Biomedical subjects
Publications and source records attributed to A Pelikán.
The authors point out advantages of the laparoscopic approach in colorectal surgery. The laparoscopic approach is not commonly used in a number of our clinics, therefore, the authors would like to present a rectal resection procedure used in the Surgical Clinic of the Faculty Hospital in Ostrava.
The authors present results of a study of a distal intramural spread of the rectal carcinoma beneath its aboral margin, which was conducted over several years. The authors closely cooperated with the Pathological Anatomy Institute of the Faculty Hospital in Ostrava, where each preparation was examined not only macro- and microscopically, but also the tumor's microscopic spread beneath its macroscopic margin was assessed in standard distances of 2 mm, 5 mm, 1 cm, 2 cm and 5 cm. The study did not record tumorous spread at the distance of 5 cm from the aboral margin of the tumor. The authors also confirmed that the distal intramural spread of the tumor is fairly rare and, at the same time, it signifies a highly advanced and aggressive disorder with a poor prognosis. Therefore, the authors favor management with a maximum quantity of the sphincter- saving procedures, with a sufficiently radical mesorectal excision, which they consider the essential method of the radical surgical treatment. Furthermore, the authors have not recorded cases of the differenciated adenocarcinoma spread, even at the distance of 2 mm from the aboral margin of the tumor. All positive findings of the distal intramural spread have been recorded in medium- low differenciated adenocarcinomas.
The authors demonstrate a history of the rectal carcinoma surgical therapy, based on the available literature data or on oral information. Furthermore, they add their own experience with treatment of the rectal carcinoma, the disorder, which in the Czech Republic and, namely, in the Northern Moravian region, has one of the highest worldwide incidence rates.
Surgical procedures of the anus for rectal malignancies are amongst the most difficult procedures within abdominal surgery. Especially when the tumor is located in the middle and distal third of the rectum and the surgeons aim to conduct a sphincter-saving procedure, the pre-operative diagnostics is a pre-requisite for a successful treatment. The authors aim to inform the medical community on a non-traditional and rarely used examination method of the anorectal angle prior to surgical procedures of the rectal carcinomas.
The authors present an unusual and, according to the available literature data, so far unused method--management of the rectovaginal fistule, using a T.E.M. technique (transanal endoscopic microsurgery). In their case-review of a female patient, they present advantages of this technique in a case of a rare disorder - a benign rectovaginal fistule. All of the following employment of a harmonic scalpel in the T.E.M. method, as well as of a tissue adhesive Tissucol and of a surgical rectoscope in the vaginal phase of the procedure, deserve attention of surgeons and gynaecologists.
The authors present their own initial experience with virtual colonoscopy. Both benign and malignant stenosing processes of the colon and rectum, which make examining oral parts of the colon using colonoscopy or irrigography impossible, are the main indication for the procedure described. The authors' first experience with this method is totally positive. The more experienced the examiners, the better interpretation of the findings not only by radiologists but also by operating surgeons. In certain indications, the examination has its firm place in the algorithm of the facultative examinations prior to the colorectal carcinoma surgical procedures.
The authors present a summary of literature data and their own experience with management of locally advanced rectal carcinomas. They prefer advanced surgical procedures, such as pelvic exenterations, and urge for preserving "quality of life".
The author wish to submit information on the use of a new method of surgical therapy of haemorrhoids about which they acquired information at a workshop of Ethicon Co. in Ljubljana (Slovenia). At the same time they want to demonstrate their first experience with introduction of the new method into practice.
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The paper deals with pancreatic abscess as one of three entities of pancreatic infection. In spite of the common origin with infected pancreatic necrosis and infected pancreatic pseudocyst, the treatment of each kind of pancreatic necrosis has its own requirements. By comparing 30 pancreatic abscesses (mortality 18%), 29 infected pancreatic pseudocysts (mortality 6%) and 35 infected pancreatic necroses (mortality 43.5%) we concluded that the best treatment for pancreatic abscess is surgical evacuation with external drainage, for that of infected pancreatic pseudocyst internal drainage operation, and for infected pancreatic necrosis surgical debridement with external drainage, lavage and open-abdomen procedure. Differences in CT scan, treatment and prognosis require different surgical approach to each type of pancreatic necrosis. (Fig. 3, Ref. 24.)
The study compares three diagnostic procedures, the analysis of which is aimed at a choosing the optimal extent of resection on the thyroid. Diagnostic procedures, when based on clinical examination (palpation, scintigraphy, laryngoscopy, X-ray), lead to the optimal extent of resection in 74.2% of patients. Procedures selection performed on the basis of fine-needle aspiration cytology (FNAC) results lead to the correct extent of resection in 93.1% of patients. The procedures of frozen section lead to the correct resection extent in 81.3% of patients. (Tab. 1, Fig. 1, Ref. 25.)
The paper summarizes experience with diagnosis and surgical treatment of insulinomas of the pancreas. Experience with three patients subdued to surgical treatment at the Department of Surgery of F.D. Roosevelt Hospital in Banská Bystrica confirm the rules of effective treatment of insulinomas: importance of neurological symptoms in early diagnosis, importance of angiography as the best method for localization of insulinomas in comparison with ultrasonography and CT. In addition, algorithm of the surgical treatment of insulinomas together with the specificity of the surgical technique were confirmed.
The authors describe two patients with breast cancer which was manifested during pregnancy. The authors deal with diagnostic and therapeutic possibilities, depending on the stage of disease and the stage of the pregnancy. A delay of the diagnosis and adjuvant therapy deteriorates the prognosis of this disease.
Authors describe all limiting factors influencing resectability of pancreatic carcinoma: invasion to the large vessels, lymphnode involvement and diffuse intrapancreatic tumor spread. Described is how to solve vascular involvement, how and why to perform radical lymphadenectomy and necessity of perioperative histological examination of resection border. On the group of 21 patients with pancreatic resection for carcinoma authors compare their results and experience with procedures recommended in literature.
The authors present results of modality and immunomodulating treatment of breast cancer. In the treatment they use levamizole (Decaris) which has useful properties, as compared with other immunomodulating drugs--accurate dosage, simple administration and good tolerance. In a group of 84 patients it was administered after operation after adjuvant chemotherapy with Cyclophosphamide in a total dose of 300 mg orally, making check-up examinations of leucocytes and thrombocytes. As to other laboratory parameters, the authors assessed transaminases, alkaline phosphate, immunoglobulin, T-lymphocytes and carcinoembryonic antigen. During the same period the survival of patients in this group was significantly higher, as compared with a group of patients formerly treated by adjuvant chemotherapy with Cyclophosphamide without levamizole. Comparison of the results with those of other authors indicates that it is correct to include immunomodulating treatment in comprehensive treatment of breast cancer.
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