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A Gryga

Publications and source records attributed to A Gryga.

At least 19 recordsLinked to original sources
PubMed2004

Esophageal dysfunction in a female patient with diabetes mellitus and achalasia.

BACKGROUND: Achalasia is an infrequent disorder of esophageal motility. Diabetes mellitus is an endocrine metabolic disease, the complication of which can afflict the motor activity of gastroenteral tract. The combination of these diseases in one patient is also very rare. In this study we introduce one patient suffering from this scarce coincidence of diseases. CASE HISTORY: A 54-year-old diabetic patient who lost weight of 26 kg in one month with repeated hypoglycaemic collapse states and regurgitation of poorly digested food and saliva with maintained appetite and thirst. The diagnosis of esophageal achalasia II was proved. A standard surgical performance was chosen, namely the laparoscopic myotomy. The extent of myotomy was verified by preoperative manometry. Approximately 1 month after the surgery, intermittent mild dysphagia especially after the consumption of solid food and some sorts of fruit appeared. The suspicion of stricture in the site of myotomy led us to the performance of endoscopic and radiologic examinations. The balloon calibration of cardia did not reveal any residual muscular fibres. The supplementation of a prokinetic drug of itoprid three times a day resulted in a significant improvement of difficulties. CONCLUSION: Despite the sufficient extent of surgical treatment in a patient suffering from these two diseases, the resulting effect was not fully satisfactory. It is apparent that despite the correctly indicated and performed operation in patients suffering from a metabolic disease, the complications of which afflict the motility of upper digestive tract, the ideal response to treatment cannot be expected. The supplemented prokinetic therapy is inevitable, and informing the patient on the expected result and particular residual disorders can save both the patient and surgeon from disappointment. (Fig. 3, Ref. 8.).

Deglutition Disorders↗
PubMed2003

[Peroperative diagnostic methods during esophageal achalasia surgery. Initial experience].

AIM OF THE STUDY: The authors present their first experience with the application of esophageal manometry during the operation on achalasia of esophagus. The completeness of performed myotomy is evaluated on the basis of decreased pressure in the region of lower esophageal sphincter (LES). METHODS: Stationary pull-through four-channel manometry was performed twice during the operation: before the application of capnoperitoneum to localize LES with evaluation of its length and tonus and after the myotomy was performed after capnoperitoneum was abolished to verify sufficient extent of myotomy. The subsequent endoscopic control was used to exclude damage of esophagus mucous membrane. RESULTS: In the period of one year during 2002/2003 the authors operated on four patients with achalasia, when manometry was used for peroperative localization of LES and evaluation of the extent of myotomy. The peroperation manometry demonstrated decreased tonus of LES (the mean 42.06 mmHg before myotomia and the mean 20.03 mmHg after myotomia) and in one case the finding resulted in necessary extension of myotomia. CONCLUSIONS: Based on our preliminary experience with peroperation manometry in operations on achalasia of esophagus it may be stated that it is a useful method for objectivization of the completeness of myotomy, which does not significantly prolong the period of operation. It contrast, it makes it possible to respond to lasting hypertonic area in LES subjected to myotomy, which may be the cause of lasting complaints of patients after the operation.

Esophageal Achalasia↗
PubMed2003

[Complications after laparoscopic surgery of inguinal hernias].

AIMS: The authors describe the occurrence of complications in laparoscopic approach to treat inguinal hernias in patients operated on at 2nd Surgical Clinic in Olomouc from May 1991 to the end of the year 2002. METHODS: The occurrence of preoperation and postoperation complications and relapses in inguinal hernias treated with laparoscopy in the period of May 1991 to the end of 2002. The TAPP method was used for operation on 98% of inguinal hernias, the IPOM method for 0.9% of inguinal hernias, TEP method in 0.4% and a simple suture in operation on 0.7% of inguinal hernias. RESULTS: Five hundred and thirty four (56% of all surgically treated inguinal hernias) were treated with laparoscopy in adult patients in the period of May 1991 to the end of 2002. Eight preoperation and postoperation complications (1.4%) were encountered. These included two cases of hematoma in the wound after port (0.3%), one hematoma of scrotum (0.2%), two artificial perforations of intestine (0.3%), one case of neuralgia of n. genitofemoralis, one artificial perforation of urinary bladder (0.2%), and one postoperation hydrocele (0.2%). There were 14 relapses (2.6%) in the 534 inguinal hernias operated on with laparoscopy. CONCLUSION: Based on our experience in the solution of inguinal hernias with laparoscopy the method of transabdominally-preperitoneally localized grid (TAPP). In this method we have used three-point fixation--by a screw to pected ossis pubis and the upper margins of the grip with two transparietal stitches fixed permanently in subcutaneous tissue.

Adult↗
PubMed2003

[CHS 100P surgical mesh in inguinal hernioplasty in adults using the Lichtenstein tension-free method].

AIMS: The authors present their initial experience with surgical grid CHS 100 P with strengthened middle strip for the intestinal hernioplasty by the method without tension according to Lichtenstein. METHODS: In the inguinal hernioplasty by anterior transinguinal way in adult patients the authors use prolene grid and a surgical grid CHS 100 P with strengthened middle strip having been developed in collaboration with the Research Knitting Institute in Brno. RESULTS: From November 2001 to May 2003 56 adult patients were operated on inguinal hernia by the tensionless plasty according to Lichtenstein using a surgical grid CHS 100 P. No preoperation of postoperation complication or relapse were encountered. The patients were subject to load in the first postoperation day. CONCLUSION: Based on our first experience with flexible surgical grid with strengthened middle band CHS 100 P used for tensionless inguinal hernioplasty in adult patients according to Lichtenstein it may be concluded that the grid is well tolerated by the patients. Flexibility of the grid makes it possible to fully load inguinal area during the first postoperation day.

Hernia, Inguinal↗
PubMed2002

[Manometry in esophageal achalasia].

OBJECTIVE: Manometric findings in achalasia are pathognomic already in early clinical stages of the disease. The authors evaluate the importance of manometry in the diagnosis and therapy, in particular in early stages of the disease. METHOD: During manometry we obtain data on the function of the lower oesophageal sphincter and the body of the oesophagus. Impaired relaxation of the sphincter is evaluated, as well as increased tonus of the sphincter and tertiary contraction of the body of the oesophagus. In patients with achalasia we implement laparoscopically extramucous myotomy. RESULTS: In 1997 we started a prospective manometric study of dysphagic complaints. We examined 304 patients on account of different diseases of the oesophagus incl. 16(5.2%) where we proved or confirmed achalasia in stage I, II or III according to the radiological classification. These patients were indicated for laparoscopic myotomy. In one instance we had to convert the operation to an open one. In two instances we added partial fundoplasty according to Thal on account of perforation of the oesophageal mucosa. Four patients were subjected after a 5-12-month interval to remyotomy. Twice because of the development of a fibrous stricture at the site of myotomy and twice for an obviously inadequate original myotomy. The history of dysphagia in patients with primary operations was on average 37.3 months. CONCLUSIONS: Manometric examination of patients with functional dysphagia makes it possible to detect achalasia in early stages and to indicate in time surgical treatment. In case of a relapse or persistence of complaints manometry makes it possible to express objectively the cause which is most frequently an atonic oesophagus with inadequate evacuating capacity, stricture at the site of myotomy or inadequate myotomy.

Adult↗
PubMed1999

[Present status of minimally invasive surgery in the Czech Republic].

OBJECTIVE: The authors evaluate the contemporary state of miniinvasive surgery in the Czech Republic. METHOD: The authors made a questionnaire survey in surgical departments of the Czech Republic. Some 58% of the addressed departments (118 departments) replied. They evaluated the prevalence and use of miniinvasive techniques in 1997 in the following areas: flexible endoscopy, sonography, intervention radiology and endoscopic surgery. RESULTS: 40% of the surgical departments possess flexible endoscopes and 14% surgeons use endoscopy. Interdisciplinary collaboration is being enforced. In 54% departments endoscopy is ensured in collaboration by surgeons and gastroenterologists. Single-handed sonography was recorded among 3.2% surgeons, but 80% feel that surgeons should do sonography single-handed. Intervention radiology as an alternative to surgery is indicated by 88% surgeons. However only 1.2% surgeons participate actively in these examinations. The era of endoscopic surgery was started in the Czech Republic in 1991. At present these operations are made at all departments. The number of operations increases steadily. Thoracoscopy is used in 21% departments. In addition to cholecystectomy (100%) most frequently the following operations are made: appendenctomy--81%, inguinal hernia--67%, acute abdomen--55% and in a smaller number of departments (cca 10%) some more pretentious operations are made in the region of the oesophageal hiatus, intestinal resection etc. CONCLUSION: Endoscopic surgery replaced in some areas classical surgery. The importance of flexible endoscopy and sonography induced an ever increasing numbers of surgeons to use these methods actively. Intervention radiology is also of increasing importance and in many cases it is the preferred alternative of classical operations.

Czech Republic↗
PubMed1999

Miniinvasive approach to the treatment of liver cysts.

During the period from 1995 to 1997 we followed and treated six patients for liver cysts. Diagnostics was based not only on clinical examination but also on ultrasonography and computational tomography (CT). Surgery is applied in solving larger cysts damaging liver parenchyma and causing pressure symptomatology. Nowadays most cysts can be solved by means of laparoscopy.

Adult↗
PubMed1998

[Palliative treatment of inoperable esophageal stenoses using stents: long-term results, complications].

The authors evaluate the effectiveness of palliative treatment of inoperable oesophageal stenoses by means of self-expandable stents in a group of 102 patients and discuss complications. In all patients after implantation of the stent dysphagia improved by at least two degrees. Eighty nine patients of the group died, the mean period of survival was 107 days. At the time of evaluation 13 patients survive, the mean survival period being 175 days. As to complications the authors recorded incomplete expansion of the stent (n = 1), fissuring of the tumour (n = 1), migration of the stent (n = 8), oesophagorespiratory decubital fistula (n = 4), ingrowth of the tumour into the stent (n = 4), obstruction of the stent by food (n = 7) and arterial haemorrhage (n = 1). The effectiveness of palliative treatment of inoperable oesophageal stenoses by self-expanding stents is high and prompt. The total number of complications is 22%, the mortality after surgery is zero. The majority of complications is easily resolved by methods of interventional radiology.

Esophageal Neoplasms↗
PubMed1997

[Surgery of gastroduodenal ulcers in the Czech Republic].

OBJECTIVE: Evaluation of surgical treatment of gastroduodenal ulcers during the past 20 years and its importance at the present time. METHOD: During the past 20 years three questionnaire surveys were implemented in surgical departments in the Czechoslovak Republic (1975-57 departments, 1989-80 departments) and in the Czech Republic (1994-80 departments) focused on surgery of gastroduodenal ulcers. The authors analysed also a group of patients from their own department covering a five-year period (1990-89 operations and 1995-27 operations). RESULTS: In surgical departments of the Czechoslovak and Czech Republic the ratios of different operations during the mentioned years were as follows: 1975: resections 85%, vagotomy 9%, suture of perforation 6%. 1989: 71%, 10%, 19% and 1995: 48%, 8%, 31% and other operations 13%. In the authors department the ratio of these operations in 1990 was as follows: 23%, 23%, 10% and in 1995: 59%, 7%, 23%, 11%. The surgical approach declined in the course of five years by 70%. During the last two years in the Czech Republic and in the authors department first experience was assembled with laparoscopic suture of perforated ulcers and with superselective vagotomy. The initial results are very encouraging. CONCLUSION: The basis of treatment of gastroduodenal ulcers is modern medicamentous treatment, surgery is indicated most frequently if conservative treatment fails or in case of haemorrhage (78% of haemorrhages are controlled endoscopically). In gastric ulcers resection is indicated most frequently, similarly as in complications of duodenal ulcers. In non-complicated duodenal ulcers superselective vagotomy is an equivalent alternative of long-term conservative treatment.

Czech Republic↗
PubMed1996

[Treatment of perforating mediastinitis].

In 1986-1994 at the Second Surgical Clinic in Olomouc Faculty Hospital and Medical Faculty 23 patients with perforating mediastinitis were treated. The treatment of this serious disease is associated with a 30% lethality. The cause of its development are complications after surgery of the oesophagus, more frequently operations in the area of the cardia but also damage during instrumental treatment of the upper digestive tract. The analysis draws attention to the risk of perforation of the oesophagus in different types of operations. The author emphasize the importance of early comprehensive intensive treatment, incl. support of respiratory functions.

Esophageal Perforation↗
PubMed1996

[Retroperitoneoscopic lumbar symathectomy].

During the period between August 1995 and February 1996 at the Second Surgical Clinic of the Faculty Hospital in Olomouc 12 retroperitonescopic lumbar sympathectomies were performed on account of different indications. The authors present an elaborate technique of access into the retroperitoneum and their own technique of lumboscopic sympathectomy. The success of the method was evaluated clinically and by histological evidence of sympathetic ganglia in the collected material. Retroperitoneoscopic lumbar sympathectomy is considered a gentle and safe method which can be used also in other patients where the risk of open surgery would be excessive.

Adult↗
PubMed1994

New possibilities of miniinvasive treatment of esophageal stenoses.

We report our first very good experiences with the treatment of inoperable, especially malignant stenoses of the esophagus, with perorally inserted metallic self-expanding stents. During the period since August 1993 up to now, we have introduced 17 stents in 15 patients. We have compared the introduction of stents with other modalities of palliative treatment of esophageal stenoses, as actinotherapy, contact or focused laser, palliative by-pass surgery, classic surgical or endoscopical stenose-pertubation. In the last place for the patient stands the dismal nutrition-gastrostomy. From this point of view, the miniinvasive treatment with metallic stents is very successful, easy, well tolerated by the patients, and practically without complications. The therapeutical effect, elimination of severe swallowing-discomfort, allows especially to patient with malignancies to live terminal months of life with a relatively maximum quality of deglutition.

Catheterization↗
PubMed1994

Mediastinitis due to perforation.

The oesophageal perforation is a begining of tragedy. We present a group of patients with serious complication-mediastinitis after operations of the oesophagus or after instrumental diagnostics and instrumental treatment.

Catheterization↗
PubMed1991

[Surgical treatment of patients with paraesophageal and mixed hiatal hernias].

In 1948-1990 the authors operated 112 patients with paraoesophageal and mixed hiatus hernias. 100 patients operated in 1988 were followed up on a long-term basis. Gastroesophageal reflux was recorded before operation in 52%, haemorrhage in 18%, an ulcer in the neck in 7% an incarceration and obstruction in 9%. Before the onset of the seventies hiatorrhaphy and gastropexy were performed. During check-up examinations in these patients relapses were recorded in 47%, reflux in 43%, subjective complaints in 26%. This made the authors change the surgical procedure and in subsequent years they performed hiatorrhaphy, fundoplication, fundophrenopexy and anterior gastropexy. The incidence of relapses of hernia during check-up examinations declined to 21%, of gastroesophageal reflux to 9% and subjective complaints to 10%. The follow-up period varied between 1 and 19 years. The surgical lethality was 2%.

Adult↗
PubMed1991

[Long-term follow-up of patients with diffuse colonic polyps].

During the years from 1968 to 1984, at the First Department of Surgery in Olomouc, 10 patients with diffuse polyposis of the colon were treated. In 5 of them, a familial occurrence of polyposis was dealt with. In three of them, malignity developed. In five unfamilial polyposes, malignity occurred only once. In one patient, the occurrence of malignity was found present immediately with the first manifestation of the disease. In the other patients, it was after an interval of 3 to 17 years after the onset of the disease. Three patients died from generalization of the malignant process. In two of them, carcinoma developed in the remaining part of the colon, once after previous hemicolectomy and once after colectomy. One patient with an advanced disease died one year after proctocolectomy. Two other operated on patients survive after proctocolectomy 12 and 13 years. The other patients who had been operated on before the development of malignity are healthy. The choice of an adequate radicalintervention is of importance. Optimal is the performance of colectomy with ileorectal anastomosis and the regular endoscopic and bioptic follow-up of the stump of the intestine. When proctocolectomy is necessary, it is of advantage to apply Kock's continent ileostomy.

Adult↗