Biomedical subjects

J Leffler

Publications and source records attributed to J Leffler.

At least 19 recordsLinked to original sources

PubMed2005

Strictures of the terminal bile duct--who profits from the surgery?

BACKGROUND: Elucidation of the etiology of terminal bile duct strictures is oftentimes challenging. In choosing the optimal treatment method, a multidisciplinary approach is necessary. AIMS AND METHODS: To demonstrate the advantages and indications of surgical management, 153 patients with terminal bile duct strictures were retrospectively analysed. All patients had been treated during a period of eight years (1st January 1995 - 31st December 2002) in same department. The principal datas studied were surgical morbidity, thirty-days' mortality rates and recurrence of jaundice. RESULTS: During a period of eight years, 153 patients (100%) underwent laparotomy. Radical surgery (duodenopancreatectomy) was performed in 79 patients (51.6%), while 74 others (48.4%) benefited from bypass procedures. Postoperative morbidity reached 13.1%; nine patients (5.9%) died within the thirty days of surgery. Recurrence of jaundice was observed in three patients (1.9%). CONCLUSION: Surgical management of terminal bile duct strictures is indicated in most patients with benign strictures, strictures of unknown origin and with malignant strictures, where the patients are in a reasonably satisfactory clinical condition. The surgical approach provides the potential advantage to obtain a definite histological diagnosiscare and to remove the tumour in many patients. Patients with non resectable tumours could benefit from bypass procedures ensuring long-term and effective drainage of the bile.

Cholestasis↗

PubMed2005

[Carcinoma of the pancreatic head and periampular carcinomas. 10-year results of their resection management].

INTRODUCTION: Parcial duodenopancreatectomy (DPE) remains the principal treatment method of carcinomas located in the region of the pancreatic head. Although several surgical clinics use this method, assessment of, mainly the long-term, treatment results is virtually absent in our literature. AIM: Presentation of early and late results of the procedure collected in a clinic, managing the procedures with "medium frequency". The study is aimed at patients with histologically confirmed carcinomas of the pancreatic head. MATERIAL AND METHODS: Prospective data from a group of patients who had undergone the DPE during the 10-year study in the Surgical Clinic of the IInd Medical Faculty of the Charles University in Prague-Motol, have been collected. RESULTS: From January 1995 to the end of 2004, 121 DPEs were completed, the 30-day mortality rate was 4.9% and the morbidity rate reached 17.5%. The long-term results were assessed in 71 cancer patients - the median survival rate was 18 months following the procedure (1-121 months), depending on the tumor type. CONCLUSIONS: The collected results are similar to those presented by foreign clinics (but conducted with lower frequencies here) and fall within a European better average.

Adult↗

PubMed2004

[Gastric carcinoma and D2 lymphadenectomy--technique and possible complications].

Lymphadenectomy in gastric cancer became vital and obligatory part of staging procedure. Therapeutic effect of lymphadenectomy with patient's prognosis improvement still remains uncertain. In subgroups, extensive lymphadenectomy enhance radicality of the procedure, enables to reach R0 resection in the area of tumour bed and hopefully improves survival. D2 lymphadenectomy is now becoming as a standard also in our country. Technique and possible complications of D2 lymphadenectomy are the matter of this article.

Adult↗

PubMed2004

[Spontaneous rupture of a splenic pseudocyst].

In the course of chronic pancreatitis diverse complications may arise. Intraparenchymal splenic complications are very rare. In the following case the authors describe rupture of splenic pseudocyst with acute intraabdominal bleeding as a complication of chronic pancreatitis.

Chronic Disease↗

PubMed2003

Sentinel node biopsy in gastric cancer: preliminary results.

BACKGROUND: Extent of lymphadenectomy in gastric cancer is one of the still unresolved and ongoing questions. Whether extensive procedures lead to better survival remains controversial. The detection of sentinel node could become a helpful method to define the desirable extent of lymph node dissection for each particular patient. MATERIAL AND METHODS: Prospective, single-centre, clinical trial. Sentinel node is identified using vital blue dye. After performance of D2 lymphadenectomy, the pathologist minutely investigates all lymphatic nodes by histological and immunohistochemistry techniques. RESULTS: During a period of 36 months, an attempt to localise the sentinel node for biopsy was made in 22 patients. The successful rate of sentinel node detection with a good relation between metastatic involvement of the sentinel node and other nodes was 56% (13 out of 22 patients). All these patients suffered from small tumours and early stage of the disease. In large tumours and advanced stages, blue dye stained the tissue around the tumour diffusely rendering the identification of true sentinel node impossible. Fresh frozen section of the sentinel node resulted in two patients in a false negative outcome because of micrometastatic involvement. CONCLUSIONS: Sentinel node biopsy in gastric cancer using vital staining is a feasible method. Reliable results were seen in early stage of the disease. Fresh frozen section of sentinel node has probably a low sensitivity for detection of micrometastases.

Feasibility Studies↗

PubMed2003

[Stenoses of the terminal choledochus--surgical treatment].

INTRODUCTION: Obstructive jaundice caused by stenosis of the terminal choledochus remains even nowadays a serious differential diagnostic and therapeutic problem. OBJECTIVE: The objective is to draw attention to possible contemporary treatment and its indications. MATERIAL AND METHODS: The authors evaluated retrospectively the results achieved by surgical treatment in 145 patients operated during the last 8 years on account of benign or malignant obstruction of the terminal choledochus. RESULTS: Within 30 days after surgery 9 patients (6%) died. A relapse of the obstructive jaundice occurred in three instances (2%). The morbidity amounted to a total of 14% and is comparable with data in the contemporary literature. CONCLUSIONS: The presented results support the inclusion of surgical treatment as the method of first choice in patients with stenosis of the terminal choledochus of uncertain biological nature. For surgery also patients are indicated with obstruction of malignant origin who cannot be treated radically (M1), provided they are in a satisfactory general condition (ASA I-III). Surgical therapy is suitable also for treatment of the majority of patients with a benign stenosis or stricture of the terminal choledochus.

Cholestasis, Extrahepatic↗

PubMed2003

[Lymphadenectomy in gastric carcinoma--present status, new trends and personal experience].

The only hope for long time survival in gastric cancer is radical surgery with complete tumour removal. Lymphadenectomy as a part of surgical procedure helps to remove tumour completely. The value of lymphadenectomy for staging is clear and surgeons have no doubt about it. Therapeutic effect of lymphadenectomy with improvement of the prognosis remains uncertain. In this work we would like to discuss current trends in lymphadenectomy in gastric cancer, especially evaluating the value and extent of the procedure.

Adult↗

PubMed2003

[Massive hemorrhage from a pancreatic pseudocyst into the duodenum].

Pancreatic pseudocyst or pseudoaneurysm bleeding related to chronic pancreatitis is associated with high mortality. Diagnostics includes angiography and contrast CT; therapy is based mainly on percutaneous transvascular embolisation (PTE) and surgery. Mortality burden related to conservative approach is up to 90%. Case report describes massive pancreas pseudocyst bleeding from erosion-affected arteria gastroduodenalis in 44-years-old patient with chronic pancreatitis. Spontaneous pseudocyst perforation into the duodenum caused hemorrhagic shock with necessity of urgent surgery. Identification of bleeding vessel was enabled thanks to longitudinal gastroduodenotomy and pseudocyst dissection through duodenum wall. Article reminds some diagnostics and therapeutics issues related to chronic pancreatitis complications with bleeding as well as information published in recent literature.

Adult↗

PubMed2002

[Gastric carcinoma--the sentinel node concept: initial experience].

Gastric cancer is a serious malignant disease. The only hope for long time survival is radical surgery. It consists of gastrectomy and also resection of adjacent lymphatic tissues. The extent of lymphadenectomy is one of the currently discussed questions. D2 lymphadenectomy is now becoming standard also in our country. This extensive procedure can be quite difficult and needs an experienced surgeon. It is also connected with prolonged operation time and higher costs. According to some authors, this procedure is also associated with a higher morbidity. The question, whether D2 lymphadenectomy should be performed, could be answered by the sentinel node concept, which is the topic of our work.

Adenocarcinoma↗

PubMed2001

[Impaired healing of pancreatic anastomoses].

Impaired healing of anastomoses of the pancreas are a specific and very serious complication of surgery of the pancreas. Based on experience with healing in 88 patients with anastomoses of the pancreas during the last 5 years (77 partial duodenopancreatectomies (DPE) and 11 limited resections or drainage operations) it was found that the decisive factor for complications in the area of anastomoses is soft tissue of the unaltered pancreas at the site of resection. Impaired healing was recorded in 9 cases (10%), in three of them it was however the cause of complications which proved fatal (33%). In treatment effective drainage of the peripancreatic area is most important as well as reduced pancreatic secretion due to octreotide administration. Surgical solution is called for only in the most serious cases of an insufficient anastomosis, the lethality is however, regardless of the tactics of surgical treatment, high.

Anastomosis, Surgical↗

PubMed2000

Factors influencing stereoacuity in accommodative esotropia.

PURPOSE: Despite successful optical realignment, many children with accommodative esotropia (ET) have abnormal stereoacuity. In a prospective study, we examined the influence of age of onset, age at alignment, duration of constant misalignment, and accommodative convergence/accommodation ratio on random dot stereoacuity outcomes in accommodative ET. METHODS: Participants were 111 consecutive children with accommodative ET. Random dot stereoacuity was measured using the Randot preschool stereoacuity test, the Randot stereoacuity test, the infant random dot stereoacuity cards, and the Lang 1. RESULTS: Age of onset has only a minor influence on stereoacuity (P <.02); children with onset >/=age 25 months have better stereoacuity compared with children with an onset between ages 7 and 17 months. Age at alignment has a minor influence on stereoacuity (P <.001); children with intermittent ET who have been treated have better stereoacuity than children with a constant ET aligned between ages 6 and 24 months and after age 24 months. Duration of constant misalignment has the strongest influence on stereoacuity (P <.001); children who had intermittent misalignment or who had a constant misalignment of less than 4 months' duration have better stereoacuity than patients who had a constant misalignment greater than 4 months' duration. The accommodative convergence/accommodation ratio does not influence stereoacuity outcomes (P >.10). CONCLUSIONS: Fine random dot stereoacuity is associated with a constant misalignment of less than 4 months' duration. These findings promote prompt and aggressive treatment of accommodative ET at the onset of intermittent or constant misalignment.

Accommodation, Ocular↗

PubMed1999

[Biliary ileus. Diagnosis and therapy].

Based on retrospective evaluation of therapeutic results of all patients operated at the Second Surgical Clinic of the Second Medical Faculty Charles University on account of biliary ileus during the last 10 years the authors submit their ideas on treatment of this relatively rare disease. Decisive for the patient is early, though frequently difficult assessment of the diagnosis and the speediest possible removal of the obstruction. Enterlithotomy with thorough revision of the gut above the obstruction and removal of the contents is a sufficiently effective procedure. Subsequent elective cholecystectomy is indicated only in patients with further symptoms of biliary disease and confirmed cholecystolithiasis.

Aged↗

PubMed1999

[Pancreatic head tumors--preoperative examination and reality].

The authors evaluated in a retrospective study the asset and accuracy of methods of preoperative diagnosis (ultrasonography, endoscopy, computed tomography and endoscopic sonography) in 47 patients with a preoperative finding of a tumour in the region of the head of the pancreas, where during the last three years a radical resection was performed. As compared with objective morphological findings of the resected tissues, endoscopic sonography proved the most sensitive and most reliable method for detection of focal changes in this area. The other compared methods also belong to the indispensible standard of preoperative diagnosis and in clear cases are sufficient for indication of surgery. Evaluation of nodal affection based on the finding of enlarged nodes during preoperative examination is very unreliable and should not influence decisions on indications for surgery.

Biopsy↗

PubMed1998

[Bleeding gastroduodenal ulcers from the viewpoint of the surgeon].

The article has discoursed of a diagnosis and a therapy of bleeding peptic ulcer. There has been used the group of the patients admitted at The Surgical Unit of The Faculty Hospital Motol in Prague during two and half years. Urgent endoscopy and endoscopic treatment of indicated findings have been performed as a common procedures. The surgical therapy has been necessary for the part of this patients. Operation's indications, types of the operations and their timing have been discussed.

Humans↗

PubMed1998

Early treatment of congenital unilateral cataract minimizes unequal competition.

PURPOSE: Dense congenital unilateral cataracts may compromise visual development through visual deprivation and biased interocular competition, whereas dense congenital bilateral cataracts compromise visual development primarily through visual deprivation alone. Differences in sensory deficits between the two patient groups with these disorders may reflect the specific effects of unequal competition. To determine whether early treatment (at <8 weeks of age) minimizes the adverse effects of unequal competition, grating acuity deficits during the immediate posttreatment period and contrast sensitivity deficits at 6 to 8 years of age were assessed in 29 children with histories of dense congenital unilateral or bilateral cataracts who had had treatment between 1 and 8 weeks or 12 and 30 weeks. All children maintained good to excellent compliance with optical correction and occlusion therapy. METHODS: Grating acuity was measured using a two-alternative forced-choice preferential-looking staircase protocol. Contrast thresholds at three spatial frequencies (0.38, 1.5, and 6 cyc/deg) were measured at each of two temporal frequencies (2- and 8-Hz sinusoidal counterphase modulation) using D6 grating patches. RESULTS: Grating acuity deficits in the immediate posttreatment period were similar in patients with a history of unilateral cataract (n=10) and those with a history of bilateral cataracts (n=6) when treatment was provided during the first 8 weeks of life. With later treatment, patients with a history of unilateral cataract (n=7) had significantly larger grating acuity deficits than patients with a history of bilateral cataracts (n=6). Children with a history of dense congenital unilateral cataract had similar deficits in contrast sensitivity to children with a history of bilateral cataracts when treatment was initiated during the first 8 weeks of life. When treatment was initiated later (i.e., at 12-30 weeks), patients with a history of unilateral cataract showed greater deficits in contrast sensitivity and a dependence of the amount of spatial contrast sensitivity deficit on temporal frequency than did patients with a history of bilateral cataracts. CONCLUSIONS: These findings support the hypothesis that only visual deprivation is active as an amblyogenic factor during the first weeks of life, but when unilateral deprivation is prolonged to 12 to 30 weeks, unequal competition also plays a role in amblyogenesis.

Amblyopia↗

PubMed1998

[Pancreatic tumors--pessimism, optimism or realism?].

Among 35 patients with the preoperative diagnosis of a tumour of the head of the pancreas who had a radical operation at the Surgical Clinic of the Second Medical Faculty Charles University in Prague-Motol between January 1995 and March 1998 a malignant tumour was confirmed in 24 instances. Another nine patients had a histological finding of chronic pancreatitis and the remaining two patients a benign cystadenoma of the pancreas. The 30-day mortality in the whole group is 5.7% (2/35). Both deaths within 30 days after surgery were due to massive haemorrhage into the upper GIT in patients with pancreatic cancer. The haemorrhage developed within 21 and 30 days after surgery. The source of haemorrhage was not proved unequivocally, neither clinically nor post mortem. Obviously late haemorrhage from some gastrointestinal anastomosis was involved. From a total of 24 patients after Whipple's operation on account of a malignant tumour of the head of the pancreas nine died. The mean survival period was seven months after surgery. Fifteen patients survive and after a mean follow-up period of 14 months the median of survival calculated to the date of March 31 1998 is 17 months for stage UICC I and five months for stage UICC III. Because of the short follow-up period the results cannot be compared properly with data in the contemporary literature but they are promising for further work in this sphere of surgery and evidence that it is correct to refute the nihilist view held in the past. Hitherto achieved therapeutic results in this country and abroad certainly do not justify yet an optimistic view as regards the perspective of patients with carcinoma of the pancreas.

Female↗

PubMed1996

[An unusual cause of death after the Whipple operation].

The authors describe and discuss the sudden death of a patient 22 days after curative resection of a tumour of the head of the pancreas. The previous quite uncomplicated postoperative development was terminated by massive haemorrhage into the upper digestive tract. As a result of this haemorrhage the patient died in shock before the source of the haemorrhage could be investigated. On necropsy an obvious source of haemorrhage was not detected. Only three minor submucous venectasias in the blind stump of an excluded jejunal loop. One with a minor mucosal defect, may have been the cause of this fatal complication.

Fatal Outcome↗

PubMed1996

[History of the anatomy and surgery of the thyroid gland].

The submitted historically oriented paper reviews anatomical and surgical prerequisites for the development of thyroid surgery. Operations which up to the middle of the last century were associated with an extremely high lethality and were considered heroic and unjustified, changed due to new findings and procedures into standard operations performed in some thyroid diseases. Despite this, indications for operation and views on some surgical procedures are even in contemporary medicine highly controversial.

History, 17th Century↗