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Biomedical subjects

J Chmel

Publications and source records attributed to J Chmel.

At least 19 recordsLinked to original sources
PubMed2001

Extracorporeal shock wave lithotripsy of gallstones with oral dissolution. Results in course of ten years in Czech Republic in correlation to indication criteria.

BACKGROUND/AIMS: We compared the results of treatment of gallbladder stones by extracorporeal shock wave lithotripsy with dissolution during two periods to different criteria of indication. In the first period (1990-1991) we treated patients with stones up to 3 cm in diameter. In the second period (1992-1994) the indication included stones up to 1.5 cm with gallbladder contraction on cholecystography, which was also quantitatively determined by USG exceeding 60% of fasting volume. METHODS: We used Czech made lithotriptors MEDILIT. The shock waves (SW) are produced by an underwater high voltage discharge and the concentration of SW is achieved by reflection. The localization of stones is performed by means of a sonographic probe. After stone localization usually 700 SW are applied to a patient lying in prone position. Oral dissolution was started in both groups of patients two weeks before shock wave application. Ursodeoxycholic acid and chenodeoxycholic were administered in doses of 7.5 mg/kg body weight/day. RESULTS: In the first group of 260 patients (average age 42), which had moderate indication criteria, disappearance of fragments during one year was found only in 148 (57%). The remaining patients were treated symptomatically or recommended to cholecystectomy. In a second group of 160 patients (average age 45), disappearance of fragments during one year was achieved in 125 (78%). We used stricter indication criteria and our results are much better compared to the first group. Only 208 patients from both groups were controlled for more 5 years, in 89 cases of this number was a recidivity of lithiasis and at 20 of them we indicated cholecystectomy, 22 of the patients refused to continue in the therapy, because the stones are asymptomatic. CONCLUSION: In our opinion, this therapy (ESWL combined with oral dissolution) is suitable in 7% patients with gallbladder stones. Its side effects are very small, practically negligible. It can be performed without general anaesthesia and on an out-patient basis. After the advent of laparoscopic cholecystectomy we observed diminished interest of both patients and their physicians for gallbladder ESWL, however, after it has reached a widespread use, a new interest in ESWL and dissolution therapy is emerging, which we attribute to its above-mentioned advantages.

Administration, Oral↗
PubMed2001

An absence of changes in kidney tissues after an enormous number of shock waves.

Repeated sessions of unilateral extracorporeal shock wave lithotripsy (ESWL) were performed in a patient with multiple bilateral calycolithiasis who suffered from Crohn's disease of long duration and from recurrent gastric ulcers. To achieve complete clearance of stones from the left kidney it was necessary to apply 10,000 shock waves during seven sessions within five weeks. This number is exceedingly high compared to average total doses which were applied to other patients of our group (920 SW per one session). For the treatment was used an electrohydraulic lithotripter (Medipo). A surgical reconstruction of the abdominal wall which had been planned long before was made six weeks after the last ESWL session. The postoperative course was complicated by bleeding gastric ulcer of which the patient died despite an intensive treatment. The autopsy and histology revealed no damage of kidney tissue or adjacent organs caused by ESWL.

Crohn Disease↗
PubMed1998

[Enteroclysis in the diagnosis of tumors of the cecum and ascending colon].

In two patients examination of the small intestine by enteroclysis was indicated on account of haemorrhage into the digestive tract and severe anaemia and in one patient the ultrasonographic picture arousing suspicion of Crohn's disease of the terminal ileum. Although in all instances previously colonoscopy was made, considered complete, in one instance also irrigoscopy, with a negative result, enteroclysis revealed and surgery confirmed extensive carcinomas of the caecum and colon ascendens. The authors discuss the value and problems of the applied diagnostic method.

Cecal Neoplasms↗
PubMed1997

[Biological effects of interacting shock waves. A modeling study of the effects of interacting shock waves using erythrocyte hemolysis].

AIM: The effects of high-energy shock wave on tissues were discussed in literature. The shock wave sources which were used for experiments were developed for stone fragmentation. The side effects of the applicators are generally low. Increase of shock wave pressure induce bigger negative pressure amplitude and this may cause significantly bigger side effects. We used tow shock waves, with time interval of 5 microseconds. In our opinion, the first shock wave causes acoustic inhomogenity in shock wave focus and therefore second shock wave acts in a region with different acoustic parameters. The second shock wave may loss energy in the focus area by dissipation or absorption. We termed the coupled shock waves as "interacting shock waves". METHODS AND RESULTS: Hemolysis of erythrocytes was used for examination of biological toxicity. Shock wave pressure was 80 MPa, the ratio of positive to negative pressure of single shock waves is 30. For correlation we applied 50 and 100 single shock waves and 50 or 100 couples of two shock waves. Hemolysis after 50 simple shock waves was 4.28 times lower compared with hemolysis after the same number of coupled shock waves (interacting shock waves). CONCLUSION: After 50 couples of shock waves hemolysis is 2.14 times higher compared with 100 single shock waves. This result suggests that the hypothesis of some interaction existing between two shocks applied in a very short time interval make future study rightful.

Hemolysis↗
PubMed1995

[Treatment of pancreatic stones with extracorporeal lithotripsy with sonographic localization].

BACKGROUND: Pancreatic stones may be treated by endoscopic extraction or by surgery. Extracorporeal shock wave lithotripsy increased possibility of noninvasive steps to their elimination. The aim of this study was to describe our first experience with this method. METHOD AND RESULTS: 10 patients (6 men and 4 women) in average age 47 years (between 19 to 72 years) were treated. The lithotriptor MEDILIT with sonographic targeting was used for fragmentation of pancreatic stones. Fragmentation was achieved in 8 patients, in 4 cases we observed spontaneous disappearnace, in 3 cases an endoscopic extraction of fragments was necessary. In one case good fragmentation was observed at control ECRP, but the repeated Wirsungography showed a big pseudocyst which had not been diagnosed at the first examination and surgery was necessary. In 2 cases no fragmentation was achieved and in these cases surgery was also indicated. No serious side effects were observed, nor elevation of amylase values compared with the situation before the shock wave treatment. CONCLUSIONS: Extracorporeal shock wave lithotripsy of pancreatic stones revealed good fragmentation and disappearance stone from ductus Wirsungi without serious side effects on clinical course and surrounding soft tissues.

Adult↗
PubMed1995

[Biliary-duodenal prosthesis in the palliative treatment of tumors in the subhepatic region].

In the group of 347 patients (pts) with biliary cancer (218 females and 129 males, age range 42-88 years), the large size bilio-duodenal endoprostheses (BDE) were inserted. The success rate in BDE implantation varied from 68 to 92% according to the localisation of the common bile duct stenosis and its anatomy. The BDE introduction was followed by step-by-step normalisation in laboratory markers of biliary obstruction in 76% of pts, the full functional capacity of BDE varied from 26 to 311 days (median 168 days). In pts treated by BDE the survival median was 210 days. Early complications did not exceed 2.2%, late complications were observed in 8% out of cases. The 30-day mortality was 1.7%.

Adult↗
PubMed1994

[Regional chemotherapy in the treatment of biliary tract tumors].

BACKGROUND: Subjective complaints of patients with tumours of the biliary tree are late, early diagnosis is difficult and frequently impossible, the therapeutic results are unsatisfactory and the prognosis is poor. Surgical intervention is in more than 90% palliative, the tumours are not radiosensitive and their sensitivity to systemically administered cytostatics is low. The perspective of some patients was improved by implantation of bilioduodenal endoprostheses. The objective of the submitted work was to assemble experience with this method in patients with tumours of the upper portions of the biliary tree. METHODS AND RESULTS: Between January 1991 and May 1993 75 patients (42 females and 33 males, aged 48-65 years) with malignancies of the upper and middle part of the biliary tree were treated. Bilioduodenal endoprostheses (BDE) were inserted endoscopically in 70 patients. In 21 of them stenting was combined with regional chemotherapy via an implantable portho catheter. For patients with BDE alone, the median survival time was 18 months, for those with BDE and chemotherapy the median survival was 23 months (p < 0.01). 5-fluorouracil in monocombination was as potent as in combination with carmustine and/or doxorubicin. CONCLUSIONS: Endoscopic implantation of a bilioduodenal endoprosthesis with subsequent regional administration of 5-fluorouracil is an important therapeutic procedure in the treatment of malignant tumours of the upper and middle biliary tree.

Aged↗
PubMed1994

[Tumor markers in the diagnosis of tumors in the subhepatic area].

Concentrations of CA 19-9, CA 50, CA 195 and DUPAN-2 were followed in serum, bile and pancreatic juice of 65 patients with malignant or benign lesions of CBD and/or pancrease. In sera, significant differences between neoplasias and benign lesions were seen only in patients with tumors in stages III. and IV. In the bile, however, the significant increase of DUPAN-2 and CA 195 were present in all stages of cholangiocarcinoma when compared with benign CBD lesions. In the pancreatic juice, the significant increase on of CA 19-9, CA 50 and DUPAN-2 in patients with pancreatic cancer (stages I-IV) could also be evidenced.

Adult↗
PubMed1993

[Measurement of impedance in liver tissue].

At the First Medical Clinic (First Medical Faculty, Charles University) a new method of assessment of impedance of hepatic tissue was developed. A special thin injection electrode was designed which makes it possible to take readings in deep tissue. The measurements are made and aimed throughout the procedure under ultrasonographic control. From the sites of assessment specimens were taken for cytological and histological examination. So far 44 operations were completed. In 33 patients according to ultrasonography focal changes were involved, in the remainder the liver parenchyma was homogeneous or there were slight diffuse changes. Based on the results of the histological examination, the group was divided into 11 subgroups some of which are very small and thus difficult to interpret. Therefore this is only a preliminary study. Its objective is to introduce the technique of a new method because even from the small hitherto assessed values of impedance by means of the injection electrode under ultrasonographic control the conclusion can be drawn that the assessed impedance values could provide more detailed information on the character of focal changes.

Electric Impedance↗
PubMed1991

Treatment of a gastric bezoar by extracorporeal shock wave lithotripsy.

A bezoar of the stomach was diagnosed by X-ray and endoscopy in an 8-year-old boy who presented with intermittent dull epigastric pain. Attempts at endoscopic extraction failed because of the size and hardness of the bezoar. Extracorporeal shock wave lithotripsy was therefore applied using ultrasound to locate the bezoar. Disintegration of the bezoar and spontaneous evacuation of the fragments was achieved.

Bezoars↗
PubMed1991

[Treatment of kidney stones using shock-wave lithotripsy with sonographic control].

Lithotripsy by means of an extracorporeal shock-wave was performed in 128 patients with urolithiasis. In this group for the first time in Czechoslovakia ultrasound control of kidney stones was used in 44 patients; in the remainder X-ray control was used. The authors used equipment designed and manufactured locally. The ultrasonic probe is laterally connected with the shock-wave applicator. Disappearance of the fragments after lithotripsy was achieved in 39 patients where ultrasonic control was used. The paper presents the results, discusses the advantages and limitations of ultrasonic control in extracorporeal lithotripsy of urolithiasis.

Adult↗
PubMed1990

[Shock-wave lithotripsy in the treatment of 12 patients with choledocholithiasis using an apparatus manufactured in Czechoslovakia].

Lithotripsy by shock wave was performed in 12 patients with choledocholithiasis using the authors' own apparatus. The shock wave is created by an electric spark and the concentration is made by a rotational semi-elipsoid. The pressures attained in the second focus are 150 MPa. The focusing of the stones and the setting to the site of maximal pressures is made by means of two X-ray projections. Patients were indicated for the procedure when the method of endoscopic extraction had failed. Before the procedure a nasobiliary drain was inserted and after administration of analgesia on average 520 shocks were applicated. During the procedure no complications were observed. Fragmentation was achieved in 11 patients. Spontaneous release of fragments was recorded in five of the patients and in 6 during the check-up ERCP endoscopic extraction was made.

Adolescent↗