BACKGROUND: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. CASE: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient's wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn't heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. CONCLUSION: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

• Klíčová slova
• burr holes, chronic wounds, limb salvage, lower limb reconstruction,
• MeSH
• dospělí MeSH
• hojení ran MeSH
• lidé MeSH
• tibie * chirurgie   MeSH
• trepanace metody   MeSH
• vředy dolních končetin chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Purpose of the study is to evaluate a possible influence of subdural drainage duration and burr hole quantity on a relapse of a unilateral chronic subdural haematoma (CHSH). METHODS: Sixty - five patients who underwent evacuation of unilateral CHSH via 1 or 2 burr holes and subdural drainage during a period from January 2014 to December 2018 were retrospectively analyzed. Duration of the subdural drainage and the number of burr holes used were assessed in relation to an incidence of CHSH recurrence. According to the subdural drainage duration, we divided the patient cohort into two subgroups: with the subdural drainage duration of 1-3 days and 4-5 days. We also evaluated a possible influence of the subdural drainage duration on risk of postoperative infection. RESULTS: An overall incidence of CHSH recurrence was 18.5%. In 45 patients treated by means of a single burr hole the haematoma recurrence was observed in 10 patients (22.2%), in 22 patients with two burr holes recurrence occurred in 2 of them (9.1%). The difference was however, not statistically significant (p=0.3214). We did not observe any significant influence of age, gender and subdural drainage duration on the incidence of CHSH recurrence. The duration of subdural drainage had not significant impact on postoperative infection rate (p=0.0950). CONCLUSION: The number of burr holes used does not affect the rate of unilateral CHSH recurrence. Similarly the duration of subdural drainage affects neither the unilateral CHSH recurrence rate nor the incidence of postoperative infection.

• Klíčová slova
• burr hole, chronic subdural haematoma, postoperative infection, recurrence, risk factors, subdural drainage,
• MeSH
• chronický subdurální hematom chirurgie   MeSH
• drenáž MeSH
• lidé MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• trepanace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome. METHODS: Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery-trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied. RESULTS: Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients. CONCLUSIONS: Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.

• Klíčová slova
• Acute subdural hematoma, Brain injury, Contralateral subdural hematoma, Decompressive craniectomy, Reoperation,
• MeSH
• akutní subdurální hematom epidemiologie   etiologie   chirurgie   MeSH
• antikoagulancia terapeutické užití   MeSH
• antikonvulziva terapeutické užití   MeSH
• dekompresní kraniektomie statistika a číselné údaje   MeSH
• dospělí MeSH
• epilepsie farmakoterapie   epidemiologie   MeSH
• Glasgowská stupnice kómat MeSH
• Glasgowská stupnice následků MeSH
• inhibitory agregace trombocytů terapeutické užití   MeSH
• kraniocerebrální traumata komplikace   MeSH
• kraniotomie statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neurochirurgické výkony statistika a číselné údaje   MeSH
• otrava alkoholem epidemiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• trepanace statistika a číselné údaje   MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antikoagulancia MeSH
• antikonvulziva MeSH
• inhibitory agregace trombocytů MeSH

INTRODUCTION: Chronic subdural hematoma (ChSDH) is, by definition, a subdural collection of blood older than 21 days. It is not exceptional that ChSDH is diagnosed in regional hospitals and thus we believe that basic knowledge on this topic is relevant for every general surgeon. Below, we summarize information on ChSDH and present simple clinical management guidelines. TREATMENT: In asymptomatic patients with ChSDH, monitoring alone may be sufficient. Subdural collections of only a few millimeters are a relatively common incidental finding on graphical examination of the brain, especially in the elderly with brain atrophy. In symptomatic patients, surgical treatment is justified. As a first step, burr hole evacuation of the hematoma in local anesthesia is performed. It is a simple, well-tolerated procedure and advantageous in elderly polymorbid patients. In symptomatic patients with recurrent ChSDH, reoperation using either the same burr hole or a new one is indicated. Patients with multilobulated hematomas that recur after the burr hole are scheduled for a craniotomy. CONCLUSION: ChSDH is a common condition encountered by all general surgeons during their clinical practice. The most common clinical presentations of ChSDH are headache, confusion, hemiparesis and aphasia. Asymptomatic patients may be followed by watchful waiting, whereas symptomatic patients are indicated for surgical treatment. All patients with ChSDH should be referred to a neurosurgical department (preferably a certified level 1 trauma center) with experience in neurotrauma care.

• Klíčová slova
• neurosurgery - head trauma - chronic subdural hematoma - burr hole -craniotomy.,
• MeSH
• chronický subdurální hematom * diagnóza   chirurgie   MeSH
• drenáž MeSH
• kraniotomie * MeSH
• lidé MeSH
• recidiva MeSH
• reoperace MeSH
• senioři MeSH
• trepanace * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence. Standard treatment of CSDHs is surgical evacuation. The objective of this study is to present a modification of standard burr-hole hematoma evacuation using a flexible endoscope and to assess the advantages and risks. METHODS: Prospectively, 34 consecutive patients diagnosed with CSDH were included in the study. Epidemiological, clinical and radiographical data were collected and reviewed. All patients underwent a burr-hole evacuation of CSDH. A flexible endoscope was inserted and subdural space inspected during surgery. The surgeon was looking specifically for the presence of septations, draining catheter position and acute bleeding. RESULTS: Thirty-four patients underwent 37 endoscope-assisted surgeries. Presenting symptoms were hemiparesis (79%), decreased level of consciousness (18%), gait disturbances (15%), headache (12%), aphasia (6%), cognitive disturbances (6%) and epileptic seizure (3%). Average operative time was 43 min, and the average increase in operative time due to the use of the endoscope was 6 min. Recurrence rate was 8.8%, and clinical outcome was favorable (defined as mRS ≤ 2) in 97% of the cases. CONCLUSIONS: To our knowledge, the present cohort of 34 patients is the largest group of patients with CSDH treated using an endoscope. This technique allows decent visualization of the hematoma cavity while retaining the advantages of a minimally invasive approach under a local anesthesia. The main advantages are correct positioning of the catheter under visual control, identification of septations and early detection of cortex or vessel injury during surgery.

• Klíčová slova
• Burr hole, Chronic subdural hematoma, Endoscopic surgery, Head trauma, Minimally invasive neurosurgery, Neuroendoscopy,
• MeSH
• bolesti hlavy etiologie   MeSH
• chronický subdurální hematom chirurgie   MeSH
• dospělí MeSH
• drenáž metody   MeSH
• endoskopie přístrojové vybavení   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• pooperační komplikace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• subdurální prostor chirurgie   MeSH
• trepanace metody   MeSH
• vědomí MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• Aegean Bronze Age, Hagios Charalambos, Trepanation,
• MeSH
• lebka chirurgie   MeSH
• lidé MeSH
• neurochirurgie dějiny   MeSH
• trepanace dějiny   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• komentáře MeSH

In skeletal material from the neolithic settlement at Makotrasy, county Kladno, were analysed two children's craniums (identification numbers Ao 8218 and Ao 4184) with pathological cases. Case 1 (Object 127, Ao 8218) is the individual about 4 to 5 years old. There is oval aperture with the diameter 25 x 20 mm in the area of anthropometrical point bregma, with vertical, multiple knurled edges. Bevelled and rounded segment in the left frontal part of the aperture with diameter 10 mm is imitating healing process. We suggest this case is the trephination with the marks of the healing process in the period of 1 to 2 weeks after the surgery took over. Case 2 (Pit 25, Ao 4184) is child with age determined about 4 years old. Cranium was found buried separately. There is oval defect located at os occipitale and os parietale sin and goes through sutura lambdoidea. Caudal part of defect is missing. The edge of the defect is sharp and inward bevelled with exposed diploe. Traces of any vital reaction were not identified. Diameter is around 50 mm. Perimortal trephination leading to death, or postmortal taking of the trephinational amulet must be considered. There were several pathological lesions on the same skull. Defect of oval shape sized 8 x 12 mm is located at the os parietale dex. Defect interferes mostly with lamina externa and less with lamina interna. Exposed diploe is without any vital reaction.

• MeSH
• dějiny starověku MeSH
• lebka patologie   MeSH
• lidé MeSH
• paleopatologie MeSH
• předškolní dítě MeSH
• trepanace dějiny   MeSH
• Check Tag
• dějiny starověku MeSH
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• Geografické názvy
• Česká republika MeSH

Trephination of the skull is an old surgical procedure practised in both the Old and New Worlds from the Neolithic period 7,000 years ago up to the present. Four methods (scratching, cutting, drilling and circling) were used for therapeutic or ritual (magical) reasons, predominantly in older males. The survival rate was between approximately 25% and 75%, the drilling and especially cutting being most dangerous. Macroscopic, CT and histopathological examination of three trephined skulls from the collection of Hrdlicka's Museum of Man, Charles University, revealed two types of bone defect. In the first type the margin of the defects was covered by the cortical bone of identical structure as the cortical bone on the inner and outer surface of the surrounding skull bones. These cases probably represent defects that healed in living persons for a long time, and consequently new cortical bone developed (skull No. 1). However, congenital origin of defects of this type cannot be excluded. The second type of defects, without cortical bone cover at the hole margin, could be caused by trauma in the post mortem period or may have been performed during the people's lifetimes--if they died shortly after their skull damage, so the healing period was too short for the formation of new cortical bone (skull No. 2 and 3).

• MeSH
• archeologie MeSH
• dějiny starověku MeSH
• dějiny středověku MeSH
• lebka diagnostické zobrazování   patologie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• trepanace dějiny   MeSH
• Check Tag
• dějiny starověku MeSH
• dějiny středověku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

A well performed and processed trephine renders a perfect idea about tissue and cellular structure of bone marrow. Gentle taking and adequate processing of a sample are a prerequisite for successful biopsy. The most convenient and often sufficient is the paraffine technique with an entry evaluation of the first section and setling up the group diagnosis. Another time, it stimulates further choice of immunohistology and electron microscopy. There are presented detailed evaluation schemes for marrow suppression, hyperplasias, myelofibroses and tumours. They were checked in a group of 400 cases.

• MeSH
• biopsie * metody   MeSH
• histologické techniky MeSH
• kostní dřeň patologie   MeSH
• lidé MeSH
• trepanace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Easy paraffine technique in processing of bone marrow samples is convenient for structural evaluation and for immunohistology as well. A short fixation in 10% formalin will do, especially when combined with decalcination in Chelaton III. Preparation of sections, staining and immunohistology are analogous to other tissues. Nevertheless, it would be better try to dilute antibodies higher than is usually recommended even if a longer incubation were needed. Intensity of staining can be increased by performing lead sulphocyanate treatment in a microwave oven.

• MeSH
• biopsie metody   MeSH
• histologické techniky * MeSH
• kostní dřeň patologie   MeSH
• lidé MeSH
• trepanace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH