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Biomedical subjects

A Ferko

Publications and source records attributed to A Ferko.

At least 19 recordsLinked to original sources
PubMed2006

Temporary liver blood-outflow occlusion increases effectiveness of radiofrequency ablation: an experimental study on pigs.

AIM: To evaluate the feasibility of liver blood outflow (LBOF) occlusion and its impact on the effectiveness of radiofrequency ablation (RFA). METHODS: The experiment was performed on 10 pigs. The animals were divided into groups A and B according to RFA protocol. In group A (n=5) the RFA time was that taken to reach the target temperature of 105 degrees C, whereas group B (n=5) had a constant RFA temperature of 105 degrees C and constant time of 8min. The liver blood flow (LBF) was quantified using Doppler ultrasonography before LBOF occlusion and after that. RFA were performed using an expandable 3cm RF needle. Two liver ablations created in different liver lobes were compared; the first ablation was created before balloon inflation and the second one was created under LBOF occlusion. The time required for RFA procedure, liver ablation volumes, shape and microscopic changes of the thermoablated zones were recorded. RESULTS: The LBF dropped significantly in all liver vessels after balloon inflation. The volume of the ablated area was 8.2+/-2.2cm(3) and increased significantly after LBOF occlusion to 17.4+/-3.8cm(3) (p<0.001), in group A. A significant enlargement of the ablated area with occluded LBF was registered in group B, it was 6.7+/-2.8cm(3) versus 19.4+/-1.8cm(3) respectively (p<0.01). CONCLUSIONS: Temporary LBOF occlusion led to a significant reduction in liver blood flow, enlargement of the thermoablated area volume and homogeneity of the coagulated zones.

Animals↗
PubMed2006

Intraoperative enteroscopy: ten years' experience at a single tertiary center.

BACKGROUND AND METHODS: Intraoperative enteroscopy is an invasive technique for small bowel investigation. It enables us to investigate the entire small intestine and to treat pathological findings by endoscopic or surgical means at the same time. The investigation is invasive and that is why the proper indication is mandatory. RESULTS: Forty-one intraoperative enteroscopies were performed at our center within a 10-year period. The procedure was diagnostic in 37/41 patients (90.2%); in 3 patients no pathology was found, and in 1 patient we found only previously diagnosed celiac disease. The investigation was therapeutic in 35/41 (85.4%) patients; 2 patients with small bowel ulcers did not require any intraoperative therapy. The pathological findings were arteriovenous malformations (found in 12 patients), small bowel NSAID-induced or Crohn's ulcers (8 patients)--ulcerations and arteriovenous malformations were simultaneously found in three patients; carcinoid of the small intestine (5 patients); Peutz-Jeghers syndrome (5 patients); bleeding polyps (2 gastrointestinal stromal tumors, 1 paraganglioma, and 1 lipoma--in 4 patients); Rendu-Osler-Weber disease (2 patients); multiple cavernous hemangiomas in blue rubber bleb nevus syndrome (1 patient); Henoch-Schönlein purpura (1 patient); aortoenteral fistula (1 patient); and retrograde intussusception of Meckel's diverticulum (1 patient). In five patients with Peutz-Jeghers syndrome, 6-22 hamartomas (median of 18 per session) were removed by means of endoscopic polypectomy during intraoperative enteroscopy. There were no major procedure-related complications in our series. CONCLUSIONS: Intraoperative enteroscopy is accepted as the ultimate diagnostic procedure for complete investigation of the small bowel. Despite the introduction of double-balloon enteroscopy into clinical practice, intraoperative enteroscopy will be reserved for those cases where double-balloon enteroscopy cannot be performed or fails to investigate the entire small intestine, especially to prevent excessive bowel resection.

Adolescent↗
PubMed2006

A modified radiofrequency-assisted approach to right hemihepatectomy.

AIMS: To evaluate a modified radiofrequency-assisted approach to right hemihepatectomy. METHODS: Following a bilateral subcostal incision and intraoperative ultrasonography, the liver was mobilized in the standard manner, and a cholecystectomy was performed. The portal vein was isolated, encircled, and ligated. After demarcating the liver parenchyma, coagulation necrosis was achieved using a radiofrequency-assisted device along the line demarcated for transecting the liver parenchyma. The actual transection of the liver parenchyma and the right portal vein was done using a surgical scalpel along the radiofrequency-coagulated line. The right hepatic vein was coagulated using the radiofrequency sealer or by stitching in the resection plane. The hepatic artery was not dissected and was sealed together with the bile ducts in the resection plane using the radiofrequency instrument. The hepatic vein was not divided. RESULTS: Between July 2005 and July 2006, a total of 49 liver resections were performed in our unit. Of these, the radiofrequency-assisted technique was used in 33 cases with metastatic disease; 14 of these cases had right hemihepatectomies, including 2 repeat resections. The mean operation time was 180min (range, 120-240min), and the average blood transfusion was 0.14U (range, 0-2U). Postoperatively, there was no morbidity, such as bleeding, infection, or biliary fistula, related to the liver resection technique, and no patients died as a result of surgery. In 8 out of the 14 right hemihepatectomies, a right-sided pleural effusion was observed; 3 of them required evacuation. CONCLUSION: This paper describes a modified radiofrequency-assisted hemihepatectomy, which allows one to obtain control of the portal blood flow going into the resected part of liver. The modified approach appears to be simple and safe.

Catheter Ablation↗
PubMed2006

[Radiofrequency assisted liver resection in non-cirhotic liver. Initial clinical experience].

AIM OF THE STUDY: To evaluate the radiofrequency assisted liver resection using Habib sealer (RITA Medical System, Inc., Mountain View, CA). METHODS: The operation time, liver transection time, transfusion units used, and postoperative complications were recorded in a prospective way. RESULTS: 22 liver resections were performed between July 2005 and December 2005, 15 of them were done using radiofrequency technique. Twelve anatomical resections and three non-anatomical resections were performed in total. The mean operation time equalled 155 (120-240) minutes. An average of 0.6 (0-4) transfusion units was used. In 13 of the 15 operations, which represent 86% of the patients, no transfusions were used. Postoperatively, no major bleeding from the resection plane was noted and no biliary fistula was observed. CONCLUSIONS: Radiofrequncy assisted liver resection is a safe technique with the major benefit of minimal perioperative blood lost.

Catheter Ablation↗
PubMed2006

Military surgery at the turn of the century.

The authors present a summary of current postgraduate education status in the field of military clinical specializations with the focus on surgery and military surgery. Recent organizational changes in medical care within the Czech Army, along with changes associated with the new legal directives regulating the acquirement of professional and specialized medical qualification, will require a new approach to the training of surgeons and other physicians in the Czech Republic. This will involve new educational goals, adaptation of specialized curricula and introduction of systematic quality measurement methods of teaching and training.

Czech Republic↗
PubMed2005

A rare cause of mediastinal expansion with a massive pleural effusion.

The authors present a case of a 53 year old woman, who was admitted to hospital because of an unusual cause of massive pleural effusion. During diagnostic examination the mediastinal propagation of the pancreatic pseudocyst was discovered as a complication of the chronic calcifying pancreatitis. The patient was operated on and the pseudocyst was resolved by Roux-en-Y cystjejunostomy. The diagnostics and treatment of this unusual pancreatic pseudocyst spreading is discussed.

Anastomosis, Roux-en-Y↗
PubMed2005

[Elective standard appendectomy versus elective laparoscopic appendectomy in women. A retrospective study].

AIM: Comparison of open appendectomy and laparoscopic appendectomy with focus on the wound infectious complications. METHODS: Retrospective comparison of the early postoperative complications of the elective open and elective laparoscopic appendectomy in the Surgical Clinics of the Teaching Hospital Hradec Králové in period January 2001-July 2004. RESULTS: 250 elective appendectomies in women were performed in followed period. 187 (75%) were done by laparoscopic approach, 63 (25%) by open procedure. Conversion was necessary in 18 cases (9.6%). The average hospital stay was statistically significantly shorter following laparoscopic than open appendectomy, 4.6 +/- 1.5 days counter to 6.1 +/- 1.6. The global morbidity was comparable in both groups 15%, one patient died (0.5%) in laparoscopic appendectomy group. The incidence of early postoperative complications was not statistically different in both groups. CONCLUSIONS: The average hospital stay was statistically significantly shorter following laparoscopic appendectomy. Laparoscopic appendectomy did not improve the results regarding infectious complications and was a cause of serious complications. Some of them required operational revision.

Adolescent↗
PubMed2005

[The endovascular treatment of the aortic trauma].

BACKGROUND: Traumatic injuries of the thoracic aorta are very frequent during motor vehicle accidents with sudden deceleration. Spiral CT has become the modality of choice for evaluating significant blunt trauma and grading system for aortic injury has been developed. Immediate diagnosis, introduction of antihypertensive therapy and endovascular treatment by means of stentgraft give a better chance for patients with blunt aortic injury. AIM: Prospective evaluation of results of endovascularly treated patients with blunt aortic injury. MATERIALS AND METHODS: We prospectively followed patients after endovascular treatment of acute aortic injury. Diagnosis was based on chest x-ray and CT examination. Stentgrafts were placed under fluoroscopic guidance and patients were routinely followed by CT and clinical visit. RESULTS: Between December 1999 and September 2004 we endovascularly treated seven patients (6 men, 1 woman, mean age 41.7 years) for blunt aortic injury of the thoracic aorta. Stentgraft was implanted between 5 hours and 6 days (mean 3.2 days) after injury. Seven stentgrafts were implanted in 7 patients in total. One patient died due to failure of endovascular technique for collapsed stentgraft. A new onset of lower legs paraparesis was detected in one patient. Other five patients are regularly followed (3-55 months, mean 30.7 months) without any complications. CONCLUSION: Endoluminal technique can be used successfully in the immediate repair of aortic trauma. At present time in our center, treatment by means of the stentgraft placement is the first line therapy in injured patients. It allows rapid stabilization of aortic trauma and further treatment of other injuries.

Absorptiometry, Photon↗
PubMed2005

[Amoebic liver abscess--case report].

The authors present a case of a young male, who suffered with extraintestinal form of amoebiasis-amoebic liver abscesses. The patient traveled to India two month before symptoms onset. The diagnosis based on ultrasonography and computed tomography was definetely confirmed by serological examination. Metronidazol treatment was given initially, followed by percutaneous drainage. Open surgical tretment was indicated due to failure of percutaneous treatment. Patient was discharged home in a good condition one month after surgery. At this time patient is doing well eight months after surgery.

Adult↗
PubMed2005

[Fast track in surgery].

The authors describe a newly introduced method of the perioperative care for patients hospitalized in surgical departments. The main principle of the fast track method is explained. It is based on complex and continuous approach of all professional specializations, cooperating in the process of preparation of a patient for a procedure, a procedure itself and a postoperative care. The aim of this method is to minimize the hopitalization times while maintaining the indicated diagnostic-therapeutic procedures.

Clinical Protocols↗
PubMed2004

[War surgery at the turn of the century. Some aspects of surgeon's education and preparation].

Authors describe current situation in surgical residents training in the military environment with focus on military surgery and surgery. The recent changes running in Czech Army Military Medical Service and changes associated with the new law regulating postgradual education in medical subjects require quite new approach to residents training in Czech Republic. This process will have to set up new educational goals, curricula remake and method of teaching quality measurement.

Czech Republic↗
PubMed2003

[Pigmented hepatocellular adenoma of the liver caused by long-term use of phenobarbital].

A 28-year-old female patient was operated on account of symptomatic hepatocellular adenomas of the liver. Tumours with a diameter of 10 x 11 cm in the left lobe and 9 x 7 cm in the right lober were extirpated. In the adenomas non-ferric pigment resembling the pigment in Dubin-Johnson's syndrome was detected. The patient did not use contraceptives and was treated for more than 10 years for epilepsy. The size, pigmentation, frequency of adenomas and absence of contraceptives in the case-history made the authors consider another aetiology of these adenomas. The authors discuss the possible development of adenomas of the liver as a result of long-term use of phenobarbital. As a basis they use experimental observations where this drug acts as a strong promotor of DNA synthesis and leads to the development of multiple adenomas and carcinomas in the liver of rats and mice.

Adenoma, Liver Cell↗
PubMed2003

[Intraoperative enteroscopy--personal experience from 1995 to 2002].

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

Adult↗
PubMed2003

[Echinococcal cysts in the liver and lungs].

The authors present the case of a patient with relapsing parasitic cyst of the liver and a parasitic cyst of the lungs. The patient was treated by surgery. The cystectomy of the echinococcus cyst in the liver was made in the first stage and subsequently a resection of the lung tissue containing another echinococcus cyst was made. Pharmacological therapy by the anti-helmintic drug albendazol was a part of the treatment. There were no complications during both surgical interventions and the subsequent treatment. In the scolocidal liquid of the liver cyst, echinococcus organisms were diagnosed by microscopy and documented by photography.

Adolescent↗
PubMed2003

[Sharp transsection of the parenchyma in liver resection].

UNLABELLED: Extended clinical application of total vascular isolation (TVI) in resection liver surgery made a more radical and invasive liver interventions possible as well as the application of new so far non-standard technique. The sharp transsection of liver parenchyma in vascular isolation represents a technique that could provide some advantages as compared with classical technique of finger fracture. AIMS OF THE WORK: To verify the safety of the sharp liver transsection and total vascular isolation in non-anatomical liver resection. MATERIAL AND METHODS: The experiments were performed in minipigs (N = 9). The surgical intervention was performed under aseptic conditions in general endotracheal anesthesia. After TVI the authors performed non-anatomical resection of the right liver lobe in a sharp way by the scalpel. Individual structures, i.e. branches of protobiliary triad and branches of hepatic vein were treated by stitches. In the course of operation the authors evaluated the diameter and the number of the treated structures in the resection surface, duration of the operation and duration of TVI. The blood loss during the operation, changes in blood count and hepatic enzymes were evaluated. RESULTS: The surgical intervention lasted 88.7 min (55-139 min) on the average, vascular isolation of the liver lasted 24 min (19-33 min) on the average. The mean blood loss was 193.7 ml (40-400 ml). The decrease in Hb values was 8.25 mg/l (6-11 g/l) on the average. In one resection surface the authors treated 9 (6-11) tubular structures on the average, as soon as the clamp was removed, a branch of hepatic artery had to be subsequently treated three times and a branch of portobiliary triad once. CONCLUSION: The combination of total vascular isolation and sharp transsection of liver parenchyma enable a safe management of branches of portobiliary triad smaller than 1 mm in the case of vessels as well as biliary pathways. The management of small hepatic veins, smaller than 1 mm and the branches of hepatic artery pose greater problems which are, however, related to the anatomical difference of the model.

Animals↗
PubMed2002

[Infectious aneurysm of the abdominal aorta caused by Salmonella: diagnosis, endovascular therapy].

The authors present a case of an infected abdominal aortic aneurysms by means of a minimally invasive endovascular method using a stent graft. This patient had already been treated by TIPS (transjugular intrahepatic portosystemic shunt) for repeated varicose bleeding due to liver cirrhosis. Standard surgical therapy of infected abdominal aneurysms and about advantages and possibilities of endovascular treatment with stent grafts are discussed. Regular follow-up of the patient and long-term antibiotics therapy are important for accurate assessment of an implanted stent graft into the infected abdominal aorta. Endovascular stent graft combined with antibiotic therapy may be an alternative to conventional open surgery in managing infected infrarenal abdominal aneurysms.

Aneurysm, Infected↗
PubMed2000

Autologous vein stent-graft: feasibility study.

PURPOSE: To evaluate expandable stents healed into vein wall as autologous vein stent-grafts for endoluminal grafting. MATERIALS AND METHODS: Balloon expandable stents were placed into external jugular veins of eight dogs. Stent and vein patency was followed by ultrasonography. Five weeks after stent placement, jugular veins with endothelialized stent were harvested. The autologous vein stent-grafts were divided into two groups. In group A, autologous vein stent-grafts (n = 3) were placed immediately into Baker solution for microscopic examination. In group B, autologous vein stent-grafts (n = 3) underwent mechanical manipulation; they were compressed, mounted on angioplasty balloon, pushed through a 9-F sheath and dilated. The autologous vein stent-graft endothelialization and changes after mechanical manipulation were evaluated by light and electron microscopy. RESULTS: Stent placement was successful in seven dogs. One stent migrated into the pulmonary artery. One well placed stent was damaged by compression dressing and thrombosed. At 5 weeks, gross and microscopic examinations revealed the autologous vein stent-grafts were fully covered by a 0.115- +/- 0.036-mm-thick neointimal layer. Small wall thrombus was observed in one autologous vein stent-graft. Repeated manipulations did not result in any intimal damage or stent loosening in the autologous vein stent-grafts. CONCLUSION: Expandable stents healed into a vein have potential to be used as autologous vein stent-grafts for endoluminal grafting without risk of disruption during percutaneous transcatheter introduction.

Animals↗