This paper presents the case of a 32-year-old female patient with acute colon incarceration in the thoracic cavity due to Bochdalek hernia. An asymptomatic right Bochdalek hernia was also discovered, which is a rare finding. The patient underwent laparotomy with reposition of the incarcerated organs and primary closure of the left-sided defect. The stenotic portion of the originally incarcerated colon was resected one year later due to the symptoms of chronic bowel problems. At present, 18 months from the first surgery, the patient's clinical condition remains good with a positive clinical response to the secondary surgery involving resection of the stenotic colon, and the right Bochdalek hernia remains asymptomatic.
- Klíčová slova
- Bochdalek hernia, diaphragmatic hernia, incarceration,
- MeSH
- brániční hernie chirurgie diagnostické zobrazování MeSH
- dospělí MeSH
- lidé MeSH
- nemoci tlustého střeva * chirurgie diagnostické zobrazování MeSH
- střevní obstrukce chirurgie etiologie diagnostické zobrazování MeSH
- vrozená brániční kýla chirurgie diagnostické zobrazování komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. METHODS: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). RESULTS: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× - 32%), subgaleal/subdural cerebrospinal fluid effusion (29× - 31%), soft tissues oedema (29× - 31%), haemorrhagic progression of brain contusion (17× - 18%), malignant brain oedema (8× - 8.5%), hydrocephalus (8× - 8.5%), temporal muscle atrophy (7× - 7.5%), peroperative massive bleeding ( 6× - 6.4%), epilepsy (4× - 4.3%), syndrome of the trephined (2× - 2.1%), skin necrosis (2× - 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). CONCLUSION: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.
- Klíčová slova
- complications, decompressive craniectomy, traumatic brain injury,
- MeSH
- dekompresní kraniektomie škodlivé účinky MeSH
- kraniocerebrální traumata komplikace chirurgie MeSH
- lidé MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- poranění mozku * MeSH
- retrospektivní studie MeSH
- subdurální efuze chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Radiation necrosis in eloquent areas of the central nervous system (CNS) is one of the most serious forms of toxicity from radiation therapy. The occurrence of radiation necrosis in the CNS is described in a wide range of 3 months to 13 years after radiation therapy. The incidence of this complication covers a wide range of 3-47%. The potential advantage of proton therapy is the ability to reduce dose to normal tissue and escalate tumor dose. Proton beams enter and pass through the tissue with minimal dose deposition until they reach the end of their paths, where the peak of dose, known as the Bragg peak, occurs. Thereafter, a steep dose fall-off is evident. Such a precisely-distributed dose should reduce the toxicity of the treatment. PATIENT: A 23 year-old female patient underwent radical microsurgical resection of anaplastic ependymoma that originated from the floor of the fourth ventricle. The tumor was growing into the foramen magnum dorsally from the medulla oblongata. Taking into account the age of the patient, the localization of the tumor and the required dose of 60 Gy, proton therapy was chosen due to the lower risk of damage to the brain stem. Radiation therapy was performed using pencil beam scanning and one dorsal field. Following this course of treatment, radiation necrosis of the medulla oblongata and the upper cervical spinal cord occurred with fatal clinical impact on the patient. The article analyses possible causes of this complication and a review of the current literature is given. CONCLUSION: Despite the theoretical advantages of proton therapy, no clinical benefit in CNS tumors has yet been proven in comparison with modern methods of photon therapy. Proton therapy is accompanied by many uncertainties which can cause unpredictable complications, such as radiation necrosis at the edges of the target volume. Following proton therapy, there is not only a higher incidence of radiation necrosis but it occurs both sooner and to a higher degree. In cases of high anatomical complexity, the neurosurgeon should cooperate in the creation of the radiation treatment planning to ensure its optimization.Key words: brain tumors - ependymoma - radiation therapy - proton therapy - necrosis - radiation necrosis This work was partially supported by research project MH CZ - DRO (Faculty Hospital in Pilsen - FNPl, 00669806). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 29. 6. 2017Accepted: 25. 7. 2017.
- MeSH
- čtvrtá mozková komora patologie chirurgie MeSH
- ependymom radioterapie chirurgie MeSH
- krční mícha patologie účinky záření MeSH
- lidé MeSH
- medulla oblongata patologie účinky záření MeSH
- mladý dospělý MeSH
- nádory mozku radioterapie chirurgie MeSH
- nekróza etiologie MeSH
- protonová terapie škodlivé účinky MeSH
- radiační poranění patologie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The authors present the technical aspects of perioperative safety during the microsurgery of cerebral aneurysms. We evaluated the advantages and disadvantages of the microvascular Doppler ultrasonography, the intraoperative digital subtraction angiography, the intraoperative transit time flowmetry, the intraoperative monitoring - motor evoked potentials and somatosensory evoked potentials, and the ICG videoangiography. The authors, based on their own experience, recommend combining different methods to eliminate the weak points of the individual specific methods. Combining the ICG with the flowmetry and the motor evoked potentials enhances safety during the surgery of cerebral aneurysms with the resultant reduction of the perioperative morbidity/mortality.
Cerebral aneurysms occur in 5% of the adult population. Their most severe clinical manifestation is subarachnoid haemorrhage occurring in half of the patients. Morbidity and mortality of subarachnoid hemorrhage is relatively high. Stopping blood flow into the aneurysmal sac is the treatment objective. The basic techniques to achieve this are closing the aneurysmal neck with a clip - clipping - and the induction of intraaneurysmal thrombosis using platinum coils - coiling. Fusiform and giant aneurysms represent a technical challenge. The solution for indicated cases is the occlusion of the magistral artery along with a high-flow bypass. A new option is the use of special stents - flow-diverters - in unruptured aneurysms. The authors present the current view on the treatment of both ruptured and unruptured aneurysms. At the same time the authors focus on factors that influence the application of up-to-date knowledge on everyday activities in their departments.
- MeSH
- intrakraniální aneurysma chirurgie MeSH
- lidé MeSH
- mikrochirurgie * MeSH
- neurochirurgické výkony metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: In this article, we present our experience with such operations performed under local anaesthesia. METHODS: From January 1997 to November 2007, there were 387 patients operated on for asymptomatic carotid stenosis. Patient data were retrospectively evaluated. Thirty-day neurological morbidity and mortality from six different subgroups were analysed and compared. The numbers of perioperative transient ischaemic attacks, as well as surgical and other perioperative complications were also evaluated. RESULTS: Overall morbidity and mortality was 1.8% (seven patients). Stroke was noted in 1.3% (five patients). Transitory ischaemic attacks within the first 30 days were observed in 1.6% (six patients). Only those patients who had intraluminal shunt insertion were found to have significantly higher morbidity and mortality. (p = 0.000018). Myocardial infarction was observed in 0.5% (two patients), one fatal. CONCLUSION: We have achieved acceptable morbidity and mortality rates (1.8%) according to the parameters set by previous studies such as Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Stenosis Trial as well as American Heart Association and European Stroke Organisation guidelines. All surgeries were done under local anaesthesia. Shunts were inserted in 22 cases (5.68%).
- MeSH
- cévní mozková příhoda etiologie mortalita prevence a kontrola MeSH
- karotická endarterektomie metody mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální anestezie metody mortalita MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stenóza arteria carotis etiologie mortalita chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
AIM: Evaluation of operative results and complications in high-risk patients who underwent combined carotid and coronary revascularization. PATIENTS AND METHODS: Combined operation--carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) was performed in the period 2000-2009 in 68 patients. Simultaneous operation was indicated in patients with unstable angina pectoris and 1. symtomatic internal carotid artery (ICA) stenosis > or = 50%, or 2. bilateral asymptomatic ICA stenosis > or = 60% or 3. asymptomatic ICA stenosis > or = 60% combined with contralateral ICA occlusion. Combined operations represented 5.8% of whole CEA series. Mean age was 69.9 (51-82) years, men were 46, women 22. Carotid angiography proved unilateral (always symptomatic) ICA stenosis in 25 patients, bilateral ICA stenosis in 35 patients and ICA stenosis combined with contralateral carotid occlusion in 8 patients. Neurological preoperative symptomatology: TIA was present in u 20 patients, minor stroke in 6 and major stroke in 5 patients. 37 patients were asymptomatic. One CABG was performed in 5 patients, 2 CABG in 20 patients, 3 CABG in 19 patients and 4 CABG in 6 patients. The rest of 18 patients had CABG operation combined with valve procedure. Comorbidity: hypertension 100%, diabetes mellitus 57.3%, hyperlipidemia 60.3%. Shunt was selectively used in 4.4%. The need for shunt was established using back stump pressure and near infrared spectroscopy. RESULTS: Mortality was 8.8% (6/68). The cause of death were multiorgan failure in two cases, ipsilateral stroke in two patients, respiratory insufficiency and cardiac failure due to graft occlusion both in one patient. Good recovery was recorded in 91.2%. CONCLUSION: Combined carotid and coronary revascularization has acceptable neurological morbidity/mortality in high risk patients. Strict requirement is thorough selection of patients.
Authors present case-report of 29-year old man with acute subdural hematoma and contusions in right basal frontotemporal area. Despite adequate conservative treatment and surgical therapy (hematoma evacuation and decompressive craniectomy) uncontrollable intracranial hypertension occurred 4th postoperative day. Situation has been effectively solved by resection of hemorrhagic temporal muscle together with duroplasty (fascia lata) and skin plastics using combined dressing fabric COM 30. Fabric was removed after eleven days followed skin suturing. Clinical status after four months is favorable, the patient is without neurological deficit. Bone flap return is planned.
- MeSH
- dekompresní kraniektomie * metody MeSH
- dospělí MeSH
- intrakraniální hypertenze diagnostické zobrazování etiologie chirurgie MeSH
- lidé MeSH
- mozek diagnostické zobrazování MeSH
- okluzivní ošetření rány * MeSH
- počítačová rentgenová tomografie MeSH
- poranění mozku komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Authors present case-report of young man with incomplete spinal cord injury after penetrating stab wound. Knife blade entered the skin in the level C3/4 in the back of the neck and directed to the right and downward. Both dorsal spinal cord columns and right half of spinal cord were transected. Neurological presentation was Brown-Séquard syndrome combined with dorsal columns syndrome. Wound revision was performed followed by dural closure. 18 month after injury significant neurological improvement of right hemiparesis was recorded and the patient is self-sufficient. Spinal cord stab wounds are rare. Typical clinical symptomatology is incomplete spinal cord injury. Clinical improvement of Brown-Séquard syndrome in our patient entirely corelates with literature.
- MeSH
- bodné rány komplikace chirurgie MeSH
- Brownův-Séquardův syndrom etiologie MeSH
- krční obratle MeSH
- lidé MeSH
- mladý dospělý MeSH
- poranění míchy komplikace chirurgie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
A case of compound depressed fracture of occipital bone in 52-years old man caused by crane hook is presented. Bone fragments were depressed 40 millimetres causing blindeness and huge hemorrhage with symptoms of hemorrhagic shock. Laceration of left occipital lobe and penetration of superior sagittal sinus were treated during the operation. Primary elevation, debridement and primary bone replacement with additional covering of bone defect by bone cement were performed. Primary wound healing was achieved. Cortical blindeness subsided to the stage of contralateral homonymous hemianopia.
- MeSH
- lacerace diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- otevřené fraktury diagnóza chirurgie MeSH
- sinus durae matris zranění MeSH
- týlní kost zranění chirurgie MeSH
- týlní lalok zranění chirurgie MeSH
- vpáčené fraktury lebky diagnóza chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
