Rozhledy v Chirurgii最新文献

Anatomical terminology is a key tool for describing the human body. It uses Latin and Greek terms, with the second latest version, Terminologia Anatomica from 1998, being the officially recognized nomenclature version in our country. The development of the anatomical terminology has been long and complex, and challenges still persist. An eponym (a name derived from a person) is a commonly used linguistic tool; in anatomy, eponyms are practical due to their brevity, but they can be unclear to non-experts. This article discusses the use of eponyms in anatomy, which were completely excluded from the official anatomical nomenclature in 1955 (Parisiensia Nomina Anatomica), yet they continue to be used in clinical practice and anatomical literature. In some cases, -eponyms have made their way into official nomenclature, such as Purkinje layer and cel-ls or Schwann cells. However, this article primarily provides an overview of anatomical eponyms, their Latin equivalents, and basic information about the individuals behind the eponyms related to abdominal and pelvic structures, particularly the body sur-face, organ projection, abdominal wall structure, fasciae, peritoneal cavity and its recesses and folds.

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.

Introduction: Thoracic drainage is a standard component of lung resections. It serves as a postoperative control of the pleural cavity, drains fluid, and detects air leaks. The digital drainage system allows more accurate detection and quantification of air leak.

Aim and methods: The primary objective of this study is to compare the duration of drain-age with a conventional three-chamber drainage system versus the Medela Thopaz+ digital drainage system in patients undergoing lung resection for tumor. This is a prospective randomized study, conducted between 2017-2020. A total of 154 patients were enrolled in the study, divided into two groups, a group using conventional chest drain-age (group K, N = 84) and a group using the digital chest drain (group D, N = 70). In these groups, patients were then divided according to the extent of lung resection (anatomical, group A, and non-anatomical, group N).

Results: There was no significant difference in drainage duration between digital and conventional drainage in the study group (drainage duration: group A, P = 0.865, group N, P = 0.775). The incidence of air leak was 33% in group K and 52% in group D, of which prolonged air leak occurred in 3.6 vs. 2.8% (K vs. D).

Conclusion: Digital chest drainage does not affect the duration of drainage and thus shorten hospital stay, considering the extent of lung resection. However, it represents a more accurate and easier control of postoperative air leak and pleural secretion. The advantages include the easy handling of the device and the possibility of reusing the drain with a reduction of costs.

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.

Introduction: Gastric bypass has not gained as much popularity in the Czech Republic as technically simpler restrictive bariatric procedures, frequently with a fading long-term effect. The aim of the presentation is to point out the long-term results after two types of gastric bypasses.

Method: Retrospective analysis of prospectively collected data in an initial set of patients after laparoscopic RYGB (Roux Y gastric bypass) and OAGB/MGB (one anastomosis/mini gastric bypass) performed at Breclav Hospital in 2010-2013. Evaluation based on the BAROS system, according to weight development, comorbidities, psychological aspects, complications and reoperations.

Results: Data available for evaluation are from 32 patients out of a total of 60; the follow-up rate is 53%. The patients are lighter by 34 kg on average (0-64 kg); TBWL (total basic weight loss): 25.7%. The majority of operated diabetics are free of signs of diabetes, and all others have a reduced need for antidiabetic medication. Hypertension, sleep apnea and psychological assessment of life in 6 domains improved. Eight of the 32 followed patients underwent reoperation during 10 years; only 2 of these procedures were acute for complications (anastomotic ulceration), both in smokers; further elective reoperations included 2 conversions of OAGB/MGB to RYGB due to reflux, 2 corrective surgeries, and 2 procedures for a suspected internal hernia. There was no conversion from laparoscopic to open surgery, no peritonitis associated with a leak, and no mortality within 30 days. The BAROS score (5.56) indicates a "very good result" of the gastric bypasses after 10 years.

Conclusion: Gastric bypasses are safe and provide a high and lasting metabolic effect that meets the general expectations of an invasive intervention that can fundamentally improve the quality of treatment for otherwise incurable chronic diseases related to adiposity (so-called ABCD), especially type 2 diabetes.

Introduction: Thanks to mammographic screening and the improvement of breast cancer diagnostics, the detection of precancers is also increasing. They are defined as morphological changes of the mammary gland which are more likely to cause cancer. The evaluated precancers are atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS) and radial scar.

Methodology: In the period 1. 1. 2018-31. 12. 2022, we performed 1,302 planned operations for breast disease at the Surgical Clinic of Teaching Hospital Plzeň, of which 30 (2%) were precancer operations. ADH was confirmed 11×, LCIS 8×, and a radical scar 11×. The average age of the patients in all three groups was 56 years (27-85). Precancer was diagnosed 8× only by sonography, 3× by mammography and 19× by a combination of both methods. Subsequently, a puncture biopsy was always completed. We performed 28 tumor excisions with intraoperative biopsy and 2 mastectomies.

Results: In the case of ADH from puncture biopsy, ADH was confirmed intraoperatively 8×, DCIS was diagnosed 2×, and mucinous carcinoma 1×. In LCIS, no tumor was found by intraoperative biopsy 4×, LCIS was confirmed 1×, lobular invasive carcinoma was diagnosed 1×, mastectomy was performed 2× without intraoperative biopsy. In the radial scar, ADH was diagnosed 3×, sclerosing adenosis 6×, DCIS 1×, invasive carcinoma 1×. After the final histological processing of the samples, there was an increase in diagnosed carcinomas. In ADH, DCIS was confirmed 3×, DIC 2×, and mucinous carcinoma 1×. In LCIS, LIC was diagnosed 3×. In the radial scar, DCIS was confirmed 1×, and invasive carcinoma remain 1×. Thus, carcinoma was diagnosed in 11 patients (37%) thanks to the surgical solution. No patient underwent axillary node surgery. All 11 patients subsequently underwent oncological treatment, always a combination of radiotherapy and hormone therapy. All patients are alive, 10 patients are in complete remission of the disease, one with DCIS experienced a local recurrence after 4 years.

Conclusion: Surgical treatment of precancers of the breast makes sense, DCIS or even invasive cancer is often hidden in addition to precancer. Thanks to the surgical solution, the cancer was detected in time.

This paper provides a brief overview of current information and recommendations for surgical treatment of breast cancer in pregnancy, including three currently controversial areas - indications for breast-conserving surgery in the 1st trimester of pregnancy, indications for sentinel lymph node biopsy and its technique, and fetal monitoring during surgery.