[A case report of endoleak type Ib and IIIa combination after endovascular subrenal aneurysm repair]. / Prípad kombinace endoleaku Ib a IIIa typu po zavedení stentgraftu pro subrenální výdut' aorty.

Authors describe a case report of complications and theirs solutions after endovascular abdominal aneurysm repair. There was symptomatic progression of aneurysmal sac due to endoleak type Ib in this patient 4 years after successful stentgraft treatment. Endovascular treatment was done with optimal effect, but aneurysm sac rupture had early become. The patient was urgently operated. The cause of the rupture was endoleak type IIIa, that was diagnosed perioperatively. This complication was solved with direct suture of disconnected parts of stentgraft. Despite of postoperative complications the patient vas released home in a good condition after 23 days of hospital staying. Endoleaks and their management are discussed in the article.

[Clostridial sepsis and gas gangrene of the abdominal wall after cholecystectomy]. / Klostridiová sepse a plynatá snet' brisní steny po cholecystektomii.

Clostridial sepsis is a rare complication after intraabdominal operations, mostly fatal. According to our knowledge only two papers describing clostridial sepsis as postoperative complication in 4 patients were published in the Czech literature, only one of them survived. Authors present a case report of patient operated on for cholecystolithiasis and obstructive icterus where within 48 hours after cholecystectomy the clostridial sepsis and gas gangrene of the abdominal wall developed and that were successfuly managed.

Testing intestinal permeability in rats with burns and administration of early enteral nutrition.

Damaged intestinal mucosa in patients with extensive burns is one of the causes of the development of SIRS and MOFS. No unequivocal method has been established so far for assessment of the extent of damage of the intestinal mucosa. In the presented work the authors focus their attention on assessment of intestinal permeability in rats with burns. As their experimental method they used the lactulose-mannitol test (LAMA test). The animals were subjected to a deep burn with an extent of 20% body surface (TBSA). Then the LAMA test was performed 24, 48 and 72 hours after the burn. The rats were divided into groups: the first with a burn without enteral nutrition, the second with a burn and polymeric enteral nutrition and the last with oligomeric enteral nutrition. From the conclusions it is evident that a burn extending over 20% TBSA causes in the laboratory rat to experience impaired intestinal permeability. The work did not prove a significant difference between groups with and without enteral nutrition. Due to its simplicity speed, repeatability and high yield the LAMA test is a method which can be used in patients with burns in departments for the treatment of burns.

[Sharp transsection of the parenchyma in liver resection]. / Ostrá transekce parenchymu v resekcní chirurgii jater.

UNLABELLED: Extended clinical application of total vascular isolation (TVI) in resection liver surgery made a more radical and invasive liver interventions possible as well as the application of new so far non-standard technique. The sharp transsection of liver parenchyma in vascular isolation represents a technique that could provide some advantages as compared with classical technique of finger fracture. AIMS OF THE WORK: To verify the safety of the sharp liver transsection and total vascular isolation in non-anatomical liver resection. MATERIAL AND METHODS: The experiments were performed in minipigs (N = 9). The surgical intervention was performed under aseptic conditions in general endotracheal anesthesia. After TVI the authors performed non-anatomical resection of the right liver lobe in a sharp way by the scalpel. Individual structures, i.e. branches of protobiliary triad and branches of hepatic vein were treated by stitches. In the course of operation the authors evaluated the diameter and the number of the treated structures in the resection surface, duration of the operation and duration of TVI. The blood loss during the operation, changes in blood count and hepatic enzymes were evaluated. RESULTS: The surgical intervention lasted 88.7 min (55-139 min) on the average, vascular isolation of the liver lasted 24 min (19-33 min) on the average. The mean blood loss was 193.7 ml (40-400 ml). The decrease in Hb values was 8.25 mg/l (6-11 g/l) on the average. In one resection surface the authors treated 9 (6-11) tubular structures on the average, as soon as the clamp was removed, a branch of hepatic artery had to be subsequently treated three times and a branch of portobiliary triad once. CONCLUSION: The combination of total vascular isolation and sharp transsection of liver parenchyma enable a safe management of branches of portobiliary triad smaller than 1 mm in the case of vessels as well as biliary pathways. The management of small hepatic veins, smaller than 1 mm and the branches of hepatic artery pose greater problems which are, however, related to the anatomical difference of the model.