The spleen is one of the most commonly injured organ in blunt traumas to the chest and abdomen. Splenic injury can be a serious complication of fracture of the left 9th to 11th rib. The authors present a case report of a 65-year-old male patient with a blunt trauma to the left chest and abdomen, diagnosed with multiple left rib fractures, left hemothorax and splenic injury with a small subcapsular hematoma with no signs of active splenic bleeding. Due to hemodynamic instability and a large volume of blood loss via the chest drain, the patient was indicated for emergency left thoracotomy. A perforation in the lower lobe of the left lung caused by rib fractures was found, which was treated with sutures. Furthermore, the diaphragm was examined, two ruptures were identified from which blood was coming out, and thus a phrenotomy was performed. The bleeding central splenic rupture came as a big surprise. A spleen preserving surgery was impossible, therefore a splenectomy had to be performed, followed by chest wall stabilization with splints. Transthoracic approach to manage the splenic injury through phrenotomy should not be used as a standard. In a selected group of patients with concomitant chest and upper abdominal organ injuries, the use of this surgical approach appears to be highly beneficial. Key words: splenic injury, splenectomy, thoracotomy, rib fractures, diaphragmatic rupture.

• MeSH
• fraktury žeber * chirurgie   MeSH
• hematom MeSH
• lidé MeSH
• poranění břicha * MeSH
• senioři MeSH
• splenektomie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Diffuse peritonitis is an acute abdominal condition characterized by high mortality. The main treatment modality is surgery, requiring a subsequent prolonged hospital stay. These patients are, among other things, at risk of developing hospital-acquired pneumonia (HAP), which considerably worsens their treatment outcomes. This study aimed to extend the existing knowledge by providing more detailed microbiological characteristics of complicating HAP in patients with secondary peritonitis, including the identification of isolated bacterial pathogens and their potential sources. METHODS: The 2015-2019 retrospective study comprised all patients with an intraoperatively confirmed diagnosis of secondary diffuse peritonitis who were classified in accordance with the quick Sepsis Related Organ Failure Assessment scoring system. RESULTS: HAP developed in 15% of patients. The 90-day mortality rates were 53% and 24% in patients with and without HAP; respectively. The most frequent pathogens responsible for HAP were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae complex and Enterococcus faecalis. Multidrug resistance to antibiotics was found in 38% of bacterial pathogens. Clonal spread of these bacterial pathogens among patients was not detected. Rather, the endogenous characteristic of HAP was confirmed. CONCLUSIONS: The initial antibiotic therapy of complicating HAP in patients with secondary peritonitis must be effective mainly against enterobacteria, including strains with the production of ESBL and AmpC beta-lactamases, Pseudomonas aeruginosa and Enterococcus faecalis. The study further highlighted the importance of monitoring the respiratory tract bacterial microflora in patients with secondary peritonitis. The results should be used for initial antibiotic treatment of complicating HAP instances.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

Cysty mediastina představují nevelkou, avšak diagnosticky důležitou skupinu, která tvoří 5-18 % všech primárních tumorů mediastina. Perikardiální cysty jsou převážně benigního charakteru, lokalizované ve středním mediastinálním kompartmentu, zejména v pravém kardiofrenickém úhlu. Soubor 7 nemocných indikovaných k chirurgickému odstranění perikardiální cysty v letech 2009-2019 (5 žen a 2 mužů) byl hodnocen retrospektivně, průměrný věk pacienta 51,5 let. Cysty byly nejčastěji nacházeny v pravé pleurální dutině (5x), všechny byly kompletně odstraněny miniinvazivně, průměrný operační čas byl 51 minut. Průměrná doba hospitalizace byla 4, 57 dne, největší rozměr cysty byl 40x95 mm. U jedné nemocné se objevila po měsíci stehová píštěl v místě operační rány. Pacienti v našem souboru byli indikováni k operaci dle jasných indikačních kritérií, pooperační komplikace prakticky nebyly a závěrem lze konstatovat, že videothorakospická exstirpace je zlatým standardem k chirurgickém řešení perikardiálních cyst.

Mediastinal cysts represent a small, diagnostically important group that constitute for 5-18% of all primary tumors of the mediastinum. Pericardial cysts are predominantly benign in nature, located in the middle mediastinal compartment, especially in the right cardiophrenic angle. A group of 7 patients indicated for scheduled surgical removal of a pericardial cyst in the years 2009-2019 (5 women and 2 men) was evaluated retrospectively, the average age of the patient was 51,5 years. The cysts were most often found in the right pleural cavity (5x), all were completely removed minimally invasively, the average operating time was 51 minutes. The average length of hospitalization was 4.57 days, the largest size of the cyst was 40x95 mm. One patient developed a sutural fistula at the site of the surgical wound after a month. The patients in our group were indicated for surgery according to distinct indication criteria, there were practically no postoperative complications, and in conclusion it can be stated that videothoracoscopic exstirpation is the gold standard for the surgical treatment of pericardial cysts.

PURPOSE OF THE STUDY Rib fractures represent one of the most common fractures sustained by 10-40% of all patients with blunt chest trauma, their incidence increases with age. In the current literature, however, new indication criteria continue to emerge. The purpose of this study is to assess the indication criteria, the timing of surgery and the use of individual plates in dependence on fracture location in our patients after the chest wall stabilisation in a retrospective analysis. MATERIAL AND METHODS Our group of patients (n = 349) included the patients who were hospitalised in the Trauma Centre of the University Hospital Olomouc from 1 January 2015 to 31 January 2019, of whom 16 patients were indicated for a surgery. In case of polytrauma, spiral CT was performed, while all patients with a more serious wall chest trauma underwent 3D CT chest wall reconstruction. The surgical approach was chosen based on the fracture location, most frequently posterolateral thoracotomy was opted for. The type of plates was chosen based on the location and type of the fracture. The most common was the lateral type of fracture. RESULTS The most common indication for surgery was multiple rib fractures with major chest wall disfiguration with the risk of injury to intrathoracic organs, present hemothorax or pneumothorax. The age of patients ranged from 44 to 92 years. 8 patients sustained a thoracic monotrauma, the remaining patients suffered multiple injuries, mostly craniocerebral trauma, pelvic or long bone fractures or parenchymal organ injury. The patients were indicated for surgery between 1 hour and 7 days after the hospital admission, on average 3 plates per patient were used and the most commonly used type of plate was the newly modified Judet plate made by Medin. All the patients underwent a surgical revision of pleural cavity, in 3 patients diaphragmatic rupture was found despite a negative preoperative CT scan. The duration of mechanical ventilation in polytrauma patients was 16 days, in thoracic monotrauma patients it was 2 days. CONCLUSIONS Prevailing majority of patients with a blunt chest trauma with rib fractures is still treated non-operatively, which is confirmed also by our group of patients. Nonetheless, correctly and early indicated stabilisation of the chest wall based on accurate indication criteria is of a great benefit to the patients. The aim of each and every trauma centre should be to develop a standardised protocol for the management of blunt chest trauma (the so-called "rib fracture protocol"), which comprises precisely defined criteria for patient admission, multimodal analgesia, indications for surgery, comprehensive perioperative and postoperative care and a subsequent rehabilitation of patients. Key words: rib fracture protocol, chest wall stabilisation, flail chest.

• MeSH
• fraktury žeber * diagnostické zobrazování   chirurgie   MeSH
• hrudní stěna * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• paradoxní dýchání * diagnostické zobrazování   etiologie   chirurgie   MeSH
• poranění hrudníku * diagnostické zobrazování   chirurgie   MeSH
• retrospektivní studie MeSH
• tupá poranění * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Publikace se zaměřuje na nádory mezihrudí a jejich léčbu. Určeno odborné veřejnosti.; Odborná publikace se zabývá nádorovým onemocněním mezihrudí.

• MeSH
• diagnostické techniky a postupy MeSH
• hrudní chirurgie MeSH
• mediastinum patologie   MeSH
• nádory hrudníku MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• onkologie
• NLK Publikační typ
• kolektivní monografie

• Publikační typ
• abstrakt z konference MeSH

Úvod: Jedinou kurativní metodou v léčbě tumorů hrudní stěny (primárních či sekundárních) zůstává navzdory veškerému pokroku v onkologické léčbě stále chirurgická radikální resekce. Na léčbě mnoha nádorů hrudní stěny v závislosti na lokalizaci tumoru participuje plastický chirurg a eventuálně neurochirurg. Cílem naší práce bylo zjistit co možná nejoptimálnější chirurgický postup v léčbě tumorů hrudní stěny v závislosti na počtu komplikací. Sledovali jsme histologickou povahu jednotlivých tumorů, délku hospitalizace, věk, perioperační mortalitu a morbiditu. Dalším neméně důležitým sledovaným parametrem, byl rozdíl v přežívání mezi jednotlivými skupinami maligních nádorů (primární hrudní nádory versus sekundární -plicní nádory infiltrující hrudní stěnu). Metody: Na I. chirurgické klinice lékařské fakulty Univerzity Palackého a Fakultní nemocnice v Olomouci v letech 2006−2012 podstoupilo resekci hrudní stěny pro primární či sekundární nádor celkem 57 pacientů. V tomto souboru byly sledovány následující parametry: histopatologický typ nádoru, pohlaví, věk počet resekovaných žeber nebo plochu resekce sterna, typ rekonstrukce hrudní stěny, délka umělé plicní ventilace, pooperační komplikace, délka hospitalizace, perioperační morbidita a mortalita a délka přežívání pacientů u maligních nádorů. Výsledky: 57 pacientů (39 mužů a 18 žen) ve věku od 16 do 86 let podstoupilo resekci hrudní stěny pro primární tumor v 51% a pro sekundární tumor v 49 %. Resekce nejméně jednoho žebra nebo parciální resekce sterna byla provedena u každého pacienta. Rekonstrukce s použitím síťky u 22 pacientů, u 10 byla kryta svalovým lalokem. Pooperační komplikace se objevily u 10 pacientů (17,5 %)-nejčastěji infekce rány, pneumotorax a fluidothorax. V časném pooperačním období bylo zaznamenáno jedno úmrtí na rozvinutý ARDS (acute respiratory distress syndrom). Závěr: Tumory hrudní stěny patří vzhledem k nízkému výskytu k vzácným diagnózám. Je nutno dodržovat základní principy jejich léčby, proto by operace těchto nádorů měla být soustředěna do center. Vždy před operací by měla být stanovena diagnóza pomocí biopsie a vyloučena generalizace onemocnění, nejlépe pomocí PET/CT. Nejdůležitější pro úspěšnou léčbu je zkušenost a mezioborová spolupráce celého týmu, který se podílí na léčbě tumorů hrudní stěny, tím pádem lze docílit minima komplikací, nízké mortality a morbidity, což potvrzují výsledky našeho souboru pacientů.

Introduction: The only curative treatment of tumors of the chest wall (primary or secondary),despite all the progress in oncological therapy, is a surgical radical resection. The goal of the paper is the identification of a complication occurring after chest wall resections for a tumor (evaluation of morbidity and mortality). Furthermore, the tumor type and employed reconstruction method were analyzed. Methods: A group of patients who underwent resection of the chest wall for primary or secondary tumors at the 1st Dept. Of Surgery, University Hospital Olomouc, was retrospectively analyzed. Age, diagnosis, procedure, histopathology of the tumor, preoperative and postoperative oncological treatment, preoperative co-morbidities, postoperative complications, the use of artificial lung ventilation and recurrences were recorded for all patients. Results: 57 patients aged 16 to 86 years underwent a chest wall resection, 51% for a primary tumor and 49% for a secondary tumor. Resection of at least one rib or partial resections of the sternum were performed in every patient. Reconstruction with a mesh was employed in 22 patients; in 10 patients the mesh was covered with a muscle flap. Postoperative complications occurred in 10 patients (17.5%). Conclusion: It is necessary to follow the basic principles of treatment of chest wall tumors; therefore surgery of these tumors should be concentrated to specialized centers. Always before surgery, diagnosis should be established by means of a biopsy and generalization of the disease should be excluded, ideally using PET/CT. Most important for successful treatment is experience and interdisciplinary cooperation of the team. This results in a low mortality and morbidity rate, which was confirmed by our results.

BACKGROUND: Even after successful radical treatment of lung cancer, patients in stages I and II of the TNM system very frequently suffer recurrence, which end lethally. Detection of subclinical residual disease after surgery is thus one of the most important emerging diagnostic methods. Minimal residual disease (MRD) is defined as the presence of isolated tumor cells or circulating cells in a patient after curative primary tumor removal and at the same time, no clinical signs of cancer. Conventional methods cannot detect minimal residual disease and hence there is a need for detection using new molecular biological methods. METHODS: We searched the PubMed database for original and review articles on minimal residual disease in lung cancer. Search words were "lung cancer", "minimal residual disease" and "detection of minimal residual disease". The publications we found were compared with the results of our own studies on the detection of minimal residual disease in lung cancer and the personal experiences are described. Examination of blood samples from 98 healthy volunteers and bone marrow from 12 patients with non inflammatory and non tumour illness, were used to determine cut-off values for specific markers in the compartments. Subsequently, expression of selected markers in tumor tissue was analysed in a pilot sample of 50 patients with lung cancer and the presence of MRD was measured as expression of values of the tested markers correlated with clinico-pathological characteristics. CONCLUSIONS: Recent studies on other malignancies apart from lung cancer have shown the importance of MRD detection in the determination of disease progression and prognosis. The methods of MRD diagnostics are based on detection of specific tumor markers. Of these, the most specific for lung cancer, appears to be the LunX protein. The best method for determining MRD is probably RT-PCR. Further studies should expand knowledge in this area: to refine understanding of the importance of tumor markers for prognosis, as well as to confirm the significance of these findings in clinical practice.

• MeSH
• erbB receptory genetika   MeSH
• fosfoproteiny genetika   MeSH
• glykoproteiny genetika   MeSH
• keratin-19 genetika   MeSH
• lidé MeSH
• messenger RNA krev   MeSH
• nádorové biomarkery krev   MeSH
• nádorové cirkulující buňky * MeSH
• nádory plic krev   diagnóza   chirurgie   MeSH
• nemalobuněčný karcinom plic krev   diagnóza   chirurgie   MeSH
• protoonkogenní proteiny c-met genetika   MeSH
• reziduální nádor MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• Publikační typ
• abstrakt z konference MeSH