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INTRODUCTION: Schwannomas are a group of well differentiated benign tumors originating from the Schwann cells of the peripheral nervous system. Their localization in the pelvis is very rare. Schwannomas with expansive growth can cause wide neurologic symptoms or oppression of pelvic organs. CASE REPORT: The authors present a case study of a 60-year-old woman with a large, symptomatic deep pelvic schwannoma. The patient underwent robotic-assisted surgery resulting in complete tumor extirpation. The patient's postoperative course was uneventful with a total of two hospitalization days. The diagnosis of a schwannoma was confirmed by histopathologic analysis. At 11-month follow-up surveillance the patient did not present any neurological deficit or other symptoms. CONCLUSION: Robotic-assisted surgery allows safe and effective surgical treatment in difficult-to-access anatomical areas. Magnetic resonance imaging is required for preoperative imaging of neurogenic tumors. Histological verification is not recommended in cases where evidence of a schwannoma is found. Multidisciplinary cooperation of a dedicated team experienced in minimally invasive pelvic surgery is necessary.

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INTRODUCTION: Multidisciplinary teams (MDTs) have become a standard part of treating oncological patients. Based on the available data, they have lead to significantly higher survival rates in the treatment of colorectal cancer (CRC). Reported negatives include potentially longer times between diagnoses and the start of appropriate treatment, and the lack of quality controls over the MTDs actions. This report aims to assess the benefits of MDTs using our own data set for 2017. METHODS: Year 2010 saw the institution of an MDT at the Central Military University Hospital in Prague, with the obligation to refer CRC patients to the MDT before the start of treatment. Having standardized the registration, we have implemented a simple procedure to track the quality of our MDTs involvement and its patient benefits: number of patients, number of referrals with proposed diagnostic and therapeutic procedure, frequency and reason of changes to original strategies, and the frequency of variations from the MDTs conclusions. RESULTS: 405 CRC patients were referred to the MDT in 2017; we have found 499 referrals in this group. The data set was formed predominantly by men (61%), with the mean age of 63 (21-91), and the median age of 64.5 years. Surgical treatment was the most commonly proposed procedure (59%), followed by systemic treatment or, as the case may be, radiotherapy. In 24% of the cases, the conclusion did not match the originally proposed procedure. The decision not to go through with the proposed surgical treatment was the most common change (66 %). We have found a difference in the quality of referral in patients examined specifically by the referring doctor, as opposed to patients whose medical records have just been sent in. We have found therapeutic variation in the MTDs conclusions in less than 5% of patients. CONCLUSION: Having analyzed our data for CRC patients referred to the MDT in 2017, we have found out that in 24% of the patients, the MDT referral leads to a change in the originally proposed diagnostic and therapeutic procedure. Consensus among the MDTs members on the CRC patients treatment guarantees an optimum procedure. What is fundamental is that the referring doctor knows the patient. Constant tracking of the MDTs outputs forms a condition for sustaining the quality of its work and a base for assessing its benefits to the patients.

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INTRODUCTION: Acute appendicitis is the most common cause of intra-abdominal emergency surgery worldwide. The approach to its treatment keeps changing. The number of acute appendectomies has been decreasing. Many patients are treated conservatively with success. Our study compares conservative and surgical treatment of acute appendicitis, including its complications in our department. METHODS: We retrospectively analyzed the group of 117 patients hospitalized with the clinical diagnosis of acute appendicitis. We distinguished patients with complicated and uncomplicated appendicitis, and patients operated and treated conservatively. We evaluated complication rates and recurrences of the disease, respectively, in 1-year follow-up. The Student t test and Fishers exact test were used for the statistical analysis. RESULTS: In 2012 we hospitalized 117 patients with acute appendicitis: 83 patients (71%) for uncomplicated and 34 (29%) for complicated appendicitis. 41% of patients with complicated and 13% with uncomplicated appendicitis (p=0.02) were treated conservatively. Conservative treatment or laparoscopic surgery, respectively, were used more often in women ( p0.001). There was no failure of conservative treatment. Perioperative morbidity was 13%. No patient died. 6 patients (24%) of the conservatively treated group were hospitalized in the subsequent year for recurrent problems. 4 (16%) were reoperated. The rate of negative appendectomy (negative pathological findings) was 11%. The hospitalization time was shorter in patients treated conservatively or using laparoscopy, respectively, compared to the group of patients undergoing appendectomy. CONCLUSION: In the modern era of available complementary examinations and a broad spectrum of antibiotics the conservative approach is favoured as a treatment of complicated appendicitis. Conservative treatment of uncomplicated appendicitis is an option, but not the method of choice. Routine elective appendectomy after successful conservative treatment is groundless. Laparoscopic appendectomy is associated with lower morbidity than open appendectomy. Despite the available tests and scoring systems the negative appendectomy rate remains high. KEY WORDS: appendicitis - appendectomy - laparoscopy - antibiotic treatment.

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BACKGROUND: The authors examined the incidence of musculoskeletal injuries according to their type and location in the period of winter at a highland hospital, which also functions as a regional hospital for a few winter sport resorts. METHODS AND RESULTS: . In the sample there were 1644 patients (696 women, 948 men) treated for primary musculoskeletal injuries from 1.1. to 31.3.2008. This was a retrospective study; the data were collected from medical reports. It included: age, sex, mechanism of injury, diagnosis and whether the patient had to be hospitalised or not. Age of the patients ranged from 1 to 95 years with an average of 29 years (31 for women and 28 for men). Younger age groups dominated among men. After 70 years of age there was a prevalence of women. Fractures were the most common cause of injury (653, 39.7%), followed by injuries to the joints' ligamentary apparatus by mechanism of distortion (379, 23.1%). Next in incidence were soft tissue injuries caused by contusion (325, 19.7%) and open wounds (241, 14.7%). The least common were luxated joints (43, 2.6%) and closed injury to muscles and tendons (3, 0.1%). The most frequent site of injury was the hand (404, 24.6%), while the least frequent place was the thigh (17, 1.0%). CONCLUSIONS: In conclusion the study confirmed that other than the age, gender and the season, the geographic location also influences the spectrum of musculoskeletal injuries. The study also showed that the most common type of injuries was that of the upper extremity. The study did not confirm the expected prevalence of fractures among women. The prevalence of men was probably because of the prevalence of winter sport activities as a leading cause of injury (mostly skiing and snowboarding).

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