Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Case Reports
[Urgent thyroidectomy for a mechanical syndrome caused by a toxic nodular goiter--a case report].
We present a case of emergency surgery of an 86-year-old patient with an extensive cevicomediastinal toxic nodular goiter. Acutely onset mechanical syndrome during hospitalization of the patient in another department for a different diagnosis (vertebrogenic algic syndrome of Th-L spine) warranted acute intubation and mechanical ventilation. ⋯ All published cases of acute compression syndrome with respiratory insufficiency involve anaplastic carcinoma transformation, fast growing lymphoma, injuries with an intraglandular haemorrhage or infected cysts. In this case the reason was the benign disease of the thyroid gland.
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One of possibility of treatment FBSS is posterior lumbar interbody fusion, PLIF with posterior transpedicular stabilization. ⋯ Our study results show that PLIF with posterior transpedicular stabilization can be safely perfomed and that can allow decrease pain and improve quality of life in FBSS patients.
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In dealing with benign tracheal stenosis, segmental tracheal resection yields superior results in experienced hands when properly indicated, timed end executed. Several factors may contribute to early or delayed failure of resectional treatment. In our retrospective study we analyze the potential causes of tracheal restenosis in patients who underwent segmental tracheal resection for benign tracheal stenosis between 1995-2009 and propose an algorithm for prevention and treatment of such complication. ⋯ In the paper we analyze the causes of restenosis after segmental tracheal resection and propose an algorithm of restenosis treatment. We consider insufficient assessment of resected segment length and subsequent anastomosis construction in inflamed tracheal tissue to be the most important cause of early restenosis. The late restenoses in our experience were caused by excessive anastomotic tension and possibly by other factors, such as steroid medication. Indication and timing of re-resection depend also on identifying the cause of restenosis. Early restenoses possibly induced by technical error may be treated by reresection sooner than delayed restenoses, which usually require 6-12 months for inflammatory changes to subside. In both scenarios T-tube insertion represents a reliable temporary or even permanent solution.
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Review of literature and a single-institution retrospective analysis of possibilities and results of various surgical techniques in treatment of benign tracheoesophageal fistula (TEF). ⋯ In the paper we analyze the advantages and disadvantages of various techniques and their alternatives in the treatment of TEF. As the most reliable and suitable solution for patients with postintubation TEF, breathing spontaneously and with acceptable nutritional status, we favour segmental trachea resection with end-to-end anastomosis and esophageal suture without muscle interposition, regardless of presence of concomitant tracheal stenosis. Fistulae of other etiologies require diverse approaches, especially tailored with respect to their location. Management of tracheo-neoesophageal fistula following esophagectomy for carcinoma is extremely demanding. Therefore, it is crucial to adhere to basic rules of prevention of such benign but potentially fatal entities as TEF and TNEF.