Biomedical subjects
Publications and source records attributed to J Duben.
The authors present a case-review of a cavernous haemangioma of the small intestine as a cause of haemoperitoneum in a young female. The authors discuss the patient's history, completed examinations and surgical management of the case including a detailed histological examination of the intestinal resecate with cavernous haemangioma. Discussion includes literature data of the published case-reviews.
AIM: The aim of this study is to evaluate the lymphatic mapping method during the colorectal carcinoma surgery and to increase a number of the detected lymphonodes up to the level of the internationally recommended standards. METHODOLOGY: In the group collected in 2002 and 2003, the lymphatic mapping method was applied in cases of 32 patients suffering from the colorectal carcinoma, according to the protocol. RESULTS: In the group of 32 patients suffering from all stages of the colorectal carcinoma, a total number of 408 lymhonodes was examined, which is 12.75 lymphonodes per patient, on average. Out of this, in the rectal carcinoma cases--7.85 lymphonodes per patient were detected on average, and in the group of the colon tumors--13.72 lymphonodes per patient. CONCLUSIONS: The retrospective evaluation of the patients who underwent surgery for the colorectal carcinoma proved the method of the lymphatic mapping to increase the number of the detected lymphonodes from 6-8 up to nearly 13. Thus, the average number of the examined lymphonodes already complied with the international oncosurgical criteria. The lymphatic mapping technique proved to significantly increase the number of the examined lymphonodes and to improve the colorectal carcinoma patients staging.
AIM: The method of extended lymphadenectomy in the early gastric carcinoma treatment remains controversial. The aim of this prospective study is to assess the above method feasibility with acceptable rates of complications, in our conditions. METHODOLOGY: From 2000 to 2003, 11 patients with early carcinomas of the stomach were treated using the method of extended lymphadenectomy. The study group included 7 males and 4 females. RESULTS: In 6 cases, the tumors were located in the distal, in 4 cases in the middle and once in the proximal third of the stomach. In a single case, the IIIA stadium was concerned, the other cases were rated lower. In total, 205 lymphonodes measuring 18.6 on average (median of 16) were examined. The total of 5 lymphonodes were malignant, all of them were found in one patient. The method of the sentinel lymphonode biopsy was applied once. A cardiopulmonary complication was reported once, a punction of the subphrenic absces was reported once, a primary disorder causing a death was reported once and the patient concerned exited after a 14-month-period of his follow-up. Once, a local relaps of the disorder was reported 43 months after the procedure. The follow-up median was 27 months. CONCLUSION: The method of extended lymphadenectomy can be conducted even in our conditions with acceptable rates of complications.
AIM: The aim was to introduce a new surgical method and to verify its validity. METHODOLOGY: In 20 patients whose ultrasound findings correlated with the MIBI scintigraphic results, a radiation-navigated parathyreoidectomy using a C-Track was conducted, following a radionucleotide application. RESULTS: From 2001 to 2003, 20 patients with hyperparathyreosis were operated. In all cases, an altered parathyroid gland with increased activity was detected using radionavigation. After the surgery, the calcium and the parathormone blood levels decreased. CONCLUSION: The MIRP is a miniinvasive surgical method indicated for the use in cases when hyperparathyreosis is confirmed and the ultrasound findings correlate with the MIBI-scintigraphic findings.
AIM: Rates of the newly-detected DCIS reach up to 20% in developed countries. There is no unified therapeutic scheme to deal with the disorder. The aim of this work is to assess the author's own therapeutic results. METHODOLOGY: From 1999 until 2003, 11 female patients suffering from the DCIS were treated and 2 DCIS female patients were treated using microinvasion. The diagnosis was established 5x by the core-cut and 8x by the surgical excision. RESULTS: The size of the tumors varied from 0.5 cm to 6.0 cm. Conservative procedures were performed 11 times, a simple mastectomy once and a mastectomy with reconstruction once, as well. The sentinel lymphonodes were examined in all cases and once the examination was accompanied by the axilla dissection. The number of the sentinel lymphonodes was 29. All of the lymphonodes were negative. Seven female patients were given a complementary therapy. All female patients have had no local relapse in the breast and have had no signs of the disease process since. The average follow-up time is 13.5 months. CONCLUSION: The conservative procedures sufficiently provide treatment of early forms of the DCIS of the breast. The sentinel lymphonode biopsy is a patient- kind method, giving exact information on the status of the axillary lymphonodes and it is considered a suitable part of the DCIS therapy.
OBJECTIVE: Authors report the validity and accuracy of lymphatic mapping with sentinel node biopsy in patients with early breast cancer between 1998 and 2000. TYPE OF STUDY: Prospective study. LOCATION: Department of Surgery, Atlas Hospital Zlin. METHODS USED: Lymphatic mapping and sentinel node biopsy using patentblue in patients with breast cancer was performed between 1998 and 2000. Combination of patentblue and radiocoloid Nanocoll Nycomed Amersham has been used from 2000. C-Track device (Care Wise Medical Product Morgan Hill) was applied for detection of radiocoloid in sentinel node. Gamma probe intraoperatively localised sentinel nodes. Lymphoscintigraphy was performed routinely. Patients were tested with routine hematoxylin & eosin staining. When the H&E staining in sentinel nodes was negative the immunohistochemical procedure was used. Following identification of sentinel nodes, axillary node dissection was applied. Axillary node dissection was abandoned by patients with tumor T1 and sentinel node negative. RESULTS: In 124 cases, the sentinel node was successfully identified. 122 patients were women with unilateral and one woman with bilateral cancer. 1 was a male. Of these 124 cases 60 were node-positive and sentinel nodes metastasis was in 26 cases only. 1375 nonsentinel nodes were examined (a mean 13.4). 268 sentinel nodes were examined (a mean 2.2). Hematoxylin and eosin staining was used routinely and if no tumor was identified then imunohistochemical cytokeratin staining was performed. Imunohistochemical staining was used in 21 cases. Only in one patient micrometastases were identified. Three sentinel nodes were negative in patient with axillary disease. CONCLUSION: This study demonstrates that sentinel node biopsy in patients with early breast cancer is safe and highly accurate an can be used to avoid axillary lymph node dissection.
The authors summarize literary data on contemporary knowledge and development of views regarding lymphadenectomy in breast cancer. They deal also with the history and technique of detection of a sentinel node by Patentblau and radioisotope 99mTc. In a group of 29 patients operated in 1998-1999 with a detected sentinel node they analyze the surgical technique and present their initial results. In the group they extirpated and examined a total of 354 axillary nodes, i.e. on average 12.2 nodes per patient. Eleven times the nodes were positive, incl. the sentinel node. This number comprised six cases where the sentinel node only was affected. In 16 cases all axillary nodes were negative. In two instances the sentinel node was falsely negative. These results are thus quite comparable with those from reknown departments concerned with sentinel nodes. Examination of the sentinel node very probably determines the affection of axillary nodes and the patient's prognosis. Unnecessary dissection of the axilla with subsequent associated complications can thus be avoided.
The authors present a review on the development of views on breast cancer from the beginning of the century and contemporary views on the problem, its solution world-wide and in the Czech Republic. They base on their own group of 475 patients of 1991-1998, they analyze the development of possible solutions of early breast cancer and their view on the discussed problem. With regard to favourable results they advocate progressive breast preserving operations associated with postoperative radiotherapy and the use of the method of sentinel nodes.
The authors made one thousand thyroidectomies in the course of five years. In the submitted paper they discuss indications, for surgery, the extent of the operations, the results of the histological findings. They describe the surgical procedure, required preoperative examinations and postoperative monitoring. They analyze different postoperative complications incl. their frequency in the discussed group. They emphasize a physiological surgical technique, verifications of the recurrent nerve, care of the parathyroid bodies and collaboration with endocrinologists.
A prospective study of pharyngitis was carried out in the general population of twenty-two thousand in a small country town, over a period of ten weeks in the fall of 1984. It has been confirmed that, as in the past clinical diagnosis "streptococcal" and "nonstreptococcal" pharyngitis without microbiological examination is still highly inaccurate. From the clinical and microbiological parameters, the incidence in the period of follow-up was calculated as 7.2 and 12.0 cases per 100 population per year for streptococcal and nonstreptococcal pharyngitis, respectively. These data document the health importance of this disease which is frequently underestimated. The M (by M or OF antigens) typability accounted for 62% of group A strains isolated, the prevailing types being M 1 and M 12. Comparison of M and OF typability of field strains immediately after isolation and three weeks later proved the superiority of an early typing. The accurate identification of prevailing types is essential for the prospect of streptococcal vaccine. In streptococcal pharyngitis cases treated with penicillin, the increase of antistreptolysin O and antideoxyribonuclease B titres was recorded in very few instances during a three week period after the onset of the disease. The examination of patients with nonstreptococcal pharyngitis aimed at detecting the role of some viruses or of M. pneumoniae proved that the etiology by these agents was practically nil in the cases concerned at this particular period of time. This finding suggests focusing interest on a possible role of other pathogens. The morbidity rates of pharyngitis, and the clinical as well as the microbiological data resulting from the study make it urgent to pay further attention to this infection and to attempt to elucidate the missing points in the etiology and diagnosis of this disease which belongs to the bacterial infections most frequently seen in man in economically developed countries.
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An outbreak of severe dysentery-like disease developed in a pensioners' home in autumn 1979, with 30 out of 75 exposed persons becoming involved. The agent was E. coli O 164 (serotype 147) resembling Shigella in some of its properties. Positive cultivations were obtained from 18 patients out of a total of 54 subjects examined. The isolates produced keratoconjunctivitis in guinea-pigs. An unusual feature marking the onset of the illness in about half of the patients was a transient paresis of the lower extremities. The outbreak was suppressed with peroral neomycin. This was the second instance of E. coli O 164 isolation in Czechoslovakia and the first record of its ability to cause an epidemic process.
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The development of acute bacillary dysentery was followed in 23 patients involved in two outbreaks and in three sporadic, mutually unrelated cases. Repeated cultivations performed at 2-day intervals for 10 days yielded 386 identifiable strains of "opportune intestinal flora". Escherichia coli colicinogenic activity is one of the significant factors of gastrointestinal tract protection. The period of shigella excretion is significantly reduced (p less than 0.02) if an appropriate colicinogenic E. coli strain is present. Analysis of the results suggested a working hypothesis of differentiated approach to bacillary dysentery treatment in outbreaks. In the absence of a suitable colicinogenic flora neomycin therapy should be administered since it does not damage the natural colonizing flora (bacteroids, bifidobacters, aerobic lactobacilli); in the presence of a suitable colicinogenic flora, no antibiotic should be used as this would abolish the coli-flora.
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A one-year-round study on pharyngitis incidence among the general population of a town (24,300 inhabitants) was carried out. All patients, with pharyngitis who visited health centres were examined clinically and mcirobiologically. The overall pharyngitis incidence rate and the streptococcal pharyngitis incidence rate were, respectively, 8.3 and 3.9 cases per 100 population. Age-related incidence was highest in the group of 5-10 years, seasonal incidence was highest in autumn. Clinical diagnoses made preliminary to bacteriological examination were correct in only a half of the streptococcal pharyngitis cases. The accuracy of clinical diagnosis of streptococcal pharyngitis could, at best, be raised to 80% if fever of less than or equal to 38.0 degrees C and presence of exudate on tonsils should be considered significant criteria. A great majority of the streptococcal pharyngitis cases were caused by group A streptococci; the prevailing M types were 12, 1 and 3. Emphasis is laid on the necessity of performing microbiological examination of all pharyngitis cases in order to ensure etiological diagnosis and causal therapy. 15)