INTRODUCTION: Thymectomy has always been considered an important treatment modality for patients with Myasthenia Gravis (MG). Because of the absence of randomized trials, its exact role was not clear and was even questioned by some. Indications for surgery were made on empirical basis. It was not until the results of the first randomized double- blinded multicentric study were published, where the combined surgical treatment of patients with nonthymomatous MG was proved superior to conservative treatment alone. In this study the technique of extensive thymectomy via longitudinal sternotomy was used as a mainstay of surgical treatment. In the advent of minimally invasive techniques a variety of options were presented for minimally invasive surgical treatment of thymic pathology. METHODS: The authors present a retrospective analysis of short term results using the slightly modified method of “Minimally Invasive Maximal Thymectomy” developed by Zielinski over a 10 year period (20082018). Besides the demographics, we assessed the peri- and postoperative results such as the length of surgery, blood loss, the need for conversion, learning curve impact, the lengths of drainage and hospital stay and the complication rate, both surgical and systemic. RESULTS: 48 patients underwent surgery using the above mentioned method for non-thymomatous MG. 81.25% (n=39) of patients were diagnosed with a seropositive generalized form of MG, 6 (12.5%) had seropositive ocular form and 3 patients (6.25%) had seronegative form of the disease. The sex ratio profoundly favored females (89.5%; n=43). The median value of the length of surgery was 186,5 minutes, the mean LOS and length of drainage were 4 and 3 days, respectively. CONCLUSION: According to our results and experience with Minimally Invasive Maximal Thymectomy, we found it to be an effective and safe method for MG patients after conquering the learning curve.

• Klíčová slova
• VATS, maximal thymectomy, minimally invasive surgery, nonthymomatous Myasthenia Gravis,
• MeSH
• hrudní chirurgie video-asistovaná MeSH
• lidé MeSH
• myasthenia gravis chirurgie   MeSH
• retrospektivní studie MeSH
• sternotomie škodlivé účinky   MeSH
• thymektomie * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Descending necrotizing mediastinitis is a severe, fulminant, life-threatening bacterial infection of the mediastinum. Even though improvements in diagnostics and treatment were achieved, the mortality rate remain shigh. Contrast-enhanced CT of chest and neck is the diagnostic gold standard. Radical debridement and drainage of the mediastinum should be considered the primary therapeutic target. The authors present a complicated case of a female patient with cervical necrotizing fasciitis and descending necrotizing mediastinitis. She was initially treated for a deep neck infection at the department of otorhinolaryngology. Surgical treatment, antibiotics, and intensive care became an integral part of the therapy after the transfer to the department of thoracic surgery. The authors had to face various complications with tracheostomy and extensively debrided soft tissues in the neck region. That is why the patient underwent repeated surgeries during several hospital stays, with an overall duration of treatment reaching 220 days.

• Klíčová slova
• deep neck infection, descending necrotizing mediastinitis, tracheostomy,
• MeSH
• drenáž MeSH
• fasciitida nekrotizující chirurgie   MeSH
• krk MeSH
• lidé MeSH
• mediastinitida komplikace   diagnostické zobrazování   chirurgie   MeSH
• nekróza MeSH
• tracheostomie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

• Klíčová slova
• anastomic leak, management of dehiscence, oesophageal cancer, oesophageal stent, oesophagectomy complication,
• MeSH
• anastomóza chirurgická škodlivé účinky   MeSH
• ezofagektomie škodlivé účinky   MeSH
• lidé MeSH
• nádory jícnu chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Varicose veins of lower extremities represent a common medical condition with minimally invasive percutaneous endovenous ablation techniques as a treatment of choice. A very rare complication is a catheter migration in the deep venous system. In the literature only 7 cases have been published so far, with only 2 cases with migration to the systemic circulation and heart involvement. In this paper we present an interesting case report from the perspective of a thoracic surgeon with the finding of a laser ablation catheter remnant in the left pleural cavity during thoracoscopic exploration for a spontaneous hemothorax in a 47-year old male patient after collapse. A similar complication affecting the pleural cavity has not been published before. In this paper we discuss possible routes of the cathether migration into the left pleural cavity, impending complications when a part of the catheter is left behind in the body and the means of prevention of these serious potentially fatal complications even after many years following the initial treatment.

• Klíčová slova
• VATS, complications, endovenous laser ablation, hemothorax, varicose veins of lower extremities,
• MeSH
• hemotorax * etiologie   MeSH
• katetrizační ablace * MeSH
• laserová terapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• migrace cizích těles * komplikace   MeSH
• pánev MeSH
• varixy * terapie   MeSH
• vena saphena MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Pectus excavatum is the most common congenital chest wall deformity. Aproximatelly 1 out of 400 to 1000 newborns are affected by this diagnosis. Surgical correction is indicated in patients that fulfil the indication criteria. The highly modified Ravitch correction (HMRR) and minimally invasive pectus excavatum repair (MIRPE) are by far the most popular methods of correction. MIRPE has been established as the method of choice amongst children. Feasibility of the minimally invasive approach in the funnel chest correction in adult population still remains controversial. METHODS: The authors present a retrospective analysis of adult patients treated by MIRPE in their institution. Sixty adult patients with pectus excavatum underwent MIRPE from October 2010 to March 2015. Various parameters were evaluated retrospectively. The effectiveness and safety of both techniques were evaluated with the use of statistical software SPSS® version 21.0 (IBM, USA). Data were evaluated using Student´s t-test or Mann-Whitney U-test for normally and non-normally distributed data, respectively. The comparison of categorical variables between the groups was evaluated by Pearson´s chi-square test. A p value of less than 0.05 was considered statistically significant. RESULTS: 45 men and 15 women underwent MIRPE during the period. Median age in the group was 23 years without any statistically significant difference between males and females (p=0.386). Median Haller index was 3.93 and was slightly higher in women (p= 0.285). Asymmetric deformities were present in 20 patients (33.3%) without any statistically significant difference between the sexes (p=0.206). Median duration of the surgical correction was 73 minutes and was longer in males (p=0.312). Two bars were implanted in 27 patients with no significant difference between the sexes (p=0.454). Complication rate was 25% (15/60) without any significant difference based on the number of implanted bars (p=0.178), sex (p=0.863) or the presence of an asymmetric deformity (p=0.527). Wound seromas with 10% (6/60) were the most common complication. Median postoperative length of stay was 5 days without any significant difference between males and females (p=0.653) and patients with different number of bars implanted (p=0.600). The need for rehospitalisation and reoperation was indicated in 5 patients (8.3%). Allergy to chromium led to bar extraction in 1 patient and 4 patients were treated by V.A.C.® therapy (KCI, USA) because of wound abscess (1) and seroma (3). CONCLUSION: Minimally invasive pectus excavatum repair is an effective surgical technique for the treatment of pectus excavatum in adult patients. This technique can be learned and performed safely even without any former experience with this correction in children. KEY WORDS: adult patients - MIRPE pectus excavatum.

• MeSH
• délka pobytu MeSH
• dospělí MeSH
• hrudník vpáčený chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• pooperační komplikace MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• torakoskopie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Recurrent pectus excavatum is the most serious late complication after primary repair. Redo open repair (Highly Modified Ravitch Repair, HMRR) or minimally invasive repair of pectus excavatum (MIRPE) are usually performed in indicated cases. This paper focuses on the evaluation of available redo surgical techniques in adult and adolescent patients with recurrent pectus excavatum. METHODS: 126 operative corrections, predominantly in adult patients, were performed by the authors between June 2006 and October 2014. HMRR was the method of choice in 51 cases, and MIRPE in 75 cases. Recurrent pectus excavatum was the indication in 12 repair procedures (9.5%) in 11 patients. Prior repairs included HMRR in 10 patients and MIRPE in one case. Both HMRR and MIRPE were indicated as redo procedure in six cases. The median age in the redo group was 23.5 (1744) years and the median interval between the primary correction and the redo procedure was 9.5 (231) years. The male to female ratio was 3:1. RESULTS: The use of MIRPE resulted in shorter operation time (120 vs. 172 min). There was no difference in the length of postoperative hospitalisation. Three complications (50%) were recorded in the HMRR group (wound seroma, intrapericardial bar migration with hemopericardium, displaced rectus abdominis muscle) and one (16.7%) occurred in the MIRPE group (symptomatic fluidothorax). CONCLUSION: Despite our limited experience with both techniques in the treatment of recurrent pectus excavatum we believe that MIRPE should be regarded as a safe and effective technique for the redo repair in adolescent and adult patients.Key words: HMRR - MIRPE recurrent pectus excavatum.

• MeSH
• dospělí MeSH
• hrudník vpáčený chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• retrospektivní studie MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

UNLABELLED: Alcohol consumption is a worldwide spread phenomenon influence of which on a human organism may even be fatal. Consequences of alcoholism are not only medical but also social and economical. The basic principles of alcohol dependence development remain still unclear. Submitted article offers a short review of alcohols effects mechanisms and its interaction with neurotransmitters. KEYWORDS: alcohol - biomembranes fluidity - GABA - dopamine - serotonine - neurotransmitters.

• MeSH
• buněčná membrána účinky léků   metabolismus   MeSH
• ethanol farmakologie   MeSH
• lidé MeSH
• mozek účinky léků   metabolismus   MeSH
• N-methylaspartát metabolismus   MeSH
• nervový přenos účinky léků   MeSH
• neurotransmiterové látky metabolismus   MeSH
• receptory GABA metabolismus   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• ethanol MeSH
• N-methylaspartát MeSH
• neurotransmiterové látky MeSH
• receptory GABA MeSH

UNLABELLED: Motorcyclists are extremely vulnerable road participants who are exposed to severe, often fatal injuries. Relative to four - wheeled vehicles, motorcycle pose a greater hazard of death or serious injury to operators and passengers. In fatal crashes, the motorcyclist typically collides with moving or stationary objects in the riding environment. The most common mechanism of crashes is hitting a moving vehicle followed by hitting a stationary object. The mechanism of injury resulting in death usually comes from severe blunt force trauma, creating internal and external injuries to the motorcyclist, especially craniocerebral, spinal, and sometimes with very characteristic injury patterns. The paper also identified effects of alcohol, which represent a significant risk factor for motorcycle operators. Presented concise review of selected risk factors and typical motorcycle-related injuries may be useful for both forensic pathologists, clinicians and law enforcement in preventive and repressive steps. KEYWORDS: motorcycle fatalities - risk factors - injury patterns - alcohol impairment - medicolegal study.

• MeSH
• dopravní nehody * MeSH
• lidé MeSH
• motocykly * MeSH
• rány a poranění etiologie   mortalita   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIM: Review of literature and a single-institution retrospective analysis of possibilities and results of various surgical techniques in treatment of benign tracheoesophageal fistula (TEF). MATERIAL AND METHODS: Between 1995 and 2010, 26 patients with benign tracheoesophageal fistula of various etiology underwent surgical treatment at the Department of Thoracic Surgery of Slovak Medical University and Faculty Hospital in Bratislava. The majority of patients had a postintubation TEF (21 cases), two fistulas were of traumatic origin, one iatrogenic, one congenital with adulthood manifestation and one tracheo-neoesophageal (TNEF) following an esophagectomy for carcinoma via extended cervical approach with lymphadenectomy and sternal retraction adpoted from transcervical extended mediastinal lymphadenectomy. We review the possible means of surgical treatment of TEF, of which we most frequently used segmental tracheal resection with end-to-end anastomosis and a non-overlying suture of the esophageal defect without muscle flap interposition (16 patients), transsection of the fistula with muscular flap interposition via cervical (2 patients) or transthoracic (1 patient) approach; or a T-tube insertion with (1 patient) or without (5 patients) discision and suture of the TEF. The only tracheo-neoesophageal fistula in our experience had been treated by neoesophagectomy, covering of tracheal defect by intercostal muscle flap and cervical esophagostomy. RESULTS: Short- and long-term results of TEF treatment in our institution have been favourable, with perioperative mortality of 3.8% (the patient with tracheo-neoesophageal fistula). Morbidity included 1 partial tracheal anastomotic dehiscence, 3 temporary left recurrent nerve palsies, temporary deglutition disorders (15 patients), tracheal anastomosis granulations in 1 patient and 2 wound infections. Out of 26 patients 15 (58%) are being followed-up on a regular basis, all with good (12 patients) or satisfactory (3 patients) functional results. CONCLUSION: In the paper we analyze the advantages and disadvantages of various techniques and their alternatives in the treatment of TEF. As the most reliable and suitable solution for patients with postintubation TEF, breathing spontaneously and with acceptable nutritional status, we favour segmental trachea resection with end-to-end anastomosis and esophageal suture without muscle interposition, regardless of presence of concomitant tracheal stenosis. Fistulae of other etiologies require diverse approaches, especially tailored with respect to their location. Management of tracheo-neoesophageal fistula following esophagectomy for carcinoma is extremely demanding. Therefore, it is crucial to adhere to basic rules of prevention of such benign but potentially fatal entities as TEF and TNEF.

• MeSH
• ezofágus chirurgie   MeSH
• hrudní chirurgické výkony metody   MeSH
• intratracheální intubace škodlivé účinky   MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři MeSH
• trachea chirurgie   MeSH
• tracheoezofageální píštěl etiologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

AIM OF STUDY: In dealing with benign tracheal stenosis, segmental tracheal resection yields superior results in experienced hands when properly indicated, timed end executed. Several factors may contribute to early or delayed failure of resectional treatment. In our retrospective study we analyze the potential causes of tracheal restenosis in patients who underwent segmental tracheal resection for benign tracheal stenosis between 1995-2009 and propose an algorithm for prevention and treatment of such complication. PATIENTS AND METHODS: Between 1995-2009, of 249 patients with benign tracheal stenosis 169 underwent segmental tracheal resection with zero perioperative mortality. Of 9 serious anastomotic healing complications (5.3%) we experienced 2 partial and 1 complete anastomotic dehiscence, and 6 serious restenoses (3.6%). Another 2 patients with restenosis were referred from other hospitals. Four patients had a T-tube implanted, of these in 2 it was possible to restore airway continuity by means of a successful parastomic implantation of perforated rib cartilage and tracheoplasty. Two early and two delayed restenoses were dealt with by segmental re-resection. One of our patients with partial anastomotic dehiscence after first tracheal resection underwent a rib-cartilage tracheoplasty after initial T-tube insertion. Subsequently a slowly progressing restenosis had been treated by re-resection after 2 years of observation and worsening symptoms. RESULTS: In the patient with complicated history described above the long-term result of treatment continues to be uncertain. In the remaining 4 patients (80%) both anatomical and functional results of re-resection have been favourable even after a very long period of time (8-16 years). DISCUSSION: In the paper we analyze the causes of restenosis after segmental tracheal resection and propose an algorithm of restenosis treatment. We consider insufficient assessment of resected segment length and subsequent anastomosis construction in inflamed tracheal tissue to be the most important cause of early restenosis. The late restenoses in our experience were caused by excessive anastomotic tension and possibly by other factors, such as steroid medication. Indication and timing of re-resection depend also on identifying the cause of restenosis. Early restenoses possibly induced by technical error may be treated by reresection sooner than delayed restenoses, which usually require 6-12 months for inflammatory changes to subside. In both scenarios T-tube insertion represents a reliable temporary or even permanent solution.

• MeSH
• intratracheální intubace škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• recidiva MeSH
• reoperace MeSH
• stenóza průdušnice etiologie   chirurgie   MeSH
• trachea zranění   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH