Successful treatment of gastrosplenic fistula after sleeve gastrectomy.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures. But it is also associated with serious and potentially life-threatening staple line-related complications, such as stomach leak and bleeding. CASE REPORT: The article describes a case of surgical treatment of an early fistula between the stomach and the spleen 3 weeks after LSG. We have focused our attention on the diagnosis and possible treatment options for this potentially life-threatening complication. CONCLUSION: Efforts to reduce the frequency of leakage after LSG include a number of different measures. It is advisable to have expert knowledge not only in primary bariatric surgery, but also in the management of problems and reoperations in gastrointestinal surgery. An individualized approach and multidisciplinary teamwork are essential for successful therapy.

Transversus abdominis release in the management of a large, chronic defect of the abdominal wall.

INTRODUCTION: Chronic defects and hernias of the abdominal wall are a common complication of repeated surgical procedures and/or their accompanying complications. Reconstruction of the abdominal wall is difficult in these defects/hernias and debates of an ideal method of treatment have not reached a conclusion. Primary suture is usually impossible. Onlay, inlay, sublay, underlay and IPOM plasty procedures have their limits and often lead to unsatisfactory results. CST (component separation technique) technique is a new therapeutic approach enabling a solution of large defects and hernias of the abdominal wall with very good short-term results. TAR (transversus abdominis release) is a posterior approach in CST. It releases transversus abdominis muscle (MTA) to mobilize the posterior sheath of the rectus abdominis muscle (MRA). TAR preserves MRA and its neurovascular bundle, creates a large space for mesh insertion and allows complex reconstruction of the abdominal wall. CASE REPORT: A 55-year-old patient underwent surgery for perforated diverticulitis of colon sigmoideum with diffuse peritonitis. Hartmans operation was performed. The patient was reoperated for colostomy necrosis and fascia dehiscence on the 7th postoperative day. After healing 6 months later, colostomy occlusion was indicated. The operation itself - colorectal anastomosis using an end-to-end circular stapler - was without complications. However, complications occurred in the postoperative period including an intra-abdominal abscess in the lesser pelvis and subsequent destructive phlegmona and necrosis of the abdominal wall, resulting in a non-healing extensive chronic abdominal wall defect. After the failure of conservative treatment, the chronic defect was excised and the abdominal wall was reconstructed using the TAR method. CONCLUSION: TAR is an acceptable method in the treatment of large defects and hernias of the abdominal wall, associated with low perioperative morbidity and low recurrence rates.

Ileus as a complication of butterfly wing disease case report.

Epidermolysis bullosa or butterfly wing disease is a rare genetic disorder of connective tissue associated with the formation of blisters. The clinical manifestations are very diverse and affect not only the skin cover, but also mucosal surfaces of the gastrointestinal, urogenital and respiratory systems. A large proportion of patients suffer from severe constipation with the development of megacolon. The case report describes intestinal obstruction in a patient with a dystrophic form of epidermolysis bullosa which required surgical treatment.

Granulomatous mastitis treatment options and our experience.

Granulomatous mastitis (GM) is a rare benign inflammatory disease of the breast, first described by Kessler and Wolloch in 1972. Clinically, it can present as unilateral, sometimes painful, increasing breast resistance, or as a hard, irregular mass. Sonography is the most useful diagnostic method for GM evaluation. The only method for definitive diagnosis is the use of biopsy. In histological findings, GM is characterized by non-caseifying granulomas, often associated with microabscess and fistula formation. There is considerable heterogeneity in treatment options; this may explain the high recurrence rate which is close to 50%. Such a high recurrence rate is alarming and proves that current treatments are suboptimal. Two treatment options are discussed worldwide: conservative strategies involving drug therapy with corticosteroids versus a surgical approach involving partial or total mastectomy. All conservative treatment options are associated with a high risk of recurrence, and most patients require surgery in the end. Thorough excision of inflammatory tissue is crucial for successful treatment while negative surgical margins are associated with a low recurrence rate. The surgical approach to GM requires sufficient radicality and presumes knowledge in the field of reconstructive breast surgery, similarly to oncosurgical breast conservation operations. However, alternatives to GM treatment with oral steroids may be acceptable for patients concerned about surgery. This article presents six case reports of patients treated at our department.

Sebaceous carcinoma of the breast area a case report.

INTRODUCTION: Sebaceous carcinoma is a rare malignant tumor of the sebaceous glands. Sebaceous carcinoma occurs mainly in the head and neck region, rarely in trunk.  Case report: We present a case report of 63-year-old patient, operated on for sebaceous carcinoma in the right breast area. The patient underwent radical surgery, removal of the tumor with the skin, subcutaneous tissue, and the large pectoral muscle. The patient is in good clinical condition eight months after the surgery. She is being constantly monitored and so far, there are neither signs of local recurrence nor tumor progression.  Conclusion: Patients with rare tumors should be treated comprehensively with subsequent lifelong dispensarisation in specialized centers. Multidisciplinary medical teams are able to eruditely diagnose, recognize, treat and dispense patients.

[Minimally invasive liver resections]. / Miniinvazivní resekce jater.

INTRODUCTION: Laparoscopic surgery is a standard and preferred modality of surgical treatment. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to approach laparoscopic liver resections in selected patients. Initially operations were performed for benign and peripheral lesions, but nowadays more than 50% of total laparoscopic surgery is due to malignancy. METHOD: We conducted a literature search using Pubmed; by entering the keywords "Laparoscopic Liver Resection" we obtained a set of publications focused on this issue. We limited the selection to the period from 1991 to the present. Additionally, the selection was limited to reviews, prospective randomized trials or cohort studies. Also, we selected publications in the English and Czech languages. RESULTS: On the basis of the search, we identified 2345 publications, of which the abovementioned criteria were satisfied by 319 papers. Of these, 312 publications were in English and 7 in the Czech language. 59% of the searched publications were published in the last 5 years, which gives evidence of progression of the laparoscopic liver resection method. CONCLUSIONS: Laparoscopic liver resections are considered as safe for both benign and malignant lesions with comparable oncological outcomes compared to open resections. They also provide better short-term results such as a shorter hospital stay, lower overall costs, lower postoperative pain, reduced blood loss, earlier intestinal recovery, generally shorter convalescence of the patient, better cosmetic results and a lower rate of complications.Key words: laparoscopic liver resections - hand-assisted laparoscopy.

delta Ef1 binds to a far upstream sequence of the mouse pro-alpha 1(I) collagen gene and represses its expression in osteoblasts.

The transcription of type I collagen genes is tightly regulated, but few cis-acting elements have been identified that can modulate the levels of expression of these genes. Generation of transgenic mice harboring various segments of the mouse pro-alpha1(I) collagen promoter led us to suspect that a repressor element was located between -10.5 and -17 kilobase pairs. Stable and transient transfection experiments in ROS17/2.8 osteoblastic cells confirmed the existence of such a repressor element at about -14 kilobase pairs and showed that it consisted in an almost perfect three-time repeat of a 41-base pair sequence. This element, which we named COIN-1, contains three E2-boxes, and a point mutation in at least two of them completely abolished its repressor effect. In gel shift assays, COIN-1 bound a DNA-binding protein named delta EF1/ZEB-1, and mutations that abolished the repressor effect of COIN-1 also suppressed the binding of delta EF1. We also showed that the repressor effect of COIN-1 was not mediated by chromatin compaction. Furthermore, overexpression of delta EF1 in ROS17/2.8 osteoblastic cells enhanced the inhibitory effect of COIN-1 in a dose-dependent manner and repressed the expression of the pro-alpha 1(I) collagen gene. Thus, delta EF1 appears to repress the expression of the mouse pro-alpha 1(I) collagen gene, through its binding to COIN-1.

Nickel speciation of residual oil fly ash and ambient particulate matter using X-ray absorption spectroscopy.

The chemical speciation of Ni in fly ash produced from approximately 0.85 wt % S residual (no. 6 fuel) oils in laboratory (7 kW)- and utility (400 MW)-scale combustion systems was investigated using X-ray absorption fine structure (XAFS) spectroscopy, X-ray diffraction (XRD), and acetate extraction [1 M NaOAc-0.5 M HOAc (pH 5) at 25 degrees C]-anodic stripping voltammetry (ASV). XAFS was also used to determine the Ni speciation of ambient particulate matter (PM) sampled near the 400-MW system. Based on XAFS analyses of bulk fly ash and their corresponding acetate extraction residue, it is estimated that > 99% of the total Ni (0.38 wt %) in the experimentally produced fly ash occurs as NiSO4.xH2O, whereas > 95% of the total Ni (1.70 and 2.25 wt %) in two fly ash samples from the 400-MW system occurs as NiSO4.xH2O and Ni-bearing spinel, possibly NiFe2O4. Spinel was also detected using XRD. Acetate extracts most of the NiSO4.xH2O and concentrates insoluble NiFe2O4 in extraction residue. Similar to fly ash, ambient PM contains NiSO4.xH2O and NiFe2O4; however, the proportion of NiSO4.xH2O relative to NiFe2O4 is much greater in the PM. Results from this and previous investigations indicate that residual oil ash produced in the 7-kW combustion system lack insoluble Ni (e.g., NiFe2O4) but are enriched in soluble NiSO4.xH2O relative to fly ash from utility-scale systems. This difference in Ni speciation is most likely related to the lack of additive [e.g., Mg(OH)2] injection and residence time in the 7-kW combustion system.

[Voice disorders in children with gastroesophageal reflux disease]. / Zaburzenia glosu u dzieci z choroba refluksowa.

The study concerns 11 patients with gastroesophageal disease confirmed by pH-metric examination of esophagus. The clinical assessment included lupolaryngoscopy, stroboscopy and acoustic analysis of voice. Basing on the tests there were confirmed inflammatory lesions at the posterior part of larynx (laryngitis posterior) as well as pathological changes of voice acoustic tests.

[Hormonal conditioning of vocal changes in male]. / Hormonalne uwarunkowania mutacji przedluzonej u osobników plci meskiej.

Porophonia pubertum is the change of voice following activation of gonads in puberty. The present paper shows disorders of porophonia pubertum in 3 boys. The objective of the paper was to explain the pathogenesis of these disorders. Basing on clinical and genetic tests, a non-physiological, high position of spoken voice typical for the prolonged porophonia pubertum was proved. The genetic test confirmed the male sex. However, hormonic tests proved a significantly increased level of estradiol. We suppose that excessively increased estradiol level in blood serum caused the porophonia pubertum disorders in our patients.

Reduced amounts of cartilage collagen fibrils and growth plate anomalies in transgenic mice harboring a glycine-to-cysteine mutation in the mouse type II procollagen alpha 1-chain gene.

We have generated transgenic mice harboring a glycine-to-cysteine mutation in residue 85 of the triple helical domain of mouse type II collagen. The offspring of different founders displayed a phenotype of severe chondrodysplasia characterized by short limbs and trunk, cranio-facial deformities, and cleft palate. The affected pups died of acute respiratory distress caused by an inability to inflate lungs at birth. Staining of the skeleton showed a severe retardation of growth for practically all bones. Light microscopic examination indicated a decrease in cartilage matrix density, a severe disorganization of growth plate architecture, and the presence of streaks of fibrillar material in the cartilage matrix. Electron microscopic analysis showed a pronounced decrease in the number of typical thin cartilage collagen fibrils, distension of the rough endoplasmic reticulum of chondrocytes, and the presence of abnormally large banded collagen fibril bundles. The level of expression of the mutant type II procollagen alpha 1 chain transgene in cartilage tissues was approximately equal to that of the endogenous gene in two of the strains. We propose that the principal consequence of the mutation is a considerable reduction in density of the typical thin cartilage collagen fibrils and that this phenomenon causes the severe disorganization of the growth plate. We also postulate that the abnormal thick collagen fibrils are probably related to a defect in crosslinking between the collagen molecules. The cartilage anomalies displayed by these transgenic mice are remarkably similar to those of certain human chondrodysplasias.

Mouse type II collagen gene. Complete nucleotide sequence, exon structure, and alternative splicing.

Several overlapping clones covering the entire mouse type II collagen gene including 10 kilobases (kb) of 5'- and 15 kb of 3'-flanking sequences were isolated from a cosmid library. The overall gene structure was determined by restriction mapping and sequencing. The gene spans 28.9 kb from the start of transcription to the polyadenylation site and contains 54 exons. It codes for a major mRNA species of 4910 bases which translates into a polypeptide of 1419 amino acids. A less abundant RNA species of 5110 bases contains additional sequences corresponding to an alternatively spliced exon 2. Except for the amino-terminal propeptide (N-propeptide) domain the exon-intron organization of the mouse pro alpha 1(II) collagen gene is remarkably similar to genes for other fibrillar collagen types. The overall identity of the coding sequences of the mouse and human type II collagen genes is 89% at the nucleotide level, but only 37 amino acid changes occur within the mature alpha 1(II) collagen chains between mouse and man. Intron sizes are also conserved between the mouse and human genes but not with the chick alpha 1(II) gene. The promoter of the mouse type II collagen gene is similar to those of the rat and human genes containing a TATA box and several G + C-rich elements but no CCAAT box. The 3'-untranslated sequence contains two regions of high homology between chick, mouse, bovine, and human genes preceding the major polyadenylation site. Additional size variation in the mRNA arises from the use of a minor polyadenylation signal. Information on conserved noncoding sequences will help in studies on the regulation of the pro alpha 1(II) collagen gene. Detailed knowledge of the gene is also necessary for site-directed mutagenesis and work with transgenic mice.

Specific hybridization probes for mouse type I, II, III and IX collagen mRNAs.

We have constructed DNA probes for the specific detection of mouse pro alpha 1(I), pro alpha 1(II), pro alpha 1(III) and alpha 1(IX) collagen transcripts. To avoid cross-hybridization the probes for fibrillar collagens cover mainly sequences in the 3' untranslated region of the gene. Sequencing and Northern analysis confirmed that the clones share minimal sequence similarity and detect only the specific mRNAs under normal hybridization and washing conditions. The clone for mouse alpha 1(IX) collagen covers coding sequences but is sufficiently divergent from other collagen transcripts to allow specific detection of the corresponding mRNA.