Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
-
Chylothorax is a rare disorder, predominantly of traumatic (iatrogenic) or tumorous aetiology. Its symptomatology complies with other types of fluidothorax. ⋯ The authors present a literature overview and their own case-review of chylothorax resulting from the suprarenal aortic aneurysm surgery. The conservative management failed and the complication in the 75-year old patient was managed using pleuroabrasion and talk pleurodesis.
-
Controlled Clinical Trial
[Preparation of patients for operation with per-oral intake on the day of the planned surgery].
The clinical studies carried out leads to the hypothesis that the starvation of patients for several hours prior to a surgical procedure has a negative influence on the internal metabolic environment of a patient. It also has an impact on the psychosomatic disposition of the patient's physiology of metabolic processes and the proper functioning of vital organs and systems. This hypothesis was already stated by doctors specialized in Intensive Care Units in other European countries. In the frame of methodology, ERAS (enhancement recovery after surgery) also known as fast track, solves this problem not only on the level of clinical studies but also clinical practice. METHODOLOGY AND GROUP OF PATIENTS: The group of patients selected had been surgically treated for disease of the colon (both benign and malignant) and were divided into 3 groups: A--basically starving from mid-night of the day of operation, B--patients secured the night before the operation and on the day of the operation by a parenteral intake of 10% glucose solution with minerals, C--patients drinking a special drink, consisting basically of sugars (mainly maltodextrin) mixed in with minerals, the evening before the operation and on the day of the operation. Patients used in this study were required to fulfill several criteria to be included into the study: these criteria consisted of a co-morbidity of ASA 1-2, weight 60-90 kg, age 35-75 years, operating time of the procedure on the colon of 120 +/- 30 min. without complications. These patients also had not been given any transfusions of red blood cells or blood derivatives during or after the surgery (or during the time of hospitalization etc). The selected biochemical markers, muscular power, some cardial function, and subjective patients feelings were monitored in all patients during perioperative period. The basic statistical methods were used for evaluation of current results. ⋯ Till date the findings documented by monitored indicators may prove that the implementation of per-oral intake on the day of an surgery will benefit and improve the quality of care of surgically treated patients and increase the number of successful operations.
-
Serious blunt injuries are accompanied with the worsening of the mechanics of ventilation due to the chest and lung injuries alone as well as with a systemic inflammatory response (SIRS) that always affects the lungs. The development of an injury-induced respiratory failure is multifactorial and timely pharmacological intervention is likely to contribute to the treatment algorithm, thus improving prognosis in some patients with a serious chest trauma. THE OBJECTIVE OF THE STUDY: The objective of this study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response of the body (SIRS) in serious blunt chest injuries. The study also intends to identify whether the administration of indomethacin could reduce SIRS score and prevent multiorgan dysfunction and multiorgan failure. ⋯ We proved that the factors that can be affected by the blockade of cyclooxygenase display statistically significant changes in subgroups with the administration of indomethacin. No changes were recorded with regard to acute phase proteins whose synthesis is not mediated by prostaglandins. The administration of indomethacin positively affects the development of SIRS, reduces and diminishes its effects as well as impact on the impaired body.
-
The decision on the surgical approach in the operative treatment of the fractures of thoracolumbar spine is possible only by following a detailed classification. However, the application of the classification systems is not reliable without a complex imagination of the bony and fibrous structures involved into the fracture. Pre-op investigation should include x-rays, CT-scans and MRI. ⋯ Overall graphical imagination of the thoracolumbar fractures (including MRI) is essential for their classification. The classification helps to choose the optimum surgical approach. The approach related to the fracture classification prevents the treatment failure.
-
Surgery on the pancreas is a major abdominal procedure leading to a number of pathophysiological alterations during the early post-operative period. Novel approaches to perioperative care including shortened pre-operative starving periods, pre-operative glucose load, sophisticated pain management and early enteral feeding have resulted in major improvements of surgical results after major colorectal surgery. These alterations of perioperative care have been introduced to visceral surgery as so-called fast track surgery or multimodal rehabilitation (multimodal rehabilitation, ERAS = enhanced recovery after surgery). So far it is not known whether or not these approaches can also be applied in pancreatic cancer surgery. ⋯ While routine laboratory parameters showed similar changes during the postoperative course after pancreatic surgery, the clinical outcome parameters clearly indicated that the concept of fast track rehabilitation can be even beneficially applied to these high-risk patients undergoing elective surgery for pancreatic cancer.