PubMed Health⌕ Search

Biomedical subjects

B Certík

Publications and source records attributed to B Certík.

12 recordsLinked to original sources
PubMed2005

[An inflammatory aneurysm of the abdominal aorta].

Inflammatory aneurysm of the abdominal aorta is a rare disorder, affecting approximately 3-10% of the population with a diagnosis of the abdominal aortic aneurysm. The principal etiological agents of the disorder include bacterial microorganisms, primarily Salmonella, Staphylococcus aureus, and Escherichia coli. However, in many cases the etiology od the disorder remains unclear and, likely, autoimmune and genetic dispositions may play a certain role, as well. The principal diagnostic procedures include ultrasound, CT and MRI examinations. The principal therapeutic procedures include open resection of the inflammatory aneurysm with complete removal of the infectious tissue and its replacement by a prosthesis or a vascular allograft "in situ" or through an extraantomical reconstructive procedure. New procedures also include endovascular therapy which is technically much simpler, less demanding for a patient, however, it may leave a potential infectious focus in the organism with a risk of further septic complications to follow. Therefore, the authors recommend a strictly individual treatment strategy in each patient with this serious disorder. In case of positive cultivation bacteriological findings, extended (a minimum of 6 weeks) antibiotic therapy and regular, long-term patient follow-up with regular visits, are essential.

Aged↗
PubMed2004

[Modified eversion carotid endarterectomy].

The authors describe their own modified eversion technique of the carotid endarterectomy, which they began to carry out in the surgical clinic in Pilsen in 2002. A perfect endarterectomy of the bulbus and of the common carotid is the main advantage of this modified technique, when compared to the classical eversion technique. Later on, the authors learned from the literature that the technique was not entirely new, but a similar technique of the carotid endarterectomy had been used more than 30 years ago, already.

Carotid Stenosis↗
PubMed2004

[Acute resection in unusual cases of symptomatic aneurysms of the abdominal aorta].

On three unusual cases of symptomatic abdominal aortic aneurysms, the authors demonstrate the need for satisfactory erudition of a vascular surgeon, who must manage the above serious conditions. In the first case, the authors deal with a symptomatic aneurysm of the abdominal aorta and a homolateral dystopy of the right kidney co-existence. In the second case, the authors describe a rare, nevertheless a very serious communication between a vein and an adjacent aneurysm. In the third case, the authors prefer the left-sided retroperitoneal approach in the management of the juxtarenal AAA in combination with a "hostile abdomen".

Aged↗
PubMed2004

[Infections of vascular reconstructions in the aortofemoral region].

Infections of vascular reconstructions in the aortofemoral region are among the most feared of conditions in the vascular surgery, having a very poor prognosis. The perioperative mortality reaches over 50% and the extremity loss up to 75%. The authors point out inaccuracies in diagnostics and definitions of the vascular reconstructions infections. On four cases of the vascular reconstructions infections in the aortofemoral region which have been managed in the Surgical Clinic in Plzen in last two years, they demonstrate severity of the above conditions.

Aorta, Abdominal↗
PubMed2003

[Rupture of abdominal aortic aneurysm (RAAA)--predictors of the early postoperative mortality].

PURPOSE: To evaluate the main factors of the 30 days mortality rate of patients operated on for abdominal aortic aneurysm rupture (RAAA. PATIENTS AND METHOD: Univariate and multivariate analysis of various factors associated with RAAA was performed in a group of 73 patients operated on for RAAA between 1996-2001. RESULTS: The 30 days mortality rate was 35.6 %. The main factors of mortality were: misdiagnosis, cardio- pulmonary-cerebral resuscitation (CPCR) on admission, configuration of RAAA, number of blood transfusions, hypotension on admission (p < 0.0001) and duration of operation, type of reconstruction and hypertension in anamnesis (p < 0.01). Important factors (p < 0.05) of postoperative mortality were also low haemoglobin level on admission, abdominal aortic aneurysm (AAA) diameter and ischaemic heart disease in anamnesis. The probability of patient's death is the highest (p < 0.003), if factors like CPCR, number of blood transfusions and aneurysm diameter are combined (multivariate analysis, stepwise method). CONCLUSION: The early detection and surgical or endovascular elective treatment of AAA, the regular dispensation of patients with small AAA especially in hypertonics, the correct diagnosis of RAAA without time delay are the best tools for patients survival. The patient's chance for survival increases with highly trained prehospital resuscitation system and experienced team of vascular surgeons and anesthesiologists.

Aged↗
PubMed2003

[Abdominal aneurysm resection in aged patients at the Surgery Clinic in Plzen from 1998 to March 2003].

The authors evaluate resection therapy on aneurysms of abdominal aorta in patients of high age (mean 85 years) at the Clinic of Surgery in Plzen. In the period of 1998-March 2003 the authors performed 13 elective resections on aneurysms of abdominal aorta in patients of high age with zero mortality and 21 acute resections with 38% mortality. In the given period of time, 178 resections of aneurysms of abdominal aorta were made in patients younger than 78 years, 57 being acute interventions. Mortality of elective interventions was 2.9%, in acute interventions being 28%. The present groups indicate that mortality of resection therapy sharply increased in relation to circulation instability of the patients in cases of ruptured aneurysm, but nor in relation to age of the patients.

Aged↗
PubMed2002

[Injuries of extremity blood vessels, personal experience and results].

The authors evaluated the results achieved in 47 patients with injuries of the acral vesels where they performed a total of 50 vascular operations during the five-year period from 1998-2001. 21.3% injuries were part of multiple injuries. The mean period of hospitalization was 14.7 days. The 30-day mortality was 6.4% and the morbidity 12.8%. The upper extremity was saved in all instances (100%), the lower extremity in 77.3% of the injured. The reason for high amputations of the lower extremity were most frequently injuries of the popliteal artery associated with skeletal injury and extensive contusion of the soft tissues of the extremity. The authors discuss the optimal diagnostic and therapeutic procedures in injuries of the acral vessels. They emphasize a multidisciplinary approach without delay with early, frequently during the primary operation indicated fasciotomy, to prevent the development of compartment syndrome. The order of operations in concurrent injuries of the acral skeleton depends on the stage of ischaemia, type of injury and solution of the skeletal fractures. This type of injury frequently calls for repeated redressing in the operation theatre with repeated necrectomies of soft tissues to prevent infection which may prove fatal for the extremity. Injuries of the acral vessels should be nowadays treated in specialized departments with a 24-hour diagnostic and therapeutic traumatological service which comprises a highly specialized team of vascular surgeons.

Adolescent↗
PubMed2000

[Manifestation of popliteal aneurysm during pulse spray thrombolysis (PST)].

We report the case of a 32-year-old woman presenting with acute extremity ischemia due to thrombosis of a previously undetected popliteal artery aneurysm. The popliteal artery aneurysm was revealed by PST which was indicated for the treatment of thrombosis of the superficial femoral artery. PST was complicated by a peripheral embolism with subsequent severe extremity ischaemia. Immediate embolectomy and reconstructive vascular surgery led to a successful result. This case illustrates the diagnostic problems of a thrombosed popliteal artery aneurysm and warns of embolic complications during PST.

Adult↗
PubMed2000

[A kidney harvesting technic from a non-heart beating donor].

The authors describe the technique of collection of kidneys from NHBD. They present their own protocol elaborated in Plzen for collection of kidneys from NHBD. For collection they use a special double-balloon catheter inserted into the aorta to ensure that the perfusion fluid will penetrate into visceral branches of the aorta. For the flow of the perfusion fluid a urinary catheter is used inserted via the femoral vein into the vena cava inferior. Immediately after the beginning of perfusion laparotomy is performed with immediate cooling of the kidney with ice. The authors give an account of their own experience and discuss further technical possibilities as regards collection of kidneys from NHBD.

Cadaver↗
PubMed1999

[Small aneurysms of the abdominal aorta].

As "small" an aneurysm of the abdominal aorta is defined, the diameter of which is < 5 cm in the maximal anteroposterior or transverse diameter. The authors investigated the development of a small aneurysm of the abdominal aorta in a group of 55 patients for a period of 30 months. They evaluated also the influence of the main risk factors and firmness of the thrombus on the growth rate of the aneurysm. A statistically highly significant factor for the growth of the aneurysm was untreated hypertension (p < 0.0001). Other factors (age, smoking, diabetes, ischaemic heart disease) were not significant for the development of the aneurysm. The firmness of the thrombus correlated with its size but was not directly related to the rate of enlargement of the aneurysm. Based on their own experience and reports in the literature the authors assume that elective surgery or endovascular treatment is indicated in patients where the growth of a small aneurysm exceeds 0.5 cm in six months and also patients where the aneurysm has reached the size of 5 cm during regular check-up examinations. Untreated or inadequately treated hypertonic patients with an aneurysm 4-5 cm in diameter should be indicated for surgery sooner. The question remains whether to indicate for early surgery patients with an unchanging diameter of an aneurysm who are in a good general condition without serious risks. Elective surgery is indicated in these aneurysms in view of the low incidence of ruptures only in departments where the surgical mortality is substantially lower than 5%.

Aged↗
PubMed1997

[Role of pulse spray thrombolysis in acute ischemia of the extremities--comparison of results with the low dose technique of local thrombolysis, embolectomy and thrombectomy].

BACKGROUND: The reported mortality of patients suffering from acute limb ischemia is in the range of 10% to 30%, as is the incidence of amputation in the survivors. MAIN PURPOSE: The evaluation of the pulse spray thrombolysis (PST) role in the treatment of acute extremity ischemia originating from thrombosis or embolism of native artery or bypass graft. The comparison of PST with low dose technique thrombolysis (LD), thrombectomy (TE) and embolectomy (EE). METHODS: Ninety nine consecutive patients were evaluated during a two year interval (1994-1996). PST, resp. LD, TE and EE were the method of choice in 22, resp. 11, 35 and 31 patients of average age 58.3 +/- 13.7; resp. 60.0 +/- 8.9; 74.2 +/- 11.7; 76.9 +/- 9.3 years. The native artery was occluded in 15 (68.2%), resp. 8 (72.7%), 31 (88.6%) and 30 (96.8%) patients with PST, resp. LD, TE and EE treatment. The vascular reconstruction was occluded in the rest of the cases. The lower limb extremity arteries were occluded in 20 (90.9%) of patients indicated for PST, 10 (90.9%) for LD, 33 (94.3%) for TE and 26 (83.9%) for EE. The contraindication for local fibrinolysis was severely ischemic limb in which viability was imminently threatened. RESULTS: PST was successful in 19 (86.4%), LD in seven (63.4%), TE in 13 (37.1) and EE in 27 (87.1%) patients. The failure of procedure required amputation in one patient (4.5%) with PST, one (9.1%) with LD, nine (25.7%) with TE-p < 0.001 and two (6.5%) with EE. The mortality was 4.5% (one patient), resp. 0%, 28.6% (10 patients)-p < 0.001 and 3.2% (one patient) in PST, resp. LD, TE and EE. The long term results were better if the successful local fibrinolysis was combined with percutaneous transluminal angioplasty (PTA), stent implantation or small vascular reconstruction. CONCLUSION: PST is the method of choice in the treatment of thrombotic or embolic occlusion of native artery or bypass graft in condition of good limb viability where there is no danger of time delay. EE is indicated in limb embolism where the viability of extremity is threatened. Thrombectomy alone has no place in the treatment of artery or bypass graft thrombosis.

Embolectomy↗