A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant aortic and tricuspid regurgitation and ventricular septum defect. The patient underwent multiple consecutive operations and interventions having, among others, finally replaced the entire thoracic aorta with the use of the hybrid elephant trunk technique. and T. Holubec, J. Raupach, J. Dominik, J. Vojácek
Úvod: U 60 % nemocných s kolorektálním karcinomem jsou diagnostikovány jaterní metastázy (JMKRK), ať už v době stanovení diagnózy, nebo v průběhu léčby. Chirurgická léčba je jedinou potenciálně kurabilní metodou s pětiletým přežíváním dosahujícím cca 50 %. Jaterní resekci však podstoupí méně než 20 % pacientů s JMKRK. Společnou snahou onkologů a chirurgů je navýšit počet resekovaných pacientů. Jedním z postupů, jak navýšit resekabilitu JMKRK, je „liver first approach“ (LFA). Autoři prezentují vlastní předběžné výsledky této metody. Metody: Do multicentrického grantu IGA MZ NT 13660 – Hodnocení kvality multimodální péče u nemocných s jaterními metastázami kolorektálního karcinomu – bylo od září 2012 do ledna 2015 zařazeno v ÚVN 102 pacientů. LFA jsme použili u 12 pacientů (12 %). Po příznivé léčebné odpovědi neoadjuvantní systémové léčby jsme pacienty indikovali k resekci jater. U 11 pacientů se jednalo o mnohočetné (>4 meta) bilobární postižení. V jednom případě se jednalo o objemnou solitární metastázu pravého jaterního laloku. Primární tumor byl u 9 nemocných v rektu, u 3 v oblasti rektosigmatu, 3 pacienti měli derivační kolostomii, ostatní byli bez poruchy pasáže. Výsledky: U 11 pacientů jsme provedli R0 resekci jaterních metastáz, 3x jsme indikovali dvoufázovou hepatektomii s portální embolizací (PVE), 1x jsme pro progresi po PVE ustoupili od 2. fáze). Velkou resekci jsme provedli 7x, neanatomickou resekci včetně RFA 11x (6x v kombinaci s velkou resekcí). Perioperační mortalita byla nulová, morbidita 33 % (Dindo-Clavien >2). 10 pacientů absolvovalo adjuvantní chemoterapii, 7 z nich včetně radioterapie malé pánve pro lokálně pokročilý tumor rekta. U 7 pacientů (58 %) jsme doplnili resekci primárního tumoru. V současné době zemřeli na progresi onemocnění 2 pacienti (17 %), progresi onemocnění jsme zaznamenali u 6 pacientů (50 %). Závěr: LFA považujeme za vhodný především u pacientů s generalizovaným tumorem rekta, kdy lze po resekci jater adjuvantní systémovou léčbu kombinovat s radioterapií malé pánve. Otázkou zůstává načasování operace primárního tumoru, kdy je nutné vyloučit recidivu jaterních metastáz, která se objevuje u více než 50 % pacientů. Profit LFA musí být prokázán randomizovanými studiemi., Introduction: Liver metastases are diagnosed in 60% of patients with colorectal cancer, both at the time of diagnosis or later in the course of their management. Surgical treatment is the sole potentially curable method with 5–year overall survival of approximately 50%. However, only less than 20% of patients underwent liver resection. A joint effort of medical oncologists and surgeons is to increase the numbers of resected patients. The “liver first approach” (LFA) is one of approaches aimed at increasing resecability. The authors present their preliminary results using this method. Methods: 102 patients were included in the multicentre study supported by the grant IGA NT 13660 − Evaluation of quality of multimodal treatment for patients with colorectal cancer liver metastases – conducted at the Central Military Hospital between September 2012 and January 2015. We used LFA in 12 patients (12%). Patients were indicated for liver resection based on good response to neoadjuvant systemic therapy. Multiple bilobar liver involvement (>4 metastases) was present in 11 cases and one large solitary metastasis in the right liver lobe in one case. The primary tumor was located in the rectum in 9 patients, in the rectosigmoid in 3 patients; 3 patients had a colostomy. Others showed no signs of bowel obstruction. Results: We have performed R0 resections in 11 cases, and two-stage hepatectomy with portal vein embolisation was indicated 3 times (in one case we did not finish the second stage due to quick progression after PVE). We performed major resections 7 times, along with sever extraanatomic resections, incl. 11 RFA (6 times in combination with major resections). Perioperative mortality was 0%, morbidity 33% (Dindo-Clavien >2). Ten patients underwent adjuvant chemotherapy, in 7 cases including radiotherapy of the small pelvis due to a local advanced primary tumor. Resection of the primary tumor was done in 7 patients (58%). Two patients died recently because of disease progression (17%); progression was observed in 6 patients (50%). Conclusion: We deem the LFA suitable especially for patients with metastatic rectal tumors where adjuvant systemic therapy can be combined with radiotherapy. The timing of the resection of the primary tumor still remains a question: it is necessary to rule out potential recurrence of liver metastases, which affected more than 50% of the patients. The benefit of LFA must be confimed by randomised studies., and J. Pudil, S. Batko, K. Menclová, M. Bláha, M. Ryska
Takotsubo kardiomyopatie je náhle vzniklé onemocnění charakterizované reverzibilní poruchou kinetiky levé srdeční komory. V typickém případě se rozvíjí následkem silného stresového podnětu a prezentuje se symptomy, EKG a laboratorním nálezem, které připomínají akutní koronární syndrom. Od toho se liší nepřítomností onemocnění koronárních tepen a ve většině případů nekomplikovaným průběhem s následnou velmi dobrou dlouhodobou prognózou. V kazuistice popisujeme případ 63leté ženy, u které se počátek onemocnění projevil fibrilací komor. Díky okamžité kardiopulmonální resuscitaci a následné odborné péči ve specializovaném kardiocentru, která mimo jiné zahrnovala implantaci implantabilního kardioverteru-defibrilátoru v rámci sekundární prevence náhlé srdeční smrti, se pacientka zotavila bez jakýchkoliv následků. Takotsubo kardiomyopatie je důležitou jednotkou v diferenciální diagnóze akutního koronárního syndromu. I přes dobrou prognózu, kterou se vyznačuje ve většině případů, ji nelze podcenit a zaslouží si náležitou pozornost a léčbu, která umožní předcházet případným komplikacím., Takotsubo cardiomyopathy (TTC) is an acute syndrome characterized by rapid onset of transient systolic dysfunction of the left ventricle. Symptoms, ECG and laboratory findings resemble acute coronary syndrome, from which TTC differs by the absence of coronary artery disease. In typical cases, TTC is triggered by exposure to unexpected stress and the clinical course and prognosis are very good. We present a case of a 63-year-old woman, in whom the onset of the disease was complicated by ventricular fibrillation. The patient recovered without sequelae thanks to immediate cardiopulmonary resuscitation and following care in a specialized cardiocenter, which involved also implantation of implantable cardioverter defibrillator to prevent sudden cardiac death. Takotsubo cardiomyopathy is an important entity in the differential diagnosis of acute coronary syndrome. Despite very good prognosis in most cases it should not be underestimated and it deserves careful attention and treatment which can prevent harmful complications., and Lumír Koc, Marie Pavlušová, Jiří Pařenica, Jan Maňoušek, Jitka Vlašínová, Jindřich Špinar, Petr Kala
The Black Death plague constituted a major disruption of the ordinary pace of life of the society in early modern period. As such it attracted interest and drew attention. The Black Death menace caused panic and fear, and therefore various measures and actions which were supposed to prevent the outbreak of the plague or at least considerably limit its consequences were defined and carried out. Such practices were shaped by contemporary ideologies and mentalities and reflected everyday experience. The study of various means of dealing with the Black Death menace may be like looking in a mirror in which the curves of the quotidian lifestyle of the period are reflected. The present paper which analyses the last Black Death plague of 1713-1714 in the environment of a southBohemian town offers one such view. The mechanisms which the inhabitants of the regional capital Písek formulated and applied in the attempt to confront the iimpending Black Death menace, are specifically examined. The bearing of these mechanisms on contemporary devoutness is also problematized at the level of socalled semifolk discourse., Zdeněk Duda., and Obsahuje bibliografické odkazy
Približne každý piaty Slovák je obézny a každý druhý má nadváhu. Z tohto dôvodu bol realizovaný projekt Diateens – projekt pre mládež na prevenciu diabetes mellitus. Záštitu nad projektom prevzala Slovenská diabetologická spoločnosť a slovenská kancelária WHO ako jeden z edukačných programov v rámci Národného diabetologického programu. Cieľom projektu bolo zlepšiť informovanosť mladých ľudí o ochorení diabetes mellitus, zmapovať ich zdravotný stav a podporiť zdravý životný štýl (zdravé správanie) ako významný komponent v prevencii proti uvedenému ochoreniu. Kľúčové slova: diabetes mellitus – Diateens – nadváha – obezita – prevencia – zdravie podporujúce správanie, Približne každý piaty Slovák je obézny a každý druhý má nadváhu. Z tohto dôvodu bol realizovaný projekt Diateens – projekt pre mládež na prevenciu diabetes mellitus. Záštitu nad projektom prevzala Slovenská diabetologická spoločnosť a slovenská kancelária WHO ako jeden z edukačných programov v rámci Národného diabetologického programu. Cieľom projektu bolo zlepšiť informovanosť mladých ľudí o ochorení diabetes mellitus, zmapovať ich zdravotný stav a podporiť zdravý životný štýl (zdravé správanie) ako významný komponent v prevencii proti uvedenému ochoreniu. Kľúčové slova: diabetes mellitus – Diateens – nadváha – obezita – prevencia – zdravie podporujúce správanie, and Viera Cviková, Adriana Ilavská
Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus. and N. R. Kosai, H. S. Gendeh, M. Noorharisman, P. A. Sutton, S. Das
The purpose of this study was to test the hypothesis that more recently developed rubber dam systems (OptraDam ® Plus and OptiDam™) are faster and easier to handle, and that the quality of isolation is not decreased. The rubber dam systems were applied in standard conditions on a dental simulator in several model clinical situations. The time of preparation, application and removal were measured and the quality of isolation was evaluated. The median time of rubber dam placement was 51 s (Q1 = 38 s; Q3 = 79 s). The shortest median time of application was with OptiDam™ (42 s), followed by a conventional rubber dam (53 s), and finally the longest was with OptraDam® Plus (58 s). The median volume of fluid remaining in the isolated space after 5 minutes was 9.5 mL (Q1 = 8 mL; Q3 = 10 mL). The largest median volume of remaining water was with OptiDam™ (10 mL), followed by a conventional rubber dam (9.5 mL) and the least with OptraDam® Plus (8.5 mL). The afore-stated hypothesis about the advantages of modern rubber dam isolation systems was accepted for OptiDam™, but rejected for OptraDam® Plus. The results could contribute to decision-making concerning the choice of rubber dam system. and Martin Kapitán, Zdeňka Šustová, Romana Ivančaková, Jakub Suchánek
The aim of this study was to compare the isolation systems OptraDam® Plus and OptiDam™ with the conventional rubber dam in terms of objective and subjective parameters. The isolation systems were applied during the dental treatment of the patients. The time of preparation, placement, presence and removal were measured and the quality of isolation was evaluated. The median time of rubber dam placement was 76 s (Q1=62 s; Q3=111.25 s). The application time of OptraDam® Plus was significantly longer compared to the other systems (P ® plus. The results presented in this study could guide clinicians for choosing the most appropriate isolation system. and M. Kapitán, T. Suchánková Kleplová, J. Suchánek
Short-winged (brachypterous) and long-winged (macropterous) adult females of Pyrrhocoris apterus (L.) originating from a Mediterranean population (Israel) were analyzed for their adipokinetic responses. The adipokinetic response, expressed as an increase of haemolymph lipids after injection of adipokinetic hormone from Locusta migratoria (Lom-AKH-I), was assessed in relation to age and dose of the hormone. We demonstrate in this study that the adipokinetic responses induced by bug's corpora cardiaca extract and Lom-AKH-I were dose-dependent for both brachypterous and macropterous females. Significant differences between the morphs were recorded for doses >= 0.25 corpora cardiaca equivalent (P < 0.01) and doses >= 0.25 pmol Lom-AKH-I (P < 0.05). The haemolymph lipid elevations induced in both morphs by 2 pmols Lom-AKH-I are comparable with that induced by crude extract of one pair of the bug's own corpora cardiaca. The age-dependent test showed much higher adipokinetic responses (P < 0.01) in macropterous females (>= 5 days old) than in the brachypterous females of the same age, when treated with 2 pmols Lom-AKH-I. Starting from day 7, the concentration of haemolymph lipids was also considerably higher (2.5-5 times) in macropterous females than in the brachypterous ones. The obtained data indicate that difference in mobilization of lipids between brachypterous and macropterous females is a geographically independent feature and represents a true wing morph characteristic of P. apterus., Dalibor Kodrík, Radomír Socha, and Lit