The article is focused on the topic of venous thrombosis and on the current conception of its prophylaxis. Pathophysiology and incidence of postoperative thromboembolism are described and principles of thromboembolic disease prevention, which are based on conclusions of the 7th Conference of American College of Chest Physicians (ACCP - 2004) are mentioned.
Paper refers the first in Czech Republic liver transplantation in a child with the donor being the close living relative - the father. Indication was the chronic liver failure caused by biliary atresia after the Kasai procedures, which enabled the child to survive two years. Liver segments II. -III were transplanted with favourable postoperative development. Within the following twenty months the nutrition status and the psychomotor development of the child significantly improved. Authors discuss present situation and results of the paediatric liver transplantation in the world.
AIM: The aim of this study was to create an easily reproducible model of the acute hepatic failure (ASJ) in a minipig, which may allow to test supporting eliminating systems. The aim of this report was to describe the surgical technique with the anaesthesiological procedure and to demonstrate the experimental results on a group of the laboratory animals. METHODOLOGY: The ASJ was mocked using surgical devascularization of the liver: a ligature of the a. hepatica propria and v. portae, creating a portocaval anastomosis end-to-side. The animals were analgosedated during the experiment and were on a ventilatory support. Biochemical indicators of the hepatic failure, the ICP and the haemodynamics parameters were monitored. Hypoglycaemia with levels below 3.5 mmol and any increase of the intracranial pressure (ICP) were considered the onset of the hepatic failure. MATERIAL: 20 minipigs weighing 25-30 kg and divided in 3 groups, were included in the experiment: I--10 animals were assigned to the acute hepatic failure (ASJ) group, II--5 animals with the mock acute hepatic failure (ASJ), whose ICP was monitored in conjunction with the standard monitoring and III. 5 animals without the acute hepatic failure (ASJ)--a control group. RESULTS: We proved significant differences in the AST levels (33.44 +/- 39.96 vs. 1.56 +/- 0.50 mmol/l), the lactate levels (2.97 +/- 1.16 vs. 1.18 +/- 0.61 mmol/l), and the ammonium levels (264.3 +/- 93.05 vs. 42.5 +/- 12.98 micromol/l) in the acute hepatic failure (ASJ) group compared with the control group (p < 0.01) 6 hours after the surgery and significant changes in the glycaemia levels and the intracranial pressure (ICP) measurements 4 hours after the surgical procedure. Increase in the pulse frequency, the blood pressure, decrease of the mean arterial pressure (MAP) and decrease in the systemic venous resistence index (SVRI) in the acute hepatic failure (ASJ) group was recorded 6 hours after the procedure compared with the initial findings, with significant differences between the acute hepatic failure (ASJ groups and the control group as late as during the 12th hour following the procedure (SVRI: 953 ASJ vs. 1658 control, p - 0.05, MAP: 58.1 ASJ vs. 76 control, p - 0.05). No statistically significant differences in the heart index between the acute hepatic failure (ASJ) group and the control group were recorded. The animals with the acute hepatic failure (ASJ) survived 13 hours following the surgical procedure, on average.
The authors describe a case of 60-year-old man with primary adenocarcinoma of the distal duodenum. The first, ex post assumed symptom, was haemorrhage into the gastrointestinal tract almost two years before the final diagnostic conclusion. The diagnosis was not correctly established even during subsequent examinations during progression of the disease and not even during the first surgical revision. The reason is, no doubt, the rareness of the diagnosis and the adverse site of the tumour. An asset was was enteroscopy, although its conclusion was not accurate as regards the site. The tumour was radically removed only during the second operation by segmental resection of the distal duodenum with a duodenojejunal anastomosis in the region of D2. The patient was then referred to the care of an oncologist. The case shows the diagnostic difficulties and the unique operation that was performed. Possible success of treatment is always conditioned by coordinated gastroenterological, surgical and oncological care.
- MeSH
- adenokarcinom * diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory duodena * diagnóza chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
The author presents a review of the approach of vascular surgeons to penetrating injuries of the extremities from the initial period of development of the discipline when surgical exploration was preferred and performed as a matter of routine, across the sixties, seventies and eighties characterized by universal use of angiography, up to the last decade and the present time when specialists accept the necessity of selective indication of angiography derived from the clinical picture. Certain persisting differences in views pertain only to some aspects of the clinical finding. Some authors were for instance concerned with investigation of the probable risk of arterial injuries with regard to the site of penetration, from their conclusion ensues in the great majority the recommendation to perform angiography in injuries of the medial side of the thigh and arm, popliteal area, leg and forearm, incl. asymptomatic ones. Other investigations sought a relationship between the incidence of injuries and the presence of some clinical symptoms and recommend to indicate angiography in injuries associated with at least one "hard" symptom (pulse or neurological ischaemic deficiency) or at least two "soft" symptoms (haematoma, haemorrhage, hypotension, malleobrachial index smaller than 1). The author presents also his own attitude to the problem and emphasizes expert comprehensive clinical examination, taking into account the site of penetration, character and mechanism of injury, character of clinical symptoms, their intensity in relation to the general state of the circulation and its possible changes, in selected cases supplementation of the clinical finding by sonographic examination.
Indication for conservative treatment in the blunt injuries of the liver and the spleen have been recently significantly extended. On the example of the case histories and discussion in the literature the authors specify the necessary conditions, difficulties and results of this procedure. Key words: conservative treatment, injury of the liver, injury of the spleen.
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The authors present the case-history of a patient with multiple injuries where the dominating injury was haemorrhage into the retroperitoneum and subsequently into the abdominal cavity. The solution after CT and sonographic diagnosis was laparoscopy and subsequent arteriography with embolization. The authors consider the described procedures as the most suitable one in the given case.
- MeSH
- angiografie MeSH
- krvácení diagnostické zobrazování etiologie terapie MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- polytrauma * MeSH
- retroperitoneální prostor * MeSH
- terapeutická embolizace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The authors give an account of the interesting clinical development of a primarily erroneously diagnosed and inadequately treated arterial injury caused by a splint. They emphasize the necessity of angiographic examination and truthful recording in the surgical protocol.
- MeSH
- arteria femoralis zranění MeSH
- chybná diagnóza MeSH
- cizí tělesa diagnóza MeSH
- dospělí MeSH
- lidé MeSH
- nepravé aneurysma diagnóza etiologie MeSH
- ozbrojené síly * MeSH
- poranění tlakovou vlnou diagnóza MeSH
- třísla zranění MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
The author describes a technical 8-shaped variation of continuous suture of longitudinal arteriotomy. He describes the technical details of implementation of the suture which by crossing of the thread between the margins of the arteriotomy prevents overlapping of the margins and thus narrowing the arterial lumen. Practical aspects of the use of the suture are described, incl. evaluation of conditions and local findings where this continuous suture can, due to its functional effect, replace autovenous or prosthetic plastic surgery of the artery.
- MeSH
- arterie chirurgie MeSH
- lidé MeSH
- šicí techniky * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
In the course of 24 months (July 1 1996 till June 30, 1998) after CT examination of the abdomen 23 patients were subjected to laparotomy or laparoscopy as injury of the liver or spleen was assumed. Conclusions of CT are in the literature considered one of the necessary prerequisites of possible conservative treatment of the mentioned injuries, their accuracy and reliability is however not unequivocal. On comparison of the CT and surgical finding in the above patients at the time of examination the positive CT finding was correct in 17 of 19 cases, i.e. in 89%. Four patients were on count of clinical signs of intraabdominal injury operated despite a negative CT, in two of them liver injury was found in the obl. lig. falciforme. The overall accuracy was 83%. During the second assessment the overall accuracy increased to 87%. CT, using the A.A.S.T. classification underrated injury on average by 0.45 degree. In the authors' opinion CT of the abdomen is indicated in multiple injuries and severe associated injuries in case of circulatory stability as it makes it possible to examine effectively within a short time also other injured areas. It should always be made, using contrast.
- MeSH
- játra diagnostické zobrazování zranění chirurgie MeSH
- lidé MeSH
- počítačová rentgenová tomografie * MeSH
- slezina diagnostické zobrazování zranění chirurgie MeSH
- tupá poranění diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
