Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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The overview presents the current situation in the diagnostics and therapy of unstable thoracic wall injuries. The diagnostic spectrum is enlarged by multidetector computed tomography with 3D reconstruction imaging in rib fractures. The use of MDCT in routine examination of blunt thoracic injuries proved to bet the most sensitive imaging method in rib fractures detection, including their dislocations and assessment of the extent of thoracic wall deformity. ⋯ Relative indications for surgical stabilization of fractures include block and serial rib fractures, thoracic deformities and defects and rib fractures healing disorders combined with other limiting criteria. Surgical stabilization is technically managed using metal or absorbable plasters. Surgery with open reduction and internal rib fixation, in particular in block or serial rib fractures, is associated with reduction of ventilation support time and reduction in the risk of infection.
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Pilonidal sinus disease (PSD) is defined as a cyst of sacrococcygeal hair follicle. Complete excision of lesion and skin reconstruction is still the only definitive treatment. Opinions on form and size of excision and type of skin reconstruction and flap are ambiguous. ⋯ Using of primary closure without flap carries just little benefit in shorter surgery time. Suture outside of midline minimize risk of early postsurgical complication and decrease risk of disease recurrence. Published literature in correlation with our results show that modified Limberg flap may be useful standard in PSD treatment.
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Therapeutic endoscopy is mostly primary method in treatment of biliary tree obstruction with its various complications. A case review describing an oncological pacient examined for obstructive icterus, with recognised pneumoscrotum after endoscopic examination (ERCP). In discussion we try to point out the need of knowledge of clinical examination, clinical signs of duodenal lesions and optimal treatment measures.
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Case Reports
[Surgical repair of bladder rupture associated with the pelvic fracture without suprapubic tube--a case report].
The authors are presenting a case of 42-year-old polytraumatized man with pelvic fracture associated with extraperitoneal urinary bladder rupture. This was verified by intraoperative retrograde cystography and treated with suture without making suprapubic tube drainage. Urinary draining was assured with a transurethral permanent urinary catheter. ⋯ Suprapubic tube is not beneficial in surgical repair of urinary bladder rupture. However, it is normal practice that the suprapubic tube associated with bladder suture is indicated according to urology department tradition or by an individual physician - urologist himself. In the choice of surgical treatment tactics in these types of injuries proper communication between the urologist and the surgeon dealing with complex pelvic trauma is important.
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Vertebral hemangiomas (VH) are usually asymptomatic and, therefore, are commonly detected as accidental findings on spinal imaging. No treatment is indicated in these cases. Nevertheless, some hemangiomas may clinically manifest as axial pain and neurological deficit and may require surgery or other treatment. The aim of this study was to assess outcomes of surgical management of symptomatic vertebral hemangiomas at two neurosurgical clinics. ⋯ Vertebroplasty resulted in pain score improvement in all patients with symptomatic vertebral hemangiomas. Combinations of vertebroplasty and decompression had positive impact on myelopathic symptoms in all the patients concerned.