We present four cases of proctitis in HIV-infected men having sex with men (MSM) living in the Czech Republic. The causative agent in all cases was the lymphogranuloma venereum (LGV) biovar of Chlamydia trachomatis. The spread of proctitis caused by C. trachomatis serovars L1–3 among MSM has been observed in several European countries, the United States and Canada since 2003. To our knowledge, no LGV cases in eastern Europe have been published to date.
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.
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.
Introduction: Extrapulmonary tuberculosis can involve any organ or tissue. It is a rare disease in the Czech Republic with an incidence rate of 0.62 cases per 100.000 persons. It affects mostly immunocompromised patients. The most common sites include lymph nodes, the urogenital system, skin, joints, bones and serous epithelium – the peritoneum, pleura, and pericardium. Splenic involvement is rare. Mycobacterium is a slow growing intracellular parasite. The diagnostic process is very difficult; microbiological diagnosis is critical. Case report: An 84 years old female patient with subcapsular splenic rupture with no trauma history as a cause of anemia. Splenic abscess was diagnosed during surgical revision and splenectomy. Tuberculosis was suspected based on subsequent histological analysis, which was confirmed after nine weeks of peritoneal fluid culture. The surgical procedure and postoperative hospitalization were not associated with any complications. The patient was referred to the respiratory clinic for further treatment. Conclusion: The diagnosis of extrapulmonary tuberculosis including splenic localization should always be considered. A sample from the affected tissue or effusion must be collected in the case of unclear perioperative findings and sent for complete bacteriological testing, including mycobacterial culture. If a tuberculous splenic abscess is found, the therapeutic process should involve its complete drainage in combination with long-term anti-TB medication.
Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study.Between 9/2009 and 9/2011,57 patients with severe peritonitis were included in the study at the Department of Surgery of the Bulovka Faculty Hospital; 28 of them were randomized to the TNP laparostomy group and 29 to the primary closure group. The two groups did not differ in age, gender, polymorbidity and severity of peritonitis.The length of hospital stay was similar in both groups (median: 22 days; range 10-171 days) in the intervention group and 23 days (range 3-71) in the control group (p = 0.89). The mortality rate was significantly lower in the TNP laparostomy group in comparison with the primary closure group (3 patients, 11% vs. 12 patients, 41%; p = 0.01). A complete closure of the abdominal wall including fascia and complete abdominal wall healing was achieved in 80% of survivors in the TNP group, compared to 29% in the primary closure group (p = 0.01). No enteral fistula occurred in any surviving patients from both groups. The overall length of abdominal wall healing was significantly shorter in the TNP group (median: 7; 7-94 days, versus 30; 7-223; p = 0.04).Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.
Uvod: Mimoplicni tuberkuloza může postihnout kterýkoli organ ci tkaň. Jedna se o v CR vzacne onemocněni s výskytem 0,62 na 100 tisic obyvatel. Setkavame se s ni předevsim u imunokompromitovaných nemocných. Nejcastějsimi lokalizacemi jsou mizni uzliny, urogenitalni trakt, kůže, klouby a kosti a serozni výstelky – peritoneum, pleura, perikard. Tuberkuloza sleziny je raritni. Mykobakteria jsou pomalu rostouci intracelularni parazite. Diagnostika nemoci je obtižna. Mikrobiologicka diagnostika zde hraje rozhodujici roli.Kazuistika: Popisujeme připad 84lete nemocne, ktere byla v ramci vysetřovani anemie zjistěna atraumaticka subkapsularni ruptura sleziny. Při provedene splenektomii byl zjistěn absces sleziny. Nasledným histologickým vysetřenim bylo vyjadřeno podezřeni na tuberkulozni proces. V ramci dalsiho komplexniho vysetřovani byla prokazana TBC až po 9 týdnech kultivaci peritonealniho výpotku. Pacientka se chirurgicky zhojila bez komplikaci a byla odeslana k dalsi lecbě do plicni lecebny.Zavěr: Na diagnozu mimoplicni tuberkulozy vcetně lokalizace ve slezině je nutno myslet předevsim. Při nejasnem operacnim nalezu je třeba odebrat vzorek postižene tkaně a výpotku na kompletni bakteriologicke vysetřeni vcetně kultivace na mykobakteria. Lecebným postupem u abscesu při tuberkuloze sleziny je sanace ložiska v kombinaci s dlouhodobou antituberkulozni lecbou.
