[Treatment of an asymptomatic splenic cyst using percutaneous drainage]. / Lécba asymptomatické slezinné cysty perkutánní drenází

Asymptomatic voluminous splenic cysts can be detected as an accidental finding whereas those with surrounding organs compression might be sought after. After succesful diagnosis a reasonable therapy proceeds. There are two treatment options, either a commonly used surgical management including resection or unroofing of the cyst (a better option), or splenectomy. The authors present two case reports of not revolutionary but yet rarely used splenic cyst drainage and sclerotisation procedure with very good outcomes.

[Explorative thoracotomy in patients with bronchogenic carcinoma]. / Explorativní torakotomie u nemocných s bronchogenním karcinomem.

The authors analyse in a retrospective study a group of 31 patients with explorative thoracotomy, which was performed on account of inoperable bronchogenic carcinoma. The causes of inoperability were assessed and the period of survival after explorative thoracotomy was evaluated. From the total number of 496 patients indicated in 1985-1990 for surgery on account of bronchogenic carcinoma 465 pulmonary resections were made and 31 (6.25%) explorative thoracotomies. In all these patients the c TNM and p TNM classification was assessed. Disagreement in the evaluation of these parameters was found in particular in parameter T which was in agreement only in three instances. Conversely agreement was more frequent in parameter cN and pN (n = 18). The most frequent cause of inoperability was penetration of the tumour into the mediastinum (n = 25). Death within 30 days after surgery was not recorded in the group, three patients of 31 survived 5 years after exploration. Explorative thoracotomy did not exert a negative effect on the period of survival which corresponded to the given stage of the disease. Due to improving preoperative examination methods the number of explorative thoracotomies will probably decline in future, but at present it cannot be completely eliminated.

[Treatment of hemorrhoids with elastic ligature]. / Lécení hemoroidu elastickou ligaturou.

The authors present a report on the treatment of haemorrhoids by elastic ligature at the Second Surgical Clinic in Prague in 93 patients. In 75% they evaluate the results as excellent, in 22% as very good, only two patients, i.e. 3%, did not improve. The method is reliable, provides very good results and involves a low risk.

[An unusual complication after tracheal resection for cicatricial stenosis]. / Neobvyklá komplikace po resekci prudusnice pro jizevnatou stenózu.

The authors describe the case of a patient where after segmental resection of the trachea on account of cicatricial postcannulation stenosis of the trachea osteomyelitis of the sternum developed with a tracheocutaneous fistula. The cause of the fistula was probably a small dehiscence not detected after operation at the site of the anastomosis with subsequent development of chronic inflammatory changes in the anterior mediastinum and sternum. The authors describe the diagnostic procedure and surgical solution of this uncommon complication.

[Implantation of the T-tube in patients with postintubation tracheal stenosis]. / Zkusenosti s implantací T-tubusu u nemocných s postkanylacní stenózou prudusnice.

The authors submit an account on their experience with implantation of a Montgomery T-tube in patients with postcannulation stenosis of the trachea. The T-tube was implanted in 10 patients during an 11-year period (1987-1997). In three patients the tube was inserted on account of restenosis which developed after resection of the trachea. In three patients resection treatment was not indicated because of the considerable length of the stenosis (60 mm), in two patients because of the finding of two stenoses at different levels of the trachea, in one patient because of a high stenosis of the trachea with penetrating granulation into the subglottic space and in one patient because of a medical contraindication. The diagnosis of stenosis and its character was based on tomograms of the trachea, bronchoscopy and possibly CT. The T-tube was implanted under general anaesthesia after revision of the tracheal stenosis and if necessary dilatation. The length of the tube always extended over the stenotic portion, in three patients it extended from the bifurcation to the stoma. The T-tube was very well tolerated by the patients and was renewed usually after one year. Only in one patient it proved possible to perform decannulation and close the stoma by a plastic operation using costal cartilage. In the remaining patients the cannula is gradually reduced in length and in some possible decannulation with closure of the stoma in future is assumed. The authors consider the use of a T-tube in some patients with tracheal stenosis a very good therapeutic method which should be used at present in indicated cases.

[Surgical treatment of pulmonary aspergilloma and its complications]. / Chirurgická lécba plicního aspergilomu a její komplikace.

The authors present an account of their experience with the surgical treatment of 44 patients with pulmonary aspergilloma who were treated at the Clinic of Pneumology and Thoracic Surgery of the Third Medical Faculty Charles University in Prague during 1957-1999. The diagnosis of the disease before surgery was made in 39 patients (88.6%), in five patients it was established only after histological examination following resection of the lung. The presence of an aspergilloma was observed most frequently in a TB cavern (n = 30) and in bronchiectatic cavities (n = 9) with the most frequent localization in the upper pulmonary lobes (n = 38) and prevalence on the right side (n = 23). The most frequent symptom of the disease was haemoptysis (n = 39). All patients with the established diagnosis were treated before surgery by antimycotics. Treatment was however not successful and therefore the patients were indicated for surgery. The preoperative diagnosis of aspergilloma was based on X-ray or CT examination, serological examination (positive in 92.8%) and cultivation of sputum (positive in 58.9%). The most frequent surgical operation was lobectomy (n = 20), segmentectomy (n = 9), atypical resection (n = 8), pneumonectomy (n = 3); cavernostomy was performed in four patients. The most serious postoperative complication was a bronchopleural fistula with subsequent empyema (n = 2). During the postoperative period three patients died from respiratory failure associated with bronchopneumonia (6.8%). The authors recommend, based on their own experience, an active approach in patients with pulmonary aspergilloma and consider surgery as the main therapeutic method.

[Acute resection of the large intestine]. / Akutní resekce tlustého streva.

The authors evaluate the results of 32 acute resections of the large intestine on account of a malignant process or an inflammatory aetiology causing obstruction. They recommend to prefer this method to multi-stage operations even in patients of advanced age, if their general condition permits it.

[Resection of the trachea in acquired cicatricial stenosis]. / Resekce trachey pro získanou jizevnatou stenózu.

The objective of the submitted paper is to draw attention to the possible occurrence of post-cannulation ciccatrial stenoses of the trachea after long-term artificial pulmonary ventilation and possibilities of a surgical solution. The optimal therapeutic method is resection of the stenotic portion of the trachea. The authors present an account on 22 patients where during the period from 1996-1998 a resection of the trachea was performed. Of basic importance for indication for resection of the trachea is bronchoscopic, X-ray (tomograms) and CT examination which assesses the diameter, site and length of the stenosis. The limiting factor is assessment of the length of the stenotic portion. In stenoses longer than 5-6 cm it is useful to consider insertion of a stent. The authors made resections of the trachea of a maximum length of 55 mm. As to postoperative complications restenoses were most frequent and were resolved by implantation of a Montgomery T-tube. Indications of patients for surgery on account of stenosis of the trachea calls for close interdisciplinary collaboration of the bronchologist, radiologist and thoracic surgeon. Due to the small number of patients operated with this complication it is useful to concentrate these patients in specialized departments.

Influence of clonazepam on cortical epileptogenic foci in the rat.

The antiepileptic action of clonazepam was studied on epileptogenic foci induced by penicillin in sensorimotor cortex in acute experiments in rats. Clonazepam (1 mg/kg intraperitoneally) only moderately decreased the frequency of interictal discharges of single cortical focus and delayed the propagation of discharges into the ipsilateral occipital region. On the contrary, clonazepam failed to influence the callosal projection of interictal discharges in single unilateral as well as in two symmetrical foci. Spontaneous transition of interictal discharges into ictal phases regularly seen when two symmetrical foci were formed was only delayed but not blocked by clonazepam. It may be concluded that clonazepam exhibits only a weak anticonvulsant action against cortical foci and against secondary generalization of epileptic activity.