Rozhledy v Chirurgii最新文献

Introduction: Volkmann's ischaemic contracture (VIC) is a disabling condition resulting from tissue necrosis due to impaired vascular supply to the limb. Over the years VIC has become rare in developed countries with many different aetiologies described. It was alarming to have high incidence of established VIC in our practice in Nepal. A detailed analysis was conducted to accurately describe this issue.

Methods: We collected 47 cases of VIC over six years and noted the age, sex, district of origin and cause of VIC, duration of injury to presentation, and the grade of VIC. Then we compared these characteristics of VIC of each Nepal province and created a map to show the problematic regions.

Results: Out of 47 patients, 46 could have been prevented by an early treatment. The most common cause was a tight cast in 25 patients (53.19%), followed by unintentionally self-caused VIC by applying tight bandages in 21 patients (44.68%). Most cases came from province 6 (29.78%). Our group included three mild (6.4%), 35 moderate (74.5%) and nine severe (19.1%) cases of VIC. Only 14 cases (29.78%) had a timely fasciotomy in the past.

Conclusion: VIC is an irreversible complication of the compartment syndrome which is an easily preventable condition in the setting of developing countries. Our focus should, therefore, aim at preventing such disastrous conditions as 97.87% of cases we encountered could have been avoided by proper primary care. In the case of Nepal most cases came from province 6 and province 3.

Background and study aims: Magnetic resonance imaging (MRI) has been used for more than 20 years in the region of the proximal femur to diagnose occult, or incomplete, fractures of the femoral neck and the trochanteric segment. MRI has also potential to contribute to the understanding of the pathogenesis and pathoanatomy of trochanteric fractures.

Methods: The group including 13 patients was examined by MRI for a suspected, or incomplete, fracture of the trochanteric segment within 24 hours post-injury. In all cases, this was the first injury to the hip joint, with the other hip joint remaining intact.

Results: The coronal scans showed a marked fracture line which, in the region of the intertrochanteric line, extended from the base of the greater trochanter (GT) medially and distally and involved the medial cortex. This inclination, however, was gradually changing posteriorwards and close before the posterior cortex. The fracture line was passing vertically along the lateral trochanteric wall as far as the level of the lesser trochanter (LT). Then the fracture line changed its course and ran horizontally to the cortex of the LT. Sagittal scans showed clearly the primary fracture line originating in the greater trochanter, extending medially and starting to separate the posterior cortex.

Conclusion: Analysis of MRI findings has documented that the primary fracture line in pertrochanteric fractures originates in the GT and extends distally, medially and anteriorly towards the anterior cortex, the intertrochanteric line and the LT. Thus, the GT presents a rather vulnerable site and is always broken into more fragments than shown by a radiograph.

Early postoperative wound complications in revascularization procedures in the groin very often include complications associated with injury to the lymphatic system such as lymphocele and lymphorrhea with subsequent local infectious complications and the risk of infection of prosthetic grafts. We present a case report of successful treatment of postoperative lymphocele with subsequent lymphatic fistula and dehiscence of the surgical wound by intranodal embolization of the injured lymph node with Histoacryl tissue glue.

This paper presents the case of a 32-year-old female patient with acute colon incarceration in the thoracic cavity due to Bochdalek hernia. An asymptomatic right Bochdalek hernia was also discovered, which is a rare finding. The patient underwent laparotomy with reposition of the incarcerated organs and primary closure of the left-sided defect. The stenotic portion of the originally incarcerated colon was resected one year later due to the symptoms of chronic bowel problems. At present, 18 months from the first surgery, the patient's clinical condition remains good with a positive clinical response to the secondary surgery involving resection of the stenotic colon, and the right Bochdalek hernia remains asymptomatic.

The ambulatory surgeon deals daily with patients who come for various pigmented skin lesions. A number of patients come on the recommendation of a dermatologist, but for the majority of patients, the primary visit is directly to the surgical clinic. The reason for removing a pigmented lesion may be an unsatisfactory cosmetic appearance or frequent irritation due to inappropriate location of the lesion, but also the fear of the development of malignancy. Pigmented lesions of the skin are a very hetero-geneous group represented from benign nevi to malignant melanoma. They occur in all age groups. Congenital nevi and hemangiomas are most often treated at an early age, and the incidence of skin malignancies increases in older patients. The ambulatory surgeon is often faced with the decision whether and how radically the pigmented lesion needs to be removed. Skin lesions such as lentigo solaris do not need to be treated surgically. Other lesions, such as basal cell carcinoma, require radical excision and subsequent professional dispensary. However, the treatment of melanoma is complex, it is led by specialists in dermato-oncology centers and therefore interdisciplinary approach is neces-sary. Every ambulatory surgeon should be knowledgeable and experienced enough to be able to decide on the need for removal of pigmented lesions and, in case of uncertainty, refer the patient to a skin specialist. This article provides a brief overview and specifics of basic skin pigment manifestations and criteria for their surgical removal.

Obesity is a global problem with a rising prevalence, which has serious implications not only for individuals' health but also for society as a whole. The increased incidence of overweight and obesity leads to higher healthcare costs and limits the employment opportunities of individuals, affecting their quality of life. The treatment of obesity encompasses various approaches, including diet, exercise, pharmacotherapy, and surgical bariatric procedures. New and promising methods of treatment include endoscopic sleeve gastroplasty (ESG). ESG offers a safe, minimally invasive method that reduces the volume of the stomach and has long-term results in terms of weight reduction. Thanks to significant advances in the field of endoscopy and endoscopic suturing, we can expect new and improved devices to be used in ESG. This will make ESG even safer, less dependent on the expertise of physicians, and its outcomes will significantly approach those of traditional bariatric surgery.

Bariatric and metabolic surgery is the most invasive but also the most effective treat-ment for severe obesity and associated comorbidities. The most common procedures performed are laparoscopic sleeve gastrectomy and Roux-Y gastric bypass. Postoperative complications occur in 4-10% cases. The majority of them are mild and are treated conservatively. Complex management of severe complications often involves surgical re-intervention, which is associated with high morbidity. Technological advancements in therapeutic endoscopy expand the options for minimally invasive treatment of these complications and, in selected cases, may even be the method of choice in their management. The authors present a summary of current endoscopic procedures for managing ulcerations, leaks, fistulas, strictures, and other complications. Based on a cohort of 45 patients treated over a period of 10 years (11/2013-11/2023) at the district hospital in Jablonec nad Nisou, an overview of the endoscopic methods used, procedure numbers, duration, and outcomes of endoscopic treatment is provided. The author's commentary describes trends leading to further improvement in the outcomes of endoscopic treatment.

Introduction: The aim of the study was to summarize the results of pancreatic surgery over a ten-year period at the surgical department of the university hospital Kralovske Vinohrady and analyse the prognostic factors of pancreatic ductal adenocarcinoma.

Methods: From October 2012 to December 2022, 331 patients underwent proximal pancreatectomy, 142 patients underwent distal pancreatectomy, and 84 patients underwent total pancreatectomy. Of the total number of resected patients, the analysis was performed only in patients with proven findings of ductal adenocarcinoma of the pancreas (221 patients). Survival analysis was conducted using the Kaplan-Meier method, and prognostic factors were assessed using Cox analysis for these patients.

Results: The average length of hospitalization was 13 days (3-53 days). According to the Clavien-Dindo classification, 90 patients had an uncomplicated postoperative course, 65 had minor complications (grade I and II), and 66 patients had major complications (grade III-V). Based on TNM staging, 27 patients were in stage I, 136 in stage II, 41 in stage III, and 17 in stage IV. The median survival was 304 days. Overall, 1-, 2-, 3-, and 5-year survival rates were 62.7% (95% confidence interval (CI) 55.9%-70.4%), 39.0% (95% CI: 31.9-47.6%), 27.3% (95% CI: 20.7-36.0%), and 12.8% (95% CI: 6.9%-24.0%), respectively. Using the Cox model, the following negative prognostic factors were identified: severe postoperative complications, positive lymph nodes, T stage, and positive resection margins.

Conclusion: Pancreatic ductal adenocarcinoma is an aggressive tumour. Radical resection represents the only chance for long-term survival. The best results are achieved in specialized centres with a high volume of pancreatic resections.

Presented are three casuistics of seemingly identical breast lesions which even by adopting advanced laboratory techniques may represent diagnostic challenge. Microscopic features of some bland spindle cell lesions of different histogenesis (epithelial or mesenchymal) are misleading and a potential source of unaware errors, which might affect optimal therapeutic strategy. In the setting of three diverse entities (low-grade spindle cell metaplastic carcinoma, desmoid fibromatosis and phyllodes tumor) is documented both demanding diagnostic algorithm and revealing molecular landscape on one side as well as evolving predictive/prognostic parameters on the other one. Close interdisciplinary cooperation is inevitable for accurate interpretation/understanding of revealed diagnostic facts which is required for adjustment of competent rational and individualized therapy.

Meckel's diverticulum (MD) is one of the most common malformations of the gastrointestinal tract. Most cases are asymptomatic; clinical symptoms occur only in about 4% of patients, presenting as gastrointestinal bleeding, intestinal obstruction, inflammation, or perforation. Bleeding is most frequently observed in children under 2 years of age. Older patients tend to experience inflammatory complications. Here, we present the case report of a 17-year-old male patient with life-threatening acute gastrointestinal bleeding due to MD. Based on this case report, we performed a retrospective study of a small group of patients admitted to the Department of Pediatric Surgery and Traumatology, Third Faculty of Medicine, Charles University and Thomayer University Hospital in Prague (KDCHT FTN) between January 2012 and March 2023 with the primary or secondary diagnosis of MD.