This paper deals with a wavelet-based algorithm for automatic detection of isoelectric coordinates of individual QRS loops of VCG record. Fiducial time instants of QRS peak, QRS onset, QRS end, and isoelectric PQ interval are evaluated on three VCG leads (X, Y, Z) together with global QRS boundaries of a record to spatiotemporal QRS loops alignment. The algorithm was developed and optimized on 161 VCG records of PTB diagnostic database of healthy control subjects (HC), patients with myocardial infarction (MI) and patients with bundle branch block (BBB) and validated on CSE multilead measurement database of 124 records of the same diagnostic groups. The QRS peak was evaluated correctly for all of 1,467 beats. QRS onset, QRS end were detected with standard deviation of 5,5 ms and 7,8 ms respectively from the referee annotation. The isoelectric 20 ms length PQ interval window was detected correctly between the P end and QRS onset for all the cases. The proposed algorithm complies the (2σCSE) limits for the QRS onset and QRS end detection and provides comparable or better results to other well-known algorithms. The algorithm evaluates well a wide QRS based on automated wavelet scale switching. The designed multi-lead approach QRS loop detector accomplishes diagnostic VCG processing, aligned QRS loops imaging and it is suitable for beat-to-beat variability assessment and further automatic VCG classification.

This paper presents a newly-designed and realized Invasive Blood Pressure (IBP) device for the simulation on patient’s monitors. This device shows improvements and presents extended features with respect to a first prototype presented by the authors and similar systems available in the state-of-the-art. A peculiarity of the presented device is that all implemented features can be customized from the developer and from the point of view of the end user. The realized device has been tested, and its performances in terms of accuracy and of the back-loop measurement of the output for the blood pressure regulation utilization have been described. In particular, an accuracy of ±1 mmHg at 25 °C, on a range from −30 to 300 mmHg, was evaluated under different test conditions. The designed device is an ideal tool for testing IBP modules, for zero setting, and for calibrations. The implemented extended features, like the generation of custom waveforms and the Universal Serial Bus (USB) connectivity, allow use of this device in a wide range of applications, from research to equipment maintenance in clinical environments to educational purposes. Moreover, the presented device represents an innovation, both in terms of technology and methodologies: It allows quick and efficient tests to verify the proper functioning of IBP module of patients’ monitors. With this innovative device, tests can be performed directly in the field and faster procedures can be implemented by the clinical maintenance personnel. This device is an open source project and all materials, hardware, and software are fully available for interested developers or researchers.

Multimodalni přistup k lecbě pacientů s kolorektalnim karcinomem a synchronnimi metastazami jater umožňuje aplikovat různe kombinacejednotlivých lecebných modalit (resekce kolorekta, resekce jater, systemova lecba, radioterapie). Primary-first approach a simultanni resekcepředstavuji tradicni lecebne postupy, jejichž využivani je zdůvodňovano skutecnosti, že primarni nador je hlavnim zdrojem tvorby metastaza zdrojem komplikaci souvisejicich s lokalni progresi nadoru (obstrukce, perforace ci krvaceni z kolorekta).V důsledku velmi nepřiznivých výsledků tradicnich lecebných postupů byly do praxe zavedeny tzv. reverzni strategie lecby (liver-first approacha up-front hepatectomy approach). Tyto strategie jsou založeny na snaze upřednostnit resekci jaternich metastaz před resekci kolorekta (vzhledemk tomu, že prognoza pacientů s generalizovaným onemocněnim zavisi předevsim na kurabilitě metastatickeho postiženi jater). Dle dostupne literaturyjsou reverzni strategie indikovany zejmena u pacientů s asymptomatickým primarnim nadorem kolorekta.Strategie lecby každeho pacienta by měla být stanovena individualně v zavislosti na stavu a rozsahu onemocněni. V předkladanem souhrnnemsděleni nabizeji autoři aktualni přehled problematiky jednotlivých strategii lecby pacientů s kolorektalnim karcinomem a synchronnimi metastazamijater se zaměřenim na dostupna data mediciny založena na důkazech.

This present study investigated the impact of the application of stem cells to liver regeneration following the first stage of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The experiment was conducted on a pig model (n=6, 3 that did not receive application of stem cells, 3 that received application stem cells). Collected samples of liver (day 0 and 9 following surgery) were subjected to complete transcriptome sequencing. In total, 39 differentially expressed genes were found in the group without the application of the stem cells (genes of unwanted processes such as fibrosis and inflammation). In the group that did receive application of stem cells, no significantly differentially expressed genes were found, indicating a properly regenerated liver remnant. The present study therefore demonstrated, to the best of our knowledge for the first time, the positive effect of stem cells application in the liver regeneration process during ALPPS procedure in the pig model.

Multimodal approach in the management of patients with colorectal carcinoma and synchronous liver metastases allows for the application of various combinations of treatment modalities (colorectal resection, liver resection, chemotherapy, radiotherapy). The primary-first approach and simultaneous resection represent traditional strategies used because the primary tumor is thought to be the main source of subsequent metastases as well as the source of symptoms associated with local tumor progression (obstruction, perforation, colorectal bleeding). Poor long-term outcomes of traditional strategies have led to the proposal of reverse strategies (the liver-first approach and up-front hepatectomy approach). The idea behind reverse strategies is to give preference to liver resection over colorectal resection (prognosis of patients with stage IV colorectal cancer is determined mainly by the curability of liver metastases). According to available literature, reverse strategies are suitable mainly for patients with asymptomatic primary tumor. Treatment strategy for each patient should be individualized depending on the patients performance status, comorbidities, and tumor stage. In this paper, the authors offer an up-to-date review of treatment strategies for patients with colorectal carcinoma and synchronous liver metastases focusing on available data of evidence-based medicine. Key words: liver first - primary first - colorectal carcinoma - liver metastases - reverse strategies.

Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

Background and Aims: Most patients with type 2 diabetes mellitus have obesity. Studies show that bariatric surgery is superior to medical treatment for remission of type 2 diabetes mellitus. Nevertheless, very few patients undergo surgery, and a less-invasive endoscopic alternative is desirable. Methods: This was a single-arm first-in-human pilot study designed to evaluate the technical feasibility, safety, and clinical performance of the incisionless magnetic anastomosis system (IMAS) to create a partial jejunal diversion (PJD). Ten patients with obesity and type 2 diabetes mellitus, prediabetes, or no diabetes were enrolled. A PJD to the ileum was attempted in all patients under general anesthesia. The IMAS was delivered through the working channel of a colonoscope, with laparoscopic supervision. The patients were not required to participate in an intensive lifestyle/diet management program. Endoscopic visualization of the anastomosis was obtained at 2, 6, and 12 months. Patient weight, glycemic profile, and metabolic panels were acquired at 0.5, 1, 2, 3, 6, 9, and 12 months. Results: A PJD was created in all patients with no device-related serious adverse events. The anastomosis remained widely patent in all patients at 1 year. Average total weight loss was 14.6% (40.2% excess weight loss at 12 months). A significant reduction in glycated hemoglobin level was observed in all diabetic (1.9%) and prediabetic (1.0%) patients, while reducing or eliminating the use of diabetes medications. Conclusions: Permanent anastomosis for PJD was created in all patients with the IMAS. This resulted in improvement in measures of hyperglycemia and progressive weight loss.

PURPOSE:The aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy.METHODS:This study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604). With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with 99mTc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated.RESULTS:In all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation) in the Roux-en-Y group and 89.4±37.8 minutes in the "J-pouch" group; the difference was statistically significant (P<0.001). Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation) in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016). There were no important adverse events.CONCLUSION:After total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction. Whether these two observations have a direct causative link remains unanswered.

INTRODUCTION:Minimally invasive adrenalectomy has become the gold standard for surgery of the suprarenal gland. Retroperitoneoscopic adrenalectomy with dorsal approach is preferred. The aim of our case report is to discuss potential complications that may arise from retroperitoneoscopic adrenalectomy, specifically an intra-operative injury of the inferior vena cava.CASE REPORT:A 47-year-old male patient was admitted to undergo elective adrenalectomy on the right side. The reason for the surgery was a hormonally active adenoma with clinical signs of Conns syndrome. Biochemistry revealed the typical signs of hyperaldosteronism. A one-year history of unsuccessful treatment for hypertension was known. Ultrasound examination showed an enlarged suprarenal gland on the right side with the diameter of 5.2 cm. A CT scan confirmed the results of the ultrasound examination. Retroperitoneoscopic adrenalectomy was performed. The inferior vena cava was intraoperatively injured. The high pressure in the retroperitoneal space prevented bleeding. The injury to the vena cava was treated using a continuous stitch without the necessity of conversion to open surgery. The patient was discharged on the third postoperative day without any other complications.CONCLUSIONS:Retroperitoneoscopic approach is regarded by many authors as the new gold standard for adrenalectomy. However, very serious complications such as an injury of the inferior vena cava may occur. It is possible to treat this injury using retroperitoneoscopy. The risk of air embolization due to elevated pressure in the retroperitoneum (20 mm Hg) and open lumen of the IVC needs to be taken seriously.Key words: adrenalectomy - retroperitoneoscopy - complication.

INTRODUCTION:Minimally invasive esophagectomy is becoming a standard procedure in the treatment of esophageal cancer. We would like to present our experience with Ivor Lewis esophagectomy completed by minimally invasive technique.METHODS:The primary aim of the study was to analyse potential technical difficulties and intraoperative complications of thoracolaparoscopic Ivor Lewis esophagectomy with intrathoracic anastomosis. A secondary aim of the study was to evaluate postoperative complications according to the Clavien-Dindo classification. The inclusion criterion for the study was a history of thoracolaparoscopic esophagectomy. Multidisciplinary approach was employed in the diagnosis, surgery indications and perioperative care of all patients.RESULTS:Between January 2011 and January 2016, 19 patients underwent completely minimally invasive esophagectomy with intrathoracic anastomosis. There were 13 men and 6 women. Adenocarcinoma was confirmed by histopathological examination in all the patients. The cumulative postoperative morbidity was 68.4%. According to the Clavien-Dindo classification, we recorded grade I complications in 10.5% of the patients, grade II in 15.8%, grade III in 36.8% and grade IV in 5.3% of the patients. Anastomotic leak was the most serious complication; it was initially managed by negative pressure (vacuum) therapy followed by stent implantation. Postoperative mortality was 0%. Mean hospital stay was 12 days and mean stay at intensive care unit was 3.6 days.CONCLUSIONS:The basic oncosurgical principles of radicality need to be respected during minimally invasive procedures. However, functionality, safety, and cost effectiveness have to be preserved as well. In this paper, we present thoracolaparoscopic Ivor Lewis esophagectomy as one of feasible and accessible options of intrathoracic anastomosis. It seems to be safe with respect to technical obstacles, short-term and long-term complications.Key words: esophagectomy - intrathoracic - anastomosis - laparoscopy - thoracoscopy.

INTRODUCTION:After laparoscopic cholecystectomy, laparoscopic fundoplication has become another gold standard of minimal invasive surgery. The level of satisfaction of patients undergoing endoscopic surgery is almost 90%. Laparoscopic fundoplication, like other surgery methods, can also be burdened with grave complications, which could result in a fatal outcome even if the surgery is performed by a skilled surgeon. Even the authors themselves encounter complications despite their rich experience (more than 3,500 laparoscopic operations in the diaphragmatic hiatus area in more than 20 years).CASE REPORT:The authors report on a rare left hepatic vein injury during laparoscopic hiatoplasty and fundoplication according to Toupet for giant paraoesophageal hiatal hernia.CONCLUSION:For its low percentage of complications, laparoscopic fundoplication is considered as a safe operative method for gastroesophageal reflux disease and hiatal hernias. However, severe complications may still arise during the surgery and the surgeon should be familiar with them, be prepared for them and be able to manage such complications.Key words: gastroesophageal reflux disease hiatal hernia laparoscopic fundoplication left hepatic vein.

Many investigations on surgical methods and medical treatment are currently done on pigs. This is possible because the pig is sufficiently close genetically to humans. In recent years, progress in liver surgery has opened new possibilities in surgical treatment of liver diseases. Because the methods are relatively novel, various improvements are still needed, and it is thus helpful to conduct experimental surgeries on pig livers. We reviewed the literature to compare the anatomic and functional features of pig and human livers, information that will be of great importance for improving surgical techniques. During the literature review, we used various sources, such as PubMed, Scopus, and veterinary journals. Our results were summarized in diagrams to facilitate understanding of the vascular structure and biliary systems. We conclude that, although the shapes of the human and pig livers are quite different, the pig liver is divided into the same number of segments as the human liver, which also shows a common structure of the vascular system. Thus, with the anatomic and structural features of the pig liver taken into account, this animal model can be used in experimental hepatic surgery.

INTRODUCTION:Low anterior resection (LAR) with total mesorectal excision (TME) represents the gold standard for patients with low rectal carcinoma. Protective ileostomy (PI) is commonly performed during LAR in an effort to protect low rectal anastomosis. The aim of this study is to analyse outcomes in our own patient population, focusing on morbidity associated with PI.METHOD:A retrospective clinical study of patients operated on between 2013 and 2015 was conducted in University Hospital Ostrava. All patients after LAR with PI due to low rectal cancer were included. The study design did not require randomisation.RESULTS:A total of 52 patients who underwent LAR with PI were included. Mean tumour height was 9.1±2.3 cm. 15.4% of the patients were classified as ASA I, 53.8% were classified as ASA II and 32.7% of the patients as ASA III. 30-day postoperative morbidity was 38.5%, and complications associated with PI (within 30 days after LAR) occurred in 7 (13.5%) patients. Three of these patients underwent urgent surgical revision due to small bowel obstruction (PI semirotation around its longitudinal axis in two patients and volvulus of the small bowel around PI in one patient). Mean time interval between PI creation and reversal was 252 days. During this period, complications associated with PI were detected in 25 (48.1%) patients; seven patients had more than one complication. Minor complications (such as peristomal dermatitis, stoma herniation or bleeding, wound infection after stoma reversal) were observed in 17 (32.7%) patients. Major complications (small bowel obstruction at the site of PI, dehydration due to high stoma output, intraabdominal abscess after stoma reversal) occurred in 8 (15.4%) patients.CONCLUSIONS:PI offers protection to low colorectal or coloanal anastomosis in rectal cancer surgery. However, this benefit is counterbalanced by a high risk of various complications which may occur during the whole period when PI is present. The decision for diversion should therefore be made only after careful consideration.Key words: rectal cancer - low anterior resection - laparoscopy - protective ileostomy - stoma complications.

INTRODUCTION:Laparoscopic surgery is a standard and preferred modality of surgical treatment. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to approach laparoscopic liver resections in selected patients. Initially operations were performed for benign and peripheral lesions, but nowadays more than 50% of total laparoscopic surgery is due to malignancy.METHOD:We conducted a literature search using Pubmed; by entering the keywords "Laparoscopic Liver Resection" we obtained a set of publications focused on this issue. We limited the selection to the period from 1991 to the present. Additionally, the selection was limited to reviews, prospective randomized trials or cohort studies. Also, we selected publications in the English and Czech languages.RESULTS:On the basis of the search, we identified 2345 publications, of which the abovementioned criteria were satisfied by 319 papers. Of these, 312 publications were in English and 7 in the Czech language. 59% of the searched publications were published in the last 5 years, which gives evidence of progression of the laparoscopic liver resection method.CONCLUSIONS:Laparoscopic liver resections are considered as safe for both benign and malignant lesions with comparable oncological outcomes compared to open resections. They also provide better short-term results such as a shorter hospital stay, lower overall costs, lower postoperative pain, reduced blood loss, earlier intestinal recovery, generally shorter convalescence of the patient, better cosmetic results and a lower rate of complications.Key words: laparoscopic liver resections - hand-assisted laparoscopy.

INTRODUCTION:The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures.METHODS:We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms "augmented reality" and "surgery." Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review.CONCLUSIONS:The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

This paper presents the design of an innovative active capacitive electrode with a ceramic dielectric layer. The electrode meets the requirements for contactless measurement, resistance to motion artefacts and possibility to make long and repeated recordings. The proposed capacitive electrode is distinguished from other capacitive electrodes by the construction of the capacitive coupling element, which is placed on the body surface. While common capacitive electrodes use a metal plate with a relatively large surface area as the capacitive coupling element, the proposed electrode uses a dielectric ceramic layer with high permittivity and a surface area no greater than a few cm(2). In order to test the electrode, an electrocardiography (ECG) measuring system was designed. Several different dielectric materials, different sizes of the electrode surface, as well as different electronics of the electrode were compared. The results show 26 dB signal to noise ratio (SNR) for the electrode with a ceramic dielectric layer, which was put on a skin over a cotton fabric, compared to 13 dB SNR for an electrode with a metal plate with a four times larger surface area. (C) 2017 Published by Elsevier B.V.

Objectives: The aim of this prospective study was to compare the effect of two surgical methods, Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Greater Curvature Plication (LGCP), weight loss, and clinical parameters (fat, lean body mass [LBM], glycemia) on subjective perception of quality of life (QoL) regarding health and on anxiety and depression in obese patients during 12 months after the procedure. Further aim was to ascertain which clinical parameters contribute to a positive QoL after bariatric surgery. Methods: The research set consisted of 68 patients undergoing bariatric treatment (LSG and LGCP). QoL data were collected by means of the WHOQOL-BREF questionnaire, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression. Patients filled the questionnaire before the planned surgery and later 3, 6, and 12 months after the planned surgery. Results: Body mass index (BMI) and body weight decreased, all monitored clinical parameters improved, and QoL, namely physical and psychological health, improved as early as 3 months after bariatric surgery (p < 0.01). No statistically significant differences in monitored parameters were found between the surgery types. Regarding physical and psychological health, an association was determined between changes in QoL and changes in BMI and circumference of the hips. Conclusion: QoL improvement experienced after bariatric surgery is associated particularly with weight reduction and lower levels of anxiety and depression, but not with other clinical parameters.

INTRODUCTION:CT guided percutaneous drainage is currently the gold standard in the treatment of abdominal fluid collections, having substituted open surgical drainage in many cases. It burdens the patient less than surgical drainage. Its efficiency is comparable to standard surgical drainage when properly indicated. It is readily available even in smaller hospitals. However, this method can also have many complications, which originate most often from an improperly targeted drainage catheter.CASE REPORT:The authors describe a case report of a 55 years old man with a right-sided subphrenic abscess. The right ventricle of the heart was perforated during a CT guided percutaneous drainage. The bleeding was minimal, but the patient suffered a profound septic shock as a result of massive bacteremia during direct communication of the contents of the abscess cavity with blood circulation. He was operated immediately. The right ventricle was sutured, and the subphrenic abscess was drained. There were no complications after the operation, and the patient was discharged on day 17 after the surgery.CONCLUSION:The CT guided drainage of an abdominal abscess or a fluid collection in a risk area should be preferably done in hospitals whose therapeutic portfolio also includes the handling of serious complications.KEY WORDS:heart injury drainage.

Uvod: Sleeve gastrectrectomy (SG) je jako samostatna bariatricko-metabolicka operace ve světě použivana od roku 2003 a v Ceske republice je použivana od ledna 2006. Cilem sděleni je shrnout problematiku sleeve gastrectomy - tubulizace žaludku v Ceske republice v průběhu 10 let od roku 2006 do roku 2015.

INTRODUCTION:Sleeve gastrectomy (SG) as a single bariatric/metabolic procedure has been performed since 2003 in the world, and since 2006 in the Czech Republic. We report 10 years experience with SG in the Czech Republic from 2006 to 2015.METHOD:Prospectively collected data from 14 surgical departments was evaluated retrospectively using descriptive statistics for every year from 2006 to 2015 and subsequently evaluated and compared for the entire period. The number of the patients, mean age, mean weight and BMI at the time of surgery, the number of patients with T2DM after SG, mean follow-up, mean %BMIL (% Body Mass Index Loss), distance of the starting point of the resection line from the pylorus, the size of the calibration bougie, the rate of complications, and the number and type of conversion procedures were evaluated.RESULTS:4134 sleeve gastrectomies were done in the Czech Republic from 2006 to 2015 with the mean follow-up of 32.9 months (range 2145 months) from the procedure. The mean weight at the time of surgery fluctuated between 114.2 kg and 128.9 kg; mean BMI fluctuated between 42.3 and 46.7. Mean %BMIL was 63.2% for the entire evaluated period. The distance of the starting point of the resection line from the pylorus changed from the mean 6.1 cm (range 67 cm) to mean 4.2 cm (range 36 cm) and the size of the calibration bougie changed from the mean 39.2 F (range 3642 F) to mean 37.1 F (range 3542 F). As regards early postoperative complications, bleeding from the resection line occurred in 1.4% and a leak from the staple line occurred in 1.1%. The gastroesophageal reflux disease and hiatal hernia occurred in 17.3% as the most frequent late complications. Conversion to another bariatric procedure was approached in 3.8% in the event of an unsatisfactory effect of the SG.CONCLUSION:Bariatric or metabolic surgery, respectively, is a safe and effective surgical method for the treatment of severe obesity and T2DM in morbidly obese patients. Currently, SG is the most widely used bariatric/metabolic procedure in the Czech Republic as well as in most other countries and the long-time results are similar in comparison with other authors.Key words: bariatric surgery - sleeve gastrectomy - resection line - complications.