Biomedical subjects
Publications and source records attributed to J Belácek.
In this case review, the author analyses causes of pancreatic fistules in patients who underwent pancreatic resections. He presents a conservative therapeutic approach, which may be combined with invasive endoscopic and surgical methods. Considering the high morbidity rate of the disorder, it is recommended to perform a preventive pancreatojejunoanastomosis already during the primary treatment of the pancreas.
The authors present a group of 76 patients with chronic venous insufficiency in the stage or crural ulceration. After staging of the disease (C 6, E prim, E sec, A sup. pr. ref., P re) in the first stage they used a conservative approach, the method of compressive bandages: either an elastic bandage or zinc-glue bandage (Varolast). 49 patients were cured by conservative treatment (64.5%) in the course of 5 months. 12 patients were indicated for surgery (15.8%). Thus the authors cured finally 80.2% patients. A relapse was recorded in 6 patients (7.8%) and in 9 patients treatment failed (11.8%). For treatment with zinc-glue bandages they recommend patients without obstruction in the deep venous system, with large chronic ulcers and associated oedema of the whole leg.
The authors evaluated a group of patients operated at the Surgical Clinic in 1992-1996 on account of a hernia in a scar by the Mayo plastic operation. During a mean follow-up period of 33 months 44% patients were re-operated or had a relapse. The results confirmed data reported in the literature of 30-50% relapses of hernias in scars when synthetic nets are not used. With regard to the unfavourable results the authors use since November 1997 synthetic nets in plastic operations of hernias.
The authors used ambulatory sclerotherapeutic treatment in 910 patients whom they also followed up. All these patients suffered from primary and relapsing varicosities of the lower extremities. A favourable effect was recorded in 82% of the patients. A relapse was recorded in 13.2% of patients, where subsequent operation was recommended. Complications after sclerotherapy were recorded in 4.5% patients.
Based on the evaluation of long-term results of supraselective vagotomies (5-20 years after surgery) the authors consider laparoscopic vagotomy by Taylor's method justified in the primary treatment of duodenal ulcers. It was revealed that after open (laparotomic) supraselective vagotomy more than 80% of the patients are for prolonged periods free from complaints. The authors draw attention to the advantages of laparoscopic vagotomies, they discuss their causes and possible relapses of ulcers.
The authors submit a questionnaire-based epidemiological study from 61 surgical departments in Slovakia, focused on the problem of amputation of the lower extremities. The objective of the study was to evaluate indirectly the standard of care of diabetic feet in Slovakia. In the study 61 surgical departments participated with a catchment area comprising 4,814,000 insured persons, i.e. 85% of the Slovak population. In these patients a total of 2116 amputations on account of non-traumatic causes were performed (44/100000 population). This number included 1578 diabetic patients (74.6%). Minor amputations were performed 1044 times, incl. 92.2% in diabetic subjects. Major amputations were made 1072 times, incl. 57.3% in diabetics. The prevalence of major amputations in 1995 was 21.8/100000 population. The authors recorded a 2.65 fold increase of the total number of amputations since 1985. They recorded dissatisfaction with the small number of revascularization operations-total 294 (13.9%) which is only one quarter of the desirable number. The authors submit their study as the basis for a systemic solution of care of the diabetic foot in Slovakia and as a challenge for its improvement.
In case-histories of four patients the authors present an account on atypical abdominal abscesses which are late symptoms of advanced malignity of the large bowel or inflammatory intestinal disease. They discuss whether it is suitable to use percutaneous drainage or surgery. The latter holds despite the higher mortality a permanent place in the solution of serious intraabdominal infections, in particular if combined with malignity.
Based on a group of six patients with carcinoid of the appendix treated at the Surgical Clinic of Dérer's Hospital in Bratislava in 1988/93, the authors discuss the diagnosis and treatment of clinically silent carcinoids (< 2 cm). Appendectomy was performed and the mesoappendix was removed. The prognosis of these patients is good, after five years 100% of the patients survive. The carcinoid syndrome is a symptom of an advanced tumour or secondaries in the liver where comprehensive treatment (surgery + metastasectomy + chemotherapy) is indicated. One third of the patients survive after five years.
The authors present an account of a survey (by questionnaires) focused on surgery of inguinal hernias. The recovery rate of questionnaires was 84%. The standard techniques in surgery of child hernias are Gross (29%) and Girard (29%). In primary hernias more than 50% are made by Bassini's and Girard's plastic operation. So far the worldwide accepted plastic operation of Shouldice is rarely used 14%. In the techniques of relapsing hernias also inadequate plastic operations are used; the ratio of Lichtenstein's plastic operation which has the lowest relapse rate is only 4.5%.
Changes in the immunity of 10 patients were studied during aortofemoral bypass surgery. A marked drop in the level of transferrin and of C 3 and C 4 components of complement was observed in the course of the operation and on the first postoperative day. Transferrin levels exhibited a statistically significant difference even on the 7th postoperative day (p less than 0.05). The orosomucoid response was less pronounced. In cell mediated immunity the most remarkable change was recorded in the drop of T-lymphocytes which persisted all over the first postoperative week. Alterations in immunoglobulins were most prominent in the immediate postoperative period and persisted up to the 7th postoperative day. The authors discuss some factors which, in addition to the surgical load, may be involved in immunodepression.
The authors give an account of the therapeutic procedure in 22 patients with solitary cysts of the right liver lobe. In 13 pyogenic cysts (abscesses) drainage of the abscess was made under CT control, in four cysts anatomical or non-anatomical resection of the liver was performed, in three cysts enucleation, in one biliary cyst cystojejunostomy with a Roux-Y loop of the jejunum. Aetiopathogenesis of the cysts: pyogenic cysts 14, echinococcal cysts 2, inborn parenchymatous cysts 3, posttraumatic cysts 3.
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