Appendicolith as a cause of late complications after appendectomy - a case report and literature review.

INTRODUCTION: Acute appendicitis is one of the most common acute abdominal conditions. One of its complications is postoperative formation of abscesses in the peritoneal cavity or in the retroperitoneal space. Among other things, appendicoliths left in the peritoneal cavity are responsible for this process. Their release from the lumen occurs preoperatively and during the operation. An appendicolith, with the bacteria present on its surface, provides an environment that supports the onset of an infection. CASE REPORT: The authors present a less common case of a retroperitoneal abscess caused by an incarcerated appendicolith. Unusual is the long period between appendectomy and clinical manifestations of the abscess. The patient underwent surgical treatment with abscess evacuation and extraction of the appendicolith. The postoperative course was adequate; wound healing was supported by negative wound pressure therapy. CONCLUSION: During appendectomy, it is necessary to keep in mind the risk of releasing appendicoliths and their role in infectious complications. A conscientious revision of the peritoneal cavity is required, as well as a good surgical technique. If necessary, imaging methods can help to locate the appendicolith in the postoperative period.

Surgical treatment of hepatocellular carcinoma.

The incidence of hepatocellular carcinoma (HCC) in Europe and throughout the world is currently increasing. This is caused by an increase in the number of patients with alcoholic liver damage, metabolic syndrome, and by increasing incidence of hepatitis B and C.From January 1, 2004 to December 31, 2013, resection or radiofrequency ablation of the liver was done in 360 patients with benign lesions or malignant tumors of the liver. In 28 patients HCC was diagnosed and histologically confirmed (7.8 %). Seven patients had HCC associated with liver cirrhosis (25 %), and 21 patients were without histologically confirmed cirrhosis (75 %). R0 resection was done in 18 (64 %) patients.Surgical complications occurred in 6 (21 %) patients and reoperation due to tumor relapse or progression was done eight times in 6 (21 %) patients. One-year and five-year patients' survivals were 64 % and 10 %, repectively, and did not statistically differ from the survival of the whole set of patients with tumor diseases in the given time period. In the future it will be possible to improve the long-term survival of patients with HCC by using screening methods for presymptomatic diagnosis of HCC, precise preoperative diagnosis and efforts for R0 resection (Tab. 1, Fig. 4, Ref. 11).

SiOC glasses produced from silsesquioxanes by the aerosol-assisted vapor synthesis method.

In this paper, we describe a new method based on aerosol-assisted vapor synthesis for making glass materials by pyrolysis of readily available silsesquioxanes CH3Si(OCH3)3 and CH3Si(OC2H5)3. Combined powder X-ray diffraction (XRD) and spectroscopic studies in the far infrared region (FIR) showed that under applied conditions the method yielded amorphous materials. Subsequent structural studies with the application of the (29)Si and (13)C MAS NMR, Raman, and middle infrared (MIR) techniques led to the conclusion that the pyrolysis of the silsesquioxane precursors resulted in glass materials with a structure of amorphous silica v-SiO2. In the case of certain glasses prepared from CH3Si(OCH3)3, they were also shown to possess in the structure some Si-C bonds (black glasses), whereas those originated from CH3Si(OC2H5)3 were composites that in addition to the silica glass phase contained domains of free/unbound carbon.

Treatment results of non-varicose bleeding from upper gastrointestinal tract.

UNLABELLED: Treatment results of non-varicose bleeding from upper gastrointestinal tract are changing by improved endoscopic methods and introduction of new drugs in treatment. OBJECTIVE: Objective of this work was to compare the results in treatment of patients with non-varicose bleeding from upper gastrointestinal tract in two different 5-years periods. MATERIAL: We hospitalised 229 patients with non-varicose bleeding from upper gastrointestinal tract at the Department of Surgery in Faculty Hospital of Martin in the period 1992-1996. (161 men and 68 women, average age 56.7, patients up to 60 were 42.4%). 203 patients were hospitalised in the years 2003-2008 (146 men and 57 women, average age 61.5, patients up to 60 were 54%). METHODS: We compared both groups by retrospective analysis and we evaluated differences by using statistical methods (nonparametric test of independence of the qualitative data). RESULTS: There was only minimal difference in primary conservative and endoscopic haemostasis in both groups. Relaps of bleeding was the same in both groups. Definitive conservative and endoscopic haemostasis was higher by 3.2% in the period 2003-2008 and number of urgent operations decreased by 5.1%. Differences in total mortality were minimal between both groups but postoperative mortality was higher by 5.9% in the years 2003-2008. CONCLUSION: Number of urgent operations decreased due to improved results in definitive conservative and endoscopic haemostasis in the treatment of non-varicose bleeding from upper gastroinestinal tract. There was no significant change in the relaps of bleeding. There were only minimal changes in total mortality between both groups, but postoperative mortality increased in the second period (Tab. 8, Ref. 35).

[Neuroendocrine tumours of the upper gastrointestinal tract, characteristics and comparison of localization diagnostics]. / Neuroendokrinné nádory horného tráviaceho traktu, charakteristika a porovnanie efektivity lokalizacnej diagnostiky.

In daily clinical practice it's important to think of neuroendocrine tumors, since their prevalence for the past 5 years exceeded even the common occurrences of stomach, esophageal and pancreatic cancers. Patients diagnosed early and accurately with NET, have a greater chance for complete cure. The diagnostic tools over the past century were significantly inefficient in diagnosing NET i.e. (40% of tumors were not localized after USG, CT, MRI, AG investigations). Until the past 2 decades that major turnover in diagnostic methods has been achieved. In particular, the introduction of the somatostatine receptor scintigrafy (SRS) and endoscopic ultrasonography (EUS) have increased sensitivity of localization diagnostics up to 90%. Our work is to test the success of the localization diagnostics in 22 patients with surgically and histologically confirmed NET ofthe pancreas and duodenum. These patients fulfilled jointly SRS, CT and/or MRI, but also classic USG and EUS. From our comparison, clearly endoscopic USG is the most efficient tool with 90% sensitivity.

[Intrathoracic goitre--undiagnosed--nevertheless operated]. / Intratorakální struma--nediagnostikovaná--prece odoperovaná.

A case review of a female patient, who was indicated for surgery for a goitre with minor bilateral retrosternal spread. The procedure included bilateral thyroidectomy during which the surgeon noticed unusual intrathoracic pathology in the left hemithorax, under the removed lobe. Postoperative chest x-ray and CT examinations revealed intrathoracic goitre, which was then removed during a following procedure. In the article, the authors discuss this uncommon pathology. Because of its uncommon location, the pathology was not detected on standard preoperative endocrinological examination. It was the follow up, postoperative examination, based on which the correct treatment was initiated.

Consideration of endoscopic retrograde cholangiopancreatography in cases of acute biliary pancreatitis.

AIM: The important question to be answered in all cases of ABP is whether or not a calculous biliary obstruction is still present. Answering this question conditions subsequent management, including the need for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the relationship between persistent common bile duct stone (CBDS) and laboratory values, and dilation of bile duct in order to find possible significant associations in patients with acute biliary pancreatitis (ABP). METHODS: Retrospectively, statistical evaluation of a group of 76 patients with ABP who had received early ERCP. RESULTS: The prevalence of choledocholithiasis in patients > 70 years old was 54.2%, in patients < or = 70 years old it was 36.5%. Following cholecystectomy, CBDS was present in 81.8% of patients, p = 0.005. The probability of CBDS occurrence in patients > 70 years old with bile duct dilation was 81.3%; in the absence of bile duct dilation CBDS was not present, p < 0.001. The probability of CBDS occurrence in patients 70 years old with bile duct dilation was 57.7%, in the absence of bile duct dilation CBDS was present in 15.4%, p = 0.002. In patients with bile duct dilation predictive factors are as follows: bilirubin (Bi), after excluding patients with acute cholecystitis and cholangitis, p = 0.05; alanine aminotransferase (ALT) in patients 70 years old, p = 0.004; gamma-glutamyl transferase (GMT) in patients > 70 years old, p = 0.02. CONCLUSIONS: ERCP is indicated in patients with ABP if biliary obstruction is present and the presence of a ductal stone is suspected. From our results it is clear that the predictive parameter for choledocholithiasis is the dilation of the bile duct and previous cholecystectomy. In patients with bile duct dilation possible predictive factors are Bi, ALT, and GMT (Tab. 1, Fig. 8, Ref. 20).

Itinerant spin excitations near the hidden order transition in URu(2)Si(2).

By means of neutron scattering we show that the high temperature precursor to the hidden order state of the heavy fermion superconductor URu(2)Si(2) exhibits heavily damped incommensurate paramagnons whose strong energy dispersion is very similar to that of the long-lived longitudinal f spin excitations that appear below T(0). This suggests that there is a strongly hybridized character to the itinerant excitations observed previously above the hidden order transition. Here we present evidence that the itinerant excitations, like those in chromium, are due to Fermi surface nesting of hole and electron pockets; hence the hidden order phase probably originates from a Fermi surface instability. We identify wavevectors that span nested regions of a f-d hybridized band calculation and that match the neutron spin crossover from incommensurate to commensurate on approach to the hidden order phase.

Dynamic spin ice: Pr2Sn2O7.

In this Letter, we report a new spin ice--Pr2Sn2O7--which appears to have enhanced residual entropy due to the dynamic nature of the spins. Neutron scattering experiments show that at 200 mK, there is a significant amount of magnetic diffuse scattering which can be fit to the dipolar spin-ice model. However, these short-ranged ordered spins have a quasielastic response that is atypical of the canonical spin ices, and suggests that the ground state is dynamic (i.e., composed of locally ordered two-in-two-out spin configurations that can tunnel between energetically equivalent orientations). We report this as an example of a dynamic spin ice down to 200 mK.

[Cystic feochromocytoma, mimicing a liver cyst. A case review]. / Cystický feochromocytóm, imitujúci cystu pecene.

Cystic feochromocytoma is a special subtype of supraadrenal tumors, with a specific clinical course, symptomatology, CT and MRI pictures and histological findings. The above factors frequently contribute to a wrong diagnosis and increased risk during its surgery. The authors present a case review of a patient with a cystic tumor of the right liver lobe. Its laparoscopic fenestration attempt resulted in hypertonic crisis with cardial decompensation and lung edema. Furthermore, attempts to embolize the tumor resulted in another hypertonic crisis, despite of the preoperative care as appropriate in feochromocytoma procedures. Only complete surgical removal of the tumor relieved the patient of the clinical symptoms. The authors discuss diagnostic and therapeutical problems of this specific and rare feochromocytoma subtype and suggest radical surgical management following a standard preoperative care as appropriate in all feochromocytoma procedures.

DUHOCAMIS: a dual hollow cathode ion source for metal ion beams.

In this paper we describe a novel ion source named DUHOCAMIS for multiply charged metal ion beams. This ion source is derived from the hot cathode Penning ion gauge ion source (JINR, Dubna, 1957). A notable characteristic is the modified Penning geometry in the form of a hollow sputter electrode, coaxially positioned in a compact bottle-magnetic field along the central magnetic line of force. The interaction of the discharge geometry with the inhomogeneous but symmetrical magnetic field enables this device to be operated as hollow cathode discharge and Penning discharge as well. The main features of the ion source are the very high metal ion efficiency (up to 25%), good operational reproducibility, flexible and efficient operations for low charged as well as highly charged ions, compact setup, and easy maintenance. For light ions, e.g., up to titanium, well-collimated beams in the range of several tens of milliamperes of pulsed ion current (1 ms, 10/s) have been reliably performed in long time runs.

An alternative approach to carbon nanotube sample preparation for TEM investigation.

A two-stage replication technique (positive replica) is shown to be suitable for transmission electron microscopy (TEM) examination of carbon nanotubes (CNTs) and other one-dimensional nanostructures in their longitudinal direction. This method enables handling the fragile nanostructures, is fast and simple and allows to study the growth mechanism of nanofeatures, including the early stages of their growth. CNTs may also be examined when the growth layers are very thin, and even when only a few nanotubes are on a substrate. Replicas can be taken from various substrate shapes covered with nanostructures and from minute or specifically selected areas of the substrates. CNTs extracted by the replica are not disturbed, and their nanostructures are preserved. It is demonstrated that using positive replicas, HRTEM images from the nanosized carbon forms can also be obtained.

Partial field-induced magnetic order in the spin-liquid kagomé Nd3Ga5SiO14.

The distorted kagomé system Nd3Ga5SiO14 has been investigated with neutron scattering down to 0.046 K with no evidence of magnetic long range order of the Nd3+ moments in a zero field. Substantial diffuse scattering is observed which is in agreement with nearest-neighbor correlations between the fluctuating spins. Upon the application of a field in the c direction, the diffuse scattering is reduced in intensity while the magnetic Bragg peaks grow in intensity to saturate by 1 T to 1/2 of the expected magnetization. These measurements suggest that a unique spin-liquid state develops in Nd3Ga5SiO14 with a frustration index of f approximately |theta|/T_{C}> or =1300.

Nelson's syndrome -- 46 years later: clinical experience with 37 patients.

OBJECTIVE: Pituitary tumours occurring after bilateral adrenalectomy for Cushing's disease (Nelson's syndrome) are frequently aggressive, so an early diagnosis and careful management are of prime importance. For a new insight into this entity it is necessary to analyse the factors predisposing to its development and the course of the disease, as well as the methods of diagnosis and modalities of treatment. PATIENTS AND METHODS: Thirty-seven patients with Nelson's syndrome were observed, 32 women and 5 men, aged 16 to 61 years at the time of pituitary tumour detection (at present, 27 to 82 years old). The diagnostic methods included clinical observation, imaging examinations (X-ray studies, CT, MRI), hormonal evaluation (especially ACTH and cortisol levels during replacement therapy) and ophthalmologic investigations. Neurosurgery was the main method of treatment. RESULTS: The clinical analysis indicated that young age at the time of adrenalectomy, pregnancy, insufficient replacement therapy and fulminant course of Cushing's disease were the main factors predisposing to Nelson's syndrome. MRI appeared to be the most valuable imaging method, as this detected Nelson's tumours in the microadenoma stage in 7 patients. Plasma ACTH levels varied between 32.6 pmol/l in an early phase to 2 000 pmol/l in the full-blown syndrome. Absolute temporal scotomas found in ophthalmologic examinations were an early abnormality. The best results after therapy were obtained in patients treated by neurosurgery using a transsphenoidal approach in an early stage. CONCLUSIONS: MRI, ophthalmologic examination and plasma ACTH determination were the most valuable investigations for early diagnosis of Nelson's syndrome. Early neurosurgery offered the best outcome in our group of patients.

The significance of clinical markers in the prediction of hemodynamic and cardiac complications of capnoperitoneum in patients at risk.

OBJECTIVES: The aim of this prospective study was to find out the predictive value of concomitant diseases of cardiovascular system (CVS), lungs and kidneys as well as metabolic diseases to be able to anticipate the potential origin of hemodynamic and cardiopulmonary complications as a result of insufflated CO2 peritoneum. METHODS: The study investigated eleven patients at the anaesthetic risk of ASA III-IV and cardiac risk of NYHA II-III in whom elective laparoscopic surgical intervention had been indicated. RESULTS: We have found out that the significance of the increase in biologic ANP markers, catecholamines and PRA was not sufficient to signal the deepening of cardiac dysfunction, latent cardiac failure or hemodynamic disorder (p > 0.01). The courses of regression lines have shown the dependence on the increased IAP (intra-abdominal pressure) of capnoperitoneum in PRA and adrenaline. The reactions of biologic markers correlated with reactions of clinical hemodynamic markers of BP and HR. We have proved that the increased level of IAP causes a significant increase in CVP (p < 0.01) being one of the factors determining the preload of right ventricle (RV) and in coincidence with intact transpulmonary circulation also the optimal function of left ventricle (LV). CONCLUSION: Our investigation of peroperative clinical and biologic markers of hemodynamics and neuroendocrine response to operative stress and development of CO2 peritoneum has proved that the course of laparoscopic operations in patients in the risk group of ASA III-IV and NYHA III does not necessarily have to be deteriorated by complications. It can be assumed that increased values of biologic markers regulate the neurohumoral response in the physiologic range and do not predict a severe CVS dysfunction within its course. (Tab. 2, Fig. 3, Ref. 22.)

Effect of steroids and nitric oxide on pituitary hormone release in ovariectomized, peripubertal rats.

The purpose of this study was to determine the effects of the duration of steroid depletion on the steroid-induced luteinizing hormone and prolactin surges in ovariectomized, peripubertal female rats. Additionally, the role of nitric oxide (NO) in mediating the surge responses was determined. Peripubertal, 6-week-old, female Sprague-Dawley rats were ovariectomized. One or three weeks later, animals were injected with 17 beta-estradiol (50 microg, sc) followed 48 h later by progesterone (2.5 mg, sc). Effects of NO were examined by administering L-arginine (300 mg/kg, ip). The response of ovariectomized, adult females to steroid treatment was also determined. One and three weeks after ovariectomy, steroid replacement produced an LH and prolactin surge in peripubertal animals. However, both the magnitude and duration of the LH surge was greater 3 weeks after ovariectomy. While L-arginine significantly enhanced the magnitude of the LH surge 1 week after ovariectomy, by 3 weeks L-arginine caused a decrease in the duration, but not the magnitude of the surge. In contrast, L-arginine did not affect either the magnitude or duration of the prolactin surge one week after ovariectomy, but diminished the magnitude after 3 weeks of steroid depletion. In adults, steroids induced significant increases in both LH and prolactin. These results demonstrate that sensitivity to NO stimulation of LH, but not prolactin secretion, is modulated by the duration of gonadal steroid hormone depletion. The differences in the responsiveness of LH and prolactin to steroid-induced stimulation in peripubertal animals demonstrate that these hormones are regulated by NO through different mechanisms.

Effects of cyclic steroid hormone replacement on prolactin and luteinizing hormone surges in female rats.

The ability of steroid hormones to produce an LH or prolactin (PRL) surge was determined in rats ovariectomized at 6, 9 or 13 weeks of age and subjected to one, three or six cycles of estrogen and progesterone replacement. Sensitivity to steroid replacement was dependent on the age of the animal at the time of ovariectomy. Repeated cyclic steroid hormone replacement significantly increased the magnitude of the PRL response, but not the LH response, in animals ovariectomized at 6 weeks. The LH response was significantly altered by cyclic steroid replacement only in animals ovariectomized at 13 weeks. These results indicate that the mechanisms involved in the regulation of PRL secretion are influenced by steroid hormone replacement and that cyclic steroid hormone exposure increases the magnitude of the PRL secretory response.

Short-stay open appendectomy.

PURPOSE: This report describes a minimally invasive short-stay open appendectomy technique which improves the length of stay in comparison to traditional open appendectomy and improves the cost of hospitalization in comparison to laparoscopic appendectomy. STUDY DESIGN: This retrospective analysis reviewed 100 consecutive children treated with traditional open appendectomy and 100 consecutive children treated with a minimally invasive short-stay open technique with local infiltration of bupivacaine hydrochloride. Data collected for each child included age, sex, diagnosis, operative time, return to activity time, complications, length of stay, and hospital charge. RESULTS: The mean length of stay (LOS) was reduced from 2.7 days for traditional open appendectomy patients to 1.0 day for minimally invasive short-stay open appendectomy. The mean hospital charge (HC) for this short-stay open appendectomy, US dollars 6795, was significantly less than the mean HC for traditional open appendectomy (US dollars 8162), and for laparoscopic appendectomy (US dollars 7668). CONCLUSION: This short-stay open appendectomy technique offers an efficacious alternative to both traditional open appendectomy and laparoscopic appendectomy.

[Acute cholecystitis in diabetics]. / Akútne cholecystitídy u diabetikov.

UNLABELLED: Diabetes modifies by its consequences the course of different diseases. OBJECTIVE: In the submitted work the authors compare the course of acute cholecystitis in diabetic and non-diabetic subjects. METHOD: The authors evaluated in a retrospective study a group of 246 patients whom they operated on account of acute cholecystitis. The group comprised 44 (18%) diabetics and 202 (82%) non-diabetic subjects. They compared the two groups in some selected parameters. The significance of differences was evaluated by statistical methods. RESULTS: Significant differences between the groups were found in the pathomorphological finding on the gallbladder, in the incidence of acute cholangitis, comorbidity and early infection to the disadvantage of diabetics. CONCLUSION: The clinical course of acute cholecystitis in diabetics may be masked which is often the reason of inadequate therapeutic radical measures and of subsequent risks of the development of serious perioperative complications. Despite the higher comorbidity in the diabetic-group the perioperative course in the two groups was comparable if early surgery and adequate preoperative preparation were provided.