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F Vyhnánek

Publications and source records attributed to F Vyhnánek.

At least 19 recordsLinked to original sources
PubMed2006

[Contemporary approach to treatment of the posttraumatic empyema of the thorax].

INTRODUCTION: Empyema of the thorax is a serious morbidity and mortality causative factor in the postoperative period in severe blunt and penetrating thoracic injuries. The posttraumatic empyema of the thorax results, primarily, from secondary infections of the haemothorax. Current therapeutic management of the posttraumatic empyema of the thorax depends on the disease stage. AIM: A retrospektive analysis of the treatment procedures in patients with posttraumatic empyemas of the thorax. MATERIAL, METHODS, RESULTS: A study group included 118 patients with empyemas of the thorax, who were operated during the period from 1996 - June 2005. The commonest type of the empyema was a parapneumonic empyema, present in 86 (73%) subjects. 15 (13%) patients were operated for posttraumatic empyemas of the thorax. In 13 (11%) patients the empyema followed elective intrathoracic procedures (lung or oesophagus resection). In 4 (3%) cases the empyema resulted from intraabdominal inflammatory disorders. The cause of the posttraumatic empyema of the thorax was a secondary infection following repetitive drainages for the pneumothorax in three patients, infection of the retinated haemothorax in two patients and infection of the pleural exudate from a subphrenic absces following a stab injury of the abdomen in one patient. Another patient developed empyema as a complication of the oesophagus perforation by a foreign body. 8 injured patients with ventilation pneumonias developed parapneumonic empyemas. The patients were indicated for surgeries. Videothoracoscopic procedures (VTS, VATS) proved successful in 4 injured patients with empyemas, stage II. Thoracotomy with decortication was conducted in the remaining 11 injured patients (in 3 of them as a VTS conversion). The postoperative course following the decortication in the injured group with the posttraumatic empyema was complicated by a protracted air leak with a partial pneumothorax in two subjects and by a relaps of the pleural exudate in one operated subject. CONCLUSION: 1. Open thoracotomy with empyemectomy and decortication is a standard treatment method in the thoracic empyema, grade III. 2. The videothoracoscopic procedures (VTS, VATS) are indicated in early forms of the grade II of the disorder. 3. The quality and the result of the therapy depend on the following: the management of the focus of the infection, as well as a sufficient lung expansion while the residual pleural cavity is being minimized and also the management of the air leak from the lung.

Empyema, Pleural↗
PubMed2006

[Technical aspects of the liver resection procedure--options for combinations of individual methods].

INTRODUCTION: The liver resection procedure as a treatment method of benign and malignant hepatobiliary disorders grows more important due to the fact, that its postoperative morbidity and mortality rates have been reduced, a result of the patients selection method, surgical techniques and perioperative care improvements. The aim of this report was to assess combinations of recent liver transsection techniques, based on the authors' own experience and results of recent studies. MATERIAL, METHODS AND RESULTS: From 1999 to May 2005, in the Surgical Clinic of the Faculty Hospital Královské Vinohrady in Prague, the liver resection procedure was completed in 133 patients with benign or primary and secondary malignant tumors. In the liver transsection procedure, the following instrumentation was used, starting from 1999: harmonic scalpels, ultrasonographic dissectors, water jet scalpel, bipolar diathermia, argon coagulation and radiofrequency. The liver tissue dissection using the ultrasonographic dissector or the water jet scalpel in combination with the harmonic scalpel or bipolar diathemic coagulation, reduced the postoperative blood loss in extensive non-anatomical liver resections. This dissection method was also used in some "centrally" located tumors for their non-anatomical resections. The benefit of the combination of the methods is based on sufficient coagulation and interruption of minor vascular branches and bile ducts in the resection line, without intermittent closure of the blood influx to the liver, using a Pringle manoeuvre. The radiofrequency, as a novel method for the liver tumors ablation, was used in anatomical and non-anatomical liver resections to coagulate the liver tissue prior to its transection prior to the R0 resection. The postoperative morbidity rate was 14% (19 patients). Within 30 postoperative days, no death was recorded. CONCLUSION: 1. The above listed liver transsection techniques, employing the ultrasonographic dissector or water jet scalpel, are safe alternative liver resection methods, reducing the blood loss. 2. Diathermic coagulation is an alternative to the harmonic scalpel for intersecting minor intraparenchymatous vascular branches and bile ducts. 3. A combination of the ultrasonographic dissector technique or water jet scalpel with the harmonic scalpel or diathermic coagulation technique, aids the liver resection by closing and interrupting the vessels and bile ducts in the resection line. 4. Radiofrequency and pre-transsectional coagulation of the liver parenchyma reduces the bleeding during the resection procedure and is a method of choice in resections of centrally located tumors, reducing the loss of the functional parenchyma.

Hepatectomy↗
PubMed2005

[Anatomical resection for liver metastases of the carcinoma of the large intestine and the rectum].

UNLABELLED: Resection of the colorectal carcinoma liver metastases is an effective therapeutical procedure with a five-year survival rate in 20-50% of the operated. Opinions on the most optimal type of the resection procedure remain to be controversial. The aim of this study was to assess all indication criteria for anatomical resections of the colorectal carcinoma liver metastases. SUBJECTS AND METHODOLOGY: This retrospective study analyzed 98 patients with liver resection for colorectal metastases. In 31 patients, extensive anatomical resections of the liver were conducted, segmentotomie were conducted in 20 patients and nonanatomical wedge resections in 47 patients. Extensive anatomical resections were conducted in cases of tumorous foci larger than 2cm and located marginally between individual segments of a single lobe, and in cases of multiple tumorous foci affecting a single liver lobe. The nonanatomical resections were conducted in cases of metastases smaller than 2 cm, localized on the liver surface or in cases of multiple peripheral foci, including cases when both liver lobes were affected. RESULTS: In the group with the wedge-type resections, a histologically positive border was found in 4 cases. Postoperative complications were recorded in 10 (19.6%) patients with the anatomical resection and in 9 (19.1%) with the wedge resection. CONCLUSION: 1. Anatomical resection of the liver for the colorectal carcinoma metastases is indicated in cases of larger foci (over 2 cm), located marginally between segments or in multiple metastases affecting a single liver lobe. 2. Anatomical approach to the resection lowers the rates of histologicaly non-radical resections (R 1). 3. The new surgical technique of the liver transsection lowered, even in cases of anatomical resections, the postoperative morbidity rates.

Adult↗
PubMed2005

[A contemporary situation in the antimicrobial treatment of the secondary peritonitis].

UNLABELLED: Peritonitis infection is polymicrobial, with the following prevailing pathogens - gram-negative aerobic and anaerobic bacteria and anaerobic cocci. Treatment of the secondary peritonitides includes surgical management of the infectious focus, initial empiric antimicrobial therapy and intensive adjunctive therapy aimed to control any secondary and terciary disorders. MATERIALS, METHODS AND RESULTS: Based on the results of the actual sensitivity of each pathogen of the intraabdominal infections and on the results of the past restrospective clinical studies, recommendations for initial empiric antimicrobial therapy of the secondary peritonitis have been compiled. Sensitivity of aerobic pathogens to parenterally administered antibiotics in the secondary peritonitits was regulary recorded and the results were summarized in 2004. The minimum inhibition concentrations (MIC in mg/l for the anaerobic bacteria and cocci are presented, based on present data of the National Reference Laboratory for Anaerobic Bacteria. A comparative retrospective study of the antimicrobial treatment in the secondary peritonitis from perforation of the diverticle of the large intestine, proved comparable results between treatment with antimicrobial monotherapy (piperacillin/tazobactam) and combined therapy (aminoglycosides with lincosamides or with nitroimidasoles). The effect of antimicrobial prophylaxis and therapy (aminopenicillines with the beta-lactamase inhibitor) was assessed in another restrospective study in acute appendicitis. The recommendations for initial empiric antimicrobial therapy in the secondary peritonitis are based on clinical and peroperative findings, on an estimated prevalence of the pathogens in the infectious focus and on sensitivity results of the individual antimicrobial medicines to the commonest pathogens in the secondary peritonitis. RESULTS: 1. Initial empiric antimicrobial treatment in the secondary peritonitis as a monotherapy with a broad-spectrum antibiotic or a combination of two antibiotics, should be effective against gram-negative aerobic, anaerobic bacteria and cocci. 2. With respect to morbidity and mortality rates, related to enterococcus infection not affected by antimicrobial therapy, administration of an antibiotic effective against enterococci is justified. 3. The choice of an antibiotic, duration and method of administration is based on the diagnosed infectious focus, peritonitis stage, on the current sensitivity findings of the commonest pathogens and on the overall condition of the patient (underlying disorders, immunodeficiency). 4. Treatment of other pathogens - Pseudomonas aeruginosa and mycoses is based on their laboratory confirmation and their sensitivity examination and usually is not an essential part of the initial empiric treatment. 5. In the initial empiric treatmet of early stages of the peritonitis, aminopenicilllin with the beta-lactamase inhibitor is the antibiotic of choice. 6. Due to its broad-spectrum effect against isolated bacteria and the safety parameters and low toxicity when used as monotherapy, pipracillin/tazobactam is indicated as the antibiotic of choice in advanced peritonitides with underlying disorders of the aboral part of the digestive tract.

Anti-Bacterial Agents↗
PubMed2004

[Non-surgical aproach in blunt injuries to the liver and spleen].

INTRODUCTION: Non-surgical approach in blunt injuries of the liver and spleen in patients haemodynamically stable, is widely accepted as their therapeutical method of choice. Based on a retrospective analysis, the aim of this study is to assess the injured patients with blunt injuries of the liver and spleen who were treated non-surgically. SUBJECTS AND METHODOLOGY: 75 injured patients with blunt intraabdominal injuries were hospitalized from 2001 to 2003. The spleen injuries were diagnosed in 40 patients, out of which 12 of them suffered from concomittent injuries of other intraabdominal organs, the liver injuries were diagnosed in 37 cases, out of which 24 injuries were isolated. The non-surgical approach was indicated in haemodynamically stable patients with isolated injuries of the spleen and the liver of the ISt-IVth grade with haemoperitoneum up to 300 ml, diagnosed on a spiral CT examination. RESULTS: 47 (63%) patients were urgently operated for intraabdominal injuries, 7 of them (15%) exited within 30 days after the surgery. The non-surgical approach was indicated in 28 (37%) cases. In this group, 19 patients suffered from liver injuries, 7 from spleen injuries and 2 from pancreatic injuries. The severity of the injury was classified as the It degree in 7 patients, as the IInd degree in 7 patients, as the IIIrd degree in 7 patients and as the IVth degree in 5 patients. The non-surgical procedure failed in 5 (19%) cases of patients with IIIrd or IVth degree liver or spleen injuries. The failure was caused by a delayed bleeding from the injured spleen in 3 patients and by a continuous bleeding in the IVth degree liver injury and the bile collection from the biliary bladder rupture in the patient with the IIIrd degree liver injury. The spleen injury was treated using splenectomy. In the IVth degree liver injury a debridement of the dilacerated tissue of the 7th segment and a ligature of the injured branch of the right hepatic vein, were conducted. The patient with the IIIrd degree injury was treated using cholecystectomy with a suture of the liver rupture. CONCLUSION: The non-surgical approach to the treatment of the isolated blunt liver and spleen injuries is indicated for the injured patients who are haemodynamicaly stable, with Ist-IVth degree injuries, without or with minor (up to 300 ml) haemoperitoneum and with continuous intensive care. The non- surgical approach to the higher degree blunt liver and spleen injuries has higher treatment failure risk rates.

Adult↗
PubMed2003

[Current diagnostic and therapeutic approaches in liver injuries].

PURPOSE OF THE STUDY: The recent improvements in hospital care system (centralized specialized care) and the use of new imaging methods and modern technologies in surgical treatment have greatly enhanced successful outcomes of therapy in liver injury. The aim of the study was to evaluate the contribution of procedures included in the diagnostic-therapeutic algorithms to the treatment of blunt injury to the liver in our patient population. MATERIAL: Our group consisted of 43 patients with blunt injury to the liver who were treated at the Emergency Department between 1998 and 2002. In 28 patients, blunt injury was part of polytrauma, in 7 patients it was associated with thoraco-abdominal injury and, in 8 patients, it was the only trauma sustained. METHODS: The diagnosis and therapy were based on the algorithm currently used for treating liver injury at the Emergency Department. In addition to clinical examination and assessment of the actual status of hemodynamics, spinal computed tomography was carried out to establish the therapeutic procedure. Fourteen patients were treated conservatively according to the criteria of a non-surgical approach and 29 patients underwent urgent surgery. Indications for revision surgery included, apart from signs of ongoing abdominal bleeding related to liver injury, combined spleen and kidney trauma. All patients with thoraco-abdominal involvement had laparotomy; in addition, four underwent thoracotomy including repair of the lacerated lung by suturing and three patients required suturing of a rupture of the right part of the diaphragm. RESULTS: In the patients treated conservatively, 10 showed spontaneous regression of parenchymal hematomas and four had to be treated by suction drainage. Out of 29 patients operated on, five died with signs of an irreversible hemorrhagic shock from multiple trauma and one died of multiple organ failure. DISCUSSION: The principal criterion determining therapy in blunt liver injury is the patient's hemodynamic status; laparotomy is mandatory in intra-abdominal trauma with severe hemoperitoneum or when unstable hemodynamics is due to intraperitoneal bleeding. Non-surgical treatment of blunt liver injury, on condition that the established criteria are observed, has several advantages such as less stress for the patient, fewer intra-abdominal complications and fewer blood transfusions needed. The modern technologies used in the operative procedure are related to both a transient vascular occlusion and a strategy for selective care in liver trauma. CONCLUSION: 1. The treatment strategy in a patient with blunt liver trauma is determined by the patient's hemodynamic status; in a stable patient, spinal CT examination of the thorax and abdomen is mandatory. 2. Urgent laparotomy is indicated when the patient with blunt liver trauma is hemodynamically unstable due to diagnosed hemoperitoneum or suspected intraperitoneal bleeding. 3. Conservative therapy is applied when the criteria for non-surgical treatment are fulfilled. 4. Surgical strategy for blunt liver trauma is based on the extent and localization of the injury, the patient's overall status and severity of associated injuries. Resection of the injured parenchyma is indicated when laceration of a liver lobe occurs. 5. The prognosis of blunt liver injury is influenced, apart from hemorrhagic shock reversibility, by the severity of associated injuries in multiple trauma.

Adolescent↗
PubMed2003

[What are indications for hepatic resection in metastases?].

INTRODUCTION: In the last 20 years the resection of liver metastases became the method of choice in the therapy of malignant tumors, particularly of colorectal cancer. The study was aimed at evaluating indication criteria and operation tactics in liver metastases resection. MATERIALS AND METHODS: The authors retrospectively analyzed a group of 154 patients subjected to liver resection for metastases, having been operated on since 1980 to May 2003. The preoperative indication procedure included a) imaging examination of the liver (CT, NMR, DSA--radiological staging), b) evaluation of tolerance to liver resection to liver resection (ASA, hem-coagulation tests, liver tests, nutritional state), c) examination to exclude the occurrence of extrahepatic tumor (imaging and endoscopic methods). In addition to peroperative examination (surgical staging) and selective vascular exclusion in anatomical resection, the standard operation procedure was supplemented in the last five years with transaction of the liver by means of the harmonic scalpel. From the total number, metastases of colorectal cancer were resected in 116 patients, in 20 gall bladder cancers, in 6 stomach cancers, in 4 breast cancers, in three carcinoids of colon and intestine and in two kidney cancers. Individual patients suffering from metastases of adrenal cancer, pancreas cancer and melanoma, respectively, were also operated on. More extensive anatomical resections were performed in 44 patients, segmentectomy was made in 43 subjects and non-anatomical wedge-shaped resections in 67 individuals. RESULTS: Postoperative complications occurred in 15 (9.8%) patients (subphrenic hematoma, abscess, cholascos, fluidothorax, pulmonary or early infection). Two patients died within 30 days (1.3%) for hemorrhagic shock due to bleeding from duodenal ulcer and from hepatorenal failure). CONCLUSION: 1. Liver resection is indicated is resectable metastases of colorectal cancer. 2. The resection exerts a therapeutic effect in non-colorectal metastases in neuroendocrine tumors, tumor of uropoetic and genital system, breast cancer, sarcoma and melanoma. 3. The preoperative diagnosis should include: a) imaging examination of the liver and the site of primary tumor and possible occurrence of other metastases, b) determination of tolerance to liver resection. 4. The operation tactics includes the peroperative evaluation of operability, radical resection of metastases with 1 cm border of unaffected liver tissue and procedures leading to diminished blood loss and biliary stasis. 5. Anatomical resection is indicated in larger metastases affecting segments of one lobe. Non-anatomical wedge-shaped resection is aimed at removal of peripheral foci.

Adult↗
PubMed2002

[When is resection indicated in primary liver tumors?].

The development of hepatic surgery involved also definition of indications for resection in primary liver tumours. Based on an analysis of a group of 76 patients with primary liver tumours operated in 1978-2001 (up to the end of October) the authors evaluated the indication criteria for resection of primary hepatic tumours. As to benign tumours most frequently haemangiomas were resected (in 35 patients) and follicular nodular hyperplasia in 10 patients. Indication for resection was the symptomatology of the tumour (40x), signs of progression during a check-up examination (13x) or doubts as regards preoperative ruling out of malignity (16x). Hepatocellular adenoma was resected in 8 patients, incl. 7 where the preoperative diagnosis was assessed by bioptic examination. The extent of resection depended on the size and site of the tumour, in haemangiomas and follicular nodular hyperplasia non-anatomical resections predominated (in 27 patients). On account of hepatocellular carcinoma resections were made in 18 patients, incl. 8 who suffered also from cirrhosis which limited the extent of resection. In patients without cirrhosis with carcinoma in one of the lobes an anatomical resection was implemented. Postoperative complications developed in 14 patients (18%), two died (3%) from hepatic failure and pulmonary embolism.

Adult↗
PubMed2002

[Traumatic rupture of the diaphragm in blunt injuries].

The authors present a group of 12 casualties operated on account of a traumatic rupture of the diaphragm. The rupture of the diaphragm was part of an associated thoracoabdominal injury or multiple injury. The casualties were examined within the framework of the diagnostic algorithm, in 11 of them rupture of the diaphragm was proved by spiral computed tomography. The diaphragm was injured in 7 subjects on the left and in 5 on the right. In 8 casualties during injury of the diaphragm also a serious intrathoracic injury was treated (in 5 laceration of the lungs) and of intraabdominal organs (in 4 laceration of the liver and in 2 laceration of the spleen). On the left side injuries of the diaphragm were always treated from laparotomy, on the right in 4 patients from thoracotomy. In 4 patients with concurrent injury of the intrathoracic and intraabdominal organs a thoracoabdominal approach was selected. During the postoperative period one female patient with multiple injuries died. The cause of death was contusion of the brain. According to the authors' experience it is useful to apply for early diagnosis of diaphragmatic injuries modern non-invasive imaging methods (spiral post-contrast computed tomography). The surgical approach depends on the presence of associated intrathoracic and intraabdominal injuries. The therapeutic results are limited by the presence of serious associated injuries.

Adult↗
PubMed2002

[Initial empirical antimicrobial therapy with piperacillin/tazobactam in intra-abdominal infections due to perforation of the large intestine and rectum and in postoperative complications after resection of the large intestine and rectum].

One of the basic therapeutic procedures in surgical intraabdominal infections is early administration of antimicrobial drugs. The basic requirement for the selection of antimicrobial drugs is a broad-spectum bactericide action with low toxicity. Within the framework of a retrospective non-comparative investigation the action of the betalactam antibiotic piperacillin combined with the betalactamase inhibitor tazobactam was tested which was used in the initial empirical antimicrobial treatment of 33 patients with intraabdominal infectious complications caused by perforation of the large bowel or dehiscence of the anastomosis on the large intestine or rectum. Twenty-eight patients developed diffuse inflammation of the peritoneum (caused by perforation of a diverticulum in 17, by dehiscence of the anastomosis on the large intestine and rectum after resection on account of carcinoma in 7, by a penetrating injury of the large bowel and rectum in 3 and by postirradiation necrosis of the rectum in one female patient). Five patients developed an intraabdominal abscess as a complication of diverticulitis of the large intestine or as a postoperative infectious complication after resection of the large bowel and rectum. All patients were operated (resection of the large bowel according to Hartmann, or stoma above the site of injury or dehiscence of the intestinal anastomosis or drainage of the abscess). After surgery administration of piperacillin/tazobactam (4.5 g, subsequently after 8 hours). The period of administration was on average 8 days (5 to 11 days). After surgery the contents of the peritoneal cavity were collected for bacteriological examination incl. evaluation of the sensitivity of the isolated bacteria to piperacillin/tazebactam. From the isolated pathogens 58% were Gram-negative aerobic bacteria, in 24% anaerobic bacteria and in 18% enterococci. In 3 patients antimicrobial treatment was because of resistance of isolated bacteria to piperacillin/tazobactam (Klebsiella species, Pseudomonas aeruginosa) combined with aminoglycosides (amikacin, netilmicin). Postoperative complications developed in 9 patients (27%), incl. 3 who died (9%). In patients with intraabdominal infection caused by perforation of the large bowel and rectum or dehiscence of the anastomosis after resection of the large bowel and rectum piperacillin/tazobactam is the antibiotic of choice for the initial empirical antimicrobial treatment on account of its great efficacy against the majority of isolated bacteria, its safety and low toxicity.

Abdominal Abscess↗
PubMed2002

[Liver transection with the harmonic scalpel in elective liver surgery].

More procedures used in transection of the liver parenchyma include also resection by means of a harmonious scalpel with an enhanced haemostatic effect. Based on analysis of 51 patients operated on account of liver disease using a harmonious scalpel, the authors evaluate its asset to the liver resection technique. The harmonious scalpel was used in transection of the liver in seven patients with benign liver disease (inborn cysts, follicular nodular hyperplasia, haemangioma, hepatocellular adenoma) and in 44 with malignant disease (hepatocellular carcinoma, metastases, most frequently, i.e. 34x of colorectal carcinoma). Anatomical liver resection (hemihepatectomy, lateral bisegmentectomy, segmentectomy) was implemented in 34 patients, and in 17 a wedge-shaped resection. Transection of the parenchyma by a harmonious scalpel was made using 10 mm coagulation scissors, i.e. their blunt blade with a lower oscillation grade. The preoperative blood loss was from 30 to 300 ml. As to postoperative complications 2 patients developed cholascos, 2 fluidothorax, 1 respiratory failure and 2 early infection. Liver resection by means of a harmonious scalpel is a new method of parenchyma transection with adherence to the resection line without damage of the deeper structures, reducing preoperative haemorrhage and minimalizing the extent of resection in liver diseases with impaired regeneration of the parenchyma (cirrhosis). Liver transection by a harmonious scalpel is a safe method where it is essential to respect recommended technical parameters, incl. the necessary time.

Adult↗
PubMed2001

[Epidemiologic study of fatal injuries autopsied at the Institute of Forensic Medicine of the 3rd Medical School of Charles University Hospital in Vinohrady, Prague, from 1996 to 1999].

In our study comprising 1010 persons who died as a result of injury death at the age of 15-97 years and were autopsied in the Institute of Department of Forensic Medicine of the 3rd Faculty of Medicine and University Hospital Královské Vinohrady, were 748 men and 262 women. 717 died at the site of injury and 293 died from the consequences of the injury in hospital. The most frequent cause of injury death was unintentional deaths (56.14%), followed by suicide (26.83%), murder (12.48%) and occupational injuries (4.55%). Road traffic accidents accounted for 51% of unintentional injury deaths. The most frequent cause of death was traumatic shock (32.67%), followed by injuries of the brain and spinal cord (30.50%). Injuries affect most frequently the head (60.5%) and chest (56.9%). The presence of alcohol in blood was detected at 30.2% of deceased.

Adolescent↗
PubMed2001

[Indications for emergency surgery in thoraco-abdominal injuries].

PURPOSE OF THE STUDY: Under the conditions of an increasing number of car accidents and criminal injuries the thoracis and abdominal trauma is a source of a significant morbidity and mortality in blunt and penetrating mechanism of injury. On the basis of a group of patients operated on for blunt and penetrating injury of the chest and abdomen evaluation was made of the current indication and results of lifesaving surgery in case of these injuries. PATIENTS: The group included 68 patients requiring a lifesaving surgery for a blunt and penetrating injury of the chest and abdomen hospitalized between the beginning of 1966 and the end of April 2001. Forty-five patients sustained a blunt injury and 23 a penetrating injury. METHODS: In case of blunt injuries the indication for surgery was determined on the basis of clinical examination supplemented with a radiograph examination of the chest and spiral computer tomography. In case of penetrating stab wounds the surgery was indicated on the basis of clinical examination, in gunshot wounds by means of x-ray examination and spiral computer tomography performed in order to assess the scope of the injury of intraabdominal organs and the location of the projectile. Indicated on the basis of the examination in the blunt injury was thoracotomy in 6 cases, laporatomy in 34 cases and the combination of thoracotomy and laparotomy in 5 patients. In case of the penetrating injury thoracotomy was performed in 8 cases, laparotomy in 11 cases and the combination of thoracotomy and laparotomy in 4 patients. RESULTS: In the post-operative period 6 patients (9%) died: 3 patients with a polytrauma died from an irreversible damage caused by a protracted hemorrghagic shock, one female patient from the contusion of brain, one patient after splenectomy for an isolated injury died from cardiorespiratory failure and pneumonia, one patient with a stab wound of the left ventricle of the heart died from the heart failure by hypoxy. DISCUSSION: Indication for a lifesaving thoracotomy and laparotomy in our group of patients operated on corresponds to the overviews of surgeries in thoracoabdominal injuries presented in literature. The procedure in preoperative examination is identically limited by the stability of hemodynamics in the patient after the injury using mainly ultrasound and computer tomography of the stabilized patient. In contrast to a number of authors in our conditions we have not performed some of the intervention examinations such as diagnostic peritoneal lavage or thoracoscopy and laparoscopy. The improvement of results in patients operated on for thoracoabdominal injury is in our conditions given both by the timeliness of the operation in the availability of examination methods (US, spiral CT) and by adequate stabilization of the patient in the peroperative period at the emergency department. CONCLUSION: Priority indication for a lifesaving surgery in thoracoabdominal injuries is significant intraabdominal bleeding diagnosed on the basis of the result of the clinical examination in hemodynamically unstable patients. In a stabilized patient the lifesaving surgery is performed on the basis of the result of visualization methods (spiral computer tomography, ultrasound, angiography, endoscopy) revealing apart from significant bleeding also severe injuries of intrathoracic and intraabdominal organs. Protracted hypovolemic shock with the development of multi-organ failure or the occurrence of simultaneous severe associated injuries in polytrauma are the most frequent causes of mortality in patients operated on for thoracoabdominal injury.

Abdominal Injuries↗
PubMed2000

[Liver resection using the harmonic scalpel].

The authors present their initial experience with the use of a harmonious scalpel in resections of the liver. The harmonious scalpel was used as part of the resection technique in 24 patients operated in 1999. Indication for surgery was in five patients benign liver disease (inborn cysts, nodular hyperplasia, haemangioma, hepatocellular adenoma) and in 19 malignant disease (hepatocellular carcinoma and secondaries). Anatomical resection of the liver was performed in 15 patients and in 9 patients a wedge-shaped resection. During resection a combined technique with a harmonious scalpel was used (with coagulation scissors). As to postoperative complications two patients developed cholascos. According to the authors' experience introduction of a harmonious scalpel into the technique of liver resection is the method of choice in particular in non-anatomical resections because of the better control of haemorrhage and safer isolation of bile ducts and blood vessels.

Adult↗
PubMed1999

[Empyema of the thorax].

The authors evaluated the therapeutic procedure and results in patients with empyema of the chest. From December 1996 till June 1998 at the Surgical Clinic of the Third Medical Faculty, Charles University Prague 21 patients with empyema of the chest were hospitalized. The most frequent cause of empyema of the chest was pneumonia in 13 patients (62%). In 16 patients (in 76%) the empyema was classified as the third stage of the disease. Decortication, the most frequent procedure, was performed in 16 patients, incl. three where it was done using videothoracoscopy. Surgical treatment was supplemented by antimicrobial treatment, either monotherapy or a combination of antimicrobial preparations. From the total number one patient died 25 days after thoracotomy and partial decortication with a mesiotheloma of the pleura. The other patients have no signs of relapse of empyema. According to the authors experience the selection of the surgical procedure depends on the stage of the disease. In the authors group decortication by the thoracotomic route was used most frequently.

Adult↗
PubMed1999

[Current status of liver resection of metastases of colon and rectal carcinoma].

Based on an analysis of a group of patients with resection of the liver on account of secondaries of colorectal carcinoma the authors evaluate their therapeutic method. Between 1978 and June 1999 at the Surgical Clinic of the Third Medical Faculty Charles University, Prague resections of the liver were made in 222 patients, incl. 57 on account of metastases of colorectal carcinoma. The liver was resected on account of metastases by right-sided lobectomy twice, left-sided lobectomy 1x, right-sided lateral bisegmentectomy 5x, left-sided lateral bisegmentectomy 9x, segmentectomy 16x and in 24 patients a wedge-shaped resection was made (incl. 10 with multiple metastases several times). In another eight patients where a resection could not be performed either alcoholization of the tumour was used or adjuvant chemotherapy was administered. Postoperative complications were recorded in 10%, the 30-day mortality rate was 2%. The mean survival period was 23 months. Resection of the liver on account of a secondary of colorectal carcinoma is a safe and effective therapeutic method.

Carcinoma↗
PubMed1998

[Epithelioid hemangioendothelioma of the liver. Accidental detection of a solitary focus resembling a hepatic cyst].

The authors describe the case-history of a young woman with a solitary epithelioid haemangioendothelioma of the liver which on initial sonographic and CT examination reminded of a simple liver cyst. Aspiration biopsy under US control confirmed a solitary tumor evaluated under the influence of results of imaging methods, admitting the presence of a capsule, as a probable cholangiogenic adenoma developing into malignity. The patient was subjected to surgical extirpation of the tumor and the definite diagnosis of its vascular origin was assessed only during a detailed examination of the resected tissue. After an eight-month follow up the patient has no signs of relapse.

Adult↗