclusion: The Advantage™ I-125 radioactive seed localization proved to be a reliable method for detecting non-palpable breast lesions with minimal complications. Its main advantages lie in the overall comfort for patients and the ability to optimize incision placement from an aesthetic perspective. Our results confirm the high effectiveness of this method in breast-conserving surgery while achieving R0 resection.

The preservation of donor lungs and the effort to safely extend ischemic time while maintaining function is an important topic that the transplant community has been addressing for a long time. Recent publications, mainly from the Toronto team, have fundamentally influenced the existing standard of optimal preservation conditions, and their results provide a scientific basis for the shift from ice preservation to con-trolled hypothermia. Optimal preservation conditions are a necessary prerequisite for the safe extension of ischemic time. This brings additional potential for the development of the field and the possibility to improve the availability of lung transplantations and their outcomes. This review summarizes the key findings in the area of donor lung preservation from the first experimental attempts conducted 30 years ago to recent studies and discusses the various aspects that the change in preservation standard has influenced or is likely to influence.

The case report describes a rare case of the cause of abdominal pain and palpable resis-tance in the epigastric region. A CT scan of the abdomen was performed with a surprising cause of the trouble - a trichobezoar filling the stomach, also described as Rapunzel syndrome, i.e. Goldilocks syndrome. Upon further questioning, the patient's mother retrospectively admits her daughter's pulling out her own hair (trichotillomania) and eating it (trichophagia) since the age of four. The finding was consulted, and could not be removed by gastroscopy due to its size. A successful laparoscopic gastrotomy with total extraction of the trichobezoar was performed. The child recovered without complications. A psychiatric evaluation was performed and the child was discharged home on the 10th postoperative day.