Potential use of mesenchymal stem cells in the treatment of inflammatory bowel disease - a systematic review of the literature.

INTRODUCTION: The incidence of inflammatory bowel disease is increasing worldwide and, despite advances in conservative and surgical treatment, a significant proportion of patients do not achieve complete remission and have to undergo repeated surgical procedures. Stem cell therapy is a new alternative to immunomodulatory therapy. METHODS: We performed a systematic review of the literature dealing with the use of mesenchymal stem cells for the treatment of IBD. The PubMed database was searched and original studies published between 2015 and 2021 were included. RESULTS: A total of 80 citations were found, of which 21 clinical studies and 47 experimental studies were included in the review. CONCLUSION: The efficacy of MSCs in the treatment of perianal Crohns disease is at least comparable to current therapies. A positive effect of MSC administration has also been demonstrated in animal models of luminal disease or enterocutaneous fistula. The results after systemic administration in IBD patients are still ambiguous. KEY WORDS: inflammatory bowel disease.

Surgical treatment of extensive perianal hidradenitis.

INTRODUCTION: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. CASE REPORTS: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.

Crohns disease of the appendix - a case report.

INTRODUCTION: Crohns disease is a chronic inflammatory autoimmune disease with unknown etiology. Although the disease may involve any part of the gastrointestinal tract, the most frequently affected site is the terminal ileum. Crohns disease itself is more common in women and in younger patients. Typical symptoms of the condition are diarrhoea, abdominal pain, weight loss and fever. A part of patients may present with extraintestinal symptoms like exanthema, joint pain, conjunctivitis or less often a hepatic lesion. In our publication, we have reported a rare case of Crohns disease with isolated involvement of the appendix, in which the definitive diagnosis was established after the surgery. CASE REPORT: Our patient presented with atypical symptoms and endoscopy findings. The majority of patients with Crohns disease of the appendix present as if they had acute appendicitis. CONCLUSION: Appendiceal form of Crohns disease is a relatively rare variety of Crohns disease and is less aggressive than in the other locations. Surgical resection (appendectomy) is considered to be curative and the risk of relapse is very low. Key words: Crohns disease - appendix differential diagnosis - treatment surveillance.

[Compliance with the procedures of modern perioperative care (Enhanced Recovery After Surgery) at surgery departments in the Czech Republic - results of a national survey]. / Jak jsou dodrzovány postupy moderní perioperacní péce (Enhanced Recovery After Surgery) na chirurgických pracovistích v CR - výsledky národní ankety.

INTRODUCTION: The concept of the enhanced recovery after surgery (ERAS), also called fast-track surgery, is a complex of modern multimodal strategies intended to reduce the perioperative stress response and achieve faster postoperative rehabilitation and rapid recovery of normal physiologic functions. The effect of ERAS on reduction of length of stay and postoperative complications has been proven by randomized controlled trials. The recommendations are supported by substantial evidence, and they are guaranteed by the ERAS society and included in the European Society of Parenteral and Enteral Nutritions (ESPEN) guidelines. The aim of this study was to evaluate the compliance with ERAS protocol in surgical departments in the Czech Republic. MATERIALS AND METHODS: A survey with 19 questions on ERAS measures was sent to 148 surgical departments in the Czech Republic. Answers were anonymous. RESULTS: The overall response rate was 57/148 (38,5%). The indications and proper administration of preoperative nutritional support are performed according to recommendations in 37% respectively 67%. In total, 55% of responders restrict oral intake for more than 6 hours prior to an elective gastrointestinal surgery. A carbohydrate drink is administered preoperatively by 7% of the respondents. A mechanical bowel preparation before surgery is routinely used in 86% of surgical departments. Overall, 52% routinely insert a permanent urinary catheter for 3-5 days and one third of departments left a nasogastric tube in place after the operation. Early postoperative oral intake is restored in 2% of questioned departments. Epidural analgesia is standardly used by 68% respondents. Half of the surgery departments indicate artificial enteral or parenteral nutrition support without any respect to the nutrition status of the patient. CONCLUSION: Protocol of modern perioperative care recommended by ERAS and ESPEN societies should be respected in clinical practice in the Czech Republic. According to the national survey most of the surgical departments do not accept ERAS guidelines. The most challenging procedures include the inadequately long interval of perioperative fasting, use of mechanical bowel preparation and routine insertion of invasions. Early oral intake is, according to the answers, often replaced by artificial enteral or parenteral nutrition.

[Fascial closure of the abdominal wall by dynamic suture after topical negative pressure laparostomy treatment of severe peritonitis--results of a prospective randomized study]. / Uzáver steny brisní po laparostomii s pouzitím negativníiho tlaku pro tezkou peritonitidu pomocí dynamické fasciální sutury--výsledky prospektivní randomizované studie.

INTRODUCTION: Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study. MATERIAL AND METHODS: Between 9/2009 and 9/2011,57 patients with severe peritonitis were included in the study at the Department of Surgery of the Bulovka Faculty Hospital; 28 of them were randomized to the TNP laparostomy group and 29 to the primary closure group. The two groups did not differ in age, gender, polymorbidity and severity of peritonitis. RESULTS: The length of hospital stay was similar in both groups (median: 22 days; range 10-171 days) in the intervention group and 23 days (range 3-71) in the control group (p = 0.89). The mortality rate was significantly lower in the TNP laparostomy group in comparison with the primary closure group (3 patients, 11% vs. 12 patients, 41%; p = 0.01). A complete closure of the abdominal wall including fascia and complete abdominal wall healing was achieved in 80% of survivors in the TNP group, compared to 29% in the primary closure group (p = 0.01). No enteral fistula occurred in any surviving patients from both groups. The overall length of abdominal wall healing was significantly shorter in the TNP group (median: 7; 7-94 days, versus 30; 7-223; p = 0.04). CONCLUSIONS: Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.

[Antibiotic prophylaxis in acute surgical procedures--the current praxis in Czech Republic]. / Antibiotická profylaxe u akutních chirurgických výkonu--soucasná situace v CR.

INTRODUCTION: Surgical site infections (SSI) are currently one of the most frequent postoperative complications. Emergent surgery is generally subject to a higher risk of SSI. Antibiotic prophylaxis is one of many measures that should be taken to prevent postoperative infection. However, due to possible adverse effects it must be applied only in indicated cases. Many guidelines have been published abroad, but still missing in Czech Republic. Standard use of prophylaxis can be currently followed due to compliance with SCIP (Surgical Care Improvement Project) measurements and reflects the quality of surgical care. OBJECTIVES: The aim of our study was to evaluate the current clinical praxis of prophylactic antibiotic administration in Czech Republic in emergent surgery for diagnosis: acute appendicitis, small bowel obstruction and perforated gastroduodenal ulcer and evaluate the SCIP criteria adherence. METHOD: The survey was sent to 149 surgical departments. The questionnaire included 7 questions and feedback was considered to be anonymous. The compliance with 3 main SCIP measurements (INF-1, INF-2, INF-3) was evaluated by the patients with acute appendicitis as a indication for emergent surgery. RESULTS: Overall, 85 (57%) completed questionnaires were received back. According to a survey results, antibiotic prophylaxis is always administered in 15% of patients operated for acute appendicitis, 27% operated for small bowel obstruction and 47% of patients with gastroduodenal perforation. No prophylaxis is given in 11 (13%) hospitals for either of the mentioned diagnoses. Antibiotics are mostly (46%) administered at induction of general anesthesia and extended to 24 hours. The SCIP measurements adherence was as follows: INF-1--4.7%; INF-2--86%; INF-3--81% of evaluated departments. All of 3 (all-or-none) criteria were fulfilled only at 3 (3.5%) surgical departments. CONCLUSION: The clinical praxis of antibiotic prophylaxis in urgent surgical procedures in Czech Republic is highly variable and mostly ignores the current international guidelines (SCIP). There is a need of local specific guideline concerning antibiotic prophylaxis guaranteed by scientific company.

[Fast track in intestinal surgery; current review]. / Fast track ve strevní chirurgii, aktuální prehled.

INTRODUCTION: Results of the elective surgical procedures are affected not only by quality of the procedure, but also by perioperative care. Accelerated postoperative rehabilitation (fast track) reduces the frequency of postoperative complications, shortens the length of hospital stay and increases the patients' comfort. These modern procedures are subject to number of trials and they are even part of current European guidelines. AIM: The aim of this review is to evaluate scientific significance of the individual procedures in terms of fast track perioperative care and their comparison with traditional perioperative care. CONCLUSION: There is number of evidence that complex program of fast track postoperative rehabilitation improves postoperative healing. Its introduction into general practice could contribute to quality of perioperative care which differs greatly and often depends more on experiences than on scientific evidences.

[Tolerance of accelerated postoperative rehabilitation following intestinal resections]. / Tolerance akcelerované pooperacní rehabilitace po strevních resekcních výkonech.

INTRODUCTION: Modern procedures in peri-operative care arising from evidence-based medicine improve postoperative results. Their acceptance is however not a common clinical practice at most surgical centers. AIM: The aim of our study was to design a protocol and introduce it into the praxis. The subject of announcement is tolerance of protocol in our conditions. PATIENTS AND METHOD: Prospective randomized study included patients who were operated on (open bowel resection) at Department of Surgery in period 4/2005-12/2007. They were randomized in fast track group (n=53) and non-fast track group (n=52). Protocol with accelerated recovery was used in the fast track group (FTG) and we used traditional approach in the not-fast track (non-FTG). Results were statistically evaluated, 2 patients (FTG) were excluded from analysis for protocol failure (protocol was non kept by anesthesiologist in 1 patient and by the nurse in the second patient). Protocol and informed consent form was approved by the Hospital Ethics Committee. RESULTS: Both groups did not differ in age, diagnosis and length of surgery. Analgesia was controlled significantly better in FTG; similarly oral intake tolerance was higher in this group (day of surgery--mean value 634 ml versus 304 ml). Restoration of bowel functions was also faster in interventional group (mean time 2.1 versus 3.9 days). Frequency of postoperative complications was lower and hospital stay was shorter (median 7.0 versus 9.0 days, p < 0.001). CONCLUSION: Designed fast track protocol of postoperative recovery could be introduced in clinical praxis in terms of study. Patients' tolerance was very good. Application of accelerated recovery procedures is possible in our conditions but it means primarily to overcome worse tolerance of attending personnel.

[Primary retrofascial abscess in the iliopsoas muscle caused by salmonella enteritidis.]. / Primární retrofasciální absces iliopsoatického svalu zpusobený Salmonelou enteritidis.

This case report and review of literature demonstrates a rare entity of a primary retrofascial abscess in the iliopsoas muscle caused by Salmonella enteritidis, that progressed into the iliac fossa. It is of importance to the orthopedic surgeon in his differential diagnosis of hip pain and vertebrogenic disorders. It can also resemble other infectious diseases or tumors as it occurs mainly in young or imunosuppressed individuals. The primary and secondary etiology of this disease and it's different names are discussed together with the underlying bacteria. Clinical, laboratory and radiological findings are compared as well as the outcome of different types of treatment. When clinically suspecting this disease it is useful to confirm it with sonography and then perform CT scans for accurate planing of surgery. n the initial phase a CT guided drainage together with antibiotics and exceptionally only conservative treatment can cure the patient. In delayed cases it is necessary to preform an open drainage and cases with fatal outcomes have also been reported mainly in secondary abscesses. If early diagnosed and properly treated, this disease can be easily managed, therefore we have to keep it in mind in our differential diagnosis of indicated cases. Key words: primary pyogenic retrofascial abscess of the iliopsoas muscle, iliac fossa abscess, nontuberculous psoas abscess, psoitis, Salmonella enteritidis, clinical diagnosis, radiological diagnosis, surgical treatment, antibiotic treatment, ethiology.

[Treatment of colonoscopic perforations]. / Taktika resení kolonoskopických perforací.

Perforations of the large intestine during colonoscopy are relatively rare but serious complications of this routine examination. In recent years the approach to their treatment has changed in favour of more conservative procedures, in particular in perforations which occurred during polypectomy. In the authors' department during the last five years 12 patients were treated with perforations which occurred during colonoscopy. Ten patients were operated on (4x suture of the perforation, 2x primary anastomosis, 5x derivation of the gut), two patients were successfully treated by conservative methods without surgery. Fifty per cent of the operated patients had complications. Nobody died. The mean period of hospitalization was 27.9 days in the operated patients and 4.5 days in those who did not undergo surgery. From the results ensues that a differentiated approach must be used in perforations and in indicated cases (perforations after polypectomy, satisfactory condition of the patient, minimal assumed contamination of the abdominal cavity) a conservative method can be used. Correct surgical tactics reduce the morbidity and mortality.

[Drainage of the abdominal cavity using a simple and reliable system]. / Drénování brisní dutiny jednoduchým a spolehlivým systémem.

Experience with drains is more than 2000 years old, but instructive. In abdominal surgery nowadays indications for prophylactic drainage are diminishing as peroperative antibiotic administration has a similar effect. Therapeutic drainage is however still important and drainage is also useful after extensive operations, surgery of the lesser pelvis and operations with major bacterial contamination. The authors present their practical experience with a simple system of wrapped drains (Medisillen-Rubena, Brno) and a cover with an adhesive plate (B-Braun-Biotrol) which they used in 660 abdominal drainages with a very good effect.

[Initial experience with anorectal manometry with the PC Polygraf apparatus in surgery]. / První zkusenosti s anorektální manometrií pomocí prístroje PC Polygraf v chirurgii.

The authors present their initial experience with anal manometry using a PC Polygraph of Synectics Medical Co. They discuss the manometric examination of 14 patients with ulcerative colitis, incl. 12 who were operated. In all 12 patients an ilea-pouch-anal anastomosis was made. By manometry a postoperative drop of pressures at rest was found and partly also of pressures during muscular contraction as well as shortening of the zone of high anal pressure. The resulting values, however, did not influence continence, except for temporary soiling, the frequency of bowel movements being 2-8. Anal manometry is an important objective examination of the sphincter function as it makes it possible to compare values before and after therapy. It must be however combined with other anorectal physiological tests such as endosonography, EMG, defaecography etc.

[Pelvic exenteration in the treatment of locally advanced tumors of surgical, gynaecological and urological origin]. / Die Exenteration des kleinen Beckens für die Behandlung lokal fortgeschrittener Tumore chirurgischen, gynäkologischen und urologischen Ursprungs.

Pelvic exenteration is a radical extirpative procedure designed to treat pelvic malignancy that has invaded more than one of the hollow organs of the gastrointestinal or genitourinary tracts. The operation comprises several radical procedures: resection of the rectum, hysterectomy (with adnexectomy) with partial or complete vaginectomy, pelvic lymphadenectomy and total (or partial) cystectomy with diversion of the urinary tract. The retrospective analysis of our results in 27 patients treated in the years 1995 to 2000 by means of pelvic exenteration showed a 7.4 % hospital mortality and 59.3 % morbidity rate. The recurrence and survival rates were adequate. This surprisingly favourable outcome in our patients should encourage Czech surgeons to perform this difficult procedures more often.

[The Czech experience in peritonectomy and hyperthermic perioperative cytostatic lavage in the treatment of peritoneal malignancy]. / Die tschechische Erfahrung mit der Peritonektomie und hyperthermen perioperativen Zytostatikalavage in der Behandlung der Peritonealkarzinose.

UNLABELLED: Peritoneal tumor dissemination has been considered as an incurable condition with fatal outcome. However cytoreductive surgery followed immediately by hyperthermic chemoperfusion has been described both for the treatment and prevention of locoregional cancer spread from various origins. This paper summarizes our experience in this field. PATIENTS AND METHODS: 28 patients were operated on for peritoneal dissemination of malignant tumors between 1999 and 2002 in the Surgical Department of the University Hospital Bulovka. Total or limited peritonectomy was carried out in these patients. In addition intraperitoneal perioperative hyperthermic chemoperfusion was performed using an electrolyte solution containing Mitomycin C, Cisplatin or Carboplatin. The perfusion was performed for 90 minutes, reaching a real hyperthermia of 41 to 43 degrees C. RESULTS: The overall morbidity was high (85.7%), the perioperative mortality (30 days) was 10.7%. Only 3 (15.7%) of 19 patients in whom complete peritonectomy could be carried out died during the follow-up period of 3 months to 3.5 years. CONCLUSION: There is an increasing evidence of both experimental and clinical studies showing the therapeutic and prophylactic usefulness of peritonectomy and perioperative hyperthermic chemoperfusion in patients with peritoneal carcinomatosis. However, well designed randomised trials are necessary to establish the role of this promising technique.