Rozhledy v Chirurgii最新文献

Introduction: Acute appendicitis is a sudden inflammation of the appendix and is one of the most frequent causes of an acute abdominal pain, often requiring an urgent surgical procedure. A periappendiceal infiltrate is a complicated form of the acute appendicitis, identified by creation of an inflammatory mass of the tissue and organs of the abdominal cavity. The goals of our study were to identify patients diagnosed with a periappendiceal infiltrate, who were initially treated conservatively, evaluate the effectivity of such treatment, and compare our findings with both Czech and foreign literature.

Method: A retrospective data analysis regarding patients with a conservatively treated periapendiceal infiltrate and/or abscess in our hospital during a five-year period (January 2020 - December 2024) and comparison of the results with Czech and foreign literature.

Results: The number of patients with acute appendicitis in this period was 433, of which 13 (3.0%) were treated initially conservatively with intravenous antibiotics and were diagnosed with a periappendiceal infiltrate using imaging methods. There were 9 males (69.2%) and 4 females (30.8%), the average age was 57.7 years. A CT scan was initially performed in 12 of the patients (92.3%), 8 (61.5%) were found to have an abscess and 6 of the abscesses were treated via a CT-guided drainage. Twelve of the patients (92.3%) were treated successfully and without recurrence. Interval appendectomy was performed in 4 patients (30.8%).

Conclusion: Despite our study being limited in the number of patients, its results are coherent with the trend seen in foreign publications - the conservative approach using intravenous antibiotics with or without a CT-guided drainage is an adequate and effective treatment in patients with a periapendiceal infiltrate.

Introduction: Lipomas belong to the most common soft tissue tumors. If they reach at least 10 cm or weigh at least 1,000 g, they are referred to as giant lipomas. Such lesions can cause diagnostic quandaries at a biopsy examination.

Case report: The article describes a 58-year-old man who observed the progression of a subcutaneous tumor mass in the right side of the back for two years. It looked like a fibrolipoma on an ultrasound. Complete surgical extirpation was performed. Grossly, it was an encapsulated lobulated lipomatous tumor measuring 12 × 10 × 4 cm. It consisted of a composite classical and spindle cell lipoma. The spindle cell component required differentiation from an atypical lipomatous tumor, which is an oncological entity with a worse prognosis.

Conclusion: Subcutaneous lipomas over 10 cm are rare and represent a diagnostic challenge for both clinicians and pathologists. We tried to point out that lipomatous tumors of larger dimensions and especially those with a heterogeneous morphological appearance should urge the pathologist to think about a potential malignancy and require more complex differential-diagnostic approach.

Extra-intracranial bypass represents a controversial yet significant component of neurosurgical treatment for cerebrovascular diseases. The indications are moyamoya dis-ease, steno-occlusive atherosclerotic disease of the internal carotid artery, acute ischemic stroke, and, more rarely, complex intracranial aneurysms and skull base tumors. Although historical studies have yielded mixed results and limited its use, modern diagnostic and surgical techniques are reopening the path for selective application of bypass in high-risk patients. A clear indication is the rare moyamoya disease, where bypass is a proven method for preventing ischemic or hemorrhagic strokes. In patients with symptomatic chronic internal carotid artery occlusion and exhausted cerebrovascular reserve, bypass may serve as a potential treatment modality, provided it is carefully indicated -through comprehensive specialized evaluation. Emergent bypass should be considered for a narrow group of patients with acute ischemic stroke when standard treatment fails or is not feasible. Despite ongoing debate, extra-intracranial bypass remains an essential part of cerebrovascular surgery. The key to success lies in the proper selection of patients and precise microsurgical execution. Modern approaches and technologies help reduce the risk of complications and enhance the effectiveness of this intervention, offering hope to patients with otherwise limited treatment options.

Acute pancreatitis may present with a variety of complications, the whole range of thoracic complications is presented as the rare enzymatic ascending mediastinitis as well as rare mediastinal pseudocysts. The mortality rate of mediastinal complications is high, 14-47%. Due to the small number of described cases, no clear recommendations have been made regarding the treatment of mediastinal pseudocyst. From the documented cases, spontaneous regression of mediastinal pseudocysts is rare and the clear benefit is reached by endoscopic treatment. Surgical therapy should be indicated only in case of failure of pharmacotherapy or endoscopic treatment. The differential diagnosis of the patient's difficulties after pancreatitis includes a whole range of polymorphic manifestations. However, as we illustrate in this case report, we should not forget them, especially because of the mortality rate.

Introduction: Pulmonary sequestration is a rare congenital anomaly of the lower respiratory tract, usually diagnosed in childhood. It involves lung parenchyma that has abnormal or absent communication with the tracheobronchial tree. The blood supply is not connected to the pulmonary circulation but comes from the systemic circulation. Intralobar pulmonary sequestration refers to pulmonary sequestration that shares a common pleura with normal parenchyma. In contrast, extralobar sequestration has its own visceral pleura that is not continuous with the normal lung. Extralobar pulmonary sequestration, unlike intralobar pulmonary sequestration, typically does not present with infectious manifestations due to the absence of a connection to the tracheobronchial tree. Instead, it may manifest as hypoxia, cardiac failure, or rarely, torsion of the sequestrum. However, it is more often an incidental asymptomatic finding. Computed tomography currently plays a leading role in diagnosis, enabling visualization of the feeding vessels. Surgical resection is the mainstay of the treatment, primarily to prevent hemorrhage or malignant transformation of the tissue. Resection also provides material for biopsy examination.

Case report: A 68-year-old patient with nephropathy was referred by her nephrologist for abdominal ultrasound, which incidentally detected a tumor in the left retroperitoneum. A CT scan was performed, and the patient was then referred for tumor excision due to suspicion of a neurogenic tumor. Postoperatively, she was monitored in the intensive care unit with oxygen therapy for hypoxemia. The further course was uncomplicated. She was discharged home on postoperative day 5.

Conclusion: We present a case of this very rare diagnosis, which is even rarer in an adult patient.

Introduction: Local antibiotic prophylaxis in breast reconstruction with implants is a widely used method aimed at reducing postoperative infections, biofilm formation, and the incidence of capsular contracture, which can ultimately lead to implant loss, breast implant illness, or breast implant-associated anaplastic large cell lymphoma. Currently, there is no convincing guideline or protocol for irrigation, nor a specific antibiotic or combination of antibiotics set. The objective of this systematic review is to summarize the existing knowledge on this topic based on available research.

Methods: A literature review was conducted using the PubMed, Medline, and Google Scholar databases / search engines, focusing on local antibiotic prophylaxis in breast implant reconstruction.

Results: A total of seven studies meeting the inclusion criteria were selected from 79 articles. Across all studies, seven different antibiotic irrigation solutions were compared, involving a total of 2,637 patients.

Conclusion: The study findings suggest that local antibiotic prophylaxis is effective in preventing early surgical site infections and capsular contracture. However, the method-ology and study design raise concerns about potential bias and the overall reliability of the results. We believe that this issue remains insufficiently explored and that further high-quality evidence is necessary to establish its efficacy. A clearly defined protocol should be developed and incorporated into official guidelines.

Peripheral nerve injury (PNI) is defined as a disruption of the nerve's structure resulting in a loss of function. Discoveries in the 18th and 19th centuries transformed the under-standing of nerve pathophysiology and laid the groundwork for current knowledge, including the processes of central stump regeneration and peripheral stump degeneration (Wallerian degeneration). While lower-grade PNI can heal spontaneously, the disruption of axonal and endoneurial continuity often requires surgical intervention. Surgical indications should be guided by clinical examination and imaging methods; however, electromyography (EMG) plays a pivotal role in planning. Open PNI, such as in a sharp injury, should be treated immediately with primary suture (neurorrhaphy). In contrast, for closed injuries, revision surgery is considered based on EMG findings 3-4 months post-injury, when spontaneous nerve regeneration has been ruled out. Surgical options include neurolysis, neurorrhaphy, nerve grafting, or nerve transfer. The choice of the procedure depends on the extent, nature, and location of the PNI. Key prognostic factors include the timing and precision of the surgery, the distance of the injury from the target organ, the length of any nerve defect, as well as the patient's age and comorbidities. Intensive postoperative rehabilitation is an essential part of comprehensive care. Approximately 50-75% of PNI patients regain satisfactory nerve function. Future concepts with potential to improve this outcome include synthetic nerve grafts, immunomodulators, stem cells, and optogenetic modulation of injured nerve behavior.

Introduction and aims: The training of young surgeons in the Czech Republic includes the completion of mini-invasive, laparoscopic simulation courses on a voluntary basis. The aim of this study is to show how simulation is used now to train surgeons and to look back at 10 years of running a simulation, laparoscopic, mini-invasive course from the graduates' points of view using box and virtual reality simulators.

Type of study: Observational, survey.

Methods: Data were collected from 26 courses (2014-2024) by an anonymous question-naire. The questionnaires were completed by all graduates (100%). Their evaluation was done by the descriptive statistics method. Questions were asked about expecta-tions and fulfilment of the expectations from the course with its possible recommendation and financial cost.

Results: A total of 96 doctors, 55 men and 41 women, participated in the courses. The questionnaires were completed by all participants. In 89 cases (92.7%), the candi-dates wanted to learn the correct technique, tips, and tricks in laparoscopic surgery; in 42 cases (43.8%), they expected an increase in the operative time; and in 37 cases (38.5%), a deepening of anatomical and theoretical knowledge was mentioned. The course completely fulfilled the expectations in 92% of the cases, in 6.0% of the cases, it fulfilled them with minor reservations and in 2.0% it fulfilled them partially. Ninety seven percent of participants would recommend the course as compulsory; 3% would leave its recommendation to the discretion of the graduate. Twenty-eight participants (29.2%) fully paid for the course; 5 (5.2%) participants partially paid; and 63 (65.6%) participants received payment from their employer.

Conclusion: The participants recommended the simulation course for compulsory inclusion in the surgical education curriculum, and about one-third of them also expressed willingness to pay for the optional education. Although simulators and simulations in surgery represent an important training potential, the subsequent role of mentor in the form of certified, experienced colleague(s) cannot be replaced by them.

Introduction and aim: For a correct assessment of anorectal dysfunction, adequate physical and imaging examinations are required. The aim of our study was to evaluate the use of MRI defecography in patients with anorectal dysfunction. Its comparison with anorectal manometry, standard clinical examination, and patients' subjective perceptions.

Type of study: An observational, retrospective analysis.

Methods: Forty patients with symptoms of anorectal dysfunction referred to a colorectal clinic between 9/2022 and 5/2023 participated in the study. All underwent proctological examination, anorectal manometry and MRI defecography. The results of the study were statistically processed with Statistica 12.0 software.

Results: The average age of the patients was 55 years. Primary complaints were obstipation in 60% of patients, fecal incontinence in 33%, 1 patient had proctalgia and 2 patients presented for rectal prolapse. On clinical examination, 20% of patients had rectoanal intussusception and 15% had complete rectal prolapse. A total of 36% of patients reported concomitant urinary incontinence. Pelvic floor drop in the anterior compartment was also demonstrated in patients who had physiological internal sphincter function according to anorectal manometry, however, due to the small sample size, only a trend was observed and statistical significance of these differences was not -reached (P = 0.109). Patients without evidence of obstructive defecation syndrome on anorectal manometry had complete rectal emptying on MRI defecography (P = 0.0598).

Conclusion: Dynamic MRI defecography can identify anatomical and functional abnormalities of the pelvic floor. The main use of the method is in the detection of multi-compartment pathology. Multidisciplinary collaboration is required to interpret the results and establish an accurate diagnosis.

Clinically relevant variations in the area of the groove for the ulnar nerve include accessory muscles, accessory bones, and fibrous structures. Accessory muscles involve the epitrochleoanconeus muscle, chondroepitrochlearis muscle, and high origin of the pronator teres muscle. The nerve can also be compressed by the medial head of the triceps brachii muscle. Fibrous structures are found proximally, distally to the cubital tunnel, or directly at the location of the cubital tunnel and can cause compression of the ulnar nerve. Structures located proximally to the cubital tunnel include the medial intermuscular septum of the arm and Struthers' arcade. The roof of the cubital tunnel is formed by Osborne's ligament, which can cause compression of the ulnar nerve. Its absence is a predisposing factor for nerve dislocation. Among the bony structures, the clinical significance lies in the variability of the depth of the groove for the ulnar nerve. A shallow groove is a predisposing factor for compression of the ulnar nerve, especially during elbow flexion, which can lead to its subluxation or dislocation. The ulnar nerve itself also shows considerable variability. The ulnar nerve gives off branches inner-vating the joint capsule and motor branches for the both heads of the flexor carpi ulnaris muscle and a part of the flexor digitorum profundus muscle. Articular branches can hinder sufficient mobilization of the nerve during transposition, which can be over-come by intraneural dissection. During transposition, it is important to protect the motor branches to prevent paresis of the innervated muscles. The variability of anatomical structures in the groove for the ulnar nerve is cru-cial for clinical practice, as it can complicate surgical approaches to the elbow, limit ulnar nerve transposition, or contribute to the development of cubital tunnel syndrome.