Infective endocarditis (IE) is a serious disease with a high mortality rate. Complications of IE are frequent and serious, most of them manifesting as various forms of ischemia. Its rare, but equally serious complications include development of mycotic pseudoaneurysms of peripheral arteries. Total incidence of these aneurysms in connection with IE is approximately 2%. Out of this number, the majority affect intracranial arteries, while the remaining lesions occur equally in visceral and limb locations. We present a case report of a rapidly progressing popliteal artery aneurysm with a fistula into the venous system in a patient after mitral valve replacement.

Mediastinal tumors represent a wide spectrum of epithelial, mesenchymal, neuroectodermal, embryonal, germ cell, and mixed neoplasms. Nevertheless, their incidence is low, accounting for approximately 1% of all neoplasms, and clinical presentation is often nonspecific usually reflecting advanced-stage disease. Primary mediastinal tumors must be distinguished from secondary tumors and so-called pseudotumors. From the perspective of their classification, diagnostics, and therapy, the anatomical--topographical division of the mediastinum into compartments is essential, as it may facilitate identification of individual lesions based on their typical localization and imaging characteristics. Surgical resection represents the first-line therapeutic modality for the majority of mediastinal lesions, with the exception of lymphomas and germ cell tumors. Authors present an overview of mediastinal tumors in adults, including their diagnosis and treatment.

Pneumoperitoneum is defined as the presence of free air within the peritoneal cavity. In approximately 90% of cases, it results from gastrointestinal perforation and requires urgent surgical intervention. The remaining 10% represent nonsurgical (spontaneous) pneumoperitoneum, in which no perforation is detected and conservative management is usually sufficient. Etiologically, nonsurgical pneumoperitoneum can be classified into pseudopneumoperitoneum, intrathoracic, abdominal, gynecological, and idiopathic categories. Intrathoracic causes include air migration from the chest during mechanical ventilation, cardiopulmonary resuscitation, or spontaneous pneumothorax. Abdominal causes involve rupture of cysts in pneumatosis cystoides intestinalis, perforation of hepatic or splenic abscesses, barotrauma, endoscopic complications, and infections by gas-producing bacteria. Gynecological causes are associated with vaginal insufflation, sexual intercourse, or instrumentation. In a minority of cases, the etiology remains idiopathic. Differentiating between surgical and nonsurgical pneumoperitoneum is crucial, as unnecessary laparotomies are reported in up to one quarter of patients. Decision--making requires comprehensive clinical evaluation, thorough physical examination, and imaging studies, particularly contrast-enhanced CT. In the absence of peritonitis or sepsis, conservative management with observation, antibio-tics, and symptomatic therapy is recommended. Accurate dia-gnosis and awareness of the rare, nonsurgical causes of pneumoperitoneum are essential to prevent unnecessary surgical interventions and to optimize patient care in this potentially critical condition.

The exclusion of free intraperitoneal gas (pneumoperitoneum) is one of the most common indications for imaging in patients presenting with clinical signs of acute abdominal pain. Among radiological methods, upright abdominal and chest radiographs are commonly used for the dia-gnosis of pneumoperitoneum; however, they have the lowest reported sensitivity for detecting free intraperitoneal air. Native or contrast-enhanced computed tomography is considered the gold standard in this dia-gnostic setting, although it exposes patients to the highest levels of ionizing radiation. Ultrasonography is also used in the dia-gnosis of pneumoperitoneum, but it is a highly operator-dependent modality, relying significantly on the examiner's experience. This article presents typical imaging features of pneumoperitoneum across various modalities, as well as less common and potentially misleading findings.

Postoperative pneumoperitoneum is a relatively common finding on imaging examinations after intra-abdominal surgery, and its correct interpretation is of fundamental clinical importance. The key task is to distinguish between clinically insignificant pneumoperitoneum and findings indicating a serious postoperative complication, particularly anastomotic leak or gastrointestinal perforation. The mere presence of free gas in the abdominal cavity is not an indication for surgical intervention; the decisive factors are the clinical situation, dynamics of changes, and correlation with laboratory and imaging findings. The paper summarizes the incidence, natural course, and localization of postoperative pneumoperitoneum, discusses its surgical and non-surgical causes, and evaluates the significance of individual imaging methods, with an emphasis on the high sensitivity of CT examination. Special attention is paid to risk factors and warning signs that increase the likelihood of a complicated course.

Pneumoperitoneum due to lower gastrointestinal perforation is an acute clinical situation requiring rapid dia-gnosis and treatment. This condition is often the result of dis-eases such as diverticulitis, malignant tumors, Crohn's dis-ease, or complications of endoscopic examination methods and surgical procedures. If this condition is not treated promptly, it can lead to life-threatening complications. Dia-gnosis relies mainly on imaging techniques such as X-ray, ultrasound, and CT, which allow the detection of free gas in the peritoneal cavity and the localization of the perforation. Treatment is usually surgical and its success depends on the speed of intervention and the general condition of the patient. This article discusses the etiology, dia-gnostic approaches, treatment strategies, and prognostic factors associated with pneumoperitoneum from lower gastrointestinal perforation, with emphasis on current clinical practices and recommendations.

Pneumoperitoneum is a clinically significant and dia-gnostically important finding that most commonly indicates perforation of a hol-low organ within the gastrointestinal tract. Within the upper gastrointestinal tract, the most frequent cause of pneumoperitoneum is gastroduodenal perforation. However, less common etiologies must also be considered, including perforation of the distal esophagus, gallbladder, or bile ducts resulting from inflammatory dis-ease, trauma, or iatrogenic injury. Dia-gnosis is based on a combination of clinical assessment, imaging modalities, and supportive laboratory parameters. Plain abdominal radiography has limited sensitivity in detecting small amounts of free intraperitoneal gas; therefore, contrast-enhanced computed tomography is currently considered the dia-gnostic standard. Management of free gastrointestinal perforation is primarily surgical, whereas selected forms of pneumoperitoneum may be treated conservatively or endoscopically. The choice of surgical procedure depends on the affected organ, intraoperative findings, and the patient's overall clinical condition. Early recognition of the condition is essential for improving clinical outcomes and reducing patient morbidity and mortality.

A 90-year-old man with type 2 diabetes mellitus, hypertension, and hyperlipidemia was admitted for vascular evaluation due to a progressively enlarging mass on the right side of the neck. Ultrasound examination revealed a pseudoaneurysm at the bifurcation of the right common carotid artery. Clinically, a pulsatile, painless mass measuring 6 × 4 cm was present without overlying skin erythema. CT angiography confirmed the diagnosis of a pseudoaneurysm with a thickened wall and a wide neck. Following a multidisciplinary discussion, the patient was indicated for an endovascular procedure. A stent graft was deployed across the aneurysmal neck, and embolization of the external carotid artery trunk was simultaneously performed via the right common femoral artery. The procedure resulted in complete exclusion of the pseudoaneurysm and regression of the neck mass without any neurological impairment. The etiology of the pseudoaneurysm remained unclear; however, an infectious origin was considered most likely given the positive blood cultures for Staphylococcus aureus and the absence of any prior intervention or trauma to the cervical region.

The care of critically ill patients in surgical intensive care units involves a wide range of frequently routine interventions, many of which are traditionally based on clinical judgment or on the pathophysiology of the underlying condition. From the perspective of evidence-based medicine, however, it has become evident that a proportion of these practices is not sufficiently supported by data, some are outdated, and their continued use may result in suboptimal outcomes. This review therefore focuses on key areas of surgical intensive care in which conventional approaches are being re-evaluated in light of contemporary evidence-namely fluid therapy with emphasis on the risks of positive fluid balance and the selection of appropriate solutions, modern strategies in sedation and delirium prevention, and nutritional management in the critically ill reflecting current recommendations and the rationale for gradual escalation of energy intake. The article further addresses rational antibiotic use, transfusion strategies within the framework of patient blood management, and the issue of excessive laboratory testing contributing to iatrogenic anemia. Attention is also given to the appropriateness of interventions (over treatment) and to decision making regarding the transition of care goals in patients with terminal conditions. This review aims to provide a comprehensive and critically oriented overview of these topics in the context of the most recent data and underscores the need for ongoing research and its timely implementation into daily clinical practice in surgical intensive care.

With the development of cardiac surgery, particularly after 1953, when open-heart operations were first performed, the issue of protecting the myocardium from ischemic injury during cardiac arrest emerged. The most widely adopted method of myocardial protection became the use of cardioplegia, although other techniques, such as hypothermia, were also explored. Over the years, various cardioplegic solutions and their modifications have been developed to ensure myocardial protection, and today a wide range of these solutions are used in clinical practice. In the Czech Republic, the most commonly applied cardioplegias include St. Thomas, del Nido, and histidine--tryptophan-ketoglutarate. Cardioplegia not only protects the myocardium but also enables controlled cardiac arrest and the creation of a bloodless surgical field. Each type of cardioplegia has its advantages and limitations, and the choice of a specific solution depends on the type and duration of the surgical procedure, as well as the preferences of the cardiac surgeon. The aim of this article is to provide an overview of current myocardial protection strategies, with a focus on their mechanisms of action, historical development, and clinical application in the Czech Republic.

Thyroid carcinomas are rare among other human malignancies. Their incidence shows an increasing trend with the growing availability and accuracy of diagnostic options. Examination of a patient with thyroid disease relies on medical history, clinical examination, laboratory findings, and imaging studies, among which ultrasonography has been the method of choice for several decades. The range of genetic methods in clinical practice is continually expanding. The principles of treatment for differentiated carcinoma have been established for many decades. Current attention is focused on genetic testing and expanding the possibilities of biological treatment. Surgical treatment of thyroid diseases had very poor outcomes for nearly 1,000 years, with high mortality and morbidity. The refinement of surgical techniques, technological progress, and a number of medical discoveries made safe and radical thyroid surgery possible. From the era of extensive surgeries in the second half of the 20th century, there has been a gradual de-escalation of surgical procedures. National and international organization guidelines serve to provide a unified approach to patients at different stages of differentiated thyroid carcinoma, and are updated and refined hand in hand with the development of diagnostic and therapeutic options. Guidelines from professional societies for the treatment of differentiated thyroid carcinomas are dynamically evolving, not entirely uniform, and are meant to serve as recommendations that allow the surgeon to optimize treatment while considering the individual patient, with a tendency toward de-escalation of surgical procedures. Key words.