Pore size distribution and supercritical hydrogen adsorption in activated carbon fibers.

Pore size distributions (PSD) and supercritical H2 isotherms have been measured for two activated carbon fiber (ACF) samples. The surface area and the PSD both depend on the degree of activation to which the ACF has been exposed. The low-surface-area ACF has a narrow PSD centered at 0.5 nm, while the high-surface-area ACF has a broad distribution of pore widths between 0.5 and 2 nm. The H2 adsorption enthalpy in the zero-coverage limit depends on the relative abundance of the smallest pores relative to the larger pores. Measurements of the H2 isosteric adsorption enthalpy indicate the presence of energy heterogeneity in both ACF samples. Additional measurements on a microporous, coconut-derived activated carbon are presented for reference.

Local bonding and atomic environments in Ni-catalyzed complex hydrides.

The local bonding and atomic environments in the Ni-catalyzed destabilized system LiBH4/MgH2 and the quaternary borohydride-amide phase Li3BN2H8, were studied by x-ray absorption spectroscopy. In both cases the Ni catalyst was introduced as NiCl2 and a qualitative comparison of the Ni K-edge near-edge structure suggests the Ni2+ is reduced to primarily Ni0 after ball milling. The extended fine structure of the Ni K edge indicates that the Ni is coordinated by approximately 3 boron atoms with an interatomic distance of approximately 2.1 A and approximately 11 Ni atoms in a split shell at around 2.5 and 2.8 A. These results, and the lack of long-range order, suggest that the Ni is present as a disordered nanocluster with a local structure similar to that of Ni3B. In the fully hydrogenated phase of LiBH4/MgH2 a small amount Mg2NiHx was also present. Surface calculations performed using density functional theory suggest that the lowest kinetic barrier for H2 chemisorption occurs on the Ni3B(100) surface.

[Parenteral nutrition before surgery in patients with upper gastrointestinal tract resection]. / Parenterálna nutrícia pred resekcným výkonom na hornom gastrointestinálnom trakte.

BACKGROUND: The aim of this retrospective analysis was the evaluation of the effect of parenteral nutrition before surgery in malnourished patients on the reduction of risks during postoperative period after upper gastrointestinal tract resection. 57 patients with the diagnosis of oesophageal or stomach carcinoma were included into the selected group. Patients were divided into three groups: I. group: resecabile tumor, parenteral nutrition, malnutrition, II. group: nonresecabile tumor, parenteral nutrition, malnutrition, III. group: resecabile tumor, without parenteral nutrition, well nourished. METHODS AND RESULTS: In the group of malnourished patients, seven days after the applied parental nutrition, a statistical significant difference in the elevated values of proteins (I.: 62 +/- 3.8 --> 70 +/- 1.75, II.: 59.7 +/- 3.2 --> 69.2 +/- 1.2) and albumin (I: 32.6 +/- 1.95 --> 38.0 +/- 1.09, II.: 31.1 +/- 1.2 --> 37.5 +/- 0.9) p < 0.001 were achieved. Complications associated with the insertion of central venous catheter decreased as follows: plugged catheter (17.6%), local erythema (7.5%), pneumothorax (5%), phlebotrombosis (5%), haemothorax (0.4%). Postoperative complications did not achieve statistical significance (p < 0.05) in the groups I.-III. The highest incidence of wound and anastomosis dehiscention and sepsis was noticed in the first group, the lowest in the third group. Brochopneumonia had the highest occurrence in the second group, the lowest in the third group. CONCLUSIONS: Preoperative parenteral nutrition as a prevention of complications after resection surgery on stomach and oesophagus is beneficial in the middle and high grade of malnourished patients, despite of higher costs and prolonged hospitalization, considering the comparable percentage of postoperative complications in the group of non-malnourished and malnourished patients. The nutritional supplementation should take at least seven days.

[Appendicitis in pregnancy]. / Apendicitída v gravidite.

UNLABELLED: THE AIM OF THE STUDY was to highlight the problems related to acute appendicitis in pregnancy. We present our own experiences with the diagnostics and therapy of this surgical complication during gravidity. Nausea, vomiting and pain in lower right abdomen as symptoms of appendicitis are often confused with the I. trimester gravidity symptoms. The change of pain locality and the loss of somatic pain in the II. and the III. trimester cause diagnostic delay and increase the incidence of appendiceal perforation. In case of suspected appendicitis, when evaluating laboratory parameters, the common finding of leucocytosis during gravidity further complicates the differential diagnosis. In comparison to common population, ultrasonography in gravidity displays lower sensitivity and specificity. MATERIAL AND RESULTS: In the course of the last ten years, 9 gravid women in the age (25.6 +/- 3.9) underwent appendectomy in the 2nd surgical clinic FNLP in Kosice. This represents 0.6 percentage incidence of appendicitis of 1496 patients operated because of this diagnosis. One of the patient turned out to be a case of negative appendectomy while the rest had histologically confirmed gangrenous (5x), phlegmonous (1x) and catarrhalis appendicitis (2x). Perforation was encountered in one patient. In the physical examination dominated pain in the right hypogastrium, nausea and subfebrility. The diagnostic success of USG examination reached 40%. In all gravid patients leucocytosis was found, including a negative appendectomy. The average duration from hospitalization to operation was 38 hours. No maternal or fetal loss was noted. CONCLUSIONS: Correct diagnostic and early surgical intervention prevents further fetal and maternal morbidity and mortality. Physical examination is important in differential diagnosis. Leucocytosis is not a predictive marker of appendicitis. Visualization of appendix through ultrasonography is rather difficult in the third trimester.

[Spontaneous rupture of ductus choledochus in acute pancreatitis--a case report]. / Spontánna perforácia ductus choledochus pri akútnej pankreatitíde--kazuistika.

Spontaneous perforation of biliary tree is a rare disease. There are only a few case- reports published in the literature. Due to little success in the preoperative diagnosis, surgical treatment is delayed, which in a high percentage results into fatal complications. Surgeons' opinions of operative treatment in such cases are controversial, but the primary choice is decompressing drainage of biliary tree. Authors of this report present a case of 71 years old woman admitted to the second surgical clinic with the diagnosis of acute pancreatitis. Because of developing signs of peritoneal irritation, the patient was referred for a surgical procedure with the finding of biliary peritonitis and the rupture of ductus choledochus. In the above case, the diagnosis was made peroperatively, where the surgical treatment consisted of drainage of ductus choledochus by Kehr T drain and cholecystestomy by inserting Malecoat catheter into gallbladder. Postoperative period was without complications, the T drain was removed on the 28th day after operation and Malecoat catheter was also removed two days later. Three years after the operation, the patient is in good physical condition with free bile passage according to ERCP. The aim of this report is to bring the attention to this rare, but more importantly serious cause of origin of sudden abdominal event, in order to increase the interception rate concerning preoperative periods and consequent satisfactory treatment.

[Biliary ileus--a rare complication of cholecystolithiasis]. / Biliárny ileus--zriedkavá komplikácia cholecystolitiázy.

The diagnosis of ileus caused by biliary stones occurs very rarely, with the range of 2 % worldwide. This complication of cholecystolithiasis caused by the stone fistulation into gastrointestinal tract and its subsequent obstruction occurs mostly in elderly and has a high mortality rate. During the course of ten years (1996-2006) in the 2nd surgical clinic FNLP in Kosice, 1640 cholecystectomies and 255 operations, due to the obstruction ileus, were performed. Biliary ileus was recorded in four cases. In two cases, the reason being an obstruction caused by a travelled stone into jejunum, one event was caused by a mechanic wedge of a stone in duodenum and in the last event rectosigma was obturated. The diagnostic is relatively difficult because of a nonspecific symptomatology and often negative anamnesis of previous problems with gallstones. According to literature, the most reliable diagnostic method is computer tomography (CT). In our case, abdominal ultrasonography was successful, which pointed out this diagnosis. Gastroscopy localized the place of obstruction, but not its cause and X-ray image showed aerobilia two times. By the use of magnetic resonance cholangiopancreatography (MRCP) the diagnosis was not positively confirmed. Only in one out of four cases, there was a suspicion of the diagnosis of the biliary ileus, which makes its detectability 25%. The aim of this retrospective analysis is the comparison of diagnostic method-options and their range of success in the diagnosis of acute abdomen in our clinic and the entries in the world literature.

[Postintubation stenosis of the trachea--case reviews]. / Postintubacná stenóza trachey--nase skúsenosti.

Stenoses of the respiratory tract are life threatening conditions of various origins. The authors give referrence on 21 patients operated for postintubation stenoses of their trachea at the IInd Surgical Clinic of the UPJS Medical Faculty, the Faculty Hospital of L. Pasteur in Kosice, from 01. 01. 1999 to 30. 06. 2005. All patients had a tracheobronchoscopic examination and a CT examination completed prior to the procedure. Within 24 hours of their admission, 9 patients were operated, 7 underwent resection procedures and 2 patients had Montgomery's T-cannula introduced. 12 patients had their procedures planned, and were operated later than 24 hours after their admission. 10 patients underwent resections of the trachea, 2 had Montgomery's T-cannula implanted. The postoperative course following the resection of the trachea was without complications in 14 patients, 1 patient experienced transitional oedema in the anastomosis and 2 patients suffered restenoses. In this patient group, no fatal case was recorded. The authors stress up multidisciplinary approach in the diagnostics and treatment of the postintubation stenoses of trachea. In cases of postintubation stenoses of trachea, resection of the trachea with primary anastomosis represents the most advantageous treatment approach for the patient.

[Surgery in patients with organ transplants]. / Operácie chorých s transplantovanými orgánmi.

Patients after successful transplantation with immunosuppressive therapy form a "new circle of surgical patients" who can develop various surgical diseases, or injuries which bring about an inevitable urgent or planned surgical treatment. The authors present the results in three patients with transplanted organs (1993-1995) who were subdued to various surgical treatments. The first patient underwent a classical cholecystectomy, choledochotomy, and extraction of concrement from the choledochus after orthotopic transplantation of the heart. The second patient underwent transplantation of the kidneys precedingly to bilateral subtotal resection of both lobes of the thyroid gland due to marked bilateral nodal goitre intervening deeply retrosternally with a severe pressure syndrome on trachea and oesophagus. The immediate and long-term results were excellent. Orthotopic transplantation of the heart in the third patient preceded to intercostal drainage of the thorax and evacuation of pus due to an extensive empyema of the thorax and septic state, and later thoracotomy and decortication with extirpation of the substantial part of the empyema sack was performed with an excellent immediate and long-term effect. The authors present the principles which must be inevitably fulfilled in coincidence with successive surgical treatment in patients with transplanted organs in a permanent immunocomplex regime. (Fig 2, Ref. 11.)

Benign glomus tumor of the superior posterior mediastinum.

An unusual location of a benign glomus tumour, outside of the constantly located regions, e.g. in the subungual location or deeply sited in extremities, was diagnosed in a 56-year-old white female in her posterior upper mediastinum. The single similar case report was published before the era of electron microscopy and immunohistochemistry and single cases of atypical and malignant forms in this unusual location were published only recently. The tumour measuring 5 x 4 x 2 centimeters has caused cough and was associated with occasional righ-sided chest pain. Its rich vascular supply has caused intensive intraoperative bleeding. The postoperative course was uneventful and the patient is free of neoplastic disease or symptoms six years after surgery. Numerous mast cells present within the tumour's interstices must be considered in relation to the possible pathogenesis of the up to now unexplained pain in glomus tumours.

[Patients after thyroid gland surgery from the aspect of the endocrinologist]. / Chorí po operácii stítnej zl'azy z hl'adiska endokrinológa.

The authors examined 85 patients after a mean interval of 2.5 years following thyroidectomy. They focused attention on evaluation of the functional state using as criteria the TSH and TRH test. Simultaneously they examined by ultrasonography the volume of the remainder of the thyroid gland. In 8 patients operated on account of carcinoma the average volume of the thyroid gland was 1.3 ml. Five patients were hypothyroid despite permanent substitution. Of 77 patients operated on account of benign goitre evident hypothyroidism was found in 29 (37.7%) and latent hypothyroidism in 14 (18.2%). The volume of the remainder of the thyroid gland in these patients was on average smaller than 4 ml, while in patients who were euthyroid after thyroidectomy the mean volume of the remaining thyroid was more than 4.5 ml.

[The clinical picture of latent hypothyroidism in women]. / Klinický obraz pri latentnej hypotyreóze u zien.

The authors investigated the most frequent clinical symptoms in a group of 132 women with latent hypothyroidism (mean age 40.2 years, incl. 102 women younger than 45 years). They assessed the diagnosis on the basis of an excessive TSH response after administration of 0.2 mg thyreoliberin by the i.v. route (TRH test), while the thyroxine values were normal (TSH 0 min.: 4.93 +/- 3.55, TSH after 20 min. following TRH: 39.27 +/- 18.28 mIU/ml, T4: 102.0 +/- 25.02 nmol/l). Forty-one patients (31%) had goitrectomy in the case-history. USG examination of 70 patients revealed goitre in 13 (18.6%) reduced echogenity of the thyroid gland in 20 (28.6%) and microcysts in 31 (44.2%) of the patients. Analysis of the clinical symptoms revealed manifestations of a depressive symptomatology in 56 patients (40.3%), benign mammary dysplasia in 39 patients (29%). In the subgroup of women younger than 45 years an impaired menstrual cycle was recorded in 49 (48%) and galactorrhoea in 10 patients (9.8%). After thyroid substitution (L-thyroxine 50 micrograms/day) they observed in the majority normalization of the menstrual cycle and partial improvement of depressive manifestations.

[Experience with permanent cardiac pacemakers in the East Slovakian Region 1978-1987]. / Skúsenosti s trvalou kardiostimuláciou vo Východoslovenskom kraji v rokoch 1978 az 1987.

The authors present a group of patients where in the course of the 10-year period of 1978-1987 a permanent pacemaker was implanted. 587 primary implantations were made and 327 exchanges of cardiac pacemakers. The mean age in the group of primary implantations was 70.4 +/- 10.3 years, in the group of exchanges 70.4 +/- 10.6 years. n 98.8% pacemakers VVI and VOO made in Czechoslovakia were implanted. Indications for primary implantation were in 64% atrioventricular block (AV) grade III, in 11% AV block grade II, in 22% disease of the sinoatrial node and in 4% other dysrhytmias. The age category above 60 years accounts for 85.5% in the group of primary implantations. A positive feature is the low incidence of complications of surgical and technical nature. An unfavourable feature is that almost all implanted devices were the simplest single electrode systems where the frequency cannot be adapted and where other parameters cannot be changed.

[Personal experience with the treatment of pericardial effusion using pericardial fenestration]. / Nase skúsenosti s liecbou perikardiálnych výpotkov fenestráciou perikardu.

The author discusses experience with treatment of pericardial exudates of different aetiology in 11 patients aged 5-54 years. In seven patients they performed fenestration and external drainage of the pericardial cavity from a subxyphoid approach and in four by a pleurocardial window from left-sided thoracotomy. They did not record any per or postoperative complications or deaths. The best surgical approach, in particular in patients with a pericardial exudate and a poor general condition is pericardial fenestration with external drainage from a subxyphoid approach.

[Cervical pulmonary hernia]. / Cervikálna pl'úcna hernia.

Pulmonary hernia is in general a rare affection--in particular in the cervical region. Symptoms are as a rule slight and are encountered only in exceptional cases. The diagnosis is based on physical examination and imaging techniques. The authors submit a case-history of a cervical pulmonary hernia in a young woman. It was noteworthy because of marked complaints of the patient which involved professional damage. Therefore it had to be treated by surgery which was successful.

[Complaints of patients or their relatives regarding surgical complications]. / Staznosti chorého alebo jeho príbuzných v spojitosti s komplikáciami v chirurgii.

The authors analyse complaints of patients or their relatives in connection with surgical complications in 1987 to 1997 and illustrate them by short case-records. During this period, they evaluated 52 complaints and among them 27 fatal. Most complaints were from abdominal surgery. Finally, they emphasize the importance of high surgical professionality, early discovery of a complications, early, sufficient and suitable informing of the patient and his relatives, by the head of the department and in severe or fatal complications the management of the hospital. They emphasize also the requirement of precise and exhaustive records and autopsy.

[Pneumaturia as a sequela of asymptomatic diverticulitis]. / Pneumatúria ako dôsledok asymptomatickej divertikulitídy.

Pneumaturia is sometimes the first symptom of colovesical fistula. Colovesical fistula presents a difficult problem with complicated diagnosis and therapy. Most common are fistulas between the colon (sigmoid) and bladder, which results from sigmoiditis and diverticulitis. The paper reports the case of a 61-year-old man with diagnosis of diverticulitis and symptom of pneumaturia in duration of 3 months. The operation was successfully performed in cooperation with a surgeon and an urologist.

[Vascular care in devastating injuries of the extremities]. / Osetrenie ciev pri devastacných poraneniach koncatín.

The authors present an account on the treatment of blood vessels in 15 patients with serious devastating injuries of the extremities in 1982-1989. In 10 patients the injury was on the upper and in 5 on the lower extremity. In the majority of patients for reconstruction of arteries and veins venous grafts were used. In 8 patients, i.e. in 53.3%, the result was good, in 2, i.e. 13.3%, it was satisfactory and in 5, i.e. 33.3% patients, a secondary amputation had to be performed. The authors describe the surgical procedure and emphasize the necessity of team work of the vascular surgeon, traumatic surgeon and possibly plastic surgeon in the treatment of devastating injuries of the extremities. The authors draw attention to the importance of compartment and reperfusion syndrome which may complicate these injuries, as well as to the role of free oxygen radicals and the necessity to influence their noxious effect during treatment of these injuries during the per- and postoperative period.

[Sudden acute vascular diseases requiring surgery--still a reality]. / Náhle príhody angiochirurgické (NPA)--téma stále aktuálna.

In the introduction the authors emphasize that despite the fact that acute angiosurgical attacks have a fairly typical symptomatology with a characteristic clinical finding, physicians who participate in their diagnosis and treatment are not aware of it. In the clinical explanation and the material the authors mention the causes of acute angiosurgical attacks and the fact that after acute ischaemia reperfusion occurs. In a summary table they demonstrate the dynamics of the development and increase of acute angiosurgical attacks in 1985 and 1995 in the Slovak Republic, based on statistical data of the Institute of Health Information and Statistics. In the discussion it is emphasized that in the therapeutic results of acute angiosurgical attacks an important part is played by early restoration of the circulation, at least within 6 hours, but preferably within 3 hours after the onset of clinical symptoms. In conjunction with ischaemia and reperfusion attention is drawn to the fact that during early reperfusion in the tissue or organ oxygen radicals are formed which participate in a significant way in reperfusion damage. On account of the complexity of ischaemia and reperfusion in acute angiosurgical attacks it is useful to use the clinical term "acute ischaemic reperfusion syndrome". The authors mention possibilities how this syndrome can be favourably influenced by suitable angiosurgical procedures and pharmacological preparations. In the conclusion the authors emphasize the rising trend of acute angiosurgic attacks, whereby the therapeutic results are not always satisfactory.

[Incarcerated scrotal hernia containing a sigmoid colon carcinoma]. / Inkarcerovaná skrotálna prietrz s obsahom karcinómu colon sigmoideum.

The authors describe the case-history of a 65-year-old patient with an incarcerated scrotal hernia on the left side. An unexpected finding in the sac of the scrotal hernia was the sigmoid colon with an obturating tumour. The patient was subjected to two-stage surgery with a favourable final effect.

[Mesenteric venous thrombosis probably due to hereditary thrombophilia in an 18-year-old boy]. / Venózna mezenterická trombóza na podklade pravdepodobnej vrodenej trombofílie u 18 rocného chlapca.

The authors describe the case-history of an 18-year-old patient with an extensive venous mesenteric thrombosis. The case proved fatal despite repeated surgery as a result of relapsing gangrene of the small intestine with diffuse stercoral peritonitis. Thrombosis of the mesenteric veins is a rare disease and accounts only for 4 to 10% of all acute intestinal episodes. The cause of the disease is either idiopathic but more frequently it is associated with various types of coagulopathy. In this context the authors discuss etiological factors, symptoms, diagnosis as well as possible treatment of acute mesenteric venous thrombosis.