Rozhledy v Chirurgii最新文献

Introduction: Primary hyperparathyroidism (PHPT) is most commonly caused by a solitary parathyroid adenoma. The relationship between parathyroid hormone (PTH) lev-els and adenoma size remains unclear.

Methods: A retrospective analysis of 377 PHPT patients who underwent surgery at Third Department of Surgery, First Faculty of Medicine, Charles University and Motol University Hospital (2022-2023). Adenoma volume was calculated as an ellipsoid. The cor-relation between PTH and adenoma volume was assessed using regression analysis.

Results: A weak to moderate correlation was found (R = 0.315; P < 0.001). Linear regres-sion showed that a 1 pmol/L increase in PTH corresponded to an average adenoma volume increase of 104 mm³.

Conclusion: Preoperative PTH levels partially correlate with adenoma volume, but their predictive value is limited.

Although the insertion of a chest drain is a minor and common surgical procedure performed across all types of surgical departments, it continues to raise some uncertainties in clinical practice regarding indications, optimal timing of removal, and management of potential complications. Moreover, chest drainage is often performed by physicians from non-surgical specialties, particularly in intensive care settings or pulmonary departments. The aim of this review article is to clarify the key aspects of chest drainage through easily applicable recommendations based on current scientific evidence. The publication primarily focuses on the acute insertion of chest drains for pneumothorax and pleural effusion, addressing the anatomical and technical specifics of the procedure, proper localization of the drainage site, selection of an appropriate drain, principles of patient care, prevention and recognition of potentially serious conditions, and management of the most common complications.

Multiple primary malignancy is defined as the occurrence of two or more primary malignancies in one patient. Although this is a rare situation, its occurrence has been increasing over the last decade. Patients with an oncological disease have up to a 20% higher risk of a new primary oncological disease compared to the general population. Depending on the time interval between the diagnosis of individual malignancies, we divide multiple cancer cases into synchronous and metachronous. The diagnosis of four synchronous malignancies is extremely rare. In our case report, we present a patient with caecal adenocarcinoma, hepatic flexure adenocarcinoma, clear cell carcinoma of the right kidney and pheochromocytoma of the right adrenal gland occurring synchronously.

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.

Introduction: Lumbar hernia in the pediatric population is an extremely rare diagnosis and therefore requires specific diagnostic and therapeutic approaches. This case report describes the first published case of a pediatric lumbar hernia in the Czech Republic.

Case description: A 22-month-old boy was examined at a pediatric surgical clinic due to a soft reducible mass in the right lumbar region, which, according to his mother, has been present from birth. An ultrasound scan confirmed a defect in the anatomical localization of the superior lumbar triangle (the triangle of Grynfeltt-Lesshaft) measur-ing 17 × 11 mm with a bowel loop herniation. The patient underwent a skeletal X-ray and an abdominal ultrasound in order to rule out associated malformations, following which he was scheduled for an open hernioplasty. Given the small size of the defect, a primary closure without mesh hernioplasty was performed. The postoperative course was uneventful and at clinical follow-ups the patient showed no signs of hernia recurrence or growth asymmetry.

Conclusion: Lumbar hernia in children is congenital and frequently occurs with other associated malformations, which must be ruled out. The type of operation depends on the size of the defect and its purpose is to provide a tension-free closure.

Every patient with oligometastatic disease should be discussed within a multidisciplinary team.The intention of treating oligometastatic disease is curative in most cases. Surgical treatment is essential, and can be combined with ablation methods. Oncological criteria that describe the risk of progression/relapse help select patients who benefit most from neoadjuvant/perioperative chemotherapy. For optimal selection of systemic treatment for metastatic colorectal cancer, knowledge of predictive molecular factors is necessary. These include determination of RAS, BRAF and MMR/MSI. The basis of systemic treatment is chemotherapy based on combinations of fluoropyrimidines, oxaliplatin or irinotecan. A special group  includes patients with dMMR/MSI-high tumors, which are very sensitive to the treatment with modern immunotherapy with checkpoint inhibitors. The question of the indication of immunotherapy in the case of resectable metastases has not been resolved yet.

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.