[Neovascularisation as a cause of recurrence after varicose veins operation]. / Neovaskularizace jako prícina recidivy po operaci varixu dolních koncetin.

AIMS: Following surgical therapy, new varicose veins may develop, in particular at the site of the previous saphenofemoral junction. The objective of this study is the appreciation of the causes of the bad results of surgical procedures in the treatment of varicose veins and the proposal of the possibilities of their prevention. MATERIAL AND METHODS: Retrospective study of the group of 404 patients (573 procedures) with the diagnosis of the recurrence after previous radical surgery was performed. After exclusion of perforator refluxes, the most frequently, the great saphenous vein territory was affected (86%), followed by the small saphenous vein territory (14%). The group of 30 consecutive patients (35 limbs) with saphenofemoral or saphenopopliteal recurrence was selected for this study. Based on preoperative ultrasound and per-operative morphological findings, in 12 patients (14 limbs) - 8 women and 4 men, meticulous histopathological examination of the venous tissue block from the saphenofemoral or saphenopopliteal region, VEGF (Vascular endothelial growth factor) and protein S-100 investigation were performed. RESULTS: In 14 limbs with sonographic and clinical suspition for neovascularisation, this entity was confirmed in 11 of them (79%) which represents 31.42% of the whole group. CONCLUSIONS: The varicose veins recurrences can be observed not only after technically or tactically imperfect primary procedure (which is surely the most common cause of the varicose veins recurrence), but also after the operations performed by the experienced venous surgeon in the perfect way. Neovascularisation explains a certain number of postoperative recurrences despite correctly conducted disconnection of the saphenous termination. The endovascular procedures (endovenous laser or radiofrequency saphenous obliteration) without open groin access can minimise the possibility of this complication.

[Postoperative complications of a perforated aneurysm of the abdominal aorta--a case review]. / Pooperacní komplikace perforovaného aneuryzmatu abdominální aorty--kazuistika.

There discussed casuistics of the 64 years old man, who underwent urgent resection of perforated subrenal aortic aneurysm that expanded to both iliac arteries. Aortobifemoral bypass and packing of retroperitoneum were performed. The patient was operated for periprothetic abscess and aorto-enteric phistula three months later. Phistula was closed, infected prothesis was resected and replaced by new prothesis. Omentoplasty was added.

[Surgery of the saphenous-popliteal junction: a delicate procedures with potential risks]. / Operace saféno-popliteální junkce: delikátní výkon s mozným rizikem.

UNLABELLED: The authors evaluate the results achieved in two groups of patients operated on for varicose veins in small saphenous vein (SSV) territory in 3 year interval. In the first group gathered from January to December 1998 (114 patients--36 men and 78 women, 123 procedures--118 primary and 5 re-do) the operative indication was based on the clinical examination and continual doppler evaluation. These patients were operated on in general, spinal or local and flash general anaesthesia. In the second group gathered in the same period of the year 2001 (72 patients--21 men and 51 women) 75 procedures were performed (3 patients with bilateral operation). In this group, 49 patients with 50 procedures were selected. The diagnosis was based not only on clinical and continuous doppler examination, but mainly on colour flow duplex mapping. The operation was performed on strictly ambulatory basis using pure local anaesthesia completed with small dose of sedation. Any patient needed complementary sclerotherapy one month after procedure. In mid-term follow-up complementary conservative treatment was necessary in 51 p.c. of the whole series. CONCLUSION: Use of colour coded duplex ultrasound in preoperative evaluation of varicose veins patients enabled us to precise preoperative diagnosis, to diminish the number of aggressive surgical procedures in favour of less traumatic operations and to perform this surgery on ambulatory basis. Nevertheless, small sahenous vein surgery still remains delicate and sometimes also hazardous.

Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy.

OBJECT: The authors undertook a study to evaluate the effectiveness of endoscopic third ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. METHODS: Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hjpital Necker-Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic third ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary third ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between patients in Group A or B with respect to the following variables: age at presentation, evidence of metastatic disease, extent of tumor resection, or follow-up duration. In patients in Group A, however, more severe hydrocephalus was demonstrated (p < 0.01): the patients in Group C were in this respect different from those in the other two groups. Ultimately, there were only four patients (6%) in Group A compared with 22 patients (26.8%) in Group B (p = 0.001) in whom progressive hydrocephalus required treatment following removal of the posterior fossa tumor. Sixteen patients (20%) in Group B underwent insertion of a ventriculoperitoneal shunt, which is similar to the incidence reported in the literature and significantly different from that demonstrated in Group A (p < 0.016). The other six patients (7.3%) were treated by endoscopic third ventriculostomy after tumor resection. In Group C, two patients (4.3%) with postoperative hydrocephalus underwent endoscopic third ventriculostomy. In three patients who required placement of CSF shunts several episodes of shunt malfunction occurred that were ultimately managed by endoscopic third ventriculostomy and definitive removal of the shunt. There were no deaths; however, there were four cases of transient morbidity associated with third ventriculostomy. CONCLUSIONS: Third ventriculostomy is feasible even in the presence of posterior fossa tumors (including brainstem tumors). When performed prior to posterior fossa surgery, it significantly reduces the incidence of postoperative hydrocephalus. The procedure provides a valid alternative to placement of a permanent shunt in cases in which hydrocephalus develops following posterior fossa surgery, and it may negate the need for the shunt in cases in which the shunt malfunctions. Furthermore, in patients in whom CSF has caused spread of the tumor at presentation, third ventriculostomy allows chemotherapy to be undertaken prior to tumor excision by controlling hydrocephalus. Although the authors acknowledge that the routine application of third ventriculostomy in selected patients results in a proportion of patients undergoing an "unnecessary" procedure, they believe that because patients' postoperative courses are less complicated and because the incidence of morbidity is low and the success rate is high in those patients with severe hydrocephalus that further investigation of this protocol is warranted.