Case: unusual migration of osteosynthetic material.

The authors present a rare and unusual case of complication, migration of osteosynthetic material for stabilization, titanium rod, which was used for stabilization of comminutive fracture of the first lumbar vertebra. This rod migrated from the retroperitoneal space to the pleural cavity. The removal of this rod was carried out by videothoracoscopy.

[Surgical treatment of brain abscess--retrospective analysis of the group of patients with brain abscess, treated at our department in last 12 years]. / Chirurgická lécba abscesu mozku--retrospektivní analýza souboru nemocných s diagnózou abscesu mozku, lécených na nasem pracovisti za posledních 12 let.

The authors retrospectively evaluated group of patiens treated at the Department of neurosurgery in Hradec Králové from 10/1993 to 10/2004 with the diagnosis of brain abscess. During this period, we treated 23 patients, 15 males and 8 women with the median age 48 years. Patiens with the iatrogenic etiology and those with pyocefalus and subdural and epidural empyema were excluded from this group. We provided 45 surgical procedures with total mortality 17,4 %.

[Indication and radicality of surgical treatment in spinal myeloma]. / Indikace a radikalita chirurgické lécby myelomu v páteri.

In our set of 19 operated patients with spinal myeloma it was in 17 patients (89%) the first manifestation of malignant haematological disease. Indication for admission for surgery were in 18 patients (92%) graphical signs of spinal compression of osteolytic affliction of the vertebra of unclear aetiology, which in 17 (63%) of patients were demonstrated by neurological deficit. On the basis of graphical examinations the most frequent suspicion was on metastatic affliction of the spine at unknown primary focus and the basic diagnosis was determined after the operation at most of cases. In decision about the choice of radicalness of surgery intervention important data about the type of tumour in the spine were usually missing and it especially did not make possible to estimate the life expectation of the patient. When deciding about the radicalness of the surgery, we started from the degree of spinal compression and surgical character of pathological process in the spine. The aim of the operation is to decompress the spinal cord in tumour and to stabilize the afflicted part of the spine. Radical extirpation of tumour followed with stabilization and spine reconstruction we decided to carry out in 7 patients, i.e. 37%, all of them clinically improved and from this group only 2 patients (29%) died till now. We carried out only palliative surgery on the spine in next 12 patients, i.e. in 63%, only 6 patients improved neurologically, i.e. 50% and 10 patients, i.e. 83% died till now.

Prognostic impact of hemoglobin level prior to radiotherapy on survival in patients with glioblastoma.

PURPOSE: To evaluate prognostic factors in patients with glioblastoma treated with postoperative or primary radiotherapy. PATIENTS AND METHODS: From 1989 to 2000, a total of 100 patients underwent irradiation as part of their initial treatment for glioblastoma. All patients had undergone surgery or biopsy followed by conventional external-beam radiotherapy. 85 patients who received the planned dose of irradiation (60 Gy in 30 fractions) were analyzed for the influence of prognostic factors. 73/85 (86%) of patients were given postoperative irradiation, while 12/85 (14%) of patients were primarily treated with radiotherapy after biopsy. RESULTS: The median overall survival was 10.1 months (range, 3.7-49.8 months), the 1- and 2-year survival rates were 41% and 5%, respectively. Univariate analysis revealed age < or = 55 years (p < 0.001), pre-radiotherapy hemoglobin (Hb) level > 12 g/dl (p = 0.009), and pre-radiotherapy dose of dexamethasone < or = 2 mg/day (p = 0.005) to be associated with prolonged survival. At multivariate analysis, younger age (p < 0.001), higher Hb level (p = 0.002), lower dose of dexamethasone (p = 0.026), and a hemispheric tumor location (p = 0.019) were identified as independent prognostic factors for longer survival. The median survival for patients with an Hb level > 12 g/dl was 12.1 months compared to 7.9 months for those with a lower Hb level. Contingency-table statistics showed no significant differences for the two Hb groups in the distribution of other prognostic factors. CONCLUSION: The results indicate that lower Hb level prior to radiotherapy for glioblastoma can adversely influence prognosis. This finding deserves further evaluation.