Introduction: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist. Case: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient‘s condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6 cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength. Conclusion: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.
- MeSH
- dopravní nehody MeSH
- dospělí MeSH
- lidé MeSH
- motocykly MeSH
- nervový přenos MeSH
- nervus musculocutaneus * chirurgie zranění MeSH
- nervus suralis transplantace MeSH
- poranění periferního nervu * chirurgie etiologie klasifikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
Úvod: Cílem této studie bylo porovnat dva systémy uzavírání žil kyanoakrylátovým lepidlem, VenaSealTM a VariClose®, v léčbě povrchové žilní insuficience. Metody: Byla provedena retrospektivní analýza pacientů léčených od dubna 2018 do dubna 2022 kyanoakrylátovými lepidly pro insuficienci povrchových žil dolních končetin v jednom centru. Výsledky: Systém VariClose® byl použit u 27 pacientů (30 žil) a systém VenaSealTM u 97 pacientů (125 žil). Medián sledování pacientů léčených systémy VariClose® a VenaSealTM dosahoval 267 (IQR 223) a 201 (IQR 280) dnů. Po roce došlo k rekanalizaci u 11 žil léčených systémem VariClose® a u 5 žil léčených systémem VenaSealTM. Míra okluze odhadnutá Kaplanovou-Meierovou metodou v 30, 90, 180 a 360 dnech činila pro žíly léčené systémem VariClose® 100 %, 96 %, 83 % a 42 % a pro žíly léčené systémem VenaSealTM 100 %, 98 %, 96 % a 91 % (p < 0,01). Závěr: Systém VenaSealTM měl významně lepší míru okluze než systém VariClose®.
Objective: The goal of this study was to compare the cyanoacrylate venous sealing systems VenaSealTM and VariClose® in the treatment of superficial venous insufficiency. Methods: A single-centre retrospective analysis on patients treated between April 2018 and April 2022 with cyanoacrylate adhesives for lower limb superficial truncal vein insufficiency was performed. Results: The VariClose® system was used in 27 patients (30 veins) and the VenaSealTM system in 97 patients (125 veins). The median follow-up periods for patients treated with VariClose® and VenaSealTM systems were 267 (IQR 223) and 201 (IQR 280) days, respectively. At one year, recanalization occurred in 11 veins treated with the VariClose® system and 5 veins treated with the VenaSealTM system. The occlusion rates estimated by the Kaplan-Meier method at 30, 90, 180, and 360 days were 100%, 96%, 83%, and 42% for veins treated with the VariClose® system and 100%, 98%, 96%, and 91% for veins treated with the VenaSealTM system (p <0.01). Conclusions: The VenaSealTM system had significantly better occlusion rates than the VariClose® system.
- Klíčová slova
- VenaSealTM, VariClose,
- MeSH
- Kaplanův-Meierův odhad MeSH
- kyanoakryláty * aplikace a dávkování farmakologie terapeutické užití MeSH
- lidé MeSH
- retrospektivní studie MeSH
- varixy terapie MeSH
- vena saphena chirurgie patologie MeSH
- vény patologie MeSH
- výsledek terapie MeSH
- zařízení na uzavírání cév MeSH
- žilní insuficience terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Úvod: Cílem práce je analyzovat komplikace operací pro kýlu v jizvě a zhodnotit význam jednotlivých rizikových faktorů podílejících se na vzniku infekčních komplikací na Chirurgické klinice Fakultní nemocnice Královské Vinohrady za rok 2015. Metody: Analyzovali jsme 138 pacientů se zaměřením na rizikové faktory, které potenciálně zvyšují riziko vzniku pooperační infekční komplikace, jako jsou implantace síťky, kouření, přítomnost onemocnění diabetes mellitus, ischemické nemoci srdeční, malignity a imunosupresivní terapie a také akutnost operace. Výsledky: Při vícerozměrné logistické regresní analýze se akutní výkon ukázal jako rizikový faktor pro vznik infekce a při ad hoc Fisherově testu byl poměr 2,73. Diabetes mellitus byl hraničně významný faktor (p=0,071). Žádné další sledované parametry nebyly spojeny se zvýšeným rizikem SSI. Závěr: Studie prokázala jako významný rizikový faktor vzniku pooperační infekce akutní výkon. Naopak použití síťky nebylo spojeno se zvýšeným rizikem infekce.
Introduction: The aim of this study was to analyse complications associated with inicisional hernia repair surgery and to assess individual risk factors for surgical site infections occurring at the Department of Surgery of the University Hospital Kralovske Vinohrady in 2015. Methods: We analysed 138 patients with a focus on risk factors that potentially increase the risk of postoperative infectious complications such as mesh implantation, smoking, diabetes mellitus, ischemic heart disease, malignancies, immunosuppressive therapy and urgency of the procedure. Results: Based on multivariate logistic regression analysis, acute surgery proved to be a risk factor for infection, and in the ad hoc Fisher test, the ratio was 2.73. Diabetes mellitus as a risk factor reached the limit of significance (p=0.071). No other variables were associated with an increased risk of surgical site infections. Conclusion: Acute surgery was assessed as a significant risk factor for postoperative wound infection. On the contrary, mesh repair was not associated with an increased risk of infection.
BACKGROUND: The anti-PD-1 monoclonal antibody pembrolizumab has been shown to be associated with a good response in patients with metastatic gastric cancer. Excellent therapeutic results of pembrolizumab have been shown in patients with tumours showing a high microsatellite instability (MSI) and Epstein–Barr virus (EBV) positivity. GOAL: This is a retrospective study of 40 bioptic specimens from the patients, who underwent gastrectomy for gastric carcinoma. The goal of the study was to identify biomarkers (EBV, MLH-1, PDL-1 expression) that are potentially relevant for selecting the patients, who may benefit from PD-1 inhibition therapy. METHODS: Immunohistochemical (IHC) expression of PDL-1 and MSI, cytogenetic FISH amplification of the HER-2/neu gene and polymerase chain reaction of EBV RNA, including charge quantification, were performed in selected patients with metastatic or advanced gastric cancer. RESULTS: EBV-encoded RNA was detected in nine patients. None of them exhibited Her-2 overexpression or CMV infection. PD-L1 was detected in twelve patients. Ten patients were MLH1 positive. All nine cases of EBV infection showed a high expression of PD-L1 and MLH-1 (Tab. 1, Ref. 14).
- MeSH
- antigeny CD274 analýza imunologie MeSH
- biologické markery * analýza MeSH
- exprese genu MeSH
- infekce virem Epsteina-Barrové diagnóza imunologie MeSH
- klinické laboratorní techniky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrosatelitní nestabilita MeSH
- MutL homolog 1 analýza imunologie MeSH
- nádory žaludku * imunologie patofyziologie MeSH
- odběr biologického vzorku MeSH
- receptor erbB-2 analýza imunologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výběr pacientů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- práce podpořená grantem MeSH
Receptors of the large HER family play an important role in breast cancer, which is undergoing a gradual development in connection with biological development, both in the fi eld of diagnostics and therapy. Dimerization of HER-2 with other HER members, such as HER-3, is the biggest driver of tumor cell growth and survival. Numerous studies show that HER-3 gene overexpression correlates with poor prognosis. However, other studies have shown HER-3 overexpression to be a positive prognostic factor. HER-3 may confer resistance to certain EGFR or HER-2 receptor therapeutics. An interesting fact, however, is that HER-3 expression can serve as a marker in immunotherapy for triple-negative breast cancer (TNBC). It is thought to be involved not only in cell survival and proliferation, but also in the regulation of PD-L1 expression. In breast cancer, PD-L1 expression is heterogeneous and is generally associated with the presence of tumor-infi ltrating lymphocytes and a number of factors with poor prognosis such as young age, hormone receptor negativity, and high HER-2 expression and proliferation index. Our results showed amplifi cation of HER-3 (CERB3) in 2 out of a sample of 20 patients with TNBC, and 13 of 20 HER-2-positive patients. PD-L1 expression was demonstrated in 3 out of 13 HER-3-positive patients and 2 out of 2 HER-3-positive TNBC patients. There was a strong correlation between positive HER-3 and PD-L1 TNBC expression (p = < 0.001). Thus, the view of the HER-3 receptor will be much more complex, and the overexpression of this receptor appears to have both negative and positive prognostic and clinical impacts (Tab. 1, Ref. 17).
- MeSH
- amplifikace genu MeSH
- antigeny CD274 biosyntéza MeSH
- cytogenetické vyšetření MeSH
- dospělí MeSH
- erbB receptory škodlivé účinky MeSH
- imunoanalýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- proteosyntéza * MeSH
- senioři MeSH
- triple-negativní karcinom prsu * etiologie genetika imunologie patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Úvod: Cílem je zhodnotit výsledky chirurgické léčby intrahepatického cholangiokarcinomu (IHCHCA) z pohledu celkového přežití a přežití bez známek choroby a analyzovat a najít potenciální prognostické faktory ovlivňující celkové přežití a přežití bez známek choroby. Metody: Retrospektivně byla vyhodnocena skupina pacientů operovaných pro IHCHCA jater za období leden 2005 až leden 2022 (17 let), u kterých byl proveden chirurgický výkon. Za sledované období bylo provedeno 38 chirurgických výkonů, z toho ve 25 případech byla provedena resekce jater (65,8 %). Výsledky: 5leté přežití ve skupině radikálně resekovaných bylo 44 %, 5leté přežití bez známek choroby činilo 32 %. Univarietní a multivarietní analýza prokázala radikalitu chirurgického výkonu (p=0,01116) a postižení lymfatických uzlin (p=0,00576) jako negativní prognostické faktory celkového přežití. Radikalita chirurgického výkonu (p=0,018) a podání adjuvantní chemoterapie (p=0,044) pak byly významné negativní prognostické faktory přežití bez známek choroby. V rámci multivarietní analýzy ale ztratily na významnosti. Závěr: Základem léčby intrahepatického cholangiokarcinomu zůstává radikální chirurgická resekce jater s cílem dosáhnout radikálního výkonu s mikroskopicky negativním okrajem.
Introduction: The aim of this study was to evaluate the results of surgical treatment of intrahepatic cholangiocarcinoma (IHCHCA) in terms of overall survival and disease-free survival, and to analyse and find potential prognostic factors affecting overall survival and disease-free survival. Methods: Retrospective evaluation was performed of consecutively enrolled patients operated for IHCHCA from January 2005 to January 2022 (17 years) had undergone surgery. During the monitored period, 38 surgical procedures were performed, of which liver resection was done in 25 cases (65.8%). Results: The 5-year survival in the radically resected group was 44%, and the 5-year disease-free survival was 32%. Based on univariate and multivariate analysis, radicality of surgery (p=0.01116) and lymph node involvement (p=0.00576) were assessed as negative prognostic factors for overall survival. Radicality of surgery (p=0.018) and administration of adjuvant chemotherapy (p=0.044) were significant negative prognostic factors affecting disease-free survival. However, they lost their significance in the multivariate analysis. Conclusion: Radical surgical resection of the liver remains an essential treatment option for intrahepatic cholangiocarcinoma aimed at achieving a radical procedure with microscopically negative margins.
PURPOSE OF THE STUDY To compare the outcomes of parallel and convergent iliosacral screw insertion into the body of vertebra S1 in the treatment of posterior pelvic arch injuries. MATERIAL AND METHODS Radiographs of 120 patients (43 women, 77 men), aged between 14-79 years, treated with iliosacral screw fixation for posterior pelvic ring fractures between 1.1.2009 and 31.12.2019 were reviewed for inclusion in the study. In each case two screws were inserted into the body of vertebra S1. The screws were inserted in either parallel or convergent orientation. Convergent orientation allows the threads of both screws to be interconnected. In this technique, the first screw is inserted into the centre of the body of vertebra S1 as a compression screw. The second screw is inserted as a positioning screw and is placed so that the threads of both screws lock together. We believe that the interlocking of the threads of both screws and contact of the second screw with three cortices (two of the iliac bone and one of the sacrum) increase the stability of the fixation. Migration of loosened screws was measured on radiographs of the pelvis obtained at six weeks and at three, six and twelve months postoperatively. Migration of five millimetres or more within the first six weeks was considered to be clinically significant. Only patients after primary fracture treatment and with a complete one-year follow-up were included in the study. Cases of non-union and failure of osteosynthesis of the anterior pelvic arch and patients with incomplete follow-up were excluded. The incidence of significant screw migration between the two techniques was compared using Fisher's exact test with a 5% level of significance. RESULTS Sixty-three patients (23 women, 40 men) aged 17 to 79 years were included in the study. Parallel screws were used in 24 patients (8 women, 16 men) and convergent screws were used in 39 patients (15 women, 24 men). Clinically significant migration occurred in nine (38%) patients after parallel insertions. In two of these cases there was unstable fixation of the anterior pelvic arch. Migration of convergently placed iliosacral screws occurred in four (10%) cases. In three of these cases this was due to unstable fixation of the anterior pelvic arch. The difference in screw migration between the two groups was shown to be significant (p = 0.0219). DISCUSSION Iliosacral screws ensure sufficient stability of the posterior arch in type B and C pelvic fractures provided that the anterior pelvic arch is stable. Convergent insertion of iliosacral screws may increase the stability of fixation. Minimally invasive surgery with sufficient stability may be advantageous for early treatment of patients after multiple trauma and in elderly patients. The weaknesses of this study are its relatively small number of patients, which prevented reliable statistical analysis of screw migration according to the type of pelvic fractures. The second main limitation is the failure to perform densitometric examination of the skeleton in patients with X-ray proven screw migration for confirmation of osteoporosis as one of the possible causes of fixation failure. CONCLUSIONS The results of the study suggest that convergent insertion of iliosacral screws into S1 is associated with a lower risk of screw migration and subsequent failure of fixation of the posterior pelvic arch. Key words: pelvic fracture, pelvic injury, iliosacral screw, parallel screws, convergent screws, migration of iliosacral screws.
- MeSH
- dospělí MeSH
- fraktury kostí * chirurgie MeSH
- kostní šrouby škodlivé účinky MeSH
- křížová kost diagnostické zobrazování zranění chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pánevní kosti * zranění MeSH
- senioři MeSH
- vnitřní fixace fraktury škodlivé účinky metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
