Rupture of a large aneurysm of common hepatic artery - case report.

Visceral artery aneurysms are rare findings in the practice of vascular surgeons. Their inaccessibility to physical examination, asymptomatic nature in many cases, but also an inherent risk of rupture that can be life threatening, make them a complex diagnostic and therapeutic problem. By presenting a case report of a ruptured common hepatic artery aneurysm the authors summarize basic characteristics of these aneurysms, as well as diagnostic and treatment options.

Infections associated with vascular reconstruction procedures at the Department of Surgery in Pilsen in retrospect.

INTRODUCTION: Vascular graft infection is a rare but serious complication in vascular surgery, associated with high morbidity and mortality. Early diagnosis of vascular graft infection is important for proper and timely surgical and antibiotic treatment that improves the outcome. The tactic and techniques of surgical treatment of vascular graft infection have changed over the last two decades, and this trend can also be observed in our retrospective study. METHODS: We evaluated a group of patients with prosthetic vascular reconstructions performed at the Department of Surgery, University Hospital in Pilsen in the period of 2003-2021 using retrospective analysis. In the analyzed 19-year period, 23 infected vascular grafts were managed out of a total of 2090 performed peripheral bypasses, and 27 infected vascular grafts were managed out of a total set of 1940 central reconstructions. RESULTS: The incidence of peripheral vascular graft infections at our Department of Surgery in the period of 2003-2021 reached 1.1% with the early mortality rate of 8.7%; 1.4% central vascular graft infections occurred in the same time period with 33% early mortality. CONCLUSION: The results of our retrospective study are comparable virtually in all parameters with the experience of other departments. Consistently, our department switched to in situ replacements for explanted vascular grafts and we can confirm good experience with silver impregnated grafts.

[Our experience with left-sided retroperitoneal approach to resection of abdominal aortic aneurysm]. / Nase zkusenosti s levostranným retroperitoneálním prístupem pri resení výdutí brisní aorty.

INTRODUCTION: At most vascular surgery departments, transperitoneal approach predominates in resections of the aortic aneurysms. For difficult reconstructions of the aorta in the visceral segment, a left flank retroperitoneal approach is used most frequently. METHOD: The authors retrospectively evaluate the left retroperitoneal approach in the management of abdominal aortic aneurysms during a 10-year period. From the total number of 445 operated patients, the left-sided retroperitoneal approach was used in 23 cases. RESULT: All operated patients survived. Average hospital stay was 10 days in the case of elective operations. CONCLUSION: Based on favorable results, the authors confirm that left-sided retroperitoneal approach is rightly considered as a choice in the technically demanding reconstruction of the aorta in the visceral segment.Key words: aortic aneurysm visceral segment of the aorta retroperitoneal approach.

[Dual kidney transplantation - a single-center experience]. / Duální transplantace ledvin - zkusenosti jednoho centra.

INTRODUCTION: Dual kidney transplantation is one of the options to utilize the so-called marginal grafts, kidneys that would be insufficient for normal single transplantation. This time-consuming surgical procedure is also burdensome for the patient. METHODS: The authors present their experience from the Pilsen Transplant Center. Between 2008 and 2016, 13 dual kidney transplantations were performed. Median donor age was 66 years (34-77) and median recipient age 46 years (40-78). Mean operating time was 4 hours and 40 minutes (3-6 h). Mean surgery ward stay was 5 days (4-6). Bilateral surgical technique was used in all cases. Mean follow-up time was 63 months (18-101). RESULTS: From our group of DKTs (N=13), 4 patients (31%) experienced delayed graft function and we observed no primary graft non-function. Surgical complications occurred in 4 patients (31%). Currently, all 13 patients are living with good graft function, none of them being dependent on dialysis. CONCLUSION: Dual kidney transplantation is currently a viable option. The success and benefits of this surgical procedure are directly related to careful donor and recipient selection.Key words: dual kidney transplantation - marginal donor - chronic renal failure - expanded criteria donor.

[Popliteal vein aneurysm]. / Aneuryzma vena poplitea.

Popliteal vein aneurysm is a rare disease of the lower limb venous system. Massive pulmonary embolism may be a clinically serious presentation of the disease. The authors present surgical management of the popliteal vein aneurysm in two case reports.Key words: popliteal vein aneurysm surgical management.

[Kidney donors after circulatory death (DCD) - single centre experience]. / Dárci ledvin po nezvratné zástave obehu (DCD) - zkusenosti jednoho centra.

INTRODUCTION: Kidney procurement from donors after circulatory death (DCD) is an important part of worldwide transplantation programmes. The first kidney transplantation from DCD was successfully performed in the Czech Republic in 2002. METHOD: Forty four kidneys from DCD were procured in the Transplant Centre of Pilsen between 2002 and 2015. We used the technique of "in situ" procurement with the double balloon triple lumen catheter and 510 minutes of the no-touch interval. The method of pulsatile hypothermic perfusion was used to test the viability of the kidneys. Twenty eight recipients with mean age 51.1 (2673) years were transplanted. Sixteen (57.1%) kidneys were from the 2nd, 8 (28.6%) from the 3rd and 4 (14.3%) from the 4th category according to the Maastricht criteria. RESULTS: 30-day mortality and morbidity rates were 0 and 10.7% i. e.14.3% respectively (N=4). Primary non-function was presented in 2 (7.1%), and delayed graft function in 5 (17.9%) cases. One, five and ten years of recipient and graft survival rates were 100%, 86.4% and 76.7%; and 92.9%, 69.6% and 61.9%, respectively. The long-term results are fully comparable with kidneys transplanted from donors after brain death. CONCLUSION: DCD are an important source for kidney transplantation. Kidney transplantation from DCD is a logistically, economically and personally demanding method with very good long-term results. KEY WORDS: donors after circulatory death - kidney transplantation - results.

[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.

Population Responses of Potato Leafhopper (Hemiptera: Cicadellidae) to Insecticide in Glandular-Haired and Non-glandular-Haired Alfalfa Cultivars.

Conflicting results have been reported on the ability of glandular-haired alfalfa (Medicago sativa L.) cultivars to reduce potato leafhopper, Empoasca fabae Harris, population abundance in field environments. We measured potato leafhopper adult and nymph abundance and yield responses in a cultivar selected for high potato leafhopper resistance ('54H91') and in a non-glandular-haired susceptible cultivar ('54V54') with and without insecticide treatment across 3 yr. Treatments included no insecticide and insecticide applied either early or late in each summer growth cycle. Date × cultivar × treatment interactions were found for potato leafhopper population abundance. In the absence of insecticides, total potato leafhopper abundance (adults + nymphs per sweep) was lower in 54H91 than in 54V54 on 85% of sampling dates; cultivar differences were especially evident as potato leafhopper abundance peaked. Insecticide treatment reduced potato leafhopper populations in both cultivars, but populations recovered and often exceeded the normal action threshold in both cultivars within 2-3 wk of insecticide application. Yield gain from early insecticide treatment of 54V54 was >400 kg/ha in 11 of 14 summer harvests, whereas in 54H91 the yield gain was <250 kg/ha in 10 of 14 summer harvests. We conclude that glandular-haired alfalfa cultivars with high levels of potato leafhopper resistance significantly suppress potato leafhopper adult and nymph abundance, reduce yield losses in the absence of insecticides, and have potential within an integrated pest management strategy to reduce insecticide use in alfalfa production systems.

[Late failure of the endovascular infrarenal aortic aneurysm solutions - diagnosis and treatment]. / Pozdní selhání endovaskulárního resení aneuryzmatu subrenální aorty - diagnostika a lécba.

INTRODUCTION: Nowadays, there are two possible solutions to aneurysms of the abdominal aorta. One is an open resection, which is undoubtedly one of the major surgeries and endovascular solutions, and which represents a smaller operating load for the patient. Long-term monitoring of patients after the endovascular solutions showed late failure in 7-17% of cases. The late incidence of endoleaks and the migration of stents are explained by changing the anatomy of the aneurysm and the resulting change in the mechanical pressure on the stent graft. If these conditions cannot be solved by an endovascular procedure the situation may present a technical challenge for the vascular surgeon. MATERIAL AND METHODS: Our report on the five case studies points to possible late complications of EVAR and solutions to their individual states. CONCLUSIONS: In the future, it should be recognized that if the endoleak is not proven it does not mean that it cannot occur over the years and massively fill the excluded aneurysm with the risk of rupture. Undoubtedly, re-operating the open patch is a challenging exercise. Nevertheless, it is possible even with the patients who were, primarily in terms of polymorbidity, indicated EVAR.

[Internal carotid artery surgery under locoregional anaesthesia at the Department of Surgery in Pilsen during the past 10 years (2002-2011)]. / Operace na vnitrních karotidách v lokoregionální anestezii na chirurgické klinice v Plzni za uplynulý h 10 let (2002-2011).

During the ten-year period (2002-2011), carotid artery surgery was performed in 1164 patients, with a mean age of 68 years (44 to 86 years), at the Department of Surgery, University Hospital in Pilsen. In total, 1304 procedures on internal carotid arteries were performed, and the ratio of procedures in men and women was 912/392. The ratio of procedures in asymptomatic vs. symptomatic findings was 938/366. The ratio of patients with unilateral vs. bilateral damage to the internal carotid artery was 930/234. All surgical procedures on internal carotid arteries were performed under locoregional anaesthesia. From the total number of internal carotid artery operations (1304), the 30-day mortality and morbidity rate was 1.46%.

[Leriche's syndrome]. / Lerichuv syndrom.

INTRODUCTION: Leriche's syndrome is defined as atherosclerotic occlusion of the infrarenal aorta and/or the iliac axis. It is associated with claudications or critical limb ischaemia and erectile dysfunction in men. MATERIAL AND METHODS: Twenty patients with Leriche's syndrome were operated on at the Department of Surgery, University Hospital in Pilsen between 2008 and 2012. There were 6 women and 14 men of average age 60.3 years (41-76 years). Three patients were in group C and 17 in group D according to the Trans-Atlantic Inter-Society Classification IIb (TASC IIb). Fifteen patients suffered from chronic claudication or rest pain, five patients had acute limb ischaemic symptomatology. Aortobifemoral bypass with subsequent anti-aggregation therapy was the only treatment option. RESULTS: Primary 30-day patency was 100%. 30-day postoperative mortality was 5% (one patient died of acute myocardial infarction). Two patients died in two and four years after the reconstruction (10%) due to cerebral ischaemia and bronchopneumonia. Only one extremity amputation was performed within the five-year interval after vascular reconstruction. All aortobifemoral reconstructions were patent in two months to five years after the operation. We had to manage only one false aneurysm in the groin three years after the aortobifemoral reconstruction. CONCLUSION: Aortobifemoral bypass is a method of choice for the treatment of Leriche's syndrome. Endovascular treatment is suitable for patients with severe comorbidities.

[Traumatic rupture of thoracic aorta]. / Traumatická ruptura hrudní aorty.

INTRODUCTION: Thoracic aortic injury (TAI) is burdened with high mortality (80-90%). The diagnostic and therapeutic algorithm has changed radically over the last couple of years. The authors present their experience with diagnosis and treatment of TAI at the University Hospital Trauma Centre. MATERIAL AND METHODS: 24 TAIs were evaluated in a retrospective study, in 20 (83.3%) cases they were part of a polytrauma. The average age of the patients was 39.4 years (20-67). Traffic accidents formed the majority of TAIs (87.5%). Multi-detector computed tomography was used as a basic examination to detect TAI. Thoracic endovascular aortic repair (TEVAR) was the treatment of choice in 21 and open surgery in 3 injured patients. RESULTS: The 30-day postoperative mortality was 12.5%, in one case it was associated with TEVAR. 30-day morbidity was 37.5% (circulatory instability, respiratory insufficiency, bronchopneumonia, type I endoleak). CONCLUSION: MDCT and TEVAR are currently the methods of first choice in the diagnosis and treatment of TAI. TAI requires a highly specialized multidisciplinary approach within Trauma Centres providing complex cardiovascular services.

Inputs and losses by surface runoff and subsurface leaching for pastures managed by continuous or rotational stocking.

Pasture management practices can affect forage quality and production, animal health and production, and surface and groundwater quality. In a 5-yr study conducted at the North Appalachian Experimental Watershed near Coshocton, Ohio, we compared the effects of two contrasting grazing methods on surface and subsurface water quantity and quality. Four pastures, each including a small, instrumented watershed (0.51-1.09 ha) for surface runoff measurements and a developed spring for subsurface flow collection, received 112 kg N ha(-1) yr(-1) and were grazed at similar stocking rates (1.8-1.9 cows ha(-1)). Two pastures were continuously stocked; two were subdivided so that they were grazed with frequent rotational stocking (5-6 times weekly). In the preceding 5 yr, these pastures received 112 kg N ha(-1) yr(-1) after several years of 0 N fertilizer and were grazed with weekly rotational stocking. Surface runoff losses of N were minimal. During these two periods, some years had precipitation up to 50% greater than the long-term average, which increased subsurface flow and NO(3)-N transport. Average annual NO(3)-N transported in subsurface flow from the four watersheds during the two 5-yr periods ranged from 11.3 to 22.7 kg N ha(-1), which was similar to or less than the mineral-N received in precipitation. Flow and transport variations were greater among seasons than among watersheds. Flow-weighted seasonal NO(3)-N concentrations in subsurface flow did not exceed 7 mg L(-1). Variations in NO(3)-N leached from pastures were primarily due to variable precipitation rather than the effects of continuous, weekly rotational, or frequent rotational stocking practices. This suggests that there was no difference among these grazing practices in terms of NO(3)-N leaching.

[Vascular reconstructions infections in the aortofemoral region]. / Infekce cévních rekonstrukcí v aortofemorální oblasti.

INTRODUCTION: The incidence of prosthetic vascular graft infections in the aortofemoral region is reported at 0.6-3%. These complications are burdened with a high mortality of up to 50% and an amputation rate of up to 20%. The aim of our study was to give a complex view on the diagnostic and treatment possibilities of these serious complications of reconstructive vascular surgery. MATERIAL AND METHODS: Prosthetic bypass grafts were performed in 1088 patients in the aortofemoral region between 2001-2011 at the Department of Surgery, Teaching Hospital and the Faculty of Medicine, Charles University, in Pilsen. 24 (2.2%) patients suffered from graft infection at various time intervals after primary vascular reconstruction. Clinical examination, computed tomography and positron emission tomography were the main diagnostic methods of vascular graft infection. "In situ" reconstructions dominated over extra-anatomic reconstructions. When the infection involved only the peripheral part of the prosthetic graft, a more conservative approach - local debridement and drainage - was used. RESULTS: The mortality of the patients was 20.8%, high amputation rate 12.5%, and morbidity rate 58.3%, respectively. The average time of hospitalization in surviving patients was 46.5 days. Primary 30-day patency rate in "in situ" and extra-anatomic reconstructions was 100 and 60%, respectively. CONCLUSION: Prosthetic vascular graft infections in the aortofemoral region require tailored multidisciplinary treatment approach in vascular centres. "In situ" reconstructions are the method of first choice. A more conservative approach in infections involving only the peripheral part of the vascular reconstruction has a positive treatment effect.

[Incisional hernia following laparoscopy, complicated by perforated gangrenic appendicitis -- a case review]. / Kýla v jizvé po laparoskopii komplikovaná perforovanou gangrenózní apendicitidou -- kazuistika.

Acute appendicitis is the commonest cause of acute abdomen. Early indication for surgery -- appendectomy, plays the key role in its therapy. The rate of incisional hernias (of all operated hernias) is high and they are, to a certain extent, caused by technical, mechanical factors and the patient himself. The authors present a case review of a female patient, presenting with atypical urgent abdomen, who was hospitalized with a diagnosis of advanced absces of the abdominal wall, resp. strangulated incisional hernia. Surgical revision confirmed that the condition was caused by perforated gangrenous appendicitis incisional hernia following laparoscopy. Acute appendicits is a very rare complication of the incisional hernia, and it is practically impossible to make its diagnosis based on clinical examination. Its diagnosis may be facilitated using visualization examination methods, however, its final diagnosis can only be made during surgical revision indicated for progressing acute abdomen.

[Abdominal aortic aneurysms--long-term treatment results]. / Aneuryzma abdominální aorty--dlouhodobé výsledky lécby.

OBJECTIVE: To evaluate the single center experience in the treatment of patients with AAA. METHODS: 586 patients undergoing open resection (OR) and EVAR (2000-2009). The average age was 72.2 +/- 7.7 years. AAA diameter was 8.3 cm (range 5.0-13.1 cm). 451 (76.9%) patients had asymptomatic AAA, 135 (23.1%) RAAA. 448 patients (76.5%) suffered from various co-morbidities. 430 (73.4 %) OR, 156 (26.6%) EVAR and 52 (8.9%) one staged procedure (for concomitant diseases) was performed. RESULTS: 30 days mortality rate of elective OR and EVAR was 6.2, resp. 2.9% (n.s.) versus 36.6% of RAAA (p < 0.0001). 30 days mortality rate of one staged and single procedure was 19.5, resp. 3.6% (p < 0.0001). 30 days morbidity rate was in the whole group 52.1% (80.7% in RAAA x 43.4% in asymptomatic AAA - p < 0.0001), in one-stage procedures 60.8% x 51.1% in single procedures - n.s., 45.1% in OR x 39.0% in EVAR - n.s. Redo procedures were significantly higher in EVAR x OR in the long-term period after primary procedure. 1-, 3-, 5-, and 8 years survival of patients with asymptomatic AAA and RAAA was 91.6, 85.9, 81.1 and 73.6%, resp. 54.9, 48.9, 45.9 and 43.5 years (p < 0.0001). 1-, 3-, and 5 years patients survival with single versus one staged procedures was 85.5, 80.5 and 71.0% versus 71.1, 68.0 and 74.6% (n.s.). 1-, 3-, and 5- years patients survival after OR or EVAR was 91.2, 87.1 and 80.6%, resp. 90.7, 79.9 and 74.6 % (n.s.). The significant influence on patients long-term survival had RAAA, age of patients, postoperative complications and one stage procedures. CONCLUSION: High percentage of polymorbidity was the cause of the significant 30 days postoperative mortality of patients after OR. EVAR and OR have similar long-term results. One staged procedures should be used very carefully in selected patients due to the higher mortality rate and worse long-term patients survival.

[Procedures on internal carotid performed under locoregional anesthesia in the Plzen Surgical Clinic, over a seven-year period. A discussion on AHA and ESVS guidelines]. / Operace na vnitrrních karotidách v lokoregionální anestezii na chirurgické klinice v Plzni za uplynulých 7 let. Diskuse nad AHA a ESVS guidelines.

During a seven-year period (2002-2008), 830 patients underwent internal carotid surgery in the Plzen Surgical Clinic. The mean age of the patients was 68 y.o.a. (range 48-86 years). A total of 916 internal carotid procedures were performed, the male/female ratio was 667/249. 639 procedures were performed for asymptomatic and 277 for symptomatic conditions. 677 patients suffered from unilateral carotid disorders and 153 subjects from bilateral carotid disorders. All the procedures were performed under locoregional anesthesia. The 30-day mortality rate was 1% (9 subjects) of all the procedures.

[Accidental finding of a malignancy during surgery for unusual intestinal obstruction in a female patient following kidney transplantation]. / Nihodny nález maligního onemocnení pri operacním resení nezvyklé priciny strevní obstrukce u pacientky po transplantaci ledviny.

This case report of 62 year old woman observed and treated in Vascular surgery Dpt. of University Hospital in Pilsen because of small bowel obstruction may be an example of a malignant disease, which can occur after using immunosuppressive drugs. The reason of the obstruction was strangulation of the small bowel in a peritoneal defect, which was made arteficialy as a treatment of posttransplant lymf-collection. We found signs of malignant disease in peritoneal cavity during the operation, that was verified by biopsy. The patient did not suffer from malignant disease before the transplantation. The origin of malignancy was probably ovarian tumor.

Hybrid procedures in the treatment of pseudoaneurysms of the aortic arch--case report.

Classical surgical therapy of dilatation disorders of the aortic arch require extracorporeal circulation, selective brain perfusion and/or deep hypothermia and it is still associated with very high mortality and morbidity. Endovascular therapy has until recently indicated only been in cases when the disease did not affect the area of the origins of the main branches within the aortic arch. We are presenting a case report of a 68 year female patient with a vascular anomaly (arteria lusoria) and 2 pseudoaneurysms of the aortic arch between the origins of arteria carotis communis on the right and arteria carotis communis on the left, respectively between a. carotis communis on the left and arteria subclavia on the left, when we took advantage of a hybrid procedure in the therapy. The patient was treated by creating a new branching of the aortal arch using a prosthesis from the ascendant aorta and subsequently by an introduction of 2 stent-grafts to the aortic arch using femoral arteries.

Internal carotid artery surgery in regional anesthesia at the Clinic of Surgery in Pilsen during the past 5 years.

A low percentage of perioperative complications and excellent long-term outcome following carotid artery surgery in Vascular Centers demonstrate the priority of surgical solutions in patients with significant findings on carotid arteries, in the prevention and treatment of ischemic cerebrovascular accidents. The group of patients from the Clinic of Surgery in Pilsen demonstrates the benefits of regional anesthesia during internal carotid artery surgery, both in terms of the patients' health and the financial costs incurred by the hospital.