Initial experience with single incision laparoscopic appendectomy.

INTRODUCTION: Within the development of laparoscopy, the single incision laparoscopy method has been recently introduced in paediatric surgery. The aim of this study was to evaluate the initial experience with single incision laparoscopic appendectomy at the Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS: A consecutive cohort of paediatric patients (18 years) undergoing laparoscopic single incision surgery for uncomplicated appendicitis between 4/30/2019 and 4/30/2021 was retrospectively evaluated. The following parameters were monitored: patients demographic characteristics, perioperative course, surgery duration, number and method of surgery conversions, length of postoperative hospitalization, postoperative complications classified according to Clavien-Dindo classification, occurrence of incisional hernias, and length of follow-up. RESULTS: In all, 160 patients (72 (45%) females) with uncomplicated appendicitis were included in the study. The median age at the time of surgery was 12 (IQR: 9.914.9) years. The median duration of surgery was 50 (IQR: 3860) minutes. Only one conversion to multiport laparoscopy and no conversion to open surgery were reported. The median postoperative hospital stay was 2 (IQR: 23) days. We observed 5 intra-abdominal and 9 wound complications. CONCLUSION: Single incision laparoscopic appendectomy is a safe, effective and rapidly adoptable method for the treatment of uncomplicated appendicitis in children.

BILATERAL EYE INJURY WITH BILATERAL BLOWOUT FRACTURE CAUSED BY A HIGH-PRESSURE WATER JET IN 16-YEARS-OLD FIREMAN GIRL. CASE REPORT.

PURPOSE: The aim is to present a report of a case of bilateral eye injury with bilateral blowout fracture caused by a high-pressure water jet from a fire hose in a 16-year-old girl during a competition for young firefighters. METHODS: We present a case report of a 16-year-old female patient with bilateral extensive eyelid contusion, oedema and lacerations of upper eyelids, lacerations of bulbar conjunctiva, contusion of both eyes, left optic nerve and bilateral blowout fractures of orbits.  Results: The initial ocular examination revealed "hand motion" in the right eye and no light perception in the left eye. Intraocular pressure was low in both eyes. Motility of both eyes was reduced, especially in the left eye. Lacerations of the eyelids and conjunctiva required a surgical procedure. No repair of the upper canaliculus of the left eye was attempted. Paralytic mydriasis and loss of lens accommodation in both eyes did not change throughout the follow-up period. A surgical procedure was applied to resolve the left blowout fracture, ocular motility of the right eye improved spontaneously. Traumatic cataract developed in the left eye within 1 year after injury, requiring cataract surgery and posterior capsule lens implantation, the right lens remained clear. Massive scarring of the retina and choroid in the lower parts of the eyes and in the macula reduced best corrected visual acuity in the right eye to 0.15 and in the left eye to 0.08. Intraocular pressure is within normal limits without any glaucoma therapy. The follow up period is three years. CONCLUSION: This is the first reported case of child with an eye injury caused by a high-pressure water jet during a sports activity.

Calreticulin is a B cell molecular target in some gastrointestinal malignancies.

Calreticulin, upon translocation to the cell surface, plays a critical role in the recognition of tumour cells and in experimentally induced cellular anti-tumour immunity. However, less is known about anti-calreticulin antibodies and their role in malignancies. Using enzyme-linked immunosorbent assay (ELISA), we found immunoglobulin (Ig)A and/or IgG anti-calreticulin antibodies in sera of approximately 63% of patients with hepatocellular carcinoma (HCC), 57% of patients with colorectal adenocarcinoma (CRA) and 47% of patients with pancreatic adenocarcinoma (PACA), while healthy controls, patients with viral hepatitis C and with chronic pancreatitis reached only 2%, 20% and 31% seropositivity, respectively. We found significantly elevated mean levels of IgA anti-calreticulin antibodies (P < 0.001) in patients with HCC (78.7 +/- 52.3 AU, mean +/- standard deviation), PACA (66.5 +/- 30.9 AU) and CRA (61.8 +/- 25.8 AU) when compared to healthy controls (41.4 +/- 19.2 AU). Significantly elevated mean levels of IgG anti-calreticulin antibodies (P < 0.001) were detected in patients with HCC (121.9 +/- 94.2 AU), gall bladder adenocarcinoma (118.4 +/- 80.0 AU) and PACA (88.7 +/- 55.6 AU) when compared to healthy controls (56.7 +/- 22.9 AU). Pepscan analysis revealed a large number of antigenic epitopes of calreticulin recognized by both IgA and IgG antibodies of patients with HCC and PACA, indicating robust systemic immune response. Moreover, significantly elevated levels of antibodies against peptide KGEWKPRQIDNP (P < 0.001) in these patients, tested by ELISA, confirmed the distinct character of antibody reactivity against calreticulin. The high occurrence and specificity of serum anti-calreticulin autoantibodies in the majority of patients with some gastrointestinal malignancies provide the evidence for their possible clinical relevance.

Anti-calreticulin immunoglobulin A (IgA) antibodies in refractory coeliac disease.

Refractory coeliac disease (RCD) is a very rare and dangerous form of CD, in which gluten-free diet loses its therapeutic effect and the damage of intestinal mucosa persists. Because of the adherence to the diet, serological markers of CD [immunoglobulin A (IgA) antibodies against gliadin, tissue transglutaminase (tTG) and endomysium] are often missing in RCD patients. We found substantially elevated levels of IgA anti-calreticulin (CRT) antibodies in the sera of almost all RCD patients tested. These sera were negative for IgA antibodies to gliadin and tTG and only some of them showed IgA antibodies to enterocytes. Analysis of patients' IgA reactivity to CRT fragments (quarters and halves) by Western blotting revealed differences in the specificity of IgA antibodies between RCD and CD patients. We therefore used the Pepscan technique with synthetic overlapping decapeptides of CRT to characterize antigenic epitopes recognized by serum IgA antibodies of RCD patients. Employing this method we demonstrated several dominant antigenic epitopes recognized by IgA antibodies of RCD patients on the CRT molecule. Epitope GVTKAAEKQMKD was recognized predominantly by serum IgA of RCD patients. Our results suggest that testing for serum IgA antibodies against CRT and its selected peptide could be a very useful tool in RCD differential diagnosis.

[Treatment of the Hirschsprung's disease (HD) at the Department of Pediatric Surgery of Charles University, 2nd Faculty of Medicine, from 1979 to 2004]. / Lécba Hirschsprungovy choroby na Klinice detské chirurgie 2. LF UK a FN Motol v letech 1979-2004.

BACKGROUND: Survey of surgical techniques, strategy and results of the treatment of patients with Hirschsprung's disease (HD) at the Department of Pediatric Surgery of Charles University, 2nd Faculty of Medicine in Prague from 1979 to 2004 is presented. METHODS AND RESULTS: Paper summarises a twenty-five years long retrospective study of medical records of 274 patients who were operated on 1979-2004. 173 (67,3 %) pts had classical rectosigmoid (CRA) and/or long colonic aganglionosis (LCA). 19 (6,4 %) pts had total colonic aganlionosis with small bowel involvement (TCA). 72 (26,3 %) pts suffered from ultra-short rectal aganglionosis (URA). 74 pts with CRA and LCA operated on 1979-1991 underwent Kasai's colorectoplasty. 8 (10,8 %) of them had anastomotic leak, 7 (9,5 %) pts had anastomotic stricture, 2 (2,7 %) pts had postoperative enterocolitis (PEC) and 10 (13,5 %) had chronic constipation. In 6 pts an additional partial sphincteromyectomy of the internal anal sphincter SFME) had to be done. In period 1991-2004 93 pts underwent Swenson's procedure with (SFME). Anastomotic leak occurred in 3 (3,2 %) pts. Anastomotic stricture, PEC and/or chronic constipation were not registered. In 6 pts with anastomotic leak from both groups Soave re-do pull-through was done. In 2003-2004, 10 pts with CRA underwent a transanal resection of aganglionic segment with Swenson's colorectoplasty. One pt developed anal stricture. 3 of 19 pts with TCA operated on in 1979-1990 underwent classic Martin's long side to side ileo-recto-colic anastomosis. In 16 pts of 1991-2004 only short ileo-recto anastomosis according to Kasai and/or Swenson were done. In 93 pts suffering from URA a Lynn's SFME was performed. Three-stage procedure for the last time was used in 3 pts in 1984. Two- and one-stage procedures are still used. CONCLUSIONS: A number of postoperative complications decreased, a three-stage procedure was abandonned and the operation of HD is currently performed in newborn. In CRA a TAR replaced the laparatomy and in TCA the short ileo-rectal anastomosis is performed only.

[Long-term results and quality of life in patients after surgery in childhood for Hirschsprung's disease by the Kasai method of colo(ileo)rectoplasty]. / Dlouhodobé výsledky a kvalita zivota pacientu operovaných v detství pro Hirschsprungovu chorobu kolo(ileo)rektoplastikou podle Kasaie.

BACKGROUND: Evaluation of faecal continence, education and occupation of patients operated during childhood on account of Hirschsprung's disease by Kasai's colo(ileo)rectoplasty. MATERIAL AND METHODS: Analysis of data from questionnaire, ambulatory check-up examinations and case-records of 46 patients of 109 operated in 1979-1995. RESULTS: Of 46 patients (36 men, 10 women) aged 18 to 35 years (mean age 22.5 years) 42 patients (33 M, 9 F) had the classical or long type of HD, 4 patients (3 M, 1 F) suffered from aganglionosis of the entire colon (TCA). The follow-up period after operation was 8 to 24 years (on average 13.5 years) 23 patients (50%) were quite free from complaints, 23 patients (50%) have occasional complaints: constipation 8 (14.4%), diarrhoea 5 (10.9%), soiling 20 (43.5%), abdominal pain 16 (34.8%). One patient has pain in the rectum, one female patient painful sexual intercourse, 4 (8.7%) suffer from meteorism. 6(13%) patients use laxatives, 8 (17.4%) enemas. Four (8.7%) patients were reoperated on account of residual aganglionosis. Seven (15.2%) patients had a partial sphincteromyectomy of the internal anal sphincter. Two patients had ileus with adhesion, one patient resection of a urethral stricture, one female patient with TCA total thyroidectomy on account of a medullary thyroid carcinoma. Eight (16.3%) patients have elementary education, 14 (30.4%) completed an apprenticeship, 22 (47.8%) have secondary education, 2 (4.3%) have university education. Forty four (95.6%) patients work full time. CONCLUSION: Although occasional soiling is reported by 43.5% patients, all patients evaluate their situation as good or adequate.

[Transanal resection of the recto-sigmoid--the future in the treatment of classic Hirschsprung's disease?]. / Transanální resekee rektosigmoidea--budoucnost v lécení klasické Hirschsprungovy choroby?

INTRODUCTION: The technique of transanal resection (TAR) of aganglionary part in rectosigmoid, published in 1998, has gradually become a standard operation technique in the treatment of Hirschsprung's disease (H.d.). Since the TAR technique for H.d. is not yet generally widespread and has not been used in the Czech Republic yet, the authors intended to share their own experience and early results obtained by this surgical technique. COHORT OF PATIENTS: Seven patients (five boys and two girls) suffering from the classical recto-sigmoid form have been operated on since June 2003. One girl was affected with the Down's syndrome. The age of the patients at the time of operation was between one and 24 months. SURGICAL TECHNIQUE: The extent of intestinal resection was determined on the basis of per-operation biopsy. The length of the rectrosigmoid resection was between 25 and 35 cm. The colorectal anastomosis with partial sphincteromyectomy of internal anal sphincter was performed by the technique according to Swenson. The antibiotic prophylaxis was secured by three doses of cefoxitin and one dose of isepamycin. RESULTS: Intestinal passage reestablished 8-12 hours after the surgery, and complete oral intake began on day 3 or 4 after the operation. All patients healed up without complications, the period of hospitalization was seven days on the average. The final diagnosis of H.d. was confirmed by biopsy examination of the dissected portion in all cases. CONCLUSION: TAR is univocally the method of first choice in the surgery of classical Hirsprung's disease when compared with laparotomy or laparoscopy.