Penetrating abdominal trauma - selected case reports.

We present 3 case-reports with penetrating abdominal injury from our practice in this article. An urgent laparotomy was performed in all cases because of haemodynamic instability or the mechanism of injury. Penetrative abdominal traumas are associated with a high risk of life-threatening intra-abdominal injuries, require urgent revision and are often accompanied by postoperative infections of the peritoneal cavity. In recent years, there has been a growing tendency towards mini-invasive approaches or even non-operative treatment. This trend is particularly evident in the United States of America, where doctors experience a higher number of penetrating injuries compared to the prevalent blunt force trauma in Europe. The authors describe the need to follow all recommended procedures in the pre-hospital and hospital phases of treatment of these patients and compare them with recent literature. Key words: penetrating abdominal trauma.

[Metastasis of melanoma malignum in distal ileum like rare causation of ileocoecal invagination--case report]. / Metastáza maligního melanomu distálního ilea jako vzácná prícina ileocekální invaginace--kazuistika.

Authors are presenting the case of a patient, whom developed acute ileocoecal invagination, as a result of the stem tumor of distal ileum. The patient underwent ileocoecal resection with the primary anastomosis end to end. Another clinical and histopatological examinations showed and established diagnosis of metastasis of melanoma malignum in distal ileum with metastasis to liver. This was the first patient's clinical manifestation of the tumor.

[The role of CT for indicating laparotomy in blunt abdominal trauma: comparing CT results and surgical findings in a group of 101 patients. Prospective study]. / Role CT v indikaci laparotomie u tupých úrazu bricha: porovnání CT záveru a operacních nálezu v souboru 101 pacientu.

BACKGROUND: The helical contrast CT plays an important role in the management of abdominal trauma. For surgeons its reliability and utilization remain questionable. OBJECTIVE: The study aimed at correlating CT results at admission with surgical findings in patients undergoing laparotomy for blunt abdominal trauma, detecting CT sensitivity for therapeutic laparotomy and uncovering organ injury. The group of patients is from one hospital; therefore mistakes from different result interpretations or data collecting are not present. METHOD: A rentgenologist's conclusion during patient admission, late independent CT evaluation by an experienced rentgenologist and surgical finding were statistically correlated. RESULTS: 101 out of 139 patients underwent laparotomy after initial CT. Mean ISS were 27.8. CT sensitivity (SE) for indicating therapeutic laparotomy was 88.77/ 89.88%, predictive value positive result (PVPR) 92.94/94.11%, and false negativity (FN) 11.23/10.11 %. SE in liver and spleen trauma was 88.76/95.50%, PVPR 96.34/93.41%, and FN 11.24%/ 4.50%. SE in bowel and mesenteric injury was 27.27/18.18 %, SE in diaphragm injury was 33.33 %. CONCLUSION: the study presented high SE of CT forecasting therapeutic laparotomy for blunt abdominal trauma. The high SE of CT in liver and spleen injuries is useful in indicating conservative therapy. The CT accuracy was not confirmed in bowel. mesenteric or diaphragm injury. It strongly recommend patient observation even with negative CT.

[Delayed laparotomies in blunt injuries of the abdomen: incidence rates, causes, mortality rates and hospitalization times in a group of 139 operated patients. A retrospective study]. / Opozdené laparotomie u tupých úrazu bricha: výskyt, príciny, mortalita a doba hospitalizace v souboru 139 operovaných pacientfu. Retrospektivní studie.

INTRODUCTION: Employment of visualizing methods and achievements of conservative treatment methods have a major influence on the management of blunt abdominal injuries. The aim of the study is to assess incidence rates of, possibly, delayed surgeries and complications. PATIENTS AND METHODS: The authors conducted a retrospective analysis in a group of 139 operated patients. A common algorithm was followed on their admission. The following parameters were assessed in patients operated later than 24 hours following their admission (GROUP A): a cause of the delay, a mortality rate and duration of their intensive care unit (ICU) hospitalization. The parameters were compared to those of a corresponding patient group operated no later than 4 hours after their admission (GROUP B). RESULTS: The GROUP A included 17 (12.23%) patients. The delay median was 4 days (1-48). The diagnostics failed in 9 (52.94%), the conservative care failed in 8 (47.06%) subjects. The mortality rate was 29.41%. The GROUP B had significantly higher survival rates (p-value 0.0445). There was no statistically significant difference in the parameters of the ICU hospitalization duration. CONCLUSION: Diagnostic conclusions of visualizing methods, including CT scans, cannot be fully relied on in blunt abdominal injuries, mainly in cases of intestinal and diaphragmatic injuries. When a conservative treatment is indicated, the patient has to be closely monitored while sustaining an active surgical approach.

[Surgical treatment of thyreopathies. Retrospective assessment of the authors' study group]. / Chirurgická lécba tyreopatií. Retrospektivní rozbor vlastní sestavy.

The aim of this study is to expose the change in the access to thyroid gland operations during last 10-15 years when increasing radicality of the operations means any more specific complications in condition of routine detection and visualisation of recurrent laryngeal nerve and sparing of parathyroid glands. Authors analyse 458 patients with thyroid gland disease operated during years 2000-2004. Overall incidence of temporary and permanent paresis of recurrent laryngeal nerve was 2.5% and 1.5% respectively (nerves at risk). There was no permanent bilateral paresis in this study. Persistent hypoparathyroidism occurred after 0.2% of all the operations, and temporary hypoparathyroidism was noted in 10.7%. Results prove that even with increased radicality of performed operations the number of complications is in accordance with values quoted in world literature.

[Tension gastrothorax as a late consequence of an undiagnosed rupture of the diaphragm]. / Tenzní gastrotorax jako pozdní následek nediagnostikované ruptury bránice.

The authors present a case-review of a 20-year-old male who suffered from a car accident polytruma (the ISS 22, brain contusion, lung contusion, serial ribs fructures, fracture of the Th8, haematoma of the left kidney with haematuria). Surgery was not indicated, his thorax and abdomen were repeatedly examined with x-rays, ultrasound and CT scans, during the patient's hospitalization and during the follow-up period. After some time, the stomach expansion in the pleural cavity imitated the clinical and roentgenological findings typical for the tension pneumothorax. Urgent drainage solved the cardiopulmonary failure and cleared up the diagnosis. This atypical case is followed by a short literature overview.

[Perioperative antibiotic prophylaxis in hip operations. Penetration into bone, capsule tissue and cartilage exemplified by cefuroxime]. / Perioperative Antibiotikaprophylaxe bei Hüftoperationen. Penetration in Knochen, Kapselgewebe und Knorpel am Beispiel Cefuroxim.

The most serious complication of accident surgery is postoperative osteitis. At the same time, perioperative antibiotic prophylaxis is generally recommended in order to reduce the rate of infection in joint surgery. The criteria for the suitability of a substance as prophylaxis include inter alia the activity spectrum with respect to the expected microorganisms, its retention time in the body and its ability to penetrate the endangered tissue. In the present study, the systemic and local activity levels after a single i.v. dose of 1500 mg cefuroxime was investigated in relation to the time of administration in 30 patients who had to undergo total hip replacement owing to a medial fracture of the neck of the femur. The tissue and serum samples were analyzed by high pressure liquid chromatography (HPLC). The results show that the tissue levels of the intermediary cephalosporin after an i.v. single shot dose are on average still several times higher than the minimum inhibitory concentration (MIC) of the most frequent bacterium. Staphylococcus aureus, as late as 4 hours after application. The optimal time for the administration form selected was immediately prior to the operation and the concentrations measured suggest that several repeat doses of cefuroxime for short-term prophylaxis are not necessary.

Purification and immunochemical study of Plasmodium falciparum exoantigens.

Plasmodium falciparum, in in vitro culture, elaborated many antigens including soluble exoantigens that are released into the culture medium. Anionic and cationic methods of isolating these antigens offer a great potential for large scale purification from medium that is rich in proteins but contains relatively low concentrations of P. falciparum specific antigens. These exoantigens have cationic and anionic dependent elution profiles (pI between 3.7 and 4.8). Five apparent molecular weight entities (58, 80, 145, 200, and 290 kdaltons) have been determined by GEDELISA. Susceptibility to lipase and to a proteolytic enzyme confirmed the proteinaceous nature of the antigens. They were isolated from 4 strains of different geographic origin, indicating their ubiquitous nature. The analogy of these exoantigens to circulating antigens in patients with acute malaria and their potential usefulness in immunodiagnosis and immunoprophylaxis are discussed.