Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Decompressive craniotomy is usually carried out using decompressive craniectomy (osteoclastic decompressive craniotomy) when the bone flap is removed. In situations when the level of expansion does not call for decomopressive craniectomy, we do not remove the bone flap and we perform osteoplastic decompressive craniotomy. The indication is based on assessment and cross correlation of the following parameters: intracranial pressure,midline shift and the number of pathologies on CT, actual influence of antiedematous therapy, expected cerebral oedema progression and especially according to the size of the dural defect after duratomy. ⋯ After the oedema regression, the elevated bone flap spontaneously drops to its original position and is reattached. The danger of bone plate depression is eliminated with the use of a bevel bone cut using a Gigli saw. Osteoplastic decompressive craniotomy is an effective method of treating brain oedema when the degree of expansion does not require decompressive craniectomy.
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Embedded-ring finger is uncommon in clinical praxis which present mainly in psychiatric patients and drug abusers. Its removal is technical usually difficult not only due to oedema, but also for their uncooperativeness. We present a case of alcohol abuser which was admitted to our emergency department with embedded ring finger after month from beginning of constriction.
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Aberrant right subclavian artery arising from the distal part of the aortic arch and passing behind the oesophagus (arteria lusoria) is a rare congenital vascular anomaly, it is the 4th most common aortic arch anomaly. At the site of the orifice there is the Kommerell's diverticulum, which is the locus minoris resistentiae with the possible arise of the aortic aneurysm. Aneurysmatic dilatation of the anomalous artery and of the aorta may be the cause of distal embolism or rupture. Less frequently there is also the possibility of aortic dissection or traumatic rupture. ⋯ Experiences with the combined treatment published in the literature and ours are excellent, this technique is miniinvasive with a low complication rate. In our opinion it is the management of choice.
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Blunt injury of the carotid artery is uncommon but serious injury with high mortality and morbidity. The symptomatology may be inconspicuous, in other case a neurological deficit is present. ⋯ The diagnosis is usually confirmed by CT scan, CT angiography, MRI. In the therapy in present prevail heparin anticoagulation and endovascular stent implantation in some cases.