One-stage surgical approach to coarctation of the aorta and ascending aortic aneurysm.

BACKGROUND: Aortic coarctation in adults is sometimes associated with concomitant cardiovascular pathologies which require intervention. The optimal operative approach for such patients remains unsettled. An extra-anatomic aortic bypass from the ascending aorta to the descending aorta via median sternotomy allows simultaneous performance of repair of complex aortic coarctation and concomitant cardiac operation. CASE REPORT: We present herein an adult female with coarctation of the aorta combined with an ascending aortic aneurysm associated with concomitant aortic valve regurgitation. We performed a single-stage operation which consisted of Bentall's procedure and extra-anatomic bypass from the ascending to the descending aorta. The patient's postoperative period was uneventful and twelve months after the surgery she is doing well.The conclusions of our work resulted in one essential experience, namely that clinically serious, previously almost intractable conditions can be successfully resolved in unusual ways. Extra-anatomic reconstruction of aorta coarctation that for various reasons could not have been solved by resection of the affected aortic segment allowed us to achieve a structurally as well as functionally excellent outcome. Therefore, we recommend to consider this option in appropriate patients and/or incorporate it into the therapeutic armamentarium of cardiosurgical centers (Fig. 5, Ref. 11).

Aortic valve-sparing operation versus Bentall and mechanical aortic valve replacement--midterm results.

OBJECTIVES: The primary aim of this retrospective study was to evaluate short-term (one-to-six months) and mid-term (six-to-forty-eight months) results of aortic valve-sparing procedures. The second endpoint was to compare the results with the group of patients undergoing mechanical aortic valve replacement during the same period. METHODS: Between April 2008 and May 2012 at our institution, we treated 76 patients either with ascending aorta/root aneurysm/dissection or with isolated aortic regurgitation. A total of seventy-six patients undergoing aortic valve surgery. RESULTS: Analyzed parameters were divided into two parts as function of time. In the first part, i.e. during hospitalization, the mortality, duration of hospitalization, duration of extra corporeal circulation (ECC), and duration of cardiac arrest (CA) were compared and assessed. In the second part, i.e. during monitoring of the patients after their discharge from hospital (one-to-six months, and six-to-forty-eight months), the grade of postoperative AR aimed mainly at the group of aortic valve-sparing operations (subgroups A1, A2, A3), postoperative peak gradient, presence of thromboembolic and bleeding complications, postoperative endocarditis and need for reoperation or hospitalization due to cardiac reasons were analyzed. CONCLUSION: Based on our first experience, we believe that in spite of higher technical difficulty, the aortic valve-sparing operations can be possibly performed with the same or respectively lower rate of postoperative morbidity and mortality. Presented results show that compared with the aortic valve replacement, the aortic valve-sparing operation is a promising method, and an interesting therapeutic alternative for patients. After proper indications, we consider it to be a method of choice (Tab. 6, Fig. 7, Ref. 28).

[Heterotopic pancreas in the stomach wall -- a rare histological diagnosis of submucous lesson -- casuistic report]. / Heterotopický pankreas v stene zalúdka, ako raritná histologická diagnóza submukóznej lézie -- kazuistika.

Heterotopic pancreas (HP) is defraed as abnormally localized pancreatic tissue without any anatomical and vascular connection with pancreas. Incidence of HP is 0.2-0.5% of patients underwent upper medial laparotomy. The most common symptoms of HP are abdominal discomfort and pain, upper gastrointestinal bleeding and intermittent bowel obstruction. Gastroscopy is the most commonly used first diagnostic procedure. Ultrasound evaluation, computer tomography and namely endoscopic ultrasound evaluation are useful imaging procedures of HP. Casuistic report of patient with upper gastrointestinal bleeding is presented. Imaging procedures have recorded stomach tumor 3cm in diameter in back wall of stomach. Billroth II resection of stomach was performed. Histological evaluation of removed part of stomach recorded heterotopic pancreas type 1 of Heinrich classification. HP diagnosis before surgery is difficult because of submucous localization of lesion. Fine needle biopsy during gastroscopy is one of diagnostic possibilities without surgery. Endoscopic excision of lesion is possible if histological evaluation by fine needle biopsy is successful and anatomical localization is appropriate. The most of patients need surgical excision of HP. Peroperative histological evaluation allows a minimalization of excision area. Opinions of asymptomatic HP treatment are ambiguous. The most of published papers recommend excision of asymptomatic HP also, because of risk of next complications.

[Pilonidal sinus--a classical plastic procedure according to Limberg (Limberg flap procedure) or its modified version?]. / Pilonidálny sinus - klasická plastika podl'a Limberga alebo modifikovaná verzia?

Pilonidal sinus disease (PSD) is defined as a cyst of sacrococcygeal hair follicle. Complete excision of lesion and skin reconstruction is still the only definitive treatment. Opinions on form and size of excision and type of skin reconstruction and flap are ambiguous. Retrospective analysis of 83 patients underwent surgery in 1. Department of Surgery in Kosice because of chronic PSD was performed. 67 patients underwent excision with Limberg flap (LF). 16 patients underwent excision with modified Limberg flap (mLF). 19 and 3 patients were excluded because of absence of control evaluation. The control evaluations of 48 and 13 patients were performed 12 days and 12 mounts after surgery. No differences between groups in age of patients and men to women rate were recorded. We have recorded shorter hospital time (LF: 4 days; mLF: 3 days) and lower incidence of disease recurrence in one year (LF: 6.25%; mLF: 0%) in modified Limberg flap group. Using of flaps in PSD treatment decrease suture tension and minimize risk of suture dehiscence, postoperative tenderness and risk of other complications. Using of flaps in treatment of this disease reduce intergluteal groove and minimize risk of disease recurrence. Using of primary closure without flap carries just little benefit in shorter surgery time. Suture outside of midline minimize risk of early postsurgical complication and decrease risk of disease recurrence. Published literature in correlation with our results show that modified Limberg flap may be useful standard in PSD treatment.

[Uncommon rectal adenocarcinoma metastases]. / Nezvycajné metastazovanie adenokarcinómu rekta.

Rectal cancer treatment has become multimodal as a result of significant advances in imaging diagnostic, in surgery technique of re section and in neo and adjuvant therapy. The aim of the case report was to present a successfully treated adenocarcinoma recti and adenocarcinoma of hepatal flexurae with recidivistic metastasis and an extremely rare intergrowth of the metastasis into venous system. A 61 year old patient underwent low resection of recti according to Dixon because of well differentiated adenocarcinoma with classification T3N0M0. The patient was reoperated because of metastasis of adenocarcinoma in the abdominal wall (16 x 15 x 20 cm) after chemotherapy (FUL-5-fluorouracyl) and radiation dose of 50.4 Gy. The metastasis of abdominal wall was extirpated after another cycle of adjuvant therapy of FUL+Leukovorin. 26 months after the first operation, a new sessile polyp was found in the hepatal flexurae with histological finding of well differentiated adenocarcinoma. The patient underwent right hemicolectomy. Since lymphatic nodes were without metastasis, the patient was not indicated for chemotherapy. Two months later, the patient was admitted because of phlebothrombosis of left femoral vein. The patient underwent three reoperations with total extirpation of recidivistic tumor located in left thigh and received six cycles of Xeloda. Histological examination proved an intergrowth into great saphenous vein. Authors did not come across a case in the literature with an intergrowth of metastasis into venous system with a five year survival of a patient. The patient from this case report has no local relapse and metastasis six years after the first operation.

[A rare complication following anastomosis suturing using a biofragmentable Valtrac anastomosis ring--a case review and literature overview]. / Zriedkavá komplikácia po sití anastomózy biofragmentilným prstencom Valtrac--kazuistika a prehl'ad literatúry.

The use of Valtrac Ring since 1985 has brought about the ability of easier anastomosis suturing and shortening of the operative treatment. As other methods, also Valtrac ring has its disadvantages. Authors present a case report of a complication previously not described in the literature. A 67 year old patient, after right hemicolectomy with ileotransversoanastomosis with the help of Valtrac due to adenocarcinoma, underwent a control colonoscopy six month after operation. Small polyps in colon sigmoideum, colon descendens and transverse were removed and a tissue stripe with ulceration was found during the examination. The bioptic sample was taken from this stripe. After the application of Fragmine, the patient had a massive enterorhagia, which was not even resolved by adrenaline per colonoscopy. The patient underwent re-resection of ileotrasversoanastomosis. A ring of tissue, created by circular necrosis in the place of seroserous connection of biofragmentile ring of both of the lumens, was found in the tissue sample. Stenosis of the anastomosis, dehiscence, bleeding and fistulation are described in the literature as the most common complications after Valtrac use. The incidence is comparable with complications during anastomosis sutured by hand. We would like to bring this extremely rare complication to the attention to all surgeons and gastroenterologists, who perform endoscopic examinations in patients after this surgical procedure.

[Arteriovenous malformation in small intestine as atypical etiology of lower gastro-intestinal bleeding--a case report]. / Cievna malformácia v tenkom creve ako netypický zdroj krvácania z dolnej casti tráviaceho traktu--kazuistika.

Lower gastrointestinal tract bleeding (LGIB) is the acute abdomen, defined as gastrointestinal tract bleeding under the ligament of Treitz. We present the case report of patient iteratively hospitalized because of repeated LGIB. There were performed gastrofibroscopy, colonoscopy and capsule endoscopy, without the bleeding localization. Scintigraphy and computer tomography showed the origin of bleeding in terminal small intestine; the computer tomography diagnosed the arteriovenous malformation in this area. During laparotomy the resection of 120 cm of terminal small intestine was performed with end-to-end anastomosis. The recurrence of bleeding was not diagnosed. LGIB takes about 0.5% of acute hospitalization at surgery departments. After the stabilization of vital functions, the exclusion of the upper gastrointestinal tract bleeding and fast gastrointestinal tract preparation, the urgent colonoscopy is recommended. In case of non-successful colonoscopy, the most of authors recommend angiography, capsule endoscopy and double-balloon endoscopy. The conservative management is adequate in more than 2/3 of patients; in part of them the intervention during colonoscopy is possible. Surgical intervention with gastrointestinal tract resection is performed in less than 17% of patients. The urgent surgery is needed in 4.7% of patients. All the diagnostic and curative interventions have greater success and should be performed during the acute bleeding.

[Pseudodiverticulitis coeci--the atypical etiology of right iliac fossa pain--a case report]. / Pseudodiverticulitis coeci--atypická etiológia bolesti v pravom hypogastriu.

The aim of our paper is to show on the diagnosis of coecal diverticul as infrequent reason of right iliac fossa pain. We present the case report of 43-years old woman, which underwent appendectomy some years sooner, and was accepted into the hospital because of 48-hours taking right iliac fossa pain. Local peritoneal irritation was present. During laparotomy resection of right colon with the toilette of abdominal cavity was performed. Histology diagnosed the right colon pseudodiverticulitis. In case of diagnosis of right colon pseudodiverticulitis before surgery and without peritoneal irritation, the most of authors recommend the conservative management with antibiotics. If the surgery is required, the local resection of diverticul with appendectomy is recommended. If the local resection is not possible, the ileocoecal resection has lower mortality as the right hemicolectomy.

[Mesenteric ischemia--late diagnosis or managed disease?]. / Mezenterická ischémia--neskoro rozpoznaná diagnóza, alebo zle liecené ochorenie?

AIM: Diagnosis and therapy of mesenteric ischaemia as the cause of an acute abdomen is a serious problem because of its 60-80% mortality. The study presents experience with diagnosis and therapy of this disease and it compares its results with those in the literature. MATERIAL AND RESULTS: Throughout the years 2000-2009, there were 39 patients surgically treated with mesenteric ischaemia (17 men, 21 women, the average age 73 I 9.43). 38.46% of patients underwent resection of small and large bowel, in 33.3% only a part of small intestinum was resected, and in two cases (5.13%), the resection was combined with the embolectomy of artery mesenteric superior. In 23.1% of patients, only an explorative laparatomy was performed, because of an extended affection. Four patients were reoperated (dehiscence of anastomosis, perforation of small bowel, dehiscence of the wound, enterocutaneous fistula). 23% of patients needed ventilation because of postoperative complications such as respiratory insufficiency, sepsis and heart failure. There was 53.8% mortality. The abdominal pain (79%), vomitus (61.5%) and subileus (35.9%) predominated in the clinical picture. Leucocyts were elevated in 58.97% of patients. X ray examination showed non specific findings, and ultrasonography has proven to be successful in 42.3% of cases. CONCLUSION: Mortality of patients is significantly increased by low success rate of the depictive methods, non-specific clinical picture, co-morbidity in elderly patients and by late arrival to hospital.

[Giant solitary fibrous tumor of the pleura--case report]. / Obrovský solitárny fibrózny tumor pleury--kazuistika.

Solitary fibrous tumors of the pleura are rare malignant pathological findings, accounting for only 5% of all pleural neoplasms. Clinical manifestations are very unspecific and over 50% of the cases are asymptomatic. The commonest clinical symptoms include cough, pains, dyspnoea, fever and weight loss. The recommended diagnostic methods include chest x-ray, CT and MRI imaging and positrone emission tomography. The CT-assissted puction biopsy yield is less than 50%. The authors present a case review of a 58-year-old female with a history of dyspnoea. Her chest x-ray and CT examination suggested a large cystoid lesion in the right hemithorax, with extensive dystelectasis of the right lung lobe. Functional pulmonary examination confirmed severe gas transfer dysfunction, with diffusion lung capacity of 47% of the normal. Stenosis of the right middle and lower lobar bronchus resulting from extramusral pressure was detected on bronchoscopy. The authors performed right-sided thoracotomy and removed an encapsulated solid tumor measuring 24 x 16 x 13.5 cm and weighting 2850 grams from the thoracic cavity. Benign solitary fibrous tumor was diagnosed on histology. The postoperative course was complicated by bleeding into the pleural cavity, which was managed conservatively and did not require subsequent surgical revision. The patient was released for home care in a good condition. The aim of the study is to draw attention to this tumorous disorder of the pleura - the solitary fibrous tumor.

Simple interrupted percutaneous suture versus intradermal running suture for wound tensile strength measurement in rats: a technical note.

BACKGROUND: In this experimental study, simplicity of measurement and wound tensile strength of wounds fixed by simple interrupted percutaneous suture (SIPS) and intradermal running suture (IRS) were compared. METHODS: Twenty-eight male Sprague-Dawley rats were used for the experiment and separated into two groups: SIPS group and IRS group. Under general anesthesia, two parallel full-thickness (4-cm) skin incisions were made on the back of each rat. Wounds in the SIPS group were closed using 4 interrupted percutaneous sutures, whereas wounds in the IRS group were closed by intradermal running suture. Seven animals from each group were sacrificed at 2 and at 5 days after surgery for tensile strength testing. RESULTS: The wound tensile strength of IRS wounds was significantly higher than that of SIPS wounds at 2 days (SIPS = 2.9 +/- 0.8 vs. IRS = 3.7 +/- 0.9 g/mm(2), p < 0.05) and at 5 days (SIPS = 5.6 +/- 1.3 vs. IRS = 7.1 +/- 1.2 g/mm(2), p < 0.01). In addition, the measurement of IRS wounds was easier and faster due to removal of only one suture. CONCLUSIONS: These findings highlight the advantages of expanding the use of IRS suturing in experimental studies conducted on rats.

[Low molecular weight heparins and their non-antithrombotic effects on wound healing]. / Nízko-molekulárne heparíny a ich neantitrombotické úcinky na hojenie rán.

Heparin and low molecular weight heparins (LMWHs) are commonly indicated drugs for surgery and non-surgery patients because of their effectiveness and safety in prevention and therapy of deep vein thrombosis. While the effect of LMWHs on coagulation cascade is commonly known, some other effects of these drugs are unknown. Many papers present anti-inflammatory effects of LMWHs. Affecting of inflammation takes place on more levels. LMWHs block penetration of neutrophils into the tissue by inhibiting their adhesion to endothelial cells, by blocking of chemoatractants and by decreasing of elastases production. LMWHs affect production and activity of tumour necrosis factor alpha, interleukins 6 and 8 and interferon gamma. LMWHs also decrease vascular permeability and stable structure of capillary basal membrane. The effect of LMWHs on angiogenesis is not fully understood. While positive effect on fibroblast growth factor is frequently presented, the effect on vascular endothelial growth factor is controversial at least. Opinions concerning the effect on fibroblast growth and collagen production are also ambiguous. However, most of papers indicate positive effect of LMWH on this part of wound healing. Number of studies that point to the divergences of the effects of individual LMWHs is growing, thus explaining the differences between individual studies. Small uncontrolled clinical studies show the possible utilization of LMWH in chronic wound treatment, especially in inflammatory bowel diseases treatment. However, for their practical application, more studies are needed.

[Appendicitis in pregnancy]. / Apendicitída v gravidite.

UNLABELLED: THE AIM OF THE STUDY was to highlight the problems related to acute appendicitis in pregnancy. We present our own experiences with the diagnostics and therapy of this surgical complication during gravidity. Nausea, vomiting and pain in lower right abdomen as symptoms of appendicitis are often confused with the I. trimester gravidity symptoms. The change of pain locality and the loss of somatic pain in the II. and the III. trimester cause diagnostic delay and increase the incidence of appendiceal perforation. In case of suspected appendicitis, when evaluating laboratory parameters, the common finding of leucocytosis during gravidity further complicates the differential diagnosis. In comparison to common population, ultrasonography in gravidity displays lower sensitivity and specificity. MATERIAL AND RESULTS: In the course of the last ten years, 9 gravid women in the age (25.6 +/- 3.9) underwent appendectomy in the 2nd surgical clinic FNLP in Kosice. This represents 0.6 percentage incidence of appendicitis of 1496 patients operated because of this diagnosis. One of the patient turned out to be a case of negative appendectomy while the rest had histologically confirmed gangrenous (5x), phlegmonous (1x) and catarrhalis appendicitis (2x). Perforation was encountered in one patient. In the physical examination dominated pain in the right hypogastrium, nausea and subfebrility. The diagnostic success of USG examination reached 40%. In all gravid patients leucocytosis was found, including a negative appendectomy. The average duration from hospitalization to operation was 38 hours. No maternal or fetal loss was noted. CONCLUSIONS: Correct diagnostic and early surgical intervention prevents further fetal and maternal morbidity and mortality. Physical examination is important in differential diagnosis. Leucocytosis is not a predictive marker of appendicitis. Visualization of appendix through ultrasonography is rather difficult in the third trimester.

[Re-expansion pulmonary edema as a complication of a spontaneous pneumothorax drainage--a case review]. / Reexpanzný pl'úcny edém, ako komplikácia drenáze hrudníka pri spontánnom pneumotoraxe--kazuistika.

Reexpansion pulmonary edema is an iatrogenic complication occurring after reinflation of the collapsed lung of a patient with pneumothorax or fluidothorax. The following risk factors have been associated with reexpansion pulmonary edema: younger age, longer duration of a lung collapse, its large extend and a quick lung reexpansion. We report a case of 26-years-old man. The patient was admited to the second surgical clinic FNLP, Kosice because of a spontaneous pneumothorax. A chest tube was inserted in local anesthesia in the right anterior axilar line and the fourth intercostal space. An active negative pressure of 20 cm H2O was applied. Dyspnea, decrease of blood pressure, tachycardia, tachypnoe and expectoration of pink sputum were recorded after negative pressure application. Oxygen saturation decreased to 90% despite the addition of oxygen. Glucocorticoids, diuretic stimulants, analgesic and bronchodilatators were administered. Chest X-rays and computer tomography showed a strong ipsilateral pulmonary edema and an incipient contralateral pulmonary edema. The patient was stabilized and after 16 hours continuous oxygen administration was not longer needed. Because of continuous pneumothorax, a video assisted thoracoscopic surgery was performed on the seventh day after the chest tube insertion. After 13 days of hospitalization the patient was discharged in good condition without any further complications to the ambulatory care. Reexpansion pulmonary edema is a rare complication of the chest tube insertion and thoracocentesis because of pneumothorax and fluidothorax. The mortality of reexpansion pulmonary edema reaches up to 20%. Chest tube insertion and thoracocentesis are therapeutic procedures to be performed solely on medical department which can provide artificial lung ventilation.

[Chronic wound as a precancerosis (Ulcus marjolini--Marjolin's ulcer)--a case review]. / Chronická rana ako prekanceróza (Marjolinov ulkus).

Marjolin's ulcer is defined as a tumor arising from a chronic wound, scar or chronic inflammation. Commonly, it is histologically diagnosed as a squamous cell carcinoma or a basocellular carcinoma. Its management includes its excisioning including a sufficient circumferential rim and histological examination of the sentinel lymphnode. The authors present a case review of a 51-year-old male with a history of a sacral decubitus, treated for over 40 years. The patient was hospitalized to cover the defect with a skin flap. During the hospitalization, histological examinations of his inguinal lymphnodes and subsequent wound granulations were performed with an identical finding of a squamous cell carcinoma. Based on the findings, the Marjolin's ulcer was diagnosed. The patient underwent the first series of chemotherapy. However, the patient's condition deteriotated. He exited 24 days following establishment of the diagnosis. The aim of this study is to highlight one of the most dangerous complications of chronic wounds. Marjolin's ulcer is a diagnosis, which must be considered in any chronic wound of any etiology, persisting for over 3 months.

[Venous ulcer--present view on aetiology, diagnostics and therapy]. / Venózny ulkus--súcasné pohl'ady na etiopatogenézu, diagnostiku a terapiu.

The common aetiology of chronic wounds is chronic venous insufficiency. The prevalence of chronic venous insufficiency ranges from 5 to 8% and the prevalence of venous ulcers is about 1%. Venous ulcer is caused by induction of chronic inflammation. Chronic inflammation leads to deregulations of wound healing mechanisms. Senescent phenotype of wound healing cells is recorded as outcome of chronic inflammation. Diagnosis is based on classical clinical presentation of venous ulcer and on supporting examinations. Supporting examinations include duplex ultrasound, photoplethysmography, ankle brachial index investigation and examination of hemocoagulation status. Malignant transformation is a possible complication of venous ulcers. The relative risk of malignancy in chronic venous ulcers is 5.8%. The first step in venous ulcer treatment is debridement. There is no consensus in speculations about wound colonization treatment. However the signs of infection are indication for general antibiotics treatment. Local antiseptic therapy is increasingly used. On the other side local antibiotics therapy is not recommended. Compression is used as the mainstay of therapy. It is important to rule out arterial disease before initiating compression therapy. Dressings are used as an adjuvant therapy to compression. Venous ulcers treatment is an interdisciplinary problem. Large diagnostic and therapeutic methods are needed for its management.

[Spontaneous rupture of ductus choledochus in acute pancreatitis--a case report]. / Spontánna perforácia ductus choledochus pri akútnej pankreatitíde--kazuistika.

Spontaneous perforation of biliary tree is a rare disease. There are only a few case- reports published in the literature. Due to little success in the preoperative diagnosis, surgical treatment is delayed, which in a high percentage results into fatal complications. Surgeons' opinions of operative treatment in such cases are controversial, but the primary choice is decompressing drainage of biliary tree. Authors of this report present a case of 71 years old woman admitted to the second surgical clinic with the diagnosis of acute pancreatitis. Because of developing signs of peritoneal irritation, the patient was referred for a surgical procedure with the finding of biliary peritonitis and the rupture of ductus choledochus. In the above case, the diagnosis was made peroperatively, where the surgical treatment consisted of drainage of ductus choledochus by Kehr T drain and cholecystestomy by inserting Malecoat catheter into gallbladder. Postoperative period was without complications, the T drain was removed on the 28th day after operation and Malecoat catheter was also removed two days later. Three years after the operation, the patient is in good physical condition with free bile passage according to ERCP. The aim of this report is to bring the attention to this rare, but more importantly serious cause of origin of sudden abdominal event, in order to increase the interception rate concerning preoperative periods and consequent satisfactory treatment.

Early changes in the tensile strength and morphology of primary sutured skin wounds in rats.

The specific aim of this study was to measure the TS of rat skin wounds during the first week following surgical injury. Biomechanical and histological data were collected daily (days 1 to 7 following surgery) from separate groups of Sprague-Dawley rats (N = 12) each with two 3 cm long parallel skin incisions on the back. The wounds were immediately closed by four simple sutures. A control group (N = 15) was used to obtain TS measurements of unwounded skin. TS was measured by applying a ramp load until wound separation and estimated by dividing the yield strength by the wound area. The time course of biomechanical recovery followed a step-plateau pattern with the largest increase in TS observed one day after surgery (0 - 1.60 g/cm(2)). The plateau stage extended from day 1 to 5 (1.60 - 3.88 g/cm(2)). The final step (day 5-7) indicated a period of rapid rise in wound TS (3.88 - 11.57 g/cm(2)). Since even on day 7 the mean TS was only 4% of unwounded skin, the wound had to be protected from tensile loads. Histological analysis confirmed that the early changes in TS (day 1) correlated with the fibrin accumulation of the wound edges followed by a plateau stage caused by the tissue proliferation. The rapid increase in wound TS was characterized by cross-linking the incisions with collagen fibres with escalating organization. We conclude that from a biomechanical perspective, sutures can be removed during the "plateau phase", but the wound must be protected from tensile loads.

[Vacuum assisted wound closure --overview of lesson and applications]. / Podtlakové uzatváranie rán--nové poznatky a moznosti aplikácie.

The aim of this review was to provide a comprehensive actual overview of the Vacuum Assisted Closure therapy (VAC). VAC is new method for wound treatment. VAC is assigned especially for per secundam healed wounds. Open-cell foam is placed into the wound with the evacuation drain. The wound side and foam are then covered with an adhesive drape. The evacuation drain is connected to a computerized vacuum pump. The VAC removes excess fluid, reduces the number of microorganisms and increases temperature in the wound. Mechanical stress causes granulation tissue formation and neoangiogenesis. The most of published studies present positive influence of VAC for wound healing. The newest studies present positive influence for healing of contaminated wounds, wounds after thoracic surgery, traumatic wounds and also for wounds of diabetic patients. The use of VAC for oncology patients is controversial, but there are some studies to present VAC positive effect in these cases, too. However there are a few studies to present negative complications of VAC, especially increase of microorganisms in the wound. For all that VAC is not standard for wound healing treatment now, presented studies point out that VAC can by used in generally surgery.

[Basal concentrations of FSH (follicle stimulating hormone) as a predictor of succes of IVF-ICSI cycle]. / Bazálne koncentrácie FSH (folikulostimulacného hormónu) ako prediktor úspesnosti IVF-ICSI cyklu.

OBJECTIVE: To evaluate the predictive value of basal follicle-stimulating hormone (FSH) levels in relation to the ovarian reserve and to establish their effect on IVF success. DESIGN: Retrospective clinical study. SETTING: 2nd Department of Gynaecology and Obstetrics, Medical Faculty and L. Pasteur University Hospital Kosice. METHODS: 155 IVF cycles were evaluated in relation to the basal FSH levels. Several parameters were regarded--duration of stimulation, gonadotrophins dosage, number of oocytes, oocyte quality, fertilization ratio, number of embryos, pregnancy rate and miscarriage rate. RESULTS: Statistically significant correlation in relation to basal FSH levels was established in case of number of oocytes and number of embryos (p < 0.05). Other parameters were not correlated to basal FSH levels. There was not established lowerpregnancy rate in patients with elevated basal FSH levels. CONCLUSIONS: On basis of this study results we can observe that basal FSH concentrations give us some information about ovarian reserve, but they neither inform about oocyte quality nor predict IVF success.