[Traumatic rupture of the pericardium--the source of massive haemothorax, a case report]. / Traumatická ruptura perikardu--zdroj masivního hemotoraxu, kazuistika.

Extensive traumatic haemothorax is a life-threatening condition that requires the surgeon's resolute approach. Massive bleeding may first lead to hypovoleamic shock, then to haemorrhagic shock. The most common sources are bleeding from the chest wall (intercostal artery), bleeding when the lung parenchyma or major intrathoracic vessels are injured. The case report describes a rare case of massive right-sided haemothorax in pericardial rupture with cardiac herniation in a patient with polytrauma when the source of bleeding was artery pericardium. The report draws attention to the treacherousness of the diagnosis in a polytraumatised patient; the report retrospectively evaluates the interpretation of imaging examinations that were carried out

[Peroperative detection of pulmonary lesions during mini-invasive surgery]. / Peroperacní detekce plicních lézí pri mininvazivní operative.

Currently, peroperative palpatory examination of the lungs represents standard method, however the development of the new mini-invasive surgery techniques devoid of palpable facilities, demands utilization of different procedures. The authors present their experiences involving detection of pulmonary lesions during thoracoscopic surgery visually, by endoscopic instruments, preoperative dye marking and peroperative ultrasonography via an endoscopic ultrasonic probe (all performed in Liberec District Hospital a.s.). The article describes operation techniques and tactics of thoracoscopic surgeries performed with pulmonary pathological processes in both subpleural and pulmonary parenchyma locations.

[Right-sided posttraumatic ruptures of the diaphragm]. / Pravostranné úrazové ruptury bránice.

The diaphragm is the main respiratory muscle. It has the most significant function in respiratory excursions and the ability to maintain the negative thoracic pressure. Diaphragm injuries are relatively rare and they are the result of blunt or, in our conditions less often, penetrating thoracoabdominal trauma. (The ratio of blunt traumas to penetrating ones is 9:1). The diaphragmatic injuries in blunt injuries occur as a result of the increased pressure gradient between the pleural and peritoneal cavity [1]. The first description of traumatic diaphragm rupture is ascribed to Sennertus from 1541. Other sources award the primacy to the French royal surgeon A. Pare in 1579 [2]. It is similar to the primacy of the surgical repair of diaphragmatic injuries. Rioffi in 1886 [3] versus Naumann in 1888 who operated on traumatic herniation of the stomach into the left chest cavity [2]. Diaphragmatic injury diagnosis is difficult even today [4]; up to 10-50% of cases are not recognized in time. Left-sided traumatic lesion of the diaphragm occurs in 80-90% of cases. Our paper focuses on the specifics of right-sided diaphragm ruptures where the protective ability of the liver is probably reflected.