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Prezentujeme kazuistiku patologické komunikace mezi ledvinou a sestupným tračníkem, vzniklé po předchozí nekomplikované otevřené resekci ledviny pro karcinom. Píštěle mezi močovým traktem a okolními orgány představují úporný a relativně častý problém urologické praxe. Aneuryzma je ohraničené patologické rozšíření tepny, způsobené strukturálními změnami v její stěně, arteriovenózní (A-V) píštěl je anomální komunikace mezi arterií a vénou. Aneuryzmata i píštěle jsou ve většině případů iatrogenního původu, popřípadě vznikají jako důsledek nádorového a zánětlivého procesu nebo po ozáření. Patologické komunikace vzniklé mezi ledvinami a trávicí soustavou jsou raritní komplikací, literatura uvádí méně než 1 % případů ve srovnání např. s urogynekologickými píštělemi. Reno-alimentární píštěle jsou převážně iatrogenní etiologie. K diagnostice se používají zobrazovací metody, nejvíce CT a ultrasonografie, nemalou roli však hraje i klinický obraz. Léčebnou metodou byl v našem případě poměrně rozsáhlý chirurgický výkon.
We present case of pathological communication between kidney (exactly kidney aneurysm created after uncomplicated kidneyresection) and descending colon. Fistulas in the midst of urinary tract and surrounding structures are relatively frequent andpersistent problem in urology. Aneurysm is pathological artery enlargement caused by structural changes in artery wall. A-V aneurysmor fistula is anomalous artery-venous communication. Most of cases of fistulas and aneurysms have iatrogenic origin, ordue to cancerous, inflammatory or after irradiation processes. Pathological communications between kidney and digestive tractare very rare. Literature mentions less than 1 % cases. Key to diagnosis is clinical investigations and imaging methods. Treatmentof choice in our case was extensive surgical intervention.
- Klíčová slova
- renoalimentární píštěl,
- MeSH
- arteriovenózní píštěl * komplikace MeSH
- colon descendens chirurgie patologie MeSH
- iatrogenní nemoci MeSH
- ledviny chirurgie patologie MeSH
- lidé MeSH
- močové píštěle * diagnóza etiologie chirurgie MeSH
- nádory ledvin chirurgie MeSH
- nefrektomie MeSH
- pooperační komplikace MeSH
- senioři MeSH
- střevní píštěle * diagnóza etiologie chirurgie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
To present the results of surgical repair of ruptures of the distal tendon of the biceps brachii muscle and thus show the adequacy of this treatment. MATERIAL Between 1987 and 2006, 19 patients had surgery for distal biceps tendon rupture. Only one side was affected in each patient. All patients were men between 28 and 69 years (average age, 47.5 years) at the time of injury (surgery). When the patients were evaluated at the end of 2007, 18 patients were included, because one died a year after surgery. METHODS The surgical repair always included a single-incision anatomical reattachment into the radial tuberosity. In 11 patients, a modified Mac Reynolds method with screw and washer fixation was used; in seven patients the insertion was fixed with Mitek anchors and, in one, it was sutured to the adjacent soft tissues. The average follow-up was 7 years (range, 1 to 20.5 years). The patients were evaluated for the cause of injury, their physical activity, age, dominance of the injured arm, surgical procedure and complications. RESULTS In 18 patients surgical repair was done early and, in one, at 16 days after injury. In all of them the tendon was detached from its site of insertion, but never torn. The intra-operative complications included, in one patient, bleeding owing to iatrogenic damage to a branch of the brachial artery, and difficult separation of the tendon due to its previous healed injury in another patient. Early post-operative complications included superficial skin necrosis in one patient and transient neurological deficit of the dorsal brand of the radial nerve and of the lateral cutaneous nerve of the forearm in two and one patient, respectively. The late complications were heterotropic ossification in three patients and screw migration in the one treated by the Mac Reynolds method. Excellent results were recorded in 11 patients (61 %), and good outcomes with a slight restriction of motion or muscle strength not limiting the patient's physical activities were in six (33.5 %) patients; only one patient (5.5 %) experienced pain on moderate exercise and had recurrent heterotropic ossification. Apart from this condition, there was no difference in the frequency of complications associated with the method used. DISCUSSION Only sparse information on distal biceps tendon ruptures has been available in the relevant Czech literature and, if so, only small groups with short follow-ups have been involved. Conservative treatment or the methods of non-anatomical reattachment have poor functional outcomes. Much better results are achieved by anatomical reattachment. Based on our experience with the Mac Reynolds technique, an anterior single-incision approach using fixation with Mitek anchors can be recommended. CONCLUSIONS Early surgical repair involving anatomical reattachment from the anterior singleincision approach with two Mitek anchors is recommended when a rupture of the distal tendon insertion of the biceps brachii is diagnosed. Key words: biceps radii muscle, biceps tendon injury, tendon fixation, bone screw and washer use.
We report a case of subcutaneous splenosis in the abdominal wall of a 23-year-old oligophrenic man. It presented as a well-demarcated 8 x 7 x 5-cm subcutaneous tumor in the left inguinal area closely above the scar after a previous operation for hernia. The lesion simulated clinically a hernia or a tumor due to its large size and location and, additionally, no history could be taken from the patient due to his mental handicap.
Popisujeme vzácný případ podkožní splenózy v břišní stěně u 23letého oligofrenního pacienta a podáváme souhrnný přehled nejdůležitějších vlastností splenózy i v jiných lokalizacích. V našem případě šlo o dobře ohraničený podkožní tumor o rozměrech 8×7×5 cm v levé inguinální oblasti těsně vedle jizvy po předchozí operaci tříselné kýly. Vzhledem k lokalizaci a velikosti budil tento případ splenózy klinické podezření na hernii nebo nádor. Vzhledem k mentálnímu deficitu pacienta nebylo možné získat anamnézu. Diagnóza splenózy byla stanovena až histologicky po exstirpaci léze.
A case of subcutaneous splenosis in the abdominal wall of a 23-year-old oligophrenic man is reported. Further, the most important features of splenosis in various localisations are provided. The patient presented with a well-demarcated 8x7x5 cm subcutaneous tumour in the left inguinal area closely above the scar after a previous operation for hernia. The lesion simulated clinically a hernia or a tumour due to its large size and location. Additionally, no history could be taken from the patient due to his mental handicap. The diagnosis of splenosis was established histologically.
- MeSH
- diferenciální diagnóza MeSH
- finanční podpora výzkumu jako téma MeSH
- inguinální hernie diagnóza MeSH
- lidé MeSH
- osoby s mentálním postižením MeSH
- splenóza diagnóza chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
