Biomedical subjects

J Dvorácek

Publications and source records attributed to J Dvorácek.

At least 19 recordsLinked to original sources

PubMed2006

[Inovative techniques in partial laparoscopic resection of the kidney for adenocarcinoma].

Authors present the first case of laparoscopic partial resection of the kidney for RCC using modern technique of tissue sealing with FloSeal, which was used in this indication for the first time in the Czech Republic. The other most useful innovative point was the usage of tail-clipped sutures from resorbable material "Lahodny", which are suitable for suturing in renal parenchyma. Despite the relatively long time of warm ischemia, the function of rest of the kidney is more than satislying.

Adenocarcinoma↗

PubMed2005

[Reconstruction surgical procedures for iatrogenic injuries to the ureter. Examples of uncommon, however successful approaches to their management].

The authors present several less usual reconstructions of ureters after the primary iatrogenic lesions. The appropriate ureteric capacity to drain the urine after previous injury is quite demanding and hence before the definitive decision is made the wholesome health status of the patient is to be considered and all possible solutions should be weighted. The efficient primary urinary diversion above the lesion is unavoidable. The genuine reconstruction could be deferred by several weeks or months in the view that in some cases the least invasive (endourologic) methods can completely avoid the need of open surgery in difficult adhesions after previous major surgery.

Abdomen↗

PubMed2005

[Comprehensive long-term analysis of hypospadias repair using vascularized flaps and tubularized incized plates--report on 588 cases].

BACKGROUND: The article presents a comprehensive long-term analysis of the modem hypospadias repair based on preservation and use of the urethral plate. METHODS AND RESULTS: In years 1987 to 2004, 476 patients (aged 8 months to 45 years) were operated using a praeputial (mostly) flap. 81% were indicated for reconstruction of a proximal form of hypospadias, mostly penile. In years 1986 to 1991, a tubularized flap was performed in 31 patients. Since 1992, an onlay island flap in 394 patients, inlay-onlay flap in 43 patients and onlay-tube-onlay flap in 8 patients have been used. In years 2000 to 2004, 112 patients (aged 13 months do 17 years) were operated using tubularized incised plate (TIP) repair, mostly because of distal form of hypospadias. To cover the neourethra, a dartos flap was used in 72 and spongioplasty in 37 patients. We achieved the primary healing in 89% and 91%, resp., of patients after onlay and onlay-inlay island flap repairs with an average follow-up of 6,7 and 5,7 years, respectively. The most frequent complications were fistula or dehiscence of the glans. After the TIP repair combined with a dartos flap, 89% of the first operated patients healed without complications with an average follow-up of 2.3 years. A higher complication rate (40%) was found after a spongioplasty with foreskin preservation. Secondary repairs were also associated with more complications. CONCLUSIONS: Using onlay and inlay-onlay one-stage repairs, or using TIP one-stage repair combined with a dartos flap, a successful primary hypospadias repair was achieved in 90% of patients. The definite repair should be completed during early childhood.

Adolescent↗

PubMed2005

[Role of laparoscopy in uro-oncology].

The article reviews problems of laparoscopic surgery in uro-oncology. Examples supporting and opposing the laparoscopic alternative are given. Original objections against the use of the method for the treatment of malignancies are discussed from the retrospective position. According to the predominant views it looks that laparoscopic treatment by a highly educated team with good technical background, respecting oncologic and functional aspects, does not have worse short-term and long-lasting results. The improving diagnostics and possibility to identify malignancies in early stage of development will enable wider use of the laparoscopic surgery.

Humans↗

PubMed2005

[Fluorescence cystoscopy in the diagnostics and treatment of superficial urinary bladder tumors].

BACKGROUND: 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy. The goal of our study was to assess the influence of fluorescence cystoscopy used during transurethral resection on the recurrence rate and the length of tumor-free interval in stage Ta, Tl transitional cell carcinoma of the urinary bladder. METHODS AND RESULTS: In prospective randomized study 109 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. 17 patients with high grade tumors were evaluated separately. In group A the transurethral resection was performed with standard white light endoscopy, in group B with fluorescence cystoscopy. The patients were followed using standard cystoscopy and urinary cytology. Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumors separately. The median time to recurrence was 8.05 months in group A and was significantly shorter than 13.54 months in group B (p = 0.04, log-rank test). In separate analyses the median time to recurrence was significantly shorter using fluorescence cystoscopy in multiple (p = 0.004) and in recurrent (p = 0.02) tumors, but not in solitary and primary tumors. CONCLUSIONS: 5-aminolevulinic acid induced fluorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma.

Aged↗

PubMed2005

[Female sexual dysfunction].

Female sexual dysfunction (FSD) is a disorder with relatively high incidence in the community. Its incidence in age-dependent and it can significantly limit the quality of life of women concerned. Dysfunction, as a multicausal and multidimensional problem, it comprises biological, psychological and interpersonal factors. Disorders are listed according to a sexual desire, arousal, experiencing an orgasm and pain incidence. Authors summarized data on incidence, diagnosis and therapy of this disorder.

Female↗

PubMed2005

[Effect of biofeedback in the treatment of voiding dysfunction].

BACKGROUND: Biofeedback represents a treatment option for children with voiding dysfunction characterised with poor pelvic floor relaxation. METHODS AND RESULTS: Thirty nine children with symptoms of voiding dysfunction were treated in BFB program. Average number of sessions to achieve good response was three. Follow up was 12 to 24 months. Very good clinical response was obtained in 55, 7% of patients, who were characterised by cessation or resolution of incontinence in 66, 7%, dyscoordination in 57, 6% and urinary tract infection in 41, 1% of children. CONCLUSIONS: Biofeedback therapy is an effective method for treating poor pelvic floor relaxation. It helps to improve coordination of the detrusor and external sphincter function and it accelerates voiding reflex maturation.

Adolescent↗

PubMed2004

[Treatment strategy for renal abscesses].

AIM: A retrospective assessment of treatment results in a group of patients treated for renal abscesses by our work team during the last five years. The aim is to determine the most suitable therapeutical approach for each abscess group, depending on their size. PATIENTS AND METHODOLOGY: There were 13 patients in the group (10 of them were women and 3 of them were men, aged 36, on average). The ultrasound examination of the kidneys was conducted using the 5 MHz appliance. In cases when antibiotics were prescribed, they were prescribed in combination, most often ampicillin and gentamicin. The evacuation percutaneous punction of the abscess cavity was carried out using a standard technique under the sonographic control. The kidney was approached via lumbotomy during the nephrectomy procedure. RESULTS: The hospitalization lasted for 19 days on average (5-72 days). The right and left kidney involvement ratio was 5:8. In four cases we chose a conservative approach, in all cases, the patients concerned were treated during the previous three years. The abscess cavity measured 2.75 cm on average, in the above patients cases. Eight patients underwent a percutaneous punction of the abscess cavity. The average size of the renal abscess was 5.5 cm in this patient group. One patient underwent nephrectomy. The patient concerned was immunosuppressed. Three- to four months after the treatment commenced, the control CT scan revealed no residual abscess foci. CONCLUSION: The medium-sized renal abscesses may be solved using a percutaneous abscess punction. The small-sized abscesses may be successfully solved using antibiotics, introduced parenterally. The conservative treatment is considered inappropriate in cases of immunocompromized patients and for abscesses larger than 5 cm.

Abscess↗

PubMed2004

[A case of a patient with solitary prostate metastasis of the colorectal carcinoma three years after abdominoperineal amputation of the rectum].

AIM: The aim of this study is to present a case-review of a patient with an extremely rare finding of a solitary metastasis of the colorectal carcinoma in his prostate. METHODOLOGY: A Case-Review. RESULTS: The study describes a case of a 42-year-old patient who underwent abdominoperineal amputation for the rectal carcinoma pT3 N1 M0 with complementary actinotherapy and chemotherapy. Three years after his rectum amputation, a CT scan disclosed a hypodense focus in his prostate of unknown origin. Elevation of the CEA was found upon laboratory examination, other tumor markers including the PSA were not abnormal. The positron emission tomography (PET) did not disclose other distant foci. The patient was administered 4 courses of chemotherapy with, basically, no signs of regression in the prostate foci. Biopsy from the suspicious focus was conducted transperitoneally, followed by its histological examination which confirmed cribriform adenocarcinoma. Our team decided on salvage cystoprostatectomy, securing urine derivation by the ilium conduit. 6 months later, the CT examination showed a massive local relapse and two metastatic foci in the liver, further oncological therapy was not indicated. The patient died 7 moths after the radical cystoprostatectomy. CONCLUSION: This case-review points out a possibility of metastatic prostate affections connected to the colorectal carcinoma disorder, as well as its treatment procedures.

Adenocarcinoma↗

PubMed2003

[Fluorescence cystoscopy using 5-aminolevulinic acid].

BACKGROUND: Fluorescence diagnosis has an increasing importance in different medical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented. METHODS AND RESULTS: From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spots were found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases). CONCLUSIONS: The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.

Administration, Intravesical↗

PubMed2003

[Benefits and risks of urologic laparoscopic surgery in adult patients].

The paper describes the advantages and disadvantages of the laparoscopic operations, the number of which steadily rises in urology. The laparoscopic surgery is considered to be a benefit regarding the short postoperative hospital stay, painless postoperative course, and virtually non-existing postoperative paralytic ileus. As disadvantage are deemed the long learning curve for the operating personal, and high economical costs, which could be cut down only if short off-work period in productive population is included. In the paper, the pathophysiological guidelines are outlined and emphasized during the laparoscopic operation, which the surgical and anesthesiological teams have to have in mind. On the own cohort of patients, the numbers and types of operations are described, which have been done at our department.

Adult↗

PubMed2002

[Diagnosis and therapy of superficial tumors of the urinary bladder].

Among patients with bladder carcinoma, 70-80% present with superficial bladder tumors. This group is composed of papillary tumors Ta, T1 and of flat nonpapillary high-grade carcinoma in situ (Tis). Typical features of superficial tumors are their multifocal origin and high recurrence-rate after initial therapy. The first and most important step in diagnosis and treatment of the bladder cancer is urethrocystoscopy under general or spinal anesthesia with resection of papillary lesions and biopsy of suspicious areas followed by pathologic examination of the surgical specimen. This approach enables total resection of all visible tumors, classification of the tumor and determination of prognostic factors. The aims of intravesical therapy are treatment of Tis and prevention of recurrence and progression after TUR. The most often used agents for intravesical chemotherapy are mitomycin C and adriamycin. This treatment modality prolongs tumor-free interval and reduces early recurrence-rate in about 14% of patients, but cannot reduce late recurrence-rate and progression-rate. BCG intravestical immunotherapy is with 73-87% response rate the most effective treatment modality in Tis. It is also more effective than chemotherapy in prevention of recurrence, but is connected with more frequent side effects. Radical cystectomy is considered in patients who do not respond to local therapy.

Carcinoma, Transitional Cell↗

PubMed2002

[Intermittent androgen blockade in prostatic carcinoma].

Intermittent endocrine treatment or cyclic therapy of prostate cancer aims at prolonging survival by delaying progression to androgen independence and at improving quality of life by avoiding the side effects of continuous androgen ablation. Intermittent endocrine treatment is capable of inducing multiple apoptoic regressions and of improvement in quality of life including sexual functions. The recommended length of therapeutic period is 6-9 months. The mean off-therapy interval approaches 50% of the duration of the treatment cycle. The mean time to disease progression is 32 month. The definitive answer to the question of prolonged survival awaits the completion of ongoing randomized studies.

Androgen Antagonists↗

PubMed2002

[Adjuvant therapy of renal carcinoma].

A treatment approach in a group of 1498 patients with renal cell carcinoma (RCC) was studied. Out of these, 86 patients had the primarily generalised form. For the therapy of primary advanced metastasis, the treatment strategy was changed from conservative to an active approach. Such approach is based on the removal of 75% of the tumor mass, the patient should be in good conditions with no metastases in CNS, bone and liver, and the primary tumor should not be a sarcoma. The new treatment strategy of patients with advanced RCC combines surgery and chemoimmunotherapy. 47 patients from the studied group were treated with combined INF alpha + IL-2 + 5FU + isotretinoin using the Atzpodien scheme. The toxicity was minimal and only in six patients the treatment was interrupted because of the disease progression. Results of this treatment strategy are encouraging, however, further randomised trials are recommended.

Adult↗

PubMed2002

Qualitative and quantitative detection of urinary human complement factor H-related protein (BTA stat and BTA TRAK) and fragments of cytokeratins 8, 18 (UBC rapid and UBC IRMA) as markers for transitional cell carcinoma of the bladder.

OBJECTIVE: To evaluate the role of BTA stat, BTA TRAK, UBC Rapid, UBC IRMA and voided urinary cytology in the detection of bladder transitional cell carcinoma (TCC). METHODS: The study included 78 patients with TCC of the bladder (group A), 62 patients with a history of bladder TCC without tumor recurrence at the time of examination (B, control group), 20 patients with other malignancy of the urinary tract (C), 38 patients with non-malignant urinary tract diseases (D), 10 patients with urinary tract infection (E) and 10 healthy volunteers (F). Except in group F, voided urine was collected before cystoscopy or cystectomy. RESULTS: The specificity and sensitivity in bladder cancer detection were 87.1 and 74.4%, respectively with BTA stat, 79.3 and 48.7%, respectively with UBC Rapid, 100 and 33.3%, respectively with cytology, 72.6 and 75.6%, respectively with BTA TRAK, 64.5 and 70.5%, respectively with UBC IRMA. CONCLUSIONS: The BTA stat and BTATRAK tests are superior to UBC Rapid, UBC IRMA and urinary cytology in detection of bladder TCC. In daily practice however cytology remains the best adjunct to cystoscopy because of its high sensitivity in Tis and 100% specificity. Cystoscopy cannot be replaced by any of evaluated methods.

Adult↗

PubMed2002

The expression of PAX5, p53 immunohistochemistry and p53 mutation analysis in superficial bladder carcinoma tissue. Correlation with pathological findings and clinical outcome.

OBJECTIVES: The expression pattern of PAX5 in the tissue of superficial bladder transitional cell carcinoma (TCC), its prognostic value and its correlation with p53 immunohistochemistry and p53 mutation analysis were evaluated. METHODS: Study comprised 61 patients with histologically confirmed superficial bladder TCC. Expression level of PAX5 mRNA was investigated using reverse transcriptase-polymerase chain reaction (RT-PCR) and determined semiquantitatively. The presence of p53 mutations was determined by SSCP and confirmed by direct sequencing. The p53 immunohistochemistry was performed with DO1 antibody and semiquantitatively evaluated using HSCORE (HS) method. As the control group for the evaluation of the PAX5 expression served 8 men with benign prostatic hyperplasia. RESULTS: PAX5 expression was found in 50 patients with bladder TCC but in no patient from the control group. Its quantity however correlated neither with the stage nor with the grade of the tumor. P53 mutation was confirmed only in 1 patient with pTaG2 tumor in exon 5 (deletion of proline 128). On the contrary, positive immunohistochemical staining of p53 was detected in most patients. Using the cutoff value of HS 200, 56.9% of patients showed p53 overexpression. Quantity of p53 immunochistochemical positivity did not correlate with the quantity of PAX5 expression. Using the cutoff values of HS 200 for p53 and of 0.2 for PAX5, 7 of 8 patients with future progression had p53 and 4 had PAX5 overexpression respectively. CONCLUSION: The expression of gene PAX5 is a frequent event in superficial TCC of the bladder.

Aged↗

PubMed2002

[Laparoscopic transperitoneal adrenalectomy in hormonally-active adrenal tumors].

Laparoscopic adrenalectomy is considered the "gold standard" in adrenal surgery for benign functioning (and non-functioning) tumors. Laparoscopy meets criteria of miniinvasive surgery with minimal postoperative pain, short hospital stay and an outstanding cosmetic effect, the radicality of the procedure, open surgery and laparoscopy are equally effective. In cooperation with endocrinological department focused on detection of functioning adrenal tumors, the diagnostic and therapeutic procedure seems to be very efficient, so that the primary goal of rapid cure could be achieved. Patients after laparoscopic adrenalectomy mostly do not need chronic antihypertensive medication and only those after bilateral adrenalectomy (Cushing's disease) require life-long low dose hydrocortisone therapy. In pheochromocytomas, total excision of the tumor is considered to be a life-saving procedure, although up to 20% may recur as hereditary or as a part of von Hippel-Lindau's disease.

Adrenal Cortex Hormones↗

PubMed2001

[Benign hyperplasia of the prostate--a known and unknown disease].

Authors give an overview of the current approaches to diagnostics and therapy of the benign hyperplasia of the prostate (BPH). The up-to-date diagnostic possibilities are cited in the relation to our health care system and the procedures of conservative and surgical treatment of BPH are outlined. In epidemiology and diagnostics of BPH, one has always to consider the possibility of prostate cancer (PC), which may have similar symptoms, particularly in initial stages. If prostate cancer were found, it could be successfully cured at this stage only. Drug therapy or BPH enables in most cases at least temporarily to resign on surgical treatment. Patients treated with alphablockers regularly speak about an improved quality of life regarding previous micturition troubles. To diagnose BPH, the complex urological examination is needed, including some laboratory tests (prostate specific antigen PSA, uroflowmetry UFM). The article is supplemented with a graph of latest available figures referring to the number of TURPs performed annually and a table showing the list of methods for the minimal invasive surgical treatment of BPH.

Diagnosis, Differential↗