{"title":"The most common mistakes in intensive care - antibiotics.","authors":"V Adámková","doi":"10.33699/PIS.2024.103.3.79-83","DOIUrl":"10.33699/PIS.2024.103.3.79-83","url":null,"abstract":"<p><p>The enormous increase in antibiotic resistance and the limited spectrum of new, effective antibiotics are the reasons why we should think about a rational approach to anti-infective therapy. The excessive and non-indicated use of antibiotics while treating critically ill patients can be found quite often in clinical practice. Antibiotic therapy is usually indicated empirically, or it is only based on therapeutic indecision, not just in ICU patients. The antibiotics are administered before taking a sample for microbiological analysis or there is no therapy adjustment based on the laboratory findings. The solution lies in antibiotic stewardship, which is the way to ensure that antibiotics will be sufficiently effective in years to come.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 3","pages":"79-83"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421862","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":"Single anastomosis sleeve ileal bypass a single anastomosis sleeve jejunal bypass in the surgical treatment of severe obesity.","authors":"M Hrubý, D Vodičková","doi":"10.33699/PIS.2024.103.1.13-18","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.1.13-18","url":null,"abstract":"<p><p>Bariatric surgery has been proven to be an effective method in the treatement of morbid obesity. The ideal bariatric procedure should be effective, easy to perform and safe. Sleeve gastrectomy and RYGB currently represent the most frequently used bariatric/metabolic procedures. However, they have a certain percentage of complications and post-operative morbidity and also they fail in some patients. These facts lead to the development of new surgical procedures, which also include single anastomosis sleeve ileal bypass (SASI) and single anastomosis sleeve jejunal bypass (SASJ). These procedures combines the advantages of restrictive and malabsorptive operations at the same time reducing the risk of nutrient deficiencies by maintaining passage through all the alimentary tract. The results so far are encouraging, further research and especially longer-term results are necessary.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 1","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177711","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":"Sleeve gastrectomy - still popular bariatric method.","authors":"M Kasalický, E Koblihová, R Pohnán","doi":"10.33699/PIS.2024.103.1.6-12","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.1.6-12","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is currently the most common multifactorial disease affecting almost all social strata of the population. Conservative therapy of obesity usually succeeds in reducing excess weight by an average of 10-15%. After surgical treatment of severe obesity (bariatric surgery), the average decrease in excess weight is several times greater and, in most cases, has a long-term positive effect on the overall clinical condition of the patients.</p><p><strong>Methods: </strong>Sleeve gastrectomy (SG) is the most used bariatric method of treating severe obesity today. The principle of SG is a vertical resection of a major portion of the gastric greater curvature. After the resection, the residual stomach has the shape of a sleeve with a remaining volume of about 120-150 ml. The effect of the method is both restrictive and hormonal, because after SG, the plasma level of active ghrelin decreases in the long term, among other things.</p><p><strong>Conclusion: </strong>Obesity is considered one of the most serious global health problems today. In 2018 a total of 696,191 bariatric procedures were performed worldwide. Sleeve gastrectomy was originally used in high-risk severely obese patients as the first stage of a duodenal switch (DS) or gastric bypass. Since 2003, this method has been used independently because for most of the patients, SG had a sufficient effect on weight reduction and improvement of comorbidities, and that is why since 2015, SG has become the most frequently used bariatric method.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 1","pages":"6-12"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177712","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}
P Macan, J Fichtl, V Opatrný, J Moláček, A Fajfrová, M Nováková, S Paulusová
{"title":"Cecal volvulus - a rare cause of acute abdomen with ileus.","authors":"P Macan, J Fichtl, V Opatrný, J Moláček, A Fajfrová, M Nováková, S Paulusová","doi":"10.33699/PIS.2024.103.6.232-235","DOIUrl":"10.33699/PIS.2024.103.6.232-235","url":null,"abstract":"<p><p>In this article, we present case reports of two patients admitted to the University Hospital in Pilsen for acute abdomen due to a disorder of the passage through the gastrointestinal tract (GIT). Both were indicated for surgery. The patients were diagnosed intraoperatively with rarely occurring cecal volvulus (CV). The findings required an ileocecal resection; nevertheless, both patients fully recovered despite the need the resection.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 6","pages":"232-235"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592130","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":"Postoperative ileus and possibilities of pharmacological intervention.","authors":"L Urbánek, P Urbánková, T Trávníček","doi":"10.48095/ccrvch2024346","DOIUrl":"https://doi.org/10.48095/ccrvch2024346","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative ileus is a severe condition occurring especially in high-risk patients following acute and prolonged surgical procedures. Multiple factors are described as important in etiology, such as inflammation as well as neurological, hormonal and pharmacological influences. In prevention and treatment, we try to apply non-pharmaceutical procedures, to influence reversible etiological factors and, in post-operative period, to implement and use ERAS procedures. Drugs are the other pos-sibility how to influence this pathology. Short-term impairment of intestinal motility following the most of the intraabdominal surgeries must be also taken in count in the differential diagnosis and treatment.</p><p><strong>Study aim: </strong>We try to describe all possibilities of pharmacological treatment and prevention of the postoperative ileus. Effectiveness of drugs used in present praxis, especially group of so-called prokinetics is analyzed.</p><p><strong>Conclusion: </strong>Postoperative ileus is still recognized as severe complication. Pharmacological treatment options are limited, only a few substances have evident positive impact (neostigmin for treatment and alvimopan - not registered in the Czech Republic for prevention). More evidence is necessary for positive effect of 5-hydroxytryptamine 4 (5HT4) agonists, and the effect of selective COX-2 inhibitors is still controversial.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 9","pages":"346-350"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677451","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":"Current trends in breast cancer surgery.","authors":"Z Chaloupková, O Coufal, L Gabrielová","doi":"10.48095/ccrvch2024247","DOIUrl":"10.48095/ccrvch2024247","url":null,"abstract":"<p><p>The incidence of breast cancer has been increasing significantly over the past decades, while the mortality rate has, actually, been decreasing. Behind this favorable trend in the decrease in mortality are not only high-quality screening programs, but also undoubtedly advances in therapy, especially new methods in surgical treatment. The importance of oncoplastic approach integrating resection and reconstruction procedures is obvious. Our efforts continue to maximize breast-conserving therapy, which is being improved in parallel with the development of new localization methods of non-palpable lesions. Breast-conserving therapy indication spectrum is also increasing with the use of oncoplastic approach allowing the resection of a significant part of the mammary gland while achieving an acceptable cosmetic result. We improve guidelines for skin-sparing procedures and also possibilities and availability of breast reconstruction. Most popular is breast reconstruction with free abdominal flap transfer. However, due to such demanding complex procedure with limited availability, there is also a significant development of silicone-implant-based reconstruction or methods of fat transfer. Constant attention is focused on axillary surgery, now especially in cases of initial nodal involvement that responds favorably to neoadjuvant systemic treatment. Current findings indicate tendency to modify and differentiate surgical indications according to the tumor phenotype. Complex lymphedema prevention surgery, such as lymphatic mapping or restoring lymphatic flow via microsurgical lymphaticovenous anastomosis, can provide effective and long-term improvement and is challenging. Recently in the Czech Republic, we reopened the discussion about the optimal concentration of medical care in a smaller number of specialized breast centers, which we think is one of a number of steps on the constant path to improve medical results.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 7","pages":"247-254"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983877","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":"Pancreatic cancer - systemic treatment.","authors":"M Liberko","doi":"10.33699/PIS.2024.103.4.110-116","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.4.110-116","url":null,"abstract":"<p><p>Pancreatic cancer is a disease with the worst long-term survival across all stages. In clinical practice, due to asymptomatic or non-specific signs and symptoms we diagnose patients mainly with locally advanced and metastatic disease, where median survival is approximately one year. However, cases of an early local recurrence or distant metastases are observed even in early stages after curative surgery, and long-term survival is an exception even in these early stages of the disease. Despite these adverse characteristics, an improvement in median overall survival has been observed also in patients with pancreatic cancer, particularly in the last few years. It is due to advancements in the diagnosis, surgery, but mainly due to improvements in cancer treatment (chemotherapy - adjuvant, neoadjuvant, perioperative, induction and palliative, and radiotherapy). The results of many studies across all stages (resectable, borderline resectable, locally advanced, metastatic) have been published, showing an improved survival. The aim of this article is to provide a review of current treatment options for pancreatic ductal adenocarcinoma.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 4","pages":"110-116"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383943","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}
T Kriegler, T Dušek, V Ninger, P Hanousek, M Podhola
{"title":"Malignant melanoma metastasis as a rare cause of abdominal pain.","authors":"T Kriegler, T Dušek, V Ninger, P Hanousek, M Podhola","doi":"10.48095/ccrvch2024313","DOIUrl":"10.48095/ccrvch2024313","url":null,"abstract":"<p><p>The authors present the case of a 71-year-old female patient who was operated on for 16 days of abdominal pain. The work points to malignant melanoma as a rare cause of abdominal pain and then shows the inscrutability of malignant melanoma and the importance of a multidisciplinary approach to this type of disease including subsequent dispensary by an oncologist. The emphasis on the prevention of this disease is an integral part of this approach.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 8","pages":"313-317"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309118","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":"Our experience with robotic-assisted thymic surgery.","authors":"M Podhráský, J Tvrdoň, J Schützner","doi":"10.33699/PIS.2024.103.2.40-47","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.2.40-47","url":null,"abstract":"<p><p>Thoracic surgery is increasingly influenced by the development of minimally invasive approaches which have also influenced surgery in the area of the anterior mediastinum. The previously standard approach to the thymus via partial sternotomy was gradually replaced by the videothoracoscopic approach in most cases. In recent years, robotically assisted surgery has been gaining ground worldwide in this area, as well. The aim of our paper is to provide a comprehensive overview of procedures in the field of the thymus, including their indications, and to share our first experience with robot-assisted thymus surgery. At the 3rd Department of Surgery, since the start of the robot-assisted thymus surgery program, 23 thymectomies have been performed using this approach, of which 17 were performed for thymoma, 3 for myasthenia gravis, and 3 for parathyroid adenoma localized in thymus tissue. From our experience and the available data, it follows that the length of hospitalization, the rate of complications and the resulting effect of robot-assisted procedures is comparable to VTS procedures; however, the robot-assisted surgery also allows for mini-invasive treatment even in significantly obese patients and in patients with advanced thymic tumors who would otherwise be indicated for open thymectomy.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 2","pages":"40-47"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865877","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}
P Kosáč, M Zábojníková, P Vážan, V Petrů, M Ratajský, K Lajmar, B Dudešek, P Kudlová, J Duben, L Podrazká, J Gatěk
{"title":"Breast cancer in 80+ year olds.","authors":"P Kosáč, M Zábojníková, P Vážan, V Petrů, M Ratajský, K Lajmar, B Dudešek, P Kudlová, J Duben, L Podrazká, J Gatěk","doi":"10.48095/ccrvch2024258","DOIUrl":"https://doi.org/10.48095/ccrvch2024258","url":null,"abstract":"<p><strong>Introduction: </strong>The risk of breast cancer increases with increasing age. The aim of our retrospective study was to determine the extent of breast and axillary surgery, including subsequent adjuvant therapy, in 80-year and older patients.</p><p><strong>Methods: </strong>Between 2017 and 2021, 834 breast cancer patients were operated in the Surgical Department of the EUC Clinic. Ninety-eight women (2× with bilateral cancer) and 2 men were included in this retrospective study. A total of 102 breast cancer cases in patients older than 80 years were analyzed. The surgical procedure corresponded to the stage of the disease and the general condition of the patient. Adjuvant systemic therapy was indicated according to the same principles.</p><p><strong>Results: </strong>At the time of surgery, the patients were more than 80 years old (80-96 years). The predominant type of invasive ductal carcinoma was diagnosed 83×, lobular carcinoma 6×, mucinous 6×, papillary carcinoma 4×, other 3×, with luminal A, B predominating (89×). The breast-conserving procedures were performed 63×. Sentinel node biopsy was performed 65×, supplemented by axillary lymph node dissection 13×. Primary axillary lymph node dissection was performed 15×. No axillary procedure was performed 23×. Radiotherapy was given 49×, chemotherapy 9× and hormonal therapy 82×. Local and regional recurrences were each observed 2×. A total of 37 patients died, 10 of them from breast cancer.</p><p><strong>Conclusion: </strong>The most common cause of death in patients aged 80+ years is a cardiovascular disease, not breast cancer itself. This fact should be taken into account when determining the treatment plan.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 7","pages":"258-262"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983843","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}
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