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Condylar hyperplasia is one of the causes of facial asymmetry and malocclusion, characterized by enlargement of the lower jaw due to excessive condyle growth activity. The aim of this study was to use micro-computed tomography (micro-CT) to evaluate the bone architecture of the condylar head and determine whether there are differences between patients with various forms of unilateral condylar hyperplasia (UCH): hemimandibular hyperplasia, elongation, and mixed form. The cohort consisted of 28 patients with a mean age of 21.9 years. All patients underwent surgical treatment (condylar shaving) for active pathological growth activity. The portion of the condylar head removed was imaged by micro-CT and subsequently evaluated. Micro-CT imaging and semiquantitative and quantitative evaluation of the bone structure (percentage bone volume, surface density, trabecular thickness, trabecular separation, degree of anisotropy, and porosity of the subchondral bone) did not reveal significant differences between the individual types of condylar hyperplasia (P 0.05). There were no significant differences in bone structure between the anterior and posterior portions of the condylar head. No statistically significant differences between individual groups of UCH were found in the micro-CT evaluation of the condylar head bone architecture.

Sterilisation is a mandatory process for materials used in a range of medical applications including intra-operative guides and instrumentations, screening equipment accessories and patient support...

A case- review describing a desmoid in a young female. The tumor originated at the tendinuous attachment of the m. rectus abdominis on the pubic bone, which had had two relapses. During the third--so far the latest--procedure it required left-sided hemipelvectomy with resection of the rectum and a part of the vagina. The patient was instructed about the serious character of the disease, the requirement for the radical resection and about the requirement for a careful long-term follow-up of the patient after the procedure.

Endometriosis is a common gynaecological disorder, affecting 10-15% of the fertile female population. Most frequently, it affects internal genitalia, the main symptoms being pelvialgia and infertility. In 5% of the cases the disorder may also affect extragenital structures and present itself as endometriomas of the appendix, the small or the large intestine, the umbilicus, the inguinal canal, the residual scars after laparotomies or the diaphragm. They may also imitate a malignancy. The diagnostic key is the cyclic character of the pain or of the bleeding to the tract and the laparoscopic confirmation of the presence of the foci. When the diagnosis is known, a simple excision, extirpation or resection suffices. In case the malignancy cannot be excluded, a more extensive procedure is indicated. The authors present two case-reviews during a twelve-year period, in both cases the sigmoid was affected. In the first case, a radical resection of the rectosigmoid due to a suspected malignancy was performed, while in the second case, a simple excision of the endometrioma where the diagnosis was known was performed. The authors stress-out advantages of the interdisciplinary approach to the treatment of the complicated cases of endometriosis, so that the disorder would be solved in one surgical procedure.

The authors present a group of 6 patients treated in 1996-2000 with giant "impossible" hernia the contents of which "lost their rights in the abdominal cavity". The patients involved were old polymorbid people (mean age 75 years), 5 suffered from acute, one from chronic obstruction of the gut. After intensive preparation the authors implemented a hernioplasty, using an excessive surgical mesh, reduced the volume of the abdominal contents by the omentum in all subjects, by the right colon in two and by a 0.5-1 m segment of the ileum in 3 patients. Only one extremely polymorbid patient died because of multiorgan failure on the 17th day after surgery. In 5 patients artificial ventilation was necessary from 2 hours to 17 days. As to complications, diarrhoea was recorded in one patient and infection of the mesh in another one. The authors conclude that the majority of "impossible" incarcerated hernias can be resolved by visceroreduction and enlargement of the volume of the abdominal cavity by inserting an excessive surgical mesh into the enlarged hernial neck. In elective operations of such hernias for the preparation forced reduction of the weight can be used and the technique of enlargement of the abdominal volume by intermittent pneumoperitoneum. In this way a giant "impossible" hernia can be treated without threatening the patient's life by cardiopulmonary failure.

The authors describe the case of a 70-year-old man with primary adenocarcinoma of the fourth segment of the duodenum. Due to the infrequency of the condition there was diagnostic and therapeutic uncertainty. After the endoscopic and bioptic diagnosis three months elapsed before an incorrectly indicated derivation operation and only after another month the tumour was resected. The exhausted patient developed postoperative pancreatitis with subsequent multiorgan failure to which he succumbed. The disease should be suspected even if the symptomatology is poor. The patient suffered only from nausea and anaemia. From the diagnostic aspect endoscopic examination is most useful for the oral segment of the duodenum and double contrast examination for the aboral one. The method of treatment is duodenopancreatectomy for the upper part and segmental resection for the distal part of the duodenum.

From September 1988 till June 1997 the authors performed gastric banding for morbid obesity in 644 patients. In 14 (2.2%) reoperation was necessary: on account of stenosis of the stoma with excessive weight loss in 10, inadequate weight loss in four patients. Correction was performed by prolonging the circumference of the cuff in five and by re-banding of the stomach and creation of a stoma with a 12 mm diameter and a "small stomach" with a volume of 15 ml in nine patients. No death nor complications were recorded. The results with complete recovery of the condition were excellent in the group with excessive weight loss, more modest in the group with a small weight loss. The authors emphasize the necessity of comprehensive care of obese patients; an optimal bariatric operation must be followed by long-term follow-up of patients to achieve a change of lifestyle as regards dietary habits as well as regular physical activity.

Failure of conservative treatment of obesity stimulated the development of bariatric surgery. The authors performed in 1988-1995 GB in 248 obese patients with a mean overweight of 48.2 kg and with serious comorbidity. The mortality in the group was 1.6%, the morbidity 12.5%. Within 12 months after operation the overweight of the patients declined by 70%, within 24 months by 57%. In the majority of patients the comorbidity receded, the blood sugar level reached normal levels, dyspnoea and hypertension improved as well as the psychic state and social position. The attained results confirm that this treatment of morbid obesity is justified and the authors recommend its wider use. Perspectively laparoscopic gastric banding is associated with a reduced mortality and morbidity, however it is also associated with higher costs.

Based on 12 operations, the author report on the advantages of "plug tension-free" plastic operations. The femoral canal is along its entire course sealed by a cylinder of rolled up polyester net. This operation reduces the postoperative discomfort and danger of the development of a relapse.

The authors present the case of a 6-year-old girl admitted to the department three days after a blunt abdominal injury. On surgical revision a dissecting haematoma of the wall of retroperitoneal duodenal sections was revealed. After its treatment and nutritive puncture jejunostomy the subsequent postoperative course was free from complications. This is an infrequent GIT injury in childhood which can be treated also by conservative methods.

For palliation of persisting pain caused by inoperable malignity in the epigastrium or chronic pancreatitis a number of surgical and non-surgical operations of the splanchnic nerves was elaborated. Abdominal and thoracic approaches are associated with technical difficulties and burden the patient; blocks by puncture are associated with risk. The optimal procedure appears to be videothoracoscopic left-sided splanchnicectomy, the authors performed this operation in nine patients (in seven on account of a malignant process, in two on account of chronic pancreatitis). In all immediate alleviation of pain occurred, in two later some pain reappeared. Based on the favourable experience, the authors recommend this minimal invasive procedure.

Venous aneurysms are a rare condition. It is an independent nosological unit which differs from varicosities by the following signs: it is not sex- or age-linked, it is found also in children, it can affect any vein, it is found as a solitary lesion and is not associated with prolongation of the affected vein. The therapeutic approach is surgical extirpation. The most serious clinical manifestation can be pulmonary embolism. The author presents four of his own observations with localization on the external jugular vein, the v. cephalica antebrachii, the anterior tibial vein and v. dorsalis digiti manus.

The authors present their experience with operations of 264 inguinal hernias in 238 subjects where Lichtenstein's technique was used. The principle of the operation is reconstruction of the posterior wall of the inguinal canal by means of a synthetic mesh-tension free. The attained results in this group (L) were compared with a control group of 68 operated patients (group C) where the classical McVaye technique was used. They did not find a difference in the time taken up by the operation or the time of hospitalization. The postoperative mortality was 0.4% in group L and 2.9% in group C, the morbidity was 15.5% and 42.6% resp. So far they did not record a case of relapsing hernia or rejection of the mesh. The operation is easy to perform, economically unpretentious, the postoperative pain is milder and the sensation of discomfort slighter than after the classical operation. With regard to the assembled experience, the authors recommend the new operation not only in inguinal but also other types of hernias where tension free repair is impossible. For reconstruction they use polyester mesh CHS 100 manufactured by the Hosiery Research Institute in Brno.

The authors described an in this country hitherto unpublished observation of an isolated rupture of the external iliac vein following the fall of a patient from a height on her left side. The rupture developed most probably as a result of narrowing of the external iliac vein which crosses the left internal iliac artery. A mechanism of acute expansion of the external iliac vein due to a blast wave of venous blood expelled by an impact on the thigh and recoiled from the impediment at the site of crossing with the internal iliac vein was probably involved. After severing of the compressing artery, thrombectomy and suture of the lesion, the patient recovered ad integrum.

The authors describe the case-history of a nine-year-old boy engaged in sports, suffering from serious hypertension due to an aneurysm of the renal artery of the right kidney. Vascular reconstruction was performed. They boy died, however, suddenly 20 hours after operation and on necropsy serious hypoplasia of the adrenals was revealed.

In the course of the study of the syndrome of severe limb ischemia (SLI) in a representative clinical material of 300 patients and a number of experimental studies, we arrived to the proposal of this optimal methodical procedure for acute vascular closures of traumatic and non-traumatic origin in the limbs: a) In every injury and sudden pain with a change of the function of the limb, it is necessary to think of the SLI syndrome and to search targetedly for it. b) In injuries connected with bleeding our first-rate task is the control of this bleeding. For a temporary arrest of the bleeding it is necessary to prefer more physiological methods sparing collateral circulation to the still most used tourniquet. For this purpose a new device for temporary hemostasis called Hemostop has proved itself, designed by the author and attested both experimentally and clinically, protected as a Czechoslovak patent. From surgical measures have acquitted themselves from this viewpoint the insertion of vascular clamp, ligature of the vessel or its temporary cannulation. c) To set the diagnosis of SLI, it usually suffices a careful anamnesis and clinical examination, advantageous is the investigation by ultrasound. The angiography because of time consumption should be used only in indicated cases. d) The time factor--"race against the time"--has to be always borne on our mind. It is necessary to achieve the recovery of blood circulation in the limb up to 6 or at the latest up to 10 hours from the onset of injury or closure. e) For shortening of the period of tissue hypoxia it is of advantage to use the temporary cannulation of injured vessels. This should be used always, whenever because of any reasons, it is not possible to execute the final reconstructive operation up to 10 hours since the injury, e. g. in polytraumatism, transport difficulties and the like. f) In isolated vascular injuries without bleeding (about 45%) and in all non-traumatic SLI the patients must be efficiently heparinized (i. v. administration, at best by infusion) to prevent the growth of the distal thrombus. g) Final vascular reconstruction should be performed only by erudited surgeons, always with thromboctomy and in protected coagulum. Optimal reconstructive performance should be chosen: for embolism the thromboembolectomy, for acute thrombosis usually the bypassing the afflicted vascular portion by the graft, in injuries appears as the optimal reconstructive measure the anastomosis end to end. At the simultaneous or isolated lesion of the stem vein, we must always try to reconstruct it.(ABSTRACT TRUNCATED AT 400 WORDS)

A retrospective analysis of 1146 amputations of the lower extremities in five departments of the East Bohemin a region revealed that the number of amputations in the thigh is higher and less frequently preceded by angiographic examination and reconstruction operations of the arteries as compared with distinguished departments abroad. The mortality after amputations was 12.5%. The results call for more intensive training of vascular surgeons and the establishment of vascular surgical departments where it would be possible by early reconstruction operations made in time to prevent amputations or at least shift the height of the amputation in the most distal direction possible.

The authors give an account of 14 patients during a two-year period where on account of an occluding tumour of the left half of the colon they performed subtotal colectomy with ileodescendent--in 2, ileosigmoideal--in 10 and ileorectal anastomosis in two patients. After operation and by the time when the material was processed, none of the patients died. Based on data in the literature and the authors' own material, the authors discuss the advantages of subtotal colectomy, as compared with hitherto used multistage procedures. The advantages include in particular a lower operative mortality (0-14%), a higher five-year survival (46%) a markedly lower morbidity, time economy, a shorter period of hospitalization and in particular, the patients are spared colostomy, even temporary one. The authors recommend subtotal colectomy as the method of choice on account of ileus caused by tumourous occlusion of the left half of the colon.

The authors submit their own experience with pharyngogastric anastomosis in patients where on account of circumferential cancer of the oesophagus and hypopharynx laryngopharyngooesophagectomy had to be performed. For the anastomosis a tubular flap of the greater curvature of the stomach was used which was pulled through the posterior mediastinum and sutured with the mucosa and musculature of the residual pharynx and the preserved upper half of the epiglottis. The operation is pretentious and requires satisfactory cardiopulmonary function of the patient. A disadvantage of the operation is substantial loss of gastric function, compensated by the patients by a therapeutic diet and medicinal substitution of the gastric chemism. An obvious advantage of the operation is the radical character of the oncological procedure and rapid rehabilitation of swallowing which was restored in the authors' patients on the 8th to 14th day.

The hyperlipidemia may be influenced with both the conservative and surgical management. Starting from 1987, authors use Buchwald's (1963) partial ileal bypass method. They report on their experience with 16-membered total of patients. In majority of patients, the PIB was auxiliary operation mostly in relation with vascular reconstructive surgery. No lethality case or serious complication has been stated. All patients showed the substantial decrease in cholesterol and triglyceride levels, these being normalized in majority of patients. Authors are discussing PIB indications. The suggestion is made that this is the most effective of known measures in attempt to achieve a continual decrease in lipids without the serious discomfort for a patient.

During the last 30 years, 280 retrosternal esophageal replacements from stem intestinal grafts were performed at GIT Surgery Clinic AM in Wroclav. Both clinical and auxiliary investigations showed the small intestine grafts have been of the best function as to the food passage. In esophagi made from the large intestine, the following and mostly frequent changes occur: the dilatations of their lumina, the stop of food passage and inflammatory changes varying in both the degree and extent. Inflammatory changes as well as ulcers are rather difficult to detect by radiology. Through the last years, the Second Clinic of General Surgery AM in Wroclav provides endoscopy of artificial esophagi. Being sophisticated, this approach is of benefit in early determining pathologic changes in the esophageal wall, the collection of contents for biochemical tests, tissue biopsies for histology and the initiation of appropriate therapy.

A case is described of a 55 years old woman with septic thrombosis of the inferior caval vein, detected in time with the aid of computed tomography and cavography. The patient subsequently underwent successful surgical treatment.