Design of abdominal retractor.

INTRODUCTION: The purpose of this paper is to present the development and design of an abdominal retractor which allows a single person to perform operations and the fixation of the operation instruments can be done with one hand. The additional devices make the operation more comfortable for surgeons. METHODS: Conventional measuring devices have been designed and applied for determining axial forces in a surgeon's forearm during operations. The same forces must be transmitted by the frame of the retractor. Thus a simple truss structure of a retractor was done. Several types of fixations have been proposed and tested using the rapid prototyping. Finally, the abdominal retractor was manufactured from stainless steel. RESULTS: The simple-to-use abdominal retractor was built. The standard surgery instruments were modified due to the fixation system of the frame. A wide variety of additional useful devices, such as a lamp, video camera etc., were also proposed. CONCLUSION: The present abdominal retractor is user-friendly and all components are easily sterilized by conventional methods (Fig. 7, Ref. 6) Keywords: abdominal retractor, stainless steel retractor, standard surger, fixation system of the frame, lamp, video camera, conventional methods.

Results of long term testosterone replacement therapy in men with abdominal obesity, erectile dysfunction and testosterone deficiency.

INTRODUCTION: In this article, the authors evaluate subjective and objective results of long testosterone replacement therapy (TRT) and possible risk. METHODS: In a single center study, the authors treated 69 men with testosterone deficiency syndrome (TDS). The average age was 57.84 years and the follow-up period was 94.62 months. All men had at beginning a complete urological and internal examination. All the men were treated with three-month i.m. injections of 1000 mg testosterone undecanoate. The men were regularly checked according to the EAU guidelines. RESULTS: All of the men on treatment felt much better. Weight and waist circumference during monitoring showed a mild improvement. Excellent results were on red blood cells. Glucose, HDL cholesterol, triglycerides had stable values. PSA slightly increased and testosterone was within the normal range. In two men during treatment, we found a prostate cancer (low risk). Bone mineral density (BMD) of lumbar spine revealed a significant improvement. CONCLUSION: TRT had multiple positive effect on affected men with TDS. Our long-term results showed a long mild improvement during the time. Authors concluded that long term treatment had multiple benefit for affected men (Fig. 11, Ref. 13).

Effect of deuterium-depleted water on selected cardiometabolic parameters in fructose-treated rats.

Deuterium-depleted water (DDW) has a lower concentration of deuterium than occurs naturally (less than 145 ppm). While effects of DDW on cancer started to be intensively studied, the effects on cardiovascular system are completely unknown. Thus, we aimed to analyze the effects of DDW (55+/-5 ppm) administration to 12-week-old normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) treated with 15 % fructose for 6 weeks. Blood pressure (BP) and selected biochemical parameters were measured together with determination of nitric oxide synthase (NOS) activity and iNOS and eNOS protein expressions in the left ventricle (LV) and aorta. Neither DDW nor fructose had any significant effect on BP in both strains. DDW treatment decreased total cholesterol and triglyceride levels in WKY, but it was not able to prevent increase in the same parameters elevated due to fructose treatment in SHR. Both fructose and DDW increased insulin level in WKY. Fructose did not affect NOS activity either in WKY or SHR. DDW increased NOS activity in LV of both WKY and SHR, while it decreased NOS activity and iNOS expression in the aorta of SHR with or without fructose treatment. In conclusion, DDW treatment significantly modified biochemical parameters in WKY together with NOS activity elevation in the heart. On the other hand, it did not affect biochemical parameters in SHR, but decreased NOS activity elevated due to iNOS upregulation in the aorta.

Monitoring of hands movement trajectories in the field of laparoscopic and endoscopic surgeries and options in the clinical practice.

Within the project "Applied research trajectory hands in laparoscopic and endoscopic operations", ITMS Project code 26240220056, funded by the European Regional Development Fund and the state budget of the Slovak Republic, we created a technical background and algorithms for monitoring and evaluating the hand movements of the surgeon during laparoscopic and endoscopic operations. This is a unique idea and unique project transformed into clinical practice, which is promising to assist in laparoscopic training and inclusion of surgeon / endoscopist to "skilfulness" group on the evaluation of the effectiveness of movements of his hands (Tab. 2, Ref. 11).

Reccurent bleeding from Meckel's diverticulum - surgeon's challenge.

The authors of this paper want to share their experience with diagnostic and therapeutic problems in case of chronic small intestinal bleeding from Meckel's diverticulum, which ended with acute episode of massive gastrointestinal bleeding requiring emergent surgery.Despite the progress achieved in diagnosing the sources of gastrointestinal bleeding, the diagnosis of small intestinal bleeding is very frequently beyond the ability of making it right, and thus emergent surgery is often the only possibility of saving the patient's life on the one hand, and allowing stating the correct diagnosis on the other (Fig. 1, Ref. 6).

The role of laparoscopic Heller myotomy in the treatment of achalasia.

AIM: To evaluate the results of laparoscopic Heller myotomy in our group of patients. METHOD: A retrospective clinical trial was carried out to evaluate the indication, technique and controversies of laparoscopic Heller myotomy in the achalasia treatment. The following symptoms were evaluated prior and after Heller myotomy: dysphagia, heartburn, nausea/vomiting after meal and asthma/coughing. The patients were evaluated by the use of Likert score. Statistical analysis was performed by using Student t test. The intra-operative (operation time, intraoperative complications, blood loss, conversion rate), and peri-operative parameters (morbidity, mortality, hospital stay) were evaluated as well. The patients who underwent laparoscopic Heller myotomy were included in the trial. All patients were perioperatively managed by a multidisciplinary team. RESULTS: The evaluation of fourteen patients was performed (average age: 53.2 yrs., eleven men, two women, BMI 23.6 kg/m(2)). The patients were indicated for surgery in all of the stages (I-III). Previous semiconservative therapeutic modalities were performed in thirteen patients. The standard laparoscopic technique for Heller myotomy with semifundoplication was applied. All the observed symptoms were statistically improved after the surgery (p=0.05). The average operating time was 89 minutes. Intraoperative blood loss was below 20 ml. There was no conversion to open surgery. An average hospital stay was 4.3 days. Morbidity was 14.3 % and mortality 0 %. In one patient esophageal mucosa perforation was intra-operatively identified and sutured. Post-operative course in this patient was without any complications. CONCLUSION: The laparoscopic Heller myotomy has become the "gold standard" procedure for achalasia. It is an excellent method allowing precise operation technique with good visualization of the esophagogastric junction. The operation with this approach is safe, efficient, and with excellent reproducible operative results. The correct and early indication for surgery is crucial. The delayed diagnosis with a late indication for surgery is not an exemption (Tab. 2, Fig. 2, Ref. 36).

Use of intraabdominal VAC (Vacuum Assisted Closure) lowers mortality and morbidity in patients with open abdomen.

OBJECTIVE: Authors compare two groups of patients with open abdomen. The objective is to compare and evaluate two treatment modalities, namely Kern laparostomy and vacuum-assisted closure in terms of mortality, closure of abdominal wound, and fistula management, all these stratified by BMI and CRP. BACKGROUND: Open abdomen can be considered a "patient salvage technique", used in patients with abdominal sepsis, as well as in patients with abdominal compartment syndrome, and in damage control surgery. Various management techniques are known, of which Kern laparostomy is most widely used. Newer techniques using negative pressure have emerged, still waiting for their wider acceptance and use. The authors present their study, in which they compare Kern laparostomy and intraabdominal VAC in patients with open abdomen. MATERIAL AND METHODS: Study consists of 44 patients treated at the authors´ clinics, while group KERN consisted of patients managed by Kern laparostomy, and group VAC was managed by intraabdominal VAC. The groups were compared in terms of mortality, abdominal closure, appearance of enteroatmospheric fistulas, primary closure of fistulas, and possibility of diversion of enteral contents. All outputs were stratified by CRP (C-reactive protein) and BMI (Body Mass Index). RESULTS: In VAC group, a significant decrease in mortality was seen, as well as significantly higher closure of abdominal wall, and significantly higher possibility of diversion of enteral content from fistulas. No statistically significant findings were observed in stratification with CRP and BMI. CONCLUSION: Intraabdominal VAC offers patients lower morbidity and mortality and should be defined as a treatment of choice in patients with open abdomen (Tab. 4, Fig. 3, Ref. 15).

Role of human papilloma virus infection and oral-genital contact in oral cancer ethiopathogenesis.

Head and neck squamous cell carcinoma and especially oropharyngeal squamous cell carcinoma is a very significant cause of morbidity and mortality. The majors risk factors of these tumors are tobacco smoking, chewing and alcohol consumption. But there is a group, non-drinking and non-smoking, patients with oropharyngeal squamous cell carcinoma. In these patients may be oral-genital contact and human papillomavirus infection the major risk factor for oral carcinogenesis. Aim of this review is to point out this fact in correlation with clinical studies and clinical conclusion for medical practice (Fig. 1, Ref. 32).

[Retroperitoneoscopic adrenalectomy with dorsal approach]. / Retroperitoneoskopická adrenalektomie dorzálním prístupem.

UNLABELLED: INTRODUSTION: Various surgical mininvasive approaches for adrenalectomy have been established over the last two decades. We are evaluating the retroperitoneoscopic adrenalectomy with dorsal approach. MATERIAL AND METHODS: The prospective open clinical trial was carried out to evaluate intra-operative (operations time, intraoperative complications, blood loss, conversion rate) and peri-operative parameters (morbidity, mortality, hospital stay). Patients who underwent retroperitoneoscopic adrenalectomy with dorsal approach were included in the trial. A tumor size above 12 cm or BMI higher than 35 kg/m2 were considered asexclusion criteria. All the patients were perioperatively managed by a multidisciplinary team. RESULTS: A total of 81 patients were assessed (average age: 45.7 yrs, 37 males, 44 females, BMI 27.8 kg/m2). The average operating time was 61 minutes. The intraoperative blood loss was below 20 ml. The mean hospital stay was 2.1 days. Morbidity was 2.7% and mortality 0%. CONCLUSION: Retroperitoneoscopic adrenalectomy with dorsal approach is considered a method of choice in our hospital. The use of this approach is safe, efficient, with excellent reproducible operative results and impressive patient recovery.

From preoperative to intraoperative detection of hyperfunctioning parathyroid glands using tetrofosmin (99mTc) in primary hyperparathyroidism.

The impact of preoperative scintigraphy on the management of patients with primary hyperparathyroidism has been largely documented for more than two decades. More recently, preoperative scintigraphy has also been used to select patients for intraoperative detection of hyperfunctioning parathyroid glands thanks to a gamma-probe. This procedure is now widely used, with MIBI as the main radiopharmaceutical for both preoperative scintigraphy and intraoperative detection. However MIBI was not available in Slovakia until very recently and tetrofosmin (TF), the alternative 99mTc labelled radiopharmaceutical for myocardial imaging has some advantages over MIBI and a close biological behaviour. Thus we have been using TF also for parathyroid preoperative scintigraphy and for intraoperative detection, a systematic indication which has never been reported by others. This article aims to demonstrate the feasibility and to present our protocol for TF parathyroid imaging and intraoperative detection, closely associating surgeons, nuclear medicine specialists, pathologists and also biologists as intraoperative assay of intact PTH is necessary. The results of literature are subsequently reported and discussed (Tab. 2, Fig. 4, Ref. 35). Full Text in free PDF www.bmj.sk.

Autogenous venous valve construction.

AIM: The aim of this study was to assess the results of a new type of antireflux operation on the deep venous system in patients with venous ulceration not responding to treatment of the superficial system and compression. METHODS: In the period comprised between 1991-2002, the authors treated 56 patients with venous ulceration by Fegan's technique, that consists in compression sclerotherapy combined with antireflux operation of the deep veins. All patients selected had pathological reflux in the deep venous system and their ulcers did not respond to superficial and perforating vein therapy, and elastic compression. RESULTS: Using this technique of complex antireflux treatment, it was possible to heal 53 (95.4%) of the 56 ulcers with average time of complete ulcer epitelisation within 39+/-12 days. The recurrence rate, within the 5 year follow-up was 18% (10 patients), but 7 of the recurrent ulcers responded to compression sclerotherapy and healed within 3 months. CONCLUSIONS: In situ made valvuloplasty has several advantages: the valve is constructed from autogenous vein wall; all luminal valve surfaces have native venous endothelium; intraluminal foreign material is not introduced; the likelihood of thrombosis is reduced; the valve is size-matched to the host vein and this technique provides a competent bicuspid valve.

Venous leg ulcers--a surgical treatment.

OBJECTIVE: To asses the complex anti-reflux treatment of pure venous ulcers on all levels of venous system. PATIENTS: In the last 20 years the authors treated 793 patients with venous ulceration and compared the therapeutic results of 4 groups of patients treated either surgically (Linton+v.v. surgery) or with sclerotherapy (Fegan's technique) combined with the anti-reflux operation on deep veins in torpid ulcerations non responding to superficial and perforators therapy. RESULTS AND CONCLUSION: The authors consider a compression sclerotherapy (the Fegan's technique) the easiest and the most effective way of treating patients with venous ulcer. The direct valve repair techniques are appropriate only in non-thrombotic deep vein reflux, which is very rare (4 patients--0.6%). In patients with torpid ulcers, where the compression sclerotherapy failed (4.6%--28 pts), the in situ construction of a new valve could help (Tab. 2, Ref. 19). Full Text (Free, PDF) www.bmj.sk.

Gastrointestinal stromal tumors.

In the last 3 years 9 patients with gastrointestinal stromal tumors (GIST) underwent surgery at our department. All cases were with very atypical process. From these patients 3 interesting cases are described in more details. A 75-years-old woman with gastroscopically verified endoluminal tumour in the proximal third of stomach, 6x7 cm, 76-years-old man with a large endoluminal tumour in D2-D3 part of the duodenum, 4x4 cm, and 62-years-old man with verified extraluminal tumour by CT examination in the middle part of stomach. In all cases, gastrointestinal stromal tumour was histologically confirmed. Work is well photo-documented pre-surgically with endoscopic and CT-findings and during surgery: individual steps during the removal of these tumours. In assessment of the size and number of mitoses, tumours belonged to a group with highly malignant potential. Patients are regularly checked in 3-months intervals and also examination by positron emission tomography was performed--it seems to have the best demonstrability of possible relapse. All three patients live and are subjectively and objectively without significant problems (Tab. 5, Fig. 5, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Perioperative cardiovascular and noncardiovascular risk in patients with colorectal cancer.

BACKGROUND: One of the factors determining the success of colorectal cancer (CC) surgery is an appropriate stratification of perioperative risk. OBJECTIVE: To evaluate the prognostic significance ofperioperative risk in patients with CC, a comparison of two groups of patients--surviving and non-surviving the CC surgery was performed. Cardiovascular and noncardiovascular risk factors, diseases and complications were compared between these two groups. PATIENTS: 60 patients (m:30, f:30), average age: 73 ys, surviving (38), non-surviving (22). METHODS: Following parameters were compared: risk factors (arterial hypertension, diabetes mellitus, hyperlipoproteinemia, smoking or alcohol consumption, malnutrition, obesity), cardiovascular diseases (history of coronary artery disease, heart failure, brain stroke, revascularisation, chronic venous insufficiency), noncardiovascular diseases (COPD, asthma, renal insufficiency, metabolic diseases, peptic ulcer disease, chronic hepatitis, pulmonary tuberculosis, bone or kidney tuberculosis, hepatopathy), complications and laboratory parameters. RESULTS: Comparison of the listed parameters in non-surviving/surviving patients: bronchopneumonia (36%/4%), perineal haemorrhage (36%/4%), hepatopathy (28%/4%), renal insufficiency (50%/16%), hypoalbuminemia (50%/16%), history of acute stroke (21%/12.5%), history of brain stroke (12.5%/7%). CONCLUSION: Risk factors (bronchopneumonia, perineal haemorrhage, hepatopathy, renal insufficiency, hypoalbuminemia) are markers of worse prognosis. The cardial markers (history of acute stroke and history of brain stroke) play a minor role (Tab. 10, Ref 3).

Urgent situations in phlebology--variceal bleeding and it's treatment.

The aim of this study was to compare the therapeutic results of patients whose bleeding points were sutured and patients treated with compression sclerotherapy. In the years 1983-2000, 56 patients with profuse bleeding from varicose veins were treated. In a subgroup of patients with compression sclerotherapy--Fegan's way (32 patients), bleeding wound was healed completely within 7 days on average (5-13). All ulcers have healed within 2 months. The presented approach used is a surgical procedure (stitch, removal of large varicosities). Fegan's technique of compression sclerotherapy, with a detergent sclerosing solution (S.T.D.), enables to complete sclerotherapy of all pathological reflux points during 1-2 visits not only with good results, but also as a one-day surgery, keeping the patient work (Ref. 7).

Conditions responsible for small bowel resection.

The authors deal with the problems of surgery of small intestine. They analyze causes leading to small bowel resection, including small intestinal obstructions, tumors, diverticles, Crohn's disease and traumas of small intestine, in a group of patients operated at Ist Department of Surgery, University Hospital, Commenius University, Bratislava, during the last 30 years. Authors also discuss the problems of short bowel syndrome (SBS) as the consequence of an extensive small bowel resection, reporting the surgical approach to its therapy. (Tab. 1., Ref. 5.)

The abdominal compartment syndrome.

The abdominal compartment syndrome has received considerable attention only recently. It may be defined as adverse physiologic consequences that occur as a result of an acute increase in the intraabdominal pressure. The most common causes of ACS are haemorrhage, visceral oedema, pancreatitis, bowel distension, venous mesenterial obstruction, abdominal packs, tense ascites, peritonitis, tumor. The mostly affected organ systems include cardiovascular, pulmonary, renal, central nervous and splanchnic. The diagnosis depends on the recognition of the clinical syndrome followed by an objective measurement of intraabdominal pressure, preferably that of the urinary bladder. The treatment consists of adequate fluid resuscitation and surgical decompression when necessary. (Tab. 1, Ref. 29.).

Possible risks in combining endoscopic and surgical therapy of bleeding peptic ulcers.

BACKGROUND/AIMS: Today's therapy of bleeding peptic ulcers consists of pharmacological hemostasis, endoscopic therapy and surgery in chronological order. The aim of this study was to objectively assess the contribution of the contemporary algorithm of therapy with the use of endoscopic and surgical hemostasis techniques for the therapy of bleeding peptic ulcers. METHODOLOGY: This study is a retrospective analysis and comparison of two randomized groups A/B with 427/388 patients with endoscopically verified bleeding from peptic ulcer lesions Forrest I-IIb. Patients in group A (1990-1993) were treated without endoscopic intervention, compared with group B patients (1998-2001) who were treated with endoscopic intervention. In both groups we have statistically scored and compared: quantitative operative therapy share, time interval from the beginning of therapy until surgery, APACHE II score of patients at the beginning of therapy and on the day of surgery, complications requiring re-operation and mortality. RESULTS: In groups A/B surgical hemostasis was required in 15.0/10.6% cases, from which 90.6/61.0% operations were resections and bionomic operations. Data evaluation of APACHE II scores from both groups at the beginning of treatment showed no significant difference, but at the time of operative therapy the APACHE II scores were significantly higher in group B (11.83 +/- 6.49/15.00 +/- 4.36). The length of unstable intervals of bleeding in group B compared to group A was quantitatively lengthened (A = 55.6 +/- 19.8/B = 68.6 +/- 37.0 h). Significant differences were also noted in the number of re-operations 7.8/9.8% and mortality 15.6/24.3% between groups A/B. CONCLUSIONS: The contemporary accepted sequence of hemostatic therapy is accompanied by the risks of limited selection of optimal methods of endoscopic therapy, protracting the interval of bleeding with unfavorable rise in APACHE II score, and hesitancy in indication for surgery in intractable bleeding after non-surgical therapy.

Retrocaval ureter with ureteral carcinoma.

The authors report a rare congenital anomaly, retrocaval ureter (RCU) with carcinoma. The patient had recurrent pyelonephritis, hematuria and renal colic. Urography shows no function on right side. Abdominal ultrasound revealed marked right hydronephrosis. Antegrade ureterography through nephrostomy revealed a RCU. Helical C.T. confirmed the RCU and also revealed a defect in contrast medium in the upper ureter. We performed percutaneus antegrade nephro-ureteroscopy and found carcinoma of the retrocaval ureter. This may be the first case of tumor in the RCU. We did not find any other in the literature. (Fig. 3, Ref. 14.).