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The incidence of explosions in large agglomerations is high even during peacetime and continues rising. Blast syndrome injuries are complex, with shock wave causing severe injuries of multiple organ systems. In situations with large numbers of injured persons, effective triage allows an early diagnosis and treatment of the highest number of victims. Treatment is challenging, and potentially conflicting therapeutic goals may alternate. This review provides an overview of the pathophysiology of blast injuries, current diagnostic algorithms and therapeutic procedures.
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Traumatismos por Explosión , Humanos , Traumatismos por Explosión/diagnóstico , Traumatismos por Explosión/etiología , Traumatismos por Explosión/terapia , Explosiones , IncidenciaRESUMEN
INTRODUCTION: The development of an ideal dressing for wound healing remains an unresolved issue. Thanks to the development of electrospinning technology, polymers in the form of nanofibers have come to the forefront of research interest. A modern and very promising dressing material is a “nonwoven” based on nanofibers of the synthetic polymer polylactide (PLA). The aim of this work was to assess the regenerative abilities of PLA in a standardized wound in a porcine model and compare our results to the literature data. METHODS: We applied PLA-based nanofiber dressings to the standardized wounds created in the porcine model. On the third, tenth, seventeenth and twenty-fourth days after the formation of the defect, we changed the wound dressing while taking a tissue sample for histopathological examination. We continuously monitored serum levels of acute phase proteins. RESULTS: PLA stimulated an inflammatory response. From the third day, the thickness of the fibrin layer with granulocytes increased. It reached its maximum values on the tenth day (mean 340 μm); at the same time the level of serum amyloid A, as a marker of inflammation, culminated. The individual phases of healing intertwined. The highest thickness values of the granulation tissue with cellular connective tissue (diameter 8463 μm) were reached on the seventeenth day. On the twenty-fourth day, the defects were healed macroscopically with a mean reepithelialization layer of 9913 μm. CONCLUSION: PLA-based nanofiber dressing potentiates the inflammatory, proliferative and reepithelialization phases of healing. Its structure perfectly mimics the extracellular matrix and serves as a 3D network for the growth and interaction of cellular elements. In addition to biocompatibility, PLA has a unique ability of two-phase biodegradation. It is a promising material for industrial production of dressing materials. Most of the available studies were performed in vitro. In vivo comparative studies approximating the use of PLA to daily practice are still missing.
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Nanofibras , Animales , Vendajes , Poliésteres , Porcinos , Cicatrización de HeridasRESUMEN
Negative pressure wound therapy (NPWT) has been used in clinical practice for 25 years. Worldwide, it has been used to treat more than 10 million wounds. The repertoire of NPWT procedures is still growing. This originally simple procedure entails a number of pitfalls and limits, and full utilisation of the micro-deformation potential of NPWT depends on many key details. We present the pathophysiology, effects and forms of NPWT use including our own experience, tips and a proposal for the use of NPWT during the COVID-19 pandemic.
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COVID-19 , Terapia de Presión Negativa para Heridas , Humanos , Pandemias , SARS-CoV-2 , Infección de la Herida Quirúrgica/epidemiología , Cicatrización de HeridasRESUMEN
INTRODUCTION: Pulmonary hernias are rare conditions, most are the results of an injury or previous thoracic surgery. CASE REPORT: We present a case of a 48-year-old woman injured in a car accident. The examination in the trauma centre revealed a chest injury with herniation of the lung parenchyma into the chest wall and fractures of long bones of lower limbs. Initially, an osteosynthesis of the left femur and the right tibia fracture were performed. The patient underwent a subsequent surgery to repair the pulmonary hernia. CONCLUSION: A pulmonary hernia is diagnosed either directly during a clinical examination or by imaging. A sovereign diagnostic method is a computed tomography. The method of treatment is a surgical repair with primary suture of the chest wall defect or implantation of a mesh to repair the pulmonary hernia.
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Traumatismos Torácicos , Pared Torácica , Femenino , Hernia/diagnóstico por imagen , Hernia/etiología , Humanos , Pulmón , Persona de Mediana Edad , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We present 3 case-reports with penetrating abdominal injury from our practice in this article. An urgent laparotomy was performed in all cases because of haemodynamic instability or the mechanism of injury. Penetrative abdominal traumas are associated with a high risk of life-threatening intra-abdominal injuries, require urgent revision and are often accompanied by postoperative infections of the peritoneal cavity. In recent years, there has been a growing tendency towards mini-invasive approaches or even non-operative treatment. This trend is particularly evident in the United States of America, where doctors experience a higher number of penetrating injuries compared to the prevalent blunt force trauma in Europe. The authors describe the need to follow all recommended procedures in the pre-hospital and hospital phases of treatment of these patients and compare them with recent literature. Key words: penetrating abdominal trauma.
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Traumatismos Abdominales , Heridas no Penetrantes , Heridas Penetrantes , Traumatismos Abdominales/cirugía , Europa (Continente) , Humanos , Laparotomía , Estudios Retrospectivos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía , Heridas Penetrantes/cirugíaRESUMEN
INTRODUCTION: There is evidence that mesenchymal stem cells (MSCs) could trans-differentiate into the liver cells in vitro and in vivo and thus may be used as an unfailing source for stem cell therapy of liver disease. Combination of MSCs (with or without their differentiation in vitro) and minimally invasive procedures as laparoscopy or Natural Orifice Transluminal Endoscopic Surgery (NOTES) represents a chance for many patients waiting for liver transplantation in vain. METHODS: Over 30 millions of autologous MSCs at passage 3 were transplanted via the portal vein in an eight months old miniature pig. The deposition of transplanted cells in liver parenchyma was evaluated histologically and the trans-differential potential of CM-DiI labeled cells was assessed by expression of pig albumin using immunofluorescence. RESULTS: Three weeks after transplantation we detected the labeled cells (solitary, small clusters) in all 10 samples (2 samples from each lobe) but no diffuse distribution in the samples. The localization of CM-DiI+ cells was predominantly observed around the portal triads. We also detected the localization of albumin signal in CM-DiI labeled cells. CONCLUSION: The study results showed that the autologous MSCs (without additional hepatic differentiation in vitro) transplantation through the portal vein led to successful infiltration of intact miniature pig liver parenchyma with detectable in vivo trans-differentiation. NOTES as well as other newly developed surgical approaches in combination with cell therapy seem to be very promising for the treatment of hepatic diseases in near future.
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Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Vena Porta , Animales , Cirugía Endoscópica por Orificios Naturales , Porcinos , Porcinos Enanos , Trasplante AutólogoRESUMEN
Burns can be life threatening injuries with a significant risk of lifelong consequences. Severity of thermal injury is assessed using the combination of six essential factors (mechanism of injury, presence of inhalation trauma, extent of the burn area, depth of the burn, its location, patients age and co-morbidities) which also represent the determinants of referral to one of the three specialized burn centers in the Czech Republic. Early management consists of ABC Trauma Life Support (adequate oxygenation and ventilation, a venous access, parenteral fluid administration), pain relief, and sterile covering of the burn areas.
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Quemaduras , Quemaduras/cirugía , República Checa , Fluidoterapia , Humanos , Nutrición ParenteralRESUMEN
INTRODUCTION: Complete circular endoscopic dissection (CED) is frequently accompanied with post-operative strictures formation in the esophagus. Various types of therapeutic approaches have recently been tested to prevent these strictures, e.g. cell therapy or stenting. METHODS: Miniature pigs of Gottingen/Minnesota origin (n=10) were used in the study. First, we made the complete CED in the mid esophagus; next, the defect was left untreated or covered with mesenchymal stem cells (MSCs) or a mixture of MSCs and primary oral keratinocytes (pOKs) suspension without/with fully covered self-expandable metallic stent (SEMS). Consequently, we performed a control endoscopy with a stent removal, and necropsy was performed 17-36 days after cells application. RESULTS: All CED procedures were completed successfully without serious complications. Although we were able to detect MSCs or pOKs in the post-CED defects up to the 36th day after transplantation, the combination of MSCs or MSCs/pOKs with or without SEMS application did not prevent post-CED strictures development. The mixture of MSCs and pOKs resulted in the formation of cellular aggregates, which were mainly observed in submucosa, and the post-CED defect was covered with collagen fibers containing a thin scarred epithelium, accompanied by various degrees of reconstruction and integrity. CONCLUSION: Suspension application of autologous MSCs alone or in combination with pOKs with or without SEMS was ineffective in the prevention of strictures formation after complete CED. Nevertheless, the presence of MSCs or pOKs in the post-CED defect was confirmed even 5 weeks after transplantation.
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Esofagoscopía , Esófago , Animales , Constricción Patológica , Esofagoscopía/efectos adversos , Esófago/cirugía , Stents , Porcinos , Porcinos EnanosRESUMEN
INTRODUCTION: Complete circular endoscopic (submucosal) resection (CER) performed using the endoscopic submucosal dissection (ESD) technique is burdened with a high incidence of post-operative strictures in the esophagus. The most effective method of preventing them is not known so far; one of the possible methods is to prevent these strictures directly at the site of their formation by covering the defect with a stent. The aim of the study was to find a way to fix a selected biomaterial to a stent, and subsequently, to fix the stent at the CER site to prevent esophageal strictures in an animal model. METHOD: Miniature piglets from the Czech Academy of Sciences breeding unit in Libechov (N=10) were used. Endoscopy was performed using a single-channel endoscope. First, we made two circular mucosal cuts spaced 5 cm apart in the middle esophagus and we performed the CER between them using the endoscopic submucosal dissection technique. After that, we covered the defect with a stent coated with biomaterial (Xe-Derma®) while we tried to prevent stent migration into the stomach. For stent fixation, we tested endo-clips (N=3), the Apollo endoscopic system (N=1) and the suspension technique using two polyamide threads (N=6) anchored in the nasal septum. We performed a control endoscopy, stent removal and subsequent autopsy after 12 weeks. RESULTS: All procedures were completed successfully without serious complications or deaths. Although stents covered with Xe-Derma® were applied to the entire resection area, one case of mediastinitis and one paraesophageal abscess were found during autopsy, most likely due to microperforations caused during the procedure. Histological analysis showed that after contact with the biomaterial, re-epithelisation took place within one week of application to the resection area. Stent migration occurred in each case when the stent was attached to the esophageal wall by endo-clips or with the endoscopic suture system (Apollo). There was no stent dislocation in the cases where the stent was suspended by two polyamide threads. CONCLUSION: We developed a technique of fixing biomaterial to the surface of metallic stents which we used to prevent the formation of esophageal strictures after CER. Distal suspension fixation of the stent with a polyamide thread proved to be the most effective, while fixations by endo-clips or with the endoscopic suture system were ineffective.Key words: benign esophageal strictures circular endoscopic resection endoscopic submucosal dissection complication prevention.
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Neoplasias Esofágicas , Esofagoscopía , Stents , Animales , Materiales Biocompatibles , Neoplasias Esofágicas/cirugía , Esofagoscopía/instrumentación , Esofagoscopía/métodos , Esófago , Modelos AnimalesRESUMEN
Acid-base balance is one of the most vigorously regulated variables of the body, including genital organs. Subacute ruminal acidosis is a common disturbance in dairy cows that disturbs several biochemical indices in the blood, cerebrospinal fluid, and urine. The possible negative effects of metabolic acidosis on the follicular fluid (FF) composition and, subsequently, on oocyte quality, are not fully elucidated. This study aimed to evaluate the changes in acid-base balance (ABB) in FF and blood during acute metabolic acidosis in dairy heifers. Ten Holstein heifers were stimulated with FSH in eight decreasing doses at 12-hour intervals (D0-D3). Acidosis was induced by oral administration of sucrose at 9 g/kg of body weight, dissolved in 10 L of warm tap water, at D3. Samples were collected from each cow at 0, 8, 12, 16, 24, 32, 40, and 48 hours after treatment. Samples of FF, obtained by transvaginal follicular aspiration, and peripheral blood were examined for ABB parameters: pH, pCO2, pO2, HCO3-, and base excess (BE). A significant decrease in pH, HCO3-, and BE values in the blood, as well as FF, occurred after sucrose treatment. The lowest pH values occurred in blood at 16 hours, and in FF at 24 hours, after treatment (7.30 ± 0.05 and 7.33 ± 0.05, respectively). The lowest HCO3- values in blood (18.75 ± 3.2 mmol/L) and FF (18.07 ± 2.84 mmol/L) occurred 24 hours after treatment, as did the lowest BE values (-6.61 ± 3.7 mmol/L and -7.53 ± 3.89 mmol/L, in blood and FF, respectively). Significant correlations for HCO3- (r = 0.928), BE (r = 0.946), pH (r = 0.889), and pCO2 (r = 0.522) existed between blood and FF samples. The results demonstrated that metabolic acute acidosis substantially influences the characteristics of both serum and FF.
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Equilibrio Ácido-Base/fisiología , Desequilibrio Ácido-Base/veterinaria , Acidosis/veterinaria , Enfermedades de los Bovinos/sangre , Líquido Folicular/metabolismo , Desequilibrio Ácido-Base/metabolismo , Acidosis/sangre , Enfermedad Aguda , Animales , Análisis de los Gases de la Sangre/veterinaria , Bovinos , Femenino , Hormona Folículo Estimulante/farmacología , Líquido Folicular/química , Concentración de Iones de Hidrógeno , Folículo Ovárico/metabolismo , Sacarosa/farmacologíaRESUMEN
BACKGROUND: Both over-the-scope clip (OTSC) and KING (endoloop + clips) closures provide reliable and safe full-thickness endoscopic closure. Nevertheless, OTSC clip demonstrated significantly inferior histological healing in the short-term follow-up. AIM: To compare OTSC versus KING closure of a perforation with regard to long-term effectiveness and macroscopic and histological quality of healing. METHODS: We performed a randomized experimental study with 16 mini-pigs (mean weight 43.2 ± 11.2 kg). A standardized perforation was performed on the anterior sigmoid wall. KING closure (n = 8) was attained by approximation of an endoloop fixed to the margins of a perforation with endoclips. OTSC closure (n = 8) was performed by deploying OTSC (OVESCO) over the defect. Pigs underwent a control sigmoidoscopy 8 months after the closure to assess the macroscopic quality of healing. Then, autopsy was performed and the rectosigmoid was sent for histopathological assessment. RESULTS: All closures were completed successfully without air leaks. The duration of closure was similar in both techniques (OTSC 17.8 ± 7.6 min vs. KING 19.6 ± 8.8 min). At autopsy, all KING closures (100 %) were healed with a flat scar without signs of leakage. Microscopically, no inflammatory changes were observed after KING closure. In the OTSC group, microscopic ulcers were present in two pigs (25 %), cryptal abscesses in three pigs (38 %) and significant neutrophil accumulation in all eight pigs (P < 0.01). Giant cell granulomas, dysplasia or abundant scarification was not observed in either group. CONCLUSIONS: Both OTSC and KING closures offer a long-term reliable seal of a gastrointestinal perforation without stenosis or fistulas. KING closure provides long-term histologically superior healing.
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Colon Sigmoide/cirugía , Sigmoidoscopía/métodos , Instrumentos Quirúrgicos , Técnicas de Cierre de Heridas , Cicatrización de Heridas , Animales , Colon Sigmoide/patología , Endoscopía , Estudios Longitudinales , Distribución Aleatoria , Herida Quirúrgica/patología , Sus scrofa , Porcinos , Porcinos EnanosRESUMEN
BACKGROUND: A safe technique is essential for successful access site closure in Natural Orifice Translumenal Endoscopic Surgery (NOTES) and for closures of iatrogenic perforations. AIM: To compare an over-the-scope clip (OTSC) versus an endoloop + endoclips closure technique (KING closure). METHODS: 40 minipigs underwent NOTES peritoneoscopy with liver biopsy. Gastrotomies and rectotomies were closed with OTSC (n = 20; 10× stomach, 10× rectum) or KING closure (n = 20; 10× stomach, 10× rectum). The animals were euthanized 28 days after the procedure. The main outcome variables were technical feasibility, effectiveness, and healing. RESULTS: Stomach: All but one closure (KING) was successfully completed. The times of closure were similar between the techniques. At necropsy, all access sites were healed. In two animals (1× KING, 1× OTSC), an abscess, probably related to the closure technique, was found. Histologically, transmural healing with muscular bridging was observable in nine pigs for KING versus two pigs for OTSC closure (p = 0.003). Inflammation was present in three pigs for KING versus seven pigs for OTSC closure (p = 0.08). Rectum: All closures were successfully completed. The times of closure were similar between the techniques. At necropsy, all closure sites had healed. Transmural healing with muscular bridging was present in nine pigs for KING versus two pigs for OTSC closure (p = 0.003). Inflammation was present in two pigs for KING versus seven pigs for OTSC closure (p = 0.03). In one animal (OTSC), an enterocolic fistula developed in the proximity of the closure site. CONCLUSIONS: OTSC and KING closure are comparable closure techniques in terms of technical feasibility and effectiveness. KING closure provides a superior histological outcome compared with OTSC closure.
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Técnicas de Cierre de Herida Abdominal/instrumentación , Cirugía Endoscópica por Orificios Naturales/métodos , Animales , Distribución Aleatoria , Recto/cirugía , Estómago/cirugía , PorcinosRESUMEN
INTRODUCTION: Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings. MATERIAL AND METHODS: Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody. RESULTS: In the period of two years (1st January 2009 - 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients' survival data. CONCLUSION: Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.
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Escisión del Ganglio Linfático , Neoplasias Gástricas/cirugía , Anciano , Femenino , Gastrectomía , Humanos , Inmunohistoquímica , Metástasis Linfática , Masculino , Micrometástasis de Neoplasia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Tasa de SupervivenciaRESUMEN
Pre-implantation embryos derived by in vitro fertilization differ in their developmental potential from embryos obtained in vivo. In order to characterize changes in gene expression profiles caused by in vitro culture environment, we employed microarray constructed from bovine oocyte and preimplantation embryo-specific cDNAs (BlueChip, Université Laval, Québec). The analysis revealed changes in the level of 134 transcripts between in vitro derived (cultured in COOK BVC/BVB media) and in vivo derived 4-cell stage embryos and 97 transcripts were differentially expressed between 8-cell stage in vitro and in vivo embryos. The expression profiles of 7 selected transcripts (BUB3, CUL1, FBL, NOLC1, PCAF, GABPA and CNOT4) were studied in detail. We have identified a switch from Cullin 1-like transcript variant 1 to Cullin 1 transcript variant 3 (UniGene IDs BT.36789 and BT.6490, respectively) expressions around the time of bovine major gene activation (8-cell stage). New fibrillarin protein was detected by immunofluorescence already in early 8-cell stage and this detection correlated with increased level of fibrillarin mRNA. The qRT-PCR analysis revealed significant differences in the level of BUB3, NOLC1, PCAF, GABPA and CNOT4 gene transcripts between in vivo derived (IVD) and in vitro produced (IVP) embryos in late 8-cell stage. The combination of these genes represents a suitable tool for addressing questions concerning normal IVD embryo development and can be potentially useful as a marker of embryo quality in future attempts to optimize in vitro culture conditions.
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Blastocisto/metabolismo , Proteínas Cullin/genética , Desarrollo Embrionario/genética , Perfilación de la Expresión Génica , Regulación del Desarrollo de la Expresión Génica , Animales , Secuencia de Bases , Bovinos , Proteínas Cullin/metabolismo , Medios de Cultivo , Técnicas de Cultivo de Embriones/veterinaria , Datos de Secuencia Molecular , Alineación de SecuenciaRESUMEN
INTRODUCTION: NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique was developed to achieve less invasive surgery with the aim to lower frequency of postoperative complications. Cholecystectomy is one of the most frequent elective surgical procedures and is relevant for evaluation of NOTES. The aim of the experimental study was to compare hybrid transrectal and laparoscopic cholecystectomy regarding feasibility and inflammatory response. MATERIAL AND METHODS: A total of 20 pigs weighing 26-56 kg were randomized to laparoscopic or NOTES group. Transrectal approach (15-18 cm from anal edge) was created by needle knife, followed by balloon dilatation and two-channel endoscope was introduced into the abdominal cavity. Cystic artery and duct were clipped and dissected. After extirpation of the gall bladder the colostomy was closed by occlusion loop-and-clip (King' closure) technique. In the laparoscopic group, cholecystectomy was performed by three-port access. Blood samples for evaluation of inflammatory response markers (leukocytes, CRP, interleukin 6) were taken 0, 2nd, 7th and 30th postoperative day, when the experiment ended and pig was euthanized. RESULTS: Two pigs were excluded (1 died early postoperatively for pneumonia, 1 for the rectal closure impossibility after it's laceration during of the gall bladder extirpation). Other pigs survived without complications. Procedure time was significantly longer in NOTES group (134 +/- 27 minutes versus 60 +/- 22 minutes, p < 0.05). White blood cells count and CRP level increased significantly in both groups 2nd and 7th postoperative day and then normalized. Differences between groups were not significant in any of the measured laboratory markers. Sectional finding of exudate and adhesions was comparable in both groups and all transrectal closures were healed. Small subhepatal abscess was found in one pig from NOTES group. CONCLUSION: Transrectal hybrid cholecystectomy is a safe and feasible method with comparable inflammatory responses and longer operating time compared to laparoscopy. A novel loop-and-clip technique was verified as a safe and simple rectal closure.
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Colecistectomía Laparoscópica/métodos , Cirugía Endoscópica por Orificios Naturales , Animales , Sus scrofaRESUMEN
INTRODUCTION: Gastrointestinal stromal tumors (GIST) are common mesenchymal gastrointestinal tumors, however, their incidence rate is low. The tumors originate from progenitor cells of interstitial cells of Cajal-gastrointestinal pacemaker cells, and the majority of them express c-Kit, a tyrosin kinase receptor. The aim of this study was to assess the GIST treatment in a group of patients and to compare the outcomes with literature data. METHODS: The authors performed a retrospecitve analysis of all patients with histologically confirmed GISTs, who were operated in the 2nd Surgical Clinic of the Charles University Medical Faculty (LF UK) in Prague and in the Central Military Hospital Prague (UVN Praha), from 2003 to 2008. RESULTS: During the five-year period, 13 patients underwent surgery in the Central Military Hospital Prague. The commonest tumor locations were the following: stomach (46%), small intestine (duodenum 23%, jejunum 23%, ileum 8%). R0 resection was performed in 12 subjects (92%). 10 patients (77%) remain in remission, in one patient, the disease is stabilized (8%), and in one patient, the disease progression and generalization has been recorded (8%). CONCLUSION: Surgery is a standard treatment in localized tumors. Following radical resection, the patients benefit from adjacent treatment with tyrosin kinase inhibitors. Specific tyrosin kinase inhibitors have been shown effective in the treatment of metastatic and relapsing disorders. Primary surgical treatment in metastatic diseases remains a paliative option for patients with bleeding and obstruction.
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Tumores del Estroma Gastrointestinal , Anciano , Anciano de 80 o más Años , Femenino , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors present a case report of a 61-years old female with 12 month history of deteriorative chronic pain located in epigastrium and propagating to her back, tabescence and upper dyspeptic syndrome. The first grade oesophagitis and duodenogastric reflux were verified endoscopically. There were adequate biliary tree as well as pancreatic duct and two high-volumed parapapillar diverticula and the third one in the region of D 3 depicted by ERCP and enteroclysis. Neither ultrasound nor computed tomography detected any pancreatic or hepatic pathology. All the alternatives of internal medical treatment resulted in no effect. The surgical treatment lied in performance of pylorus-saving pancreatoduodenectomy (Traverso-Longmire). Five months after operation the patient suffers from no ailments and prospers in general. The authors render an account of duodenal diverticula surgical treatment.
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Divertículo/cirugía , Enfermedades Duodenales/cirugía , Pancreaticoduodenectomía , Divertículo/patología , Enfermedades Duodenales/patología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Ultrasonographical examinations of ovarian structures were performed in 27 inseminated cows at estrus days and on days 4, 9, 20, 25, 30, and 40 after ovulation. Three cows were used twice. Corpora lutea (CLs) with a cavity were compared with homogeneous CLs. in pregnant and nonpregnant cows. Diameters and volumes of CLs and cavities, as well as volumes of luteal tissue and concentrations of serum progesterone were determined. The volumes of the structures were calculated using a mathematical formula for a rotary ellipsoid. Homogeneous CLs and CLs with a cavity and their luteal tissue reached a maximum volume in nonpregnant and pregnant cows on day 9 after ovulation. At this time, CLs volumes were 7.52 +/- 3.14 (homogeneous CLs, n = 4) and 4.54 cm3 (CLs with a cavity, n = 1) in nonpregnant cows, and 6.05 +/- 1.71 (homogeneous CLs, n = 10) and 9.54 +/- 2.67 cm3 (CLs with a cavity, n = 15) in pregnant cows. The volumes of luteal tissue were 7.52 +/- 3.14 and 4.33 cm in nonpregnant cows and 6.05 +/- 1.71 and 8.62 +/- 3.46 cm3 in pregnant cows. Concentrations of progesterone in peripheral blood in pregnant cows bearing a homogeneous CLs or CLs with a cavity on day 9 were 3.15 +/- 0.69 ng ml-1 and 4.12 +/- 1.28 ng ml-1, respectively. The concentrations of progesterone were higher in pregnant cows in comparison with nonpregnant cows. CLs with a cavity in pregnant cows contained a higher volume of luteal tissue and higher secretory activity compared to homogeneous.
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Bovinos/fisiología , Cuerpo Lúteo/fisiología , Estro/fisiología , Preñez/fisiología , Progesterona/sangre , Animales , Estudios de Cohortes , Cuerpo Lúteo/diagnóstico por imagen , Femenino , Embarazo , Progesterona/metabolismo , Factores de Tiempo , UltrasonografíaRESUMEN
Blood samples were collected from v. jugularis in five-day intervals from parturition to postpartum day 45 in the rearing conditions of a dairy cow production herd, consisting of 10 groups with 10 pluriparous cows each (crossbreds of Bohemian Pied cattle with Holstein-Friesian cattle). In blood serum the following activities were determined photometrically: aspartate aminotransferase--AST (0.36-0.47 mukat.l-1), gamma-glutamyl transferase--GMT (0.50-0.83 mukat.l-1) and lactate dehydrogenase--LD (7.22-9.10 mukat.l-1); their average values were at an almost constant level. Only did AST and GMT values decrease slightly from day 25 after parturition. The glucose average content on the day of parturition (4.07 mmol.l-1) steeply decreased to postpartum day 5 (2.79 mmol.l-1), and later on, it increased irregularly. The average values of total protein (66.7-73.2 g per 1) slightly increased from postpartum day 20. The values of urea (2.33-2.37 mmol.l-1) and bilirubin (3.49-5.15 mmol.l-1) did not show any larger changes in dependence on the time elapsing from parturition. The average content of creatinine (124-162 mmol.l-1) increased irregularly from postpartum day 15 and then it decreased. Cholesterol concentrations were gradually increasing from 2.58 mmol.l-1 on the day of parturition to 4.99 mmol.l-1 on day 45 after parturition. The average contents of calcium (2.20-2.66 mmol.l-1) and phosphorus (1.75-2.27 mmol.l-1) were irregularly increasing until day 20 after parturition. Also the average content of magnesium (0.86-1.15 mmol.l-1) rose from day 25 after parturition.
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Bovinos/sangre , Periodo Posparto , Animales , Aspartato Aminotransferasas/sangre , Femenino , L-Lactato Deshidrogenasa/sangre , Embarazo , gamma-Glutamiltransferasa/sangreRESUMEN
Surface epithelium of intercaruncular endometrium in pluriparous cows, crossbreds of Bohemian Pied cattle with Holstein-Friesian cattle, was not coherent until day 15 after parturition, with a variable height of cells (16-64 microns). Oedematous nature of lamina propria was subsiding gradually. From day 15 to day 20 after parturition the cell height of coherent surface epithelium and uterine glands became equable and stabilized (16-32 microns), and the lamina propria assumed its cellular nature with marked infiltration of polymorphonuclears and lymphocytes. Noticeable symptoms of atresia were demonstrated to occur more frequently in ovaries in the follicular population until day 15 after parturition. From day 10 to day 25 after parturition an increasing occurrence of luteinized follicles with diameters of maximally 3 mm was demonstrated.