Minimally invasive endoscopically assisted remodelation (MEAR) of sagittal craniosynostosis: an alternative technique to open and endoscopic procedures with cranial orthosis time span reduction.

INTRODUCTION: Sagittal craniosynostosis represents the most frequent simplex skull suture pathology. There are currently several operative approaches to this defect. Minimally invasive techniques are preferred for young infants. Since July 2017, we have employed endoscopically assisted craniectomies followed by cranial orthosis. Gradually, we have developed our modified technique, the minimally invasive endoscopically assisted remodelation (MEAR). SURGICAL TECHNIQUE: MEAR is a combination of principles gained from classical cranial vault remodeling techniques and minimal invasive approaches. The long and wider lateral osteoectomies performed in the parietal and occipital bones along with loosening of the periosteum and dura adhesions at the lambdoid sutures lead to early correction of parieto-occipital dimensions. RESULTS: Thirty-one consecutive patients with scaphocephaly underwent MEAR. The median preoperative cephalic index of 67 units (P25:63.3, P75:70) was improved to a median postoperative cephalic index of 77 units (P25:75, P75: 81). Sufficient correction was achieved in all patients. Cranial orthosis was needed for a median of 1.5 months (P25:1, P75:2). We had no major surgical complications in this pilot series. CONCLUSIONS: With MEAR, we have achieved good cosmetic results. Duration of cranial orthosis was significantly shortened compared to conventional endoscopic-assisted procedures.

Electromagnetic navigation-guided neuroendoscopic transfrontal transaqueductal fenestration of expansive posterior fossa arachnoid cyst with simultaneous endoscopic third ventriculostomy in an infant.

INTRODUCTION: We present an infant with an expansive posterior fossa arachnoid cyst and severe clinical deterioration due to decompensated obstructive hydrocephalus. Given the dilated Sylvius aqueduct, we favoured the endoscopic transfrontal transaqueductal route to approach the cyst. CASE REPORT: A 12-month-old boy was acutely admitted for severe symptoms of intracranial hypertension. Imaging revealed spacious cystic formation in the posterior fossa with expansive behaviour towards the brain stem, fourth ventricle and cerebellum associated with obstructive triventricular hydrocephalus. The patient underwent electromagnetically navigated transfrontal transaqueductal cyst fenestration with simultaneous ETV from two precoronal trajectories with a rigid endoscope. CONCLUSION: A transaqueductal approach with a rigid endoscope is rarely published, and we were amazed by the impact on the child's clinical improvement after this minimally invasive endoscopic procedure. The case is well documented with imaging and perioperative neuroendoscopic views.

Endoscopic third ventriculostomy in an infant with vein of Galen aneurysmal malformation treated by endovascular occlusion: Case report and a review of literature.

INTRODUCTION: Vein of Galen aneurysmal malformations (VGAMs) can, through multiple mechanisms, complicate with hydrocephalus (HCP). It is generally agreed that management strategies in this scenario should focus on endovascular embolizations. Treatment options for non-responders, however, have been only scarcely reported upon. CASE PRESENTATION: We present a nine-month-old boy with a mural type VGAM complicated by HCP. Despite endovascular occlusion of the sole feeder, the child exhibited hydrocephalus progression prompting an Endoscopic Third Ventriculostomy (ETV). This procedure restored a cerebrospinal fluid (CSF) circulation otherwise impaired by aqueduct obstruction. Later, a new feeder arose and a second embolization was ultimately needed in order to achieve VGAM regression. Throughout four years of follow up, the child attained all developmental marks. DISCUSSION/CONCLUSION: VGAMs are prone to hydrocephalus development as there is both an underlying venous congestion and a mechanical, obstructive component. Although there is a rationale for addressing both components, the underlying AV shunts and subsequent venous pressure elevations usually determine failure of traditional CSF shunting strategies. It is therefore challenging to manage HCP in patients who failed to improve following endovascular embolizations. For such cases, ETV stands as an elegant minimal invasive alternative with potential to provide a more physiologic drainage route and thus better allow for neurological development.

[Is the lower extremities amputation rate on decrease?]. / Klesá pocet amputací dolních koncetin?

In the past few years, rates of the lower extremity amputations for ischemia have been decreasing in some countries and many world regions. Surely, growing numbers of revascularization procedures contribute to the situation. In the Czech Republic, the amputation and large amputation rates are similar to those in the developed countries (45, resp. 24/100 000) (according to hospital data), as well as the numbers of surgical revascularizations. However, in our country, foot amputations are on increase, while numbers of major amputations do not decrease, probably as a result of the human age prolongation and fast increase of diabetes mellitus rates. The following prerequisites are required to improve the situation: primary prevention of atherosclerosis, building a network of vascular centres which are able to provide all modern revascularization methods. In cooperation with general practitioners, angiologists, diabetologists and other medical specialists, it is necessary to prevent most patients from developing critical extremity ischemia. If it develops, it should be diagnosed immediately and the revascularization procedure should be considered.

[History of the beginning and the development of the contemporary Second Surgical Clinic of the General Teaching Hospital and of the First Faculty of Medicine, Charles University in Prague]. / Historie vzniku a výstavby budovy soucasné II. chirurgické kliniky 1. lékarské fakulty Univerzity Karlovy a Vseobecné fakultní nemocnice v Praze.

Construction of the building of contemporary Second Surgical Clinic of the cardiovascular Surgery was finished in 1921. Since the first intention to erect a new building for the Clinics of Gynaecology to its accomplishment full 46 years had elapsed. Since 1941 the building was used first by the German and later the Czech Clinics of Dermatovenerology and since 1955 it belonged to the Second Surgical Clinic of the General Teaching Hospital. In 1966 specialization of the clinic turned to the cardiovascular surgery. In relation to that, the building was to a great extent reconstructed.

[Abdominal aortic aneurysm. Results of surgical therapy during 1992-2003]. / Výdute b risní aorty--výsledky chirurgické lécby v letech 1992-2003.

BACKGROUND: Total of 142 procedures for abdominal aortic aneurysm were performed over the 1992-2003 period. METHODS AND RESULTS: Among this group, 106 patients (74%) underwent elective surgical procedure and 36 patients (26%) required urgent surgical treatment for acute ruptured aneurysm. The surgical mortality of the first group decreased from 19.5% to 4.7% over the past 40 years. On the other hand, in the same period, there is no significant change in surgical mortality rate for bleeding aneurysm (50% over the 1960-1980 and 41.6 over the 1992-2003). CONCLUSIONS: The average time between the first sign of rupture and the onset surgery is approaching 22 hours. The delay results form the time for necessary examination and for the complicated determinations of the diagnosis. Patients with the ruptured aortic abdominal aneurysm should be immediately transferred to the specialised vascular surgical clinics.

[Postcatheterization pseudoaneurysm of the radial artery]. / Postkatetrizacní pseudoaneuryzma arteria radialis.

A postcatheterization pseudoaneurysm of the radial artery remains a rare complication, considering frequencies of its punction. The radial artery is easily accessible for the punction site management after the catheter removal. We present pathogenesis of their origin, their prevention and options for surgical management of the radial artery pseudoaneurysms.

[Long-term results of femorocrural arterial reconstruction]. / Dlouhodobé výsledky femorokrurálních tepenných rekonstrukcí.

The objective of the paper is the fate of femorocrural arterial reconstructions during the long-term follow-up of 197 patients operated in 1970-1993. The patients were followed up after operation at 3-12-month intervals and cumulative curves of the patency of the reconstruction and preservation of the extremity were assessed by Kaplan-Meier s method. It was revealed that 5-year cumulative patency of femorocrural reconstructions is 55% and five-year preservation of the extremity even 78%, regardless of the patency of the reconstruction. The authors did not find a difference in the cumulative curves of patency between different crural arteries. The arteria fibularis is from the aspect of preservation of the extremity equivalent to both other arteries. From the comparative result of curves of cumulative patency for the reverse autologous asphena and for cast vascular prostheses ensued that even after five years there is no substantial difference between the two types of prostheses. In case of cast prostheses we must however foresee early thrombotic obstructions and thus repeated surgery such as thrombectomies sand plastic operations of distal anastomoses.

[The results of a questionnaire on the status of vascular surgery in Czechoslovakia]. / Výsledky ankety o stavu cévní chirurgie v CSR.

In 1985 an enquiry by means of questionnaires was made at all surgical departments of the CSR. Its aim was to assess the state of vascular surgery, conditions under which it is performed and to compare quantitative and qualitative data with the actual needs. In 1984 in the CSR a total of 2564 vascular operations were performed, incl. 751 urgent ones and 1813 planned operations. With regard to the estimated need of cca 500 operations per 1 million population (comparable data from Scandinavian countries), the 248 operations per 1 million population are quite inadequate. In contrast to this, 82 surgeons claim to be concerned with active vascular surgery which is almost twice the number needed to ensure an adequate number of vascular surgical operations. The authors analyze the causes of the inadequate development of vascular surgery which ensued from the enquiry and indicate possibilities of future development.

[The effect of mechanical support of the heart on the extent of experimental myocardial necrosis. I]. / Vliv mechanické podpory srdce na rozsah experimentální nekrózy myokardu. I. cást.

The authors investigated the influence of mechanical cardiac support with a non-pulsating blood flow on the size of an ischaemic after ligature of the descendent branch of the left coronary artery in the dog. As compared with a control group of experimental animals where mechanical cardiac support was not used, the size of the necrotic focus of the heart muscle diminished by 50% (p less than 0.01). In some of the experimental animals the size of the necrotic focus did not change despite the use of a mechanical cardiac support. Analysis of haemodynamic parameters (assessed and calculated) revealed that for the fate of the necrotic focus of the myocardium the degree of relief (decompression) of the left ventricle is decisive. In complete relief the necrosis diminishes in size.

[Surgery of infectious complications in prostheses in the abdominal aorta]. / Chirurgické resení infekcních komplikací náhrady brisní aorty.

The authors describe the successful solution of a serious and feared complication, i.e. infection of a vascular prosthesis. A hitherto not used procedure was adopted-concurrent removal of the infected prosthesis and restoration of the blood flow into both extremities by an extra-anatomical axillobiiliac bypass. The authors draw attention to the advantages of this method in context with possible future solutions; and with regard to the hitherto not complicated postoperative course they assume that this type of treatment could be final. At the same time they draw attention to the complexity of the problem from the diagnostic and therapeutic aspect.

[Popliteal artery aneurysms--acute ischemic complications]. / Výdut' podkolenní tepny--akutní ischemické komplikace.

The authors present a group of 10 patients with the diagnosis of acute ischaemia of an extremity caused by an aneurysm of the popliteal artery, during the period from 1997 till October 2002, who within a short time interval were treated by a combination of endovascular and surgical therapy. The group comprised 8 men and 2 women. The mean age was 58 years, the range 48-78 years. A bilateral aneurysm was present in 3 patients, coincidence with an aneurysm of the abdominal aorta was found in one patient. In all ten patients combined treatment was used involving local thrombolysis rtPA (Actilyse Boehringer Ingelheim) for 24-48 hours followed within 24 hours by exclusion of the aneurysm with vascular reconstruction. No death, amputation nor closure of the reconstruction was recorded during hospitalization. The medium term results suggest a 100% patency when an autologous vein was used, much poorer results are obtained when prostheses were used in particular in patients with femoropopliteal bypasses. In our opinion in acute ischaemia of the extremities as a result thrombosis of an aneurysm of the popliteal artery the application of a combination of local thrombolysis rtPA followed within a short time interval by vascular reconstruction increases the probability of saving the affected extremity and markedly reduces the necessity of amputation as compared with primary surgical treatment.

[Metabolic aspects of hypothermic extracorporeal circulation]. / K nekterým metabolickým aspektum hypotermního mimotelního obehu.

The submitted paper is devoted to some aspects of metabolic and immunity reactions of the organism to extracorporeal circulation. The authors focused attention in particular on a correlation of the whole-body oxygen consumption and the blood sugar level. Surprising findings comprise the rise of the whole-body oxygen consumption which occurs before the tissue temperature rises. As far as toxic oxygen radicals are concerned, their release is individual. It is, however, important that during the perfusion proper the activation of the immune system is suppressed. The course of the extracorporeal circulation was satisfactory from the clinical aspect; despite that it cannot be considered physiological, as also apparent from some biochemical findings.

[Metabolic and ultrastructural changes in the myocardium during heart arrest in patients undergoing surgery for ischemic heart disease]. / Metabolické a ultrastrukturální zmeny v myokardu pri srdecní zástave u nemocných operovaných pro ischemickou chorobu srdecní.

The authors give an account of metabolic changes in the ultrastructure of the myocardium which develop during cardioplegic arrest of the heart muscle by cold during aortocoronary reconstruction operations. Using the technique of arteriovenous differences before myocardial ischemia and after its termination, the assessed differences in arterial blood and blood from the sinus coronarius as regards the blood sugar level, lactate, pyruvate, potassium, phosphorus, unsaturated fatty acids and triglycerides. The results revealed a marked disorder of the carbohydrate and ion metabolism and severe impairment of the ultrastructure of the heart muscle during cardiac arrest.