INTRODUCTION Modern procedures in peri-operative care arising from evidence-based medicine improve postoperative results. Their acceptance is however not a common clinical practice at most surgical centers. AIM The aim of our study was to design a protocol and introduce it into the praxis. The subject of announcement is tolerance of protocol in our conditions. PATIENTS AND METHOD Prospective randomized study included patients who were operated on (open bowel resection) at Department of Surgery in period 4/2005-12/2007. They were randomized in fast track group (n=53) and non-fast track group (n=52). Protocol with accelerated recovery was used in the fast track group (FTG) and we used traditional approach in the not-fast track (non-FTG). Results were statistically evaluated, 2 patients (FTG) were excluded from analysis for protocol failure (protocol was non kept by anesthesiologist in 1 patient and by the nurse in the second patient). Protocol and informed consent form was approved by the Hospital Ethics Committee. RESULTS Both groups did not differ in age, diagnosis and length of surgery. Analgesia was controlled significantly better in FTG; similarly oral intake tolerance was higher in this group (day of surgery--mean value 634 ml versus 304 ml). Restoration of bowel functions was also faster in interventional group (mean time 2.1 versus 3.9 days). Frequency of postoperative complications was lower and hospital stay was shorter (median 7.0 versus 9.0 days, p < 0.001). CONCLUSION Designed fast track protocol of postoperative recovery could be introduced in clinical praxis in terms of study. Patients' tolerance was very good. Application of accelerated recovery procedures is possible in our conditions but it means primarily to overcome worse tolerance of attending personnel.
The authors present their experience with 29 extended operations performed on account of tumours of the sigmoid, rectosigmoid and rectum. These operations accounted for 13.4% of all operations on account of operable tumours of the colon and rectum in 1984-1988. In addition to the basic operation one organ was removed 11 times, two organs twice, three organs four times and four organs were removed en bloc twice. Complications occurred in 61% of the patients, the mortality rate was 6.9%. The authors submit an account of recent views published in the literature on the given subject with emphasis on en bloc resection, and conclude that when certain principles are respected, these extended operations are justified.
This article provides an introduction to peritoneal tumors, which are the subject of a series of review papers published in Issue 5 (2019) of Klinicka onkologie. Many malignant peritoneal tumors are characterized by production of mucinous and gelatinous masses, multiple peritoneal disability, so-called peritoneal carcinomatosis, and various grades of malignancy depending on their origin, staging, and histological type. Malignant peritoneal tumors are rare and their clinical symptomatology is nonspecific and varies according to the extent of disability. Diagnosis, particularly in the initial asymptomatic stages, is very complicated and often impossible, and tumors are often diagnosed by chance during other operations. Malignant peritoneal tumors were regarded as incurable and lethal for a long time; however, this view has changed over the past three decades. The Sugarbaker method, a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, was introduced in the 1990s. Postoperative cytostatic lavage is usually performed in specific cases. Classifications for the extent of disease and completeness of cytoreduction were established. Studies repeatedly confirmed the efficacy of this treatment for peritoneal malignancy. The combination of an aggressive surgical approach and intraperitoneal chemotherapy not only enhances quality of life, but also prolongs progression-free survival and overall survival in selected patients. Specialized centers for treatment of peritoneal malignancy were established based on results from the Czech Republic and around the world. These centers provide complex care, including specific surgical interventions and follow-up, for selected patients with primary and secondary peritoneal malignancy.
Uvod: Pseudomyxom peritonea je vzacne onemocněni způsobene diseminaci nadoru tvořiciho hlen a gelatinozni hmoty v peritonealni dutině. Lokalni rekurence jsou caste, siřeni mimo peritonealni dutinu naopak vzacne. Postiženi hrudniku – pleuralni a/nebo plicni metastazy – je v literatuře popisovano ojediněle.Kazuistika: Předkladame připad pacientky, kterou jsme operovali pro oboustranne plicni metastazy pseudomyxomu peritonea. Vlevo jsme odstranili 1 metastazu, vpravo celkem 12 ložisek. V dalsim průběhu nemoci byla pacientka ve velmi dobrem klinickem stavu. Doslo vsak k rozvoji dalsich plicnich ložisek. Recentně byla operovana pro metastazu v 2. bedernim obratli.Zavěr: Cytoredukcni chirurgicke výkony pro nitrohrudni postiženi při pseudomyxomu peritonea, při postiženi pleury doplněne intrapleuralni hypertermickou chemoterapii, mohou v indikovaných připadech přispět k prodlouženi života nemocných.
Periproctal inflammations related to the anus are characterized by the rapid spread of the infection to the surrounding tissue, which is determined by the anatomical characteristics and infectious agents. Inflammation, which starts as a phlegmon, quickly forms boundaries and an abscess develops in most cases. Up to 80-90% of anorectal abscesses develop according to the crypto-glandular theory on the basis of infection of the anal glands, spilling into the Morgagni crypts in the anal canal. Up to two-thirds of such abscesses are associated with the emergence of anorectal fistulas. Anorectal abscesses can be divided into marginal and subcutaneous perianal abscesses, submucosal, intersphincteric, ischiorectal and supralevator abscesses. Their diagnosis is based on thorough physical examination, sometimes also with the help of imaging methods such as computed tomography, magnetic resonance imaging and endoanal ultrasound. What is decisive for the successful treatment of anorectal abscessess is their early and adequate surgical drainage. Adjuvant antibiotic therapy is necessary only when the overall signs of sepsis are present and for patients with a comorbidity such as diabetes, valvular heart disease, or immunodeficiency.
146 procedures using hyperthermic intraoperative peritoneal chemotherapy (HIPEC) were performed in 121 patients in the FNB Surgical Clinic, during 2000-2008. During these procedures, ascites was detected in 30 subjects (24.8%) and its volume was 250-11,000 ml. The patients concerned could not undergo radical surgery for their GIT or gynecological tumors. The patient group was divided into two subgroups. Subgroup A (22 subjects) included subjects, in whom at least palliative debulking of the tumors (usually total omentectomy) was feasible, and the procedure was followed by HIPEC. Subgroup B (8 patients) included subjects who could not undergo even the minimum debulking procedure because of extensive tumorous spread in their abdominal cavity, underwent only HIPEC. Out of the total of 22 subjects in Subgroup A, ascites was not postoperatively recorded in 17 patients. In 5 patients, ascites was gradually formed from month 6.3 onwards, however, it only reached subclinical levels. In this subgroup, 7 patients exited (at the mean postoperative month 11.7), the remaining 15 patients were surviving at that time, out of whom 9 patients were surviving for more than 1 year after the procedure, 4 subjects were surviving for over 2 years after the procedure and 2 patients for over 4 years. The geometric mean survival time 16.49 months, standard deviation of 1.57. In Subgroup B (8 patients), no ascites was detected in 3 subjects until their death (37.5%), further 5 subjects presented with ascites at the mean postoperative month 7.25. These patients survived for 2-23 months. The geometric mean survival time was 6.83 months, standard deviation of 2.12. There was a statistically significant difference between the two subgoups in the survival time parametres (p = 0.009), thereas, the difference in ascites relapse rates was statistically insignificant (p = 0.12). In the whole study group, in-hospital morbidity was 16.6% and lethality 3.3%.HIPEC with/without debulking is an efficient method for controlling, managing or preventing the development of malignant ascites, it extends the mean survival time of the patients (especially when bulking is feasible) with low morbidity and lethality rates of the procedure.
Poster Presentations therapy (pancytopenia), but after omission the patient settled into the original condition.28 patients of the 32 achieved remission after the second infusion of cyclophosphamide.Conclusion: Remission was maintained in all patients for 9 months on he average (mostly by CD patients) and the drug was well tolerated.Our experience suggest that intravenous pulse cyclophosphamide therapy may be a safe and effective treatment for patients with severe IBD unresponsive for conventional treatment, but further controlled study should be considered in the future in more diverse patient population.
