A Randomized Comparison of Plasma Levobupivacaine Concentrations Following Thoracic Epidural Analgesia and Subpleural Paravertebral Analgesia in Open Thoracic Surgery.

Background: The aim of this study was to compare plasma levobupivacaine concentrations in thoracic epidural and subpleural paravertebral analgesia.

Methods: Forty-four patients indicated for open lung resection had an epidural catheter inserted preoperatively or a subpleural catheter surgically. A bolus of 0.

Immediate Removal of an Entrapped Central Venous Catheter Guide Wire.

Extravasal guide wire entrapment due to fraying during central venous catheter placement using the Seldinger technique is a rare complication, which should be resolved as soon as possible. A 68-year-old male was scheduled for open right-side decortication. After the induction of general anesthesia, an attempt was made to place a central venous line in the right subclavian vein.

Air Embolism into Superior Mesenteric Artery Following Replacement of Ascending Aorta for Aortic Dissection - A Rare and Fatal Case.

We report an unusual case of fatal air embolism into the superior mesenteric artery in a patient, who underwent replacement of the ascending aorta for aortic dissection type A. CT performed twice on the first postoperative day showed abundant air in the superior mesenteric artery and its branches (but not in the portal-venous system) indicating air embolism with no signs of bowel necrosis. On the second postoperative day, the patient underwent extensive bowel resection due to bowel ischemia and died on the third postoperative day on MODS/SIRS.

[Management of acute postoperative pain following thoracotomy - state of the art].

Unlabelled: Postoperative pain management is an important part of complex perioperative care in patients undergoing thoracotomy, irrespective of the procedure type. Adequate pain relief leads to early mobilisation, improves respiratory functions and decreases global stress response. Thus, good perioperative pain management significantly reduces postoperative complications.

Hemodynamic response to thoracoscopy and thoracotomy.

Operations in the pleural cavity are connected with circulatory changes in pulmonary circulation and general changes of hemodynamics. These changes are influenced by the position of patient's body on the operation table and by the introduction of artificial pneumothorax. Thoracoscopy is an advanced surgical approach in thoracic surgery, but its hemodynamic effect is still not known.

Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6).

Hip trauma and surgery are associated with systemic inflammatory reaction. However, little evidence exists about the role of IL-6. In order to assess the inflammatory response, we evaluated white blood cell (WBC) count, C-reactive protein (CRP) and IL-6 dynamics in sequential pre- and postsurgical samples collected from 125 elderly patients (mean age 78+/-9 years) undergoing osteosynthesis (OS) for extracapsular hip fractures (n=69), hemiarthroplasty (HA) or urgent total hip arthroplasty for intracapsular fractures (UA) (n=35), and elective total hip arthroplasty for osteoarthrosis (OA) (n=21).

[Serious complications following simple appendectomy].

Fulminant phlegmone of the abdominal wall is a very rare, however feared and severe complication, which may develop following open, as well as laparoscopic appendectomies. Most studies and the common opinion consider the open procedures to be of a greater risk of early infectious complications, while the laparoscopic procedures, compared to the open surgeries, show increased rates of intraabdominal complications. Based on their own studies, the authors came to similar conclusions.

Transcutaneous electrogastrography in patients with ileus. Relations to interleukin-1beta, interleukin-6, procalcitonin and C-reactive protein.

Background: The aim of the prospective study was to characterize the disturbance of gastric electrical control activity in different types of ileus and to correlate surface electrogastrography (EGG) findings with a set of inflammatory markers.

Patients And Methods: Fifty-four adult patients with mechanic, vascular and paralytic ileus proven on clinical and radiological exams and 14 age- and sex-matched controls were examined. Gastric myoelectrical activity was recorded using 3 Ag-AgCl disposable skin electrodes connected in pseudo-unipolar mode by Microdigitrapper device.

Inflammatory response in patients undergoing hip surgery due to osteoarthrosis or different types of hip fractures.

Objective: Hip surgery represents a major intervention associated with significant inflammatory response. The objective of our study was to compare markers of systemic inflammation and soluble adhesive molecules in patients undergoing elective hip replacement to those with hip fracture either intracapsular (IC) or extracapsular (EC).

Design: We included 65 consecutive patients undergoing hip surgery--17 patients with elective hip replacement (EL group), 29 patients with EC fracture (EC group) and 11 patients with IC fracture (IC group).

[Comparison of various types of pharmacological prevention of lower extremities deep vein thrombosis in patients with proximal femoral fractures].

Adminstration of coagulation-active substances is one of the options to prevent thromboemboembolic disease (TED), including deep vein thrombosis and systemic response to stress entailed by an injury or a surgical procedure. Lately, a synthetic analogue of the heparin molecule--of its functionally active part--pentasaccharide (PS), has been developed, among others. Potential effects of different pharmacopreventive therapies of the deep vein thrombosis was studied in a group of 146 subjects, who suffered proximal femoral fractures and were operated in the Ist Surgical Clinic, VFN Hospital, during 2001-2006.

[Venous thrombosis prophylaxis in surgery--beginnings, contemporary state, ACCP consensus, future prospects].

Presentation and analysis basis questions and changes of thromboembolic disease prophylaxis in the surgical specialities from point of view the developments in last 30 years. Demonstration of the basic and modren methods of deep venous thrombosis prophylaxis. Recommendation of the 7th conference ACCP-CHEST 2004.

[Laparoscopic diagnosis and treatment of organic hyperinsulinism--our first experience].

Laparoscopic pancreatic procedures are still at the stage of evaluation with regard to their indications and the technical variation used. Laparoscopic pancreatic surgery is currently used for staging malignant pancreatic tumours, for the resection of benign pancreatic tumours and for the occasional management of inflammatory disorders of the pancreas. Insulinomas are rare tumours with incidence per year of 0.

[Prevention of thromboembolism in surgery of fractures of the upper end of the femur].

Morbidity and mortality after hip fractures is often a result of deep vein thrombosis and pulmonary embolism. Therefore, prophylaxis for venous thrombosis is recommended in patients undergoing osteosynthesis of upper end of lower extremity or arthroplasty of the hip. Study compared efficacy of UFH and LMWH in prevention of thromboembolic disease.

[Laparoscopic splenectomy--personal experience].

The authors present an account on their own experience with laparoscopic splenectomy which is used at the First Surgical Clinic, First Medical Faculty and General Faculty Hospital in Prague since 1996. In 1996 to 2002 the authors performed at the Surgical Clinic a total of 66 splenectomies. This number included on account of injury of the spleen, tumour or cyst 12 splenectomies by the open route.

[Heparin-induced thrombocytopenia in patients and prevention with low molecular weight heparin].

Prospective study implicates problems of heparin-induced thrombocytopenia (HIT). This is one of the most important complications in heparin treatment and prophylaxis. The set was formed of patients with severe diagnosis and larger intra-abdominal operation that was associated with relative high risk of thrombotic event.

[The plug system and laparoscopic hernioplasty in recurrent inguinal hernia].

A total of 1511 patients were operated on at the 1st Department of Surgery Charles University in Prague during 1996 through 2000. Of this number, 81.3% underwent surgery for primary and 18.

[Invagination--the first manifestation of leiomyosarcoma].

The authors describe in their paper one of the less frequent ileus acute abdominal events in adult age--invagination. At the same time they comment also on the rare cause of invagination, a leiomyosarcoma of the small intestine. In the discussion they mention the relationship of this tumour to gastrointestinal stromal tumours.

[Total tyroidectomy in malignant goiter, significance and problems].

Surgical operation of the thyroid gland is a basic operation in the treatment of malignant diseases of thyroid gland. At present, total removal of the thyroid gland (total thyreoidectomy = TTE) has been the most frequently used means of the surgical intervention. TTE has been a unique surgical method for thyroid cancer.

[Metastasis as the first sign of thyroid carcinoma].

The authors present on the basis of case report the problematic of thyroid gland cancer where was manifest long-term (3 years) clinical only as the resistance on the right part of the neck in the trigonum submandibular. Histological examination confirmed the metastasis of thyroid gland papillocarcinoma. Total thyroidectomy was performed and the same type of cancer in both lobes was confirmed.

[Videothoracoscopy and video-assisted surgical procedures in penetrating injuries of the thorax].

Diagnosis and treatment of the penetrating injury of the chest is quite difficult. In all types/sizes of hospitals/these injuries has to be immediately treated in surgery departments. Often decision about the optimal treatment of these injuries is quite difficult.

[Traumatic asphyxia with an unusual etiology. Case report].

The authors present a casuistry of the injury endangering the life, which was caused by the unusual mechanism. The injured person was pulled inside of a conveyer and while shifting, not only his arm and physical (brachial) plexus was damaged, but he was also and especially, strangled by his clothes and he was seriously asphyxiated, which origin was in the first phase unexplainable.