The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL varies between 2.5 and 20% 2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined6, 7

The C-seal trial:colorectal anastomosis protected by a biodegradable drain fixed to the anastomosis by a circular stapler, a multi-center randomized controlled trial

Background: Anastomotic leakage is a major complication in colorectal surgery and with an incidence of 11% the most common cause of morbidity and mortality. In order to reduce the incidence of anastomotic leakage the C-seal is developed. This intraluminal biodegradable drain is stapled to the anastomosis with a circular stapler and prevents extravasation of intracolonic content in case of an anastomotic dehiscence. The aim of this study is to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses, as assessed by anastomotic leakage leading to invasive treatment within 30 days postoperative. Methods: The C-seal trial is a prospective multicenter randomized controlled trial with primary endpoint, anastomotic leakage leading to reintervention within 30 days after operation. In this trial 616 patients will be randomized to the C-seal or control group (1:1), stratified by center, anastomotic height (proximal or distal of peritoneal reflection) and the intention to create a temporary deviating ostomy. Interim analyses are planned after 50% and 75% of patient inclusion. Eligible patients are at least 18 years of age, have any colorectal disease requiring a colorectal anastomosis to be made with a circular stapler in an elective setting, with an ASA-classification Discussion: This Randomized Clinical trial is designed to evaluate the effectiveness of the C-seal in preventing clinical anastomotic leakage. Trial registration: NTR308

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well. Copyrigh

The steel construction of a sports hall

Obsahem bakalářské práce je návrh a posouzení konstrukčních prvků ocelové sportovní haly situované v Liberci. Objekt má obdélníkový půdorys s rozměry 42,0 x 31,2 m a výšku 11,7 m. Nosná konstrukce je tvořena sloupy a obloukovými příhradovými vazníky. Vzdálenost příčných vazeb je 5,25 m. Statický výpočet zahrnuje posouzení hlavních nosných částí včetně detailů a spojů. Konstrukce je navržena z oceli S235 a S355. Opláštění tvoří sendvičové panely.The subject of this bachelor’s thesis is the design and assessment of the structural elements of the steel sports hall, which is situated in Liberec. The plan dimensions of the structure are rectangular 42,0 x 31,2 m. The height of the structure is 11,7 m. The supporting structure consist of columns and arched truss girders. The distance of each cross links is 5,25 m. Statics calculation contains assessment of the main load-bearing parts of the structure, including details and joints. The structure is made of steel class S235 and S355. The cladding consist of sandwich panels.

Pedestrian bridge

The subject of this master’s thesis is the design and assessment of footbridge in Železný Brod across the Jizera river. The preliminary assessment contains 3 different variants of footbridges. Based on the multi-criteria analysis will be chosen the most suitable type for detailed design. Detailed static analysis contains assessment of the main load-bearing parts of the structure including joints. The length of span is 60,0 m and the width of passage is 2,5 m. The structure is made of steel class S355 and S460

Pedestrian bridge

Předmětem této diplomové práce je návrh a posouzení lávky v Železném Brodě přes řeku Jizeru. Předběžné hodnocení obsahuje 3 různé varianty lávkových mostů. Na základě multikriteriální analýzy je zvolena nejvhodnější varianta pro detailní posouzení. Podrobný statický výpočet obsahuje posouzení nosných částí konstrukce a spojů. Délka rozpětí je 60,0 a volná šířka na lávce 2,5 m. Konstrukce je vyrobena z tříd oceli S355 a S460.The subject of this master’s thesis is the design and assessment of footbridge in Železný Brod across the Jizera river. The preliminary assessment contains 3 different variants of footbridges. Based on the multi-criteria analysis will be chosen the most suitable type for detailed design. Detailed static analysis contains assessment of the main load-bearing parts of the structure including joints. The length of span is 60,0 m and the width of passage is 2,5 m. The structure is made of steel class S355 and S460.