Biomedical subjects
Publications and source records attributed to E Jandousová.
In 1997 and 1999 at the Second Surgical Clinic 35 patients with thyroid disease were operated. The authors reflect on the increasing radicality of operations from the aspect of the endocrinologist and surgeon. Extended surgical operations in relation to the original endocrinological indications are explained by the surgical finding and results of the histological examination.
In the investigated group 300 patients were operated for a thyropathy mostly struma nodosa, tumours were proved in 69 cases; 38 of them were carcinomas of various extent and 3 of them were combined with Hashinoto's lymphomatous goitre. The overwhelming majority of the carcinomas were papillary carcinomas (22 cases). The incidence of papillary carcinoma in Hashimoto's goitre was about 8%; this fact calls for more attention to autoaggressive thyroiditis both in examination of surgical material, and during autopsies in middle-aged women, where this thyroiditis is often clinically silent. Our results suggest an increase in the incidence of carcinoma in Hashimoto's goitre and the generally accepted rarity of this coincidence is questioned. We recorded also a lower incidence of medullary carcinoma than the worldwide average and a more frequent incidence of mixed-type carcinoma.
Views on the surgical procedure are not uniform. The authors summarise the basic principles of surgical technique and postoperative care in thyroid surgery, as used in their department. Attention is drawn to the possibility to use epidural anaesthesia in indicated cases. The most frequent causes of complications and their prevention are emphasised.
The authors describe their experience with combinations of endoscopic and surgical procedures when dealing with stenoses of the papilla Vateri. They give a detailed account of the endoscopic phase of surgical intervention. In their opinion the most important thing is exclusion of duodenotomy which should reduce the risk of a duodenal fistula. Another important advantage is more rapid convalescence and a shorter hospitalization period as well as a shorter time required for the intervention. Next the authors discuss possible complications described in the literature and their relationship to endoscopic papillotomy. The authors evaluate contemporary possibilities of endoscopic treatment and emphasize the necessity to extend the use of endoscopic methods in everyday surgical practice.