[The role of contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT) in the preoperative diagnosis of renal lesions]. / Die Rolle von kontrastmittelverstärktem "pulse inversion harmonic imaging" (CEUS) und kontrastmittelverstärkter Computertomographie (CECT) bei der präoperativen Diagnose von renalen Raumforderungen.

OBJECTIVE: The preoperative assessment of structural and functional changes in renal tumors using contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT). MATERIALS AND METHODS: All consecutive patients referred to two tertiary hospitals for surgery on suspicion of a malignant renal lesion, who had been examined under the predefined study protocol using CEUS and CECT, were prospectively included in the study. All renal lesions suspected of being malignant were subjected to histopathological examination. Lesions expected to be benign were followed up according to the study protocol. The accuracy of CEUS and CECT with the final histology or follow-up results and the statistically significant difference between the two imaging techniques was calculated. RESULTS: Over a period of 3 years (2008-2011), 68 of 93 patients examined met the study criteria. The prevalence of malignant tumors in the study was 72%. Fifty four (79%) patients underwent surgery and had a histologically confirmed renal tumor (clear cell carcinoma 45, urothelial papillocarcinoma 4, angiomyolipoma 1, oncytoma 3, xanthogranulomatous pyelonephritis 1) and 14 (21%) patients underwent regular follow-up. Specificity, sensitivity and area under the curve (AUC) reached 57.9%, 98% and 0.779 for CEUS and 52.6%, 98% and 0.753 for CECT. CONCLUSION: The results show that both imaging methods can reliably rule out malignant disease due to absence of enhancement. Taking into consideration that CEUS can be carried out without severe risk or discomfort, it is time to reconsider CEUS as the method of choice for diagnosis, while CECT should be reserved for staging.

[Mediastinitis after esophageal perforation]. / Mediastinitida po perforaci jícnu.

INTRODUCTION: Assessment of therapy in patients with mediastinal infection resulting from esophageal perforation. MATERIAL AND METHODS: Retrospective (2008-2012) processing of a group of surgically treated patients. The aspects assessed were aetiology, the surgical methods applied and the length of therapy. RESULTS: The total number of patients treated was 16. In 8 cases, the aetiology was iatrogenic (3 cases of leaking esophageal anastomosis in consequence of resection of the esophagus, 2 cases of perforation after fundoplication, 1 case of esophageal cardiomyotomy, and 2 cases of perforation during endoscopy). In 4 patients, the aetiology was spontaneous perforation, impacted foreign bodies caused difficulties to 3 patients, and the last cause was acid corrosive esophagitis. A stent was applied in all the patients at the site of the defect. The mediastinitis was drained through the access from thoracotomy or left thoracolaparotomy, respectively (8 cases), or by combination of laparotomy/laparostomy and pleural drainage (5 cases). Pleural (in 3 cases) and neck (1 case) drainage meant minimum intervention. Esophagectomy was not carried out in any of the patients. 4 patients died. The average period of time for which the stent was left in situ was 53.7 days; the average time of hospitalization in surviving patients was 53.4 days. CONCLUSION: Stent application does not show any difference regarding patients' survival (25% mortality), but enables shortening the total therapy time and, predominantly, preserving the native esophagus.

[Combined procedure of pulmonary resection and radiofrequency ablation of lung tumours - case reports]. / Kombinovaný výkon plicní resekce a radiofrekvencní ablace nádoru plic - kazuistiky.

The authors present two case reports to describe the possibility of performing a combined procedure when dealing with lung cancer in patients who are not indicated for radical surgery. The combination of pulmonary resection and radiofrequency ablation thus opens a new possibility for a quality extension of active life.

[Catamenial pneumothorax - case studies from our department in a ten-year period]. / Katameniální pneumotorax - kazuistiky z vlastního pracoviste v období 10 let.

Catamenial pneumothorax is defined as spontaneous pneumothorax in women of reproductive age occurring in conjunction with the menstrual cycle. The authors present 4 cases of this condition treated in our department during the past ten years. The causes leading to the development of this condition and optimal treatment procedures are also discussed.

[Surgical treatment of pulmonary carcinoids - ten-year results]. / Chirurgische Behandlung von Lungenkarzinoiden - Zehnjahresergebnisse.

INTRODUCTION: Carcinoids are malignant neuro-endocrine tumours occurring in the bronchopulmonary location in about 25 %, and accounting for approximately 2 % of all pulmonary tumours. MATERIAL AND METHODS: Our retrospective analysis included 27  patients, 14  men and 13  women, mean age 58.4  years, treated from 2000 to 2009 for carcinoids in bronchopulmonary locations. The tumour manifested clinically in 52 % of the cases, the most common symptom being cough; one tumour manifested as carcinoid syndrome. All patients underwent fibrobronchoscopy that was positive in 20  cases (74.1 %). Pre-surgery histological diagnoses were made in 13  patients (48.1 %). Chest CT scans were carried out in 26  patients, and the investigation failed to detect the expected pathological process in 2  of the patients. Octreoscans were carried out in 12  patients, and were successful in identifying a primary neuroendocrine tumour in 75 %. RESULTS: All patients in the sample underwent rad-ical surgical therapy; the most common surgical procedure was lobectomy (70.4 %). Perioperative morbidity and mortality were zero. Typical carcinoids were found in 20  cases while 7  cases were atypical carcinoids, 20  tumours were located centrally. 74 % of the tumours were consistent with stage  I A disease. Mean follow-up period was 47 (range: 6-134)  months. Local recurrences were observed in 2  patients (7.4 %), but the tumour disseminated in 4  patients (14.8 %). Two patients (7.4 %) died during the follow-up period. Overall five-year survival in the sample was 92.3 %, 90.9 % in the typical carcinoid group and 100 % for atypical carcinoids. We found a statistically significant association between disease-free interval and histological type of the tumour; the risk of progression was 8  times higher in -patients with atypical carcinoids compared to patients with typical carcinoids (Log-Rank-Test: p-value = 0.0049). CONCLUSION: Radical surgical treatment of bronchopulmonary carcinoids is the optimum therapeutic approach that results in the best results both regarding perioperative morbidity and mortality and regarding long-term survival of the patients.

Importance of miR-20a expression in prostate cancer tissue.

BACKGROUND: MicroRNAs (miRNAs), which are endogenously expressed regulatory noncoding RNAs, have an altered expression in tumor tissues. MiRNAs regulate cancer-related processes such as cell growth and tissue differentiation, and therefore, might function as oncogenes or tumor-suppressor genes. The aim of our study was to assess the expression of mir-20a, let-7a, miR-15a and miR-16 in prostate cancer (PCa) and benign prostatic hyperplasia (BPH) tissue and to investigate the relation between the expression of miRNAs and the clinicopathological features of PCa. PATIENTS AND METHODS: The study group comprised 138 patients: 85 patients with BPH and 53 patients with PCa. The total RNA was isolated from the tissue specimen core and miRNA expressions were quantified using a real-time RT-PCR method (TaqMan MicroRNA Assays). U6snRNA was used for the normalization of the miRNA expression. RESULTS: miR-20a expression was significantly higher in the group of patients with a Gleason score of 7-10 in comparison with the group of patients with a Gleason score of 0-6 (p=0.0082). We found no statistical differences in the miRNA expressions (mir-20a, let-7a, miR-15a and miR-16) in the PCa tissue samples in comparison with the BPH tissue samples. CONCLUSION: Our result shows that the more dedifferentiated PCa cells have a higher expression of miR-20a and this supports the oncogenic role of miR-20a in PCa carcinogenesis. The evaluation of miRNA expression could yield new information about PCa pathogenesis.

[Surgical treatment of liver and pulmonary metastases of colorectal carcinoma]. / Chirurgickái lécba jaterních a plicních metastáz kolorektálního karcinomu.

THE AIM: The aim of the work was to evaluate the set of 10 patients, who were operated on hepatic and pulmonary metastases of colorectal carcinoma at the Surgical Clinic of Medical Faculty of Charles University and Faculty Hospital in Plzen in years from 2005 till 2009. With regard to limited experience with the patients who underwent hepatic as well as pulmonary resection, we focused on the evaluation of a long-term survival of the patients and their mortality and morbidity. THE SET OF THE PATIENTS: In years from 2005 till 12/2009 we operated 10 patients during whose affection there occurred hepatic and pulmonary metastases of colorectal carcinoma and these were solved surgically. This concerned 5 men and 5 women at an average age of 62.4 years (42-71 years). In 10% it was hepatic resection in the first period after the operation of primary carcinoma, it was the first performance on the hepatic parenchyma in 90%. THE RESULTS: Morbidity of the set was 20.1% regarding hepatic resections and 5.6% regarding pulmonary resections. A 30-day postoperative mortality was 0%. In three cases a hepatic involvement was bilateral, in two cases in the left lung and 5 patients had an involvement of the right pulmonary lobe. In 4 cases primary carcinoma was in the rectum and in 6 cases in the large intestine. The period of three months was an average time between hepatic and pulmonary resection. Resection on liver parenchyma was the most often performance and metastasectomy with the help of laser on the pulmonary parenchyma. Rectal carcinoma spread into lungs in 50%. An average time of a 5-year survival in the patients after resection of hepatic and pulmonary metastases of colorectal carcinoma was 26%. THE CONCLUSION: Hepatic and pulmonary resection in the selected patients with generalized colorectal carcinoma extends the period of a survival and does not worsen the quality of the life. The patients after resection of both--hepatic and pulmonary metastases have got a worse long-term survival than the patients being only after hepatic resections.

Differential display code 3 (DD3/PCA3) in prostate cancer diagnosis.

BACKGROUND: Early diagnosis of prostate cancer (PCa) in an organ-confined stage following radical treatment is the only potential curative approach in PCa. Prostatic-specific antigen (PSA) is very helpful in early diagnosis, but the main disadvantage is that it has a low positive predictive value in the range of the grey zone of 2.5-10 ng/mL, which results in a high number of needless biopsies. For this reason, new tests with better parameters are needed. One promising test is that for differential display code 3 (DD3(PCA3)), which is a prostate-specific non-coding mRNA that is highly overexpressed in prostate tumor cells. The aim of the present study was to evaluate the potential of DD3(PCA3) for mRNA in PCa diagnosis. PATIENTS AND METHODS: A total of 186 patients were examined. In a group of patients with suspected PCa, one tissue specimen core was collected for testing DD3(PCA3) expression. According to the histological verification there were 100 patients with benign prostatic hyperplasia, 12 patients with prostatic intraepithelial neoplasia and 74 patients with PCa. The total RNA was isolated and DD3(PCA3) and PSA expressions were quantified using quantitative RT real-time PCR method. The DD3(PCA3)/PSA mRNA ratio was determined for all groups. RESULTS: It was found that the levels of the mRNA expression of DD3(PCA3) were significantly higher (p<0.045) in patients with PCa than in patients with benign prostatic hyperplasia. No statistically significant differences in levels of mRNA expression of DD3(PCA3) between patients with organ-confined and those with advanced or metastatic disease, nor according to Gleason score, were found. CONCLUSION: DD3(PCA3) appears to be a promising marker for early detection of PCa and also for differential diagnosis between patients with benign prostate hyperplasia and those with PCa.

[Use of the KLS Martin Nd:YAG laser MY 40 13 in lung parenchyma surgery]. / Vyuzití KLS Martin Nd: YAG laseru MY 40 13 v plicní chirurgii.

INTRODUCTION: Nd:YAG laser MY 40 1.3 has been developed to be employed in lung tumor resections. The method's principle is based on tissue absorption of light energy and its transformation into heat. The light beam wavelength is 1318 nm and its output power is 40 W. The beam even penetrates fluid media up to the depth of 6mm, and its hemostatic effect is much larger than in other models (obstruction of arteries of up to 2 mm in diameter, veins of up to 3 mm in diameter). The laser beam application to the lung parenchyma is continuous and non-contact. AIM: Analysis of our initial experience with the use of the instrument in surgical management of primary and secondary lung tumors. METHODOLOGY: From March 2008 to December 2008, the authors operated 12 male and 5 female patients, the average age was 60.7 years. In 12 subjects, lung metastases of malignant tumors were detected, 3 subjects suffered from primary lung carcinoma and two from benign lung lesions. 7 operated subjects had multiple secondary lung tumors in various lobes of a single lung or both lungs, in 5 subjects, the secondary tumors were solitary. Most commonly--in 7 cases, the subjects suffered from colorectal carcinoma metastases. All the above surgical procedures were performed under general anesthesia with selective lung ventilation via posterolateral thoracotomy. RESULTS: In the all 12 patients, the lung metastases were radically removed using parenchyma-saving laser metastasectomy. In 3 subjects with primary pulmonary carcinoma, the laser was used to perform limited resection for intraoperative biopsy purposes, which was followed by standard radical pulmonary resection. The two benign lesions were managed in a similar way. Perioperative morbidity and mortality was nil, no significant air leak was recorded in the subjects during the postoperative period. CONCLUSION: Nd:YAG laser MY 40 1.3 facilitates radical removals of secondary pulmonary neoplasms, in particular of the multiple and deeply located ones, with no need for extensive lung parenchyma resections and with minimum intraoperative morbidity and mortality rates. Furthermore, it can be successfully used in a numer of other surgical procedures, such as management of pleural adhesions, lung biopsies, resections of emphysematous bullae, resections of benign lung tumors, dissections of inerlobal fissures, etc., where the method can fully replace staplers. It has potential for its further application in miniinvasive pulmonary surgery in the near future.

[Acute mediastinitis--optimum diagnostic and therapeutic measures]. / Akutní mediastinitis --optimální diagnostická a lécebná opatrení.

The term of acute purulent mediastinitis (APM) is understood as a bacterial inflammatory process involving mediastinal tissue and organs. It is a group of clinical disorders originated primary or secondary as a complications another disease of different etiology. The definitive clinical picture is a combination of both pathologies. APM having obviously purulent character develops usually extremly fast and is objectively harming patient's life. In case of Descending Necrotizing Mediastinitis (DNM) the mortality is up to 25-40%. The only perfect and early stated diagnosis and choosen effective therapy mode can lead to patient life salvage and survival. The surgery share on therapy is substantional. During years 2004-2008 we have taken experience in this field by treatment of 18 patients with APM. Our conclusions after that most important condition for effective therapy is early and enough wide dissection of the involved area, mainly thoracocervical and mediastinal, their drainage and installation of the continual rinsing, eventually. There is no exception we indicate an operative repeated revision including rethoracotomy, if necessary.

[Late diagnosed rupture of the diaphragm --a case review]. / Pozdne diagnostikovaná ruptura bránice--kazuistika.

The authors describe a case of the patient with late diagnosis of the diaphragmatic rupture. There was a bowel obstruction found in X-ray scan. After endotracheal intubation was complicated of tension pneumotorax. Laparotomy was found rupture of the diaphragm.

[Laparoscopic adrenalectomy]. / Laparoskopická adrenalektomie.

OBJECTIVE: Laparoscopy has become the gold standard for the treatment of adrenal tumours in urology. We evaluate our experience with laparoscopic adrenalectomy (LA) in this work. MATERIAL, METHODS: We performed 38 LA between 2003-2008. We use computer tomography (CT) and magnetic resonance imaging (MRI) for the initial evaluation. Indication for procedure is made in cooperation with endocrinologist. We use transperitoneal approach with 3 or 5 ports. RESULTS: Mean age was 57.7 +/- 11.7 year (range 32-74.9 year). Nine LA were made in men (24%), in women 29 (76%). Sixteen tumours (42%) were hormonal active (7 pheochromocytoma, 6 primary hyperaldosteronism, 3 peripheral hypercortisolism). Twenty-two tumours were without hormonal activity. Mean tumour size was 4.1 +/- 2 cm (range 1-10.1 cm), mean operation time was 89 +/- 38 minutes (range 32-220 minutes), mean blood loss was 33 +/- 75 ml (range 0-400 ml), mean hospitalization time was 6.1 days (range 3-12 days). There were histologically 15 cortical adenomas, 5 nodular cortical hyperplasia, 1 calcificated hematoma, 3 cysts, 2 potentional malignant tumours on interface between adenoma and carcinoma, 1 cortical carcinoma and 7 pheochromocytoma. We found 3 metastases of renal carcinoma in adrenal gland and one metastasis mesenchymal chondrosarcoma too. Transperitoneal approach was chosen in 20 patients (53%) after previous abdominal operation (open cholecystectomy, appendectomy, transperitoneal nephrectomy, aortofemoral bypass). Complications were in 3 cases from 38 (8%). It was one perforation of diaphragm, which was resolve with laparoscopic suture, one postoperative delirium with fudge and agitation, one abscess in wound after extraction of specimen. We have got any conversion in our collection. The body mass index was higher than 38 in 3 patients. CONCLUSION: LA is a quick and safe procedure with minimal morbidity and mortality. This procedure requires very experienced surgeon. Patients profit especially from miniinvasivity and short convalescence. Especially benign tumours of smaller size (by 8 cm) are indicated, extensive and especially malignant tumours remain a domain of open approach. Previous operations in abdominal cavity do not have to be a contraindication for LA and operation is possible in patients with monster obesity.

Tumours in end-stage kidney.

OBJECTIVE: Patients with end-stage kidney disease (ESKD) show a greater risk for renal cell carcinoma (RCC), which tends to be multifocal and bilateral. The malignant potential is unclear. The question is whether to remove both kidneys in patients with a tumor on one side only diagnosed by computed tomography (CT). MATERIALS AND METHODS: Kidney tumors were found in 14 patients with ESKD from January 2002 to December 2006. One was unfit for surgery. Thirteen patients underwent nephrectomy and 6 a bilateral procedure of whom only 2 had bilateral tumors on CT, 3 multiple tumors on the contralateral side, and 1 uncontrollable hypertension with tumors as an incidental finding. Tumors were found in all 19 specimens. RESULTS: In 13 kidneys (68.4%), the tumors were multiple; in 6 (31.6%), solitary. The types of tumor were: 13 (68.4%) papillary RCCs (PRCC), 9 (47.4%) clear RCCs (CRCC), a combination of PRCC and CRCC in 4 (21.0%), and myxoid liposarcoma (with solitary PRCC contralaterally). The mean follow-up was short (19 +/- 15 months; maximum, 54 months). Only 1 patient died due to a tumor at 16 months after operation. CONCLUSIONS: There is a high risk for bilateral involvement. Patients who undergo unilateral nephrectomy must be regularly followed and contralateral nephrectomy carefully considered, mainly in transplanted patients on immunosuppression. Further studies are needed to give a definitive answer about the indications for surgery and the indications for contralateral nephrectomy as well. To date, prophylactic contralateral nephrectomy should not be a therapeutic standard.

[Incidence and management of prolonged air leak following pulmonary lobectomy]. / Výskyt a resení prolongovaného úniku vzduchu po plicní lobektomii.

INTRODUCTION: Prolonged air leak (prolonged air leak - PAL, an air leak for over 7 postoperative days) is a common complication following lung resections. It extends the period of thoracic drainage, duration of hospitalization, increases postoperative morbidity rates and the cost of the treatment. METHODOLOGY: The retrospective study included a group of 256 subjects with lung lobectomies, performed during 2002-2007, where active thoracic drainage was introduced postoperatively. The following parametres were assessed: gender, age, preoperative FEV1/FVC values, intraoperative detection of pleural adhesions, missing interlobar fissures (due to stapler resections), presence of distinct bullae, number of removed mediastinal lymph nodes, lobectomy types (upper vs. lower), use of staplers and insufficient lung inflation of 2cm, detectable on x-ray on the day of the procedure. RESULTS: PAL was recorded in 26 (10.1%) of the subjects and their thoracic drain was left in place for 8-34 days (the mean of 15.9 days). In 7 subjects, the active thoracic drainage was replaced by a passive one (on the 14.4th postoperative day, on average, the range: postoperative Day 11 to postoperative Day 22). In seven subjects, the drain's position was changed, and in a single subject, reoperation for PAL was required. In particular, the following subjects are more likely to develop PAL: patients with FEV1/FVC of 80% (p-value = 0.0066; odds ratio = 3.494), where stapler resections of interlobar fissures are required (p-value = 0.0118; odds ratio = 3.070) and males (p-value = 0.0471; odds ratio = 3.200). CONCLUSION: In patients, predisposed to develop PAL, saving techniques to optimalize surgical procedures, as well as approaches to optimalize their postoperative care, including early replacement of the active thoracic drainage for the passive method, should be employed.

[Laparoscopic radical nephrectomy--the cohort of 150 patients]. / Laparoskopická radikální nefrektomie pro parenchymový tumor ledviny--soubor 150 pacientu.

BACKGROUND: Minimally invasive surgery has been performing in the treatment of renal cancer at the Department of Urology in Plzen since January 2003. We want to present and evaluate our results of laparoscopic nephrectomy (LRN) in the cohort of 150 patients. METHODS AND RESULTS: In our institution, 150 LRNs were performed in the period between January 2003 and April 2007, 145 of them transperitoneally and 5 retroperitoneally. These 150 LRNs were completed by 4 different surgeons. We use four trocars in a rhombus disposition for left-sided LRN, we add fifth port for liver elevation for right-sided LRN. We place four ports for retroperitoneoscopical LRN. Renal vessels are sectioned either separately with lockable clips or with endoGIA stapler en bloc. After mobilization of the kidney, it is inserted into the endobag and extracted through the extended incision after the 12 mm port in lower abdomen using splitting incision. 73 right and 77 left LRN were performed in our patients cohort. The mean age of patients was 62.5 +/- 10.2 (range 33.9-84.6) years. The mean operation time was 138 +/- 44 (55-270) minutes. The mean size on CT was 54.3 +/- 15.1 (29-101) mm. The mean hospitalization time was 6.1 +/- 2 (3-15) days. Adrenalectomy was performed in 16 patients, cholecystectomy in 4 patients and appendectomy in 3 patients. Per-operative complications appeared in 5 cases (3%). Post-operative complications appeared in 7 patients (5 %). We can not evaluate own oncological results because of short-time follow-up. CONCLUSIONS: LRN has become a new gold standard in the treatment of kidney tumours T1 (to 7 cm) and it represents an important approach in the treatment of kidney tumours in our institution. We highly recommend preoperatively biphasic CT angiography because it shows the exact number and topography of renal vessels. We prefer transperitoneal approach because of the larger working space and better topographical orientation. Patients profit from advantages of miniinvasivity mainly due to the faster return to the normal life. To the main disadvantages of this technique belong the higher technical demands on the operator and a higher prize of the procedure compared to the open operation.

Expression of mRNA MMP-7 and mRNA TIMP-1 in non-small cell lung cancer.

BACKGROUND: Destruction of the extracellular matrix is a necessary precondition for metastasis and invasion of tumour cells. Metalloproteinases (MMPs) are involved in this process, matrilysin being one of them (MMP-7). The results of our pilot study with patients operated on for non-small cell lung carcinoma (NSCLC), with the assessment of MMP-7 and the tissue inhibitor of matrix metalloproteinase (TIMP-1), are presented here. PATIENTS AND METHODS: The group consisted of 34 patients who had been operated on in the course of 2005. Messenger RNA MMP- 7 and TIMP-1 were assessed in 20 cases (58%). Tissue samples were frozen to -70 degrees C, total RNA was subsequently isolated and a reverse transcription was performed from it. The quantitative assessment itself was performed using a real-time PCR method. The resulting expression level was determined as the expression ratio of the assessed gene and the housekeeping gene, glyceraldehyde-3-phosphate dehydrogenase (GAPDH). RESULTS: A higher expression of mRNA MMP-7 was found in the NSCLC tissue than in non-tumourous lung tissue. On the other hand, a higher expression of mRNA TIMP-1 in the non-tumourous surrounding lung tissue was demonstrated. The expression of mRNA MMP-7 and TIMP-1 was higher in adenocarcinoma than in the epidermoid form of NSCLC. CONCLUSION: The value of our results should not be overestimated since we had only a small group of patients and assessed only one of the whole range of metalloproteinases (MMP-7). We consider the assessment and ratio quantification of metallorpoteinases in normal lung and NSCLC to be the first step in a further application of these parameters.

[Penetrating thoracic injury--seven-year experience with its diagnostics and treatment]. / Penetrující poranení hrudníku--sedmileté zkusenosti s diagnostikou a lécbou.

AIM OF THE STUDY: A retrospective analysis of seven-year follow-up results of subjects treated for penetrating thoracic injuries, aimed at optimalizing the diagnostic-therapeutic algorithm. MATERIAL AND METHODOLOGY: During 2000-2006, 39 subjects with penetrating thoracic injuries (35 males and 4 females, their mean age was 40.5 years), were diagnosed and treated in the authors' clinic. Cold weapon attacks were the commonest mechanism of the injuries (54%). The injury resulted in pneumothorax, resp. hemothorax, in, nearly, half of the subjects. The mean ISS value in the study group was 23. Less than a third of the injuried suffered associated injuries of the neck or abdominal regions. The diagnostics was based on clinical and x-ray examinations, resp. on thoracic CT. RESULTS: The commonest therapeutic procedure was draining of the pleural cavity (17 subjects). In 36% of the subjects, surgical revision via thoracotomy, resp. sternotomy, was inevitable. In two subjects, miniinvasive approach sufficed. Four subjects were treated conservatively. Two patients exited immediately following their transport to hospital, no therapeutic management was possible. No other deaths following the treatment were recorded, postoperative complications occurred in 4 subjects (10%), and they, equally, required 4 reoperations. CONCLUSION: The diagnostic process of penetrating thoracic traumas is based on clinical examination and x-ray, resp. thoracic CT. Most injuries are sufficiently managed using good quality drainage of the pleural cavity. Only few cases require urgent surgical revision via thoracotomy or sternotomy. Selected cases, mainly including stab injuries, may be successfully treated using miniinvasive techniques.

Urological complications of congenital nephrogenic diabetes insipidus--long-term follow-up of one patient.

A male with a severe form of congenital nephrogenic diabetes insipidus (diuresis 10 l per day) had megaureters, megavesica, large residuum and a history of three traumatic ruptures of the megavesica and a recurrent urinary tract infection (RUTI). Hemodialysis was introduced at 41 years of age. At age of 42, he underwent a bilateral retroperitoneoscopic nephrectomy to prevent further RUTI and 8 months later transplantation of a cadaver kidney. Intermittent catheterization is necessary due to residual urine in the urinary bladder.

[Miniinvasive laparoscopic or retroperitoneoscopic radical nephrectomy for the parenchymal tumor]. / Miniinvazivní laparoskopická ci retroperitoneoskopická radikální nefrektomie pro parenchymový tumor.

INTRODUCTION: Laparoscopic (LRNE) or retroperitoneoscopic (RRNE) radical nefrectomy originally published in 1991, respectively in 1993, began to be introduced in common practice at the end of the 20th century. In this work we summarize our findings gathered upon introduction of these methods. SUBJECTS AND METHODOLOGY: We present a group of 50 miniinvasive nephrectomies conducted during 2003-2004 (46 LRNE and 4 RRNE). LRNE was combined with ipsilateral adrenalectomy in five cases and with cholecystectomy in three cases (in all cases the LRNE was on the right side). RESULTS: The mean age of the patient subjects was 65 +/- 11 years (34-81). The blood loss was 134 +/- 201 ml (30-1200). The tumor size according to the CT was 50 +/- 13 mm (30-82). Histologically, 45x renal carcinomas, 4x oncocytomas, 1 x urothelial carcinomas were diagnosed. The drain was removed 2.1 +/- 0.9 days following the surgery. The mean hospitalization time was 6.1 +/- 1.6 days (4-9). Only a single major, however lethal, complication arised: In a 74-year old female, the left-sided LRNE due to the carcinoma pT3bG2 and at the same time vaginal hysterectomy, extraction of the renal preparation through the vagina and anterior and posterior vaginoplasty (for a prolaps) were conducted. The patient was repeatedly revised for haemoperitoneum and she exited on the 18th postoperative day due to pneumonia. The mean duration of the LRNE was 168 +/- 40 minutes (80-265). The combined LRNE and cholecystomic procedure lasted 265 minutes. The mean duration of the LRNE with CHE was 213 minutes, and of the LRNE with adrenalectomy was 170 minutes. In 4 cases of the RRNE (indicated three times due to preceeding major surgical procedures in the abdominal cavity and once for the Crohn's disease) the mean duration was 203 minutes. CONCLUSION: Miniinvasive RNE in TI tumors is a modem reproducible methodology suitable for application in clinical practice. The laparoscopic approach appears more appropriate. The retroperitoneoscopic approach is indicated mainly in cases of postoperative adhesions in the abdominal cavity.

[Role of videomediastinoscopy in diagnostic procedures of pathological conditions in the mediastinum]. / Postavení videomediastinoskopie v diagnostice patologických afekcí mezihrudí.

Due to recent advances in videotechnology and a worldwide comback of invasive staging methods of the lung cancer, mediastinoscopy has been revived. In the Surgical Clinic of the Faculty Hospital in Plzen, the authors carried out 54 videomagnetoscopic examinations of 53 patients aged 58.1 years on average, in total, during the period from 2000 till 2003. Mostly, in 41 cases (76%) the examination was performed as a part of the lung cancer staging procedure. None of the patients exited in direct correlation with the surgical procedure. Complications, not requiring reoperation, were reported in 2 cases. The lung carcinoma staging findings agreed with the postoperative N disease classification in 86% of the examined cases. Five cases (14%) were underestimated and always the superior lobe carcinomas were concerned, out of which four of them were on the left. At the same time, the non-invasive staging examination using computer tomography (CT) in the mediastinal lung cancer dissemination examination, proved to show a high rate of false-positive findings, when compared to that with videomediastinoscopy. Mediastinoscopy remains the supreme method in determining other pathological affections of the middle mediastinum, if properly indicated. The authors carry out the above miniinvasive examination as a part of the lung cancer staging method in all patients with the CT-confirmed mediastinal lymphonodes enlarged over 1 cm. They consider this method a necessary part of this disease staging protocol, in cases of the left superior lung lobe tumors combined with videothoracoscopy. At the same time the authors recommend it as the method of choice in diagnosing other pathological processes of the middle mediastinum, mainly for its high efficiency rate and its low rates of complications.