Excellent antibacterial activity of Slovak honeys on bacteria mostly infecting chronic wounds.

INTRODUCTION AND AIM OF STUDY: Chronic wounds are commonly colonized by various bacterial species and colonization frequently turns into wound infection, severely impairing healing process. With increasing antimicrobial resistance, the antimicrobial treatment of chronic wounds may be extremely challenging. Rediscovery of old and forgotten antimicrobial therapeutic options, such as apitherapy, may contribute to solving the problem of incurable chronic wound infections. Aim of this study was to evaluate the antimicrobial properties of four kinds of Slovak honey from ecological beekeeping against the most common bacterial species contaminating and infecting chronic wounds, and to compare these antimicrobial activities with those of the approved medical-grade Manuka honey. The impact of honey sterilisation methods and long-lasting storage on the bactericidal activity was also examined. MATERIAL AND METHODS: Antimicrobial activity of honey was detected against 7 bacterial collection strains by broth microdilution antimicrobial susceptibility test according to EUCAST. The results were statistically analysed by Fisherꞌs exact test. RESULTS AND CONCLUSIONS: Slovak ecologically produced honey samples demonstrated an excellent in vitro antibacterial activity, superior to the monofloral medical-grade Manuka honey activity. Neither the gamma-irradiation, nor the three-year-long storage had impact on the bactericidal activity of the tested honey (Tab. 4, Fig. 2, Ref. 53).

Design of abdominal retractor.

INTRODUCTION: The purpose of this paper is to present the development and design of an abdominal retractor which allows a single person to perform operations and the fixation of the operation instruments can be done with one hand. The additional devices make the operation more comfortable for surgeons. METHODS: Conventional measuring devices have been designed and applied for determining axial forces in a surgeon's forearm during operations. The same forces must be transmitted by the frame of the retractor. Thus a simple truss structure of a retractor was done. Several types of fixations have been proposed and tested using the rapid prototyping. Finally, the abdominal retractor was manufactured from stainless steel. RESULTS: The simple-to-use abdominal retractor was built. The standard surgery instruments were modified due to the fixation system of the frame. A wide variety of additional useful devices, such as a lamp, video camera etc., were also proposed. CONCLUSION: The present abdominal retractor is user-friendly and all components are easily sterilized by conventional methods (Fig. 7, Ref. 6) Keywords: abdominal retractor, stainless steel retractor, standard surger, fixation system of the frame, lamp, video camera, conventional methods.

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

PURPOSE: This study aimed to specify the optimal lengths of the distal locking screws (in a female population undergoing distal radius fracture fixation with a volar locking plate) to avoid damaging the dorsal extensor tendon compartments while preserving stability. METHODS: Twenty-five female adult patients underwent volar locking plate fixation with four 2.4 mm locking screws inserted distally. Our modified dorsal tangential fluoroscopic view (DTV) was taken perioperatively followed by postoperative CT scans to compare the accuracy in determining the distal screw lengths. RESULTS: Our modified DTV was 88 %, 84 %, 88 %, and 76 % sensitive in detecting screw lengths in the first, second, third, and fourth distal plate holes, respectively. According to the CT scans, none of the screws were over-penetrated in the third dorsal compartment, over-penetration was found in the second and fourth dorsal compartment. The most-accurate screw lengths in the four most distal plate holes in female distal radius fracture are 14, 20, 20, and 20 mm from the radial to the ulnar aspect. CONCLUSION: In dorsal cortex comminution, when perioperative measuring is imprecise, inserting the most-suitable distal locking screw for problematic hole and then applying our modified DTV seems to be a simpler and safer option (Tab. 3, Fig. 4, Ref. 33).

Results of long term testosterone replacement therapy in men with abdominal obesity, erectile dysfunction and testosterone deficiency.

INTRODUCTION: In this article, the authors evaluate subjective and objective results of long testosterone replacement therapy (TRT) and possible risk. METHODS: In a single center study, the authors treated 69 men with testosterone deficiency syndrome (TDS). The average age was 57.84 years and the follow-up period was 94.62 months. All men had at beginning a complete urological and internal examination. All the men were treated with three-month i.m. injections of 1000 mg testosterone undecanoate. The men were regularly checked according to the EAU guidelines. RESULTS: All of the men on treatment felt much better. Weight and waist circumference during monitoring showed a mild improvement. Excellent results were on red blood cells. Glucose, HDL cholesterol, triglycerides had stable values. PSA slightly increased and testosterone was within the normal range. In two men during treatment, we found a prostate cancer (low risk). Bone mineral density (BMD) of lumbar spine revealed a significant improvement. CONCLUSION: TRT had multiple positive effect on affected men with TDS. Our long-term results showed a long mild improvement during the time. Authors concluded that long term treatment had multiple benefit for affected men (Fig. 11, Ref. 13).

Effect of deuterium-depleted water on selected cardiometabolic parameters in fructose-treated rats.

Deuterium-depleted water (DDW) has a lower concentration of deuterium than occurs naturally (less than 145 ppm). While effects of DDW on cancer started to be intensively studied, the effects on cardiovascular system are completely unknown. Thus, we aimed to analyze the effects of DDW (55+/-5 ppm) administration to 12-week-old normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) treated with 15 % fructose for 6 weeks. Blood pressure (BP) and selected biochemical parameters were measured together with determination of nitric oxide synthase (NOS) activity and iNOS and eNOS protein expressions in the left ventricle (LV) and aorta. Neither DDW nor fructose had any significant effect on BP in both strains. DDW treatment decreased total cholesterol and triglyceride levels in WKY, but it was not able to prevent increase in the same parameters elevated due to fructose treatment in SHR. Both fructose and DDW increased insulin level in WKY. Fructose did not affect NOS activity either in WKY or SHR. DDW increased NOS activity in LV of both WKY and SHR, while it decreased NOS activity and iNOS expression in the aorta of SHR with or without fructose treatment. In conclusion, DDW treatment significantly modified biochemical parameters in WKY together with NOS activity elevation in the heart. On the other hand, it did not affect biochemical parameters in SHR, but decreased NOS activity elevated due to iNOS upregulation in the aorta.

Monitoring of hands movement trajectories in the field of laparoscopic and endoscopic surgeries and options in the clinical practice.

Within the project "Applied research trajectory hands in laparoscopic and endoscopic operations", ITMS Project code 26240220056, funded by the European Regional Development Fund and the state budget of the Slovak Republic, we created a technical background and algorithms for monitoring and evaluating the hand movements of the surgeon during laparoscopic and endoscopic operations. This is a unique idea and unique project transformed into clinical practice, which is promising to assist in laparoscopic training and inclusion of surgeon / endoscopist to "skilfulness" group on the evaluation of the effectiveness of movements of his hands (Tab. 2, Ref. 11).

Reccurent bleeding from Meckel's diverticulum - surgeon's challenge.

The authors of this paper want to share their experience with diagnostic and therapeutic problems in case of chronic small intestinal bleeding from Meckel's diverticulum, which ended with acute episode of massive gastrointestinal bleeding requiring emergent surgery.Despite the progress achieved in diagnosing the sources of gastrointestinal bleeding, the diagnosis of small intestinal bleeding is very frequently beyond the ability of making it right, and thus emergent surgery is often the only possibility of saving the patient's life on the one hand, and allowing stating the correct diagnosis on the other (Fig. 1, Ref. 6).

The role of laparoscopic Heller myotomy in the treatment of achalasia.

AIM: To evaluate the results of laparoscopic Heller myotomy in our group of patients. METHOD: A retrospective clinical trial was carried out to evaluate the indication, technique and controversies of laparoscopic Heller myotomy in the achalasia treatment. The following symptoms were evaluated prior and after Heller myotomy: dysphagia, heartburn, nausea/vomiting after meal and asthma/coughing. The patients were evaluated by the use of Likert score. Statistical analysis was performed by using Student t test. The intra-operative (operation time, intraoperative complications, blood loss, conversion rate), and peri-operative parameters (morbidity, mortality, hospital stay) were evaluated as well. The patients who underwent laparoscopic Heller myotomy were included in the trial. All patients were perioperatively managed by a multidisciplinary team. RESULTS: The evaluation of fourteen patients was performed (average age: 53.2 yrs., eleven men, two women, BMI 23.6 kg/m(2)). The patients were indicated for surgery in all of the stages (I-III). Previous semiconservative therapeutic modalities were performed in thirteen patients. The standard laparoscopic technique for Heller myotomy with semifundoplication was applied. All the observed symptoms were statistically improved after the surgery (p=0.05). The average operating time was 89 minutes. Intraoperative blood loss was below 20 ml. There was no conversion to open surgery. An average hospital stay was 4.3 days. Morbidity was 14.3 % and mortality 0 %. In one patient esophageal mucosa perforation was intra-operatively identified and sutured. Post-operative course in this patient was without any complications. CONCLUSION: The laparoscopic Heller myotomy has become the "gold standard" procedure for achalasia. It is an excellent method allowing precise operation technique with good visualization of the esophagogastric junction. The operation with this approach is safe, efficient, and with excellent reproducible operative results. The correct and early indication for surgery is crucial. The delayed diagnosis with a late indication for surgery is not an exemption (Tab. 2, Fig. 2, Ref. 36).

Use of intraabdominal VAC (Vacuum Assisted Closure) lowers mortality and morbidity in patients with open abdomen.

OBJECTIVE: Authors compare two groups of patients with open abdomen. The objective is to compare and evaluate two treatment modalities, namely Kern laparostomy and vacuum-assisted closure in terms of mortality, closure of abdominal wound, and fistula management, all these stratified by BMI and CRP. BACKGROUND: Open abdomen can be considered a "patient salvage technique", used in patients with abdominal sepsis, as well as in patients with abdominal compartment syndrome, and in damage control surgery. Various management techniques are known, of which Kern laparostomy is most widely used. Newer techniques using negative pressure have emerged, still waiting for their wider acceptance and use. The authors present their study, in which they compare Kern laparostomy and intraabdominal VAC in patients with open abdomen. MATERIAL AND METHODS: Study consists of 44 patients treated at the authors´ clinics, while group KERN consisted of patients managed by Kern laparostomy, and group VAC was managed by intraabdominal VAC. The groups were compared in terms of mortality, abdominal closure, appearance of enteroatmospheric fistulas, primary closure of fistulas, and possibility of diversion of enteral contents. All outputs were stratified by CRP (C-reactive protein) and BMI (Body Mass Index). RESULTS: In VAC group, a significant decrease in mortality was seen, as well as significantly higher closure of abdominal wall, and significantly higher possibility of diversion of enteral content from fistulas. No statistically significant findings were observed in stratification with CRP and BMI. CONCLUSION: Intraabdominal VAC offers patients lower morbidity and mortality and should be defined as a treatment of choice in patients with open abdomen (Tab. 4, Fig. 3, Ref. 15).

Role of human papilloma virus infection and oral-genital contact in oral cancer ethiopathogenesis.

Head and neck squamous cell carcinoma and especially oropharyngeal squamous cell carcinoma is a very significant cause of morbidity and mortality. The majors risk factors of these tumors are tobacco smoking, chewing and alcohol consumption. But there is a group, non-drinking and non-smoking, patients with oropharyngeal squamous cell carcinoma. In these patients may be oral-genital contact and human papillomavirus infection the major risk factor for oral carcinogenesis. Aim of this review is to point out this fact in correlation with clinical studies and clinical conclusion for medical practice (Fig. 1, Ref. 32).

[Retroperitoneoscopic adrenalectomy with dorsal approach]. / Retroperitoneoskopická adrenalektomie dorzálním prístupem.

UNLABELLED: INTRODUSTION: Various surgical mininvasive approaches for adrenalectomy have been established over the last two decades. We are evaluating the retroperitoneoscopic adrenalectomy with dorsal approach. MATERIAL AND METHODS: The prospective open clinical trial was carried out to evaluate intra-operative (operations time, intraoperative complications, blood loss, conversion rate) and peri-operative parameters (morbidity, mortality, hospital stay). Patients who underwent retroperitoneoscopic adrenalectomy with dorsal approach were included in the trial. A tumor size above 12 cm or BMI higher than 35 kg/m2 were considered asexclusion criteria. All the patients were perioperatively managed by a multidisciplinary team. RESULTS: A total of 81 patients were assessed (average age: 45.7 yrs, 37 males, 44 females, BMI 27.8 kg/m2). The average operating time was 61 minutes. The intraoperative blood loss was below 20 ml. The mean hospital stay was 2.1 days. Morbidity was 2.7% and mortality 0%. CONCLUSION: Retroperitoneoscopic adrenalectomy with dorsal approach is considered a method of choice in our hospital. The use of this approach is safe, efficient, with excellent reproducible operative results and impressive patient recovery.

The combined algorithm of venous ulcer therapy.

AIM: This prospective study was undertaken to find a new combined algorithm to help patients suffering from long-term chronic non-healing venous ulcers. METHODS: A total number of 20 patients suffering from chronic venous ulcers and important co-morbidities such as diabetes mellitus or cardiac failure and not responding to other therapeutic modalities were treated at our surgical department with a combination of compressive sclerotherapy, and maggot debridement therapy (MDT) using larvae of green blowfly Lucilia sericata. RESULTS: Using the combined therapy we have achieved a significant clinical effect in 19 patients (95 %). In 1 patient, this effect was only impermanent while 5 patients (25 %) were completely cured. Eleven patients (55 %) benefited despite incomplete healing of the ulcer. With three of our patients we have lost contact. CONCLUSIONS: Even though the number of patients in our study is not large, we have achieved remarkable results with the combined algorithm of venous ulcer therapy. We start the healing process with compressive sclerotherapy and when this kind of therapy does not bring about the expected effect, we continue with Maggot debridement therapy. This combination of therapeutic modalities appears to be very effective and efficient (Fig. 2, Ref. 16).

Rare conditions of gastrointestinal bleeding.

The aim of this paper is to analyze and discuss an infrequent topic, i. e. rare conditions of gastrointestinal bleeding.Bleeding from gastrointestinal system is a common cause of acute abdomen and the most frequent causes are generally known.Clinicians, first of all emergency medicine staff, surgeons and internists (gastroenterology specialists), general practitioners, or less frequently other specialists, sometimes meet with less common causes of acute or chronic bleeding from gastrointestinal organs. It is quite important to be aware of the possibility the bleeding being caused by some rare condition, which is not so often met in medical practice, because of their great diagnostic and therapeutic problem. The low index of expectation of such a rare etiological unit could be the reason why destiny of such patients can be extremely problematic and why clinicians may fail at management of these patients (Fig. 4, Ref. 8).

From preoperative to intraoperative detection of hyperfunctioning parathyroid glands using tetrofosmin (99mTc) in primary hyperparathyroidism.

The impact of preoperative scintigraphy on the management of patients with primary hyperparathyroidism has been largely documented for more than two decades. More recently, preoperative scintigraphy has also been used to select patients for intraoperative detection of hyperfunctioning parathyroid glands thanks to a gamma-probe. This procedure is now widely used, with MIBI as the main radiopharmaceutical for both preoperative scintigraphy and intraoperative detection. However MIBI was not available in Slovakia until very recently and tetrofosmin (TF), the alternative 99mTc labelled radiopharmaceutical for myocardial imaging has some advantages over MIBI and a close biological behaviour. Thus we have been using TF also for parathyroid preoperative scintigraphy and for intraoperative detection, a systematic indication which has never been reported by others. This article aims to demonstrate the feasibility and to present our protocol for TF parathyroid imaging and intraoperative detection, closely associating surgeons, nuclear medicine specialists, pathologists and also biologists as intraoperative assay of intact PTH is necessary. The results of literature are subsequently reported and discussed (Tab. 2, Fig. 4, Ref. 35). Full Text in free PDF www.bmj.sk.

Rectal prolapse.

It is not so much the diagnosis that offers the surgeon a wide range of opportunities in the technical solutions of rectal prolapse. Currently there are at least 130 different techniques used in the surgical treatment of rectal prolapse and in fact none of these procedures has been shown most effective for any one patient. In this study, our intent is to describe the experiences of the authors with the treatment of rectal prolapse, to estimate the actual level of expertise of the surgeons in treatment of rectal prolapse, and to describe in which way to proceed in the future (Tab. 4, Fig. 3, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Autogenous venous valve construction.

AIM: The aim of this study was to assess the results of a new type of antireflux operation on the deep venous system in patients with venous ulceration not responding to treatment of the superficial system and compression. METHODS: In the period comprised between 1991-2002, the authors treated 56 patients with venous ulceration by Fegan's technique, that consists in compression sclerotherapy combined with antireflux operation of the deep veins. All patients selected had pathological reflux in the deep venous system and their ulcers did not respond to superficial and perforating vein therapy, and elastic compression. RESULTS: Using this technique of complex antireflux treatment, it was possible to heal 53 (95.4%) of the 56 ulcers with average time of complete ulcer epitelisation within 39+/-12 days. The recurrence rate, within the 5 year follow-up was 18% (10 patients), but 7 of the recurrent ulcers responded to compression sclerotherapy and healed within 3 months. CONCLUSIONS: In situ made valvuloplasty has several advantages: the valve is constructed from autogenous vein wall; all luminal valve surfaces have native venous endothelium; intraluminal foreign material is not introduced; the likelihood of thrombosis is reduced; the valve is size-matched to the host vein and this technique provides a competent bicuspid valve.

[Superficial thrombophlebitis--diagnostics and treatment]. / Povrchová tromboflebitída--diagnostika a liecba.

Superficial thrombophlebitis (ST) is a common disease, usually considered benign. However, the practice of systemic duplex ultrasonography has revealed a large number of deep-vein thromboses concomitant with ST. In contrast with extensive information on the management of deep vein thrombosis, little is known about the most appropriate treatment of the ST. Systematic duplex ultrasonography investigation has been proposed in the initial management of ST, to detect the presence of any underlying deep vein thrombosis. Because ST may extend into the deep venous system and potentially engender pulmonary embolism, treatment with low-molecular-weight-heparins might be the best choice. In our work diagnostic and therapeutic procedures for ST, proposed by Slovak angiological society, Slovak society for vascular surgeons, Slovak dermatological society, Slovak society for haemostasis and thrombosis, Slovak surgical society and Slovak internistic society are discussed.

Venous leg ulcers--a surgical treatment.

OBJECTIVE: To asses the complex anti-reflux treatment of pure venous ulcers on all levels of venous system. PATIENTS: In the last 20 years the authors treated 793 patients with venous ulceration and compared the therapeutic results of 4 groups of patients treated either surgically (Linton+v.v. surgery) or with sclerotherapy (Fegan's technique) combined with the anti-reflux operation on deep veins in torpid ulcerations non responding to superficial and perforators therapy. RESULTS AND CONCLUSION: The authors consider a compression sclerotherapy (the Fegan's technique) the easiest and the most effective way of treating patients with venous ulcer. The direct valve repair techniques are appropriate only in non-thrombotic deep vein reflux, which is very rare (4 patients--0.6%). In patients with torpid ulcers, where the compression sclerotherapy failed (4.6%--28 pts), the in situ construction of a new valve could help (Tab. 2, Ref. 19). Full Text (Free, PDF) www.bmj.sk.

Gastrointestinal stromal tumors.

In the last 3 years 9 patients with gastrointestinal stromal tumors (GIST) underwent surgery at our department. All cases were with very atypical process. From these patients 3 interesting cases are described in more details. A 75-years-old woman with gastroscopically verified endoluminal tumour in the proximal third of stomach, 6x7 cm, 76-years-old man with a large endoluminal tumour in D2-D3 part of the duodenum, 4x4 cm, and 62-years-old man with verified extraluminal tumour by CT examination in the middle part of stomach. In all cases, gastrointestinal stromal tumour was histologically confirmed. Work is well photo-documented pre-surgically with endoscopic and CT-findings and during surgery: individual steps during the removal of these tumours. In assessment of the size and number of mitoses, tumours belonged to a group with highly malignant potential. Patients are regularly checked in 3-months intervals and also examination by positron emission tomography was performed--it seems to have the best demonstrability of possible relapse. All three patients live and are subjectively and objectively without significant problems (Tab. 5, Fig. 5, Ref. 7). Full Text (Free, PDF) www.bmj.sk.