Solitary fibrous tumors (SFT) represent a heterogeneous group of primary pleural neoplasms with a low incidence rate and of which the biological origin, which consists of mesenchymal cells, is uncertain. The authors present herewith a retrospective analysis of 22 patients with SFTs who were diagnosed and surgically treated between the years 2000-2015. The preoperative tumors were successfully verified morphologically by transthoracic core needle biopsy under CT control in 27.3% of patients. Surgical approaches were either posterolateral thoracotomy or videothoracoscopy. The follow-up median was 45 months (range 1-188 months). Twenty tumors were surgically removed radically, two tumors were found to be unresectable due to the considerable tumor size. From histological point of view 81.8% of tumors were SFT with low malignant potential, 18.2% of tumors with high malignant potential. Despite the radical extirpation of the SFT, it relapsed in two patients. The gold standard of SFT treatment is radical surgical removal; however, patients at risk of recurrence require additional follow-ups. The results of adjuvant therapy in recurrent and malignant forms of SFTs are the subject of discussion and further study.

Introduction: Clear cell renal cell carcinoma (ccRCC) is the most common kidney tumor. If feasible, metastasectomy is preferably indicated in metastatic disease. Objective: The aim of this study was to determine the outcome of patients after pulmonary metastasectomy (PM). Methods: PM for ccRCC was performed in 35 patients in the period of January 2001–2019. Clinical characteristics, type of surgery, histopathology results, and follow-up data were recorded. Progression-free survival (PFS) after PM and overall survival (OS) were defined as outcome endpoints. Results: A total of 77 PMs were performed in 35 patients after nephrectomy for ccRCC. The mean size of pulmonary metastasis was 19.0 mm (4–90). With a median follow-up after PM of 79.2 months, the 3- and 5-year OS rates were 63.5 and 44.9%, respectively. The only statistically significant prognostic factor affecting both PFS (p = 0.019) and OS (p = 0.015) was the dimension of pulmonary metastases. Conclusions: The prognosis of metastatic ccRCC is generally poor, particularly in cases of larger size of metastasis. PM might improve the individual prognosis of patients with lung metastasis even in cases with higher number of metastases, bilaterality, synchronous metastasis, or a short progression-free interval after nephrectomy.

Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.

Einführung: Thoraxinstabilitäten bei ausgedehnten Brustkorbverletzungen gehören zu den schwersten Thoraxtraumen mit einer hohen Komplikationsrate und Mortalität, was besonders aus ihren pathophysiologischen Folgen für den Respirationstrakt resultiert. Ziel: Retrospektive Analyse einer Gruppe von Patienten, die während eines Zeitraumes von fast zehn Jahren durch Stabilisierungsoperationen mit Hilfe des Instrumentariums der Firma Medin a. s., Nové Město na Moravě, therapiert wurden. Patienten und Methodik: Vom Ende 1997 bis Ende Juni 2006 wurden an den Kliniken der Autoren 40 Verletzte (35 Männer und 5 Frauen) mit einem Durchschnittsalter von 50,4 Jahren durch Osteosynthese des Brustkorbs behandelt. Fast drei Viertel der Fälle machten Serienrippenstückfrakturen vom Typ flail chest aus, entweder als isolierte Verletzungen oder in Kombination mit einer Sternumfraktur. Verletzungen durch Verkehrsunfälle herrschten vor (75 %). In mehr als drei Viertel der Fälle waren die Thoraxinstabilitäten Folge schwerwiegender Polytraumen. Ergebnisse: Zur Osteosynthese wurden im Durchschnitt 4 Schienen verwendet. Bei 26 Verletzten wurde die Indikation zur Operation auf Grund der Brustwandinstabilität gestellt, bei 9 Personen ging eine Thorakotomie mit Versorgung einer intrathorakalen Verletzung voran. Die operative Stabilisierung wurde im Durchschnitt 3,7 Tage nach der Verletzung vorgenommen. Die Dauer der anschließenden künstlichen Beatmung überschritt in der Regel nicht eine Woche. In unserem Krankengut starb ein Verletzter an einer Sepsis bei beidseitiger Bronchopneumonie (2,5 %), postoperative Komplikationen traten bei einem Fünftel der Kranken auf, einer Nachoperation wurden 16 Patienten unterzogen. Nach Ablauf von durchschnittlich 11 Monaten wurden die Implantate bisher bei 12 Patienten (30 %) entfernt. Folgerung: Die Erfahrungen der Autoren mit der osteosynthetischen Stabilisierung der Brustwand sind durchaus positiv. Ausschlaggebend für die Wahl des Verfahrens ist die richtige Indikationsstellung, bzw. Auswahl der Patienten, die von einer operativen Stabilisierung profitieren können. Introduction: Chest wall instabilities after extensive injuries of its skeleton belong to the most serious chest trauma with a relatively high rate of complications and mortality, mainly due to its pathophysiological consequences for the respiratory system. Objective: Retrospective analysis of an almost ten year file of injured patients treated with surgical stabilisation using instrumentation from Medin a. s. Company, Nové Město na Moravě. Patients and methods: From the end of 1997 to the middle of 2006, 40 patients were treated with metallic fixation of the chest by the authors; including 35 men and 5 women with an average age of 50.4 years. Almost Ÿ of the cases represented block fractures of the ribs, flail chest type, separately or in combination with a fracture of the sternum. Traffic accidents predominated in the mechanisms of injury (75 %). More then three fourth of chest instabilities resulted from severe polytrauma. Results: On average 4 plates were used for metallic fixation, 26 patients were indicated for the procedure directly due to chest wall instability; thoracotomy preceded in 9 patients with treatment of intrathoracic injury. Surgical stabilisation was performed in the mean on the 3.7^th day after injury. The period of subsequent artificial pulmonary ventilation usually did not exceed a week. One patient in the file died on sepsis due to bilateral bronchopneumonia (2.5 %), postoperative complications occurred in one fifth of patients, re-operation was performed in 16 patients. After a period of 11 months on average the implants were so far removed in 12 patients (30 %). Conclusion: Our experience with metallic fixation of the unstable chest wall is mainly positive. Decisive for the success of this procedure is the correct indication respectively selection of patients that will have a benefit from the surgical stabilisation.