[Personal experience with injuries of the rectum and anus].

Authors analyze some new knowledge in treatment of rectal and anal injuries proceeded from own clinical experience in comparison with studies of a range of foreign authors published recently. During last ten years together 24 injured patients with this diagnose were operated in Traumatological Hospital Brno, primary reconstruction was performed in 10 patients, secondary reconstruction after precise examination of pelvic fundus pathophysiology in 14 patients, mostly transferred from other clinics. Authors prefer primary treatment in 3 hours after injury.

Tumors of the rectum and anus.

Within a ten year period we have performed 433 radical operations on the rectum. An anterior resection of rectum was done in 110 cases, low anterior resection in 60 patients, very low anterior resection was done by stapler in 32 patients and was sewn by hand in 10 patients. Colo-anal anastomoses were performed 86 times and abdominoperineal amputation of rectum sec.

[Carcinoma of the lower half of the rectum].

Authors analyze the group of patients surgically treated for rectal carcinoma during ten-years long period. While the surgical tactic in upper part of the rectum is solved by the resection with straight anastomosis, in carcinomas of lower part of the rectum there is an open question there, to use the deep pelvic anastomosis after radical resection or to perform the rectal extirpation with saving of sphincters and using the coloanal anastomosis. The necessary requirement is complex preoperative examination of the tumor and of pelvic fundus physiology.

[Does a pelvic compartment exist? Personal experience].

The authors analyze a group of 7 patients transferred to their hospital for instable fractures of the pelvic circle and lumbar spine. The pelvic compartment was manifested 24-48 hours after injury. Early diagnostics are based on the use of new imaging techniques, spiral CT examination is preferred, and angiography in stabilized patients.

[Devastating injuries--new therapeutic approaches].

Nowadays the number of devastating injuries is increasing, as a consequence of traffic accidents and criminal incidents, too. Patients are often admitted in a critical state, the mortality rate in these cases is very high (50% and more). To decrease this high mortality, new treatment approaches must be chosen incl.

[Injuries of the small intestine in polytrauma].

The authors inform on the increasing number of penetrating abdominal injuries during the last five years, especially in the criminal injuries. Diagnostic methods in a stabilised patient are analysed, diagnostic and therapeutic laparoscopy is preferred to lavage of the abdominal cavity in indicated cases. Urgent surgical revision is recommended in patients in a critical state on account of quickly increasing compartment syndrome, although staged laparotomy is needed.

[Loss injuries of the biliary tract in laparoscopic cholecystectomy-- possibilities of reconstruction].

Authors analyze occurrence of injuries of external biliary tract relating to the increasing number of laparoscopic cholecystectomies, especially of loss injuries, very demanding for its reconstruction. The early diagnosis of these injuries is emphasized and the necessity of their surgical revision as soon as possible, best still during the primary intervention. Authors present the own reconstruction method by high intrahepatic anastomoses in loss injuries of the common hepaticus and its branches.

[Our concept of defecography. Methods and reproducibility of results].

Defecography is used in the Czech Republic only exceptionally. Since 1988 the authors made 402 defecographic examinations. They submit a detailed description of hitherto assembled experience and their own modification of the examination.

[Central rupture of the liver in multiple injuries].

Authors evaluate clinical material of polytraumatized patients operated on account of liver injury during the last 15 years. The contribution of new imaging techniques is analyzed, especially of spiral computed tomography, for the diagnosis of liver injuries and associated injuries of the abdomen and retroperitoneum. These techniques enable in stabilized patients with the trauma I, II injuries and in some cases of grade III injuries to prefer conservative treatment.

[Acute surgical diseases in spinal injuries with spinal cord lesions].

Authors analyse the group of 22 operated patients admitted to the Spinal Centre of the Traumatological Hospital Brno for instable spinal fracture with the transversal lesion of the spinal cord, in whom the acutely affected abdomen and acute surgical disease manifested. The anamnestic and clinic examination of the abdomen is not reliable in patients with the transversal lesion of spinal cord for valid laws of the spinal cord. Authors evaluate the contribution of new diagnostic imaging techniques and endoscopic methods to determinate the early indication for surgical treatment.

[Injury of the extrahepatic bile ducts in multiple injuries].

During the ten-year period between 1982-1991 the authors operated in the Institute 12 casualties after perforation and avulsion of the gallbladder, 8 patients on account of injuries of the hepatocholedochus and 15 patients where after injury posttraumatic acute cholecystitis developed. The authors evaluate critically the asset of new diagnostic preoperative procedures for assessment of early indication of surgery. In the surgical tactics they prefer reconstruction procedures which prevent such serious postoperative complications as relapsing cholangitis or stricture with cholestatic affection of the liver [1,3].

[Problems with continence after deep pelvic anastomoses in rectal carcinoma].

Based on the complex evaluation of the continence by anorectal manometry, EMG examination of sphincters, transrectal sonography, defecography and Colonic Transit Time examination, the analysis of the group of 15 patients partially incontinent after operation of carcinoma of the lower part of the rectum has been done. In these patients the deep pelvic anastomosis or coloanal anastomosis was performed. In none of the patients any serious organic damage of sphincters was manifested, the causes were dominantly extrasphincteric and functional, solvable well by conservative methods.

[Problems with continence in rectal injuries].

Authors analyse the group of 17 patients operated for rectal and anal injury. In this group 7 patients were operated primarily after injury and in 11 patients the secondary reconstruction was performed. Authors called the attention to the high diagnostic difficulty before the planned and indicated secondary reconstruction.

[Associated injuries of the pelvis].

In last three years 27 injured patients were operated in Traumatological hospital Brno for associated pelvic trauma. This trauma was associated with injury of urinary tract in 8 patients, with traumatic lesion in area of the colon in 6 cases and with injured big vessels of the retroperitoneum in 8 patients. The urgent operation was performed in 44%.

[Injuries of organs in the abdominal and retroperitoneal cavities].

In the Traumatological Hospital Brno approx. 100 polytraumatised patients yearly are admitted with involvement of 2, 3 or 4 systems. During the period of years 1982-1991 authors operated 308 injured patients with increasing haemoperitoneum, 254 patients with profuse bleeding into retroperitoneum, 77 patients with traumatic perforative peritonitis and 61 patients with severe thoracoabdominal trauma.

[Pitfalls of deep pelvic anastomoses in rectal carcinoma].

Authors analyse a group of patients operated for colorectal carcinoma in their hospital during ten-years period 1982-1991. 421 patients were operated for ca recti, in more as 65% of cases the sphincter saving operation was preferred. The used method was elaborated by Hojo and Kaso from Japan.

[Early treatment of the unstable thorax in polytrauma].

Thoracic trauma represents 12.8% of all trauma patients treated in author's evaluated the contribution of new diagnostic methods, in particular CT and sonography, to determinate the indication of conservative therapy or early surgical treatment. From 1992 in the framework of the grant project the early surgical treatment of instable thorax was performed in 29 patients with polytrauma or severe associated thoracoabdominal trauma.

[Stress ulcers in patients with polytrauma].

Authors treat in their institution yearly 100-120 patients with polytrauma. In the Endoscopic Centre of the hospital approx. 20 gastroduodenal ulcers are diagnosed yearly in patients with supposed stress etiology.

[Treatment of polytraumatized patients: our experience.].

Authors evaluate their experience in treatment of patients with polytrauma during last 10 years. They use the 5 level classification applicated particularly in German and Austrian traumatologic centres. Authors initiated in their workplace the computer assessment ISS - Injury Severity Score, Apache II -Acute Physiology and Chronic Health Evaluation II.

[Instabile thorax in polytraumatized patients: set for stabilization.].

Thoracic trauma represents 12,8 % of all trauma patients treated in author's workplace. Mortality was 12,7 %. Authors evaluated the contribution of new diagnostic methods, in particular CT examination with contrast and sonography, to determinate the indication of the early surgical treatment.

[Serum levels of cytokines as a measure of response to stress after various types of elective gallbladder surgery].

The authors investigated the cytokine levels in patients after laparoscopic cholecystectomy (LCHE), conventional open cholecystectomy (OCHE) and complicated open cholecystectomy (KOMPL) in order to assess whether there is a relationship between cytokine levels and the general reaction of the organism, the type and extent of the operation. They did not find an increase of IL-1 or IL-2 levels in any of the patient groups. The IL-6 concentration was slightly raised only in three patients of the OCHE group three hours after surgery and this rise persisted for 24 hours.

Surgical treatment of the atonic bladder ("vesical cap").

As demonstrated in animal experiments and in five patients with atonic bladders, "vesical cap" surgery causally solves detrusor impairment by functionally reinforcing it with a vital muscle layer from an ileal seromuscular flap. All other genuine components of the bladder are kept intact, which is very beneficial for bladder function.

[Treatment of injuries of the cervical spine].

Injuries of the cervical spine are re-evaluated at present. New surgical procedures and research on the stability, when these procedures are used, caused that surgical treatment is used more frequently. Attention is draw to provisions in the field as well as in hospitals, on the diagnostic approach and classification of these injuries, on the procedure of conservative surgical treatment.

[Recurrent peptic ulcer--surgical complications].

Recurrent ulcer is serious complication of surgical treatment. Resection, reconstructive operations under conditions of severe adhesions, inflammatory infiltrates and abscesses are exacting and often connected with complication. In the period of 1978-1987 the authors carried out 64 reoperations for recurrent peptic ulcer, incl.