Portal venous gas and pneumatosis intestinalis are rare but important radiographic findings. Combination of these conditions is strongly associated with transmural bowel infarction with high mortality. We present a case of an 82-year-old woman who was admitted to our department for acute abdomen with these two findings on CT scans. Key words:portal venous gas - pneumatosis intestinalis - bowel ischemia.

Introduction: The aim of this study was to verify the hypothesis that the technique of stabilizing the acromioclavicular joint and lateral fractures of the clavicle using a clavicular hook plate can be considered a method of choice in the given types of injury. Material and methods: The clinical part of the study included a total of 40 patients. The indication group was formed by patients with type III acromioclavicular joint dislocation, according to Tossy. As for lateral fractures of the clavicle, the patients of group II and types IIa, IIb according to revised Allman and Neers classification, underwent surgery. 40 patients with type III acromioclavicular luxation, operated on at the same clinic, were chosen as the control group; however, the technique of traction cerclage was used here.

Results:

When evaluating our results, we recorded a lower occurrence of infectious complications in patients with a hook plate. No method failure or joint redislocation was observed in the hook plate group. There was no change in position even after the implant was removed. On the other hand, where traction cerclage was used, redislocation in the acromioclavicular joint occurred due to mechanical failure in 5 cases, in 15 cases mechanical implant failure was seen. As for patients with a hook plate, 11 cases showed irritation of the lower surface of the acromion. Statistical evaluation of parameters of the main set of patients was carried out in cooperation with the Institute of Biostatistics and Analyses of Masaryk University in Brno.

Conclusion:

Based on our results, the stabilisation of complete acromioclavicular separation and lateral end clavicle fractures using clavicle hook plate can be regarded as a suitable method for treating these lesions. Timely removal of the implant within 12 weeks of the intervention is needed to prevent irritation of the lower surface of the acromion.Key words: acromioclavicular separation - fractures of the lateral end of the clavicle - stabilisation using clavicle hook plate.

Introduction: Advanced age is reported to be an important negative prognostic factor for the final functional outcome in patients after craniocerebral injury. Worse prognosis can also be expected in the presence of significant brain contusion, requiring surgical treatment because of expansive behaviour. Definite adverse influence of alcohol intoxication at the time of injury has not been proven by current literature data. The aim of the study is to analyse the importance of the above mentioned factors for the treatment outcome in patients operated on for craniocerebral injury. Material and methods: In the group of 246 patients with craniocerebral injury operated on between 2007 and 2011, the authors focused on the influence of age (145 patients < 60 years, 101 patients > 60 years), alcohol intoxication at the moment of injury (blood alcohol level over 0.1% based mainly on serum osmolarity plus clinical signs of alcohol intoxication) and the presence of brain contusion requiring surgical decompression on the final clinical outcome (using the Glasgow Outcome Scale).

Results:

54.1% of patients under 60 years of age were alcohol-intoxicated at the moment of injury. The incidence of alcohol intoxication in patients older than 60 years was 35.7%. The incidence of expansive brain contusions requiring surgical decompression was higher in patients older than 60 years and patients with alcohol intoxication. Statistical analysis of prognosis as related to age has shown significantly worse prognosis in patients older than 60 years. The difference was also significant in the subgroup of non-intoxicated patients. Statistical analysis did not show worse prognosis in alcohol-intoxicated patients. The presence of significant contusions influenced the injury prognosis only in patients younger than 60 years.

Conclusion:

The impact of age on the final treatment outcome in patients with craniocerebral injury was proven. The study did not show significant deleterious effect of alcohol intoxication at the time of injury on the final outcome. Key words: craniocerebral injury - brain contusion - alcohol intoxication.

Introduction: Magnetic resonance (MRI) and endorectal sonography seem to be the most contributive methods in preoperative diagnostics of perianal fistula. The right interpretation of MRI requires the radiologist performing the evaluation to be very well acquainted with the issue of surgical treatment of perianal fistulas, or the surgeon to have experience with MRI findings interpretation. On the contrary, endorectal sonography is usually performed by surgeons who are able to transfer the findings to surgical practice and who also have the feedback during the description of the endorectal sonography findings in confrontation with the peroperative findings.Material and methods: There were 482 patients with the clinical diagnosis of perianal fistula in our group who were examined and underwent surgery in the period between 1 January 2001 and 31 December 2011. In evaluating the findings, we used the basic Parks classification of perianal fistulas which is modified with respect to the specific features of ultrasound examination.

Results:

In case of simple fistulas, the correspondence between preoperative diagnostics and peroperative finding was present in 304 cases (90%), in case of extrasphincteric fistulas there was correspondence in 36 patients (82%). In case of horseshoe fistulas, the correspondence was found in 16 patients (87%). The diagnosis of the fistulas with more than one sinus was accurate in 95 patients (76%). General correspondence between the preoperative examination and the peroperative finding was present in 419 patients (87%).

Conclusion:

Endorectal sonographic examination in the diagnosis of perianal fistulas is simple, cheap and less demanding for the patient, reaching at the same time high sensitivity and specificity. It is fully sufficient as a preoperative diagnostic method in most patients with perianal fistula. Key words: perianal fistula division - 3D anorectal endosonography - hydrogen peroxide imaging of fistula.

The authors give an outline of the history of chest surgery during the 20th century. It was the period when methodology of the procedures for treatment of the respiratory system was mastered. The authors point out the issue of development of the particular procedures which have become a part of daily surgical practice despite all the initial troubles.Key words: chest surgery - history - lung resection.

Perinatal spermatic cord torsion represents a less common manifestation of spermatic cord torsion. In newborns, normal fixation between testicular coverings and tunica dartos is not yet well established, and abnormal testicular mobility results in extravaginal type of torsion. Salvage rate of testes after detorsion is low. Management of perinatal torsion still remains a controversial issue. Some authors refuse scrotal exploration as useless, their opponents recommend emergent bilateral surgical exploration for the protection of the healthy gonad.Authors report a case of a newborn who underwent scrotal exploration for clinical signs of the right-side perinatal torsion. The right completely necrotic testicle was removed. It was decided to fix the contralateral testis to prevent torsion. However, the exploration of the left testicle revealed ischemic damage corresponding to the asynchronous perinatal torsion after its spontaneous detorsion. The testicle was left (preserved) in scrotum and fixed. The follow-up then confirmed the loss of functional testicular tissue. This is the first case of bilateral perinatal torsion described in the Czech and Slovak literature.Perinatal spermatic cord torsion may result in a severe complication - bilateral testicular atrophy due to asynchronous torsion of the contralateral testicle. The authors demonstrate that in newborns physical examination and ultrasonography may be not sensitive enough for the assessment of the testis condition. In the light of the case study and literature reviewed they strongly recommend early bilateral scrotal exploration with preventive testes fixation to protect the healthy gonad.

Low-molecular-weight heparins (LMWH) are a class of medication used as an anticoagulant. They belong amongst the so called direct anticoagulants. The effect on the coagulation cascade is mediated through the inactivation of anti-factor Xa. They are used in prophylaxis of thrombosis because of their lack of fibrinolytic effect. If the dosage is adequate, the effect on the bleeding time is minimal and thus monitoring is not necessary unlike in case of direct anticoagulants. Nevertheless, the monitoring is advisable in patients with renal insufficiency in whom the renal elimination of LMWH and their metabolites is reduced, hence they can cumulate in the organism and increase the risk of various bleeding complications. We present a case study of an 83-year-old patient with a massive subcutaneous haematoma caused by the cumulation of LMWH and with the subsequent huge defect of the chest wall treated with negative wound pressure therapy (Vacuum Assisted Closure - V.A.C.).

The authors present their first experience with the laparscopic hernioplasty of the incisional hernias appearing after laparotomy.In the period from January 2008 to June 2012, 29 patients underwent hernioplasty by the IPOM technique (Intra Peritoneal Onlay Mesh) using Teflon mesh. The patients were followed up prospectively for the mean time of 29 months. The mean age of the patients was 57 years, the average size of the hernias was 6.5 cm, and the average time of the operation was 75 minutes.In the early postoperative period in 3 patients (11%) occurred pseudoperitonitis caused by the irritation of the peritoneum in the area of the attached mesh. In one patient (3%) severe paralytic ileus developed, and 22 patients experienced seroma in the left hernial sac. All seroma was absorbed except for one patient. In the mentioned case, seroma absorbed completely after repeated aspiration within 3 months. During the period of follow-up no patient showed any signs of recurrence.Since the first method of choice in the treament of incisional hernias after laparotomies is still unclear, laparoscopic repair seems to be a promising option. Results of laparoscopic repair are comparable with the conventional hernioplasty using mesh.

The robotization of minimally invasive treatment in surgery has been evident since the beginning of the third Millennium. The authors present their current evaluation of the benefits of the da Vinci robotic system in the treatment of abdominal malignancy.The authors summarize published studies in the Medline and Pubmed databases that compare robotic, laparoscopic and open approaches in the treatment of abdominal malignancy. Epidemiological data, intraoperative blood loss, complications and oncological outcomes are monitored in a group of 30 patients with carcinoma of rectum.The results measured in the evaluated parameters (open conversion, perioperative and non - surgery complications, intraoperative blood loss, histological findings, lethality) are similar in the published studies, i.e. without significant differences in both groups subject to the robotic and laparoscopic treatment. The operative time in the group of robotic surgery has been is slightly longer (a non-significant difference) in most of published studies. 30 patients underwent the robotic assisted treatment of the carcinoma of the rectum (14 men and 16 women, average age of 60 years (33-80). Neoadjuvant treatment was indicated in 50% of the patients. Average blood loss was 260 ml, transfusion was administered in one case. Conversion to laparotomic treatment was performed twice, four patients had post-operative complications, no patient has died. We have not found any relapse of oncological disease in the observed set to this date.The Da Vinci robotic system is a safe manipulator in the treatment of abdominal malignancy (including HPB surgery). Randomized clinical trials (RCT) have confirmed (short-term clinical and oncological) results comparable to the laparoscopic or open approach treatment. The benefits of robotic surgery for patients in abdominal surgery (long-term results, sufficient number of patients and high-grade EBM) are yet to be evaluated, however. It is necessary to implement more randomized clinical trials going forward. Our preliminary results are similar to the results reached in other, published studies.