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Biomedical subjects

B Ohrádka

Publications and source records attributed to B Ohrádka.

At least 19 recordsLinked to original sources
PubMed2003

Pancreatic duct occlusion with acrylic glue after pancreas resection.

UNLABELLED: Postoperative complications following major pancreatic surgery are mainly due to the difficulties of performing a safe and proper anastomosis between the stomach or small bowel and the rest of the pancreas. We cannot influence the main predisposing factor of pancreatic fistula--soft pancreatic parenchyma, but we can decrease or completely block postoperative pancreatic secretion. In the last 5 years we performed 61 major pancreatic resections. There were 49 men, mean age 63 years (range 31-78) and 12 women, mean age 57 years (range 45-75). The occlusion of the main pancreatic duct was performed in 33 patients with cyanoacrylate manomer indermil (Sherwood, Davies Geck) after pancreatic resection with different types of anastomosis of their pancreatic stump. Fistula developed where glue was used only in 1 case out of 33 patients (1/33-3%) compared with 28 patients where glue was not used--fistula developed in 9 cases (9/28-32%). The difference is highly significant (p < 0.05). Only 1 out of 10 patients with pancreatic fistulation was operated later on; in 9 cases fistula closed spontaneously. Fistulo-jejunoanastomosis was performed in this patient with chronic torpid fistulation. No postoperative pancreatitis developed after blind closure of pancreatic stump. IN CONCLUSION: any decrease of pancreatic secretion from the rest of the pancreas after duodenopancreatectomy can significantly reduce the development of postoperative pancreatic fistula which can have a catastrophic influence on surgery outcome. Using glue in the pancreatic main duct is not only safe but can be an effective simple procedure in any type of pancreatic stump treatment.

Adult↗
PubMed2000

The home treatment of deep vein thrombosis with low molecular weight heparin, forced mobilisation and compression.

BACKGROUND: The aim of this prospective study was to analyse a group of patients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecular weight heparin), compression and intensive mobilisation and to evaluate its feasibility, efficacy and safety from possible risks of pulmonary embolism. METHODS: From March 1997 to September 1999, 96 consecutive patients with diagnosed DVT were enrolled in a prospective study and treated at home with enoxaparin (Clexane Rh ne-Poulenc) administered subcutaneously at doses depending on body weight (1 mg/kg) b.i.d. for a minimum of seven days. Oral anticoagulants were started two days before discontinuing LMWH and given later for three months according to the haemocoagulation parameters. All patients wore elastic second degree compression stockings during the whole period of treatment and for 12 months there after. They were encouraged to walk 1-3 km daily. The sites of thrombosis were ilio-femoral vein--38 patients (40%), femoral or popliteal vein--32 patients (33%), crural veins--26 patients (27%). According to our surgical criteria two years ago 17 patients would have been operated on and trombectomy performed. The diagnosis was made by compression ultrasonography using a colour duplex scanner (Acuscan 125), by contrast phlebography, and platelet scintigraphy (Tromboscint test). Perfusion-ventilation scintigraphy of the lungs was performed only if there were clinical signs or even a suspicion of pulmonary embolism and on all patients with iliofemoral thrombosis. Perfusion gamagraphy of lungs was carried out on 51 patients where thrombosis was localised in proximal veins. RESULTS: In 27 patients there were signs of non-fatal pulmonary embolism (53%), but only seven patients (26%) suffered mild non-specific clinical signs; 20 patients with diagnosed pulmonary embolism (74%) were symptom-free. Out of 96 patients, three admitted to hospital (3%), 67 (70%) injected LMVH themselves and felt comfortable. Eight to 12 weeks after this treatment control sonography and phlebography were carried out in 70 patients to assess the localisation and progress of the thrombosis. In 51% (36 patients) partial and 31% (22 patients) total recanalisation was found. Five out of 96 complained of minor bleeding (5%). No thrombocytopenia was noticed. The first five days on home treatment were crucial. All patients were able to walk and live at home without difficulty. None of our patients with proximal deep vein thrombosis used a vena cava filter. CONCLUSIONS: Home treatment of DVT is possible and is effective, safe and less costly on average and per patient 40% in costs was saved compared with those of a hospital stay in spite of the greater expense of LMWH. The patients who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group.

Anticoagulants↗
PubMed1999

[Pathophysiologic aspects of chronic venous insufficiency].

Knowledge of the pathophysiology of the venous circulation and its evaluation before treatment determines not only the best therapeutic plan, but at the same time makes it possible to avoid operations which are not necessary and a priori doomed to lead to a relapse. The basic therapeutic principles in the treatment of chronic venous insufficiency after evaluation and localization of the functional disorder by an objective examination method (duplex sonography, phlebography ...) are: a) compression, b) severing of pathological points of insufficient perforators, orifices of both saphenous veins, c) antireflux operation of the deep veins with preference of the popliteal vein. Any therapeutic procedure which does not have the aim to reduce venous hypertension is a priori doomed to failure and very soon a relapse develops. From this aspect it is not important to remove chaotically and extensively superficial varicosities (surgically or by sclerotherapy) but to severe the insufficient perforators and the insufficient orifices of saphenous veins surgically or by sclerotherapy.

Chronic Disease↗
PubMed1999

[Ambulatory treatment of deep venous thrombosis using low-molecular heparin, compression and mobilization].

From data in the literature as well as the authors' own experience ensues that diagnosed and objectively confirmed deep venous thrombosis can be successfully treated in out-patients departments by low-molecular heparin and compression with full mobilization without any major risk of pulmonary embolism and without the need of hospital admission (65 out-patients). Despite the high price of low-molecular heparin, treatment is economical as it does not require monitoring of haemocoagulation for hospital admission. Partsch et al. 1997 proved unequivoca lambda y that the rate of new attacks of pulmonary embolism during treatment is significantly lower than during classical treatment with non-fractionated heparin and immobilization.

Ambulatory Care↗
PubMed1998

[Anti-reflux surgery of the popliteal vein].

Any effective therapy of chronic vein insufficiency resides in the replacement or at least reduction of the pathological reflux causing venous hypertension. The aim of our study is to indicate the significance of the reconstruction of the damaged valves in the profound venous system, namely in the most critical popliteal area. On the basis of the experimental works of Wilson et al. (1991) we have introduced his technique of anti-reflux operation by the technique of invagination after the prolongation of the popliteal vein by three-fold average of its diameter by means of the axillary vein with a valve. This operation was performed in 6 patients on 7 veins. The operation lasted 3 hours in average without marked operative and post-operative complications. On the seventh day after operation, the full sufficiency is investigated by means of descendent phlebography in 5 newly formed valves and in two valves a particular insufficiency is developed. 4 patients yield a full recovery of ulcers, one patient slipped out from evidence, however sclerotisation of insufficient perforators leads quickly to recovery of dermal defects. Reconstruction of prothrombotically damaged valves is practically impossible and thus, valvuloplastic operation constructed from vascular wall in the target segment is not only possible but effective at the same time. (Fig. 3, Ref. 13.)

Adult↗
PubMed1998

[Compressive sclerotherapy monitored by ultrasound].

Echosclerotherapy and sonographic control of aimed sclerotherapy resp. is a major advance in the treatment of chronic venous insufficiency. It facilitates not only aimed administration of highly active substances but ensures above all prevention of serious complications. Functional examination of the venous system helps to locate relatively accurately the sites of pathological reflux which are in the first place responsible for the development of the whole symptomatology and it prevents the administration of excessive amounts of sclerotizing substances into intact portions of the venous system. Similarly as Baccaglini et al. (1995) the authors achieved by compressive sclerotherapy with monitoring by ultrasound occlusion of up to 90% important reflux sites such as the saphenofemoral and saphenopopliteal orifice which are to a great extent responsible for serious clinical symptoms.

Chronic Disease↗
PubMed1990

[Acute low triiodothyronine syndrome in the perioperative period].

Serum concentrations of thyroxine (T4), triiodothyronine (T3) and reverse triiodothyronine (rT3) were determined by radioimmunoassay in 11 patients (8 females and 3 males aged 42-65 years) before cholecystectomy and at various time intervals following operation up to 10 days. The surgical procedure was uncomplicated in all the cases studied. The level of rT3 was significantly increased (P less than 0.01) already on the first postoperative day and was then decreasing to its initial value. The levels of T4 and T3 were markedly reduced particularly on postoperative days 2 to 5 (the drop was significant on calculating individual values as percentages of the preoperative level of the given patient). This acutely developing syndrome of low triiodothyronine disappeared spontaneously within 7 to 10 days at a noncomplicated postoperative course.

Acute Disease↗
PubMed1988

Iodothyronines in human bile.

Bile was collected from 7 patients after cholecystectomy with routine T-tube drainage of bile duct postoperatively. In all patients reported, the total volume of bile collected was more than 500 ml which was considered to be close to the volume of bile excreted by the liver during the 24 h collection period. The excretion of total thyroxine (T4), triiodothyronines (T3 and rT3) and diiodothyronines (3,3'-T2, 3,5-T2 and 3'.5'-T2) was estimated with the aid of specific radioimmunoassay described previously. It was found that the total amount of T4 corresponded to its content in about 100 ml plasma, while corresponding figures for triiodothyronines were about 1000-1500 ml and these for diiodothyronines about 10-15 liters. It was concluded that in man the biliary excretion of iodothyronines appears to be of much less importance for their total body balance than in rats.

Aged↗