Rozhledy v Chirurgii最新文献

{"title":"Extra-intracranial bypass.","authors":"J Dostál, V Přibáň, J Mraček","doi":"10.48095/ccrvch2025247","DOIUrl":"https://doi.org/10.48095/ccrvch2025247","url":null,"abstract":"<p><p>Extra-intracranial bypass represents a controversial yet significant component of neurosurgical treatment for cerebrovascular diseases. The indications are moyamoya dis-ease, steno-occlusive atherosclerotic disease of the internal carotid artery, acute ischemic stroke, and, more rarely, complex intracranial aneurysms and skull base tumors. Although historical studies have yielded mixed results and limited its use, modern diagnostic and surgical techniques are reopening the path for selective application of bypass in high-risk patients. A clear indication is the rare moyamoya disease, where bypass is a proven method for preventing ischemic or hemorrhagic strokes. In patients with symptomatic chronic internal carotid artery occlusion and exhausted cerebrovascular reserve, bypass may serve as a potential treatment modality, provided it is carefully indicated -through comprehensive specialized evaluation. Emergent bypass should be considered for a narrow group of patients with acute ischemic stroke when standard treatment fails or is not feasible. Despite ongoing debate, extra-intracranial bypass remains an essential part of cerebrovascular surgery. The key to success lies in the proper selection of patients and precise microsurgical execution. Modern approaches and technologies help reduce the risk of complications and enhance the effectiveness of this intervention, offering hope to patients with otherwise limited treatment options.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 6","pages":"247-251"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of mediastinal pseudocyst in patient after acute pancreatitis.","authors":"P Koželský, D Hoskovec, J Ulrych, Z Krška","doi":"10.48095/ccrvch2025146","DOIUrl":"https://doi.org/10.48095/ccrvch2025146","url":null,"abstract":"<p><p>Acute pancreatitis may present with a variety of complications, the whole range of thoracic complications is presented as the rare enzymatic ascending mediastinitis as well as rare mediastinal pseudocysts. The mortality rate of mediastinal complications is high, 14-47%. Due to the small number of described cases, no clear recommendations have been made regarding the treatment of mediastinal pseudocyst. From the documented cases, spontaneous regression of mediastinal pseudocysts is rare and the clear benefit is reached by endoscopic treatment. Surgical therapy should be indicated only in case of failure of pharmacotherapy or endoscopic treatment. The differential diagnosis of the patient's difficulties after pancreatitis includes a whole range of polymorphic manifestations. However, as we illustrate in this case report, we should not forget them, especially because of the mortality rate.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 4","pages":"146-148"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extralobar pulmonary sequestration as an intraabdominal tumour.","authors":"M Skála, J Moláček, J Vodička, J Šebek, Š Hadravská","doi":"10.48095/ccrvch2025155","DOIUrl":"https://doi.org/10.48095/ccrvch2025155","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary sequestration is a rare congenital anomaly of the lower respiratory tract, usually diagnosed in childhood. It involves lung parenchyma that has abnormal or absent communication with the tracheobronchial tree. The blood supply is not connected to the pulmonary circulation but comes from the systemic circulation. Intralobar pulmonary sequestration refers to pulmonary sequestration that shares a common pleura with normal parenchyma. In contrast, extralobar sequestration has its own visceral pleura that is not continuous with the normal lung. Extralobar pulmonary sequestration, unlike intralobar pulmonary sequestration, typically does not present with infectious manifestations due to the absence of a connection to the tracheobronchial tree. Instead, it may manifest as hypoxia, cardiac failure, or rarely, torsion of the sequestrum. However, it is more often an incidental asymptomatic finding. Computed tomography currently plays a leading role in diagnosis, enabling visualization of the feeding vessels. Surgical resection is the mainstay of the treatment, primarily to prevent hemorrhage or malignant transformation of the tissue. Resection also provides material for biopsy examination.</p><p><strong>Case report: </strong>A 68-year-old patient with nephropathy was referred by her nephrologist for abdominal ultrasound, which incidentally detected a tumor in the left retroperitoneum. A CT scan was performed, and the patient was then referred for tumor excision due to suspicion of a neurogenic tumor. Postoperatively, she was monitored in the intensive care unit with oxygen therapy for hypoxemia. The further course was uncomplicated. She was discharged home on postoperative day 5.</p><p><strong>Conclusion: </strong>We present a case of this very rare diagnosis, which is even rarer in an adult patient.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 4","pages":"155-159"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic treatment of Rapunzel syndrome - a case report and literature review.","authors":"J Szarzec, J Žatecký, K Krauzová, M Peteja","doi":"10.48095/ccrvch2025165","DOIUrl":"10.48095/ccrvch2025165","url":null,"abstract":"<p><p>The case report describes a rare case of the cause of abdominal pain and palpable resis-tance in the epigastric region. A CT scan of the abdomen was performed with a surprising cause of the trouble - a trichobezoar filling the stomach, also described as Rapunzel syndrome, i.e. Goldilocks syndrome. Upon further questioning, the patient's mother retrospectively admits her daughter's pulling out her own hair (trichotillomania) and eating it (trichophagia) since the age of four. The finding was consulted, and could not be removed by gastroscopy due to its size. A successful laparoscopic gastrotomy with total extraction of the trichobezoar was performed. The child recovered without complications. A psychiatric evaluation was performed and the child was discharged home on the 10th postoperative day.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 4","pages":"165-169"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basics of laparoscopy on box and virtual simulators I: a 10-year (2014-2024) evaluation from the perspective of the course participants.","authors":"Z Chovanec, A Berková, J Habr, T Paseka, F Sasínek, P Štourač, I Penka","doi":"10.48095/ccrvch2025283","DOIUrl":"10.48095/ccrvch2025283","url":null,"abstract":"<p><strong>Introduction and aims: </strong>The training of young surgeons in the Czech Republic includes the completion of mini-invasive, laparoscopic simulation courses on a voluntary basis. The aim of this study is to show how simulation is used now to train surgeons and to look back at 10 years of running a simulation, laparoscopic, mini-invasive course from the graduates' points of view using box and virtual reality simulators.</p><p><strong>Type of study: </strong>Observational, survey.</p><p><strong>Methods: </strong>Data were collected from 26 courses (2014-2024) by an anonymous question-naire. The questionnaires were completed by all graduates (100%). Their evaluation was done by the descriptive statistics method. Questions were asked about expecta-tions and fulfilment of the expectations from the course with its possible recommendation and financial cost.</p><p><strong>Results: </strong>A total of 96 doctors, 55 men and 41 women, participated in the courses. The questionnaires were completed by all participants. In 89 cases (92.7%), the candi-dates wanted to learn the correct technique, tips, and tricks in laparoscopic surgery; in 42 cases (43.8%), they expected an increase in the operative time; and in 37 cases (38.5%), a deepening of anatomical and theoretical knowledge was mentioned. The course completely fulfilled the expectations in 92% of the cases, in 6.0% of the cases, it fulfilled them with minor reservations and in 2.0% it fulfilled them partially. Ninety seven percent of participants would recommend the course as compulsory; 3% would leave its recommendation to the discretion of the graduate. Twenty-eight participants (29.2%) fully paid for the course; 5 (5.2%) participants partially paid; and 63 (65.6%) participants received payment from their employer.</p><p><strong>Conclusion: </strong>The participants recommended the simulation course for compulsory inclusion in the surgical education curriculum, and about one-third of them also expressed willingness to pay for the optional education. Although simulators and simulations in surgery represent an important training potential, the subsequent role of mentor in the form of certified, experienced colleague(s) cannot be replaced by them.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 7","pages":"283-288"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of dynamic MRI defecography in the diagnostic algorithm of patients with anorectal dysfunction.","authors":"A Berková, P Vlček, V Červeňák, I Krejčová, T Vystrčilová, J Dolina, M Szypulová, S Tvarožek, M Jurášková, Z Chovanec, I Penka","doi":"10.48095/ccrvch2025275","DOIUrl":"10.48095/ccrvch2025275","url":null,"abstract":"<p><strong>Introduction and aim: </strong>For a correct assessment of anorectal dysfunction, adequate physical and imaging examinations are required. The aim of our study was to evaluate the use of MRI defecography in patients with anorectal dysfunction. Its comparison with anorectal manometry, standard clinical examination, and patients' subjective perceptions.</p><p><strong>Type of study: </strong>An observational, retrospective analysis.</p><p><strong>Methods: </strong>Forty patients with symptoms of anorectal dysfunction referred to a colorectal clinic between 9/2022 and 5/2023 participated in the study. All underwent proctological examination, anorectal manometry and MRI defecography. The results of the study were statistically processed with Statistica 12.0 software.</p><p><strong>Results: </strong>The average age of the patients was 55 years. Primary complaints were obstipation in 60% of patients, fecal incontinence in 33%, 1 patient had proctalgia and 2 patients presented for rectal prolapse. On clinical examination, 20% of patients had rectoanal intussusception and 15% had complete rectal prolapse. A total of 36% of patients reported concomitant urinary incontinence. Pelvic floor drop in the anterior compartment was also demonstrated in patients who had physiological internal sphincter function according to anorectal manometry, however, due to the small sample size, only a trend was observed and statistical significance of these differences was not -reached (P = 0.109). Patients without evidence of obstructive defecation syndrome on anorectal manometry had complete rectal emptying on MRI defecography (P = 0.0598).</p><p><strong>Conclusion: </strong>Dynamic MRI defecography can identify anatomical and functional abnormalities of the pelvic floor. The main use of the method is in the detection of multi-compartment pathology. Multidisciplinary collaboration is required to interpret the results and establish an accurate diagnosis.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 7","pages":"275-282"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically relevant variations in the area of the ulnar nerve sulcus and their relationship to surgical approaches to the elbow.","authors":"J Kamlerová, H Zítek, V Kunc","doi":"10.48095/ccrvch2025332","DOIUrl":"10.48095/ccrvch2025332","url":null,"abstract":"<p><p>Clinically relevant variations in the area of the groove for the ulnar nerve include accessory muscles, accessory bones, and fibrous structures. Accessory muscles involve the epitrochleoanconeus muscle, chondroepitrochlearis muscle, and high origin of the pronator teres muscle. The nerve can also be compressed by the medial head of the triceps brachii muscle. Fibrous structures are found proximally, distally to the cubital tunnel, or directly at the location of the cubital tunnel and can cause compression of the ulnar nerve. Structures located proximally to the cubital tunnel include the medial intermuscular septum of the arm and Struthers' arcade. The roof of the cubital tunnel is formed by Osborne's ligament, which can cause compression of the ulnar nerve. Its absence is a predisposing factor for nerve dislocation. Among the bony structures, the clinical significance lies in the variability of the depth of the groove for the ulnar nerve. A shallow groove is a predisposing factor for compression of the ulnar nerve, especially during elbow flexion, which can lead to its subluxation or dislocation. The ulnar nerve itself also shows considerable variability. The ulnar nerve gives off branches inner-vating the joint capsule and motor branches for the both heads of the flexor carpi ulnaris muscle and a part of the flexor digitorum profundus muscle. Articular branches can hinder sufficient mobilization of the nerve during transposition, which can be over-come by intraneural dissection. During transposition, it is important to protect the motor branches to prevent paresis of the innervated muscles. The variability of anatomical structures in the groove for the ulnar nerve is cru-cial for clinical practice, as it can complicate surgical approaches to the elbow, limit ulnar nerve transposition, or contribute to the development of cubital tunnel syndrome.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 8","pages":"332-338"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal wall gangrene as a source of sepsis: a rare complication of laparoscopic cholecystectomy - case report or do we need specialized intensive care units in the 21st century?","authors":"D Šmíd, T Kanyicska, M Stejskalová, V Opatrný","doi":"10.48095/ccrvch2025205","DOIUrl":"https://doi.org/10.48095/ccrvch2025205","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy is currently the gold standard of treatment for cholecystolithiasis. The authors present a rare postoperative complication that -caused the development of septic shock with multiorgan failure and necessitated a number of other operations.</p><p><strong>Case report: </strong>A 57-year-old woman underwent elective uncomplicated laparoscopic cholecystectomy for symptomatic cholecystolithiasis. The postoperative period was complicated by the development of septic shock with extensive abdominal wall gangrene. The finding necessitated surgical management and complex resuscitative care.</p><p><strong>Discussion: </strong>Knowledge and skills in intensive and resuscitation care are nowadays among the basic minimum that an erudite surgeon working in hospital surgery must possess. One cannot rely solely on the intensive care provided by anaesthetists. Intensivists recruited from a specific specialty (surgery, internal medicine, pediatrics) may have a better insight into the problem due to their knowledge of the complexity of the disease and are complemented by anesthesiologists.</p><p><strong>Conclusion: </strong>Initial treatment of septic shock must be early and aggressive, after stabilization of the condition it is necessary to sanitize the source of infection, if possible. Intensive care is an mandatory and necessary part of adequate treatment of septic patients.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 5","pages":"205-210"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical anatomy for reinsertion of the distal tendon of the biceps brachii muscle.","authors":"M Beneš, D Kachlík, V Kunc","doi":"10.48095/ccrvch2025317","DOIUrl":"10.48095/ccrvch2025317","url":null,"abstract":"<p><p>Ruptures of the distal tendon of the biceps brachii muscle usually require surgical treat-ment to restore strong elbow flexion and forearm supination. However, the surgical procedure carries a risk of injury to neurovascular structures adjacent to the insertional tendon, and its success relies on respecting the original anatomical relations during reconstruction of the tendon. The aim of this article is to present a compendious review of relevant anatomy and practical notes which may enhance the optimal functional outcomes. Structured discussion on morphological aspects of the insertional tendon and its topography in relation to osseous and soft-tissue structures is presented. Moreover, attention is paid to technical aspects of implantation of fixation devices, so that physiological and anatomical reconstruction can be assured. This paper contains numerous schematic drawings to demonstrate the surgically relevant anatomy.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 8","pages":"317-325"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical anatomy of the pelvis as a guide for the total mesorectal excision technique.","authors":"J Pastor, J Votava, W Golas, D Kachlík","doi":"10.48095/ccrvch2025339","DOIUrl":"10.48095/ccrvch2025339","url":null,"abstract":"<p><p>The technique of total mesorectal excision (TME) has become a widely accepted component of rectal cancer resection since its introduction in the 1980s. The quality of TME remains the only way for a surgeon to influence the oncological outcomes of surgical treatment for rectal cancer. A thorough understanding of the surgical anatomy of the pelvis, particularly the pelvic fasciae, vascular supply, and lymphatic drainage of the rectum, is essential for the proper technique of TME. Functional outcomes of rectal resections also depend on meticulous dissection and respect for the anatomy of the pelvic autonomic nerve plexuses. In this article, the authors define the key anatomical structures and terms, including lesser-known eponyms commonly used in rectal surgery. Finally, they describe the TME procedure based on the surgical anatomy of the pelvis, emphasizing the importance of respecting the developmental tissue planes and anatomical structures involved.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"104 8","pages":"339-344"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}