Mycotic Aneurysm in the Aortoiliac Area - Current Options for Treatment.

BACKGROUND: Infection represents a less frequent cause for the development of an abdominal aortic aneurysm. The diagnosis is associated with a high risk of rapir progression and rupture. CASE REPORTS: Case 1 is a female operated on urgently for a ruptured mycotic aneurysm of the abdominal aorta. After resection of the aneurysm, we performed in situ replacement using a rifampicin-soaked vascular prosthesis. In case 2, an asymptomatic aneurysm of the right iliac artery was treated by endovascular implantation of a stent-graft. Both patients were treated with antibiotics concurrently and are still alive. DISCUSSION: The discussion deals with the up-to-date treatment modalities for mycotic aneurysms in the aorto-iliac region. The indication criteria must be adjusted individually. CONCLUSION: The prognosis of patients with a mycotic aneurysm depends particularly on an early diagnosis.

[Vascular dialysis access with transposed superficial femoral vein]. / Dialyzacní cévní prístup transponovanou vena femoralis superficialis.

The authors describe the case report of a 63 years old female patient with chronic renal failure in systemic lupus erythematosus. Vascular dialysis access in upper limbs could no more be used. The condition was approached by constructing an arteriovenous (AV) fistula in the thigh with transposed superficial femoral vein as the first procedure in the Czech Republic.

[Thrombolytic therapy of acute peripheral arterial occlusions of limb arteries]. / Trombolytická terapie akutních tepenných uzáveru periferních koncetinových tepen.

INTRODUCTION: Thrombolytic therapy is a method of solution of thrombotic arterial occlusions of limbs using the physiological process of fibrinolysis. The severity of limb ischemia is the crucial for therapy. If immediate recanalization of arterial system is necessary than primarily surgical teratment is chosen. THE METHOD: The arterial closures in infrainguinal localization are indicated for thrombolysis. Especially occlusions of crural vessels and the closures of previous vascular reconstruction (bypass) are indicated. The methods of local intra-arterial thrombolysis with application of recombinant tissue plasminogen activator, (rt-PA Actilyse) through catheter introduced into the level of thrombotic occlusion by Seldinger's Metod are used in our department. RESULTS: The authors present retrospectively analyzed set of 51 patients (12 women and 39 men aged 33 to 85 years) with acute arterial occlusion solved with thrombolytic therapy in the period 02/2007 - 03/2010. Complete recanalization was achieved in 43 cases (patients) (84%), high amputation of limbs was performed in 3 cases (5.9%).

[Autogenous superficial femoral vein for replacement of an infected aorto-ilio-femoral prosthetic graft]. / Autogenní vena femoralis superficialis jako náhrada infikované aorto-iliako-femorální cévní protézy.

A group of 12 patients (10 men, 2 women; average age, 52.7 years; range, 50-79 years) with vascular prosthetic graft infection (n=9) or with an increased risk of such infection (n=3) underwent arterial aorto-ilio-femoral reconstruction using autogenous superficial femoral vein. None of the patients died or had to have revision surgery during the follow-up (mean +/- SD, 14.1 +/- 7.3 months; range, 3-27 months). No pulmonary embolism occurred, nor were any early or late complications such as recurrent infection, graft occlusion, limb amputation or aneurysmal dilatation of vein graft recorded. In one patient, benign oedema of the limb following deep vein harvest persists, but this is well managed with a compression stocking. The findings reported in the international literature as well as the authors' experience show that the use of autogenous femoral vein gives very good results in the treatment of an infected vascular prosthetic graft, one of the most feared and most serious complications of vascular surgery.

[Interdisciplinary approach to treatment of multiple arterial aneurysms in patient with eighth recurrence of incisional hernia--a case report]. / Interdisciplinární prístup k riesení mnohocetných tepenných aneuryzmat u pacienta s osmou recidivou incizionální kýly--kazuistika.

Vascular surgery is not the only option for arterial aneurysm treatment. Minimally invasive techniques are being increasingly used, especially methods of interventional radiology. We present a case of a 51-year-old man who came to our department in July 2005 because of sonographically diagnosed popliteal artery aneurysm. Simultaneous presence of subrenal abdominal aortic aneurysm, bilateral iliac and femoral artery aneurysms and left popliteal artery aneurysm was found. This patient was operated on for pancreatic pseudocyst in 2000 and then during next three years eight times for incisional hernia and its recurrences. The operations were carried out in other surgical departments. Eighth recurrence of incisional hernia was already present. Because of these facts, the risk of resection was deemed too high. Therefore, we chose stent graft implantation for abdominal aortic aneurysm treatment. The endovascular approach was also used to treat some complications that occurred. In this case report, we would like to present a combination of surgical and interventional radiological approaches to treatment of arterial aneurysms as a typical example of interdisciplinary cooperation.

The laparoscopic ventral and incisional hernia repair.

We retrospectively reviewed the first twenty laparoscopic ventral and incisional hernia repairs performed at the 2nd Department of Surgery, St. Anne's Teaching Hospital, Brno from March 2003 till April 2004. Laparoscopic repairs were performed using Biomesh mesh (Cousin Biotech, France) with a minimum of 3 cm overlap circumferentially with normal fascia and secured with spiraltacks every 3-4 cm and transparietal sutures. All adhesions on the parietal defect are released, using scissors, and whenever possible we attempted to reduce the hernia sac. The mean follow-up period was 7 months with a range of 2 to 13 months. There was no recurrence in the group. There were two hematomas and one seroma in our group, which disappeared without treatment. Two patients experienced transient pain, which was resolved by analgesic treatment over time. By this date, no chronic infection, bowel obstruction, or enterocutaneous fistula have been reported. In conclusion our results are encouraging and suggest that laparoscopic ventral and incisional hernia repair is a safe, feasible, and effective alternative to open techniques. (Ref. 10.)

[Retromuscular mesh repair of a hernia in a scar according to Rives--our first experience]. / Retromuskulární plastika kýly v jizve podle Rivese--nase první zkusenosti.

The authors present a group of 24 patients with hernias in scars operated from February 2004 to January 2005 (12 months) using a retromuscular reconstruction procedure according to Rives. 20 procedure following central laparotomies and 4 procedures following lateral laparotomies were conducted. The defect sizes ranged from 5 to 16 cm. A polypropylene mesh was used which was placed between the rectus abdominis muscle and the posterior leaf of the rectus abdominis sheath. The mesh was covered by the fascia with a minimum overlap of 5 cm in all directions. The mean follow- up period was six months (1-12 months) and no early relapses were recorderd. The complications rate was acceptable--1x secondary wound healing, 2x seroma, 1x non-transmural MI in a patient with a cardiac ischemic disorder. The retromuscular reconstruction procedure according to Rives appears to be an appropriate method for management of large ventral hernias with excellent results and minimum complications.

Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performance.

The natural history of patients with severe nonischemic mitral regurgitation (MR) from mitral valve prolapse, who are asymptomatic or minimally symptomatic and have normal right ventricular (RV) and left ventricular (LV) performance, has not been evaluated previously. To define natural history in this population and to determine if any objective variables could predict disease progression, 31 patients were followed annually with severe MR due to prolapse, who at entry were asymptomatic or minimally symptomatic and had normal RV and LV performance at rest by radionuclide cineangiography. Average follow-up in patients not reaching surgical end point was 4.7 years. The Kaplan-Meier product limit estimates were used to determine the rate of progression to either "operable" symptoms or to previously defined "high risk" ventricular performance descriptors, if the latter occurred first. Univariate comparisons of Kaplan-Meier curves and multivariate Cox proportional hazards analyses were used to define prognostically important variables measured at entry. Fourteen patients developed symptoms warranting referral for operation; none developed high-risk ventricular performance descriptors. The annual end point risk was 10.3%. Of all covariates, only change in RV ejection fraction from rest to exercise was significantly associated with disease progression. Annual risk of progression to surgical end point was 4.9% in the subgroup in which this parameter increased with exercise and 14.7% in the subgroup without an increase (p = 0.04). Patients with severe MR due to mitral valve prolapse, who are asymptomatic or minimally symptomatic with normal ventricular performance, can be expected to progress to surgical indications at an annual rate of 10.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructure of human uveal melanomas cultivated in vitro.

Ultrastructural characteristics of four mixed-cell type human uveal melanomas cultivated in vitro were described. The authors stress the significance of melanosome microtubules in the process of melaninisation. They also stress the significance of smooth membraness for the formation of premelanosomes. The question of differentiation between melanocytes and lysosomes in ultrastructure is discussed.

Establishment of cell line derived from human malignant melanoma.

A new human cell line of malignant melanoma (MJM) was established with the use of the in vitro fragment technique. It has been maintained over 34 months of continuous cultivation. Three types of cells can be recognized by light microscope. The epitheloid elements predominate, less frequent are fibroblastoid and giant multinuclear cells. The pigment production is not macroscopically visible. Over 60 per cent of analyzed metabphases showed hyperdiploid number of chromosomes, the rest was mostly tetra and hexaploid. No marker chromosomes were detected. The growth studies indicate the MJM cells have 63-hr doubling time. Cytochemistry revealed positive pigment or propigment granules in 36 per cent of cells. Ultrastructural studies did not detect melanin granules but some particles resembling atypical premelanosomes and melanosomes were recognized in some sections.

Influence of charcoal haemoperfusion on platelet count in acute poisoning and during regular dialysis treatment.

Platelet count did not significantly decrease after charcoal haemoperfusion in patients with acute poisoning and significantly decreased during regular dialysis treatment. Adherent platelets and leucocytes were found on the surface of granules after haemoperfusion using a scanning electron microscope. Decreased platelet count returned to the original level at 48 to 72 hours after charcoal haemoperfusion.

Very rare angioleiomyoma of the male urethra.

Herein is reported a case of angioleiomyoma, i.e. a benign tumour arising predominantly from smooth muscle cells of the vessel wall, in a yet unreported locality, the urethra. The closest to the tumour presented by us are leiomyomas of the urethra, so far described only in females. The angioleiomyoma of our case manifested itself as a stricture of the male urethra and resection operation showed to be the best approach with elimination of the patient's complaints.

[Composite carcinoma-carcinoid of the large intestine]. / Kompozitní karcinom-karcinoid tlustého streva.

The authors give an account of a bioptically revealed adenocarcinoma of the large bowel which was combined with a carcinoid. The carcinoid constituent of the tumor had massive metastases as revealed by the postmortem examination.

[Professor Carl Sternberg and his years in Brno]. / Profesor Carl Sternberg a jeho brnenská léta.

The report exploiting old materials in some archives in Brno is concentrated on 14 years (from 1906 till 1920) of prof. Sternberg's life and work in Brno. The most renowned head of Brno department of pathology is introduced as a man of assiduity and indefatigable diligence according to quoted authentic documents.

[Contribution of electron microscopy in the differential diagnosis of tumors of the meninges, brain and spinal cord]. / Prínos elektronové mikroskopie k diferenciální diagnostice nádoru mozkových blan, mozku a míchy.

Critical Evaluation of 200 tumours of meninges, brain and spinal cord showed that to be familiar with the ultrastructural features of meningioma and its variants was instrumental in differential diagnosis of other primary or secondary meningeal tumours (neurinoma, paraganglioma, xanthomatous and histiocytic tumours). A limited value of electron microscopy was found in astrocytoma and glioblastoma in contrast to its importance in low-differentiated ependymoma and oligodendroglioma. The examination had histogenetical and taxonomic values in medulloblastoma (CNS neuroblastoma and mixed tumours with a component featuring primitive neuroectodermal or neuroblastic differentiation). Ultrastructure was very important in the so-called primitive neuroectodermal CNS tumours where only the lack of conspicuous glial or neuroblastic differentiation confirmed the diagnosis. Electron microscopy was instrumental in rare primary CNS lymphomas as well as in some metastatic tumours.

[Tumor-related partial pseudocirrhosis of the liver]. / Tumorigenní parciální pseudocirhóza jater.

Unusual sort of breast carcinoma metastases to the liver, combined with pseudolobular transformation, was found in an autopsy of 68-year-old female after complete oncological treatment. Nodes of parenchyma in abundant connective tissue nearly consisted of tumour cells. Terminology and pathogenesis were discussed.

[Professor Pavel Kucera--the first head of the University Institute of Pathologic Anatomy in Brno]. / Profesor Pavel Kucera--první prednosta univerzitního ústavu patologické anatomie v Brne.

Pathologist Dr. Pavel Kucera was one of the first professors of the Medical Faculty of Masaryk University in Brno. History of his uncommon life was described in detail. Some mistakes occurring in literature were corrected according to data from Kucera's personal file in the Archives of the Masaryk University.

[Heterotopic chondro-osteoplastic metaplasia of the subclavian vein wall after long-term catheterization. Case report]. / Heterotopická chondroosteoplastická metaplazie steny vena subclavia po dlouhodobé kanylaci. Kazuistické sdelení.

A 59-year-old man admitted for i.m. had a 3-way cannula inserted into the right subclavian vein for 31 days. Autopsy revealed a circular firm thickening of the venous wall. Histology identified it as chondroid and osteoid tissue replacing adventitial connective tissue. Unusual chondroosteoplastic metaplasia not described up to now is discussed as about its causes.

[Ultrastructural findings in the so-called minimal glomerular changes]. / Ultrastrukturální nálezy u takzvaných minimálních glomerulárních zmen.

Fifty-eight needle biopsies of the kidneys with the light microscopical diagnosis of so-called minimal glomerular lesions were subjected to ultrastructural evaluation. The series contained children and adults under 25 years of age with the mean age of 16.9 years. The most frequent findings were those of the glomerular epithelia: vacuolation and swelling of their cytoplasm in 72.8%, microvilloustransformation in 13.6%. Endothelial lesions were less frequent: swelling and vacuolation of their cytoplasm occurred in 46.6%. The most important ultrastructural lesions appeared to be the mesangial ones. Focal increase in the mesangial matrix was seen in 44.8% and small intralobular scars in 13.6%. True focal increase in mesangial cells was rare (6.9%). The formation of duplicatures of the basement membranes in the glomeruli was exceptional (3.6%). Another important ultrastructural finding was a focal thickening of the basement membrane in a larger number of cases (32.3%). Deposits were found rarely (7 cases, 12.1%) most of them occurring in the mesangium. The cellularity of the glomeruli did not exceed the normal range.

[IgD plasmacytoma--observations in 5 patients]. / Plazmocytom IgD--pozorování peti nemocných.

The authors describe five cases of plasmocytoma IgD--two men aged 37 and 49 years and three women aged 52, 62 and 80 years. In four instances light lambda chains were involved, in one instance kappa chains. In all patients there was a massive finding of Bence Jones protein in urine. The diagnosis was assessed after bone marrow puncture, immunochemical examination of serum and urine and X-ray of the skeleton. In zone electrophoresis of serum a marked gradient was found only in three patients. In two instances, where the disease was considered at first chronic as glomerulonephritis in the final stage of renal failure, renal biopsy helped with the diagnosis. In all patients in the skeleton multiple osteolytic foci were found and histological examination revealed a myeloma kidney. In three patients affection of organs beyond bone marrow was found and in one patient an amyloid. In four patients the progression of the disease was very rapid. The patients died within 3-8 months after establishment of the diagnosis. In the discussion the authors mention some special features of the clinical course and laboratory finding in plasmocytoma IgD.