Intranodal embolization for lymphocele after revascularization procedure in the groin.

Early postoperative wound complications in revascularization procedures in the groin very often include complications associated with injury to the lymphatic system such as lymphocele and lymphorrhea with subsequent local infectious complications and the risk of infection of prosthetic grafts. We present a case report of successful treatment of postoperative lymphocele with subsequent lymphatic fistula and dehiscence of the surgical wound by intranodal embolization of the injured lymph node with Histoacryl tissue glue.

[750 satisfied patients? Stapled haemorrhoidopexy (Longo procedure) for the treatment of haemorrhoids and anal canal prolapse: a review of our 10-year experience]. / 750 spokojených pacientu? 10 let zkuseností a výsledku Longovy metody operace hemoroidu a análních prolapsu.

INTRODUCTION: Haemorrhoid disease in a common ailment, which constitues a serious clinical and social problems, especially in countries having a significant level of development. There have been a great number of articles published on the method of treatment for haemorrhoid disease and anal canal prolapse with circular stapler introduced to clinical practise by Longo in the year 1993. However, there are very few studies devoted to assessment of this procedure in the Czech medical literature. AIM: Summary our 10 year experience--to perform a retrospective evaluation of early and long-term results of surgical treatment with a Longo procedure. PATIENTS AND METHODS: We evaluated retrospectively 750 patients, submitted in our hospital to Longo procedure since January 2000 until December 2009, considering results and complications of this procedure. 435 (58%) were women and 315 (42%) men, aged from 17 to 83 (46.2 years old on overall). Mean follow up was 5.5 months (ranged from 3 months to 3.5 years). RESULTS: Complications occurred in 76 patients (10.1%). In 24 patients (3.2%) during the early post-operative period. Late complications developed in 52 patients (6.9%). 34 patients (4.5%) required reoperation. Duration of hospitalisation after the procedure ranged from 2 to 8 days, an overage of 3.2 days. CONCLUSION: Longo procedure in indicated cases--treatment of the 3rd and 4th stage of haemorrhoid disease and anal canal prolapse, is an advisable alternative to other surgical methods. Has satisfactory short and long-term effects, lower postoperative pains, shortening of the patient's hospital stay. Longo's method is safe and suitable for the haemorrhoid therapy, can be recommended in selective patients for a one-day surgery scheme.

[Results and complications of laparoscopic adjustable gastric banding--12 years experience]. / Výsledky a komplikace laparoskopické adjustabilní bandáze zaludku--12 let zkuseností.

INTRODUCTION: Bariatric surgery is currently the only effective treatment for morbid obesity. The main advantage of laparoscopic adjustable gastric banding (LAGB) is that this operation is minimally invazive to the stomach and adjustable to the patient's needs. AIM: Few long-term studies regarding the outcome of LAGB for morbid obesity have so far been publised. We report our 12-year experience with this method. PATIENTS AND METHODS: On list of 100 patients (76% women, 24% men) operated since February 1998 until December 2006 we present results and complications, reoperations. Mean follow up was 5.2 years (0.5-11.8). Patients lost to follow up was 22% at 5 years and 33% at 8 years. Complications occurred in 38% patients. 12% of the patients needed reoperation. There was no mortality. CONCLUSION: From our 12-year experience, we can state that LAGB is an effective bariatric procedure for achieving weight loss. Because of the high complication and reoperation rate, it is necessary to select patients according specific criteria and choose experienced bariatric surgery.

Learning child psychiatry skills on the adult inpatient service.

Integration of child psychiatry training into general psychiatric residency programs is often unsuccessful. The authors describe an innovative model of training in child psychiatry that involves the children of adult inpatients. This model offers several advantages: splitting of child-adult psychiatric training is avoided, child diagnostic and evaluative skills tend to be learned rapidly, preventive orientations develop, and family process is both learned and used. Preliminary experience with this model on two inpatient services suggests that it is both didactically effective and economical in child psychiatry staff hours.

Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging.

OBJECTIVE: Modern neuronavigation systems lack spatial accuracy during ongoing surgical procedures because of increasing brain deformation, known as brain shift. Intraoperative magnetic resonance imaging was used for quantitative analysis and visualization of this phenomenon. METHODS: For a total of 64 patients, we used a 0.2-T, open-configuration, magnetic resonance imaging scanner, located in an operating theater, for pre- and intraoperative imaging. The three-dimensional imaging data were aligned using rigid registration methods. The maximal displacements of the brain surface, deep tumor margin, and midline structures were measured. Brain shift was observed in two-dimensional image planes using split-screen or overlay techniques, and three-dimensional, color-coded, deformable surface-based data were computed. In selected cases, intraoperative images were transferred to the neuronavigation system to compensate for the effects of brain shift. RESULTS: The results demonstrated that there was great variability in brain shift, ranging up to 24 mm for cortical displacement and exceeding 3 mm for the deep tumor margin in 66% of all cases. Brain shift was influenced by tissue characteristics, intraoperative patient positioning, opening of the ventricular system, craniotomy size, and resected volume. Intraoperative neuronavigation updating (n = 14) compensated for brain shift, resulting in reliable navigation with high accuracy. CONCLUSION: Without brain shift compensation, neuronavigation systems cannot be trusted at critical steps of the surgical procedure, e.g., identification of the deep tumor margin. Intraoperative imaging allows not only evaluation of and compensation for brain shift but also assessment of the quality of mathematical models that attempt to describe and compensate for brain shift.

Anatomical interrelation between the phrenic nerve and the internal mammary artery as seen by the surgeon.

Paresis of the diaphragm (especially left-side paresis) is a relatively frequent finding following cardiac surgery. While, usually, it is a rather benign condition, in exceptional cases it may lead to severe impairment to death of the patient. The supposed causes of damage to the phrenic nerve include: local myocardial cooling by ice slush; opening of the pleural cavity in connection with local cooling; cross clamp length; total hypothermia; central venous cannulation; traction-related damage; mammary artery harvesting. Perhaps the commonest cause of damage to the phrenic nerve, i.e., the effect of local myocardial cooling by ice slush, and the mode of phrenic nerve protection have been studied in considerable detail. The authors focused their attention on the interrelation between the phrenic nerve and the proximal segment of the mammary artery. Using anatomical preparations, the authors demonstrate the very intimate relationship of the above entities. The interrelation of the two anatomical structures basically differs depending on whether the left or right side is concerned. 1) On the left: The phrenic nerve, on entering the thorax, runs between the subclavian artery and vein laterally from the mammary artery crossing it medially; it parts the latter and continues in mediastinal adipose tissue to run on the pericardium toward the diaphragm. 2) On the right: The phrenic nerve passes between the subclavian vein and artery medially from the mammary artery. For another 3-4 cm, it runs along the medial and dorsal edges of the mammary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

[A combination of normal physiologic management of delivery and epidural analgesia]. / Monosti kombiance fyziologického vedení porodu a epidurální analgezie.

From the anaesthesiological aspect the authors recommend the method of loss of resistance during verification of the epidural space as a safer method (lower percentage of perforations of the spinal dura mater). At the mentioned concentrations and dosage the authors did not observe any motor disorders of the lower extremities. The assembled experience with a combination of physiological delivery with emphasis on the second stage of labour and epidural analgesia justify not only the statement that this combination is possible but that it is favourable for mother and foetus. The combination reduces considerably the disadvantages of both types of management of labour, it used isolated. It puts, however, much greater demands on the staff and the costs are higher. These disadvantages should, however, not influence humanitarian trends in obstetrics.

[Surgical therapy of serious heart rhythm disorders]. / Chirurgická lécba závazných poruch srdecního rytmu.

The author summarizes his experience with operations in 40 patients. Twenty-one were operated on account of W-P-W syndrome, 9 on account of ventricular tachycardia due to IHD and in 10 patients an automatic defibrillator was implanted. None of the patients died and the results of surgery are satisfactory.

[Reconstructive surgery of the aortic valve in rheumatic stenoses]. / Plastika aortální chlopne pri revmatické stenóze.

Recently the number of plastic operations of the cardiac valves is increasing. The authors present an account on 10 patients with stenosis of the aortic valve where they performed a reconstruction without the necessity of a prosthesis. Commissurotomy and rasping can be performed in patients when the basic anatomical shape and dimensions of the valve are preserved. None of the patients died, one was successfully reoperated on account of aortic insufficiency. The authors describe and discuss the tactics and technique of the operation. They discuss the possibility of reconstruction of the aortic valve in patients indicated for aortocoronary reconstruction where the aortic defect appears to be of minor impact.

[Techniques, tactics and organizational aspects of distant procurement of donor hearts for transplantation. Experience at the Department of Cardiovascular and Transplantation Surgery of IKEM with 100 distant procurement of donor hearts]. / Technické, taktické a organizacní aspekty vzdáleného odberu dárcovského srdce k transplantaci. (Zkusenosti KKTCH IKEM se 100 vzdálenými odbery srdce)

Transplantation of the heart is currently an accepted therapeutic method. One of the factors which have an adverse effect on its availability is shortage of suitable donors. Distant procurement of hearts helps to extend the number of organs for transplantations. The authors present their experience with distant procurement of donor hearts performed during more than three years. They evaluate the influence of cold ischaemia time of the cardiac graft on early results of cardiac transplantations. In the discussion they try to draw attention to some problems associated with this technique for other organ retrieval teams participating in multiple organ procurement.

[Techniques and tactics in multiorgan harvesting]. / Technika a taktika multiorgánového odberu.

The eighties and nineties are characterized by potent development of transplantology. Despite this the number of patients with organ failures waiting for a suitable organ is steadily increasing. Due to the permanent shortage of donors transplantation surgery tries to implement the maximum possible multiple organ collection. In the conclusion the authors emphasize the importance of satisfactory cooperation of the anaesthesiologist attending donors and the organ collection teams.

The International E-vita Open Registry: data sets of 274 patients.

AIM: After the introduction of the hybrid stent-graft "E-vita-open" by the Essen group in 1/2005 for one stage repair of complex thoracic aortic disease, the International E-vita open Registry was founded in 2008 to study the principles of this treatment algorithm and to control reported favorable single center results on a large patient data set basis up to six years after the first clinical implant. METHODS: Retrospective data work-up after prospective data acquisition was achieved by institution of the International E-vita open Registry with anonymous registration and calculation at Essen University Hospital. From January 2005 to December 2010, 274 patients (mean age 60; 74% males) with complex aortic disease, 190 with aortic dissection (88 acute (AAD), 102 chronic aortic dissection (CAD), and 84 with complex thoracic aortic aneurysm (TAA) were included in the studied. RESULTS: Eighty-one out of 274 (30%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (238 total, 36 subtotal) was performed under selective antegrade cerebral perfusion (75 min mean). Cardiopulmonary bypass (CPB) and cardiac arrest times were mean 235 and 134 minutes, respectively. In-hospital mortality was 15% (40/274), 18% for AAD, 13% for CAD, and 14% for TAA. New strokes were observed in 6% (16/274), spinal cord injury in 8% (22/274). The false lumen (FL) was evaluated throughout the first hospital stay and at a median follow up time of 59 months after surgery. From the first follow up CT-examination to the last, thoracic complete FL thrombosis increased from 83% to 93% in AAD, from 72% to 92% in CAD. Full exclusion of the aneurysmal disease was achieved in 77% (61/79) during the primary hospital stay. CONCLUSION: Favorable single center results could be confirmed by an International community of cardiac surgical centers in regard to hospital mortality and morbidity, as well as a low postoperative complication rate and exclusion of false lumen in aortic dissection.

Effect of ethanol on the urinary excretion of mandelic and phenylglyoxylic acids after human exposure to styrene.

Administration of ethanol in several doses during human exposure to styrene can inhibit the urinary mandelic and phenylglyoxylic acid excretion in a way similar to that reported when ethanol was administered as a single dose. Sensitivity to this inhibitory effect has been found to differ with individual subjects. Differences in long-term consumption of ethanol resulting in different induction of the oxidizing enzymes are suggested to account for this finding. Intra-individual variation in the influence of acute ethanol ingestion on the excretion rate of the mentioned acids can also occur. The habit of drinking ethanol might be important, even for partial redirection of the styrene metabolism from styrene glycol oxidation to styrene glycol conjugation with beta-glucuronic acid and/or sulfate. The consequences of these observations for the occupational hygiene practice are briefly outlined.