[Iatrogenic biliary tract lesions requiring surgical reconstruction - presentation and classification of the lesions, their reconstruction and evaluation of the results]. / Iatrogénne lézie zlcových ciest vyzadujúce chirurgickú rekonstrukciu prezentácia a klasifikácia poranení, spôsob rekonstrukcie, hodnotenie výsledkov.

INTRODUCTION: The incidence of biliary duct injuries requiring surgical reconstruction has stabilised between 0.30.7%. Biliary reconstruction in the hands of a trained hepatobiliary surgeon may lead to better short- and long-term outcomes in patients with this infrequent, but serious complication. METHODS: This study presents a retrospective analysis of single surgeon experience with biliary injury repair during the period of 20072016. Extramucosal hepaticojejunostomy on the excluded segment of the jejunal loop was performed without the use of any transanastomotic drain. Immediate reconstruction of on-table recognised injuries was carried out; patients presenting with biliary leak were reconstructed early and patients presenting with biliary stricture underwent reconstruction depending on the degree of obstruction, presence of cholangitis and feasibility of endoscopic or percutaneous intervention. Postoperative complications were evaluated using Dindo-Clavien and ISGLS classification, and the effect of reconstruction was assessed according to McDonald criteria. RESULTS: 15 biliary reconstructions in 14 patients were performed during the study period. More than a half of the patients experienced some postoperative complication (53.33%); serious complication occurred in 2 patients. One patient (82 years old) died of non-surgical postoperative complications. Biliary leak occurred in three patients (20%), and deep surgical site infection (fasciitis) in four patients (33.33%). The average length of stay was 12.13 days. There was no revisional surgery during the index hospitalisation in any of the patients. There were two readmissions up to 90 days after biliary reconstruction (13.33%). The patients are currently followed up for an average of 4.01 years; compliance with follow-up is 100%. Successful reconstruction was achieved in 92.86% of patients; one patient required rehepaticojejunostomy (7.14%). According to McDonald criteria excellent results were accomplished in 6 patients (42.86%), good results in another 5 patients (35.71%) and 2 patients underwent percutaneous intervention on the reconstruction (14.28%). CONCLUSION: When comparing results among various centres, we should take into account: 1. Experience of the centre/surgeon; 2. Case-mix (exact classification); 3. Timing of reconstruction; 4. Criteria for successful reconstruction; and 5. The length of follow-up. Patients in our centre who fulfil McDonald A and B criteria during the whole follow-up period are considered to have a successful repair. Reconstruction in McDonald C patients is also considered as a success by some authors, although this remains debatable as an early intervention on the reconstruction may be appropriate.Key words: cholecystectomy - bile duct injury - hepaticojejunostomy stricture.

[Hepatic pseudolesions adjacent to the falciform ligament]. / Hepatální pseudoléze v blízkosti falciformního ligamenta.

INTRODUCTION: Accurate detection of hepatic pseudolesions using multi-detector CT and MRI examinations is crucial for the differentiation of benign alterations from primary and secondary malignant lesions in hepatic parenchyma. METHOD: The authors conducted a systematic literature review in PubMed. "Liver" and "pseudolesion" were used as keywords in English and Czech, and papers/articles published from 2000 to 2014 were retrieved. RESULTS: The authors presented a literature review. In addition, the authors performed a retrospective evaluation of a group of patients treated for liver disease at University Hospital Ostrava where this anomaly was encountered in 7 cases.In 3 of the patients, diagnostic laparoscopy was done, with visual examination of the lesion accompanied by intraoperative ultrasound exam (IOUS) and partial excision, to establish the diagnosis. Subsequent histological assessment of the specimens confirmed the diagnosis of a steatotic lesion in each of these 3 patients. Additional 2 of the 7 patients underwent liver surgery for concurrent metastatic lesions of colorectal cancer and an open-access revision of the suspected lesions was performed. Visual inspection and intraoperative ultrasound (IOUS) was followed by excisional biopsy. The histology revealed macro- and micro-vesicular steatosis and excluded malignant changes. The last 2 patients still continue to be followed-up regularly on a 6-month routine check-up basis at our hepatology unit. CONCLUSION: The authors presented their own experience gained through inter-disciplinary cooperation at Multidisciplinary conferences. A literature overview of this unusual subject is also included. Particularly in oncologic patients, correct interpretation of these pseudolesions may help to avoid unnecessary biopsies, further imaging examinations and diagnostic laparoscopies and/or explorative laparotomies.

Pseudoaneurysm of the left internal carotid artery following tonsillectomy.

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

Evaluation of the hazardous impact of landfill leachates by toxicity and biodegradability tests.

The aim of our research was to assess the ecotoxicity and biodegradability of leachates originating from two parts of a municipal landfill before and after biological treatment in the existing treatment plant. Biotests represent important tools for adequate environmental characterization of landfill leachates and could be helpful in reliable assessment and monitoring of the treatment plant efficiency. For ecotoxicity testing of landfill leachate before and after biological treatment, different organisms were chosen: the bacteria Vibrio fischeri, a mixed culture of activated sludge, duckweed Lemna minor, white mustard Sinapis alba, brine shrimp Artemia salina, and water flea Daphnia magna. For assessment of biodegradability, the method for determination of oxygen demand in a closed respirometer was used. The investigated leachates were heavily polluted, and in some cases, effluent limits were exceeded even after treatment. Results indicated that toxicity tests and physico-chemical parameters determined before and after treatment equivalently assess the efficiency of the existing treatment plant. However, the investigated leachates showed higher toxicity to Daphnia magna and especially to Lemna minor in contrast to Vibrio fischeri and Artemia salina (neither was sensitive to any of the leachates). No leachates were readily biodegradable. Experiments confirmed that the battery of toxicity tests should be applied for more comprehensive assessment of landfill leachate treatment and for reliable assessment of the treated leachate's subsequent environmental impact. It was confirmed that treated leachate, in spite of its better physico-chemical characteristics, still represents a potential environmental risk and thus should not be released into the environment.

Endovascular treatment of mycotic pseudoaneurysms.

The surgical correction of ruptured intracranial infectious pseudoaneurysms is associated with high morbidity and mortality. An endovascular therapeutic approach has been introduced recently. This treatment is, compared to surgical intervention, less invasive, faster, more effective and safer, thus making it a gentler option, particularly for pediatric patients. Lower morbidity and mortality have been achieved thanks to the combination of prolonged administration of antibiotics, coil embolization, and parent artery occlusion. Two pediatric cases of bleeding mycotic pseudoaneurysm treated successfully with fibered coil embolization and long-term antibiotics are dealt with in this manuscript.

Organochlorine pollutants in chub, Leuciscus cephalus, from the Svratka River, Czech Republic.

The aim was to evaluate the extent of pollution of the Svratka River with organochlorinated pollutants using the chub (Leuciscus cephalus) as a suitable bioindicator of the river contamination. The sum of 7 PCB congeners was found in range of 7.6-93.8 ng/g (with median of 31.7 ng/g) wet weight (ww), DDTs of 2.9-93.8 (29.9) ng/g ww, HCHs isomers of 0.1-5.3 (1.0) ng/g ww, HCB of 0.3-8.4 (2.2) ng/g ww and OCS of <0.1-0.5 (0.1) ng/g ww. Our results confirm predominance of metabolite DDE and higher-chlorinated PCB congeners and are comparable with similar studies and findings within the Czech Republic.

Detection of dural ectasia in diagnosis of Marfan's syndrome.

BACKGROUND: Marfan's syndrome is an inherited connective tissue disorder that affects many organ systems and has widespread phenotype expression. The diagnosis is therefore made by phenotype assessment. Dural ectasia has been classified as a major diagnostic criterium with a prevalence of over 90% in patients with Marfan's syndrome. The objective of this study determine the feasibility of performing CT angiographic examination of aorta and large vessels for dural ectasia grading in a single CT exam of patients with Marfan's syndrome. PATIENTS AND METHODS: 7 examinations in Marfan patients were performed of which 6 were CTA. In all exams the aorta was evaluated and simultaneously the lumbosacral region of the spine was well delineated. We performed calculation of spinal canal (SCI) and dural sac (DSI) indices and also qualitative grading of dural sac involvement. RESULTS: In 4 patients both SCI (> 4,50) and DSI (> 3,75) fulfil the diagnostic criteria of Marfan's syndrome. In 1 patient complete spondyloptosis was detected. CONCLUSIONS: Whole body CT examination is the perfect tool for both aorta and spinal canal evaluation. Despite differences in spinal canal grading methods in all of our patients significant changes of the spinal canal in the lumbosacral region were detected. Dural ectasia is easy to detect and quantify and may therefore be used as a sensitive and specific sign of Marfan's syndrome.

PCBs in samples from the environment of the Southern Moravia Region, Czech Republic.

The determination of polychlorinated biphenyls (PCBs) in water, sediment and fish samples from the Czech Republic was carried out using high resolution gas chromatography with electron capture detection. PCBs concentrations in water and sediment samples were rather low and corresponded with the findings from some prior studies. On the other hand, investigated samples of fish tissue were highly contaminated (on average 1.3-266 ng/g fat for individual PCBs), thus, a continuing contamination of fish species with PCBs was proved.

[Our experience with radiofrequency--assisted liver resections for hepatic tumors]. / Nase zkusenosti s radiofrekvencne asistovanou resekcí jater pro jaterní tumory.

INTRODUCTION: A technique for liver resection, utilising radiofrequency-induced coagulation necrosis is considered the latest trend in liver surgery. The authors present their clinical experience with this promising liver resection technique. MATERIAL AND METHODOLOGY: From January 2006 to September 2007, a total of 24 patients underwent radiofrequency-assisted liver resections in the Ostrava FN (Faculty Hospital) Surgical clinic. Liver malignancies (primary or secondary) were resected using open surgery or laparoscopy. The data were analyzed to assess the new technique's outcomes, including intraoperative blood loss, transfusion requirement, morbidity and mortality rates. All the patients were followed up prospectively in regular intervals to assess treatment effectivity, complication rate and the disease relaps rate. RESULTS: Radiofrequency-assisted liver resection was utilised to resect a total of 38 tumors in 24 patients. The mean tumor size was 38 cm. The authors performed 5 major liver resections (> 2 segments) and 19 minor liver resections (nonanatomical resections, segmentectomies). The mean total operation time was 190 minutes, the mean liver resection time was 65 minutes. The mean intraoperative blood loss was 384 ml, however, in the last 10 subjects it was only 70 ml. Four subjects (16.7%) received blood transfusions during the perioperative period, in particlar those, who underwent major resections. In four patients (16.7%), postoperative complications were recorded, however, without lethal outcomes. The mean duration of hospitalization was 11.7 days. Based on the histological examination of the resecates, R0 resections were performed in 91.7% of patients. CONCLUSION: Radiofrequency-assisted liver resection is a safe, well- tolerated and effective liver resection technique. It is associated with minor blood loss, it results in reduced morbidity and mortality rates and may be used in both minor or major liver resections.

[New treatment approach in liver metastates: hand-assisted laparoscopic radiofrequency liver resection]. / Nový prístup k lécbe jaterních metastáz: manuálne asistovaná laparoskopická radiofrekvencní resekce jater.

BACKGROUND: Hand-assisted laparoscopic liver surgery, a newly developed technique based on an innovative concept, has proved useful and safe for a variety of less invasive hepatectomies. Radiofrequency assisted hepatic resection has been reported to be safe, associated with minimal morbidity and mortality and decreased intraoperative blood loss and transfusion requirements. METHOD: We describe how we perform hand assisted laparoscopic radiofrequency assisted hepatic resection using a bipolar radiofrequency device. RESULTS: The use of the hand port has allowed the surgeon to use his hand in direct liver manipulation, mobilization, and retraction. It was also useful for tactile tumor localization. Radiofrequency assisted hepatic parenchymal transaction was performed using bipolar device (Habib 4X) with minimal blood loss (35 ml), and reduced operative and resection times (75 min, 17 min respectively). CONCLUSION: This combined procedure seems to offer a safer, more effective, and less time-consuming means of resection of hepatic tumours. This might encourage surgeons to perform more frequently a laparoscopic approach for liver resection.

Preparation and ecotoxicity assessment of new biodegradable polyurethane foams.

Flexible biodegradable polyurethane foams (BIO-PUR) were prepared by a one-shot process using commercially available coreactants and modified by substituting biodegradable additive based on the acetylated starch (AS), acetylcellulose (AC), 2-hydroxyethylcellulose (HEC) and carboxymethylcellulose sodium salt (CMC) for 5 or 10 wt% of commercial polyether polyol. The BIO-PUR foams were characterized by FTIR, TGA and polarization microscopy. Ecotoxicity of BIO-PUR foams freshwater extracts was evaluated using the alternative crustacean toxicity test Thamnotoxkit F. Values of toxicity were expressed as percentage mortality of the instars II-III larvae of freshwater fairy shrimps (Thamnocephalus platyurus) dependence on the effect criterion of the respective assay. The leaches of BIO-PUR foams modified with 5 or 10 wt% of HEC showed higher toxicity then other BIO-PUR foams, whereas leaches of BIO-PUR with 5wt% of AS and 10wt% of AC were even less toxic than REF. PUR foam.

Virtual colonoscopy: a new promising technique.

OBJECTIVES: Virtual colonoscopy is less invasive than conventional colonoscopy and does not require a conscious sedation. BACKGROUND: Virtual colonoscopy using the abdominal spiral computed tomography scanning allows a total colonic evaluation with minimal invasiveness. METHODS: We studied 48 patients with a virtual colonoscopy using oral iodinated contrast. Colonic lavage was achieved with an oral polyethylene glycols preparation. We examined patients who had refused a colonoscopic examinations, or patients with a stenotic processes, in which it was not possible to examine the proximal colon using standard methods. RESULTS: Our indications for CT virtual colonoscopy were following: firstly, when colonic examination by other methods (colonoscopy, barium enema) failed or was not possible, and secondly, to exclude tumour duplicity in cases with an already verified colon tumour. 26 patients underwent a virtual colonoscopy examination based on the first indication, and 22 patients based on the second indication. CONCLUSION: In summary, our results show that virtual colonoscopy is a promising method in detecting individuals with significant colorectal lesions. The aim of the present study was to assess the ability of virtual colonoscopy using oral contrast to detect patients with colorectal lesions who need a colonoscopy (Tab. 2, Fig. 3, Ref. 4). Full Text (Free, PDF) www.bmj.sk.

[Rare cases of acute urineous peritonitis as a consequence of a spontaneous rupture of the urinary bladder]. / Raritní prípady akutní urinózní peritonitidy zpusobené spontánní rupturou mocového mechýre.

Perforation of the urinary bladder is, in most cases, caused by a blunt or penetrative trauma, respectively by an iatrogenic trauma. A spontaneous rupture of the urinary bladder is very rare. In the literature, its relation with alcohol abuse is speculated. Due to their minimal frequency rates, the diagnosis is very difficult and, not uncommonly, the diagosis is verified only upon surgical revision. The authors present two cases of urgent diffuse peritonitis originating from spontaneous perforations of the urinary bladder.

[The rectal carcinoma treatment history]. / Historie lécby karcinomu rekta.

The authors demonstrate a history of the rectal carcinoma surgical therapy, based on the available literature data or on oral information. Furthermore, they add their own experience with treatment of the rectal carcinoma, the disorder, which in the Czech Republic and, namely, in the Northern Moravian region, has one of the highest worldwide incidence rates.

[A contribution of the anorectal angle measurement according to Schiessel to assessment of the safe distance of the inferior resection line in the rectal carcinomas surgical procedures]. / Prínos meiení anorektálního úhlu podle Schiessela pro urcení bezpecné vzdálenosti dolní resekcní linie pil operaci karcinomu rekta.

Surgical procedures of the anus for rectal malignancies are amongst the most difficult procedures within abdominal surgery. Especially when the tumor is located in the middle and distal third of the rectum and the surgeons aim to conduct a sphincter-saving procedure, the pre-operative diagnostics is a pre-requisite for a successful treatment. The authors aim to inform the medical community on a non-traditional and rarely used examination method of the anorectal angle prior to surgical procedures of the rectal carcinomas.

[The first case of management of the rectovaginal fistule using transanal endocsopic microsurgery]. / První prípad resení rektovaginální pístele pomocí transanální endoskopické mikrochirurgie.

The authors present an unusual and, according to the available literature data, so far unused method--management of the rectovaginal fistule, using a T.E.M. technique (transanal endoscopic microsurgery). In their case-review of a female patient, they present advantages of this technique in a case of a rare disorder - a benign rectovaginal fistule. All of the following employment of a harmonic scalpel in the T.E.M. method, as well as of a tissue adhesive Tissucol and of a surgical rectoscope in the vaginal phase of the procedure, deserve attention of surgeons and gynaecologists.

[Safe distance of the inferior resection line in the rectal carcinoma surgery]. / Bezpecná vzdálenost dolní resekcní linie pri operaci karcinomu rekta.

The authors present results of a study of a distal intramural spread of the rectal carcinoma beneath its aboral margin, which was conducted over several years. The authors closely cooperated with the Pathological Anatomy Institute of the Faculty Hospital in Ostrava, where each preparation was examined not only macro- and microscopically, but also the tumor's microscopic spread beneath its macroscopic margin was assessed in standard distances of 2 mm, 5 mm, 1 cm, 2 cm and 5 cm. The study did not record tumorous spread at the distance of 5 cm from the aboral margin of the tumor. The authors also confirmed that the distal intramural spread of the tumor is fairly rare and, at the same time, it signifies a highly advanced and aggressive disorder with a poor prognosis. Therefore, the authors favor management with a maximum quantity of the sphincter- saving procedures, with a sufficiently radical mesorectal excision, which they consider the essential method of the radical surgical treatment. Furthermore, the authors have not recorded cases of the differenciated adenocarcinoma spread, even at the distance of 2 mm from the aboral margin of the tumor. All positive findings of the distal intramural spread have been recorded in medium- low differenciated adenocarcinomas.

The highest incidence in the world of rectal cancer is in Czech Republic.

Czech Republic is among the countries with the highest incidence of rectal cancer. The aim of the prospective study was to monitor the surgical treatment of patients with the diagnosis of rectal cancer. Certain aspects were examined: mainly the safety distance of the lower resection line during the operation of rectal cancer, the types of operations carried out, the amount of lymphatic nodes spotted in mesorectum and the possibility of laparoscopic utilization. In our study we focused on patients with rectal cancer who were operated within the three-year period (2000-2002) at the Department of Surgery at University Hospital of Ostrava. During this time there were 188 patients with rectal cancer treated. In the trial we shaved proved that in the direction from aboral margin of tumour the possibility of submucosal spread decreases in accordance with the literature. The submucosal spread of tumour occurs in 11.8% of cases. The spread of the tumour was not found at a distance of 5 cm below the bottom margin of tumour. In cases of microscopical positivity below the bottom margin of tumour there was a middle or low differentiated adenocarcinoma. The spread of well differentiated adenocarcinoma was not found. (Tab. 4, Fig. 5, Ref. 18.)