Examining evidence for a relationship between human-animal interactions and common mental disorders during the COVID-19 pandemic: a systematic literature review.

Introduction: COVID-19 lockdowns, shelter in place, closures of transportation and mental health services, and dearth of mental health providers created new barriers to obtaining support for mental health needs at a time of increased rates of anxiety and depression. During the pandemic, a record number of households owned and adopted pets, opening a potential avenue to investigate the relationship between pets and mental health. This systematic literature review examined the question: What is the evidence for a relationship between human-animal interaction and/or animal ownership and common mental disorders among adults who interacted with pets compared to adults who did not during the COVID-19 pandemic? Methods: To address this question, four databases were searched: Medline, PsycINFO, Web of Science, and SCOPUS for peer-reviewed literature published between 2020 and July 2023. Of the 1,746 articles identified by the searches, 21 studies were included in this review. Results: Results suggest that there exists a relationship between animal ownership and strong pet attachment and pet interaction, though the directionality of the relationship was not investigated by the included studies. There was an association between having a stronger relationship with a pet and lower feelings of depression and other mental health symptoms. There was also evidence of an association between anxiety and higher levels of animal attachment. Conclusion: Understanding the association between human-animal interaction and common mental disorders may be helpful to clinicians assessing the mental health of clients. Clinicians may glean additional insight about stressors, risk factors, social supports, and lifestyle of clients based on the client's status as a pet owner. Future research could further explore the direction of the causal relationship of human-animal interaction and/or animal ownership on common mental disorders; this could further inform how the HAI relationship can be used to support clients with mental health struggles.

Ileus conditions after rectal and Hartmann's resections.

INTRODUCTION: Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications. METHODS: We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus. RESULTS: In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors. CONCLUSION: Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.

Effect of neoadjuvant therapy on early postoperative complications in rectal cancer.

INTRODUCTION: The treatment of locally advanced rectal cancer is multimodal. It includes neoadjuvant chemoradiotherapy (NCHRT). NCHRT has been shown to reduce the risk of local recurrence. New treatment regimens also have a positive impact on patient survival. NCHRT leads to fibrotic changes in the pelvis and is associated with side effects. NCHRT may have a negative impact on postoperative complications. The aim of this study was to demonstrate whether NCHRT increases the number of early postoperative complications. METHODS: An analysis of our own cohort of 200 patients with rectal cancer undergoing robotic-assisted surgery between 2018 and 2022 was performed. The cohort was divided into patients who underwent NCHRT and subsequently surgery and patients who underwent primary surgery. The two groups were compared in terms of duration of surgery, blood loss, incidence of anastomotic complications, and quality of mesorectal excision. RESULTS: Patients who underwent NCHRT had a longer operation time, by 34 minutes on average. We did not demonstrate a higher incidence of anastomotic complications in these patients. Patients who underwent primary surgery had a slightly lower blood loss and better quality of mesorectal excision during surgery. Nevertheless, complete or nearly complete mesorectal anastomosis was achieved in more than 85% of cases in both groups. CONCLUSION: Radiotherapy results in postradiation changes in the lesser pelvis. These changes impair visibility and dissection during surgery. Operations after NCHRT are more technically demanding and take longer but do not have more anastomotic complications. Also, the quality of mesorectal excision is satisfactory in both groups.

Robotic resection of the rectum - what are the advantages?

INTRODUCTION: Surgical treatment is the most important part of multimodal management of rectal cancer. In recent years, minimally invasive surgery has been preferred. Minimally invasive procedures include laparoscopy and more recently robotic surgery. Robotic surgery has been developed to eliminate the shortcomings of laparoscopy, especially the parallel position of instruments and their limited movement. The advantages of a robotic system should be most apparent in narrow and deep spaces, i.e. the lesser pelvis. The aim of this study was to analyze the short-term results of robot-assisted surgery for rectal tumors. METHODS: The study is a retrospective analysis of a cohort of 220 patients with robotic-assisted surgery for rectal cancer. The cohort was analyzed in terms of length of surgery, blood loss, number of conversions to open surgery, completeness of TME, distal and circumferential resection margin positivity, length of hospital stays and number of 30-day rehospitalizations. In addition, 30-day postoperative morbidity and mortality were assessed using the Clavien-Dindo score. RESULTS: Robotic-assisted surgeries lasted an average of 184 minutes. In total, 5 operations were converted, i.e. 2.3%. Complete mesorectum was achieved in 90% of the patients. Severe postoperative complications, Clavien-Dindo score 3-4, were observed in 14% of the patients. Anastomotic complications occurred in 9.6% of the patients. The mean length of the hospital stay was 8.4 days. CONCLUSION: Robotic surgery for rectal tumors is a safe method with an acceptable rate of complications. An established training method and a high degree of standardization of the surgical procedures are indisputable advantages of robotic systems, making it possible to achieve very good results in a short time. In terms of perioperative and early postoperative outcomes, robotic surgery outperforms laparoscopic surgery in some parameters.

Finite-Size Effect in Phonon-Induced Elliott-Yafet Spin Relaxation in Al.

The Elliott-Yafet theory of spin relaxation in nonmagnetic metals predicts proportionality between spin and momentum relaxation times for scattering centers such as phonons. Here, we test this theory in Al nanowires over a very large thickness range (8.5-300 nm), finding that the Elliott-Yafet proportionality "constant" for phonon scattering in fact exhibits a large, unanticipated finite-size effect. Supported by analytical and numerical modeling, we explain this via strong phonon-induced spin relaxation at surfaces and interfaces, driven in particular by enhanced spin-orbit coupling.

[Psychosocial effects of the pandemic on staff and residents of nursing homes as well as their relatives-A systematic review]. / Psychosoziale Auswirkungen der Pandemie auf Pflegekräfte und Bewohner von Pflegeheimen sowie deren Angehörige ­ Ein systematisches Review.

BACKGROUND: Following the COVID-19 pandemic residents of nursing homes, their visitors and families as well as employees are faced with new challenges. Protective measures have a strong impact on the well-being of all these groups of persons. MATERIAL AND METHODS: A systematic search was carried out for studies investigating the psychosocial consequences of the COVID-19 pandemic for residents, their visitors and families as well as nursing home staff. Results were analyzed by narrative synthesis. RESULTS: A total of 756 studies were screened and 15 studies were included. These studies were conducted between February and June 2020 with participants from 14 countries. Participants reported loneliness, grief and depressive symptoms among residents. Some gave an account of fear as a reaction of residents to social distancing. Residents with cognitive impairment suffered more although there are conflicting reports. The well-being of visitors and friends was compromised and their feeling of loneliness increased. Nursing home personnel reported fear of getting infected and of infecting residents or their own families. Infected workers in the USA expressed anger about a lack of protection. Furthermore, an increase in workload was reported. CONCLUSION: Studies conducted during the first months of the pandemic reported negative consequences for the psychosocial well-being of residents, their visitors and nursing home staff. Individual needs for future support of these groups are distinct and need further evaluation during the on-going pandemic.

Comparative analysis of self-injurious behaviour topographies in young children with and without developmental delay.

BACKGROUND: The present study presents post hoc analyses of specific topographies of self-injurious behaviour (SIB) exhibited by young children with developmental delay (DD) and children with typical development (TD). We conducted these analyses to better understand similarities and differences between the groups from a developmental perspective. No previous study has compared the prevalence, severity and co-occurrence of specific topographies of SIB in young children. METHOD: The participants were parents of two groups of children one with DD (n = 49, mean age = 37.5 months) and one with TD (n = 49, mean age = 36.6 months). Individual items of the SIB subscale from the Repetitive Behaviour Scale-Revised were used in the analyses. RESULTS: Seven of the eight Repetitive Behaviour Scale-Revised SIB categories were reported for both groups. Children in the DD group were significantly more likely to engage in Hits Self against Surface or Object, Hits Self with Body Part, Inserts Finger or Object, Skin Picking and Bites Self. Parental ratings of severity were also significantly greater for the DD group for these five topographies. The DD group engaged in a significantly greater number of SIB topographies than the children in the TD group. Children in the TD group were more likely to exhibit a single SIB topography while the DD group were more likely to engage in two or more topographies. Topographies involving self-hitting were not only more frequent among the children in the DD group but also more likely to be rated as moderate or severe in nature. CONCLUSIONS: Compared with the TD group, the topographies of SIB exhibited by the DD group were more prevalent, more severe and co-occurred with greater frequency. Inclusion of a group of children with TD provided an important comparative context for the occurrence of SIB in children with DD.

Circulating tumor DNA as a biomarker in metastatic colorectal carcinoma case report.

INTRODUCTION: Colorectal cancer (CRC) is the third most common malignant disease worldwide. The stage of the disease at the time of diagnosis and the capture of an early recurrence have a direct impact on long-term survival. Existing control screening methods often do not reflect real-time metastatic disease. In patients with detectable circulating tumor DNA (ctDNA), liquid biopsy can be an effective monitoring tool. CASE REPORT: In 2012, we performed sigmoid resection in a 57 years old patient for advanced CRC. The follow-up assessments included: blood samples for CA 19-9 and CEA, endoscopy and imaging methods. We also sampled peripheral blood to determine the level of ctDNA. Its value corresponded to the development of the disease throughout the period. Twice it outperformed imaging methods. CEA showed some degree of unreliability, especially after prolonged illness. CA 19-9 was in the normal range at all times. CONCLUSION: Circulating tumor DNA is an effective tool in the diagnosis of recurrent metastatic CRC. In patients with detectable ctDNA, its level correlates with the tumoral mass in real time. It has a predictive value in monitoring the treatment response. Its implementation in the follow-up of patients with CRC may have an impact on the choice of treatment strategy and consequently on patient survival.

Total mesorectal excision - 40 years of standard of rectal cancer surgery.

Total mesorectal excision (TME) was first described 40 years ago by Richard Heald. The purpose of this article is to point out importance of this surgical procedure. Starting from first attempts to surgically cure rectal carcinoma in the nineteenth century through Miles' operation at the beginning of the twentieth century results were not satisfactory due to high number of local recurrences after resections for rectal cancer. Progress in surgical technique and knowledge of anatomy and embryology of the rectum led to development of TME. Principle of TME is surprisingly simple: removal of the rectum with complete embryonic space containing lymph nodes which are site of primary dissemination of the disease. Main advantages and drawbacks of TME as well as focus on newer procedures developed from the concept of TME are presented in the form of a review.

[Hemicorporectomy as the Highest Grade of En Bloc Sacrectomy]. / Hemikorporektomie jako nejvyssí stupen en bloc resekce sakra.

Hemicorporectomy or translumbar amputation is an extensive surgical procedure consisting in removing the lower portion of the body. Thakur et al. found a total of 71 hemicorporectomies described in literature before 2017. In the form of a case study we present the case of our patient with terminal pelvic osteomyelitis, in whom hemicorporectomy was subsequently performed, namely from the spine surgery perspective. The man, 19 years old, was exposed to high-voltage electricity and fell down from a height of 4 meters. He suffered an instable comminuted fracture of T10 (AO A3.3.) with paraplegia (Frankel A) and multiple third-degree burns affecting 25% of his total body surface area. Subsequently, the patient underwent a total of 16 surgical procedures performed by medical experts in various specialties (orthopaedic surgery, general surgery, plastic surgery, urology, vascular surgery), but in spite of that the extensive pelvic osteomyelitis has not been successfully managed. At first, urine and stool diversion were performed. After 3 weeks, i.e. 18 months after the injury, the removal of the lower portion of the body was scheduled. The hemicorporectomy was divided into 4 stages. The surgery started by posterior transecting the spine at L4-L5 segment with nerve root and dural sac ligation and treating the bleeding venous plexus in the spinal canal. After turning the patient to the supine position, the second stage of the operation followed, consisting in transecting large vessels and harvesting a musculocutaneous flap from the right thigh. During the third stage of the surgery the separation of the L4-L5 motion segment was completed by the transaction of the anterior longitudinal ligament and m. psoas major, subsequently followed by the amputation of the lower portion of the body. During the last stage of the surgery, the wound was closed by musculocutaneous flap from the fight thigh with preserved a. femoralis. The patient was discharged to home in a generally good condition 127 days after the amputation of the lower portion of the body. Now, 1 year after the surgery, the patient enjoys good physical as well as mental health. Hemicorporectomy is an extensive surgical technique, which can despite multiple complications be offered to patients with otherwise unmanageable condition. Terminal pelvic osteomyelitis is currently the most frequent diagnostic indication and the resulting condition makes possible a long-term survival of the patient in a satisfactory condition. The spinal surgeon is an irreplaceable member of the multidisciplinary team performing the surgical procedure, the primary treatment of the spinal column considerably limits blood losses. Key words: hemicorporectomy, en bloc sacrectomy, terminal pelvic osteomyelitis, sacral tumors.

Enhanced recovery after surgery and mini-invasive approaches in rectal cancer surgery - short-term outcomes.

INTRODUCTION: The aim of this study was to evaluate short-term outcomes of patients undergoing mini-invasive rectal resection within an ERAS (enhanced recovery after surgery) protocol. METHODS: A prospectively managed database of patients undergoing rectal operations performed at our department between January 2015 and April 2020 was retrospectively analyzed. An ERAS protocol was implemented into clinical practice at our department in April 2016 and mini-invasive rectal procedures in May 2016. The ERAS group consisted of all patients who underwent mini-invasive rectal resections or amputations within the ERAS protocol. The control group consisted of patients who underwent open procedures and received standard perioperative care. The extracted data included basic patient characteristics, surgical data, postoperative recovery parameters, 30-day morbidity, length of postoperative stay and 30-day rehospitalization. RESULTS: A total of 110 patients were included in the study: 67 patients in the ERAS group and 43 in the control group. Within the ERAS group 47 patients underwent robotic procedures and 20 had laparoscopic procedures. Patients in the ERAS group had significantly better clinical and laboratory recovery parameters except for postoperative nausea and vomiting. A significantly lower incidence of paralytic ileus (20.9% vs. 3%) and a shorter length of postoperative stay (13 days vs. 9 days) was found in the ERAS group. The rehospitalization rate and 30-day morbidity were not different between the ERAS and control group. CONCLUSIONS: Implementation of the ERAS protocol in combination with mini-invasive approaches leads to better short-term postoperative outcomes after rectal surgery.

What should a surgeon known about genetic background of thyroid cancer.

Thyroid cancer is the most common endocrine malignancy, the treatment is multidisciplinary and multimodal. Thyroid tumors are heterogeneous in origin, morphology, biological behavior and therapeutic options. Substantial advances in diagnostic methods for  thyroid cancer have led to detection of earlier stages of the disease that have the possibility of targeted therapeutic treatment and improved patient prognosis. In addition to surgical treatment, hormonal suppression and radioiodine therapy, targeted molecular therapy, which requires genetic testing, has come to the fore in recent decades. In the summary, we present an overview of current knowledge on the genetic background of individual types of thyroid carcinomas and the possibilities of therapeuticintervention.

Lymph nodes detection and the mesorectal excision quality evaluation.

INTRODUCTION: Detection and examination of proper number of lymph nodes in patients after rectal resection is important for next treatment and management of patients with rectal carcinoma. There are no clear guideliness for minimal count of lymph nodes, variant recommendations agree on the number of 12 (1014) nodes. There are situations, when is not easy to reach this count, mainly in older age groups and in patients after neoadjuvant, especially radiation therapy. As a modality for improvement of lymph nodes harvesting seems to be establishing of defined protocols originally designed for mesorectal excision quality evaluation. METHODS: The investigation group was formed by patients examined in 2 three-years intervals before and after implementation of the protocol. Elevation in count of harvested lymph nodes was rated generaly and in relation to age groups and gender. RESULTS: The average count of lymph nodes increased from 10 to 15 nodes, in subset of patients whose received neoadjuvant therapy from 7 to almost 14 nodes. The recommended number of lymph nodes was obtained in all investigated age groups. By the increased number of lymph nodes, rises also possibility of positive nodes found, that can lead to upstaging of the disease, in subset of patients whose received neoadjuvant therapy it is more than 4%. CONCLUSION: Our conclusions show, that forming of multidisciplinary cooperative groups (chiefly surgeon-pathologist), implementation of defined protocol of surgery, specimen manipulation and investigation by detached specialists lead to benefit consequences for further management and treatment of the patients with colorectal cancer.

Metal Contamination Hotspots at Unregulated Firearm Target Shooting Sites in the Everglades.

Hunters and target shooters can introduce metals into the environment in the form of firearm ammunition, elevating environmental levels of these metals, which may cause plant and animal toxicity. We explored metal accumulation in the Florida Everglades at sites used for firearm target shooting that are unlicensed, unregulated, and not patrolled by law enforcement. We compared concentrations of Pb, Cu, and Al in water and soil among study sites, control sites, and a public shooting range. We also tested plants and invertebrates to identify bioaccumulation or biomagnification. Lead and Cu concentrations in the soil at the target sites were elevated (Pb mean: 11,500.1 µg g; Cu mean: 1558.7 µg g) compared with control sites (Pb mean: 35.3 µg g; Cu mean: 49.3 µg g) and were more similar to the shooting range (Pb mean: 3194.7 µg g; Cu mean: 567.1 µg g). Organisms had elevated Pb and Cu at the target sites, indicating bioaccumulation. For example, Spanish needle [ (L.) DC] had a Pb concentration of 356.9 µg g at one site but averaged 80.3 µg g at the control sites. Grass shrimp () had Pb concentrations averaging 416.1 µg g at target sites but only 18.9 µg g at control sites. Water samples did not have elevated metal levels at the sites. Aluminum levels did not correspond to firearms use. We conclude that the illicit shooting sites are hotspots of metal pollution and pose a risk of contamination to several types of organisms. Because these sites are undocumented and unregulated, remediation may be difficult.

Malignant large bowel obstruction - what is the priority of treatment?

Obstruction by a tumor accounts for more than half of all emergency large bowel operations. The results of the treatment depend on the type and extent of the operation, the construction or elimination of anastomosis, the number of operation stages, the radicality achieved, or the modalities of treatment. Mortality and morbidity arise from local and systemic disorders due to obstruction and from postoperative complications, in the case of one-stage resections mainly from anastomotic failures. Tactics and technology of treatment change. The quest for oncological radicality raises the question of the priority of treating these conditions. To answer this, current literature, analyses and meta-analyses were reviewed concluding that the priority remains to resolve the obstruction and only then, if possible, eliminate the cause. Key words: large bowel - malignant obstruction - choice of procedure - choice of operation - treatment priorities.

The dead space after extirpation of rectum. Current management and searching for new materials for filling.

Pelvic surgeries such as extirpation of the rectum or pelvic exenteration lead to a creation of a dead space, which can be cause of complication, such as bowel obstruction, perineal hernia, abscess or hematoma. A growing incidence of complication is expected in connection with the increasing use of laparoscopic and robotic approaches or ELAPE method. Since the bone structures do not allow compression, the only way to deal with the dead space is to fill it in. Present methods provide the filling with omental or myofascial flaps. The length and the mobility of the omental flap can be the limitation. Myofascial flaps are technically more demanding and bring the complications of a donor place. Synthetic or biological meshes do not deal with dead space problematic. Modern technologies using nanomaterials offer the possibility to produce a material with specific properties for example shape, inner structure, surface, or time of degradation. The modified material could also satisfy the requirements for filling the dead space after surgeries.

Electrospun nanofibers as support for the healing of intestinal anastomoses.

The breakdown of intestinal anastomosis is a serious postsurgical complication. The worst complication is anastomotic leakage, resulting in contaminated peritoneal cavity, sepsis, multi-organ failure and even death. In problematic locations like the rectum, the leakage rate has not yet fallen below 10 %. Such a life-threatening condition is the result of impaired healing in the anastomotic wound. It is still vital to find innovative strategies and techniques in order to support regeneration of the anastomotic wound. This paper reviews the surgical techniques and biomaterials used, tested or published. Electrospun nanofibers are introduced as a novel and potential material in gastrointestinal surgery. Nanofibers possess several, unique, physical and chemical properties, that may effectively stimulate cell proliferation and collagen production; a key requirement for the healed intestinal wound.

[Artificial bowel sphincter ten years later]. / Umelý sverac anu po deseti letech.

INTRODUCTION: Congenital anorectal malformation is the most common cause of fecal incontinence in children and young adults. Surgical treatment options are limited. One of the treatment methods is the implantation of an artificial bowel sphincter. The goal of this study was to investigate the efficacy of the artificial bowel sphincter in reaching long-term fecal continence in patients with anorectal malformation. METHODS: Young adults with fecal incontinence due to anorectal malformation were included in the study. Those who underwent an artificial bowel sphincter implantation were followed each year for a period of 10 years. Outcome measures included the level of continence and the need for reoperation including explantation. RESULTS: Out of the 20 patients with congenital anorectal malformation, nine underwent implantation. Three devices were explanted within the first year; two were permanently removed and one was replaced. Thus, after the first year, seven patients (78 %) had a functional artificial bowel sphincter. Four patients (44 %) had a fully functional artificial bowel sphincter at 10 years after implantation. Although the artificial bowel sphincter improved the level of continence in all patients, full continence was not achieved in any of them. In one patient the artificial bowel sphincter was explanted after 10 years upon her request and a colostomy was created. CONCLUSION: Artificial bowel sphincter is a potential treatment modality for fecal incontinence in patients with congenital anorectal malformation. The main reason for failure results from inability to accurately assess the extent of the anorectal malformation before device implantation. Changes in the perineal region consequent to previous operations are the main limiting factors for artificial bowel sphincter implantation.Key words: anorectal malformation - incontinence - artificial bowel sphincter - long-term results.

[Intra-operative fluorescence angiography of colorectal anastomotic perfusion: a technical aspects]. / Technické aspekty fluorescencní angiografie pro peroperacní hodnocení perfuze anastomózy v kolorektální chirurgii.

INTRODUCTION: Anastomotic leak after colorectal surgery is a serious complication. Tissue perfusion plays a key role for anastomotic healing. Fluorescence angiography with indocyanine green under near-infrared excitation allows a real-time perfusion assessment. The aim of this study was to evaluate the feasibility and the potential benefit of intraoperative assessment of anastomotic perfusion in colorectal surgery using indocyanine green-enhanced fluorescence in near-infrared light. METHODS: 53 patients with primary anastomosis after elective colon or rectum resection were enrolled between 1 January 2016 and 31 January 2017. Near-infrared fluorescence angiography with indocyanine green was performed to assess tissue perfusion. The data of patient characteristics, data of surgery, data related to perioperative fluorescence angiography and postoperative complications were collected prospectively. RESULTS: Intraoperative fluorescence angiography was successful in 52 patients (98%). There were no adverse effects related to procedure. The mean time from indocyanine green application to visible fluorescence was 35 seconds, the mean added procedure time was 5 minutes. The best contrast was achieved by reducing the dose to 0.1 mg/kg. In 5 patients (9%), fluorescence angiography resulted in a change of the surgical plan. In two cases, the resection line was moved proximally, in two cases the anastomosis was corrected and in one case perfect perfusion of the anastomosis contributed to the decision to abandon the planned protective ileostomy. There was no postoperative anastomotic leak. CONCLUSIONS: Perioperative assessment of anastomotic perfusion in colorectal surgery by use of indocyanine green in near-infrared light is technically feasible with the potential to alter surgical strategy (including avoidance of defunctioning stoma) and to reduce the anastomotic leak rate.Key words: anastomotic leak colorectal surgery fluorescence angiography indocyanine green.

[Hirschsprungs disease in adults two case reports and review of the literature]. / Hirschsprungova choroba v dospelém veku dve kazuistiky a prehled literatury.

Hirschsprungs disease (HD) in adults is extremely rare, only three publications in Czech and Czechoslovak journals making reference to the condition after childhood. We present two cases of adult patients with HD. The first case is a 46-year-old male patient suffering from chronic constipation since childhood and diagnosed with megacolon at the age of 16; however, no further detailed diagnosis was done. At the age of 41, he developed a sigmoid perforation due to fecaloma and underwent urgent rectosigmoid resection and colostomy. 5 months later, Swensons coloanal anastomosis with diverting ileostomy was performed. Postoperative course was uneventful. He has two bowel movements a day. 7 years after the Swensons procedure, he also underwent adhesiolysis for acute bowel obstruction. His daughter was operated on due to HD at 16 days of age. The second case is a 57-year-old male patient. He suffered from chronic constipation and megacolon since 2 years of age and was diagnosed with congenital megacolon at the age of 19. However, no detailed diagnostics followed. He had a long interval between stools of up to 14 days. He underwent colonoscopy and, with a diagnosis of resistant Crohns disease, was referred to a surgical department where he was diagnosed with HD. Left hemicolectomy was first performed, followed by Swensons procedure with diverting ileostomy. All postoperative courses were uneventful. Currently he passes one or two soft stools a day. Adult HD is extremely rare. However, adult surgeons should consider it in case of refractory constipation since childhood associated with megacolon. Diagnosis is based on contrast radiography and rectal biopsy. Both Swensons and Duhamels procedures are suitable for surgical management. Left hemicolectomy with colonic rotation and coloanal anastomosis and/or proctocolectomy with J-pouch anastomosis are indicated in advanced forms of non-functional megacolon.Key words: adult Hirschsprungs disease - megacolon surgical therapy.