Biomedical subjects

J Breza

Publications and source records attributed to J Breza.

At least 37 records · Page 2Linked to original sources

PubMed1996

Pre-operative management for surgery of pheochromocytoma.

The authors analyze 15 patients who underwent pre-operative management prior to the pheochromocytoma removal. The purpose of this analysis is to evaluate the relation between clinical and haemodynamic criteria evaluating the level of alpha-adrenergic blockade. The authors believe that pre-operative management based on clinical criteria does not necessarily ensure adequate alpha-adrenergic blockade. Invasive monitoring of haemodynamic variables is considered an important strategy for the quantification of actual haemodynamics status of patients with pheochromocytoma.

Adrenal Gland Neoplasms↗

PubMed1996

Tumours of the adrenal cortex.

The authors report their experience of 34 benign and 17 malignant tumours of the adrenal cortex. Both occurred more frequently in women (79.4% of cortical adenomas and 70.6% of adrenocortical carcinomas). Moreover, females were significantly younger (average age: adenomas: females 44.9 years and males 54.4 years, adrenocortical carcinomas: females 34.1 years and males 58.3 years). Some tumours presented in the form of increased hormone production, while others were hormonally inactive and did not cause clinical signs until later. Pain was the first symptom in the cases of malignant adrenocortical tumours. Adenomas occurred as frequently twice in the left adrenal gland (24 versus 12), whereas carcinomas were more than twice are frequent on the right (10 versus 7). Ultrasonography and CT were appropriate and fully sufficient methods for the diagnosis of adrenal tumours. Arteriography was valuable in the differential diagnosis of large upper abdominal masses when the organ of origin could not be identified by CT and for determination of anatomic conditions and subsequent surgical tactics. For small tumours of the adrenal cortex, the classic lumbar approach through the bed of the resected eleventh rib is adequate. For larger tumours, extended lumbotomy, laparotomy or thoracotomy is necessary.

Adolescent↗

PubMed1995

Transurethral Nd:YAG laser prostatectomy with a laterally firing fiber: local effects on tissue associated with erectile dysfunction.

BACKGROUND AND OBJECTIVES: Transurethral laser prostatectomy is anticipated to become a recognized alternative to conventional transurethral resection of the prostate. However, the effects of this procedure on the nerves of the pelvic plexus and erectile dysfunction remain unaddressed. The objective of this study was to evaluate the effects of laser energy on extent of prostatic damage as well as injury to periprostatic cavernosal nerves and erectile dysfunction in a canine model. STUDY DESIGN/MATERIALS AND METHODS: Six adult male mongrel dogs underwent transurethral laser prostatectomy at 30 (n = 3) and 40 (n = 3) watt power settings. Total laser energy delivered varied between 6,000 and 13,800 joules. Erectile function was evaluated by pelvic nerve stimulation at 2, 4, and 8 weeks. Animals were then sacrificed to assess histopathology of the prostate at each time point. RESULTS: Histopathologic changes were noted in the prostate in a dose-dependent manner and did not vary with different laser power settings. In dogs that received approximately 10,000 J, substantial prostate ablation confined within the capsule was achieved in every prostate gland. Adequate erectile responses were noted in five of six animals; all received < 10,000 J. In one animal that received a total dose of 13,800 J, an erectile response was not obtained, and histology revealed both prostatic capsule perforation in close proximity to the cavernous nerves and thermal neural damage. CONCLUSIONS: We conclude that cavernous nerve damage may result from excessive doses of laser energy during transurethral laser treatment of the prostate gland. In canines, the upper limit for periprostatic injury is between 10 and 14,000 joules.

Aluminum Silicates↗

PubMed1995

[Cushing's syndrome in pregnancy].

Active Cushing's syndrome during pregnancy is a rare phenomenon which was so far described in the literature only in 85 women. The authors give an account of a patient who developed Cushing's syndrome during pregnancy and who was delivered during the eighth month of a healthy foetus by caesarean section, afterwards the hypercortisolism associated with hyperaldosteronism was treated by dextrolateral adrenalectomy. In the removed adrenal gland was a cortical adenoma made up of clear cells and cells reminding of the zona glomerulosa. Subsequently the authors summarize data from the literature on the prevalence of different pathogenetic forms of Cushing's syndrome in pregnant women, on the influence of hypercortisolism on mother and foetus, on the optimal diagnosis and therapy of this syndrome during pregnancy.

Adult↗

PubMed1995

Transformation of the Bricker to a continent urinary reservoir to eliminate severe complications of uretero-ileostomy performed in eight patients among 200 Bricker.

Between 1969 and 1994 urinary diversion via the ileal loop (Bricker's operation) was performed in 200 patients. After introduction of methods of continent urinary diversion into clinical practice, some of young patients operated in childhood for congenital lower urinary tract malformations demanded the conversion of the primary diversion. The decision was influenced, however, not only by subjective complaints but also by severe complications having relation to the long-lasting presence of stoma. A modified Mainz pouch I, with a catheterizable stoma was constructed in 6 patients with primary uretero-ileostomy made 7 to 22 years prior to conversion because of exstrophy of the urinary bladder or a neurogenic bladder with total urine incontinence. The ileal loop used for uretero-ileostomy was detubularized or combined with additional segments of ileum and colon. The ileal stoma was connected to the umbilicus. In other two patients suffering from a neurogenic bladder the uretero-ileostomy was converted to an orthotopic ileal pouch. The authors present long-term results (1.5 to 7 years) of follow-up with urodynamic and radiological evaluation. The results both compensate the urologist's efforts and enhance the patient's quality of life.

Adolescent↗

PubMed1995

[Diagnosis and treatment of erectile dysfunctions].

OBJECTIVES: Erectile dysfunction (ED) is the most frequent form of male sexual dysfunctions. The incidence is not known. Approximately 10% of men suffer from ED. Aging is concomitted by an exponential increase in the occurrence of erectile dysfunctions. Some groups of men (suffering from diabetes, alcoholism, ICHS, renal diseases) yield several times higher values of their occurrence. In general, ED (formerly impotentio coeundi) can be defined as an inability to achieve erection and maintain it for an appropriately long period enabling sexual intercourse. ETIOPATHOGENESIS: The etiology includes psychological, neurological, arterial, sinusoidal, venous and hormonal factors which participate in erectile function. ED arises predominantly in consequence of impaired haemodynamics of the penis. It develops either due to insufficient blood inflow into the erectile bodies or due to their excessive drainage. The traumatic lesions of penile vessels are less frequent. Drugs and medicaments play a significant role among etiologic factors causing erectile dysfunctions. DIAGNOSIS: No regulations and principles are generally valid in coincidence with examination of patients with erectile dysfunction. The signs of neurologic, hormonal and vascular defects are detected. An objective method of examination of erectile capacity of the penis resides in the monitoring of penile nocturnal tumescensions. The examination of arterial system of the penis provides information on the perfusion pressure and blood flow in the cavernous arteries. The vascular structures of the penis and their functions can be evaluated by means of duplex ultrasonography and flowmetry. The quality to arterial supply to erectile bodies is evaluated by dynamic examination of arteries prior to and after intracavernous application of vasoactive substances. The functional state and size of venous leak from the cavernous bodies are evaluated by dynamic cavernosometry. THERAPY: The application of vasoactive substances meant a significant contribution to the diagnosis establishment and therapy of erectile dysfunctions. They have a common feature which resides in their myorelaxation effect and thus in their ability to induce erection by means of relaxation of the smooth muscles of cavernous bodies. Intracavernous application of vasoactive substances is the mostly spread means of therapy of erectile dysfunction as a whole, frequently with no regard to the etiology. Surgical therapy of vasculogenous impotence is based on knowledge concerning the impact of vascular lesions on the haemodynamics of erectile function of the penis. the revascularisation operations are aimed at the regeneration of normal haemodynamic conditions in the penis. CONCLUSION: Sexual life is currently considered as a proportion of life of individuals. The physicians therefore have to seek ways of how to help the patients who due to acquired erectile dysfunctions are handicapped in the establishment of family harmony and sexual life. (Ref. 31).

Erectile Dysfunction↗

PubMed1995

[Procedure for multiorgan procurement (heart, liver, kidneys)].

A significant growth in transplantation activity has been recorded in the past decade, namely in transplantations of the heart and liver. The numbers of transplantations of the lungs, and of the combination of pancreas with kidneys have increased to a smaller extent. The number of transplanted kidneys has become stabilized during the past several years. The development of organ transplantations led to a change of conception in the procurement of cadaveric organs from the until now performed procurement of a single organ to multiorgan procurements where in addition to the kidneys at least one other organ is procured. In countries with the highest number of multiorgan procurements the latter form as many as 80% of the total number of cadaveric procurements. Since January 1, 1995 a principle has been officially recognized in the Slovak Republic where an agreement with organ donation is presumed. Procurements of organs do not take place in cases when the donors have made during their lives a written or any other kind of declaration disapproving any intervention into their corporal integrity. Organs are also not procured in cases of foreigners, persons under legal sentence and those whose identities cannot be proved. The authors describe the technique of multiorgan procurement (heart, liver, kidneys) as well as contraindications to procurements of individual organs. (Fig. 2, Tab. 1, Ref. 12.).

Adult↗

PubMed1994

Advantages of converting incontinent to continent urinary diversion.

A modified Mainz pouch with catheterizable stoma was constructed in six patients who had originally undergone incontinent urinary diversion by ureteroileostomy 7 to 22 years previously for bladder exstrophy or neurogenic bladder with total urinary incontinence. The surgical technique differed from the standard as follows: after stomal excision, the preexisting ileal loop was detubularized and combined with additional ileal and colonic segments for pouch construction. In patients in whom the original ureteroileal anastomoses were patent and the contrast medium refluxed freely to the upper urinary tract during loopography, the ureters were not reimplanted but kept intact. In all patients the ileal valve was connected as stroma to the umbilicus. In addition, two patients underwent construction of a standard Mainz pouch. One had had primary ureterosigmoidostomy and the other one ureterostomies, 10 and 3 months previously, respectively. The urodynamic characteristics of the reservoir were normal in all. In six ureteropelvic units dilation improved significantly and in two patients the bilateral loop-ureter reflux diminished. Long-term follow-up (up to 45 months) showed no further impairment of the kidneys.

Adolescent↗

PubMed1994

Improved hemodynamic response after long-term intracavernous injection for impotence.

OBJECTIVE: To investigate the phenomenon of spontaneous erections in patients on long-term intracavernous injection therapy. METHODS: We undertook an objective assessment of the penile circulation of 35 patients; 21 used prostaglandin E1 (PGE1) alone and 14 used a combination of papaverine, phentolamine, and PGE1. All underwent duplex ultrasonography before initiation of home self-injection and again after a mean of thirty-one months of treatment (most patients performed injections once or twice a week). RESULTS: The diameter of the cavernosal arteries did not change significantly after treatment. However, the mean peak flow velocity increased highly significantly (P < 0.001): 17.9 cm/second in the right cavernous artery and 21.2 cm/second on the left before treatment; 24 cm/second on the right and 29 cm/second on the left after treatment. More than one third (13 of 35 patients [35%]) achieved functional erection without injection at least some of the time, giving clinical support to the sonographic findings. CONCLUSIONS: We suggest that the combination of vasodilatory drugs and sexual stimulation may act to improve sinusoidal and penile arteriolar smooth muscle function.

Adult↗

PubMed1994

Is colchicine effective in Peyronie's disease? A pilot study.

OBJECTIVES: The treatment of Peyronie's disease with oral or topical agents has not been entirely satisfactory. In this pilot study, we hypothesized that colchicine, known to induce collagenase activity and decrease collagen synthesis, might be an ideal agent in the treatment of Peyronie's disease. METHODS: Colchicine was administered orally for 3 to 5 months to a group of 24 previously untreated patients with Peyronie's disease. RESULTS: Peyronie's plaque decreased or disappeared in 12 of the 24 patients, 7 of 9 patients with painful erections reported significant relief, and penile curvature was improved in 7 of 19 cases. Erectile status, narrowing of the penis, and accompanying Dupuytren's contracture did not change in any of the cases. CONCLUSIONS: Although this pilot study shows some promising results of the use of colchicine in the treatment of Peyronie's disease, the ultimate usefulness of this agent will be determined only by a prospective double-blind clinical study.

Aged↗

PubMed1994

Role of penile vascular injury in erectile dysfunction after radical prostatectomy.

OBJECTIVE: To investigate the cause of erectile dysfunction after nerve-sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B). PATIENTS AND METHODS: Erectile function was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed. RESULTS: Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury. CONCLUSION: We conclude that post-prostatectomy impotence is multifactorial but vascular injury plays a substantial role.

Adenocarcinoma↗

PubMed1993

Intracavernous sodium nitroprusside: inappropriate impotence treatment.

On the basis of reports describing nitric oxide as a form of endothelium-derived relaxing factor and on our own experience with intracavernous use of nitric oxide-releasing substances in animal models, we undertook an approved human study of intracavernous sodium nitroprusside as a treatment for impotence. We report our early experience in which severe hypotension and only mild tumescence in our first 3 patients caused us to discontinue the trial.

Aged↗

PubMed1993

High flow priapism: a spectrum of disease.

We describe 4 cases of high flow arterial priapism, ranging from 1 week to 3 years in duration. The mode of presentation, evaluation using a duplex scanner, treatment and ultimate resolution are discussed. In 1 patient treated with ice compression the erection subsided spontaneously. One patient underwent percutaneous embolization and achieved detumescence. In 2 men a vascular pseudocapsule formed around the site of the ruptured cavernous artery that provided an important anatomical landmark for intraoperative localization. The ruptured branch of the cavernous artery was ligated in an open procedure. Based on these cases and a review of the literature, we outline a modified diagnostic and therapeutic approach for patients with high flow arterial priapism.

Adolescent↗

PubMed1993

[Functional evaluation of the penile venous system using dynamic pharmaco-cavernosometry and cavernosography].

The penile venous system plays an important role in the haemodynamics of erection. Failure of the venous occlusive mechanism leads to venous incompetence and impotence. The authors have examined the functional capacity of the penile venous system by dynamic pharmacocavernosometry in 31 patients with erectile dysfunction. This diagnostic tool enables to evaluate quantitatively the extent of the venous incompetence. In 26 patients it was possible to localize cavernosographically the site of venous leakage through one of the three venous systems draining the penis. Dynamic cavernosometry and cavernosography together with systematic knowledge of the anatomy of the penile venous system are of primary importance for correct diagnosis and treatment of the erectile dysfunction caused by venous incompetence. (Tab. 2, Fig. 7, Ref. 27.)

Adult↗

PubMed1993

[Revascularization of the penis].

Revascularization of the penis is indicated in those patients in whom peripheral arterial occlusion of the internal pudendal artery alone or in combination with the venous incompetence of the penis, was detected to be the cause of erectile dysfunction. The authors present the results of penile revascularization in 12 patients impotent after crushing pelvic fracture associated with urethral rupture. Revascularization of the dorsal artery of the penis by the inferior epigastric artery was used as the method of surgical treatment. Satisfactory functional results were achieved in 58% of patients. In other 8 patients with combined arteriogenic and venogenic impotence, arterialization of the venous system of the penis was utilized. In 6 patients the method of "triple" anastomosis of the inferior epigastric artery, dorsal artery of the penis, and penile deep dorsal vein was used. In 2 cases the deep dorsal vein of the penis was arterialized by the inferior epigastric artery. The cumulative success rate of venous arterialization of the penis was 62.5%. (Fig. 5, Ref. 15.)

Adult↗

PubMed1993

[Electrostimulation of the urinary bladder].

The authors present their first results with urinary bladder stimulation in dogs by using an electronic stimulator and electrodes of their own construction. Neurostimulation was carried out by means of contactless application of electrical rectangular pulses with the voltage ranging from 1 to 10 volts, frequency from 10 to 300 Hz and pulse with 1 ms. Due to the stimulation of the branches of the pelvis plexus an isolated contraction of the bladder detrussor with an increase of intravesical pressure up to 65 cm H2O was observed with subsequent spontaneous voiding. The stimulation of the intact sacral root S2 led to detrussor-sphincteric dyssynergia caused by simultaneous contraction of the detrussor and the striated urethral sphincter. The poststimulus spurt of urine was observed at the end of each S2 stimulation. The authors inform about the further plan of experimental work before introducing the method into clinical practice. (Fig. 4, Ref. 17.).

Animals↗

PubMed1993

[Erectile dysfunctions in patients treated with hemodialysis and kidney transplantation].

The incidence of erectile dysfunction in patients suffering from severe renal diseases in the stage of renal insufficiency is significantly higher in comparison with healthy men of the same age. In the etiopathogenesis of erectile disorders, both organic and psychogenic factors participate in combination. By means of a questionnaire, the authors have collected information from 53 men treated by hemodialysis and kidney transplantation because of renal failure. Erectile disorders occurred in 41.5 per cent of men with chronic renal insufficiency. On one side hemodialysis improved the erectile dysfunction in two patients, in total, however, the incidence of impotence increased to 64.2 per cent. Erectile dysfunction was reported by 71.7 per cent of patients after kidney transplantation. The authors describe two cases of iatrogenic arterial insufficiency of the penis as the cause of impotence after secondary renal transplantation. In uremic patients as possible therapeutic methods, intracavernous application of vasoactive drugs or penile prostheses implantation should be considered. (Fig. 2, Ref. 20).

Adult↗

PubMed1992

Diagnosis and treatment of cortical tumours of the suprarenal gland.

The authors report on their own groups of benign (20 patients) and malignant (14 patients) cortical tumours of the suprarenal gland. In both kinds of tumour the occurrence is higher in females. Adenoma occurred more often in the left adrenal gland and cancer in the right one. Some tumours manifested themselves by an increased production of suprarenal hormones, others were hormonally inactive and did not become manifest until the later stage of development. In the therapy of adenomas the classical lumbar approach through the 11th intercostal space is adequate, in the case of cancer and extended lumbotomy laparotomy or thoracotomy is necessary. The need of participation of other specialists in the treatment (endocrinologist, radiologist, oncologist, anaesthesiologist) is emphasized.

Adenoma↗