[Experience with hepatoblastoma treatment in small children - the use of preoperative 3D virtual analysis MeVis for liver resections]. / Skúsenosti s liecbou hepatoblastómu u najmensích detí - vyuzitie predoperacnej 3D virtuálnej analýzy MeVis pri resekciách pecene.

INTRODUCTION: Hepatoblastoma is an uncommon but most frequent liver cancer in infants and children. The therapy is complex, including neoadjuvant, surgical, and adjuvant therapy. For surgery, the presence of a specialized surgeon and an anaesthesiologist is required. For planning the surgery, the 3D analysis MeVis is currently available. The objective of the work is the assessment of a group of children operated for a liver hepatoblastoma and the assessment of contribution of a pre-surgery virtual 3D analysis MeVis for a surgeon. METHODS: It represents a retrospective assessment of the operated children for the given diagnosis. Upon confirming the disease, the patients underwent neoadjuvant therapy, and then the MeVis analysis of a liver, a surgery, and an adjuvant therapy. The oncologic treatment was performed according to the SIOPEL recommendations. RESULTS: In the period of 2012 to 2016, we treated 5 infant patients with the diagnosed hepatoblastoma. The children were at the age between 4 and 37 months, 4 girls, 1 boy. The size of tumours according to the SIOPEL classification was PRETEXT II to IV. All children underwent a surgery without any complications and without any signs of post-operative failure of the post-resection remnant of the liver. The functional volume of the post-resection remnant of the liver was between 28%70% according to the MeVis analysis. During the long-term monitoring, one patient underwent lung metastasectomy, all children are currently without any signs of relapse of the disease. CONCLUSION: In case of quick catching and correct management of a hepatoblastoma, the results of therapy are very good. For successful treatment, a surgeon experienced in liver resection, presence of a specialized paediatric anaesthesiologist, and a paediatric oncologist are is required. The exact volumetric analysis MeVis is a contribution for a pre-operational review of the finding, and for the preparation of the surgery. The disease is uncommon, and therefore, the groups of patients are small. Due to that reason, the treatment should be centralized to a specialized department.Key words: hepatoblastoma MeVis volumetry liver resection.

[Complications after percutaneous transhepatic drainage of the biliary tract]. / Komplikácie po perkutánnych transhepatických drenázach zlcových ciest.

INTRODUCTION: The aim of this work is to demonstrate perioperative and postoperative complications after percutaneous transhepatic drainage of the biliary tract and, on the basis of our own experience, to show the possibilities of solving these complications within hospital care as well as the ways of preventing such complications in outpatient and home care where the role of home care nurses is very important. MATERIAL AND METHODS: At the Department of Radiology in F.D. Roosevelt Teaching Hospital Banska Bystrica, more than 100 percutaenous transhepatic biliary tract drainage procedures are performed every year. In 2013, 105 such procedures were performed. Indications included nonresectable cholangiocarcinomas of the biliary confluence (Klatskin tumours) or common bile duct as well as benign bile obstructions in which endoscopic drainage could not be performed (benign stenosis of thecommon bile duct, stenosis of biliodigestive anastomosis, intrahepatic biliary stones). Between 2009 and 2013, 151 patients with percutaneous transhepatic drainage of the biliary tract were hospitalised at the Department of Surgery in F.D. Roosevelt Hospital Banska Bystrica,of whom 98 had malignant obstruction and 53 benign obstruction. RESULTS: In 151 patients hospitalised at the Department of Surgery, the following postoperative complications occurred: catheter obliteration in 6.6%, biliary peritonitis in 2%, sepsis with cholangitis in 3.3% and haemorrhage in 4.6% of all patients. Mortality directly related to the PTD procedure was 0.66% (1 patient). CONCLUSION: Percutaneous transhepatic biliary tract drainage requires a skilled radiologist who is able to manage all perioperative complications. At the same time, experienced medical staff are needed who are able to treat the drainage catheters correctly and are able to recognize severe complications in time. Complications after PTD occur also during home care of the patients; therefore, cooperation of home care nurses with hospitals where PTD is performed is therefore important. Catheter flushing should be included in the catalogue listing home care procedures.

[First Czech and Slovak domino liver transplantation]. / První Cesko-Slovenská domino transplantace jater.

INTRODUCTION: The study introduces the first international, Czech and Slovak Domino Transplantation performed based on a tight cooperation between the Czech and Slovak transplant centres. MATERIAL AND METHODS: The donor of the cadaveric graft was a young Slovak man with Familial amyloidotic polyneuropathy. The livers of these patients are the predominant source of circulating transthyretin, and liver transplantation is the only treatment available for the disease. The graft was obtained from heart beating deceased donor with brain death. The domino graft was then transplanted to Czech sixty-three years old man with hepatocellular carcinoma and liver cirrhosis based on HCV. RESULTS: Both recipients had an uneventful immediate postoperative course with early graft function. The Czech patient faced early HCV recurrence in a graft which necessitated the reduction of immunosuppressives. CONCLUSION: The domino liver transplantation represents a suitable way for addressing graft shortage and reducing waiting list time. A well-organized cooperation between the two international centres is required to complete successful domino transplantation.

Radical surgery for cancer of the pancreas.

The basic principles of oncological radicality in surgery are: a) the surgeon have to perform always an R0 resection and he have to use perioperative investigation of resection margin, b) lymphadenectomy must be rational meaning that it is enough to perform regional lymphadenectomy (radical lymphadenectomy is not necessary), c) if portal vein resection enables increased curability of resection, then it is valuable to resect part of this vessel and to perform end-to-end venous anastomosis. (Ref. 5.).

Primary aldosteronism caused by aldosterone-producing adenoma in pregnancy--complicated by EPH gestosis.

Pregnancy in conjunction with primary aldosteronism is an unusual occurrence. We report a 28-year-old woman who presented with mild hypertension and hypokalemia as manifestations of primary aldosteronism caused by an aldosterone-producing adenoma in the left adrenal gland during pregnancy. Although the diagnosis was straightforward, the patient refused to undergo the proposed operation during the second trimester of her pregnancy. She was not admitted to hospital until she developed EPH gestosis in the 27th week of gestation, which had an unfavourable outcome for the infant who died nine days after delivery. The patient underwent a laparoscopic adrenalectomy which resulted in normalization of blood pressure and blood potassium levels. In cases of aldosterone-producing adenoma, surgery in the second trimester is the most appropriate option to avoid a poor obstetric outcome.

[Malignant melanoma of soft parts (clear cell sarcoma)--a rare case of multiorgan localization]. / Malígny melanóm mäkkých castí (svetlobunkový sarkóm)--raritný prípad viacorgánovej lokalizácie.

Malignant melanoma of soft parts (MMSP) is a rare tumor originally described by Enzinger in 1965 as clear cell sarcoma of tendons and aponeuroses because of its affinity to tenosynovial structures. Tumors are found predominantly at the extremities. First visceral case was described in 1993 in the duodenum. We describe the case of 64-years old man with malignant melanoma of soft parts in the stomach, in the pancreas, in the mesocolon, in the left thigh and in the left axilla. This patient was successfully treated surgically by the resection of the stomach, resection of the pancreatic head, extirpation of the tumor from mesocolon, from the left thigh and from the left axilla. In all these localisations the tumor was histologically and imunohistochemically proved to be MMSP (positivity: s-100 protein, vimentin, HMB-45 and negativity CK, EMA, desmin, actin). This multivisceral occurrence is extremely rare and according to the review of literature this is probably the first published case of MMSP in the stomach and in the pancreas.

[Initial experience with laparoscopic adrenalectomy]. / Prvé skúsenosti s laparoskopickou adrenalektómiou.

We present the first experience with laparoscopic adrenalectomy, which was in Slovakia introduced to the surgical practice on March 3, 1996. We analyse first seven patients who underwent completed laparoscopic adrenalectomy (five leftsided, two right-sided). Four patients had cortex adenoma (clinically 2 incidentalomas and 2 Cishing syndroma), three patients had cortex hyperplasia (clinically Conn syndroma). Average duration of operation was 120 minutes, there were no postoperative complications. Average postoperative hospital stay was 5 days. Our initial experiences are comparable with that of surgical departments which has more than two-years experiences. Laparoscopic adrenalectomy is a perfect method for the small adrenal tumors and it is better than traditional transabdominal approach.

[Pancreatic abscesses]. / Abscesy pankreasu.

The paper deals with pancreatic abscess as one of three entities of pancreatic infection. In spite of the common origin with infected pancreatic necrosis and infected pancreatic pseudocyst, the treatment of each kind of pancreatic necrosis has its own requirements. By comparing 30 pancreatic abscesses (mortality 18%), 29 infected pancreatic pseudocysts (mortality 6%) and 35 infected pancreatic necroses (mortality 43.5%) we concluded that the best treatment for pancreatic abscess is surgical evacuation with external drainage, for that of infected pancreatic pseudocyst internal drainage operation, and for infected pancreatic necrosis surgical debridement with external drainage, lavage and open-abdomen procedure. Differences in CT scan, treatment and prognosis require different surgical approach to each type of pancreatic necrosis. (Fig. 3, Ref. 24.)

[The effect of preoperative diagnostic methods on the correct selection of operative procedure on the thyroid gland]. / Vplyv predoperacných diagnostických metód na správnost' vol'by operacného výkonu na stítnej zl'aze.

The study compares three diagnostic procedures, the analysis of which is aimed at a choosing the optimal extent of resection on the thyroid. Diagnostic procedures, when based on clinical examination (palpation, scintigraphy, laryngoscopy, X-ray), lead to the optimal extent of resection in 74.2% of patients. Procedures selection performed on the basis of fine-needle aspiration cytology (FNAC) results lead to the correct extent of resection in 93.1% of patients. The procedures of frozen section lead to the correct resection extent in 81.3% of patients. (Tab. 1, Fig. 1, Ref. 25.)

[Effectiveness of laparoscopic cholecystectomy using various surgical techniques]. / Efektívnost' laparoskopickej cholecystektómie pri rôznej operacnej technike.

The study compares two groups, both in number of 100 patients subdued to laparoscopic cholecystectomy. In each group a different surgical technique was performed. The comparison study regarded duration of surgical performance, incidence of postoperative complications, surgical morbidity and mortality, as well as duration of hospitalization and return to full activity. The surgical interventions were performed at two distinct workplaces. Neither of the mentioned parameters yielded significant differences in dependence on the utilized operation technique. The entire group of 200 cholecystectomic performances was thereafter compared with a comparable group of classical cholecystectomies which had been performed at the identical hospitals. The mentioned parameters yield statistically significant differences in postoperative morbidity, hospitalization duration and return to full professional activity. The results speak in favour of laparoscopic cholecystectomy. The duration of surgical performance, number of postoperative complications requiring reoperation, and mortality do not yield significant differences. The comparison of the observed parameters in relation to age categories presents laparoscopic cholecystectomy as the method suitable also for older patients above 65 years of age. (Tab. 2, Fig 2, Ref. 6).

[Surgical treatment of insulinoma]. / Chirurgická liecba inzulinómu.

The paper summarizes experience with diagnosis and surgical treatment of insulinomas of the pancreas. Experience with three patients subdued to surgical treatment at the Department of Surgery of F.D. Roosevelt Hospital in Banská Bystrica confirm the rules of effective treatment of insulinomas: importance of neurological symptoms in early diagnosis, importance of angiography as the best method for localization of insulinomas in comparison with ultrasonography and CT. In addition, algorithm of the surgical treatment of insulinomas together with the specificity of the surgical technique were confirmed.

[Primary aldosteronism--personal experience with diagnosis and surgical treatment of adenomatous forms]. / Primáry aldosteronizmus--vlastné skúsenosti s diagnostikou a chirurgickou liecbou jeho adenómových foriem.

Primary aldosteronism (Conn's syndrome) forms about 2% of disease in patients with arterial hypertension. Primary aldosteronism is in 50% of patients caused by aldosteron producing adenoma. Surgical treatment of these adenomas is excellent, or with complete disappearance of the disease, or with simple drug control of the symptoms after adrenalectomy. In the diagnostic process we can meet also seemingly divergent results of investigations. In these cases diagnosis usually requires the catheterization of adrenal veins with selected sampling of aldosteron level and thus determines the localisation of the tumor. Localised adenomas are indicated for surgical treatment. The best approach seems to be the abdominal transperitoneal incision with removal the whole adrenal gland. In this paper authors describe their experience with 5 patients treated at the F.D. Roosevelt Hospital in Banská Bystrica. (Tab. 1, Fig. 2, Ref. 25.)

[Factors limiting resectability of pancreatic carcinoma]. / Limitujúce faktory resekability karcinómu pankreasu.

Authors describe all limiting factors influencing resectability of pancreatic carcinoma: invasion to the large vessels, lymphnode involvement and diffuse intrapancreatic tumor spread. Described is how to solve vascular involvement, how and why to perform radical lymphadenectomy and necessity of perioperative histological examination of resection border. On the group of 21 patients with pancreatic resection for carcinoma authors compare their results and experience with procedures recommended in literature.