Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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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.
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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.
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Penetrating thoracic or abdominal or combined injuries are associated with high risk of life-threatening intraabdominal or intrathoracic organ injury. Most patients require acute surgery. When miniinvasive technique is available, thoracoscopic or laparoscopic intervention is indicated in hemodynamically stable patients to evaluate severity of the injury, as well as to treat the condition. ⋯ Incidence of penetrating thoracic, abdominal or combined thoracoabdominal injuries is fairly rare in our country. Subjects with unstable hemodynamic conditions are indicated for acute thoracotomy or laparotomy. Miniinvasive procedures have diagnostic and therapeutic benefit in stable patients. Diagnostic thoracoscopy and laparocopy provides evidence of some injuries (diaphragm, alimentary tract). Therapeutically, miniinvasive methods may be used to manage the source of bleeding and for targeted drainage. Nonsurgical procedure is the method of choice in a selected group of hemodynamically stable patients with stab injuries, with monitoring of the patient's condition, including the use of x-ray imaging.
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The authors give an outline of the issue of acute mediastinitis. It is a severe infection of connective tissue of the mediastinum. ⋯ Acute mediastinitis may be divided in the postoperative sternal infections with infection of the mediastinum, mediastinitis due to perforation of the aero-digestive tract and descending necrotizing mediastinitis. The authors describe etiopathogenesis, diagnostics and therapy in each particular type of mediastinitis.
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Blunt chest trauma produces a variety of injuries. Penetrating cardiac injuries from rib fractures are extremely rare. ⋯ We did find eight patients reported in the literature having penetrating cardiac injuries from rib fractures. The clinical finding and the diagnosis of this injuries are discussed.