BACKGROUND: Identifying relevant perforators is crucial in planning a deep inferior epigastric perforator (DIEP) flap. Color Doppler ultrasonography (CDU) has gained popularity for localizing perforators; however, current evidence on its efficiency is still inconclusive. This study aimed to compare the efficiency of CDU with that of computed tomography angiography (CTA) in localizing and selecting the relevant perforators. METHODS: In this randomized controlled trial, 60 patients undergoing DIEP flap breast reconstruction (uni- or bilateral) were randomly assigned to the CDU group (i.e., CDU was performed to map and select the relevant perforators preoperatively) or the CTA+CDU group (i.e., mapping was based on CTA and supplemented by CDU). CDU was performed by the same surgeon with a well-defined sonography experience from our previous study. The reference XY coordinates of the dissected perforators were measured intraoperatively, and deviations from preoperatively deducted coordinates were calculated (ΔCDU or ΔCTA+CDU). The flaps were categorized according to the number of dissected perforators, and adherence to the preoperative strategy was evaluated. RESULTS: Overall, 22 patients (30 flaps) in the CTA+CDU group and 27 (39 flaps) patients in the CDU group were evaluated. The average ΔCDU (0.6 cm) was significantly lower than the average ΔCTA+CDU (1.0 cm) (p < 0.001). Adherence to the mapping-based dissection strategy was higher in the CDU group; however, the difference was insignificant (p = 0.092). CONCLUSION: CDU is not inferior to CTA + CDU in localizing and selecting relevant DIEA perforators. Therefore, CDU mapping is a possible complementary or substitute modality for CTA mapping.

• Klíčová slova
• Breast reconstruction, Color Doppler ultrasound, Computed tomographic angiography, DIEP flap perforator mapping, Localization of perforators, Perforator flaps,
• MeSH
• arteriae epigastricae diagnostické zobrazování   chirurgie   MeSH
• CT angiografie metody   MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• perforátorový lalok * chirurgie   MeSH
• ultrasonografie dopplerovská barevná MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

• Klíčová slova
• Cardiac perforation, Pacemaker lead penetration,
• MeSH
• kardiostimulátor * škodlivé účinky   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• poranění srdce * MeSH
• srdeční komory diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Perforator mapping using diagnostic methods facilitates deep inferior epigastric perforator (DIEP) flap planning. Computed tomographic angiography (CTA) is a well-proven tool for perforator mapping. However, the benefits of color Doppler ultrasonography (CDU) are as follows: 1) CDU involves dynamic real-time examination and 2) does not use radiation. Comparing the accuracies of both methods in a cohort of patients, this study aimed to evaluate the learning curve of surgeon-conducted CDU perforator mapping. METHODS: Twenty patients undergoing DIEP flap breast reconstruction were enrolled in a cohort study. All patients underwent CTA perforator mapping preoperatively. XY coordinates of significant perforators were subtracted by a radiologist. A single surgeon (sonographer) with minimal experience with CDU performed CDU perforator mapping, including XY coordinates subtraction. The sonographer was blinded to the CTA data. The reference coordinates of dissected perforators were measured during surgery. Deviations from reference coordinates for both methods were compared, and CDU mapping learning curve was assessed using Joinpoint Regression. RESULTS: We included 20 women (32 DIEP flaps and 59 dissected perforators). The mean deviation between mapped and reference coordinates was 1.00 (0.50-1.12) cm for CDU and 0.71 (0.50-1.12) cm for CTA. The learning curve of CDU mapping showed the breaking point after the seventh patient (≈ 21 localized perforators). After the breaking point, no significant differences between the deviations of both methods were found (p = 0.980). CONCLUSION: A limited number of examinations were needed for the surgeon to learn CDU DIEA perforator mapping with accuracy similar to that of CTA mapping.

• Klíčová slova
• Color Doppler ultrasound, computed tomographic angiography, DIEP flap perforator mapping, Learning curve,
• MeSH
• arteriae epigastricae diagnostické zobrazování   chirurgie   MeSH
• chirurgové * MeSH
• kohortové studie MeSH
• křivka učení MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• perforátorový lalok * krevní zásobení   MeSH
• ultrasonografie dopplerovská barevná metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

2 cases of perforation of the uterine wall by an IUD, in women 31- and 32-years-old, are presented. The 1st case involved the clear perforation of the uterine wall upon insertion. In the 2nd case the insertion of the device into the puerperal wall proceeded clinically asymptomatic and the point of perforation was not safely ascertained. The occurrence of uterine perforation with an IUD is uncommon, its frequency varying from 1:200 to 1:2000 depending on the type of device. It occurs most frequently with the Dana and Dana Super. The possibilities of migration of a deformed device into the uterine wall are considered, although examination of data shows that the extrauterine localization of the IUD invariably occurs during the insertion.

• Klíčová slova
• Case Studies *, Contraception, Contraceptive Methods--complications, Diseases, Family Planning, Iud--complications *, Perforations, Research Methodology, Studies, Uterine Perforation *,
• MeSH
• dospělí MeSH
• lidé MeSH
• metroragie etiologie   MeSH
• nitroděložní antikoncepční prostředky škodlivé účinky   MeSH
• uterus zranění   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

Breast conserving surgery has been reserved for patients with favorable proportion between tumor dimensions and breast size. Introduction of local flaps from the lateral thoracic region has widened the indications for breast conserving surgery, by allowing surgeons to perform wider excisions, thus yet be able to ensure tumor-free surgical margins and a good aesthetic result. We have used lateral intercostal perforator flaps and flaps harvested on the lateral thoracic artery and lateral thoracic artery axial flap in patients with small breasts and an unfavorable tumor to breast size proportion. From May 2015 to October 2016, 19 patients with breast tumors have been treated with BCS and immediate volume replacement reconstruction by pedicle perforator flaps from the lateral thoracic region. In 15 patients lateral intercostal artery perforator flaps or lateral thoracic artery perforator flaps were used after quadrantectomy or wide local excision, in 3 patients as volume replacement after mastectomy and in 1 patient after mastectomy following previous augmentation mammoplasty. In all patients, good breast symmetry was achieved, with no major complications. Fibrosis of the flap and residual breast parenchyma, with volume reduction were noticed after postoperative radiotherapy in thin patients or flaps with little subcutaneous fat. Perforator flaps from the lateral thoracic region should become the gold standard for reconstructions after breast conserving surgery involving less than 20% of the breast volume or after mastectomy in patients with small breasts. The operating procedure is safe, quick and allows sparing of the latissimus dorsi muscle and thus minimal donor site morbidity, as well as an excellent aesthetic result.

• Klíčová slova
• LICAP, LTAP, breast reconstruction, perforator flaps,
• MeSH
• lidé MeSH
• mamoplastika metody   MeSH
• nádory prsu patologie   chirurgie   MeSH
• perforátorový lalok krevní zásobení   MeSH
• prsy patologie   chirurgie   MeSH
• segmentální mastektomie * MeSH
• tumor burden MeSH
• velikost orgánu MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Authors present the case of patient with perforation of atypicaly localised diverticula of small intestine. The most important in clinical picture of patient was the sudden progress of sepsis and symptoms of organ failure. This status was progreding after the first operative revision of abdominal cavity when no explanation for peritonitis was found. During the second operation revision we found the perforated diverticula of the mesenterial side of distal jejunum. In the period after operation several complications such as wound healing failure and organs failure were occurred.

• MeSH
• divertikl komplikace   chirurgie   MeSH
• lidé MeSH
• nemoci jejuna komplikace   chirurgie   MeSH
• perforace střeva etiologie   chirurgie   MeSH
• peritonitida etiologie   MeSH
• senioři nad 80 let MeSH
• septický šok etiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

A blunt duodenal injuries are rare in spite of high-energetic injuries are common in this time. The diagnostic is very difficult not only for the reason of the little experience with this type of the injury but in term of the duodenal anatomic localization too. On the other side just late injury Identification of the retroperitoneal part of the duodenum leads to rapid development of the fatal retroperitoneal phlegmon. The development of the clinical symptoms and results of the paraclinical equipment examinations during blunt injury of the upper abdominal part with consequent perforation of the posterior retroperitoneal segment of the duodenum is well-documented by means of the mentioned case. The development of the retroperitonal phlegmon was not noticed despite of the slight diagnostic delayed and defect in the duodenal wall was treated by suture of the perforation aperture. The early detection of the duodenal injury is necessary premise for the good choice of the adequate surgical treatment.

• MeSH
• bromhexin MeSH
• dopravní nehody MeSH
• dospělí MeSH
• duodenum zranění   chirurgie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• perforace střeva diagnóza   etiologie   chirurgie   MeSH
• poranění břicha komplikace   MeSH
• tupá poranění komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• bromhexin MeSH

AIM: To report a case of progressive corneal thinning and spontaneous corneal perforation in the setting of recurrent keratoconjunctivitis of undetermined etiology in a 20-year-old female patient. MATERIAL AND METHODS: Longitudinal follow-up of the reported case was performed with regular slit-lamp examination, anterior segment optical coherence tomography, and laboratory evaluation. Relevant scientific literature was reviewed to discover potential etiologies and causes of the reported case. CASE REPORT: Recurrent bilateral keratoconjunctivitis was detected and followed up in a 20-year-old female patient. Long-standing blepharitis and several ocular inflammatory episodes were observed involving the conjunctiva and cornea causing corneal thinning and irregular astigmatism on both eyes. Patient's history, physical and laboratory examination did not reveal any systemic inflammatory or dermatological disorder. After 4 years from the onset of symptoms, spontaneous corneal perforation was observed on the right eye and treated with amniotic membrane transplantation. At that time, eyelid margin culture was positive for Streptococcus mitis. The graft healed completely with paracentral stromal scarring. Best spectacle corrected visual acuity was 20/25 OD and 20/40 OS a month after the procedure. CONCLUSION: Corneal and ocular surface inflammation is a potential multifactorial disease. Bacterial hypersensitivity, atopy and dermatological disorders such as atopic dermatitis and rosacea may play a role in recurrent keratitis, corneal thinning and eventually corneal perforation. Frequent and regular follow-ups are required to detect complications early as well as to discover all possible local and systemic contributing factors of keratoconjunctivitis.

• Klíčová slova
• keratitis, Hypersensitivity, conjunctivitis, corneal perforation,
• MeSH
• keratokonjunktivitida * komplikace   MeSH
• lidé MeSH
• mladý dospělý MeSH
• perforace rohovky * etiologie   MeSH
• rohovka * patologie   MeSH
• streptokokové infekce * komplikace   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

An evaluation of anti-ulcer effects of mono- and dibasic carbamate local anaesthetics was performed using two experimental models of gastric ulcers, i.e. those induced by stress, or by ligation of the pylorus. These models have been found not to be identical. In the case of stress-induced ulcers, no experimental animal died as compared to the second experimental group with a 30% mortality rate due to the more frequent occurrence of ulcer perforations. Result similarities of both models could only be found with respect to the range of damage of the mucous membrane of the stomach. A premedication with a majority of basic carbamates decreased the incidence and range of ulcer lesion. The anti-ulcer activity of monobasic carbamates was more significant when compared with dibasic compounds.

• MeSH
• anestetika lokální * MeSH
• fyziologický stres komplikace   MeSH
• karbamáty chemie   terapeutické užití   MeSH
• krysa rodu Rattus MeSH
• peptický vřed farmakoterapie   etiologie   MeSH
• potkani Wistar MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• anestetika lokální * MeSH
• karbamáty MeSH

INTRODUCTION: Peritonitis due to perforated peptic ulcer (PPU) is a surgical emergency associated with high mortality. Preoperative management includes immediate initiation of broad-spectrum antimicrobial therapy. The objective of this study was to assess the spectrum of microbial pathogens in peritoneal fluid. METHODS: Retrospective observational study of patients who underwent surgery for PPU at the 1st Department of Surgery - Thoracic, Abdominal and Injury Surgery, General University Hospital in the period 2015-2020. Analysis of the microbiological analytical results of peritoneal fluid. RESULTS: The microbiological profile of PPU-associated peritonitis is somewhat different from microbial pathogens involved in secondary peritonitis due to bowel perforation. A high rate of negative culture findings, high incidence of Candida spp. and low incidence of anaerobic bacteria are characteristic for PPU-associated peritonitis. Negative culture from the peritoneal fluid collected during surgery was identified in 42% of the patients. A total of 66 isolates of microbial pathogens were identified, including Candida spp. (42.5%), aerobic gram-positive bacteria (30.3%), aerobic gram-negative bacteria (22.7%) and anaerobic bacteria (4.5%). Candida albicans and Candida glabrata represented the most common species. Decreased susceptibility to fluconazole and resistance to itraconazole was associated with all Candida glabrata isolates. CONCLUSION: Although PPU-associated peritonitis is mostly of community origin, we confirmed a significant incidence of Candida spp. with decreased azole susceptibility. The choice of antifungal therapy should always be based on local epidemiology.

• Klíčová slova
• Candida spp., antifungal susceptibility, antifungal therapy, perforated peptic ulcer,
• MeSH
• antifungální látky terapeutické užití   MeSH
• ascitická tekutina mikrobiologie   MeSH
• Candida MeSH
• lidé MeSH
• perforace peptického vředu * komplikace   mikrobiologie   chirurgie   MeSH
• peritonitida * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• antifungální látky MeSH