High-Dose Rate Brachyther-apy in the Treatment of Early Stages of Penile Carcinoma.

BACKGROUND: Interstitial low dose rate brachyther-apy is established organ spar-ing treatment of T1- T2 penile carcinoma. Experience with high-dose rate brachyther-apy is limited in this indication. MATERIALS AND METHODS: Twenty-six patients with early penile carcinoma were treated by high-dose rate brachyther-apy at dose 18 × 3 Gy per fraction twice daily between 2002- 2018 at the Department of Oncology and Radiother-apy, University Hospital in Hradec Kralove. Breast interstitial brachyther-apy template was used for fixation and precise geometry reconstruction of stainless hollow needles. RESULTS: Median follow up was 85 months (range 7- 200 months). Acute reaction usually consisted of grade 2 mucositis that dissolved dur-ing 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed necrosis of the glans requir-ing partial amputation. Currently, there are 24 patients alive without signs of dis-ease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse. CONCLUSION: Hyperfractionated interstitial high-dose rate brachyther-apy with 18 × 3 Gy per fraction twice daily is a promis-ing method in selected patients with penile carcinoma and deserves further evaluation in a larger prospective study. Key words penile neoplasms -  conservative treatment -  brachyther-apy This work was supported by programm Progres Q40. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 1. 2019 Accepted: 15. 1. 2019.

Semi-spherical Radiofrequency Bipolar Device - A New Technique for Liver Resection: Experimental In Vivo Study on the Porcine Model.

The incidence of colorectal carcinoma is still growing in the Czech Republic and also all around the world. With success of oncological treatment is also growing a number of potential patients with liver metastases, who can profit from surgical therapy. The aim of this study was to confirm on porcine models that this method by using new surgical device is effective and safe for patients who have to undergo liver resection. The primary hypothesis of the study was to evaluate whether this new device is able to consistently produce homogeneous and predictable areas of coagulation necrosis without the Pringle maneuver of vascular inflow occlusion. The secondary hypothesis of the study was to compare the standard linear radiofrequency device and a new semi-spherical bipolar device for liver ablation and resection in a hepatic porcine model. Twelve pigs were randomly divided into two groups. Each pig underwent liver resection from both liver lobes in the marginal, thinner part of liver parenchyma. The pigs in first group were operated with standard using device and in the second group we used new developed semi-spherical device. We followed blood count in 0(th), 14(th) and 30(th) day from operation. 14(th) day from resection pigs underwent diagnostic laparoscopy to evaluate of their state, and 30(th) day after operation were all pigs euthanized and subjected to histopathological examination. Histopathological evaluation of thermal changes at the resection margin showed strong thermal alteration in both groups. Statistical analysis of collected dates did not prove any significant (p < 0.05) differences between standard using device and our new surgical tool. We proved safety of new designed semi-spherical surgical. This device can offer the possibility of shortening the ablation time and operating time, which is benefit for patients undergoing the liver resection.

[Endovascular treatment of obstetric hemorrhage]. / Endovaskulární lécba krvácení v souvislostis porodem a tehotenstvím.

PURPOSE: To evaluate effectiveness and safety of hypogastric artery branches embolization in the treatment of postpartum hemorrhage, hemorrhage associated with cesarean section and termination of pregnancy. MATERIALS AND METHODS: All women with intractable bleeding and who were treated by embolization, were included from the period between 1996 to 2010. The retrospective study included 16 women of mean age 30.5 years. RESULTS: Intractable hemorrhage related to regular delivery occurred 7 times, five times after cesarean section and four times after termination of pregnancy. Seven women (44%) were in hemorrhagic shock during therapeutic embolization. Extravazation was angiographically proved in 50% cases. Embolization was successful in hemorrhage control in 87,5% of women, in two women embolization was repeated for persistent bleeding. There were 21 additional surgical procedures performed in 13 women before embolization including 2 hysterectomies. Two hysterectomies were done after embolization because of infection. In remaining 3 women embolization was done as a primary method of bleeding control. No patient died. In the group of 10 women with maximally 1 surgery before embolization length of hospital stay was 10.1 days in average, while in a group of six women having 2 to 3 surgeries before embolization the hospital stay was 21.2 days in average (p = 0.03). CONCLUSION: Embolization of hypogastric arteries decreases length of hospital stay in patients with obstetric hemorrhage and should be done soon if routine methods of bleeding control fail.

[The value of positive arthrography in the diagnosis and pathogenesis of retrofemoral Baker's cysts (author's transl)]. / Wert der positiven Arthrographie zur Diagnostik und Pathogenese retrofemoraler Bakerzysten.

Retrofemoral Baker's cysts are occasionally found in athletes; they occur as a result of a rupture in the dorsal part of the bursa semimembranosa gastrocnemia. The rupture itself may occur if there is increased pressure in joints or a considerable increase in the amount of synovial fluid. Ruptures can also occur if the joint wall is inadequately adapted and the synovial fluid fails to flow into the ventral joint spaces, as is possible due to certain movements in some sports. Active movement delays healing of the rupture of the capsule: the para-articular structures become encapsulated or, respectively, adhere to one another. Depending on the duration of the effusion and the amount of fluid, the pseudocyst may become pencil-shaped, spherical, cylindrical or rhomboid. It is, therefore, a traumatic pseudocyst, which occurs as a result of insufficient adaptation, principally in athletes of individuals whose occupation involves typical stresses on the knee joint.

[Detection of a subcutaneous metastasis of renal adenocarcinoma by angiography. Case report (author's transl)]. / Aniographischer Nachweis einer Hautmetastase des Adenokarzinoms der Niere.

A subcutaneous metastase in the left forearm is detected by direct angiography of the A. brachialis 18 months after nephrectomy of the right kidney because of renal carcinoma. The angiography shows a solitary well defined tumor with pathological vascularisation. The pattern of vascularisation corresponds to the histological findings of the excised metastase.

[Comments on the problem of differential diagnosis of tumours of the nerve sheaths in angiography (author's transl)]. / Zur Problematik der Diff.-Diagnose der Geschwülste der Nervenscheiden im angiographischen Bild.

The article describes the special features governing the assessment of angiographic findings in tumours of the nerve sheaths. Considerations of differential diagnosis, especially between neurinoma and neurofibroma, are discussed. Likewise, the problems of differential diagnosis of such tumours against neoplasms of the tissue of the soft parts, are also discussed. Angiography permits only a limited determination of the degree of malignancy of the neurinoma and neurofibroma. It is always mandatory to correlate these findings with the histological findings. However, angiography does seem to be justified as an additional examination technique, since it supplies fundamental pointers for surgery.

Angiography in synovitis of the knee.

In inappropriately treated synovitides of the knee joint with shift towards a villonodular inversion, an inflammatory angiographic symptomatology may be expected which is different according to the seriousness of the illness including (1) local hyperaemia, (2) deviation of arteries, (3) morphologic and formative vascular inversions and (4) diffusion of the contrast material into synovitic conglomerates and (5) shunts. From these findings the stadia of synovitis may be evaluated, including the extent and place of the villonodular inversion in the clinically or arthrographically inaccessible sites. Differential-diagnostic contributions to the origin of the synovitis cannot be expected from angiography and biochemical as well as bacteriological methods (cultivation) remain necessary. Despite this, angiography has its supplementary value in all cases where an analysis of synovitis is impossible by other means and also in all cases, where the extent of the synovitic changes must be evaluated for an operative treatment.

Some unusual complications of myelography and lumbosacral radiculography.

In 570 patients an examination of the subarachnoideal space was performed. In 77 of them oily contrast media, in 93 oxygen and in the remaining 400 patients different water-soluble contrast media were used, including Conray 60, Dimer X and Amipaque. Neurotoxic spinal complications occurred in 12 of the 400 patients investigated with hydrosoluble agents (i.e. in 3%). In one of them after investigation with Dimer X, intense cramps in the lower extremities caused a fracture of the femoral neck within a few hours after the investigation. In another patient, investigated with Amipaque, a psychotic reaction with amentia and paranoid symptoms developed, which disappeared completely after 4 days.