OBJECTIVES: To test contemporary rates and predictors of open conversion at minimally invasive partial nephrectomy (MIPN: laparoscopic or robotic partial nephrectomy). MATERIALS AND METHODS: Within the National Inpatient Sample database (2008-2015) we identified all MIPN patients and patients that underwent open conversion at MIPN. First, estimated annual percentage changes (EAPC) tested temporal trends of open conversion. Second, univariable and multivariable logistic regression models predicted open conversion at MIPN. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. RESULTS: Of 7649 MIPN patients, 287 (3.8%) underwent open conversion. The rates of open conversion decreased over time (from 12 to 2.4%; EAPC: 24.8%; p = 0.004). In multivariable logistic regression models predicting open conversion, patient obesity achieved independent predictor status (OR:1.80; p < 0.001). Moreover, compared to high volume hospitals, medium volume (OR:1.48; p = 0.02) and low volume hospitals (OR:2.11; p < 0.001) were associated with higher rates of open conversion. Last but not least, when the effect of obesity was tested according to hospital volume, the rates of open conversion ranged from 2.2 (non obese patients treated at high volume hospitals) to 9.8% (obese patients treated at low volume hospitals). CONCLUSION: Overall contemporary (2008-2015) rate of open conversion at MIPN was 3.8% and it was strongly associated with patient obesity and hospital surgical volume. In consequence, these two parameters should be taken into account during preoperative patients counselling, as well as in clinical and administrative decision making.

• MeSH
• karcinom z renálních buněk patologie   chirurgie   MeSH
• konverze na otevřenou operaci statistika a číselné údaje   MeSH
• laparoskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• nádory ledvin patologie   chirurgie   MeSH
• následné studie MeSH
• nefrektomie metody   MeSH
• obezita patofyziologie   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• robotika metody   MeSH
• senioři MeSH
• specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Accumulated endovascular aneurysm repair (EVAR) procedures will increase number of patients requiring conversion to open repair of abdominal aortic aneurysms (AAA). In most cases, patients undergo late open surgical conversion (LOSC), many months, or years, after initial EVAR. The aim of this study is to analyze results of LOSC after EVAR in elective and urgent setting, including presenting features, surgical techniques, as well as to review the clinical outcomes and their predictors. METHODS: Retrospective review of all consecutive patients undergoing LOSC after EVAR was performed at three distinct, high volume, vascular centers. Patients that required primary conversion within 30 days after EVAR have not been included in this study. Between January 1st 2010 and January 1st 2017 total of 31 consecutive patients were treated. LOSC were performed either in elective or in urgent setting, thus dividing patients in two groups. Primary outcome was 30-day mortality and secondary postoperative complications. RESULTS: LOSC rate after EVAR was 4.51%. Most common indication for LOSC was type I endoleak (N.=20, 64.51%). All patients that presented with ruptured AAA had some form of endoleak (type I endoleak was present in five from six cases). Most common site for aortic cross-clamping was infrarenal (51.61%). Stent-graft was removed completely in 18 patients (58.06%) and partially in 13 (41.93%). 30-day mortality rate was 16.12% (5 patients) and most common cause of death was myocardial infarction (60%). Following univariate factors were isolated as predictors for 30-day mortality: preoperative coronary artery disease, chronic obstructive pulmonary disease, urgent LOSC, prolonged time until LOSC, ruptured AAA, supraceliac clamp, higher number of red blood cell transfusion, postoperative myocardial infarction, and prolonged intubation (more than 48 hours). CONCLUSIONS: LOSC seems to be safe and effective procedure when preformed in elective manner. On the other side, urgent LOSC after EVAR is associated with very high postoperative mortality and morbidity. Endoleak remains the main indication for open conversion. Further studies are necessary to standardize timing and treatment options for failing EVAR.

• MeSH
• aneurysma břišní aorty diagnostické zobrazování   mortalita   chirurgie   MeSH
• časové faktory MeSH
• cévy - implantace protéz škodlivé účinky   metody   MeSH
• databáze faktografické MeSH
• endoleak chirurgie   MeSH
• endovaskulární výkony škodlivé účinky   metody   MeSH
• konverze na otevřenou operaci metody   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• mortalita v nemocnicích MeSH
• multivariační analýza MeSH
• prediktivní hodnota testů MeSH
• příčina smrti * MeSH
• prognóza MeSH
• reoperace metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Background: To test contemporary rates and predictors of open conversion at minimally invasive (laparoscopic or robotic) radical prostatectomy (MIRP). Materials and Methods: Within the National Inpatient Sample database (2008-2015), we identified all MIRP patients and patients who underwent open conversion at MIRP. First, estimated annual percentage changes (EAPCs) tested temporal trends of open conversion. Second, multivariable logistic regression models predicted open conversion at MIRP. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results: Of 57,078 MIRP patients, 368 (0.6%) underwent open conversion. The rates of open conversion decreased over time (from 1.80% to 0.38%; EAPC: -26.0%; p = 0.003). In multivariable logistic regression models predicting open conversion, patient obesity (odds ratio [OR]: 2.10; p < 0.001), frailty (OR: 1.45; p = 0.005), and Charlson comorbidity index (CCI) ≥2 (OR: 1.57; p = 0.03) achieved independent predictor status. Moreover, compared with high-volume hospitals, medium-volume (OR: 2.03; p < 0.001) and low-volume hospitals (OR: 3.86; p < 0.001) were associated with higher rates of open conversion. Last but not least, when the interaction between the number of patient risk factors (obesity and/or frailty and/or CCI ≥2) and hospital volume was tested, a dose-response effect was observed. Specifically, the rates of open conversion ranged from 0.3% (patients with zero risk factors treated at high-volume hospitals) to 2.2% (patients with two to three risk factors treated at low-volume hospitals). Conclusion: Overall contemporary (2008-2015) rate of open conversion at MIRP was 0.6% and it was strongly associated with patient obesity, frailty, CCI ≥2, and hospital surgical volume. In consequence, these parameters should be taken into account during preoperative patients counseling, as well as in clinical and administrative decision making.

• MeSH
• laparoskopie * MeSH
• lidé MeSH
• nádory prostaty * chirurgie   MeSH
• prostatektomie MeSH
• rizikové faktory MeSH
• robotika * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Autoři se ve své práci zabývají konverzí zevní fixace na zavřené nitrodřeňové - podle možností zajištěné hřebování, pri léčbě komplikovaných diafyzárních zlomenin bérce a femoru. Zvlášť výhodný je tento postup u pacientů s otevřenými zlomeninami, u polytraumatizovaných poraněných a také u nemocných s hrozícím, nebo i s manifestním kompartment syndromem. Léčení těchto zlomenin není vždy snadné a představuje závažnou problematiku v každodenní traumatologické praxi. Ošetření fraktur zmíněným postupem vykazují velmi dobré výsledky s minimem komplikací. Zatímco defekt skeletu dovedeme dnes nahradit a tím i obnovit nosnost končetiny, škody na svalstvu jsou často nevratné a zapříčiňují trvalou invaliditu.

In this study the authors present a method of conversion of external fixations to closed intramedullary ones in the treatment of complicated diaphyseal fractures of the calf and femur. According to the conditions, the fixation is secured by a pin. The above mentioned procedure is advantageous especially in cases of patients with open fractures, in patients with polytraumas as well as in patients with a threatening or with a present compartment syndrome. Treatment of the above fractures is not always simple and represents a serious problem in everyday traumatological practice. Treatment of fractures using the above procedure has very good results with a minimum of complications. Although, nowadays, the skeletal defect can be solved and therefore the bearing capacity of the extremity be renewed, damages to the muscles are often irreparable and cause a permanent invalidity.

• MeSH
• fixace fraktury metody   MeSH
• intramedulární fixace fraktury MeSH
• lidé MeSH
• otevřené fraktury chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

INTRODUCTION: Long-term results after laparoscopic surgery with conversion to open surgery for colorectal cancer are seldom published. AIM: The study analysed the impact of conversion of laparoscopic surgery to open resection for colorectal cancer on short- and long-term results. MATERIAL AND METHODS: The prospectively collected data of 469 patients with colorectal cancer in the period from 1 January 2001 to 31 December 2006 were analysed. Short- and long-term results were compared. RESULTS: The relative frequency of conversion was 7%. The subgroups were statistically similar regarding age, gender, body mass index (BMI), localization of tumour, T stage, and TNM stage. We observed a lower frequency of previous surgery (p = 0.018) in the group of patients with conversions to open surgery as well as statistically significantly higher frequency of patients with American Society of Anesthesiologists (ASA) score II (p = 0.039). There was no statistical difference in morbidity, mortality, or the length of hospital stay between both the groups of patients. The operating time was significantly higher in the group of patients with conversion (p = 0.00001). There was a significantly higher blood loss in the patient groups with conversion to open surgery and in the group with primarily open surgery (p = 0.00023). There was no difference in the overall survival (p = 0.712), disease-free survival (p = 0.072) or in the local (p = 0.432) or distant (p = 0.957) recurrence. CONCLUSIONS: No negative impact on short- or long-term results of conversion to open surgery was verified in patients with colorectal surgery.

• Publikační typ
• časopisecké články MeSH

Autoři prezentují metodu konverze zevní fixace na nitrodreňový hřeb při léčbě komplikovaných zlomenin diafyzy berce. Tento postup je vhodný zvláště u otevřených zlomenin a zlomenin v rámci polytraumat, které jsou stále složitou traumatologickou problematikou. Použití konverze vykazuje velmi dobré terapeutické ( výsledky s minimem komplikací. Účelem tohoto čiánku je objasnit postup a uvést naše první zkušenosti a výsledky s jeho použitím na souboru šesti pacientů.

The authors present the method of conversion of external fixation to an intramedullary nail in treatment of complicated fractures of the diaphysis of the leg. This procedure is useful in particular in open fractures and in fractures associated traumatological issue. Conversion gives very satisfactory therapeutic result with a minimum of complications. The purpose of the present paper is to elucidate the procedure and make the readers familiar with the autors' experience assembled with the method in the first six patients.

• MeSH
• diafýzy chirurgie   patologie   MeSH
• externí fixátory MeSH
• fraktury tibie terapie   MeSH
• intramedulární fixace fraktury MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• kolorektální nádory * chirurgie   MeSH
• konverze na otevřenou operaci MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• filozofie MeSH

• Konspekt
• Věda. Všeobecnosti. Základy vědy a kultury. Vědecká práce
• NLK Obory
• humanitní vědy a umění

The authors describe experience with conversions to open surgery after endovascular abdominal aneurysm repair and evaluate the frequency, causes and results of a total of 7 cases in their series of 165 patients treated over a 10-year period.

• MeSH
• aneurysma břišní aorty chirurgie   MeSH
• cévy - implantace protéz MeSH
• lidé středního věku MeSH
• lidé MeSH
• reoperace MeSH
• senioři nad 80 let MeSH
• stenty MeSH
• výkony cévní chirurgie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• časopisecké články MeSH