Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
-
The increasing prevalence of obesity and type 2 diabetes mellitus (T2DM) worldwide may nowadays be regarded as a "twin" metabolic pandemic, causing the number of patients with the metabolic syndrome (MS) to rise rapidly. MS is a combination of several interrelated medical disorders such as obesity, T2DM, hypertension, dyslipidaemia etc. These conditions very frequently result in atherosclerosis, ischaemic heart disease, liver steatosis or even steatofibrosis. MS usually causes a significant worsening of the quality of life, often also leading to shortened life span. Bariatric, also referred to as metabolic (B-M), surgery currently represents a very powerful method for the treatment of morbid obesity and the metabolic syndrome. ⋯ Treatment options for the metabolic syndrome include bariatric-metabolic surgery, preferably using the mini-invasive laparoscopic method. These procedures are indicated primarily in morbidly obese patients with BMI > 40 kg/m2 after conservative therapy failure, or patients with severe obesity (BMI > 35 kg/m2) associated with serious circulatory, metabolic or mobility complications. Moreover, surgical treatment of T2DM has been proven to be possible in the last decade.
-
Randomized Controlled Trial
[Fascial closure of the abdominal wall by dynamic suture after topical negative pressure laparostomy treatment of severe peritonitis--results of a prospective randomized study].
Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study. ⋯ Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.
-
Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. ⋯ In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision.