Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Severe sepsis is currently reported the commonest cause of deaths in non-surgical emergency department patients. The aim of the study was to establish degree of complicance with diagnostic and therapeutic procedures in the severe sepsis treatment, as a part of the "Surviving sepsis campaign". Furthermore, the authors aimed to assess success rates of corticosteroid administration, its effects on circulatory stabilization and to assess the healthcare professionals' awareness of the campaign. ⋯ Considering the reduction in the time interval between the onset of the septic shock symptoms and the catecholamine administration, and considering its established positive effects on circulation, it may be concluded that administration of low-dose hydrocortisone in the septic shock treatment is substantiated.
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Fractures of the proximal humerus actually represent 5% of all fractures and 45% of all humeral fractures with the highest incidence in women over 60 years of age. The outcomes of the greatest concern at these patients (pain, function of the shoulder and activities of daily living) get worse with age, osteoporosis, grading of fracture type and of initial fracture displacement. According to the literature (Evidence Based Medicine--EBM level II-III) operative treatment of displaced fractures reduces pain and need for assistance in activities of daily living, but open reduction with internal fixation by conventional screws and plates was connected with implant loosening, infection and avascular necrosis, whereas closed reduction with different methods of miniinvasive percutaneous stabilisation is threatened by primary malreduction. ⋯ In spite of low follow-up rate we conclude, that the method of closed reduction and intramedullary fixation of two- and three-part fractures of proximal humerus after Zifko offers above-average final results with acceptable rate of complications, mostly not severe ones. The essential pre-condition of good result is proper reduction--closed of percutaneous one. On the contrary, suboptimal results correlate with primary and secondary malreductions. The incidence of latter increases in intraarticular fracture types with small fragment of head and thus with insuficient implant retention. To evaluate the merit of the method in relation to angle-stable extra-/or intramedullary implants, the prospective trials are needed.
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Comparative Study
[Implementation of POSSUM scoring system in assessing morbidity after laparoscopic colorectal surgery].
The aim of the study was objective morbidity comparison of the open and laparoscopic colorectal surgery using the recalibrated POSSUM scoring system, taking into account potential "case mix" of samples. ⋯ The elective laparoscopic colorectal surgery is associated with lower post-operative morbidity than the open approach, including high-risk patients.
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Intestinal fatty acid binding protein (I-FABP) deriving from the cytoplasm of the intestinal epithelial cells is a new biochemical marker with potential to indicate intestinal mucosal injury early in the phase of enterocyte damage. I-FABP is thought to be promising marker for detection of the systemic inflammatory response syndrome (SIRS) and sepsis before its onset. ⋯ There were no differences in the mean plasma I-FABP levels preoperatively and in the postoperative period after the major surgery. Because surgery alone probably has no influence on I-FABP plasma levels we can say that the concept of l-FABP as the early marker of the intestinal mucosal injury is also viable in postoperative period.
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Case Reports
[Omentoplasty as a part of complex management of postpneumonectomy empyema with large bronchopleural fistula].
The authors present a case reivew of a patient with thoracic empyema and large bronchopleural fistula. Following preceeding failing procedures, the condition was managed using Eloesser open drainage, the pleural cavity was cleared and the main bronchus fistula was sutured using omentoplasty. A pediculated omental flap (Kiricutu) was transposed into the pleural cavity through the diaphragm. ⋯ Treatment of postpneumonectomic empyema with bronchopleural fistula requires complex approach in several steps. During the final phase, following the pleural cavity drainage and clearing and when the dehiscent bronchus is sutured, omental flaps, transposed from the abdominal into the thoracic cavity, may be used to cover the suture and to obliterate the postpneumonectomic pleural cavity. Significance of omentoplasty consists in its features, such as: neovascularization, resorption and absorption qualities, immunological and mechanical functions, which, finally, facilitate healing of serious postpneumonectomic complications.