Search

Purpose: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm., Methods: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months., Results: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up., Conclusion: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

We describe a rare case of solitary metastasis of follicular carcinoma of the thyroid gland into the petroclival region in a 58-year-old woman. The metastasis was the first and only manifestation of the disease. The histology of the tumor, differential diagnosis and clinical course are discussed. In a few similar cases described so far the tumor was always a well or moderately differentiated follicular carcinoma located in the petroclival region. As in this presentation, these cases also clinically mimic a meningioma. The differential diagnosis includes adenoma of the thyroid gland and thyroid gland dystopia. We demonstrated the primary focus of carcinoma within the thyroid after its detailed examination initiated by our finding. The clinical outcome of such rare cases is usually excellent, much better than in metastases of papillary carcinoma into the brain.

Purpose of the Study: To evaluate the results of percutaneous osteosynthesis of scaphoid fractures and to verify whether this approach is more effective than conservative treatment., Material: A total of 25 patients were treated by percutaneous osteosynthesis at the Emergency and Accident Department of the University Hospital in Olomouc from March 1, 2002, till March 31, 2003. According to the Herbert classification, five had type A2 fractures, four had type B1 and 16 had type B2 fractures. The surgery was performed at 20.6 days on average after injury. HBS screw (Martin) fixation was used in 22 patients, a 3.5 mm cortical screw and a 4.0 mm cancellous bone screw (Poldi 5 set, Kladno, CZ) were inserted in one and two patients, respectively. The wrist was immobilized with a brace in 11 patients. After a short hospitalization, the patients were referred to an out-patient department for follow-up., Methods: We evaluated the duration of postoperative immobilization, necessity to initiate assisted rehabilitation, length of follow-up at the out-patient department and the functional outcome. The control group comprised of 43 patients who were treated between March 1999 and December 2001. Only patients with type A, B1 or B2 scaphoid fractures managed conservatively were included. Nine patients were excluded because, during treatment, they were converted to conventional open osteosynthesis through the palmar approach., Results: In the study group, the average postoperative immobilization with a brace was 17 days; assisted rehabilitation was initiated in 50% of the patients and resulted in excellent functional outcomes; the average follow-up was 10.3 weeks. In one patient, the fractured scaphoid failed to heal. In the control group, the average postoperative immobilization was 7.5 weeks; assisted rehabilitation was started in 53% of the patients and 23% reported persistent complaints; the average follow-up was 11.4 weeks., Discussion: To achieve a good outcome of percutaneous osteosynthesis of a fractured scaphoid, it is important to make a precise diagnosis based on CT scan. This approach is suitable for type A2, B1 and B2 fractures. A good outcome of surgery depends on the correct insertion of a screw among fragments in order to achieve adequate compression among fragments. The necessity of postoperative immobilization and its manner and duration are current issues of discussion., Conclusions: Our preliminary results show that, in indicated fractures types, the percutaneous osteosynthesis of a fractured scaphoid provides better functional outcomes than conservative treatment.

The authors describe the case of a patient who suffered multiple injuries and who after diagnosis of anisocoria was subjected to CT examination of the brain with a negative result. Because of deterioration of the clinical condition CT of the brain was repeated after five hours; it revealed an epidural haematoma in the left frontal area which led to indication of urgent surgery. The patient recovered. Key words: epidural haematoma, diagnosis, computed tomography.