[Treatment of perforating mediastinitis]. / Lécba perforacní mediastinitidy.

In 1986-1994 at the Second Surgical Clinic in Olomouc Faculty Hospital and Medical Faculty 23 patients with perforating mediastinitis were treated. The treatment of this serious disease is associated with a 30% lethality. The cause of its development are complications after surgery of the oesophagus, more frequently operations in the area of the cardia but also damage during instrumental treatment of the upper digestive tract. The analysis draws attention to the risk of perforation of the oesophagus in different types of operations. The author emphasize the importance of early comprehensive intensive treatment, incl. support of respiratory functions.

Mediastinitis due to perforation.

The oesophageal perforation is a begining of tragedy. We present a group of patients with serious complication-mediastinitis after operations of the oesophagus or after instrumental diagnostics and instrumental treatment.

Analgesia after intercostal thoracotomy.

At present, several possibilities of postoperative analgesia have been known in the case of thoracotomy. Most frequent is the bolus administration of various analgetic drugs, continuous analgetic infusions, or, now more preferred the epidural application of analgetic drugs. The authors compared two groups of patients subjected to intrathoracic surgery and hospitalized at the Ist Surgical Clinic in Olomouc. The first group (23 patients) was given analgetics by the classical method (bolus administration), to the second group (15 patients) epidural morphine was applied. No significant differences were found between the both groups. Postoperative complications (e.g. atelectasis) did not occur in any group of patients, values of blood gas according to Astrup were within normal limits. The day of the operation was subjectively better tolerated in the second group but there were some insignificant complications related to morphine administration (vomiting, urine retention) even in 60% of cases.

[Diagnosis of traumatic ruptures of the bronchi]. / Príspevek k diagnostice traumatické ruptury bronchu.

The author presents a report on the course of the disease and diagnostic difficulties of a rupture of the bronchus in a patient with a severe thoracic injury. He draws attention to the diagnostic difficulties in these injuries and evaluates diagnostic and therapeutic possibilities. She assumes that with more frequent chest injuries the possible more frequent incidence of these injuries must be foreseen. The author emphasizes interdisciplinary team work in the diagnosis of the condition and the comprehensive character of care.