[The spectrum of diaphragmatic injuries managed in a Prague traumatology centre].

Introduction: Diaphragmatic injuries may result from blunt or penetrating injuries. The symptomatology is usually overlaid by symptoms of associated abdominal or thoracic injuries or by symptoms of other systems injuries in polytraumas. Multidetector computer tomography (MDTC) facilitates the improvement of preoperative diagnostics in blunt injuries.

[Surgeries for blunt and penetrating thoracic injuries].

Introduction: Up to 50% deaths due to fatal injuries result from thoracic injuries. Approximately 10-15 % of the injuries require thoracotomy.

Aim Of The Study: Indications and outcome of the surgery were assessed, based on the restrospective analysis data from subjects operated for blunt and penetrating thoracic injuries.

[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.

[Percutaneous localization and marking of small solitary pulmonary nodules in CT imaging before video thoracoscopy surgery].

Background: The localization of small lung nodules by palpation is not possible when videothoracoscopic surgery is performed. Transparietal fine needle biopsy is frequently not successful in small lung nodules.

Methods And Results: The authors describe their experiences with percutaneous CT controlled marking of small lung parenchyma around small lung nodules by patent blue and contrast medium mixture.

[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%).

[Significance of blunt injury of thorax in polytrauma.].

Based on the analysis of a group of 100 patients with polytrauma evaluation was made of the impact of thoracic injury on post-injury period, including the incidence of complications, and on the outcome of the treatment. Blunt thoracic injury occurred in 64 patients. The most frequent complications of intrathoracic injury were pneumothorax, haemothorax and contusion of lungs.

[Use of collagen with gentamycin in abdominal and thoracic surgery].

Based on an analysis of a group of 16 patients operated at the Surgical Clinic of the Third Medical Faculty, Charles University Prague the indication of collagen with gentamycin was established. Collagen with gentamycin is used locally for prophylaxis and treatment of intraabdominal and intrathoracic infections. In a group of patients it was used for prophylaxis of postoperative infections in elective abdominal operations such as plastic operations of the abdominal wall, anastomoses in the aboral part of the GIT, in operations of fistulae as part of treatment of intraabdominal abscesses and advanced cholecystitis and appendicitis.

[An unusual complication of establishing a capnoperiteoneum for laparoscopic cholecystectomy].

The authors describe the case history of a female patient indicated for laparoscopic cholecystectomy. In the patient with progressing muscular dystrophy and thickening of the peritoneum it did not prove possible to establish a capnoperitoneum at the onset of the operation.

[Videothorascopic surgery--initial experience].

Practical experience with the miniinvasive laparoscopic technique in abdominal surgery logically led to extension of this method to thoracic surgery. Video-assisted thoracoscopic operations hold their place in the treatment of spontaneous pneumothorax, pleural syndrome, benign tumours of the thoracic wall etc. A curative solution of malignant diseases by this route is so far controversial and is reserved only for specially defined cases.

[Importance of blunt injuries of the chest for assessment of the therapeutic procedure and prognosis in multiple injuries.].

Based on analysis of a group of 62 casualties with multiple injuries where a blunt chest injury was found, the authors submit some principles for assessment of the priority of the therapeutic procedure. The patients were hospitalized at the intensive care unit of the Surgical Clinic of the Third Medical Faculty in Prague between 1989 and 1992. Craniocerebral injury was the most frequent associated injury, its sequelae were the cause of death in the majority of injured patients who died.

[Stab and gunshot thoracoabdominal injuries].

The authors give an account of their experience with the treatment of punctures and gunshot injuries of the chest and abdomen in 43 patients hospitalized at the Surgical Clinic of the Third Medical Faculty, Charles University Prague 10 between 1989 and 1992. Injuries of the chest were recorded 15 times, abdominal injuries in 25 patients and concurrent injuries of the chest and abdomen in three patients. To ensure treatment of penetrating injuries the authors present an algorithm which comprises differentiated care as well as some non-interventional diagnostic methods (ultrasonography, computed tomography).

[Diagnostic and therapeutic approaches to spontaneous pneumothorax].

Based on a retrospective study of 33 patients with spontaneous pneumothorax, the authors present their experience with the diagnostic and therapeutic procedure. In the majority of patients treatment was started by active suction drainage of the chest. After re-expansion of the lung another X-ray examination was made, incl.

[Noxythiolin VUFB as part of antimicrobial prophylaxis and therapy in inflammatory intraabdominal complications in surgery].

The author investigated the antimicrobial action of noxythioline, prepared by the Research Institute for Pharmacy and Biochemistry in Prague, in laboratory work as well as under clinical conditions. In the laboratory investigation the author assessed the minimal inhibitory concentration against aerobic and anaerobic bacteria within the range of 512-2048 mg/l, which is sufficient from the aspect of the noxythioline concentration (2.5%) used in clinical work.

[Parenteral nutrition using branched-chain amino acids (Nutramin VLI Spofa) in the early postoperative period in patients with intra-abdominal inflammatory diseases].

In 19 patients with intraabdominal septic conditions hospitalized at the Surgical Clinic of the Medical Faculty of Hygiene, Charles University, Prague 10 in 1987-1988, the effect of the gradually increasing ratio of branched amino acids administered in parenteral nutrition was investigated. The administration of branched amino acids (Nutramin VLI Spofa) was started already on the first day after operation. By increasing the ratio to 43% of branched amino acids gradual normalization of metabolic changes occurred, incl.

[Use of Nutramin VLI Spofa for parenteral nutrition in the early post-injury period in polytrauma].

The solution of branched-chain amino acids of gradually increasing concertration ranging from 22.7 to 43 per cent was administered to 15 patients with polytrauma as part of parenteral nutrition. Parenteral nutrition was started with during 24 hours after the trauma.