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

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Despite ongoing efforts, recurrence and reoperation rates after surgical treatment remain high. We synthesize scientific evidence on the treatment of CSDH with biophysical principles and then propose a simple and effective surgical technique aiming to reduce the recurrence rate. Under local anesthesia, one burr hole is placed in the area above the maximum hematoma thickness. One drain is inserted into the dorsal direction to the deepest point of the hematoma cavity, and a second drain is inserted frontally into the highest point. Next, saline is gently instilled to the dorsal drain to eliminate air from the hematoma cavity through the frontal drain. Once saline has filled the frontal drain, the frontal drain is removed. The dorsal drain is left in situ for 48 h, and the pressure within the cavity may be adapted hydrostatically. We implemented evidence-based conclusions of previous studies and modified the classical burr-hole technique to reduce the recurrence rate. As a result, we developed a straightforward surgical procedure that is possible to perform under local anesthesia, suitable for everyday practice in rural and remote areas while working with limited resources. The novelty of this technique is in the purposeful reduction of postoperative pneumocephalus, a known independent factor of recurrence. Subdural air is eliminated during surgery using a two-drain system. Safety and efficacy of the technique need to be evaluated in future clinical trials.

• Klíčová slova
• Chronic subdural hematoma, evidence-based medicine, head trauma, neurosurgery, pneumocephalus,
• Publikační typ
• časopisecké články MeSH

This article focuses on the technologies used by a manufacturing company to produce threads in chrome-nickel steel 1.4301 at specific sheet thicknesses. To enhance production quality, two specific technologies were chosen for hole formation, considering the requirements of the company. Both conventional drilling and nonconventional laser cutting methods were evaluated as potential techniques for hole production. Conventional thread-cutting technology and progressive forming technology were employed to create metric internal threads. The aim of integrating these diverse technologies is to identify the optimal solution for a specific sheet thickness in order to prevent the occurrence of defective threads that could not fulfil the intended purpose. The evaluation of the threads and holes relies on the examination of surface characteristics, such as the quality of the surface, as well as the lack of any signs of damage, cracks, or burrs. Furthermore, residual stresses in the surface layer were monitored because these stresses have the potential to cause cracking. Additionally, extensive monitoring was performed to guarantee that the form and size of the manufactured threads were correct to ensure smooth assembly and optimal functionality.

• Klíčová slova
• cutting, hole, laser, quality, shape accuracy, thread,
• Publikační typ
• časopisecké články 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

The aim of the study is to present a case report describing patient, admitted for subdural haematoma located on temporal lobe base and brain convexity with intracerebral haematoma located in the depth of temporal lobe. Both haematomas were evacuated from burr holes. Histological analysis of tissue obtained during intracerebral haematoma aspiration has proven tumorous tissue consistent with anaplastic astrocytoma. Contrast enhanced MRI has confirmed the diagnosis and patient underwent tumor surgery. The study brings additional data to differential diagnosis of subdural haematoma, especially of non traumatic origin. When compared with meningiomas and metastatic tumors primary brain glioma is an exceptional cause of subdural haematoma of non traumatic origin.

• MeSH
• akutní subdurální hematom etiologie   MeSH
• astrocytom komplikace   diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory mozku komplikace   diagnóza   chirurgie   MeSH
• spánkový lalok * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The objective of this investigational analysis was to study the influence of process variables on the response during the drilling of LM6/B4C composite materials. Stir casting was employed to produce the LM6/B4C composites. A Vertical Machining Center (VMC) with a dynamometer was used to drill the holes and to record the thrust force. An L27 orthogonal array was used to carry out the experimental work. A grey relational analysis (GRA) was employed to perform optimization in order to attain the lowest Thrust Force (TF), Surface Roughness (SR) and Burr Height (BH). For minimal responses, the optimum levels of the process variables viz. the feed rate (F), spindle speed (S), drill material (D) and reinforcing percentage (R) were determined. The process variables in the drilling of the LM6/B4C composites were indeed optimized, according to confirmational investigations. The predicted Grey Relational Grade was 0.846, whereas the experimental GRG was 0.865, with a 2.2% error-indicating that the optimization process was valid.

• Klíčová slova
• ANOVA, composites, drilling, optimization, parameters,
• Publikační typ
• časopisecké články MeSH

In today's world, engineering materials have changed dramatically. Traditional materials are failing to satisfy the demands of present applications, so several composites are being used to address these issues. Drilling is the most vital manufacturing process in most applications, and the drilled holes serve as maximum stress areas that need to be treated with extreme caution. The issue of selecting optimal parameters for drilling novel composite materials has fascinated researchers and professional engineers for a long time. In this work, LM5/ZrO2 composites are manufactured by stir casting using 3, 6, and 9 wt% zirconium dioxide (ZrO2) as reinforcement and LM5 aluminium alloy as matrix. Fabricated composites were drilled using the L27 OA to determine the optimum machining parameters by varying the input parameters. The purpose of this research is to find the optimal cutting parameters while simultaneously addressing the thrust force (TF), surface roughness (SR), and burr height (BH) of drilled holes for the novel composite LM5/ZrO2 using grey relational analysis (GRA). The significance of machining variables on the standard characteristics of the drilling as well as the contribution of machining parameters were found using GRA. However, to obtain the optimum values, a confirmation experiment was conducted as a last step. The experimental results and GRA reveal that a feed rate (F) of 50 m/s, a spindle speed (S) of 3000 rpm, Carbide drill material, and 6% reinforcement are the optimum process parameters for accomplishing maximum grey relational grade (GRG). Analysis of variance (ANOVA) reveals that drill material (29.08%) has the highest influence on GRG, followed by feed rate (24.24%) and spindle speed (19.52%). The interaction of feed rate and drill material has a minor impact on GRG; the variable reinforcement percentage and its interactions with all other variables were pooled up to the error term. The predicted GRG is 0.824, and the experimental value is 0.856. The predicted and experimental values match each other well. The error is 3.7%, which is very minimal. Mathematical models were also developed for all responses based on the drill bits used.

• Klíčová slova
• ANOVA, composites, design of experiments, drilling, grey relational analysis,
• Publikační typ
• časopisecké články MeSH

Interhemispheric subdural haematoma is considered to be rare finding even in the era of computer tomography. The aim of the paper is to present a group of 14 patients (5 males, 9 females), average age 57.9 years, operated on for interhemispheric subdural haematoma, in all but one patient of traumatic origin. Symptoms related to the compression of medial cortex of cerebral hemisphere described as typical were not fully exacerbated in all patients. Falx syndrome as the sole manifestation was described in two patients, in other patients the clinical symptoms were determined by associated injuries. CT was the investigation of choice in all patients. Surgical evacuation of haematoma by means of parasagital osteoplastic craniotomy or burr hole trephination was used in all patients. Clinical outcome was determined by clinical condition on admission and the presence of haemorrhagic contusions. Another adversive prognostic factors were anticoagulation treatment or the presence of coagulopathy. It is mandatory to stress the possibility of sudden clinical worsening of initially conservatively treated patients.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• subdurální hematom diagnóza   diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH