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Introduction: Aggressive fibromatosis, also known as desmoid tumour (DT), is a locally invasive soft tissue malignancy originating from fascial planes, connective tissue, and musculoaponeurotic structures of the muscles. The symptoms greatly depend on the location and size of the tumour. Case report: A 68-year-old male patient without any comorbidities with a large, palpable mass in the abdomen underwent computed tomography (CT) of the abdomen during diagnostic examination in September 2017 in another centre. The CT scan revealed a giant intraperitoneal 30×40cm tumour without signs of infiltrating the surrounding organs and large vessels. The tumour biopsy revealed an aggressive DT. The patient was scheduled for tumour resection. Midline laparotomy was performed in the supine position under general anaesthesia. After gaining access to the abdominal cavity, 8 litres of clear ascites were evacuated. The tumour was not attached to the abdominal wall. Large omentum was freed from the DT. The perioperative finding confirmed the CT images of DT encapsulation of the medial colic artery, part of the small intestine, and transverse colon. The tumour was resected with part of the mesenteric radix, 30 cm of small intestine, and 2/3 of the transverse colon. After the DT was removed entirely, the small intestine was re-anastomosed end to end. The abdominal cavity and the liver were carefully checked for bleeding. The abdominal cavity was closed in a standard manner. Results: The postoperative hospital stay was uneventful. The patient was discharged on the 7th postoperative day with prophylactic low weight molecular heparin for one month. Currently, we have five months of follow-up with no signs of DT recurrence based on CT examination. The histology of the resected tumour confirmed the diagnosis of a desmoid tumour (aggressive abdominal fibromatosis). Conclusion: Desmoid tumours are benign neoplasms with no metastatic potential. However, their treatment is challenging due to their aggressive growth, infiltrative behaviour, and a high tendency to recur

Uterus transplantation (UTx) is a promising treatment option for women who wish to give birth but suffer from absolute uterine factor infertility. This paper presents an interim analysis of a trial focusing on the causes, prevention, diagnosis, and management of graft thrombosis. Our team analyzed 10 cases of UTx (recipients numbered 1 to 10). Early thrombosis developed in 2 of 10 (20 %) recipients, and thrombectomy and temporary viability preservation were achieved in both cases. However, re-thrombosis developed in both cases, and a graft hysterectomy was carried out. In recipient number 2, vascular changes might have contributed to graft thrombosis. The histopathological finding of the explant revealed subintimal excentric fibrosis with focal sclerotic changes. In recipient number 8, thrombosis was facilitated by external compression of the vascular pedicles by the hematoma as well as production of de novo donor-specific antibodies. Thrombosis led to graft loss in both cases despite an attempt at a thrombectomy. Therefore, the focus must be on the prevention including a thorough evaluation of the donor candidate. In the postoperative course, perfusion is closely followed-up with an ultrasound, Doppler flow monitoring, and macroscopic evaluation of the cervix. In the case that findings are unclear, a relaparotomy should be promptly indicated. If thrombosis is revealed, a thrombectomy and an attempt to salvage of the graft are indicated; however, the role of this strategy is questionable due to the low chance of long-term success. The indication of upfront graft removal and early retransplantation in the treatment of uterine graft remains debatable., This study was supported by the project National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, Project No. LX22NPO5104) - Funded by the European Union - Next Generation EU. The authors appreciate contributions by Alena Langerova (Gennet, Prague), Jaromir Masata (Department of Obstetrics and Gynecology, General University Hospital, Prague), Stepan Machac (IVF Clinic, Olomouc), and Radovan Pilka (Department of Obstetrics and Gynaecology, Olomouc University Hospital). They provided essential gynecological and obstetrical expertise. We also wish to thank Brian Kavalir for his proofreading services.

The aim of this study was to assess the effects of radiofrequency electromagnetic field (RF EMF) on heart rate variability (HRV) in rabbits with intensity slightly exceeding the limits for occupations. Totally 21 New Zealand white rabbits divided into two groups were used in this double-blind study. The first group of animals without general anesthesia was subjected to HRV examination under exposure to a device generated RF EMF source (frequency 1788 MHz, intensity 160 V/m, lasting 150 min.). The second group (premedications + α chloralose mg/kg) underwent the same protocol under the exposure to the real RF EMF signal from the base stations of mobile providers (frequency range 1805 – 1870 MHz - corresponding to the downlink signal of Slovak mobile providers, 160 V/m, 150 min., respectively). Individual 5 min records were used to analyze the HRV parameters: heart rate and root Mean Square of the Successive Differences (rMSSD) for time domain analysis and spectral powers in the low (LF-VFS) and high frequency (HF-VFS) bands for frequency domain analysis. Our study revealed the increased in HRV parameters (HF-HRV, rMSSD) associated with lower heart rate indicating increased cardiac vagal control under the exposure to RF EMF in experimental methods.

This research longitudinally examines the association between levels of state Medicaid prescription spending and the state strategies intended to constrain cost increases: the negotiated pricing strategy, as indicated by state rebate programs, and the price transparency strategy, as indicated by state operation of All-Payer Claims Databases. The findings demonstrate evidence that state Medicaid prescription spending is influenced by the negotiated pricing strategy, especially Managed Care Organization (MCO) rebates under the Patient Protection and Affordable Care Act, but not influenced by the price transparency strategy. State decisions for MCO rebates, such as carving prescription benefits into managed care benefits, were effective in containing levels of Medicaid prescription spending over time, while other single- and multi-state rebate programs were not. Based on these findings, state policymakers may consider utilizing the MCO rebate program to address increases in Medicaid prescription spending.

The connection of theory to practice in public administration represents a critical transfer of information between scholarship and application. This important relationship establishes a basis of exchange among those engaged in the field, a bond that may be most magnified and accessible at the local levels of government. This study examines the perspectives of practitioners and scholars toward improving the theory–practice exchange in local government management through a series of focus group interviews held at the International City/County Management Association (ICMA) annual conference over 4 years. The findings suggest that the scholar and practitioner communities agree on several approaches and principles that may contribute to enhancing the theory–practice exchange within the themes of research transaction, collaboration, and professionalism. These themes offer mutual contexts for theory–practice interactions, which may help to inform institutional integration and best practice models, and facilitate a functional coexistence of interdependence and improved exchangeability in local government management.

Differences in the status of professionalism in local government management among U. S. states may be attributed to various cultural, regional, and institutional factors. The prominence of the Mast...

Aorto-iliac occlusive disease is best treated with endovascular angioplasty/stenting or surgical bypass, depending on disease severity. Aorto-iliac endarterectomy was frequently used until the 1980s. However, it can still be performed in cases of previous failure or contraindication of standard methods. The aim was a retrospective evaluation of a single-center case series of aorto-iliac endarterectomy.Seven patients at mean age 60±8 years (5768 years) were treated by aorto-iliac endarterectomy between 2013 and 2018. Rutherford categories of leg ischemia were 2 (moderate claudication) 3x, 3 (severe claudication) 2x, 4 (rest pain) and 5 (toe gangrene). The reasons for endarterectomy approach were: late in-stent iliac occlusion in an oncology patient, failure or complication of previous endovascular treatment of short iliac stenosis 2×, high infection risk of prosthesis use in long iliac-femoral occlusion, and short iliac occlusions 3x. Two patients after previous organ transplant were on immunosuppression.Technical success rate was 100%. There was no peri-operative (30 days) death or amputation. Mean follow-up was 17 months (1.1 month3.3 year). One patient required additional tibial bypass 1 month after endarterectomy to heal foot gangrene. One patient developed symptomatic re-stenosis which was treated with iliac stenting 8 months after procedure. All patients clinically improved and recovered from leg ischemia. Two patients died of tumor with preserved limb 1.1 month and 3.1 years after procedure, respectively. Five remaining patients are asymptomatic with patent revascularization to date.Aorto-iliac endarterectomy is a vital alternative technique for revascularization in selected patients when other methods seem inappropriate. Key words: endarterectomy - peripheral arterial disease - iliac artery - abdominal aorta.

This analysis examines the effects of political culture on the nature and practice of professional local government management by comparing the structures, responsibilities, and relationships of city administrative executives in the democratic countries of the United States and Norway. The findings suggest that, despite fundamental differences in societal institutions and settings, American and Norwegian city managers serve similar roles in their respective local government organizations. However, the notable variations in the processes of municipal management identified between the two nations appear to reflect the contextual influence of divergent political foundations on the operational environment of professional public administrators.

Local government administrators have embraced intergovernmental collaboration as a viable alternative in the delivery of public programs for many years, characterizing an increasing emphasis on interlocal cooperation as a response to common problems and situational needs. In the process of collaboration, local governments often use a combination of linking mechanisms, ranging in degrees of formality and specificity. This study longitudinally examines the administrative networks and mutual organizations that comprise the collaborative mechanisms of municipalities in the state of Nebraska. The findings suggest that, over time, the nature and use of interlocal cooperation mechanisms have shifted toward the more informal and general varieties.

Uterus transplantation is the youngest solid organ transplantation described in the literature. This procedure is the only treatment method for congenital or acquired Absolute Uterine Factor Infertility.The method is not recognised as standard clinical care yet, there were only some 13 cases performed worldwide so far. There is only one clinical trial worldwide, which has proven both feasibility and also healthy child delivery.Czech Republic Ministry of Health permitted the uterus transplant clinical trial in 2015. The first phase of the surgical part includes performance and description of the uterus retrieval from a deceased donor.The first uterus retrieval from a deceased donor as a part of multi-organ retrieval was performed in the Czech Republic on January 13th, 2016; the case is described in the paper.uterus - transplantation - deceased - donor - retrieval.

BACKGROUND: The surgical technique and tactics of pancreas transplantation are issues not fully resolved as yet. The beginnings of pancreas transplant program at our center date 20 years back, the history of the program being characterized by seeking and looking for the best surgical techniques. METHODS: In line with global trends, we have employed the enteric drainage technique with the last fifty pancreas transplants. The pancreatic graft was placed outside the peritoneal cavity. RESULTS: One-year actual patient and pancreas survival rates in this set of transplants were 96 percent and 88 percent, respectively. Apart from the healing of the wound, surgical complications were seldom encountered. The most frequent complication in our group of patients was bleeding. CONCLUSIONS: The current standard is to transplant whole pancreas with the duodenal segment and enteric drainage. The extraperitoneal placement of the pancreatic graft facilitates access during mandatory biopsies of the graft, which is an essential advantage especially for isolated pancreas transplants.

The last decade has seen great improvement in the surgical treatment of diabetic foot syndrome. Today it is common knowledge that the critically ischemic diabetic foot can be successfully revascularised. Several papers have been published detailing excellent results with the combined procedure of arterial bypass with free muscle transfer. The procedure appears promising for limb salvage in patients with extensive gangrene and infection in the limb, however this complicated operation is not able to salvage the limb in cases. The patient presented in this study underwent a pedal bypass and free muscle transfer operation on both limbs in a 13-month period. We successfully saved only one lower limb despite the fact that we performed the same procedure on both extremities. Progressive foot gangrene developed despite even though the bypass and vital flap was functioning properly. The cause of the foot gangrene development was researched. The main reason for the progressive ischemia development is believed to be the “Steal Phenomenon” an infrequent complication confirmed by the literature reviewed. Case Report

Venous and arterial graft usage in vascular reconstructions was re-discovered in connection with organ transplantation development. Allografts are employed in many clinics, however, uniform opinion on the use of immunosuppression after the procedure of venous graft transfer from a cadaveric donor, is still lacking.The authors present their own group of patients who underwent vascular reconstructions, and in whom allogenic vein was used. The majority of indications for bypass procedures resulted from critical limb ischemia. Immunosuppressive medication was administered during the vascular procedure and, over the past several years, it purely consisted of tacrolimus monotherapy.In the group of 101 patients, no serious complications due to adverse effects of immunosuppression therapy were recorded.

Liver transplantation is a life-saving procedure in patients with end stage liver disease. Five-year survival in patients indicated for transplantation based on standard indication criteria, has reached a rate over 80%. Shortage of suitable grafts remains the main problem in these procedures. While the situation in adult patients is relatively satisfactory, liver transplantations in children, mainly in the low-weight categories, remain a worldwide problem because of the absolute lack of suitable donors. In order to reduce mortality in the youngest patients on the waiting list, a concept of reduction of the adult graft for pediatric use was introduced in the early 1990s. Recent introduction of novel methods, such as split transplantations or transplantations between relatives, has resulted in lower mortality rates in the youngest recipients on the waiting lists. The author assesses a group of patients below 18 years of age, who underwent reduced liver graft transplantations in the Czech Republic.From 1995 to 2009, a total of 43 patients below 18 years of age underwent transplantations, using 48 liver grafts. Further 17 children were sent abroad for transplantations, where a total of 23 liver grafts were used. Only patients who underwent transplantations using the liver grafts adjusted in IKEM were assessed in the patient group, i.e. 14 patients, resp. 16 liver grafts. Reduction was performed in 13 subjects. One subjects underwent transplantation between relatives and a liver split was used in two subjects. In the lowest weight category up to 10 kgs, 5 liver reductions were performed.Out of the total (n = 16), 4 grafts failed (2 were early postoperative failures, ie. within 2 postoperative days and 2 grafts failed in Month 5). The mean graft survival was 65 months. Within the youngest recipient age group (n = 5), no graft failure was recorded. The mean survival time is 26 months.Since 2007, the Czech Republic has been providing a program for all patients, including the lowest weight-category pediatric patients. To date data are satisfactory. No graft failure has been recorded in the category of the smallest (up to 10 kgs) pediatric patients.

Improvements in immunosuppressive therapy during the past decade brought about improvements of the long term tolerance of organ allografts. However, the long-term immunosuppressive therapy has an important limitation, because it can increase the risk of cardivascular diseases, infections and tumors. As compared with age-matched healthy population, organ-transplant recipients have an increased incidence of tumors.

Paper refers the first in Czech Republic liver transplantation in a child with the donor being the close living relative - the father. Indication was the chronic liver failure caused by biliary atresia after the Kasai procedures, which enabled the child to survive two years. Liver segments II. -III were transplanted with favourable postoperative development. Within the following twenty months the nutrition status and the psychomotor development of the child significantly improved. Authors discuss present situation and results of the paediatric liver transplantation in the world.

Pancreas transplantation is a routine method for the treatment of diabetes mellitus. One of the main challenges of a transplant with extraperitoneal placement of the pancreatic graft is impaired wound healing due to massive amylase and lipase secretion by the pancreatic graft, evoking edemtous fluid. From February 2002 through January 2003, we performed pancreatic transplant procedures in 21 patients who were prospectively and randomly assigned to two groups: 8 organ donors and the recipients were administered somatostatin by continuous infusion. Thirteen grafts were harvested and transplanted without somatostatin infusion. The two groups did not show significantly differences in mean donor or recipient ages, weights, of serum amylase and lipase content values or drain output until day 6. There was a significantly lower lipase in the drain output of transplant recipients given somatostatin (12.5 and 54.2 micromol/L, respectively; P

The aim of our study was to evaluate the potential advantages of the left retroperitoneal (RP) approach for abdominal aortic surgery and compare the aortic exposure with the transperitoneal (TP) approach which is widely used.Total 55 consecutive patients who underwent elective aortic surgery between 1998 and 1999 were evaluated retrospectively. Thirty three patients underwent the RP exposure and 22 the TP approach in the treatment of abdominal aortic aneurysm or aortoiliac occlusive disease. Demographic data and premorbid status were not significantly different between these two groups. Fourteen intraoperative and postoperative parameters were monitored and statistically analyzed.We found statistically significant differences in three of 14 intraoperative and postoperative parameters. Patients operated with the RP approach to the abdominal aorta were able to take clear fluids orally sooner. A statistically significant difference was also detected in the postoperative extubation time as RP patients were extubated almost one hour sooner than TP patients. Bowel function onset was statistically significantly faster return in the RP group. In the rest of recorded data there were no significant differences, however in all of follow-up parameters we found results in favour of RP group.We conclude that the RP group of patients had statistically significant improvements three of 14 postoperative clinical parameters. (Tab. 3, Ref. 18.)

The aim of this retrospective analysis was assessment of both patency and limb salvage rates of diabetic ischemic feet which underwent pedal bypass surgery within the period of 3 years.Authors evaluated 50 critically ischemic diabetic feet where the pedal bypass was indicated for limb salvage. Total 41 pedal bypasses were performed and median follow-up was 16.7 months (1-39). The free muscle transfer were performed either in one session with or subsequently after the pedal bypass surgery in six limbs.Authors achieved 61% and 76% graft patency and limb salvage rates, respectively, within the median 16.7 months follow-up. All successfully revascularised feet healed up within the median period of 3 months postoperatively. No patient died within 30 days postoperatively.We conclude, that pedal bypass is safe procedure with acceptable limb salvage rate in the medium-term follow-up. Surgeons can markedly extend an indication criterions for limb salvage by exploiting of this technique.

The authors present their results of the treatment of diabetic foot critical ischemia by means of surgical revascularisation together with minor amputation or debridement. They discuss the causes of higher amputations and re-amputations in revascularised ischemic diabetic lower limbs and presents patency rates in different types of peripheral arterial bypasses. The authors evaluated 81 diabetic feet with chronic critical ischemia, where they performed 50 arterial bypass procedures in the 50 limbs (13 femoropopliteal, 13 femorodistal, 19 pedal bypasses and 5 aorto/ilicofemoral or extraanatomical bypasses). 41 minor amputations or debridements (82%), 6 minor re-amputations (12%) was performed in the group of 50 revascularised limbs. The primary patency rates, secondary patency rates and limb salvage was achieved 92%, 92% and 92% in femoropopliteal bypass, 91%, 91% and 92% in femorodistal bypass, 78%, 83% and 84% in pedal bypass, respectively. The average follow-up time was 11.4 months. 6 minor re-amputations (12%) and 5 high amputations was necessary to perform in the group of 50 revascularised lower limbs. The main cause of re-amputation and high amputation was continuing ischemia. 30 day mortality rate was 0%, 30 day morbidity rate was 8% (myocardial infarction and pulmonary embolism).

The authors present the technique of chemical lumbar sympathectomy by an anatomically new medial transdiscal approach. On a group of 80 operations they analyze the indication criteria, complications and results of this method. They compare the percutaneous technique of severing of the sympathetic nerve with the classical surgical approach. In 41 patients where a modified transdiscal approach was used the authors did not encounter any serious complications. Using thin needles (minimum 23-G) they recommend this method as an alternative of the classical approach of Kappis.

The minimally invasive method of skin biopsy with intraepidermal nerve fiber (IENF) counts may be used to analyze nerve regeneration in pancreas transplant (PTx) recipients. We assessed IENF counts as a database for long-term follow-up of diabetic neuropathy.Skin biopsies were performed using a 3-mm punch from lower thigh and upper calf areas of 16 (13 pancreas/kidney, 3 pancreas alone) PTx patients (mean +/- SD: age, 45+/-8 years; type 1 diabetes duration, 27 +/- 8 years) at 1 month posttransplant. Ten healthy gender- and age-matched controls (C) were also examined. After fixation and freezing, 40-microm sections were stained using rabbit polyclonal antibody to the panaxonal marker PGP 9.5 followed by mouse antirabbit IgG antibody conjugated with rhodamine. Samples were imaged with a digital camera, mounted on a microscope, and equipped for fluorescence. The average number of IENF per millimeter length of epidermis was derived. Clinical neuropathy was assessed by foot vibration perception thresholds (VPT) with a biothesiometer (normal valuesmean + 2 SD of C).Significantly lower IENF densities were found in skin biopsies from PTx (PTx vs C: thigh, 0.74 +/- 0.88 vs 9.74 +/- 2.41 IENF/mm; calf, 0.34 +/- 0.91 vs 7.66 +/- 3.16 IENF/mm; P.001). IENF were totally absent from the thigh and calf samples of 7 and 12 PTxs, respectively. Clinical neuropathy (VPT21 V) was present in all but one PTx.Severe intraepidermal nerve fiber depletion is present in the lower limb area of pancreas transplant recipients with neuropathy. Long-term follow-up would probably be necessary to assess the possibility of posttransplant nerve fiber regeneration.

Prophylaxis by means of antibiotics in the form of a so-called "protected coagulum" is an important part of prevention of postoperative infections in renal transplantations. The antibiotic is selected with regard to its effectiveness against the most frequent pathogens, tissue penetration, undesirable effects (in particular nephrotoxicity). The authors investigated a group of 450 renal transplantations with cefotaxime prophylaxis. During the four-week follow-up period after operation infection of the surgical wound (abscess, purulent secretion) occurred in 15 patients (3.33%). The mentioned results indicate that cefotaxime is suitable for use as a protected coagulum also in patients with postoperative immunosuppression.

Although the number of pancreas transplants has increased significantly in previous years, debate continues concerning the optimum technique for exocrine pancreas drainage. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD). We prospectively assigned 40 consecutive pancreas transplant recipients to either bladder (n = 20) or enteric (n = 20) drainage. Patient, kidney, and pancreas graft survival rates at 1 year after simultaneous kidney-pancreas transplantation were 95%, 95%, 85%, for BD group and 90%, 85%, 85% for ED group, respectively. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections, and CMV disease were similar between groups. The length of the initial hospital stay was likewise comparable. However, the BD group showed a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Based on the results of our study, patient and graft survivals were excellent irrespective of technique.

Only marginally improved results have been observed in standard autonomic function tests (AFT) in follow-up studies after simultaneous pancreas and kidney transplantation (SPK). We therefore used power spectral analysis (PSA) of heart rate variability (HRV) to assess the effect of SPK on autonomic neuropathy in patients with type I diabetes mellitus (DM I). We evaluated 82 patients with DM I who were insulin and dialysis free following SPK. Both pre- and posttransplant (at [mean ± SD], 25 ± 15 months post-SPK) examinations were performed in 29 patients. Posttransplant evolution was examined in another 60 patients with two serial examinations at 20 ± 20 and 43 ± 27 months after SPK. Comparisons included 32 age-matched healthy controls and 13 patients with kidney transplant alone (KTA) matched for age and duration of DM I at a comparable time point posttransplant. Short-term time (modified Ewing battery) and frequency domain (PSA of HRV: LF-low, HF-high frequency, and TP-total spectral power) analysis was performed with a telemetric, on-line, computer-aided system. Significantly worse results in all standard AFT and PSA indexes were obtained for SPK patients compared with controls at all time points. No significant improvement was seen in SPK patients in the posttransplant period and no differences were found compared with KTA patients. Thus the results of a power spectral analysis of HRV failed to show improvement following SPK. This examination adds little positive information to that obtained from standard autonomic function tests.

In this paperthe numerical modeling of composite materials in view of Nondestructive Testing is considered. The composite material is assumed to be modeled at the macroscopic scale by a possibly complex dielectric permittivity tensor. The material is probed by means of an electromagnetic field having wavelength much larger than the relevant geometrical dimensions. As well known, the numerical modeling is critical especially in this “low-frequency” regime where a strong ill-conditioning of the relevant stiffness matrix typically occur (the so-called low-frequency breakdown problem). The proposednumerical model is robust w.r.t. this underlying ill-conditioning.

International audience; The European project SIMPOSIUM (standing for Simulation Platform for Non Destructive Evaluation of Structures and Materials) aims at developing simulation tools adapted to the needs of industrial partners, regarding non-destructive testing and material characterization techniques. This communication presents the results obtained with two different simulation methods in the case of an eddy current inspection of pieces with complex shapes.