Developing a core outcome set for clinical trials in olfactory disorders: a COMET initiative.

STATEMENT OF PROBLEM: Evaluating the effectiveness of the management of Olfactory Dysfunction (OD) has been limited by a paucity of high-quality randomised and/or controlled trials. A major barrier is heterogeneity of outcomes in such studies. Core outcome sets (COS) - standardized sets of outcomes that should be measured/reported as determined by consensus-would help overcome this problem and facilitate future meta-analyses and/or systematic reviews (SRs). We set out to develop a COS for interventions for patients with OD. METHODS: A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders' views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed patients and healthcare practitioners to individually rate the outcomes in terms of importance on a 9-point Likert scale. RESULTS: After 2 rounds of the iterative eDelphi process, the initial outcomes were distilled down to a final COS including subjective questions (visual analogue scores, quantitative and qualitative), quality of life measures, psychophysical testing of smell, baseline psychophysical testing of taste, and presence of side effects along with the investigational medicine/device and patient's symptom log. CONCLUSIONS: Inclusion of these core outcomes in future trials will increase the value of research on clinical interventions for OD. We include recommendations regarding the outcomes that should be measured, although future work will be required to further develop and revalidate existing outcome measures.

Position paper on olfactory dysfunction: 2023

BACKGROUND: Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. CONCLUSIONS: We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.

Massive intrathoracic haemorrhage as a complication of pulmonary parenchymal haemorrhage and anticoagulant treatment of lung embolization during COVID-19 - two case reports.

INTRODUCTION: The medical and social interest in the SARS-CoV-2 infection is currently high. This infection can, in severe cases, be accompanied by a series of complications, such as thromboembolic disease or pulmonary parenchymal haemorrhage. CASE REPORTS: The paper presents two rare cases of massive intrathoracic haemorrhage caused by pulmonary parenchymal haemorrhage and exacerbated by full anticoagulant treatment of thromboembolic disease. RESULTS: In both cases, the haemorrhage originated in the left lower lobe and was life threatening, requiring urgent anatomical lung resection - left lower lobectomy. CONCLUSIONS: The combinaion of anticoagulant therapy and thromboembolic events related to COVID-19 can cause, in rare cases, massive pulmonary haemorrhage. This rare complication proved lethal in one out of two of the cases described in this paper. An imminent and adequate reaction is necessary when the first signs of haemorrhage appear.

Delayed diagnosis of diaphragmatic rupture after blunt chest trauma - 2 case reports.

INTRODUCTION: Diaphragmatic rupture is a rare but life-threatening condition that occurs in 0.85% of surgically managed thoracoabdominal injuries. In most cases, the condition is accompanied by associated traumas responsible for poor prognosis. Signs of diaphragmatic rupture are often masked by more serious manifestations of the associated trauma. The rupture is usually revealed by an X-ray of the chest or CT scan. However, a minor defect may be missed, especially if the patient is not indicated for urgent surgery. METHODS: The authors present 2 case reports of patients treated for chronic diaphragmatic rupture at the Department of Surgery of the Faculty of Medicine, Charles University and University Hospital in Pilsen between 01 January 2009 and 31 December 2021. The aim was to analyze the clinical data and to compare this data with literature. RESULTS: Both patients with the chronic diaphragmatic rupture were men in their productive age. The mechanism of their primary trauma was a traffic accident. In the first case, the rupture was diagnosed 6 years after the trauma. The second case was diagnosed 14 years after the primary trauma. The diaphragmatic rupture was present on the left side in the first case and on the right in the other. Both patients underwent suture of the diaphragmatic defect via thoracotomy. CONCLUSION: Unrecognized diaphragmatic rupture is a severe condition that can result in a life-threatening complication, namely incarceration of abdominal organs dislocated to the chest. It is necessary to keep this diagnosis in mind in patients with gastrointestinal or respiratory problems after a previous high-energy, blunt-force abdominal and thoracic injury, even many years after the trauma.

The risk of thromboembolism in relation to in vitro fertilization.

OBJECTIVE: Summary of available literature concerning recommendation of antithrombotic prophylaxis in the infertility treatment by in vitro fertilization (IVF) and in pregnancies after IVF. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc; Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc. METHODS: Analysis of literary sources and databases Medline, Web of Science, Scholar Google, 2010-2018. CONCLUSION: The incidence of thromboembolism in the first trimester of pregnancy after IVF is 0.2% e. g. 10-times higher compared to normal pregnant population. Pregnancies after IVF are complicated in 6-7% by ovarian hyperstimulation syndrome (OHSS), they then have the risk of venous thromboembolism (VTE) 1.7% in the first trimester, what is 100-times higher as compared to the general population. Women after IVF without OHSS have a 5-times higher risk of VTE compared to the general population. To lower the risk of thromboembolism during treatment, use of low dose gonadotrophin (mild) stimulation protocols, prioritization of antagonistic stimulation protocols, avoidance of OHSS using GnRH agonists instead of hCG, cryo embryotransfer in natural cycles, reduction of incidence of multiple pregnancy by single embryo transfer, use of prophylactic and therapeutic low molecular weight heparin (LMWH) is recommended. These strategies can reduce the risk of thromboembolism. The LMWH application is suitable in pregnant women in the first trimester of pregnancy after IVF where OHSS was present.

The role of mesenchymal-epithelial transition in endometrial function and receptivity.

OBJECTIVE: During reproductive age of a woman, endometrium undergoes frequent stuctural and functional changes. Abilities of regeneration, remodelation and differentiation are precondition of endometrial receptivity and implantation and development of an embryo. These processes are conditioned by mutual transformation between mesenchymal and epithelial fenotype of endometrial cells: epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET). The aim of this study is to present contemporary knowledge of transformation between epithelial and mesenchymal endometrial cells and its influence on human fertility. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk university and University Hospital Brno; Department of Obstetrics and Gynecology, University Hospital Faculty of Medicine, Palacky University, Olomouc. METHODS: PubMed was searched for articles in English indexed until February 2019 with terms of „endometrial receptivity“, „embryo implantation“, „endometrial regeneration“, „mesenchymal-epithelial transition/transformation“. RESULTS: It has been proved, that mesenchymal stromal cells participate on regeneration of not only the endometrial stroma, but also of the epithelium. During endometrial decidualisation under influence of ovarian steroids, the MET is under way. Stromal fibroblasts gain the morfological and functional properties of epithelial cells. During implantaion of an embryo, the trofoblast interacts with decidualised endometrium. Epithelial cells transform into mesenchymal (EMT), which mediate the growth of trofoblast. CONCLUSION: Mutual transformation between stromal and epithelial cells in essential for normal function of endometrium and implantation and development of an embryo.

Therapy of liver cysts - experience of the Department of Surgery, University Hospital in Pilsen 20092018.

INTRODUCTION: Liver cysts are present in about 5% of the population and are asymptomatic in most cases. Currently, liver cystic lesions are disco-vered arbitrarily during imaging assessments of the abdomen indicated for unrelated reasons. The final findings vary from solitary cysts to multiple lesions or eventually the polycystic liver disease which can result in liver transplantation. Most cases are congenital. In the case of a symptomatic manifestation, pressure pain in the upper right quadrant is the predominant symptom. The therapy is surgical; laparoscopic approach is preferred. METHODS: A retrospective evaluation of the sample of 55 patients was conducted. The patients had been surgically treated at the Department of Surgery, University Hospital in Pilsen, from 01 Jan 2009 to 21 Dec 2017. The evaluation covered basic demographic data, the size of the dominant cyst, complications, hospitalization length, any relapse of the disease, etc. Results: In the presented period 62 surgeries of symptomatic liver cysts were performed, 55 of them by laparoscopy. The mean age of the patients was 61.7 years (32-83 years), women predominated (N=54, i.e. 87.1%). Complications occurred in 8 patients (12.9%); the most common was a bile leak. The mean length of hospitalisation was 4.5 days (2-20 days). In the follow-up period, 41 patients (66.1%) remained without any recidivism. CONCLUSION: Currently, the treatment of symptomatic liver cysts is laparoscopic, with fenestration being the standard approach. Due to potential complications centres with experience in liver surgery are prioritized.

Implantation and diagnostics of endometrial receptivity.

OBJECTIVE: Literature review of endometrial receptivity in embryo implantation and its diagnostic possibilities. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Palacky University, Olomouc; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc. RESULTS: Endometrial tissue is very dynamic, undergoing cyclic proliferation, differentiation and cell transportation, especially of immune system cells under the influence of circulating estradiol and progesterone. Endometrial remodelling during embryo implantation is controlled by decidual cells senescence and effectivity of their immunologic destruction. Endometrial receptivity can be assessed by transcriptomic profiling of endometrial biopsy using ERA system or proteomic analysis of either endometrial secretome or cervical mucus by gel electrophoresis (DIGE) or mass spectrometry (MS). CONCLUSION: With respect to recent discoveries in endometrial physiology and molecular biology, clinical application of proteomic approaches in research of potential biomarkers of endometrial receptivity could be of interest.

Robot assisted laparoscopic abdominal cerclage: two case reports.

OBJECTIVE: In this work we report the first use of robot-assisted preconceptual abdominal cerclage in the Czech Republic with subsequent live birth. We present two patients with a history of late pregnancy losses (late miscarriage) who underwent robotic abdominal cerclage. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký Univesity, Olomouc. METHODS: The da Vinci S surgical system was used for the robot-assisted abdominal cerclage. RESULTS: One robot-assisted laparoscopic transabdominal cerclage patient delivered at term a live infant and the second patient currently undergoes infertility treatment with in vitro fertilization. CONCLUSION: Robotic abdominal cerclage is a relatively new minimally invasive method for treatment of cervical insufficiency. This technique provides 3D visualization and better instrumentation than the conventional laparoscopic approach.

[Various approaches of endometrial preparation for frozen-thawed embryo transfer]. / Moznosti prípravy endometria ke kryoembryotransferu.

OBJECTIVE: Various approaches of endometrial preparation for frozen-thawed embryo transfer. DESIGN: Retrospective analysis. SETTING: Department of Obstetric and Gyneacology, Faculty of Medicine, Palacky University, University Hospital Olomouc. METHODS: Effectivity of frozen-thawed embryo transfers was carried out between January and August 2017 in the IVF unit at the University Hospital Olomouc. Results were compared among groups A, B, C with various approaches of endometrial preparation. Group A - natural ovulating cycle, group B - artificial cycle with oral estrogen, vaginal gestagen and group C - artificial cycle with transdermal estrogen and vaginal gestagen. One blastocyst (two blastocyst in five cycles) was transferred on day 6 post ovulation (group A) or after 6 days of using gestagens (group B, C). RESULTS: The highest pregnancy rate was observed in group C (56%), similar pregnancy rate was found in group B (52%) and the lowest was seen in group A (22%). All pregnancies in group A continued over 12 weeks, in group B continued 57 percent and in group C continued 56 percent of pregnancies. CONCLUSION: Frozen-thawed embryotransfers in natural cycles are highly time-consuming. Our study has demonstrated the lowest effectivity of frozen-embryotransfer in natural cycles. Artificial cycles managed by oral or transdermal form of estrogen have shown better results.

Pleural empyema - single center experience.

INTRODUCTION: Retrospective analysis of a group of patients treated for pleural empyema in the Department of Surgery, University Hospital Pilsen, over the last ten years. METHOD: We evaluated a group of patients treated for pleural empyema in the Department of Surgery, University Hospital in Pilsen, during the period 2007-2016. We focused on the demographic data of this group, the causes of empyema in these patients, surgical procedures performed in connection with empyema, the microbial species found in empyema, and, last but not least, on morbidity and lethality. RESULTS: We treated 103 patients with pleural empyema during the above period - 80 men (77.7%) and 23 women (22.3%) aged 23-83 years (average age 59.4 years). 64 patients had a history of surgical or invasive procedure (62.1%). The length of history was traceable in 55 patients (53.4%) and was 23.1 days on average, remaining unclear in the rest of the group. 1/3 of cases were metapneumonic empyemas, 1/3 postoperative empyemas and 1/3 of the cases were due to other reasons. The most commonly cultivated bacterial genus was Streptococcus, species Staphylococcus aureus. The most common surgery was chest drainage (51%). 13 patients died (lethality 12.6%) after surgery, the most common cause of death being sepsis; postoperative morbidity was 34%. CONCLUSION: Pleural empyema is a serious condition with very high morbidity and lethality. Surgical procedures done to manage empyema are associated with a very high risk of necessary reoperation. Positive mycological culture from empyema seems to be associated with a higher risk of complications and death. Key words: empyema - thoracic drainage - thoracotomy - lung decortication - videothoracoscopy.

Splenectomy in patients older than 65 years - a single-center experience.

INTRODUCTION: Despite current efforts at the most conservative approach possible to splenic injury, splenectomy remains a relatively common surgical procedure. Indications for splenectomy, however, are not limited to spleen injury. In senior patients in particular, non-traumatic reasons for splenectomy becomemore frequent. In addition, previous studies have indicated a relatively wide range of complications and lethality in splenectomized patients without taking into account the age aspect. Within the scope of geriatric surgery, this study deals with splenectomy in elderly patients and is based on retrospectively evaluated experience of our clinic. METHOD: We studied a group of patients older than 65 years having undergone splenectomy at our institutionover the past 11 years. For each patient, the demographics, the reason for splenectomy, the mechanism of injury (if any), the degree of spleen damage, co-morbidities, the length of hospital stay, complications and lethality were evaluated. A group of patients operated on due tospleen trauma and the other group operated on for other reasons were analysed separately. Attention was paid to the reasons leading to splenectomy in the non-traumatic patients. Complications and lethality rate were evaluated in relation to the individual patient groups. RESULTS: 269 splenectomies were performed in our clinic between 2006 and 2016. Of these, only 57 (21.2%) were carried out in patients older than 65 years (32 men and 25 women aged 6590, mean age 73.6). Splenectomy was even rarer in association with splenic trauma:it was performed in only 13 senior patients. Other causes leading to splenectomy in elderly patients were: perioperative spleen injury (17 patients), gangrene, septic activation or spontaneous rupture of the spleen (10 patients), splenectomy during an operation on another organ (8 patients), splenomegaly (5 patients) and splenic artery aneurysm (4 patients). Lethality in the entire group was 29.8%, the percentage of complications was 57.9%; however, circumstances leading to splenectomy and also potential co-morbidities played a significant role. The average length of hospitalization in the entire group was 20.3 days. CONCLUSIONS: Splenectomy in patients over 65 years of age is associated with a high risk of complications and very high lethality. However, senior patients after splenectomy for monotrauma and those after elective splenectomy have a very good prognosis. Key words: geriatric surgery splenic rupture - splenectomy.

Can the One-Step Nucleic Acid Amplification method of lymph nodes examination make the staging of pulmonary tumours more precise?

INTRODUCTION: The aim of this article is to compare the sensitivity of detecting micrometastases in hilar and mediastinal lymph nodes in case of primary (non-small cell) and secondary (metastases of colorectal carcinoma) pulmonary tumours using standard histopathological examination with haematoxylin-eosin staining, immunohistochemistry examination with Anti-Cytokeratin 19 antibody and examination based on the One-Step Nucleic Acid Amplification method. METHOD: During radical surgical treatment of primary non-small cell lung carcinoma and pulmonary metastases of colorectal carcinoma, hilar and mediastinal lymph nodes of 100 patients enrolled in the study in the period from 2015 to 2017 were extracted based on a standard classification. These lymph nodes were subsequently divided along the longitudinal axis into 4 identical parts where part one and three on the left were intended for examination based on the One-Step Nucleic Acid Amplification method, whereas parts two and four were subjected to histopathological examination. In evaluating the respective parts of the nodes by histological examination, the nodes were first examined by a standard procedure that involves haematoxylin-eosin staining, followed by immunohistochemistry examination with Anti-Cytokeratin 19 antibody. The One-Step Nucleic Acid Amplification method was performed in the kit supplied by Sysmex (Kobe, Japan) and is based on the detection of cytokeratin 19 mRNA (messenger ribonucleic acid) by reverse transcription coupled with isothermal amplification. RESULTS: A total of 1,426 lymph nodes of the patients enrolled in the study were extracted and examined using the above mentioned methodology. In 78 patients (78%), identical results were obtained using haematoxylin-eosin staining, immunohistochemistry with Anti-Cytokeratin 19 and One-Step Nucleic Acid Amplification. Micrometastases in the lymph nodes using the One-Step Nucleic Acid Amplification method in the absence of the other methods were proven in 16 patients (16%). Only in 3 cases (3%), the examination by haematoxylin-eosin staining, or immunohistochemistry with Anti-Cytokeratin 19, was positive while One-Step Nucleic Acid Amplification was negative. The results obtained by immunohistochemistry with Anti-Cytokeratin 19 antibody were practically the same as those obtained by haematoxylin-eosin staining (97%). CONCLUSION: The results of the study have demonstrated a higher percentage of metastases detected in hilar and mediastinal lymph nodes if the One-Step Nucleic Acid Amplification method of examination was used compared to haematoxylin-eosin staining and immunohistochemistry with Anti-Cytokeratin 19 antibody (upstaging in 16%). This shows that the examination of lymph nodes using the One-Step Nucleic Acid Amplification method can have a certain potential to make the pulmonary tumours staging more accurate. On the other hand, immunohistochemistry with Anti-Cytokeratin 19 antibody seems to be not so useful. However, it is necessary to prove this hypothesis in follow-up studies, or where applicable, in a larger cohort of patients. Another task is to ascertain, by careful patient monitoring, the influence of the micrometastases detected in their lymph nodes using the One-Step Nucleic Acid Amplification method on these patients' follow-up. Key words: lung cancer - lymph nodes - H&E - IHC CK19 - OSNA assay.

[Traumatic pneumothorax - diagnosis and treatment of 322 cases over a five-year period]. / Traumatický pneumotorax - diagnostika a lécba 322 prípadu v petiletém období.

INTRODUCTION: Retrospective analysis of a set of patients treated for traumatic pneumothorax in the Trauma Centre of Teaching Hospital in Pilsen over a period of five years. METHOD: In total, 322 patients with traumatic pneumothorax were treated in the study period 20122016. The set included subjects whose injury fell within the definition of traumatic pneumothorax and who underwent either primary treatment or secondary transport to the Trauma Centre following basic treatment in another health facility on the day that the trauma occurred. The exclusion criterion was a pneumothorax <1 cm; in addition, patients with inconclusive findings from imaging screening were not included in the set. Basic demographic information, the mechanism, type and laterality of the traumatic pneumothorax, the Injury Severity Score, associated injuries, diagnostic procedures, timing, method and outcome of the treatment, as well as any complications and reoperations, were identified in the set. Other assessed information included deaths of patients with traumatic pneumothorax, including the cause and time of death in relation to the time of admission to the Trauma Centre. RESULTS: The vast majority of traumatic pneumothoraces (94.1%) occurred as a result of blunt chest trauma, car accidents being the most common mechanism (about 28%). Closed pneumothoraces dominated (91.3%). Traumatic pneumothorax was part of a polytrauma in about one half of the injured. The average Injury Severity Score within the set was 20 points. Traumatic pneumothorax was diagnosed in more than three quarters of the patients based on clinical examination and computed tomography. The most common therapeutic procedure was drainage of the relevant pleural cavity (259 patients - 80.5%). Almost two thirds of surgical procedures were carried out within 1 hour of admission to the Trauma Centre. Complications associated with traumatic pneumothorax treatment were reported in 10.2% of the cases, and 33 reoperations were carried out. 15 patients (4.7%) in the set died, out of which 12 on the day of the trauma, all of them as a result of decompensated traumatic shock. CONCLUSION: Traumatic pneumothorax is a relatively frequent type of chest trauma found in up to half of the patients with chest trauma as part of a polytrauma. It usually occurs as closed pneumothorax as a result of blunt chest trauma. The diagnostic process is based on clinical examination and chest radiogram. However, ultrasound examination could be an alternative to chest radiogram in emergency situations. Computed tomography is the method of first choice for more serious traumas and inconclusive findings. To manage this condition, proper drainage of the relevant pleural cavity is sufficient in the vast majority of the patients. With timely diagnosis and adequate therapeutic intervention, the prognosis for patients with traumatic pneumothorax is favourable.Key words: traumatic pneumothorax - diagnosis - chest drainage.

[Penetrating chest trauma - experience of the Pilsen University Hospital Trauma Centre]. / Penetrující poranení hrudníku - zkusenosti Traumacentra Fakultní nemocnice Plzen.

INTRODUCTION: Retrospective analysis of a set of patients treated for penetrating chest trauma in the Trauma Centre at University Hospital Pilsen over seventeen years. METHOD: Overall, 96 injured with penetrating chest trauma were treated in the study period 2000-2016. Basic demographics, the mechanism, type, location and extent of the penetrating chest trauma, Injury Severity Score, existence of associated injuries, diagnostic procedures, timing and method of the chest trauma treatment as well as any complications and reoperations were identified in the set. Other collected information included deaths of the injured, and the cause and time of death in relation to the time of admission to the Trauma Centre. RESULTS: The most common mechanism of injury was attack by a stabbing weapon (54%) and the most common type of injury was pulmonary laceration (33%). The average Injury Severity Score within the set was 24 points. The most common therapeutic procedure was pleural cavity drainage (47 patients), and less than 40% of the cases required revision surgery by means of thoracotomy or sternotomy. One patient died immediately after being admitted to the Trauma Centre without a chance to apply any therapy; three other patients died during resuscitative thoracotomy or laparotomy. Post-operative complications occurred in 13 patients (13.5%) and required 14 reoperations. CONCLUSIONS: The diagnostic and therapeutic algorithm of penetrating chest trauma is primarily determined by the condition of the injured. Adequate drainage of the relevant pleural cavity is sufficient to treat one half of the patients; on the other hand, 40% of traumas, injuries of the heart, large vessels and gunshot wounds in particular, require urgent revision surgery by means of thoracotomy or sternotomy. If the injured patient is transported to a specialized centre for timely treatment, the prognosis of penetrating chest traumas is quite favourable.Key words: penetrating chest trauma - diagnosis - chest drainage - thoracotomy - sternotomy.

Position paper on olfactory dysfunction.

BACKGROUND: Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies. CONCLUSIONS: We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.

[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience]. / Poranení hrudníku a jeho operacní lécba u polytraumatizovaných nemocných v petiletém období.

UNLABELLED: PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma patients died within 24 hours of injury (61.5%). CONCLUSIONS Chest injury, almost always blunt, is often diagnosed in polytrauma patients. A prevalent cause of multiple trauma is a traffic accident. Chest injury most frequently involves pulmonary contusion. Nearly half of chest injuries require surgery, of which 2/3 are urgent procedures. The procedure most frequently performed in polytrauma patients with chest injury is chest drainage and this is also a sufficient procedure in 75% of surgically treated patients. KEY WORDS: polytrauma, chest injury, pulmonary contusion, surgical treatment, chest drainage.

[Rare malignant tumors of the appendix: surgical treatment of liver metastases case reports]. / Vzácné maligní nádory apendixu: lécba metastáz do jater kazuistiky.

INTRODUCTION: Tumors of appendix vermiformis are quite rare; they represent only about 0.4% of gastrointestinal tract tumors. They can be both benign and malignant (primary or secondary). Carcinoid is the most common tumor of the appendix. The symptoms can include nothing but non-specific abdominal pain, or on the contrary they can imitate inflammatory acute abdomen. Liver metastases are associated with an advanced stage of malignancy; their surgical treatment is presented rarely in the literature. The aim of this publication is to present two cases with different results of surgical treatment of liver metastases with the primary tumor located in the appendix. CASES: The first patient is a 50 years old female who underwent right hepatectomy for liver metastases of Goblet-cell carcinoid of the appendix in 2013 and died six months later due to tumor progression. The second patient is a 58 years old male, still alive, undergoing repeated liver and lung resections and RFA from 2009 due to metastases from appendix carcinoma. CONCLUSION: Examples of dissemination of malignant appendix tumors to the liver need to be evaluated individually. In indicated cases, surgical treatment of liver metastases is justifiable.Key words: tumors of appendix liver metastases surgical treatment.

[Castleman disease - unusual finding after operation of retroperitoneal tumor of young patient]. / Castlemanova choroba - neobvyklý nález pri operaci tumoru retroperitonea u mladého nemocného.

UNLABELLED: Castleman disease is rare diagnosis. It was first mentioned in literature in 1954 by doctor Castleman and Lown. It is rare sickness which primary affects lymfatic nodes. There are four histo-morfologic subtypes and two clinic manifestations (uni and mulicentric). Comon clinical picture is simple lymfadenopathy of neck, medistinal a retroperitonal lymfatic nodes. Signs of this disease are heterogenic and depend on histological subtype. Also prognosis depends on type of illness. It should take place as benign diagnosis (unicentric form) but also can be potencionally malignant form which shlould exacerbate to malignant lymfoproliferation (multicentric form). Authors present the case of 29 years old men with clinical manifestation (jundice, intermitent bowel obstruction) of lagre retroperitoneal tumor in subhepatal localization. The treatment was radical surgical extirpation, surgery was without complications. Definitive histological diagnosis was confirmed as hyaline-vascular type of Castleman disease. Because the patient´s clinical form was multicentric, he is now undergoing adjuvant oncological treatment. KEY WORDS: Castleman disease reproperitoneal tumor.

[Combined gunshot injuries of the heart and lungs]. / Kombinierte Schussverletzung des Herzens und der Lunge.

The authors present a case report of a 38-year-old man who suffered combined gunshot injuries of the heart and lungs from a small caliber gun. The gunshot resulted in combined injuries of a penetrating wound of the left lung, the right heart chambers and the right lung which were successfully managed despite a delay in surgery of several hours by pledget sutures of the heart wounds, wedge resection of the lingula and right lower lung lobectomy performed via a clamshell thoracotomy.