Rozhledy v Chirurgii最新文献

{"title":"Extent of surgical procedure in triple negative breast carcinomas.","authors":"J Kotal,&nbsp;V Petrů,&nbsp;P Kosáč,&nbsp;P Vážan,&nbsp;M Zábojníková,&nbsp;P Jančík,&nbsp;M Ratajský,&nbsp;K Lajmar,&nbsp;B Dudešek,&nbsp;J Duben,&nbsp;P Holík,&nbsp;J Gatěk","doi":"10.33699/PIS.2023.102.4.159-164","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.4.159-164","url":null,"abstract":"<p><strong>Introduction: </strong>Triple negative breast carcinomas (TNBC) account for approximately 15-20% of all breast carcinomas. This subtype is characterised by an unfavourable prognosis with early locoregional recurrence a metastases. Only few studies have focused on the impact of local surgery on the overall therapeutic outcome. However, decisions are difficult to make in the case of TNBC, and no particular molecular subtype or marker exists that would make the decision-making process easier. The aim of our retrospective study was to analyse the TNBC surgical management outcomes at EUC Clinic in Zlin.</p><p><strong>Methods: </strong>440 women with breast carcinoma were operated on at EUC Clinic from 2014 to 2016, including 29 patients with TNBC; bilateral carcinoma was present in one case. Neoadjuvant chemotherapy (NAC) was indicated in 6 cases. The tumour centre was marked with a clip. The extent of surgery depended on the residual size of the tumour. Sentinel lymph node biopsy was indicated in clinically negative lymph nodes; further management followed the Z0011 study if the biopsy was positive. Axillary lymph node dissection was performed after NAC. In all cases, surgery was followed by systemic chemotherapy, and by radiotherapy in the case of breast-conserving procedures.</p><p><strong>Results: </strong>The group included 29 women and one patient with bilateral carcinoma, i.e. 30 cases of TNBC. Mean age was 57 years and median age was 55.5 years. Mean follow-up was 62.9 months, with the median of 69.9 month. NAC was indicated in 6 patients; complete pathological response was achieved in one case. NAC was followed by mastectomy in 5 cases including a bilateral procedure in one case, and by breast-conserving surgery in one case. Axillary dissection was performed in all cases. Breast-conserving surgery and sentinel node biopsy predominated in the group (16 cases). Local recurrence was observed in 4 cases, 2 times as an isolated local recurrence after one year and 2 times as part of generalization, always after mastectomy. Six patients died of generalized disease. No regional recurrence was observed.</p><p><strong>Conclusion: </strong>TNBC is characterised by a worse prognosis and a higher rate of local recurrence. As confirmed by our study, the results of breast-conserving surgery can be comparable to those of radical procedures, and thus radical surgery should be indicated prudently.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 4","pages":"159-164"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675970","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":"Preoperative nutritional management - compliance with current guidelines.","authors":"R Slováček, Z Adamová","doi":"10.33699/PIS.2023.102.7.298-303","DOIUrl":"10.33699/PIS.2023.102.7.298-303","url":null,"abstract":"<p><strong>Introduction: </strong>Major surgery poses a significant stress to the patient. The nutritional status is one of crucial factors that have a substantial impact on the final outcome of the surgery. Preoperatively established malnutrition or an increased nutritional risk in this group of patients requires a maximum effort to minimize this negative impact as soon as the operation is scheduled. The aim of this retrospective study was to assess compliance with guidelines focused on preoperative nutrition management at our site.</p><p><strong>Methods: </strong>Our retrospective descriptive observation was focused on the period from January 1, 2017 to June 30, 2020. All patients scheduled for major surgery were screened for nutritional status using a nutritional questionnaire, and an appropriate type of nutritional intervention was indicated based on the achieved score.</p><p><strong>Results: </strong>Two hundred and forty gastrointestinal operations were performed during the study period. In total, 208 (87%) of patients were screened at the time of counselling. Diet adjustments with an increased protein intake were recommended to all 125 (100%) patients with normal nutrition status. In total, 95 patients were at nutritional risk and sipping was prescribed to all of them (100%) in the outpatient setting. All 20 malnourished patients (100%) underwent preoperative nutritional optimization as inpatients.</p><p><strong>Conclusion: </strong>Nutritional status of patients before major surgery is considered a predictive indicator of potential postoperative complications. Compliance with recent ERAS guidelines concerning preoperative screening and nutritional support is high in our department.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 7","pages":"298-303"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577006","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":"Peripheral vascular trauma - basic management, diagnosis and treatment.","authors":"V Spudil, L Hána, R Pohnán","doi":"10.33699/PIS.2023.102.8.315-320","DOIUrl":"10.33699/PIS.2023.102.8.315-320","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral vascular injuries occur in 1-3% of all traumas in civilian settings. The management of these injuries is often based on experience derived from war medicine where these injuries are more common. The goal of this article is to summarize basic guidelines for the diagnosis and treatment of vascular injuries.</p><p><strong>Methods: </strong>Western Trauma Association (WTA) and Eastern Association for the Surgery of Trauma (EAST) both have their own guidelines for vascular trauma management.</p><p><strong>Results: </strong>Vascular injuries occur both in penetrating and blunt traumas. Complete vessel disruption occurs more frequently in penetrating traumas. In the case of blunt trauma, intimal defects are more common, resulting in dissection, false aneurysm, or intramural hematoma. The limb is mostly endangered due to ischemia, reperfusion injury and the compartment syndrome. Prompt diagnosis and treatment are paramount. Vascular trauma management is part of the ATLS protocol and life-over-limb principle. The primary goal is to stop the massive external bleeding. Clinical examination and CT angiography are the most helpful for the diagnosis. Surgical revision is indicated when hard signs are present. This can be a damage control surgery with the primary goal to stop the bleeding as quickly as possible. A shunt can be used for temporary reperfusion of the limb. Definitive treatment can take the form of a simple suture, patches or graft interposition; both prosthetic and autologous grafts are used. Sufficient debridement and fasciotomy are important steps in the therapy. In some cases, endovascular treatment can be used.</p><p><strong>Conclusion: </strong>Over the last century, the treatment strategy changed dramatically. Data from recent military conflicts show a decrease in amputation rates, and limb salvage has become a standard.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 8","pages":"315-320"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577009","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":"Case report Ileal diverticulitis with covered perforation complicated by pulmonary embolism - case report.","authors":"V Válek,&nbsp;M Svoboda,&nbsp;D Bartušek,&nbsp;V Procházka,&nbsp;M Mechl,&nbsp;A Šprláková-Puková","doi":"10.33699/PIS.2023.102.1.32-36","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.1.32-36","url":null,"abstract":"<p><p>Diverticulitis of the ileum is an inflammatory complication of diverticulosis. It is an uncommon cause of acute abdomen that can have a very serious course, leading, for example, to intestinal perforation or bleeding. Imaging findings are very often negative and the true cause of the condition is only revealed peroperatively. In this case report, we present a case of perforated ileal diverticulitis in a patient with bilateral pulmonary embolism. This was the main reason for conservative management in the first period of time. After resolution of the pulmonary embolism, resection of the affected bowel segment was performed at the time of the next attack.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 1","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10764916","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":"Position of surgical treatment in step-up management of severe acute pancreatitis.","authors":"J Sedláčková,&nbsp;J Zajak,&nbsp;B Jon,&nbsp;J Maňák,&nbsp;S Rejchrt,&nbsp;F Čečka","doi":"10.33699/PIS.2023.102.2.64-74","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.2.64-74","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures.</p><p><strong>Methods: </strong>We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome.</p><p><strong>Results: </strong>The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed.</p><p><strong>Conclusion: </strong>After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 2","pages":"64-74"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9475313","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":"Incidence of postoperative complications in patients with breast cancer depending on the type of drain.","authors":"V Procházka,&nbsp;A Závadová,&nbsp;J Žatecký,&nbsp;L Martínek","doi":"10.33699/PIS.2023.102.1.17-22","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.1.17-22","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative complications in patients with breast cancer delay the initiation of adjuvant therapy, prolong the length of hospitalization and reduce the patients' quality of life. Although their incidence can be influenced by many factors, the connection with the type of drain is insufficiently studied in the literature. The aim of this study was to assess whether there is an association between the use of a different drainage system and the occurrence of postoperative complications.</p><p><strong>Methods: </strong>The data of 183 patients included in this retrospective study were collected from the information system of the Silesian Hospital in Opava and then statistically analyzed. These patients were divided into two groups according to the type of drain used - a Redon drain (active drainage) was used in 96 patients, and a capillary drain (passive drainage) was used in 87 patients. The incidence of seromas and hematomas, the duration of drainage and the amount of wound drainage were compared between the individual groups.</p><p><strong>Results: </strong>The incidence of postoperative hematomas was 22.92% in the group of patients with the Redon drain, and 10.34% in patients with the capillary drain (p=0.024). The incidence of postoperative seromas was comparable for the Redon drain (39.6%) or the capillary drain (35.6%) (p=0.945). No statistically significant differences were found in the drainage time or the amount of wound drainage.</p><p><strong>Conclusion: </strong>A statistically significantly lower incidence of postoperative hematomas was observed when using a capillary drain compared to the use of a Redon drain in patients after breast cancer surgery. The drains were comparable with respect to seroma formation. None of the studied drains was significantly more beneficial in terms of the total drainage time and the total amount of wound drainage.</p><p><strong>Key words: </strong>breast cancer, postoperative complications, drain, hematoma.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 1","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9130884","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":"Giant peritoneal loose body - case report.","authors":"M Rykovský, M Michal","doi":"10.33699/PIS.2023.102.9.366-370","DOIUrl":"10.33699/PIS.2023.102.9.366-370","url":null,"abstract":"<p><p>The article presents the case of a rare, free moving, completely benign intra-abdominal formation called \"giant peritoneal loose body\". In our case, an expansion of the left hypogastrium with central calcification, in intimate contact with intestinal loops, of rather benign etiology, reminiscent of a mesenteric calcifying fibrous tumor, was accidentally detected on CT angiography. A possible neoplastic process was suspected, and therefore PET/CT was completed, showing that the expansion had moved to the right hypogastrium, and the radiologist evaluated the finding as a possible teratoma not originating from an intestinal loop. Due to the still indeterminate nature of the expansion, an exploratory laparotomy was performed with the discovery of a loose ovoid mass without any vascular supply and unrelated to other structures, which was extracted and sent for histological examination. The result was surprising. According to the pathologist, it was a rare, completely benign intra-abdominal lesion called the \"giant peritoneal loose body\". This pseudotumor should be considered as a differential diagnosis whenever we accidentally detect an asymptomatic, freely moving intra-abdominal lesion with central necrosis or calcification, in order to avoid unnecessary surgery, because according to available information, only symptomatic ones should be surgically removed.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 9","pages":"366-370"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577012","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":"Triple neurectomy following Lichtenstein repair of inguinal hernia.","authors":"B Jíšová, P Hladík, B East","doi":"10.33699/PIS.2023.102.9.363-365","DOIUrl":"10.33699/PIS.2023.102.9.363-365","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain is a distressing complication that can occur after inguinal hernia repair, affecting between 5% and 20% of patients as reported in literature. There are several reasons for chronic pain, including peripheral nerve irritation caused by surgical mesh or stitches. Preoperative pain is a risk factor for chronic pain.</p><p><strong>Case report: </strong>We present the case of a 59-year-old man who experienced chronic inguinal pain following Lichtenstein hernia repair. Conservative therapy was ineffective, and he subsequently underwent triple neurectomy without removal of the original polypropylene mesh. The patient experienced significant pain relief immediately after the surgery. There was no reported pain 1 month and 1 year post-surgery.</p><p><strong>Conclusion: </strong>The management of patients with chronic pain following hernia repair should be comprehensive and, ideally, centralized. Conservative procedures should be attempted first, but neurectomy and mesh removal may be necessary in cases where conservative measures are unsuccessful.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 9","pages":"363-365"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577016","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 significance of glycocalyx in surgery.","authors":"L Hána, J Kočí, R Pohnán, D Řehák, D Astapenko","doi":"10.33699/PIS.2023.102.12.453-458","DOIUrl":"10.33699/PIS.2023.102.12.453-458","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment is associated with an unwanted response of the organism to the so-called surgical trauma. This response is called surgical stress. Ischaemia-reperfusion injury is one of essential causes of tissue damage. It comprises functional and structural changes in tissue that occur after the restoration of circulation, after an episode of ischaemia. Necrosis of irreversibly changed cells and endothelial and mitochondrial-induced tissue swelling occur.</p><p><strong>Methods: </strong>Physiology, pathophysiology of endothelial glycocalyx: Endothelial glycocalyx is a 0.2 to 5 micrometres thin heteropolysaccharide layer that covers the endothelium on its intraluminal side. Backbone molecules of the glycocalyx include proteoglycans, glycoproteins, and glycosaminoglycans. Damage of the endothelial glycocalyx was described in trauma patients, in patients with septic shock, in ischemia and reperfusion injury, and during extensive surgical procedures. Approaches to prevent endothelial glycocalyx damage: Remote ischemic preconditioning was tested as a method of ischemia and reperfusion injury prevention during and after surgery. Nevertheless, the expected effect was not confirmed in performed meta-analyses. Endothelial glycocalyx damage can be prevented pharmacologically with a broad spectrum of substances, such as antithrombin III, doxycycline, hydrocortisone, etanercept, or nitric oxide donors. Hydrogen inhalation or albumin affects glycocalyx positively. Sulodexide provides a positive effect on the protection and reparation of endothelial glycocalyx. This proteoglycan with antithrombotic, fibrinolytic, hypofibrinogenemic, and lipolytic function is used for the treatment of venous diseases, ischaemic heart disease, and peripheral arterial disease. A positive effect of sulodexide on renal dysfunction was documented in a model of ischaemia and reperfusion injury. Equally, a positive effect of sulodexide was described on endothelium repair after its mechanical damage.</p><p><strong>Conclusion: </strong>Further research needs to be performed to evaluate the effect of endothelium-protectives on glycocalyx damage prevention and repair in ischaemia and reperfusion models involving large laboratory animals or in clinical trials in patients undergoing surgical revascularisation procedures.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 12","pages":"453-458"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914049","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":"Maisonneuve ankle fracture.","authors":"J Bartoníček,&nbsp;P Fojtík,&nbsp;E Bunganičová,&nbsp;M Tuček","doi":"10.33699/PIS.2023.102.2.48-59","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.2.48-59","url":null,"abstract":"<p><p>Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 2","pages":"48-59"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845545","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}