搜索结果：Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti

This article focuses on gynecological causes of acute abdominal emergencies, which represent serious conditions requiring prompt diagnosis and treatment. It describes their pathogenesis, clinical presentation, diagnostic procedures, and therapeutic options. As a review paper, its aim is to identify the most common indications for urgent gynecological intervention and to facilitate differential diagnosis in acute zone, particularly within surgical outpatient departments. Gynecological causes are categorized into three main groups: non-infectious, infectious, and emergencies associated with early pregnancy. The article provides a detailed overview of expected findings from lab-oratory tests and transvaginal gynecological ultrasound examination. For each condition, surgical management is described, with laparoscopy being the preferred ap-proach in gynecological cases.

A 90-year-old man with type 2 diabetes mellitus, hypertension, and hyperlipidemia was admitted for vascular evaluation due to a progressively enlarging mass on the right side of the neck. Ultrasound examination revealed a pseudoaneurysm at the bifurcation of the right common carotid artery. Clinically, a pulsatile, painless mass measuring 6 × 4 cm was present without overlying skin erythema. CT angiography confirmed the diagnosis of a pseudoaneurysm with a thickened wall and a wide neck. Following a multidisciplinary discussion, the patient was indicated for an endovascular procedure. A stent graft was deployed across the aneurysmal neck, and embolization of the external carotid artery trunk was simultaneously performed via the right common femoral artery. The procedure resulted in complete exclusion of the pseudoaneurysm and regression of the neck mass without any neurological impairment. The etiology of the pseudoaneurysm remained unclear; however, an infectious origin was considered most likely given the positive blood cultures for Staphylococcus aureus and the absence of any prior intervention or trauma to the cervical region.

Colorectal surgery is associated with a high risk of postoperative complications, particularly infections. In recent years, the role of the microbiome in this context has been increasingly discussed. Probiotics and synbiotics are being investigated as potential tools for modulating the microbial environment and improving surgical outcomes. This review article summarizes the available evidence from randomized con-trolled trials, meta-analyses, and systematic reviews evaluating the effects of probiotics and synbiotics on the incidence of complications and postoperative recovery in patients undergoing colorectal surgery. Current studies indicate that the administration of probiotics and synbiotics may reduce the risk of infectious complications, modulate systemic inflammatory responses, accelerate the restoration of bowel function, and shorten the duration of antibiotic therapy. Data regarding their impact on anastomotic leakage remain limited. The intervention appears to be well tolerated and safe. Perioperative administration of probiotics or synbiotics represents a promising and cost-effective intervention in colorectal surgery. However, larger and more standardized trials are required to prove the effect, determine the optimal composition, dosage, and duration of therapy before routine clinical implementation.

Head trauma is one of the most challenging injuries a trauma victim can suffer, as it can impair airway patency and complex neurological function. Most of these patients with gunshot head injuries do not reach the hospital alive. We conducted a survey about early mortality, comparing head injuries and their outcome to other injury locations. All patients admitted between October 2000 and May 2005 to the Trauma Unit at Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa. The criteria for inclusion were an injury to the cerebrocranium or other body locations with a documented evaluation of a) systolic blood pressure on admission; b) inspection of the trauma and - in case of penetrating injury - the weapon type; and c) consciousness on admission (N = 214). After data analysis, there was a 50% share of penetrating injuries in the emergency department; with half gunshot wounds and half stab wounds occurring. While blunt injuries occurred at 39%, burns were at 4%. As can be deduced, of the three major injury mechanisms of gunshot wounds, stab and blunt injuries, there is a 5% to 6% mortality for gunshot wounds and blunt patients, while stab injuries carry an early 1% mortality. Patients with head injuries die after a longer interval and reach plateau, several hours later than other observed injuries. In mixed blunt and penetrating trauma injuries, head injuries account for the highest mortality rate; especially gunshot wounds of the head, with an early demise of around 40%.

The posterior thigh flap is a fasciocutaneous flap predominantly based on perforating branches of the profunda femoris artery and the medial circumflex femoral artery, with additional vascular supply from perforators of the inferior gluteal artery. It can be used for reconstruction of perineal defects. We describe the case of a 40-year-old man with extensive Fournier's gangrene resulting in complete loss of perineal skin coverage, the entire scrotum, and a large portion of penile skin. After radical necrectomies, intensive resuscitation for septic shock, and supportive therapy including hyperbaric oxygenation, the defect was reconstructed using bilateral posterior thigh flaps. All procedures were in accordance with the Helsinki Declaration. The postoperative course was uneventful. Both flaps remained fully viable, and donor sites healed per primam. No further necrectomy or surgical revision was needed. The posterior thigh flap represents a reliable and safe method for reconstruction of extensive perineal defects with acceptably low donor-site morbidity.

Immediate breast reconstruction (IBR) with implants has become an integral part of comprehensive care for patients undergoing mastectomy for breast cancer. This review summarizes current evidence on indications, contraindications, surgical techniques, complications, and clinical outcomes of IBR with an implant. Properly selected pa-tients benefit from enhanced psychological well-being, shorter recovery, and improved cosmetic results. IBR is primarily indicated in women with stage T1-T2 tumors without metastases. Contraindications include advanced disease, the requirement for adjuvant radiotherapy, comorbidities such as diabetes mellitus, obesity, or smoking, and poor skin flap qual-ity. The most widely used surgical approach is the direct-to-implant (DTI) technique, allowing definitive reconstruction in a single operation. Potential complications include infection, seroma, capsular contracture, skin necrosis, and implant exposure. Their incidence depends on tissue quality, surgical exper-tise, and patient-related risk factors. Current studies demonstrate that IBR does not adversely affect oncologic safety nor delay adjuvant treatment. In addition, IBR has been shown to be cost-effective and to yield high patient satisfaction, particularly in domains of body image, sexuality, and psychosocial adjustment. In conclusion, IBR with implants represents a safe and effective reconstructive option for appropriately selected patients.

Burn injuries represent a significant healthcare challenge requiring specialized care and efficient patient transport to appropriate facilities. This article focuses on optimizing the transfer of burn patients of all ages to specialized burn centers in the Czech Republic. It analyzes key factors determining the necessity of transfer, such as the extent, depth, and localization of burns, the presence of inhalation trauma, or severe comorbidities. The article also highlights the importance of burn centers in providing comprehensive diagnostic, therapeutic, and rehabilitative care that addresses not only physical but also psychological aspects of treatment. It proposes recommendations for effective triage and offers practical guidance for healthcare personnel to ensure safe and efficient patient transport, ultimately leading to improved treatment outcomes and higher quality care for burn patients.

This report on neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, highlights the diversity of clinical manifestations associated with this condition. In addition to the predominant neurological symptomatology, this work also reveals the rarer involvement of the gastrointestinal tract in the form of an associated gastrointestinal stromal tumor (GIST). NF1 is an autosomal dominant genetic disorder with multisystem involvement, most commonly affecting the nervous system, skin, and skeleton. In approximately 7% of patients with NF1, a GIST may develop, representing the most frequent intestinal manifestation of neurofibromatosis. The case of a female patient with genetically confirmed and previously known NF1 initially presented with vertigo, anemia, and melena, ultimately leading to the diagnosis of a bleeding GIST. The tumor was confirmed only through histological examination following intestinal resection. In patients with NF1, GIST typically presents as multifocal disease with distinct biological behavior and absence of classical mutations. The primary treatment is surgical resection, indicated based on symptoms or tumor size. Hemorrhage from GIST represents both a diagnostic challenge and a serious complication, which could be mitigated through targeted surveillance, facilitating earlier detection and optimal timing of intervention.

Bariatric surgery is an effective treatment for severe obesity, offering substantial improvements in patients' metabolic profiles. However, increasing attention is being paid to potential long-term complications, including malignancies developing in the excluded portion of the stomach - an area that poses significant diagnostic challenges. We report the case of a 68-year-old woman with a history of biliopancreatic diversion, who was diagnosed with advanced diffuse gastric carcinoma 10 years after surgery. The clinical presentation was non-specific, and both laboratory and imaging studies repeatedly yielded false-negative results. A definitive diagnosis was established only during diagnostic laparoscopy - unfortunately, at a stage too advanced for curative treatment. This case underscores the risk of late-onset malignancy in the excluded stomach following bariatric surgery and highlights the considerable diagnostic difficulties. Early detection requires a high index of clinical suspicion, access to advanced endoscopic techniques, and close multidisciplinary collaboration. The absence of standardized screening protocols further hampers timely diagnosis.

Mediastinal tumors represent a wide spectrum of epithelial, mesenchymal, neuroectodermal, embryonal, germ cell, and mixed neoplasms. Nevertheless, their incidence is low, accounting for approximately 1% of all neoplasms, and clinical presentation is often nonspecific usually reflecting advanced-stage disease. Primary mediastinal tumors must be distinguished from secondary tumors and so-called pseudotumors. From the perspective of their classification, diagnostics, and therapy, the anatomical--topographical division of the mediastinum into compartments is essential, as it may facilitate identification of individual lesions based on their typical localization and imaging characteristics. Surgical resection represents the first-line therapeutic modality for the majority of mediastinal lesions, with the exception of lymphomas and germ cell tumors. Authors present an overview of mediastinal tumors in adults, including their diagnosis and treatment.

Pneumoperitoneum is defined as the presence of free air within the peritoneal cavity. In approximately 90% of cases, it results from gastrointestinal perforation and requires urgent surgical intervention. The remaining 10% represent nonsurgical (spontaneous) pneumoperitoneum, in which no perforation is detected and conservative management is usually sufficient. Etiologically, nonsurgical pneumoperitoneum can be classified into pseudopneumoperitoneum, intrathoracic, abdominal, gynecological, and idiopathic categories. Intrathoracic causes include air migration from the chest during mechanical ventilation, cardiopulmonary resuscitation, or spontaneous pneumothorax. Abdominal causes involve rupture of cysts in pneumatosis cystoides intestinalis, perforation of hepatic or splenic abscesses, barotrauma, endoscopic complications, and infections by gas-producing bacteria. Gynecological causes are associated with vaginal insufflation, sexual intercourse, or instrumentation. In a minority of cases, the etiology remains idiopathic. Differentiating between surgical and nonsurgical pneumoperitoneum is crucial, as unnecessary laparotomies are reported in up to one quarter of patients. Decision--making requires comprehensive clinical evaluation, thorough physical examination, and imaging studies, particularly contrast-enhanced CT. In the absence of peritonitis or sepsis, conservative management with observation, antibio-tics, and symptomatic therapy is recommended. Accurate dia-gnosis and awareness of the rare, nonsurgical causes of pneumoperitoneum are essential to prevent unnecessary surgical interventions and to optimize patient care in this potentially critical condition.

The exclusion of free intraperitoneal gas (pneumoperitoneum) is one of the most common indications for imaging in patients presenting with clinical signs of acute abdominal pain. Among radiological methods, upright abdominal and chest radiographs are commonly used for the dia-gnosis of pneumoperitoneum; however, they have the lowest reported sensitivity for detecting free intraperitoneal air. Native or contrast-enhanced computed tomography is considered the gold standard in this dia-gnostic setting, although it exposes patients to the highest levels of ionizing radiation. Ultrasonography is also used in the dia-gnosis of pneumoperitoneum, but it is a highly operator-dependent modality, relying significantly on the examiner's experience. This article presents typical imaging features of pneumoperitoneum across various modalities, as well as less common and potentially misleading findings.

Three-part pertrochanteric fractures with a large posterior fragment have been reported both in historical and recent 3D CT studies, however, without a detailed description. From the collection of the Institute of Anatomy, the authors obtained 6 specimens of hip joints of individuals who had sustained a three-part pertrochanteric fracture with a large posterior fragment, and 7 patients with the same type of fracture were identified in a cohort of 56 patients with a trochanteric fracture documented by 3D CT reconstructions. The study focused on the anatomy of the posterior fragment, the courses of the fracture lines, the integrity of the medial cortex and the lateral trochanteric wall. Two types of the posterior fragment were identified, the quadrangular and the triangular ones. Separation of either of them markedly weakened the lateral trochanteric wall, more specifically, one quarter to two-thirds of its lateral surface. The triangular fragment was associated with shear instability on the medial aspect of the proximal femur and was markedly displaced in 5 of 7 cases. Exact identification of the shape and size of the posterior fragment was impossible with the use of postinjury radiographs alone. In agreement with historical and recent CT studies, the findings of this study confirm the existence of a three-part type of pertrochanteric fracture with a large posterior fragment, and provides its detailed description, including its relevance to clinical practice.

Pneumoperitoneum due to lower gastrointestinal perforation is an acute clinical situation requiring rapid dia-gnosis and treatment. This condition is often the result of dis-eases such as diverticulitis, malignant tumors, Crohn's dis-ease, or complications of endoscopic examination methods and surgical procedures. If this condition is not treated promptly, it can lead to life-threatening complications. Dia-gnosis relies mainly on imaging techniques such as X-ray, ultrasound, and CT, which allow the detection of free gas in the peritoneal cavity and the localization of the perforation. Treatment is usually surgical and its success depends on the speed of intervention and the general condition of the patient. This article discusses the etiology, dia-gnostic approaches, treatment strategies, and prognostic factors associated with pneumoperitoneum from lower gastrointestinal perforation, with emphasis on current clinical practices and recommendations.

Managing a large number of seriously injured patients (massive casualties - MASCAL) is a situation faced by medical teams in war conflicts and during disasters. MASCAL is an incident with a mass receive of injured patients, where the number of casualties exceeds the capacity and capabilities of the healthcare facility, placing enormous demands on the work of medical teams and effective management of limited human and material resources. In this communication, we describe a burn-related MASCAL that occurred in Kabul following a gas cylinder explosion. Within a 72-hour period, a ROLE 3 field hospital at the Kabul base received and treated 71 patients with deep burns covering 5-90% of their body surface area. Despite the exceptional scale of this tragedy, it was managed successfully through a staged system of care delivery and subsequent redistribution of burn patients to other alliance healthcare facilities. Receiving a mass influx of patients with extensive burns is one of the most medically, organizationally, and logistically challenging situations, placing extreme demands on the healthcare delivery system. MASCAL situations require a rapid and coordinated response with established treatment priorities and a prepared strategy for the efficient distribution of personnel, supplies, and equipment.

Infective endocarditis (IE) is a serious disease with a high mortality rate. Complications of IE are frequent and serious, most of them manifesting as various forms of ischemia. Its rare, but equally serious complications include development of mycotic pseudoaneurysms of peripheral arteries. Total incidence of these aneurysms in connection with IE is approximately 2%. Out of this number, the majority affect intracranial arteries, while the remaining lesions occur equally in visceral and limb locations. We present a case report of a rapidly progressing popliteal artery aneurysm with a fistula into the venous system in a patient after mitral valve replacement. We present the case of a 70-year-old man with a history of diabetes, hypertension, and post-STEMI who underwent mitral valve replacement for infective endocarditis. A complication occurred postoperatively in the form of a multidrug-resistant polymicrobial respiratory infection. Ten days after transfer to the local hospital from the cardiovascular center, deep vein thrombosis of the right lower extremity developed despite effective anticoagulation. Subsequent diagnostics revealed a rapidly progressing aneurysm of the popliteal artery with destruction of the vascular wall and arteriovenous fistula. The patient underwent urgent resection and reconstruction of the artery and deep vein with autologous vein grafts. The case demonstrates rapidly progressive complication of polymicrobial sepsis after infective endocarditis emphasizing the need for early diagnosis and aggressive surgical and antimicrobial therapy for mycotic aneurysms. Autologous vein replacement in mycotic aneurysm is considered the method of choice. However, regular lifelong follow-up is necessary to monitor possible late complications.

Fractures of the proximal femur, i.e., femoral neck fractures and trochanteric fractures, may be associated with a number of late complications. The most frequent of them in-clude non-union, varus malunion, unequal limb length, avascular necrosis of the femoral head, malrotation of the extremity and osteoarthritis of the hip joint. Individual affections are very often combined, for example, varus malunion, short-ening of the limb and its malrotation. This may result in pain, limp and, later, in dis-orders of other joints, especially the knee, and the lumbar spine. In the past, many of these complications were treated with intertrochanteric osteotomy. Currently, however, the indications for osteotomies have significantly decreased due to advances in internal fixation of proximal femur fractures and the introduction of THA. Nevertheless, intertrochanteric osteotomy remains the method of choice in management of certain complications of proximal femur fractures. Not every orthopedist or traumatologist has the capacity to perform these surgeries, but everyone should know about them and their indications. The aim of this article is therefore to give a brief overview of the current possibilities of valgus intertrochanteric osteotomy in the management of posttraumatic -non-unions of the femoral neck.

Monteggia lesion (ML) is a complex and rare injury in children that requires expert diagnosis and treatment. Failure to recognize or insufficiently diagnose this condition can be catastrophic for the child in terms of upper-limb motor function. The aim of this study is to analyze retrospective data of patients with ML treated at the Department of Pediatric Surgery, Comenius University and National Institute of Children's Diseases in Bratislava between 2010 and 2020, and to evaluate treatment outcomes. A retrospective analysis of 131 patients with ML was performed and categorized according to the timing of management: acute (within 24 hours), subacute (after 24 hours), and chronic (after more than 3 weeks). Treatment outcomes were evaluated using the Anderson scoring system. For statistical analysis, non-parametric methods were used: the Wilcoxon paired test to compare pre- and postoperative changes, and the Kruskal-Wallis test to assess differences among the three groups. Out of the 131 patients, 95 were diagnosed with ML (72.5%) and 36 with Monteggia equivalent lesions (EML; 27.5%). In the acute group, 63 patients received treatment with excellent outcomes. Patients with EML achieved satisfactory results, but with a higher rate of surgical intervention. Among chronic ML cases, functional outcomes improved in 13 out of 15 patients (86.6%). Rapid and accurate diagnosis and treatment of ML are essential to prevent complications and to ensure optimal outcomes. Chronic ML often leads to poorer results, underscoring the importance of early recognition and prevention.

In this case report, we present the management of an uncommon case of genital burns in a patient with pre-existing phimosis. Generally, a burn wound on the prepuce is -treated with a standard burn wound care strategy; however, in this case, circumcision was performed to address both the phimosis and the genital burns simultaneously. To the best of our knowledge, no similar cases have been reported in the literature. Genital burns are not often encountered due to their protected anatomic location and the additional coverage provided by clothing. Thus, genital burns are usually associated with extensive total body surface area (TBSA) burn injuries. Currently, there is no available standardized algorithm or treatment guideline for genital burn injuries. The treatment of burns in this region is primarily conservative. In this case, a 55-year-old male patient presented with extensive scald burn injury, including genital burns. He was diagnosed with third-degree scald burns on both upper extremities and deep second-degree burns on the lower extremities, abdomen, perineum and genitals, covering 46% of the TBSA. However, his penis was protected by native phimosis. We performed fluid resuscitation and burn wound management, including circumcision. The use of circumcision as a simultaneous treatment for genital burns and phimosis led to a highly favorable outcome, including good wound healing, effective pain control, satisfactory prognosis, and excellent cosmetic appearance.