Rozhledy v Chirurgii最新文献

Diverticulitis of the colon, i.e. inflammation of one or more diverticula, is the most common manifestation of diverticulosis, which affects more than 60% of people over the age of 70 in developed countries. Acute diverticulitis includes a range of degrees of inflammatory involvement, from mild diverticulitis to stercoral erythematosis. The diagnosis of diverticulitis of the colon has changed, especially in the last 30 -years. Imaging using ultrasound and computed tomography allows the assessment of the severity and extent of inflammation without surgery expressed by classification and facilitates the decision on the choice of treatment. Treatment has also changed. Uncomplicated diverticulitis can now be treated without antibiotics and without hospitalization, abscesses can be evacuated by percutaneous guided drainage. The basis of the surgical treatment of peritonitis of diverticular origin remains the arrest of contamination and sanitation of the abdominal cavity.  Mere diversion is insufficient. An effective solution is resection of the inflamed or perforated segment of the intestine, a new option is laparoscopic lavage. The best results are -achieved by intestinal resection with primary anastomosis; which should be established only if certain conditions can be met. Exclusion of the anastomosis reduces the demands of the operation, but generally leads to worse results. Despite the recommendations -based on EBM, opinions on the choice of operation are still not clear today. The text presents the development of diverticulitis treatment, arguments in favor of or against resection with anastomosis, resection with exclusion of the anastomosis and laparoscopic lavage. The conditions of the procedures, especially the safe establishment of the anastomosis, and current recommendations are presented.

Introduction: Coral reef aorta (CRA) is a rare clinical entity characterised by hard, protruding calcifications in the juxta and supra-renal aorta, which cause haemodynamically significant stenosis of the aorta and its branches. We are presenting a case report of a 65-year-old female patient with bilateral 30-meter claudication on both lower extremities and a haemodynamically significant stenosis of the left renal artery.

Case report: The patient underwent computed tomography angiography (CTAG) of the abdominal aorta and lower extremities. CTAG revealed severe abdominal aortic wall calcification with circular atherosclerotic calcification in the area of the renal arteries branch off, causing haemodynamically significant stenosis of the aorta and the left renal artery. The patient was scheduled for an elective open surgery. The left retroperitoneal approach dissects the abdominal aorta, including both renal arteries. -Cross-clamps were placed on both renal arteries, the subrenal aorta and the suprarenal aorta, just below the superior mesenteric artery. Circular aortic calcifications protruded through the aortotomy, and aortal endarterectomy was performed. The calcific plaques extend-ing to the left renal artery were dissected similarly. Identically, an endarterectomy of both common iliac arteries orifice was performed.

Result: The patient was discharged on the 8th postoperative day with excellent renal parameters, normal left kidney perfusion, and without limiting claudications on both lower extremities. Currently, we have a 12-month follow-up with the patient.

Conclusion: CRA is a rare clinical entity. The optimal treatment has yet to be established. Up-to-date, the gold standard treatment for CRA is surgical endarterectomy.

Introduction: The authors discuss the history of carotid disease and injuries and focus on historical milestones of carotid endarterectomy worldwide and in Bohemia.

Results: The first part discusses the carotid artery and ischemic stroke, beginning with Hippocrates' description of apoplexy. It then highlights Willis's discovery of the collateral circulation, followed by the 19th-century thromboembolic theory of ischemic stroke caused by carotid artery occlusion, which is associated with the work of Wirchow and Chiari. Then, in the 1950s, C. M. Fisher visionarily pointed out the possible surgical management of carotid stenosis in the prevention of stroke. In the second part, carotid ligature, treatments for arterial injuries are mentioned, starting with A. Paré in 1552, to ligature of the extracranial carotid artery for intracranial aneurysm by V. Horsley in 1885. The third part describes the history of reconstructive carotid surgery, especially carotid endarterectomy worldwide, with the priorities of Carrea, Eastcott and DeBakey in the early 1950s. The priority in Bohemia belongs to Jaroslav Lhotka, who published his results in 1962.

Conclusion: The authors summarize the history of carotid disease, especially carotid endarterectomy, worldwide and in Bohemia.

Background: Upper gastrointestinal bleeding is a relatively common but potentially fatal medical emergency. Many medical disciplines are involved in the diagnosis and treat-ment of this condition. The patients are usually admitted primarily to surgical wards and the attending surgeon is responsible for management of the patients. Surgery may also be an ultimatum refugium when less invasive treatments fail.

Objective: The aim of this study is to review the current practice in the management of patients with upper gastrointestinal bleeding based on a literature review and our own experience in the management of these patients.

Conclusions: Upper gastrointestinal bleeding is a relatively common emergency. It is a hemorrhage whose the source is proximal to the ligament of Treitz. The diagnosis and treatment require a multidisciplinary approach. Today, endoscopy plays a key role in the diagnosis and treatment. The correct timing of each step is essential for patient survival. This article provides a clear summary of the current recommended procedures from initial resuscitation, fluid therapy, administration of blood substitutes, ad-justment of coagulation parameters in patients on anticoagulant and antithrombotic therapy, endoscopic diagnostic and therapeutic options, and procedures for recurrent bleeding, including angiointervention and surgical treatment, with a main focus on nonvariceal bleeding.

Introduction: The author presents two case reports of the use of angioembolization in the therapy of bleeding from an injured spleen, he discusses indications, benefits and risks of its use. The case reports: Two case reports of use of angioembolization in the treatment -grade 3 spleen injury are presented. In both patients, we were successful in salvaging the spleen, but in both cases it was complicated by febrile reaction and considerable elevation of CRP, which required administration of antibiotics and even elective splenectomy was considered. The question is whether angioembolization was not rather counterproductive in these patients.

Conclusion: Angioembolization is a first choice method in hemodynamicaly stable patients with active bleeding from an injured spleen, but it has also some drawbacks and some, not negligible, morbidity. It should not be overused in patients who do not fulfill the criteria for its use.

Watch-and-wait (WW) strategy offers an alternative to radical resection with total mesorectal excision (TME) in selected patients with distal rectal adenocarcinoma after achieving complete clinical response (cCR) to neoadjuvant therapy. This approach is based on intensive follow-up, where a multidisciplinary team, especially the surgeon, is confronted with a demanding follow-up regimen including repeated anorectoscopies, per rectum examinations and magnetic resonance imaging. The prediction of pathological complete response in cCR is particularly problematic. The risk of recur-rence (regrowth) in cCR is a key factor, which occurs in 26-36% of patients, especially during the first 3 years of follow-up, and increases the risk of metastasis. Early salvage R0 resection is indicated when regrowth is detected and is feasible in more than 90% of cases. WW offers comparable oncologic outcomes in compliant patients and better functional outcomes compared to TME in patients with pCR.

Introduction: With the introduction of the Da Vinci Xi robotic system, there has been an exponential development of robot-assisted surgical interventions. The benefits of robotic surgery are also successfully used in the field of pancreatic surgery. We present a case report of a 24-year-old female with solid pseudopapillary neoplasia of the pancreas operated on using this robotic system.

Case report: A young female patient with symptomatic solid pseudopapillary neoplasia of the cauda of the pancreas underwent robot-assisted spleen-preserving distal pancreatectomy (the Kimura procedure). The operation was performed according to the plan with the use of the Da Vinci Xi robotic system without complications. The post-operative course was smooth with subsequent discharge on the sixth postoperative day. Further postoperative development was favorable and the patient is in good general condition six months after the operation.

Conclusion: Robot-assisted surgical procedures also bring a number of advantages to the field of pancreatic surgery, which can be achieved safely and minimally invasively even in anatomically unfavorable terrain with the help of a robotic system. Although presenting a technically challenging method, it is a safe method in the treatment of benign and low-grade malignant pancreatic neoplasia.

Sarcomas are rare malignant mesenchymal tumors, occurring both in the childhood and in adult population. The differential diagnosis of soft tissue lesions includes a wide range of tumors with different clinical manifestation and biological behaviour. Clinical examination of superficial lesions is insufficient and often leads to an underestimation of the extent of the disease. Correct diagnosis and operative technique are key parameters to avoid unnecessary excessive resections in benign tumors, or, on the contrary, non-radical procedures in malignant tumors. Many of the patients are examined late. Unplanned surgical resections represent a major problem in local control of the dis-ease. The goal of this work is to increase the awareness of the medical professionals in the field of soft tissue tumors.

Introduction: Carotid endarterectomy (CEA) is performed by surgeons, vascular surgeons and neurosurgeons. This article aims to familiarize the reader with the neurosurgical principles of CEA.

Results: CEA anesthesia can be locoregional or general. In neurosurgical departments, both techniques are utilized according to standard practices. Both techniques are used in our department, with general anesthesia predominating. A microscope is always used during surgery. The advantages are magnification, perfect illumination and precise dis-obliteration. The gentle running suture allows minimal prevention of the vessel wall and substantially reduces the risk of residual stenosis/restenosis. The use of shunts is strictly selective. We use dominantly somatosensory evoked potentials in combination with EEG to monitor the need for shunt. We rarely use the eversion endarterectomy technique in carotid artery kinking with an abundant vessel wall.

Conclusion: The neurosurgical principles of carotid endarterectomy are characterized by a microscope/exoscope, microsurgical technique, and selective use of shunt. The dominant neurosurgical technique remains microendarterectomy with primo suture of the artery.

Anatomical terminology has developed over a long period of time and has undergone several revisions with the aim of unifying the nomenclature. The first systematization was created under the name Basiliensia Nomina Anatomica in 1895, the first international anatomical nomenclature Parisiensia Nomina Anatomica was adopted in 1955 and was subsequently modified until the Terminologia Anatomica version (1998). The latest revision of Terminologia Anatomica 2 (2019) caused controversy due to changes in established terms, leading to a split in opinion among experts. The Czech Anatomical Society continues to acknowledge the Terminologia Anatomica first published in 1998. Czech anatomical terminology developed less dramatically, the first systematic attempts at Czech medical terms date from the 14th-16th centuries. Significant contributions were made during the national revival and thanks to the efforts of personalities such as Wáclaw Staněk, whose work on Czech anatomical nomenclature was unfortunately not completed. The last attempt at unification was the publication of the Czech Anatomical Nomenclature in 2010. Clinical medicine did not have time enough to follow the frequent changes in anatomical nomenclature, which led to the mixing of different versions of the terms and the emergence of "clinical dialect". This resulted in inconsistencies, for example, in the naming of lymph nodes. Our contribution provides an overview of the use of older (obsolete/invalid) anatomical terms, both Czech and Latin; examples of introduced Latin terms, inaccurate use of terms, clinical simplification, spelling errors, and missing anatomical terms. Confusion in terminology can lead to misunderstandings in communication between physicians themselves, physicians and patients as well as teachers and students. Therefore, the anatomical nomenclature should be simple, clear, unanimous, uniform and widely accepted in order to serve for clear communication and prevent possible misunderstandings, errors or complications.