Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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A group of 9 patients with a suspected fracture of the hip underwent radiography and subsequently magnetic resonance imaging (MRI) diagnosis. Radiographic findings were in 2 cases negative and in 7 cases the radiographs revealed a fissure or fracture of the greater trochanter. MRI proved a complete pertrochanteric fracture in 1 case, an incomplete pertrochanteric fracture in 8 cases and in all the 9 cases a fracture of the greater trochanter. ⋯ All the 9 patients healed without complications. The authors indicate MR imaging diagnosis in clinically suspected fractures of the proximal femur where the radiographic finding is negative. Fractures with a radiographic finding of a fissure or fracture of the greater trochanter should be examined by MRI that in most cases reveals an occult pertrochanteric fracture.
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The course of acute pancreatitis varies from mild, fortuitous forms to grave, life threatening disease. Approximately 80-90% of all forms are mild with low morbidity and mortality. The rest consist of severe, sometimes even fatal forms with present necrosis. ⋯ In accordance with international recommendations, the only way to meet these requirements is creation of specialized units dedicated to treatment of severe acute pancreatitis e.g. pancreatic units. Authors present their ideas of such pancreatic unit estabilished at their clinic. Professional experiences of authors come from 1350 patients being hospitalized with diagnosed acute pancreatitis throughout years 1990 to 2006.
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Case Reports
[Infected brachial artery pseudoaneurysm--infrequent complication secondary to parenteral drug abuse].
Intravenous drug abuse brings many infectious and surgical complications. Considering the duration of a drug scene in Czech Republic, pseudoaneurysms are not frequent complications, but we can expect their increased frequency with time. ⋯ The pseudoaneurysm was treated with excision, tying the proximal and distal ends of brachial artery without urgent revascularization, extensive debridement of all necrotic tissues and leaving the incision to heal by secondary intention. Our approach did not threaten viability of the limb, which did not show any signs of ischemia during close postoperative monitoring. Our way seems to be appropriate and in agreement with current literature. The peroperative finding stresses the necessity of standard and Doppler ultrasound in every intravenous drug abuser with clinical picture of "a typical abscess" located in groin, elbow and armpit.
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The authors assessed options for vertebral body replacements with the Synex telescopic expansion cage. Autologic or homologic bone grafts, a titanium "Harm's" cage or a polymethylmetacrylate filling reinforced by Kirschner wires, may be used for vertebral body replacements. The cement filling is indicated in oncological patients, the Harm's cage requires filling with a quantity of bone grafts and, with massive bone grafts, the collection place or the graft availability may be a problem. The telescopic expansion implant is fairly easy to implant, is stable and requires to be filled with a minimum of spongious grafts. ⋯ The Synex titanium expansion implant has been designed for vertebral body implantations in any indication. It requires additional stabilization, either by an anterior fixator or a cast, or a posterior transpedicular fixation. It is primarily indicated in traumatic vertebral body destructions or in reconstructions of maltreated fractures. Considering its higher price and the expected shorter patient survival period in oncological patients, its use in oncological indications is controversial.
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Nutritional support in critically ill patients has an impact on both prevention and treatment. Development of complications and organ failure can be prevented, good status of gut mucosa kept and positive nitrogen balance induced. Inflammatory response can be modulated. ⋯ There is a need for an active nutritional screening to find patients in the risk. Other important points are the following: a progressive approach to early enteral nutrition combined with PN, multiprofessional cooperation and protocol implementation.