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Biomedical subjects

I Kott

Publications and source records attributed to I Kott.

At least 19 recordsLinked to original sources
PubMed2004

[Effects of climate change on the incidence of tick-borne encephalitis in the Czech Republic in the past two decades].

The study objective was an attempt to explain uneven distribution of the incidence of tick-borne encephalitis (TBE) throughout the past two decades. A sharp rise was recorded in the last decade: while 2596 TBE cases were reported in the decade 1983-1992, as many as 5892 TBE cases were reported in the decade 1993-2002, with high rates persisting also in the following years (606 TBE cases reported in 2003). Data from the database TBE EPIDAT of the National Institute of Public Health, Prague, and that of the Communicable Diseases Information System, Ostrava, were used for analysis. Meteorological data were taken from the database of the Czech Institute of Hydrometeorology, Prague. In 1971 to 2003, 13 231 laboratory confirmed TBE cases were reported in the Czech Republic. Uneven distribution of these TBE cases in time is consistent with the observations of climate variation made between 1931 and 2000. The increase in the TBE incidence in the Czech Republic in the last decade was characterized by the following features: 1) higher rates of TBE cases manifested in regular TBE natural focuses, 2) reemergence of TBE in the same localities after 20 and more year intervals and 3) emergence of TBE in localities where it was not reported before. At the same time shifts in TBE seasonal trends (i.e. to March and October-November) were observed, associated with a TBE incidence peak in autumn. Field research revealed that the major factor are the climate-related changes in ecology of the TBE vector Ixodes ricinus and resulting variation in its population density. TBE emergence in new areas is linked to the occurrence of ticks Ixodes ricinus at higher altitudes (previously found at 700 m and currently spreading to 1200 m) as well as to a coming warm climate era.

Czech Republic↗
PubMed1997

The secrets of the unknown trauma patient. The hazards of undiagnosed subclavian steal syndrome in the chest trauma patient: a case report.

Chest trauma can be complicated, among others, with cardiac tamponade. This life-threatening condition should be treated promptly and adequately to assure a positive outcome. During the rapid events that take place in the emergency room with the arrival of a polytrauma patient, anamnestic data are not always available, especially if dealing with a non-cooperative, unaccompained traumatized patient. The following case report describes our experience with a chest trauma patient after a vehicle accident, who was admitted to our ward exhibiting a constellation of signs compatible with a cardiac tamponade. The only demonstrable objective signs included distended mediastinum and heart shadow on the chest X ray and muffled heart sounds. However, despite the impressive clinical picture, the patient continued to exhibit constant, though low blood pressure measurements and after a short period of observation, given the homodynamic stability, it was decided against pericardiocenthesis. The "secret" of our patient was finally discovered at angiography, when a left subclavian steal was diagnosed. The literature in this matter is discussed, stressing the importance of anamnestic data in the trauma patient. Most importantly, we address the significance of relying on hard clinical data (homodynamic stability) rather than on isolated signs (widened mediastinum/heart shadow) to reach as accurate a diagnosis as possible before pursuing invasive, usually not-innocuous procedures (pericardiocenthesis).

Accidents, Traffic↗
PubMed1996

Successful treatment of anal tumors with CO2 laser in elderly, high-risk patients.

The central issue in elderly surgery remains the operative risk, which is usually a direct factor of age, ASA classification, and other pathologies, especially cardiovascular diseases. It is the surgeon's role to define properly the risks involved with a patient and to anticipate the involved operative mortality. Based on this, we performed CO2 laser fulguration of anal canal tumors in 10 patients suffering from either squamous cell or adenocarcinoma localized up to 4 cm from the anus. The rationale was to avoid prohibitive operative and anesthetic risk, achieve local control of disease and improve quality of life by avoiding surgical convalescence and an otherwise certain colostomy. All patients underwent fulguration (25-30 W) every 3-4 months. Complications included minor pain and bleeding. Three patients required operation (Hartman's pouch) within 2 1/2 years due to continuous tumor bleeding and stricture of the anal canal. The remaining 7 patients were treated regularly and satisfactorily by fulguration and the mean survival in this group was 8 years (in all cases the causes of death were unrelated to the procedure or the tumor). We conclude that CO2 laser fulguration of anal canal tumors in elderly, high-risk patients represents an invaluable option of treatment, while avoiding major operative risk, controlling the local spread of disease, maintaining physiological bowel function, and avoiding colostomy. Most importantly, the main dividends of the study are patient satisfaction and maintenance of good quality of life.

Adenocarcinoma↗
PubMed1996

The CO2 laser in the treatment of lesions of the eyelids and periorbital region.

The CO2 laser can be used for the treatment of various lesions of the eyelids and peri-orbital region with the advantage over other modalities of precise, controllable, hemostatic, non contact atraumatic ablation with the reduction of post-operative pain and improved cosmetic results. Its application in palpabral and peri-orbital surgery is recommended.

Carbon Dioxide↗
PubMed1995

The use of CO2 laser for inguinal hernia repair in elderly, pacemaker wearers.

Interference of electrical current with pacemaker activity is well known and has long been described. Almost every surgical procedure is now performed with the electrical knife, or electrocautery. In patients wearing a pacemaker this poses a problem, because of the danger of electronic interference within the pacemaker with consequent firing-frequency changes and the higher risk of intra- and postoperative bleeding and oozing when using a scalpel instead of cautery. We have performed 25 hernioplasties in elderly patients with permanent pacemakers using the CO2 laser technique. All operations were technically successful, and the immediate and long term (1 year) follow-up proved uneventful. Additionally normal pacemaker function was maintained during surgery and through the follow-up period. CO2 laser surgery is advantageous over electrocautery in patients with pacemakers because it does not interfere with pacemaker activity. Moreover, the laser produces normal hemostasis and does not stimulate muscle and nerve activity during surgery.

Aged↗
PubMed1994

The CO 2 laser in mastectomy: a ten-year follow-up.

We compared the healing process, postoperative course, and follow-up of patients who underwent modified radical mastectomy in the conventional way with those who underwent a laser procedure. Sixty women, aged 33 to 77 years, who suffered from carcinoma of the breast were randomly divided into two groups: Group 1: surgery was performed using scalpel and electrosurgery; Group 2: surgery was performed with a CO 2 Sharplan laser, skin-to-skin including the axilla dissection; maximal power, 40-60 W. The postoperative course was uneventful in both groups. Wound healing was normal. Sutures were removed on the tenth day. Patients were followed at the Outpatient Clinic for 10 years. The circumference of the arm and forearm was measured at fixed points before surgery and at follow-up. Mammography and liver and bone scans were performed every year. Four Group 1 patients developed swelling and edema of 2 to 3 cm at 6 to 8 months after surgery. Also two patients from subgroup A developed local recurrence. No edema or swelling or local recurrence could be detected in patients operated by laser. Surgery with laser is preferable to the conventional approach.

Adult↗
PubMed1994

Myasthenia gravis: rarity of gallstone formation.

There is an increase in the production of gallbladder stones (cholelithiasis) following gastrectomy associated with vagotomy; we hypothesized that in the presence of constant stimulation of the vagal system, there should be decreased production of gallstones. Forty-two myasthenia gravis patients taking continuous anticholinesterase medications underwent ultrasound study of the gallbladder; only one patient, aged 62, had gallstones. In the control group of 112 nonmyasthenics matched for age and ethnic origin, 45 had stones. This study suggests that cholinergic medications protect against gallstones.

Adolescent↗
PubMed1992

The risk of cholecystectomy for acute cholecystitis in diabetic patients.

In order to evaluate the risk of acute cholecystitis in diabetic patients, we analyzed 2,700 consecutive cholecystectomies, 566 of which were performed in the presence of acute cholecystitis. Of these patients 123 had diabetes mellitus (DM) and 433 had no diabetes (ND). The aim of this study was to establish the comparative risks in the two groups. We found that diabetics are more likely to be operated on in the acute stage of their disease (22% vs. 12%). The DM group had a higher rate of septic bile, gangrenous changes and perforations of the gallbladder wall. The morbidity rate was higher in the DM group (21% vs. 9%), and mortality was slightly higher in the DM group. The degree of additional operative risk does not in our view justify recommending cholecystectomy in diabetic patients with asymptomatic gallstones. Early surgery however, is highly recommended in diabetics with symptomatic gallstones and acute cholecystitis.

Acute Disease↗
PubMed1989

Barrett's mucosa of distal esophagus with concomitant isolated Crohn's disease and intramucosal adenocarcinoma. Report of a case and analysis of the literature.

The presence in the esophagus of three distinct entities--Barrett's mucosa, Crohn's disease, and adenocarcinoma--is a very rare finding. In a 60-year-old man with a long history of heartburn and recently developed dysphagia, narrowing of the distal esophagus was found to be related to the presence of Barrett's mucosa. A short time later repeated endoscopy revealed adenocarcinoma in this area. The patient underwent esophagogastrectomy and died a few days after surgery. Findings in the surgical specimen and upon autopsy were consistent with isolated Crohn's disease of the distal esophagus as well as with intramucosal adenocarcinoma. Analysis of the data available in the literature reveals that Crohn's disease of the esophagus, although rare, clearly possesses some definite characteristics of its own. It is suggested that the presence of these three features in a single patient constitutes no more than a chance coexistence.

Adenocarcinoma↗
PubMed1988

Changing trends in surgery for benign gallbladder disease.

Hospital charts and notes of 2181 consecutive cholecystectomies performed between 1969 and 1984 were computer analyzed. They were divided into three categories of patients operated on 5, 10, and 15 yr ago. The trends of change throughout this period were as follows: 1) The population operated on in the last 5 yr is older, the proportion of males, especially over 70-80 yr old, and diabetics, is growing constantly. 2) The frequency of acalculous cholecystitis and gangrenous changes increase; the same is true for common bile duct pathology and positive bile cultures. 3) There is a marked decrease in hospitalization time, postoperatively, without significant increase in rate of wound infection and thromboembolic phenomena, or mortality. It seems that there is no change in the frequency of gallstone-related pancreatitis and perforations of gallbladder. The same is disappointingly true for positive choledochal exploration index. We think that the subcostal approach, with rational prophylactic and therapeutic antibiotic regimen, contribute to the shortening of hospitalization time and the fixed rates of wound infection and herniae in scar. Prophylactic heparin given subcutaneously seems to avoid possible thromboembolic phenomena.

Acute Disease↗
PubMed1986

Macrophage migration inhibition factor test in breast tumors.

Thirty women with breast lumps who attended our outpatient clinic were randomly chosen for this study. The breast tumors were benign in 8 and malignant in 22 patients. Ten healthy women constituted a control group. In 15 of the 22 patients (68%) with malignant lesions, the migration inhibition factor (MIF) test was positive. Only one of the patients with benign lumps had a positive reaction. The MIF test was negative in all women in the healthy control group. It seems reasonable to conclude that the human cell-mediated immunity system is affected by the presence of breast cancer, and that the MIF test aids in the differentiation between benign and malignant breast tumors and has a sensitivity of at least 70%. The test may be of value in the postoperative follow-up of patients with breast cancer.

Adult↗
PubMed1984

Duodenal diverticula occurring in a family--chance or inheritance?

The incidence, aetiology and possible inheritance of duodenal diverticula remain controversial. These aspects are discussed through the presentation of a family, in which duodenal diverticula occurred in a man and his two sons. To the best of our knowledge, this is the first such family documented in the medical literature. This familial occurrence may be attributed solely to the high incidence of duodenal diverticula in the general population (set by various authors at up to 14.2%), and, therefore, of no hereditary significance at all. We believe a screening study of the families of individuals with proven duodenal diverticula is most desirable, for it could shed light upon the controversial questions of incidence, aetiology, and inheritance patterns of duodenal diverticula.

Aged↗
PubMed1984

Statistical value of various clinical parameters in predicting the presence of choledochal stones.

Persistent choledochal stones, as well as negative choledochal explorations, lead to increased morbidity and expense in operations upon the biliary tract. In an attempt to establish more precise criteria for the presence of CBD stones, 1,000 consecutive cholecystectomies were studied and computer analyzed. Precise determination of the choledochal diameter and preoperative bilirubin levels permit a quite accurate estimate of the probable presence of a choledochal stone.

Adolescent↗