Morphological features of vasa vasorum in pathologically changed human great saphenous vein and its tributaries.

BACKGROUND: The question whether the primary increase of vasa vasorum (VV) of venous wall (i) plays an initial role in varicogenesis or (ii) is an expression of impairment of the nutritional conditions in superficial veins of lower extremities is not unambiguously solved yet. The aim of the study was to describe the arrangement of the VV within the wall of the human great saphenous vein (GSV) qualitatively, and of its tributaries at different stages of varicosis and in other pathological states like thrombophlebitis or phlebosclerosis. MATERIAL AND METHODS: 22 patients deserving an aorto-coronary bypass surgery or GSV surgery were subdivided into three groups according to the staging of their varices and other pathology. The harvested GSV were prepared for light and scanning electron microscopy. One cadaverous specimen of GSV was injected with India ink. RESULTS: In specimens from reticular and primary large varices local intimal hyperplasia was regularly found, partially accompanied with a mild increase of VV. Tortuosities and irregular dilations of adventitial veins were also found. In patients with recurrent primary varices or thrombophlebitis severe intimal and medial hyperplasia, thrombosis and a striking increase of VV were found. The intima remained avascular in all cases. CONCLUSIONS: Remarkable increase of VV accompanies the most severe forms of varices as well as all cases of the extreme grades of phlebosclerosis, medial hyperplasia and thrombosis. We hypothesize that this increase in VV is rather a secondary vascular reaction to the impaired metabolic conditions within the venous wall than a primary varicogenic factor.

Catch a falling apple: Isaac Newton and myths of genius.

Newton has become a legendary figure belonging to the distant past rather than a historical person who lived at a specific time. Historians and scientists have constantly reinterpreted many anecdotal tales describing Newton's achievements and behaviour, but the most famous concerns the falling apple in his country garden. Newton's apple conjures up multiple allegorical resonances, and examining its historical accuracy is less important than uncovering the mythical truths embedded within this symbol. Because interest groups fashion different collective versions of the past, analysing mythical tales can reveal fundamental yet conflicting attitudes towards science and its practices.

[Isolated aneurysm of the iliac artery as a source of postoperative peripheral embolism]. / Izolovaná výdut ilické tepny jako zdroj periferní pooperacní embolizace.

An isolated aneurysm of the iliac artery is a rare disease occurring 10 times less frequently than an aneurysm of the aorta. Aneurysms of the iliac artery are yet 10 times less frequent. The rare incidence of the condition is the cause why it is not taken into account in the differential diagnosis. Electively treated aneurysms have a minimal mortality and morbidity, while symptomatic aneurysms with subsequent complications due to haemorrhage, penetration or embolization calling for urgent surgery, have a mortality of cca 50%. In the patient described by the authors embolization and ischaemia of the lower extremity developed during the immediate postoperative period after prostatectomy. Only the peroperative finding explained the cause of the embolization.

[Fasciocutaneous flaps]. / K problematice fasciokutánních laloku.

Fasciocutaneous flaps proved useful for covering soft tissue defects in the region of the leg. After experience with the use of these flaps in six patients the authors recommend this method for covering these defects. In all patients very satisfactory results were achieved.

[Musculocutaneous flaps in the treatment of chronic decubitus ulcers in the ischial region]. / Uzití muskulokutánního laloku k lécení chronických dekubitálních vredu v ischiální krajine.

In a group of 28 decubiti in 21 paraplegic patients, operated during the past five years the authors draw attention to the advantages of the use of three types of musculocutaneous (MC) flaps for surgical and radical treatment of ischial decubiti. The method using musculocutaneous flaps makes it possible to restore a relatively satisfactory cover of the defect by a multilayer long-lasting flap.

[Aggressive fibromatosis in the extremities]. / Problematika agresivní fibromatózy lokalizované na koncetinách.

The authors demonstrate in a group of 10 patients treated in the course of 15 years the rare incidence of aggressive fibromatosis of the extremities and the large number of relapses after surgery. They also emphasize the necessity of detailed preoperative examination, priority of a surgical approach, as compared with radiotherapeutic procedures, and the possibility of skeletal and vascular reconstruction after radical surgery.

[Prevention and treatment of persistent perineal sinuses. Literature review and initial experience]. / Moznosti prevence a lécení perzistujících perineálních sinu. Literární prehled a první zkusenosti.

The objective of the work was to demonstrate possibilities of radical treatment of a perineal sinus, a very unpleasant complication after proctectomy. The authors prefer the use of a fasciocutaneous gluteofemoral flap based on the descendent branch of the inferior gluteal artery. The authors describe the whole surgical procedure and recommend to assemble experience with solution of decubital defects in the pelvic region.

Segmental neurofibromatosis follows blaschko's lines or dermatomes depending on the cell line affected: case report and literature review.

BACKGROUND: Segmental neurofibromatosis type 1 (NF-1) has the characteristic features of generalized NF-1 but is isolated to a particular segment of the body. Segmental NF-1 results from a postzygotic mutation during embryogenesis in the NF-1 gene on chromosome 17. The embryologic timing of the mutation and cell types affected predict the clinical phenotype. OBJECTIVE: We present a case of a 52-year-old woman with segmental neurofibromas isolated to the right cheek and neck. We review the recent literature on the genetic and cellular differences between the various clinical manifestations of segmental NF-1. METHODS: A MEDLINE search for cases of segmental neurofibromatosis was conducted. RESULTS: In patients with segmental NF-1 presenting as neurofibromas-only, the distribution follows a neural distribution in dermatomes because the genetic mutation appears to be limited to Schwann cells. In patients with pigmentary changes only, the NF-1 mutation has been shown to occur in fibroblasts and the distribution tends to follow the lines of Blaschko. CONCLUSION: Our patient's neurofibromas were secondary to a postzygotic mutation in the NF-1 gene of neural crest-derived cells. This mutation most likely occurred later in embryogenesis in cells that had already differentiated to Schwann cells and were committed to the dermatomal distribution of the right neck and cheek region (C2).