[Clostridial sepsis and gas gangrene of the abdominal wall after cholecystectomy]. / Klostridiová sepse a plynatá snet' brisní steny po cholecystektomii.

Clostridial sepsis is a rare complication after intraabdominal operations, mostly fatal. According to our knowledge only two papers describing clostridial sepsis as postoperative complication in 4 patients were published in the Czech literature, only one of them survived. Authors present a case report of patient operated on for cholecystolithiasis and obstructive icterus where within 48 hours after cholecystectomy the clostridial sepsis and gas gangrene of the abdominal wall developed and that were successfuly managed.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

Gastric banding: intraoperative and early postoperative complications and their prevention.

BACKGROUND: Intraoperative and early postoperative complications in patients operated for morbid obesity were assessed. METHODS: 114 morbidly obese patients underwnent gastric banding (non-adjustable or adjustable). The influence of body mass index (BMI), age and preoperative morbidity on the occurrence of postoperative ventilatory disturbances was evaluated. RESULTS: Risk of postoperative ventilatory disorders increased with preoperative cardiovascular disease (p < 0.01), diabetes (p < 0.05), and increasing BMI (p < 0.01). Age, hypertension and pulmonary disease did not influence significantly the risk of complication in this series. There have been no deaths. CONCLUSION: In patients undergoing banding for morbid obesity, the potential for ventilatory complications increases with higher BMI, diabetes and cardiovascular disease in the preoperative comorbidities. Principles for postoperative care were developed.

[Hemorrhage into the digestive tract as a cause of death in patients after kidney transplantation]. / Krvácení do zazívacího traktu jako prícina úmrtí u nemocných po transplantaci ledvin.

The authors investigated the prevalence, cause and possible prevention of haemorrhage into the gastrointestinal tract in 218 patients after transplantation of the kidney (TK). 1. Haemorrhage into the gastrointestinal tract after TK occurred in 32 patients incl. 53.1% who died. In the total mortality after TK haemorrhage into the gastrointestinal tract account for 15.7%. 2. The danger of haemorrhage into the gastrointestinal tract is increased in particular: in the early postoperative period (within one month after transplantation of the kidney), during acute rejection with declining function of the graft, in infectious complications, after graftectomy, in preexisting peptic ulcers. 3. The most frequent cause of haemorrhage were duodenal ulcers. The authors elaborated a system of preventive provisions which involve: a) medicamentous prophylaxis by administration of H2 blockers and antacids not only at the time of transplantation of the kidney and during the early postoperative period but also when there is an increased risk, b) detailed gastroenterological examination before transplantation of the kidney, c) in case of relapsing peptic ulceration in the case-history or haemorrhage into the gastrointestinal tract, subject patients on the waiting list for transplantation of the kidneys during the dialyzation period to proximal gastric vagotomy, or so-called highly selective vagotomy.

Upper gastrointestinal bleeding as a complication in end stage renal disease patients.

The commonest pathological findings in the upper gastrointestinal tract have been verified by studying 320 autopsies as related to chronic renal failure through the 20-year span. In our series of 99 patients having been hospitalized within the period of 1989 to 1990, lesions of upper gastrointestinal tract were summarized that might be responsible for bleeding in the course of the dialysis and after renal transplantation. In accordance with literature sources, the investigated group showed gastric and duodenal mucosal lesions to be the most frequent sources of hemorrhages. For both the early diagnosis and therapy all patients have to be examined prior to the initiation of a regular maintenance dialysis. Gastroscopy is also indicated in all patients without any exception. Subsequent conservative treatment should be performed in an intensive and accurate way. While unsuccessful, the surgery is indicated. Authors referred to indicatory criteria based on surgical management of gastroduodenal ulcer. Both the early diagnosis and indication to surgery were stated to be of crucial importance for patient's destiny when the conservative treatment has failed. The present study should contribute to a closer collaboration of nephrologists, gastroenterologists and surgeons in order to prevent such serious complications that are represented by gastrointestinal bleeding in patients with chronic renal failure.

The changing pattern in peptic ulcer surgery.

The authors analyse the methods of treatment for the peptic ulcer disease (PUD) in two 5-year periods (group A 1979-1983, group B 1985-1989). From these groups patients with perforated gastroduodenal ulcer were excluded. In the first period 206 operations were carried out using nearly exclusively classical partial gastrectomies of both types (94 per cent). The second period involves 94 operations, where the most frequent type of operations was the proximal gastric vagotomy (40.4 per cent), and vagotomy with anthrectomy in the Roux-en-Y modification (26.6 per cent). The number of operations for a complicated PUD has increased from 43.2 per cent to 53.2 per cent, the ratio between the duodenal and gastric ulcer has changed from 3:1 to 2:1. The mortality was 5.3 and 4.7 per cent respectively, the morbidity 14.5 and 13.8 per cent respectively. The authors confirmed their accordance with the world-wide trend of diminution of the proportion of surgically treated PUD and a shift in the pattern of surgical methods towards the non-resective and more physiological procedures.

[Subtotal colectomy in the treatment of obstructive tumors in the left half of the colon]. / Subtotální kolektomie v lécbe obturujících nádoru levé poloviny tracníku.

The authors give an account of 14 patients during a two-year period where on account of an occluding tumour of the left half of the colon they performed subtotal colectomy with ileodescendent--in 2, ileosigmoideal--in 10 and ileorectal anastomosis in two patients. After operation and by the time when the material was processed, none of the patients died. Based on data in the literature and the authors' own material, the authors discuss the advantages of subtotal colectomy, as compared with hitherto used multistage procedures. The advantages include in particular a lower operative mortality (0-14%), a higher five-year survival (46%) a markedly lower morbidity, time economy, a shorter period of hospitalization and in particular, the patients are spared colostomy, even temporary one. The authors recommend subtotal colectomy as the method of choice on account of ileus caused by tumourous occlusion of the left half of the colon.

[Pharyngo-gastric anastomosis in the treatment of cancer of the pharyngo-esophageal region]. / Faryngogastrická anastomóza v lécbe rakoviny faryngoezofageální krajiny.

The authors submit their own experience with pharyngogastric anastomosis in patients where on account of circumferential cancer of the oesophagus and hypopharynx laryngopharyngooesophagectomy had to be performed. For the anastomosis a tubular flap of the greater curvature of the stomach was used which was pulled through the posterior mediastinum and sutured with the mucosa and musculature of the residual pharynx and the preserved upper half of the epiglottis. The operation is pretentious and requires satisfactory cardiopulmonary function of the patient. A disadvantage of the operation is substantial loss of gastric function, compensated by the patients by a therapeutic diet and medicinal substitution of the gastric chemism. An obvious advantage of the operation is the radical character of the oncological procedure and rapid rehabilitation of swallowing which was restored in the authors' patients on the 8th to 14th day.

[An antireflux modification in gastric resection as a prevention for alkaline reflux]. / Antirefluxní modifikace resekce zaludku jako prevence alkalického refluxu.

The alkaline duodenal or intestinal reflux of contents back to the stomach or postgastrectomy stump is known to result in chronic atrophic gastritis. In accord to several authors, it implies significantly the initiation of carcinoma of postgastrectomy stump. Authors of the present work referred to their routinely provided antirefluent modifications of Roux-en-Y gastrojejunoanastomosis in patients indicated to gastrectomy. Technically important steps of operation have been also reported. The 22-membered total of patients was presented with postsurgery revision results 3 to 36 month postoperatively. The operation mentioned was in accord with preventive DGR query. Remotely, the operation effectiveness should be evaluated as to the prevention of malignancy onset in postgastrectomy stump.