[Arthroscopic Excision of Osteoid Osteoma of the Femoral Head]. / Artroskopická exstirpace osteoidního osteomu hlavice femuru.

Osteoid osteoma is a primary benign bone tumor with rare intra-articular occurrence. Our case report describes a rare case of a 21-year-old man with long-term severe pain in the right hip region caused by osteoid osteoma managed by arthroscopic excision. The clinical finding of pains and a limited range of motion did not correlate with the normal plain X-ray finding. The osteoid osteoma was suspected based on the CT scan. In literature, several methods of resection of intraarticular osteoid osteoma of the hip are described. Since our department has long specialised in arthroscopic hip surgery and based on the available examinations the tumor appeared to be located within the arthroscopic reach, we decided for arthroscopic resection of the tumor. Our study comprises a detailed description of the entire surgical procedure, the used arthroscopic approaches and the arthroscopic technique of tumor excision. The histological examination of samples taken from the mass confirmed the suspected osteoid osteoma. The success of arthroscopic excision of the tumor was later confirmed also by very positive postoperative recovery when the patient very soon experienced a considerable reduction of pain observed during our five-year follow-up of the patient (Day 13, Week 2 and 6, Year 1, 2 and 5). During the follow-up period, an increase of the Harris Hip Score (13.5 preoperatively vs 76.6/91/94/96/96 postoperatively) and a decrease in VAS (9 preoperatively vs. 3/1/1/1/1) were reported. The follow-up CT and MRI performed at 2 or 5 years after surgery did not show tumor recurrence. The case report includes also illustrations consisting of X-rays, CT and MRI scans before and after surgery as well as multiple scans taken intraoperatively. It has to be emphasized that this is a rare case and an evaluation of a larger group of patients would be necessary to verify the successful outcomes of arthroscopic technique in treatment of the hip joint osteoid osteoma.

[Clinical Results of Endoscopic Treatment of Greater Trochanteric Pain Syndrome]. / Výsledky endoskopické terapie bolestivého syndromu velkého trochanteru.

PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (p<0.05) was achieved postoperatively. The mean duration of surgical procedure was 68 minutes. Moreover, in peritrochanteric space apart from chronic bursitis also another pathology was found in a total of 14 cases (74%). In six cases (32%) it was a mild degeneration of m. gluteus medius (treated only with debridement) and in eight patients who underwent surgery (42%) the dorsal third of tractus iliotibialis was hypertrophic and protruding into bursa (treated with an incision of the hypertrophied part of the band). No serious neurovascular or thromboembolic complications were recorded. Only minor postoperative complications in a total of 7 patients who underwent surgery (37%) occurred. DISCUSSION There are lots of studies in literature presenting the results of endoscopic treatment of GTPS either using an independent trochanteric bursectomy or its combination with iliotibial band release. In our study we succeeded in achieving similar clinical results as those achieved by the other authors engaged in this area. CONCLUSIONS It has been proven in this retrospective study that the technique of endoscopic trochanteric bursectomy in patients with greater trochanteric pain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of postoperative complications. Key words: greater trochanteric pain syndrome, peritrochanteric space, recalcitrant trochanteric bursitis, hip arthroscopy, endoscopic trochanteric bursectomy, iliotibial band release.

[Correlation between the Arthroscopic and MRI Findings in Patients Active in Sports with Clinically Suspected Acetabular Labral Tear - Prospective Study Results]. / Korelace artroskopického a MR nálezu u sportovne aktivních pacientu s klinicky suspektní lézí acetabulárního labra ­ výsledky prospektivní studie.

PURPOSE OF THE STUDY The aim of our prospective study was to establish correlation between the arthro-MRI and arthroscopic findings in patients active in sports clinically suspected of having a hip labral tear. We sought to identify the benefits of arthro-MRI for clinical practice prior to the considered hip arthroscopy. MATERIAL AND METHODS The prospective study included 34 patients with hip pain and clinically suspected of having a labral tear. The group consisted of 19 men (55.9%) and 15 women (44.1%) of the mean age of 32.2 years (18 to 50 years). All our patients were active athletes, either professional (12; 35.3%) or recreational (22; 64.7%). Included in the study were exclusively patients aged 18-50 with hip pain lasting longer than 3 months, not responding to conservative therapy, with normal X-ray findings, or FAI syndrome. The patients underwent arthro-MRI and subsequently also hip arthroscopy, namely within no more than 3 months. The description of findings was translated into simple numerical scales, assessed using Spearman s rank correlation coefficient. We also examined the specificity, sensitivity, positive and negative predictive values and the odds ratio at various cut-off values of the scale for arthro-MRI. The statistical significance was set at the alpha level = 5%. The quality of tests was also evaluated using the ROC curve. RESULTS In hips assessed by the radiologist as reliably with no pathological finding (MRI type 1) the negative predictive value achieves 83.3% and the positive predictive value of 85.7%, with 96.0% sensitivity and 55.6% specificity. When evaluating the reliably negative finding together with the likely negative finding (MRI type 2) as against the pathological and certainly pathological findings (MRI type 3 and 4), the negative predictive value is 57.1%, the positive predictive value 95.0%, the specificity 88.9% and the sensitivity 76.0%. DISCUSSION In our study, the values achieved were comparable to or better than those reported by foreign authors in their studies establishing correlations between the arthro-MRI and intraoperative findings. Significantly higher was primarily the negative predictive value. CONCLUSIONS The results of our study indicate that the arthro-MRI performed as a part of preoperative examination prior to hip arthroscopy has adequate specificity and sensitivity in patients with suspected labral tear. Based on this examination a decision can be made as to whether to perform arthroscopy. Our study also shows that it is essential to have a highly competent radiologist to evaluate the arthro-MRI results. Key words: hip arthroscopy, labral tears, arthro-MRI, hip joint, predictive value of tests, sensitivity and specificity, minimally invasive surgical procedures/methods.

[A contribution of multidetector computed tomography to indications for chest wall stabilisation in multiple rib fractures]. / Prínos multidetektorové výpocetní tomografie hrudníku k indikaci stabilizace hrudní steny u blokové zlomeniny zeber: první zkusenosti.

PURPOSE OF THE STUDY: Multidetector computed tomography (MDCT) is more sensitive for the detection of injury to the thoracic wall and intra-thoracic organs than a plain chest radiograph. The chest wall deformity and instability following multiple rib fracture involves fractures of four or more adjacent ribs at two levels, sometimes including a sternal fracture. It may also be associated with lung trauma (pneumothorax, haemothorax, rupture, laceration or pulmonary contussion). An isolated multiple-rib fracture can successfully be treated conservatively. Early intubation and mechanical ventilation are indicated in patients with progressive respiratory insufficiency. Indications for surgical stabilisation of this fracture are based on the signs of respiratory failure and the results of imagining methods (MDCT at the present time). MATERIAL AND METHODS: Examination by MDCT was carried out in patients with severe thoracic trauma. In five patients with multiple rib fractures, the CT findings were included in indication criteria for open rib osteosynthesis and thoracotomy. A clinical indication criterion was respiratory insufficiency after the patient's weaning from a ventilator, manifested by paradoxical chest motion. A radiographic indication included an extensive chest deformity with rib displacement into the pleural cavity in 3D reconstruction from MDCT images. Surgery was performed within one hour to five days of admission. Access was gained through an oblique skin incision and by cutting though the chest wall muscles to release fractured ribs. To explore the thoracic cavity, a defect in the intercostal muscles was extended by an incision at the site of rib fracture. Suction of a haemothorax was done and lung ruptures were sutured in three patients. After chest drain insertion, the fractured ribs were stabilized by plate osteosynthesis (fy Medin). RESULTS: In the post-operative period, mechanical ventilation was continued for 3 to 6 days in four patients. There were no complications. In the patients with flail chest, the 3D reconstruction from MDCT images allowed us to make more exact pre- operative decisions concerning the extent of rib osteosynthesis and the method of exposure. If lung injury was also shown, this was an indication for thoracic cavity exploration. DISCUSSION: The pathophysiological effects of flail chest involve several factors including the size of a flail segment, change in intra-thoracic pressure during spontaneous breathing and multiple injuries to the intra-thoracic organs. Therapy is related to the seriousness of respiratory disorder associated with flail chest, the degree of chest wall deformity and other complications of conservative treatment (dependence on mechanical ventilation with no possibility of weaning). Surgical stabilization of the chest wall is the most reliable method of treatment which allows us to avoid or interrupt the adverse effect of rib displacement and chest instability. A contribution of MDCT examination to the indication for surgical stabilization lies in that MDCT provides imagining of the details decisive for the classification of fracture types including their tendency to displacement. MDCT permits a better visualisation of chest injury and a better understanding of the respiratory disorder. CONCLUSIONS: Based on 3D reconstruction from MDCT images, it is possible to make the pre-operative considerations for rib osteo- synthesis more specific and to choose the best approach. At the same time MDCT enables us to diagnose associated intra-thoracic injuries and provides indications for their treatment. In addition, it gives us a possibility to evaluate the role of a flail segment in breathing dysfunction and to establish indications for surgical stabilization in multiple rib fractures. Rib osteosynthesis allowed for early stabilization of the chest wall and improved the mechanics of breathing, thus requiring a shorter period of mechanical ventilation. The evaluation of statistical significance of these facts will be made when a larger group of patients examined by MDCT is available.

[The spectrum of diaphragmatic injuries managed in a Prague traumatology centre]. / Spektrum poranení bránice osetrené v traumatologickém centru.

INTRODUCTION: Diaphragmatic injuries may result from blunt or penetrating injuries. The symptomatology is usually overlaid by symptoms of associated abdominal or thoracic injuries or by symptoms of other systems injuries in polytraumas. Multidetector computer tomography (MDTC) facilitates the improvement of preoperative diagnostics in blunt injuries. The retrospective study included analysis of a study group of subjects with blunt and penetrating diaphragmatic injuries. PATIENTS, METHODS AND RESULTS: From 1996 to 2009, a total of 44 injured patients with diaphragmatic injuries were operated in the FNKV (Faculty Hospital Kralovske Vinohrady) Traumatology Centre. The group included 17 blunt injuries and 27 penetrating injuries. There were 39 male and 5 female subjects, aged from 17 to 76 years. 32 subjects suffered from left-sided diaphragmatic injuries and 13 subjects from right-sided injuries. The commonest type of penetrating injuries were stab injuries in 21 subjects. 40 patients suffered from associated injuries. The commonest associated injuries included liver and splenic injuries. Simultaneous thoracotomy and laparotomy for associated injuries affecting the both cavities was performed in 21 patients. Left-sided diaphragmatic injury with associated abdominal injury was managed using laparotomy. Thoracoscopy or laparoscopy was used in 3 subjects with penetrating injuries. CONCLUSION: Penetrating injuries are the commonest cause of diaphragmatic injuries, with prevailing left-sided location of the injury. MDCT is an asset in the diagnostics of blunt diaphragmatic injuries. Surgical approach was selected based on the injury location and on the presence or absence of associated injuries. The miniinvasive approach contributes to the daignostics of penetrating diaphragmatic injuries in patients with stable hemodynamic conditions.

[Damage control laparotomy in blunt abdominal injury]. / Damage control laparotomie u tupého poranení bricha.

PURPOSE OF THE STUDY: Damage control surgery is one of the major advances in surgical techniques used in polytrauma patients in the past 25 years. It is based on a foreshortened pre-operative examination during ongoing resuscitation which includes surgical intervention in an injured patient with severe hypotension due to haemorrhage. In this seven-year retrospective study the authors evaluate the results of damage control laparotomy in patients with injury to the abdominal organs, retroperitoneum and pelvis. MATERIAL AND METHODS: The evaluated group included 21 patients with blunt abdominal trauma who underwent damage control laparotomy in the 2001-2007 period. There were 17 men and four women; the age range was 17 to 69 years, with an average of 36 years. Damage control laparotomy was indicated in the patients with blunt abdominal trauma, or with closed or open pelvic fracture, who developed a progressive haemorrhagic shock. RESULTS: Between 2001 and 2007, a total of 21 922 patients were admitted to the Trauma Centre and 12 392 operations were performed. However, only in 21 of them (0.1 %) damage control laparotomy was indicated. The procedure was most frequently performed for liver injury (16 patients), which was associated with multiple injury to the other abdominal organs and retroperitoneum in five patients. Further three patients were operated on for haemoperitoneum at continual bleeding due to type C fracture of the pelvis. In the remaining two patients the damage control procedure was chosen to stop persistent bleeding following splenectomy and nephrectomy for traumatic rupture. In these 21 patients blunt trauma was part of polytrauma (ISS > 15). Repeat surgery was carried out within 48 to 96 hours (average, 58 h). Four patients (19 %) died; two due to progressive traumatic haemorrhagic shock and two because of brain oedema after concussion. DISCUSSION: Damage control surgery has become a fundamental component of surgical strategy for severe trauma and has been accepted by surgeons although it cannot be evaluated in randomized clinical studies. Survival after damage control laparotomy in serious intra-abdominal injuries involved in polytrauma is reported in relation to the scoring system values (ISS, GCS), but depends, first of all, on blood loss, degree of acidosis and severity of associated injuries, with craniocerebral trauma in the first place. CONCLUSIONS: Damage control laparotomy is an effective procedure in the treatment of severe trauma to the abdominal organs and retroperitoneum in critically injured patients. This time-limited, staged surgical intervention is included in resuscitation of patients with hypothermia, metabolic acidosis and coagulopathy. The outcome of damage control surgery is related to not only the severity of injury, but also experience with comprehensive acute care in trauma centres.

[Enteral fistula as a postoperative complication--a case report]. / Enterální pístel jako pooperacní komplikace--kazuistika.

Enteral fistula is a serious postoperative complication. A therapeutical approach must be individual with regard to the character of the fistula and especially with regard to the entire state of the patient. With our patient the fistula occurred as a further complication after the reconstruction operation after the preceding Hartmann resection for the perforated diverticulitis. The serious catabolic state did not make possible an immediate operational revision. It was necessary to improve first the nutritional parameters by TPN and bring about anabolism. Only then the surgical intervention with the abolishment of the fistula was possible.

[Surgical site infection following proximal GIT procedures]. / Infekce chirurgického místa po operacích na aborální cásti GIT.

INTRODUCTION: Surgical site infections (ICHM) remain a serious problem in the proximal GIT surgery, with incidence rates from 5% to 26% in planned procedures, and up to 40% in urgent procedures. Surgical site infections result in increased postooperative morbidity and mortality rates, prolonged hospitalization and increased treatment costs. Minimalization of the surgical site infection rates is an important epidemiological and therapeutical objective. AIM: A retrospective study assessed surgical site infections rates in urgent and elective procedures on the proximal GIT, and in a selected group of elective procedures on the large intestine and rectum. The significance of some risk factors was assessed based on analyses of surgical site infections in all subjects operated during the two-year study period. PATIENTS AND METHODS: Infection rates following urgent procedures were analysed in 545 subjects operated for acute abdomen during 2003-2004. In another study group of 4667 subjects operated during 2005-2006, surgical site infection rates were analysed based on assessment of some risk factors. In this group, incidence of surgical site infections in 640 patients following proximal GIT procedures was studied. In a selected group of 192 elective colorectal procedures, incidence rates of surgical site infections and peritoneal infections were evaluated. RESULTS: Surgical site infections occurred in 71 (13 %) of the subjects in the group of 545 patients operated for acute abdomen. In 48 patients, the microbiological findings in surgical site infections were positive with the following commonest pathogens: Escherichia coli, staphylococci and Enteroccocus faecalis. Surgical site infections were demonstrated in 217 subjects (4.6%) out of the total of 4667 patients included in the study group. The surgical site infections risk factors, which were found statistically significant (p < 0.05), included the procedure's duration over 2 hours (p = 0.042) and the age > 50 (p = 0.047). Surgical site infections occurred most frequently in the group of 640 subjects with proximal GIT procedures, classified as septic procedures (surgical site infections in 28.5% and in the peritenal cavity in 8%). In the group of 192 subjects with colorectal procedures, the surgical site infections occurred in 6.8%, peritoneal cavity infections in 3.1% of the subjects. CONCLUSION: Surgical site infections are the commonest postoperative infections in proximal GIT surgeries. The surgical site is the commonest location. The principal pathogens following urgent procedures include Enterobacteriacae, enterococci and staphylococci. The following risk factors were found statistically significant: the procedure's duration (> 2 hours) and the patient's age (< 50 years).

[Postoperative nutritional support in liver surgery. Effects of specialized parenteral nutrition enriched with branched-chain amino acids following liver resections for colorectal carcinoma metastases]. / Pooperacní nutricni podpora v chirurgii jater. Ucinek specializované parenterální vyzivy obohacen o rozvetvene aminokyseliny po resekci jater pro metastázy kolorektálního karcinomu.

INTRODUCTION: Perioperative nutritional support in liver surgery remains specific regarding the role of the liver in the metabolism regulation. The loss of functional liver tissue following resection procedures may result in significant metabolic disorders, particularly in patients with preoperative liver impairment in chronic conditions. Perioperative nutritional support is indicated in patients suffering from malnutrition, chronic liver disorders and also following liver resections with limiting residual parenchyma. AIM OF THE STUDY: The retrospective study assessed the effect of complete parenteral nutrition enriched with branched chain amino acids on liver function and the rate of postoperative complications following liver resections (of at least two segments) for colorectal carcinoma metastases. SUBJECTS AND METHODOLOGY: 142 subjects following liver resections for colorectal carcinoma metastases were included in the study. In 42 subjects with anatomical resections of at least two segments, complete parenteral nutrition enriched with branched chain amino acids (3.8 g) was administered postoperatively from Day 1. The parenteral nutrition was maintained for 5 to 7 days, from Day 3, additional oral diet regime was indicated. In 100 subjects with a single segment resections or wedge resections, a combination of glucose 10% and crystalloid solutions was administered from Day 1, and early oral diet was added from Day2. Liver tests were performed during the first postoperative week and protein electrophoresis 14 days postoperatively. RESULTS: During the first postoperative week, the liver test values reached normal values in patients with specialized complete parenteral nutrition. In subjects, where the specialized parenteral nutrition was not administered, increased alcaline phosphatase levels and gamma glutamyl transpherase levels were recorded through the postoperative Day 7. No significant differences were detected in protein electrophoresis values and in rates of postoperative complications (14% in both patient groups). Liver test values in specialized nutritional support patients were negatively affected by the extent of their liver resections and occurrence of additional extra hepatic disorders. Administration of complete parenteral nutrition enriched with branched- chain amino acids proved a positive effect on the liver test values recovery. CONCLUSION: Postoperative parenteral nutrition with solutions enriched with branched-chain amino acids in major liver resections (at least 2 segments) has a positive impact on the liver test values recovery during the early postoperative period.

[Polytraumas in injured patients over 65 years of age]. / Polytrauma u zranených starsích 65 let.

INTRODUCTION: Geriatric trauma is most commonly defined as a trauma in patients of 65 years of age and over. These patients represent a specific problem due to their vulnerability, limited physiological response to the traumatic stress and high frequency of associated disorders, complicating the treatment. The aim of this report is to assess polytrauma patients of 65 years of age and older, compared to a group of younger patients. PATIENTS, METHODOLOGY AND RESULTS: 198 polytrauma patients, hospitalized from 2005 to 2006 were included in the retrospective study. Out of the total, 27 subjects (13.6%) were 65+ years old. Upon their admission, the difference in APACHE II between the groups was highly statistically significant (19-27.2, p = 0.0001). The ISS (the mean value) score was higher in the elderly patients (29-38). Traffic injuries, including pedestrian-vehicle collisions (61-73%), were the commonest mechanism of injuries in the both groups. There was a significant difference in the rates of craniocerebral injuries (80-96%, p = 0.041). During the early posttraumatic period, 99 (57%) urgent surgical procedures were performed in younger patients, compared to 11 (79%) procedures in the elderly. The difference in death rates was statistically significant (25-44%, p = 0.031). CONCLUSION: Polytraumas in the elderly (65 years of age and over) injured is characterized by higher severity scores and higher rates of craniocerebral injuries. Traffic injury was the commonest mechanism of injury. The death rate was higher in the elderly patients.

[Surgeries for blunt and penetrating thoracic injuries]. / Operace u tupého a pronikajícího poranení hrudníku.

INTRODUCTION: Up to 50% deaths due to fatal injuries result from thoracic injuries. Approximately 10-15 % of the injuries require thoracotomy. AIM OF THE STUDY: Indications and outcome of the surgery were assessed, based on the restrospective analysis data from subjects operated for blunt and penetrating thoracic injuries. SUBJECTS, METHODOLOGY AND RESULTS: 85 patients were operated for blunt or penetrating thoracic injuries during the period from 2000 to May, 2006. Urgent procedures for blunt thoracic injuries were performed in 13 subjects, and for penetrating injuries in 52 subjects. Immediate thoracotomy was indicated in 4 subjects suffering from stab injuries of the heart. 16 subjects were operated consequently for posttraumatic intrathoracic complications in blunt thoracic injuries. 4 subjects exited early postoperatively (4.7 %). CONCLUSION: The aim of urgent surgical interventions is to manage the major bleeding source (heart or large vascular injury), lungs, air leakage (tracheal or bronchial injuries) and diaphragmatic injuries. Irreversible hypovolemic shock in penetrating thoracic injuries and serious related injuries in blunt traumas resulted in peroperative and postoperative mortality.

[Anatomical resection for liver metastases of the carcinoma of the large intestine and the rectum]. / Anatomická resekce u jaterních metastáz karcinomu tlustého streva a konecníku.

UNLABELLED: Resection of the colorectal carcinoma liver metastases is an effective therapeutical procedure with a five-year survival rate in 20-50% of the operated. Opinions on the most optimal type of the resection procedure remain to be controversial. The aim of this study was to assess all indication criteria for anatomical resections of the colorectal carcinoma liver metastases. SUBJECTS AND METHODOLOGY: This retrospective study analyzed 98 patients with liver resection for colorectal metastases. In 31 patients, extensive anatomical resections of the liver were conducted, segmentotomie were conducted in 20 patients and nonanatomical wedge resections in 47 patients. Extensive anatomical resections were conducted in cases of tumorous foci larger than 2cm and located marginally between individual segments of a single lobe, and in cases of multiple tumorous foci affecting a single liver lobe. The nonanatomical resections were conducted in cases of metastases smaller than 2 cm, localized on the liver surface or in cases of multiple peripheral foci, including cases when both liver lobes were affected. RESULTS: In the group with the wedge-type resections, a histologically positive border was found in 4 cases. Postoperative complications were recorded in 10 (19.6%) patients with the anatomical resection and in 9 (19.1%) with the wedge resection. CONCLUSION: 1. Anatomical resection of the liver for the colorectal carcinoma metastases is indicated in cases of larger foci (over 2 cm), located marginally between segments or in multiple metastases affecting a single liver lobe. 2. Anatomical approach to the resection lowers the rates of histologicaly non-radical resections (R 1). 3. The new surgical technique of the liver transsection lowered, even in cases of anatomical resections, the postoperative morbidity rates.

Pseudomembraneous clostridium after autologous bone marrow transplantation.

Clostridium difficile (C. difficile) pseudomembraneous colitis was diagnosed in a 13-year-old boy with Hodgkin's disease 3 months after autologous bone marrow transplantation. Hematopoiesis was fully reconstituted at the time. C. difficile infection occurred after gall bladder empyema had been treated conservatively with i.v. antibiotics and prophylactic 4-week administration of oral amoxicillin. C. difficile colitis was diagnosed early and intensive supportive therapy combined with administration of i.v. and subsequently oral vancomycin therapy failed. It is a phenomenon rarely seen and successful eradication of the clostridium infection was only achieved by a combination of higher dose vancomycin with metronidazole. During the post-colitis recovery the patient experienced a relapse of Hodgkin's disease and died following further surgical intervention 137 days post-transplantation.

[The use of improved commercial micro-LA-tests for the identification of different groups of microorganisms in clinical microbiology]. / Ispol'zovanie usovershenstvovannykh kommercheskikh mikro-LA-testov dlia identifikatsii mikroorganizmov razlichnykh grupp v klinicheskoi mikrobiologii.

Lachema kits ENTEROtest 24, ENTERO-Rapid 24, ENTERO-Screen, NEFERMtest 24, STAPHYtest 16, STREPTOtest 16, En-COCCUS test were used in identification of 871 strains of microorganisms isolated from clinical material. The kits proved to be highly reliable: they identified 88.8-97.5% cultures and permitted rapid (within 4 h) identification of enterobacteria most often occurring in clinical practice. The advantages of these kits are stripped plates allowing identification of cultures in individual stripes, a wide spectrum of biochemical tests, modern composition of biosubstrates in suspension media, and rational disposition of the tests, allowing technologically simpler identification of a wider spectrum of cultures in one stage without difficult accessory tests. Comparison of the above kits with kits manufactured by bioMérieux (France) showed a 84.6-100% correlation of the results.

Clinical anatomy of the retrocalcaneal bursa.

The goal of the study was to perform a detailed anatomical description of the retrocalcaneal bursa (RB). Its morphological arrangement was studied on 10 fresh and 30 embalmed lower extremities by microdissection and light microscopy. The RB was present constantly and in all the cases contained 1-2 cm long synovial fold, beginning on the upper wall of RB and distally interposed between the anterior surface of the Achilles tendon and the posterior surface of the calcaneal tuberosity. The volume of RB was 1-1.5 ml. The histological analysis confirmed that the inner surface of the superior and posterior wall of RB have been covered by unilayered synovial membrane, projecting into synovial villi of different shapes and sizes. In the ceiling of RB, delicate fascicle of skeletal muscle fibers was discovered, radiating distally into the regularly present synovial fold. The whole bottom of RB has been covered by 200-500 microm layer of fibrous cartilage into which the calcaneal tendon attached. The cartilagineous layer continued anteroproximally to cover the whole bursal surface of the calcaneal tuberosity, where the thickness of the cortical bone was reduced on mere 50 microm. The obtained results can be used in the improvement of the differential diagnostics and therapy of diagnostics and therapy of the retrocalcaneal bursitis as well as of other kinds of achillar enthesopathies and heel pain.