Spontaneous detumescence and full restoration of erection in a patient with high-flow priapism with persistent arterial-lacunar fistula after repeated selective embolisation-A case report.

High-flow priapism is a rare condition mainly caused by perineal trauma. Laceration of cavernosal artery results in a formation of arterial-lacunar fistula with unregulated blood flow causing prolonged erection. We present a case of a 25-year-old man with high-flow priapism and concurrent erectile dysfunction treated with repeated selective embolisation with only a partial effect. When no further embolisation was possible, we assumed on conservative management even through the fistula was still present. Spontaneous detumescence occurred 9 months, and erectile function has fully restored 24 months after the injury. To the best of our knowledge, spontaneous detumescence with full restoration of erection even through the persistent arterial-lacunar fistula has not been reported previously. Therefore, we propose conservative approach after embolisation to be an option.

[Late hematogenous infection of prosthetic joint]. / Pozdní hematogenní infekce kloubních náhrad.

The importance of prevention in late hematogenous infection is well understood but, because responsibility lies with general practitioners and other specialists, the orthopedic surgeon is usually not much interested. In both our and other countries, discussions are taking place on whether and to what extent antibiotic prevention should be carried out. Antibiotic prophylaxis of hematogenous infection is not indicated for all patients with joint arthroplasty, but only for a limited, defined group of patients at high risk. In these, however, the present state of knowledge suggests that prevention is necessary. A preventive treatment of late hematogenous infection is used for a procedure or a disease associated with risks in all the patients involved within two years of prosthetic joint implantation and, after this period, only in immunosuppressed patients. Surgery on the urogenital tract associated with the risk of bacteremia includes prostate gland surgery, operations for urinary bladder tumors, nephrolithotomy, extracorporeal lithotripsy and prostate biopsy. Certain conditions, such as urinary catheter presence, intermittent catheterization, urethral stent presence, urine retention and a history of urinary tract infection or prostate inflammation, pose an increased risk of bacterial colonization for the urogenital system. Dental procedures associated with a risk of bacteremia include tooth extraction, surgery on the parodontium, surgical extraction of an impacted tooth, dental implant treatment, procedures in a tooth's apical region, initial application of an orthodontic apparatus, intraligamentous blocks and also cleaning teeth and implants expected to bleed. Gynecological surgery with a risk of bacteremia are abdominal, vaginal and laparoscopic hysterectomies, surgery for cancer contaminated with vaginal bacteria, reconstruction surgery, operations on the pelvic floor for defects associated with urinary incontinence and use of xenotransplants. In obstetrics, a cesarean section carries some risks. In general surgery, the preventive administration of antibiotics is indicated, apart from situations always requiring antibiotic therapy, also for advanced forms of acute appendicitis, perirectal abscess, invasive endoscopy procedures on the colon, soft tissue phlegmona or abscess, surgical treatment of venous ulceration and pressure sores, and limb amputation. When inserting any piercing in patients with joint replacement at risk, it is recommended to do it with antibiotic administration; also, it is necessary to responsibly treat any inflammatory complication. The system of prevention for the late hematogenous infections of prosthetic joints is not developed as thoroughly as, for instance, it is in cardiology for patients with valve reconstruction. Because of the reasons given above, it is advisable to set up unambiguous guidelines for the prevention of late hematogenous infection in patients with joint replacement.

[Late hematogenous infection of prosthetic joints in our patients and proposal for a system of prevention]. / Výskyt pozdní hematogenní infekce kloubních náhrad v nasem souboru a návrh systému prevence.

PURPOSE OF THE STUDY: To design a prophylactic strategy for late hematogenous infection is not an easy task. It requires the assessment of risk factors for the patient as well as of a potential source of bacteremia. Cost effectiveness, efficacy of the antibiotic selected and complications associated with antibiotic treatment, such as allergic reactions and development of resistance to the antibiotic given, should also be considered. The aim of this retrospective study is to evaluate the occurrence of late hematogenous infection in our large group of patients, to analyze risk factors and to suggest an optimal system of antibiotic prophylaxis in order to prevent the development of this unwelcome complication. MATERIAL AND METHODS: Since our objective was to include a large number of patients, a retrospective study was chosen as the method used. The patients treated for infectious complications of total joint replacement at the 1st Department of Orthopaedics, Teaching Hospital in Motol, 1st Faculty of Medicine, Charles University, in the years 1991 through 2004, were evaluated with the use of a targeted questionnaire and complete medical records. The group comprised 229 patients, 149 women and 80 men. Of these, 123 were treated for infection of total hip replacement, 102 for total knee replacement, two had infection of prosthetic shoulder joints and two had infection of elbow joint alloplasty. RESULTS: Medical history of 37 patients (16.3 %) included infection of or a risk-associated procedure on the urogenital system (endoscopic or open surgery, prostate gland biopsy, extracorporeal lithotripsy). Six patients (2.6 %) underwent surgery with possible bacteremia (intestine resection for tumor, 2x; surgery for paronychium, 2x; cholecystectomy, 1x; and appendectomy, 1x). Dental surgery or mouth disease was recorded in 11 patients (4.8 %). DISCUSSION: The authors suggest that the orthopedic surgeons performing joint replacement should assume their deal of responsibility and should provide relevant, comprehensive information to both the patient and the attending physician. These surgeons should be ready to remain involved in their patients' further therapies and, after assessing all risks, should be able to recommend an optimal prophylactic treatment. The introduction of a new preventive approach requires a simple and uncomplicated scheme. Any complicated and expensive system of preventive antibiotic administration will only meet with lack of understanding and with trivialization. The requirement that antibiotic treatment should be selected according to the site and type of risk-associated disease is logical, but, in our opinion, rather formal and unrealistic. The authors prefer a simple system permitting a rapid and overall introduction of preventive measures. CONCLUSIONS: The groups of patients indicated for prevention of late hematogenous infection of prosthetic joints are clearly defined and, by no means, do they involve all patients with total joint replacement. Key words: prosthetic joint, infection, prevention, antibiotics, complication.

[Our experiences with surgical treatment of iatrogenic colon perforation]. / Unsere Erfahrungen mit der chirurgischen Behandlung der iatrogenen Perforation des Dickdarms bei elektiver Koloskopie.

Coloscopy is a routine examination of high effectiveness. From the surgical point of view it has two main risks. The first one is the bleeding after endoluminal polypectomy. The other one is the perforation of the gut which is a severe and possibly lethal complication. We report on 6 iatrogenic colon perforations and its outcome.

[Laparoscopic extirpation of the rectum--initial experience]. / Laparoskopická exstirpace rekta--nase první zkusenosti.

Laparoscopy is still more and more widespread in surgery. It's advantages and disadvantages are still evaluated. It is very complicated to evaluate positive and negative characteristics of laparoscopy. Only to make the indication case to case is the correct approaches in using laparoscopy in abdominal surgery.

[A rare case of necrotizing fasciitis and subsequent sepsis with multiorgan failure caused by Vibrio vulnificus]. / Vzácný prípad nekrotizující fasciitidy a následné sepse s multiorgánovým selháním zpusobený agens Vibrio vulnificus.

The authors report a rare case of necrotizing fasciitis, sepsis caused by a strain of Vibrio vulnificus rare in Czech Republic.

[Severe sepsis with organ failure in necrotizing fasciitis of the right leg caused by infection with Vibrio vulnificus]. / Tezká sepse s orgánovým selháním pri nekrotizující fasciitide pravého bérce vyvolané infekcí Vibrio vulnificus.

Vibrio vulnificus is a human pathogen which can cause the septicemia and necrosis of the soft tissue, especially fasciitis. The occurrence is most common in the summer, the source of infection can be sea water or the sand on the beaches, however the infection after eating seafood was described as well. The patient with predominant liver dysfunction are more often affected. The clinical course is characterized by severe sepsis, and massive skin lesion. The mortality more than 60% is reported. This case report describes the course of disease in 64 year old patient, who has spent his vacation in Bulgaria. After return he was admitted with severe sepsis with multiorgan failure and despite the intensive therapy and high amputation of the limb which was performed, the patient died.

[Fasciocutaneous flaps]. / K problematice fasciokutánních laloku.

Fasciocutaneous flaps proved useful for covering soft tissue defects in the region of the leg. After experience with the use of these flaps in six patients the authors recommend this method for covering these defects. In all patients very satisfactory results were achieved.