Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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The authors present a patient with diastematomyelia and associated congenital malformations of the spinal cord. They caused tethering of the spinal cord. Patient had cutaneous marks of malformation from birth. ⋯ Only careful surgical revision with subsequent removal of all causes of the tethering of the spinal cord produced good result. Diastematomyelia is a congenital malformation with some morphological variations and coexistence of other malformations. The presented case is a typical example of malformations associated with diastematomyelia.
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Perioperative hypothermia is associated with the development of haemocoagulation, cardiovascular and metabolic disorders leading to an increased morbidity and mortality. The objective of the investigation was to assess the extent of hypothermia and its clinical and laboratory consequences. A group of 30 patients subjected to elective radical laparotomy on account of colorectal carcinoma was divided into to equivalent groups. To the first group heated infusions were administered, to the second group not heated ones. In all patients the central and peripheral temperature, rate of postoperative normalization of the temperature, postoperative thermal comfort, consumption of analgesics and biochemical and haematological parameters were monitored. ⋯ Although no serious clinical complications induced by hypothermia were recorded, the authors recommend an active approach and provisions for the perioperative maintenance of body temperature as a standard of contemporary perioperative care.
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In the Traumatological Hospital in Brno in 1999 4975 operations were made incl. 1064 (21%) during emergency services. Thus there are on average 3 (2.91) operations per emergency shift. 88 operations were made after midnight. ⋯ The legal changes limiting overtime work make it important to seek ways how to preserve under the new conditions the scope of surgery while it is assumed that there will be a greater pressure to refer patients to the centre. The financial conditions of the Institute as regards funds are at variance with the efforts made.
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The most frequent cause of the compartment syndrome with subsequent Volkmann's contracture of the upper extremity in children is a supracondylar fracture of the humerus. Often it is being associated by some with the concurrent injury and obliteration of the brachial artery. In the majority of cases of Volkmann's contracture in children with dislocated supracondylar fractures of the humerus, described in the available literature, the development of Volkmann's contracture was preceded by reduction of the fracture and fixation with bandage or in cast with the elbow in flexion. ⋯ No Volkmann's contracture was observed in a group of 257 patients with displaced supracondylar fracture of the humerus at the authors department from 1984 till 1999 while 7 children with obliteration of the brachial artery were successfully treated without an operation. The development of Volkmann's contracture can be successfully prevented for patients with the displaced supracondylar fracture of the humerus. Minimal elbow flexion, careful manipulation during closed reduction, stabilisation of fragments by percutaneous pinning and careful clinical follow-up are the crucial factors in the prevention of compartment syndrome in this context.
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1318 patients with a clinically equivocal diagnosis of appendicitis were evaluated using graded compression sonography. Sonographic (US) examination could able be performed in 1199 patients. Appendicitis was diagnosed if the appendiceal maximal mural thickness was 3 mm or more, or the appendices presented with luminal dilatation due to a large appendicolith or non-expressible fluid. ⋯ In patients who did not have surgery the reference standard was the clinical consensus based follow-up. A pathological appendix was detected in 165 cases of 176 surgically verified ones. The sensitivity of US in detecting appendicitis was 93.7%, the specificity 95.5% and the accuracy 95.2%.