Technical innovation in minimally invasive repair of pectus excavatum.

The aim of study was to introduce technical innovation of MIRPE which reduces the risk of cardiac injury. Modification of MIRPE method with semiflexible thoracoscope and sternum elevating technique has been used. Volkmann bone hook has been inserted percutaneously to the sternum. The hook elevates the sternum forward and enlarges the retrosternal space for safer passage of thoracoscopically guided introducer. Using semiflexible thoracoscope allows better view from various angles via one site of insertion. During the period 2005-2012, the MIRPE was performed on 29 girls and 151 boys; the mean age at the time of surgery was 15.9 years (range 13-18.7 years). The mean Haller index was 4.7 (range 2.7-20.5). The most common complication was pneumothorax (3.3 %) and the incidence of bar displacement was 2 %. The most serious complication was cardiac perforation when inserting Lorenz introducer. This occurred in a 16-year-old girl; she required urgent sternotomy with right atrial repair and recovered well. External elevation of sternum with the hook was used since this case. Subsequent 113 patients underwent surgery without any serious complications. Technical innovation using semiflexible thoracoscope and hook elevation of the sternum reduces the risk of cardiac injury. The hook opens the anterior mediastinum space effectively and makes the following dissection relatively safe and straightforward.

[Surgical technique changes in the repair of pectus excavatum between 1991 and 2012]. / Zmeny chirurgické techniky pri resení Pectus excavatum v letech 1991-2012.

INTRODUCTION: The aim of this article is a retrospective analysis of the results of three methods used for the repair of pectus excavatum between 1991 and 2012. MATERIAL AND METHODS: 508 patients were operated on at the Department of Paediatric Surgery of the Second Faculty of Medicine, Charles University, and the Teaching Hospital in Motol between 1991 and 2012. 16 patients were older than 19 years (19-28 years). The average age of paediatric and adolescent patients was 14.2 years (5-19 years range). Boys (408) prevailed over girls (82), the ratio being 4.9:1. Open Holcomb technique was used to operate on 87 patients (17%), the Welch method was applied in 208 patients (41%). Minimally invasive repair of pectus excavatum (MIRPE) was used in 213 patients (42%) during the entire period of time. RESULTS: As for the 295 patients operated on by the open Holcomb and Welch method, the outcome was excellent in 239 (81%) of them. A favourable result with a small deformity remaining occurred in 44 patients (15%). Unfavourable result was found in 7 patients (2.5%): in these children, a deep excavation occurred 3-5 years postoperatively. In 5 patients (1.5%) we evaluated the result as recurrent chest wall deformity. The minimally invasive method (MIRPE) produced an excellent result in 182 out of 213 patients (85%). A favourable outcome was observed in 27 (22%), unfavourable result in 1 (0.5%) patient. CONCLUSION: In the last 15 years, minimally invasive repair of pectus excavatum has become popular worldwide. Due to very favourable cosmetic results and a relatively small, gradually decreasing number of complications, the proportion of patients requiring surgery to correct their deformity has risen sharply.

[Stab wounds in children]. / Bodná poranení u detí.

Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. Presenting 3 case reports, this article aims to show the danger of stab wounds and how easily sharp objects can penetrate human tissue. In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision.

Randomized double-blind study: wound-healing effects of a Symphytum herb extract cream (Symphytum×uplandicum Nyman) in children.

The wound healing effects of the topically applied preparation Traumaplant® containing a concentrate (10% active ingredient) from the aerial parts of medicinal comfrey (Symphytum × uplandicum Nyman) were examined in a randomized, controlled, clinical double-blind study. An otherwise identical low-dose preparation (1% active ingredient) was used as a control. The study population consisted of 108 children aged 3-12 years (n=54/group) with fresh abrasions. A 50% healing rate was reached 0.9 days earlier with the higher than with the lower concentration cream. The difference in the healing rate (0.38±0.18/day [95% CI 0.33-0.4] vs. 0.26±0.14/day [95% CI 0.222-0.297]) was statistically significant (p=0.0002). Physicians and children/parents both rated the efficacy of the 10% cream as significantly better than that of the control preparation (physicians' assessment after 2-3 and 7-9 days for verum vs. control: 90.7 and 92.6% vs. 55.6 and 74.0% of the healing rates were rated as "good" or "very good", respectively; p=0.0004 and 0.01). In subgroup analyses, there was no significant influence on the healing rate of the time elapsed between the accident and the first consultation, the wound surface, the affected body part, the origin of the injury and gender. There were no reported adverse effects or problems with tolerability such as local skin irritations. The results justify application of the Symphytum herb extract cream in children with blunt traumata with or without abrasions.

[Experimental tumor therapy using intratumoral injection of dendritic cells]. / Experimentální terapie nádoru pomocí intratumorózní aplikace dendritických bunek.

AIM OF STUDY: After the treatment of tumors, we often encounter a minimal residual sickness. However, the elimination of these leftover tumor cells is crucial for the patient. In the past years one of the most discussed options for this treatment is Imunotherapy, mainly by Dendritic cells. Dendritic cells are the most efficient cells out of the antigen presenting cell group. METHODS AND RESULTS: In the first part of the project, we perfected a technique of inducting a tumor on an experimental model. We inducted the tumor by the use of Carcinogenic substances or with the help of the Sarkom line imortalized fibroblasts. Another important part of the project was perfecting the method for the preparation of undeveloped dendritic cells from periphery blood monocytes. After these significant procedures were developed and perfected we moved onto the main part of the study. The Induction of a tumor by the carcenogenic substances Ethylennitrosamin and Phenobarbital was successful only in 20 % of the cases and therefore, was unusable for our experiment. We inducted the tumors with the Sarkom line method. After the application of dendritic cells into the tumor, a decrease in the development of the growth of the tumor was achieved. CONCLUSION: Imunotherapy using dendritic cells as a basis for treatment is a perspective method for treatment of tumors.

Dendritic cell-based immunotherapy induces transient clinical response in advanced rat fibrosarcoma - comparison with preventive anti-tumour vaccination.

In this study we present the models of preventive and therapeutic vaccination of sarcoma-bearing rats with dendritic cells that present tumour antigens from killed tumour cells. We present the characteristics of dendritic cell-based vaccine and its capacity to induce anti-tumour immune response both in vitro and in vivo. We show that preventive vaccination efficiently prevents tumour growth. On the other hand, vaccination of rats with established tumours did not lead to eradication of the tumours. Despite the induction of a vigorous immune response after administration of dendritic cell-based vaccine and transient decrease in tumour progression, tumours eventually resumed their growth and animals vaccinated with dendritic cells succumbed to cancer. In both settings, preventive and therapeutic, dendritic cell-based vaccination induced a vigorous tumour-specific T-cell response. These results argue for the timing of cancer immunotherapy to the stages of low tumour load. Immunotherapy initiated at the stage of minimal residual disease, after reduction of tumour load by other modalities, will have much better chance to offer a clinical benefit to cancer patients than the immunotherapy at the stage of metastatic disease.

Lipoblastoma in children: an analysis of 5 cases.

Lipoblastoma is a very rare benign tumour that is caused by embryonal fat. The present five cases of lipoblastoma operated on during the years 1996-2005. The localization of the lipoblastomas in our series were very unusual. A six-monthold girl with giant mediastinal lipoblastoma; a two-year old boy with very rare lipoblastoma of the kidney; a three-year old boy with mesenterial lipoblastoma; a seven-year old boy with mesenterial lipoblastoma; and an eight-week old girl with perineal localization. Histological diagnosis can be difficult. The basic differential diagnosis is to be made between lipoblastoma, myxoid, and round cell liposarcoma. In our sample group of patients all lipoblastomas were successfully and completely removed and we did not see any recurrence of the tumours. In only one case was more radical surgery needed. One patient with mesenterial lipoblastoma had to undergo a 30 cm long resection of the small intestine.

Surgical management of major pancreatic injury in children.

INTRODUCTION: Major or complicated pancreatic trauma in children is uncommon and management strategies remain controversial. The aim of this study was to evaluate our experience with both early and delayed surgery in these pediatric cases. METHODS: We carried out a retrospective analysis of data of pediatric patients with major or complicated pancreatic injury operated on between January 1994 and December 2005 in our pediatric trauma center. RESULTS: Thirteen children (9 boys and 4 girls) with a mean age of 8.5 years (range 3 - 16 years) were operated for major or complicated pancreatic injury. The extent of injury was: grade II (major contusion without duct injury or tissue loss) in 4 children; grade III (distal transection) in 5 children and grade IV injury (proximal transection) in four patients. Pseudocyst developed in 8 children: 4 with grade II injury, 2 with grade III injury and 2 with grade IV injury (one with abdominal pseudocyst and one with an abdominal and a mediastinal pseudocyst). Early diagnosis and operation was achieved in 5 cases, while delayed diagnosis and operation occurred in 8. Three children underwent cystogastrostomy; 6 had a spleen-sparing distal pancreatectomy and 4 had resection with Roux-en-Y jejunostomy drainage. Endoscopic retrograde cholangiopancreaticography (ERCP) was the most useful diagnostic tool in assessing ductal injury. There were no deaths or long-term morbidity in our group of patients. CONCLUSIONS: Our results support the view that early operation is important in ductal pancreatic injury. We recommend transferring children with a suspected ductal injury to a tertiary center with experience in both pediatric ERCP and pancreatic surgery.

[Effect of Sulfakombin SPOFA on the dynamics of the extent of coccidiosis in small rabbit breeding operations]. / Ucinnost Sulfakombinu SPOFA na dynamiku extenzity kokcidiózy v drobných chovech králíku.

We determined the yearly changes in coccidiosis extensity applying the results of an examination of 2707 rabbits performed in the years 1981-1984. A field trial was conducted to study the efficiency of the Czechoslovak anticoccidic drug Sulfakombin Spofa administered to control coccidiosis in small rabbit breedings. We made the calculations to find out the optimum time of administration of sulphonamide substances. We discuss certain factors that influence in a decisive way the changes in coccidiosis extensity in rabbit breedings.

Hallazgos bacteriologicos en sarna infectada. Hospital de Gorbea. / Bacteriologic findings in infected scabies. Gorbes Hospital

Se analizan los hallazgos bacteriologicos observados en el estudio de 100 casos de sarna infectada estudiados en el Hospital de Gorbea. Entre los germenes encontrados destacan el Staphylococcus aureus (42%); el Streptococcus beta hemolyticus no grupo A (35%) y la asociacion de ambos (14%).Todos los pacientes fueron sometidos a un tratamiento antibiotico standard de penicilina, frente al cual solo hubo un caso resistente. La terapia se completo con la aplicacion local de gamexano al 1% en todos los integrantes del grupo familiar

[Levels of osteotrophic mineral elements (total calcium, inorganic phosphorus and magnesium) in the blood plasma of calves up to the age of 4 months]. / Hladiny osteotrofických minerálních prvku (celkového vápníku, anorganického fosforu a horcíku) v krevní plazme telat do veku ctyr mesícu.

In the post-natal period (up to the age of four months), healthy heifer calves of the Bohemian Spotted breed (n = 204) were studied for the levels of total calcium, inorganic phosphorus, and magnesium in the blood plasma. The calves were divided into 17 age groups (n = 12), the age interval between the groups being one week. The highest level of total calcium was found in the calves in the first week after birth (11.77 mg%); this level significantly decreased with higher age of the calves. The minimum was recorded in the fifth week (10.13 mg%). The level of inorganic phosphorus was almost unchanged throughout the period under study, ranging about 9 mg% with insignificant variation. The level of magnesium in the plasma was also fairly stable in the first month of age (2.14--2.29 mg%), a slight increase being observed only from the fifth week on. The comparison of the valves measured in the calves with those obtained in cows indicated that the level of calcium (except the value measured in the fifth week) was higher in the valves than in the cows throughout the experimental period, and that the level of phosphorus was also significantly higher than in the cows throughout the same period. Average values of magnesium in the plasma of the calves were mostly lower than in the plasma of the cows; only in the last third of the experimental period were the magnesium levels very close to, or higher than, the levels in the cows. The dynamics of the development of the cations studied in calf plasma, the Ca/P, Ca/Mg, P/Mg, (Ca+Mg)/p ratios, and the ion product Ca. P reflect the function of these osteotrophic minerals in the process of the growth of skeleton.

[The development of transaminase activity (SGOT and SGPT), lactate dehydrogenase and alkaline phosphatase in the blood plasma of calves up to the age of 4 months]. / Vývoj aktivity transamináz (GOT a GPT), laktátdehydrogenázy a alkalické fosfatázy v krevní plazme telat do veku ctyr mesícu

A trial was performed in 204 healthy calves (heifers) of the Bohemian Spotted breed in the post-natal period from birth to the age of four months. The activities of the following enzymes in blood plasma were determined: L-aspartate: 2-oxoglutarate: aminotransferase, EC.2.6.1.1. (GOT), L-alanine: oxoglutarate: aminotransferase, EC.2.6.1.2. (GPT), L-lactate: NAD oxidoreductase, EC.1.1.1.27 (LDH), and orthophosphoric acid monoester phosphohydrolase, EC.3.1.3.1. (alkaline phosphatase). The calves were divided into age categories according to the date of birth with an interval of one week. GOT activity in blood plasma increased significantly until the age of eight weeks (from the original value of 1.1708 +/- 0.2598 micronmol ml-1 to 1.8150 +/- 0.6362 micronmol ml-1, with the maximum of 2.0317 +/- 0.7777 micronmol ml-1 of plasma in the sixth week). In the subsequent period the GOT curve has not a characteristic course. While the activity of GOT increased in the first weeks after birth, the activity of GPT showed a significant drop (from the original level of 0.9000 +/- 0.3364 micronmol ml-1 to the minimum of 0.3675 +/- 0.1901 micronmol ml-1 of plasma in the seventh week); from the 10th week on the values rise so that at the end of the period of study they reach almost the same levels as in calves in the first postnatal week. The activity of LDH in blood plasma remains at almost the same level in the first five weeks after birth (between 43.4025 +/- 8.4893 micronmol ml-1 and 46.3792 +/- 14.8952 micronmol ml-1 of plasma); it was at a statistically significantly higher level only in a short period between the 7th and 10th week after birth. The highest values of alkaline phosphatase in blood plasma were recorded at the age of two or three weeks (maximum in the second week 23.9833 +/- 9.0945 micronmol ml-1 of plasma); from the fourth week on, the values of alkaline phosphatase are significantly lower until the end of the test period, ranging betweek 5.3133 +/- 1.6017 micronmol ml-1 and 7.5425 +/- 2.2437 micronmol ml-1 of plasma. Changes conditioned by postnatal development were observed in the development of all the enzymatic activities under study, the greatest changes being observed in alkaline phosphatase.

[The level of beta-karotene and vitamin A in the blood of nursing calves and their mothers]. / Hladina beta-karoténu A vitamínu A v krvi kojených telat a jejich matek

The level of beta-carotene and vitamin A was studied in the blood plasma of the calves of the Bohemian Spotted breed (heifers, n = 24) and in the blood plasma of their mothers (n = 24). The experimental animals were divided according to the date of birth or parturition into two groups: from the 0th to the 7th day and from the 8th to the 14th day after birth or parturition. All the animals showed no manifest signs of disease, the over-all health condition of the herd was good. Examinations were performed in the period from September to October. The composition of calf feed ration guaranteed the supply of beta-carotene to the organism. The average vitamin A level in the cows 0 to 7 days after parturition was 66.0 mug per 100 ml and the average level of beta-carotene in the same animals was 950.9 mug per 100 ml of plasma. In calves 0 to 7 days after birth the average level of vitamin A reached 16.7 mug per 100 ml and that of beta-carotene 87.5 mug per 100 ml of plasma. The mentioned average values are higher than levels considered as deficient. The levels of both substances increased in calves with the time of sucking: hence an average vitamin A level of 29.8 mug per 100 ml of plasma and beta-carotene level of 280.1 mug per 100 ml of plasma were found in the calf category from the 8th to the 14th day after birth. In this age category the level of vitamin A in blood plasma was still highly significantly lower than in the blood plasma of their mothers; however, in beta-carotene the difference was not statistically significant. While the levels of vitamin A and beta-carotene in calf plasma increased with the time of sucking, the level of both substances in the plasma of their mothers decreased. However, the drop of the level of vitamin A in cow plasma 8--14 days after parturition is not statistically significant; on the other hand, the drop of beta-carotene was found significant. This suggests that the reserve of these substances, especially of beta-carotene, in the cows decreases in the post-partal period which would justify, in breeding practice, an increased supply of vitamin A and beta-carotene, both with respect to calf nutrition and with respect to the biological value of milk used for human consumption.