[Vascular dialysis access with transposed superficial femoral vein]. / Dialyzacní cévní prístup transponovanou vena femoralis superficialis.

The authors describe the case report of a 63 years old female patient with chronic renal failure in systemic lupus erythematosus. Vascular dialysis access in upper limbs could no more be used. The condition was approached by constructing an arteriovenous (AV) fistula in the thigh with transposed superficial femoral vein as the first procedure in the Czech Republic.

Mycotic Aneurysm in the Aortoiliac Area - Current Options for Treatment.

BACKGROUND: Infection represents a less frequent cause for the development of an abdominal aortic aneurysm. The diagnosis is associated with a high risk of rapir progression and rupture. CASE REPORTS: Case 1 is a female operated on urgently for a ruptured mycotic aneurysm of the abdominal aorta. After resection of the aneurysm, we performed in situ replacement using a rifampicin-soaked vascular prosthesis. In case 2, an asymptomatic aneurysm of the right iliac artery was treated by endovascular implantation of a stent-graft. Both patients were treated with antibiotics concurrently and are still alive. DISCUSSION: The discussion deals with the up-to-date treatment modalities for mycotic aneurysms in the aorto-iliac region. The indication criteria must be adjusted individually. CONCLUSION: The prognosis of patients with a mycotic aneurysm depends particularly on an early diagnosis.

[Thrombolytic therapy of acute peripheral arterial occlusions of limb arteries]. / Trombolytická terapie akutních tepenných uzáveru periferních koncetinových tepen.

INTRODUCTION: Thrombolytic therapy is a method of solution of thrombotic arterial occlusions of limbs using the physiological process of fibrinolysis. The severity of limb ischemia is the crucial for therapy. If immediate recanalization of arterial system is necessary than primarily surgical teratment is chosen. THE METHOD: The arterial closures in infrainguinal localization are indicated for thrombolysis. Especially occlusions of crural vessels and the closures of previous vascular reconstruction (bypass) are indicated. The methods of local intra-arterial thrombolysis with application of recombinant tissue plasminogen activator, (rt-PA Actilyse) through catheter introduced into the level of thrombotic occlusion by Seldinger's Metod are used in our department. RESULTS: The authors present retrospectively analyzed set of 51 patients (12 women and 39 men aged 33 to 85 years) with acute arterial occlusion solved with thrombolytic therapy in the period 02/2007 - 03/2010. Complete recanalization was achieved in 43 cases (patients) (84%), high amputation of limbs was performed in 3 cases (5.9%).

[Autogenous superficial femoral vein for replacement of an infected aorto-ilio-femoral prosthetic graft]. / Autogenní vena femoralis superficialis jako náhrada infikované aorto-iliako-femorální cévní protézy.

A group of 12 patients (10 men, 2 women; average age, 52.7 years; range, 50-79 years) with vascular prosthetic graft infection (n=9) or with an increased risk of such infection (n=3) underwent arterial aorto-ilio-femoral reconstruction using autogenous superficial femoral vein. None of the patients died or had to have revision surgery during the follow-up (mean +/- SD, 14.1 +/- 7.3 months; range, 3-27 months). No pulmonary embolism occurred, nor were any early or late complications such as recurrent infection, graft occlusion, limb amputation or aneurysmal dilatation of vein graft recorded. In one patient, benign oedema of the limb following deep vein harvest persists, but this is well managed with a compression stocking. The findings reported in the international literature as well as the authors' experience show that the use of autogenous femoral vein gives very good results in the treatment of an infected vascular prosthetic graft, one of the most feared and most serious complications of vascular surgery.

[Interdisciplinary approach to treatment of multiple arterial aneurysms in patient with eighth recurrence of incisional hernia--a case report]. / Interdisciplinární prístup k riesení mnohocetných tepenných aneuryzmat u pacienta s osmou recidivou incizionální kýly--kazuistika.

Vascular surgery is not the only option for arterial aneurysm treatment. Minimally invasive techniques are being increasingly used, especially methods of interventional radiology. We present a case of a 51-year-old man who came to our department in July 2005 because of sonographically diagnosed popliteal artery aneurysm. Simultaneous presence of subrenal abdominal aortic aneurysm, bilateral iliac and femoral artery aneurysms and left popliteal artery aneurysm was found. This patient was operated on for pancreatic pseudocyst in 2000 and then during next three years eight times for incisional hernia and its recurrences. The operations were carried out in other surgical departments. Eighth recurrence of incisional hernia was already present. Because of these facts, the risk of resection was deemed too high. Therefore, we chose stent graft implantation for abdominal aortic aneurysm treatment. The endovascular approach was also used to treat some complications that occurred. In this case report, we would like to present a combination of surgical and interventional radiological approaches to treatment of arterial aneurysms as a typical example of interdisciplinary cooperation.

[Retromuscular mesh repair of a hernia in a scar according to Rives--our first experience]. / Retromuskulární plastika kýly v jizve podle Rivese--nase první zkusenosti.

The authors present a group of 24 patients with hernias in scars operated from February 2004 to January 2005 (12 months) using a retromuscular reconstruction procedure according to Rives. 20 procedure following central laparotomies and 4 procedures following lateral laparotomies were conducted. The defect sizes ranged from 5 to 16 cm. A polypropylene mesh was used which was placed between the rectus abdominis muscle and the posterior leaf of the rectus abdominis sheath. The mesh was covered by the fascia with a minimum overlap of 5 cm in all directions. The mean follow- up period was six months (1-12 months) and no early relapses were recorderd. The complications rate was acceptable--1x secondary wound healing, 2x seroma, 1x non-transmural MI in a patient with a cardiac ischemic disorder. The retromuscular reconstruction procedure according to Rives appears to be an appropriate method for management of large ventral hernias with excellent results and minimum complications.

The laparoscopic ventral and incisional hernia repair.

We retrospectively reviewed the first twenty laparoscopic ventral and incisional hernia repairs performed at the 2nd Department of Surgery, St. Anne's Teaching Hospital, Brno from March 2003 till April 2004. Laparoscopic repairs were performed using Biomesh mesh (Cousin Biotech, France) with a minimum of 3 cm overlap circumferentially with normal fascia and secured with spiraltacks every 3-4 cm and transparietal sutures. All adhesions on the parietal defect are released, using scissors, and whenever possible we attempted to reduce the hernia sac. The mean follow-up period was 7 months with a range of 2 to 13 months. There was no recurrence in the group. There were two hematomas and one seroma in our group, which disappeared without treatment. Two patients experienced transient pain, which was resolved by analgesic treatment over time. By this date, no chronic infection, bowel obstruction, or enterocutaneous fistula have been reported. In conclusion our results are encouraging and suggest that laparoscopic ventral and incisional hernia repair is a safe, feasible, and effective alternative to open techniques. (Ref. 10.)

[Heterotopic chondro-osteoplastic metaplasia of the subclavian vein wall after long-term catheterization. Case report]. / Heterotopická chondroosteoplastická metaplazie steny vena subclavia po dlouhodobé kanylaci. Kazuistické sdelení.

A 59-year-old man admitted for i.m. had a 3-way cannula inserted into the right subclavian vein for 31 days. Autopsy revealed a circular firm thickening of the venous wall. Histology identified it as chondroid and osteoid tissue replacing adventitial connective tissue. Unusual chondroosteoplastic metaplasia not described up to now is discussed as about its causes.

[IgD plasmacytoma--observations in 5 patients]. / Plazmocytom IgD--pozorování peti nemocných.

The authors describe five cases of plasmocytoma IgD--two men aged 37 and 49 years and three women aged 52, 62 and 80 years. In four instances light lambda chains were involved, in one instance kappa chains. In all patients there was a massive finding of Bence Jones protein in urine. The diagnosis was assessed after bone marrow puncture, immunochemical examination of serum and urine and X-ray of the skeleton. In zone electrophoresis of serum a marked gradient was found only in three patients. In two instances, where the disease was considered at first chronic as glomerulonephritis in the final stage of renal failure, renal biopsy helped with the diagnosis. In all patients in the skeleton multiple osteolytic foci were found and histological examination revealed a myeloma kidney. In three patients affection of organs beyond bone marrow was found and in one patient an amyloid. In four patients the progression of the disease was very rapid. The patients died within 3-8 months after establishment of the diagnosis. In the discussion the authors mention some special features of the clinical course and laboratory finding in plasmocytoma IgD.

[Kidney transplantation at the Brno Transplantation Center]. / Transplantace ledvin v transplantacním centru Brno.

The transplantation activity in the Brno TC has increased significantly since 1994 and there are now 30 transplantations per 1 million population of the catchment area per year. It is, however, necessary to get more organ donors to attain the national average of 40 renal transplantations per 1 million inhabitants per year, which is also the average value in advanced European countries. With the use of immunosuppression with cyclosporin A the one, five and ten-year survival of grafts increased by 20, 35 and 15% resp., as compared with the period of conventional immunosuppression. The greatest losses of grafts were recorded in the Brno TC during the first year after transplantation and they accounted roughly for 25% during immunosuppression without and immunosuppression with cyclosporin A. The graft losses due to rejection declined from 63 to 21%. However, there was no decline of graft losses for non-immune reasons which accounted during all investigated time intervals for cca 20%. The ratio of graft losses on surgical--urological grounds did not change (before cyclosporin A, 5.9%, and with immunosuppression with cyclosporin A 6.6%). Also graft losses due to the recipient's death declined only insignificantly (14.4% before CyA and 8.4% with CYA). The most frequent causes of death of recipients were infections (40%), followed by cardiac deaths and haemorrhagic conditions (17% in both instances). The high rate of infections is due to aggressive immunosuppressive regimes and large doses of corticoids. Revision of immunosuppressive regimes and protective procedures is necessary. Haemorrhagic conditions such as disseminated coagulopathies remain unexplained so far. The cardiac deaths are associated above all with the rising age of renal transplant recipients and in the majority these deaths could not be prevented (acute myocardial infarctions and sudden deaths at home).

Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performance.

The natural history of patients with severe nonischemic mitral regurgitation (MR) from mitral valve prolapse, who are asymptomatic or minimally symptomatic and have normal right ventricular (RV) and left ventricular (LV) performance, has not been evaluated previously. To define natural history in this population and to determine if any objective variables could predict disease progression, 31 patients were followed annually with severe MR due to prolapse, who at entry were asymptomatic or minimally symptomatic and had normal RV and LV performance at rest by radionuclide cineangiography. Average follow-up in patients not reaching surgical end point was 4.7 years. The Kaplan-Meier product limit estimates were used to determine the rate of progression to either "operable" symptoms or to previously defined "high risk" ventricular performance descriptors, if the latter occurred first. Univariate comparisons of Kaplan-Meier curves and multivariate Cox proportional hazards analyses were used to define prognostically important variables measured at entry. Fourteen patients developed symptoms warranting referral for operation; none developed high-risk ventricular performance descriptors. The annual end point risk was 10.3%. Of all covariates, only change in RV ejection fraction from rest to exercise was significantly associated with disease progression. Annual risk of progression to surgical end point was 4.9% in the subgroup in which this parameter increased with exercise and 14.7% in the subgroup without an increase (p = 0.04). Patients with severe MR due to mitral valve prolapse, who are asymptomatic or minimally symptomatic with normal ventricular performance, can be expected to progress to surgical indications at an annual rate of 10.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of phosphorylated high molecular weight neurofilament protein (NF-H) and vimentin in human developing dorsal root ganglia and spinal cord.

The expression of vimentin and the phosphorylated variant of high molecular weight neurofilament protein (NF-H) was studied in developing human fetal dorsal root ganglia and spinal cord. The technique used for examination of cryosections was double-label fluorescence with monoclonal antibodies. Both proteins were present in the nerve fibres inside the ganglia of 6- and 8-week-old embryos. During further development the expression of vimentin continued to increase in the satellite cells, but was found to be decreasing in the ganglion cells. Phosphorylated NF-H was found in the processes of ganglion cells, as well as in the perikarya at all developmental stages. In the spinal cord of 6- and 8-week-old embryos, phosphorylated NF-H protein was found in the longitudinal fibres of the marginal layer and in processes of the mantle zone; some of the fibres also contained vimentin. Later the co-expression of the two proteins ceased and vimentin was found only in glial and mesenchymal derivatives. Phosphorylated NF-H was located, at all developmental stages, in the axons of both white and grey matter, but not in the neuronal perikarya. The results indicate that phosphorylation of the NF-H in human dorsal root ganglia starts in the perikarya of the ganglion cells while in the ganglion cells of the spinal cord it takes place in the axons.

Intraoperative transesophageal echocardiography for the detection of cardiac preload changes induced by transfusion and phlebotomy in pediatric patients.

BACKGROUND: Intraoperative blood volume changes are difficult to monitor in pediatric patients. The authors tested the hypothesis that transesophageal echocardiography would identify changes in cardiac filling resulting from manipulations of blood volume. METHODS: Eleven patients (3-15 kg) were studied following sternal closure after repair of congenital heart lesions. Transesophageal echocardiography of the midpapillary left ventricular short axis view and hemodynamics were recorded at baseline (T1), during withdrawal of blood until the systolic blood pressure decreased by 5 mmHg (T2) and 10 mmHg (T3), and after reinfusion of the blood (T4). The identical cycle of blood withdrawal and reinfusion was repeated after administration of calcium chloride (10 mg/kg; T5-T8). RESULTS: Manually traced transesophageal echocardiography images of the left ventricular end-diastolic area decreased from 4.64 +/- 1.50 cm2 at T1 to 4.03 +/- 1.25 cm2 at T2 to 3.78 +/- 1.35 cm2 at T3, and increased to 4.42 +/- 1.75 cm2 at T4. Nearly identical results were obtained at T5-T8. End-systolic areas significantly decreased from 1.96 +/- 0.86 cm2 at T1 to 1.52 +/- 0.73 cm2 at T2 to 1.41 +/- 0.62 cm2 at T3, and increased to 1.87 +/- 0.88 cm2 at T4. An experienced anesthesiologist-echocardiographer blinded to study events was able to identify mild reductions in blood volume (T2, T3, T6, T7) from recorded cine-loop video recordings with high sensitivity (80-95%) and specificity (80%). CONCLUSIONS: Transesophageal echocardiography is a potentially useful monitor of cardiac filling changes in pediatric patients.

[The effect of creatine phosphate in patients after surgery in ischemic heart disease]. / Pusobení kreatinfosfátu u nemocných operovaných pro ischemickou chorobu srdecní.

The authors submit their experience with the use of creatine phosphate in patients operated on account of coronary heart disease. They divided 50 consecutive patients into three groups. Group A--controls, group B--creatine phosphate was added to the filling of the apparatus for extracorporeal circulation and group C--creatine phosphate was added to Bretschneider's cardioplegic solution. During operation and during the early postoperative period the CK and CK MB levels were evaluated as well as levels of free acid radicals, the haemodynamic state of the patients, the incidence of ventricular dysrhythmias, the need of defibrillation, histological and histochemical examinations. The authors found a lower CK and CK MB level, a lower percentage of ventricular dysrhythmias and the same haemodynamic results of the operation in patients with a more markedly impaired systolic function of the left ventricle when creatine phosphate was used. Creatine phosphate did not affect the morphology of the heart muscle nor the level of the assessed myocardial enzymes.

Very rare angioleiomyoma of the male urethra.

Herein is reported a case of angioleiomyoma, i.e. a benign tumour arising predominantly from smooth muscle cells of the vessel wall, in a yet unreported locality, the urethra. The closest to the tumour presented by us are leiomyomas of the urethra, so far described only in females. The angioleiomyoma of our case manifested itself as a stricture of the male urethra and resection operation showed to be the best approach with elimination of the patient's complaints.

[The first isolation of Dermatophilus congolensis van Saceghem 1913 in Czechoslovakia]. / První izolace Dermatophilus congolensis van Saceghem 1913 v CSFR.

The authors present a report on the first detection of the strain Dermatophilus congolensis in Czechoslovakia. The strain was isolated from ulcerations on the dorsal part of the foot of a 47-year-old patient who previously worked for several years in Libya. Based on examinations of smears from cultures of an isolated strain and four strains from a collection, from experimental dermatofilosis of a rabbit the authors describe the micromorphology of strains of D. congolensis under a light and electron microscope (transmission an and raster microscope). They describe the colonial morphology, haemolytic properties and in particular detail the haemolytic interaction of strains of D. congolensis with Streptococcus agalactiae, Rhodococcus equi and with strains of S. aureus (monoproducers of beta-haemolysin and delta-haemolysin resp.). They assessed the sensitivity of strains of D. congolensis to some staphylococcal bacteriocin-like substances.

Experimental dermatophilosis.

The histopathologic features of an experimental dermatophilosis of rabbit skin were described. The strain of Dermatophilus congolensis used for the experimental infection was obtained from the unique isolation and cultivation of this actinomycete from the ulcerous leg lesion of one male patient. Further strains in experiment came from the collections of type cultures. The experimental infection was characterized as an exudative and crustal dermatitis with acanthosis and subcorneal abscesses. Branching hyphae and clusters of coccoid bodies were found mostly in the parakeratotic layer and infrequently in the abscesses. Both the coccoid bodies and the hyphae were Gram-positive. The hyphae were acid-fast but the coccoid bodies were non-acid-fast. The fine structure of hyphae and coccoid bodies, namely of those with flagella, was also described by means of a transmission and scanning electron microscope.

[Professor Pavel Kucera--the first head of the University Institute of Pathologic Anatomy in Brno]. / Profesor Pavel Kucera--první prednosta univerzitního ústavu patologické anatomie v Brne.

Pathologist Dr. Pavel Kucera was one of the first professors of the Medical Faculty of Masaryk University in Brno. History of his uncommon life was described in detail. Some mistakes occurring in literature were corrected according to data from Kucera's personal file in the Archives of the Masaryk University.

[Composite carcinoma-carcinoid of the large intestine]. / Kompozitní karcinom-karcinoid tlustého streva.

The authors give an account of a bioptically revealed adenocarcinoma of the large bowel which was combined with a carcinoid. The carcinoid constituent of the tumor had massive metastases as revealed by the postmortem examination.