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Biomedical subjects

J Lukác

Publications and source records attributed to J Lukác.

At least 19 recordsLinked to original sources
PubMed2004

Allogeneic peripheral blood stem cell transplantations in children--a single center experience.

We analyzed 30 peripheral blood stem cell transplantations (PBSCT) from 25 human leukocyte antigen (HLA) matched sibling donors (MSD) and 4 HLA-matched unrelated donors (MUD) in 29 patients, done between November 1996 and March 2003. Patients aged 3 to 17 years underwent allogeneic PBSCT for malignant (16 patients) and non-malignant (13 patients) diseases. Sibling donors aged 3 to 23 years were given granulocyte colony-stimulating factor (G-CSF) 5-10 microg/kg/day for 4 to 5 days. All but one of the 29 donors underwent one single leukapheresis for stem cell collection. The patients received a median of 4.2 x 10(6) CD34+ cells/kg of body weight, they all engrafted after a median of 13.5 days (range 10-25 days). Acute graft-versus-host disease (GVHD) grade II to IV developed in 11 of 26 MSD transplants and in all 4 patients after MUD PBSCT. Eleven of 27 evaluable patients experienced chronic GVHD. After a median follow-up of 662 days, 20 out of 29 patients (69%) are alive, three of them need systemic immunosuppression for chronic GVHD. Six patients experienced relapse of their underlying malignant disease, one of them still alive in complete remission. Two patients died of grade IV acute GVHD and two others due to an opportunistic infection. Based upon our experience, PBSCT is a feasible and safe method for both pediatric donors and patients. It is associated with rapid engraftment, no greater incidence of acute but a higher incidence of chronic GVHD as compared to bone marrow transplantation (BMT) and therefore suitable mainly for children suffering from malignant diseases.

Adolescent↗
PubMed2003

Short-term results from laparoscopic dissection of uterine vessels in women with symptomatic fibroids.

OBJECTIVE: To assess the outcome, tissue trauma, clinical improvement and the reduction in size of fibroid following laparoscopic dissection of uterine vessels (LDUV). SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: An uncontrolled case series of 17 consecutive women who underwent LDUV using ultrasonically activated shears for the treatment of fibroids over two years. Ultrasound imaging was carried out before and three and six months following treatment. The tissue markers (C-reactive protein (CRP), Interleukin-6 (IL-6), Creatin kinase (CK) and white blood cell count) were studied preoperatively, on the first and third postoperative day. RESULTS: All patients underwent successful LDUV without intraoperative complications. Tissue markers results show that the LDUV performed using ultrasonically activated shears is associated with insignificant tissue damage. Time of surgery ranged from 30 to 50min (mean 39min). Mean blood loss was less than 30ml and mean hospital stay was 2.3 days. Three and six months after surgery, respectively, average reduction in uterine volume was 23.6 and 36.8% and average reduction in dominant fibroid was 28.6 and 56.8%. 94.1% of women had improvement in menorrhagia or dysmenorrhoea, and 91.6% had improvement in bulk-related symptoms or pelvic pain six months after treatment. CONCLUSION: Uterine volume and dominant fibroid were reduced and symptoms were improved by LDUV. The procedure of laparoscopic dissection of uterine vessels can be completed within 30-40min with only minimal blood loss and short hospital stay if performed by experienced laparoscopists.

Abdominal Pain↗
PubMed2003

[Minimally invasive surgical treatment of symptomatic myomas using laparoscopic dissection of uterine vessels: prospective clinical study (part I)].

OBJECTIVE: To assess the clinical outcome, indication and operative technique of laparoscopic dissection of uterine vessels (LDUV) using ultrasonic technique in the treatment of symptomatic fibroids. DESIGN: Prospective case observational clinical study (Part I). SETTING: Department of Obstetrics and Gynecology, Hospital Kladno. METHODS: We analysed clinical outcome of laparoscopic dissection of uterine vessels in 46 symptomatic women with fibroids in the period 2000-2002. The operative technique and indication to surgery were studied especially in part I. RESULTS: All patients underwent successful LDUV procedure without intraoperative complications. Time of surgery ranged from 15-50 minutes (mean 37.3 minutes) in cases of LDUV only. In cases of laparoscopic dissection of uterine vessels combined with myomectomy the mean of surgery was 63.1 minutes (range 35-120). Mean blood loss was less than 25 ml and mean hospital preoperative stay 2.1 days. Only two minor febrile preoperative complications was found (4.3%). CONCLUSION: The procedure of laparoscopic dissection of uterine vessels can be completed within 25-35 minutes with minimal blood loss, short hospital stay and acceptable number of complications.

Adult↗
PubMed2003

Laparoscopically assisted modified radical vaginal hysterectomy (type II) with pelvic lymphadenectomy: ultrasonic operative technique.

OBJECTIVE: The aim of this study was to incorporate an ultrasonic operative laparoscopic technique to complete a type II laparoscopically-assisted modified radical vaginal hysterectomy (LARVH) and pelvic lymph node dissection (PLND) in early cervical cancer. METHODS AND MATERIALS: LARVH type II and PLND using a laparoscopic ultrasonic operative technique and conventional vaginal surgery were indicated in five cases of early cervical cancer (IA2). RESULTS: Complete pelvic lymphadenectomy and the laparoscopic phase of modified radical vaginal hysterectomy were successfully performed using ultrasonic instruments in all women. Uterine artery and ureteral dissection with resection of the cervicovesical fascia, cardinal and uterosacral ligaments were successful with ultrasonically activated instruments only. CONCLUSION: Our initial experience with laparoscopically assisted radical vaginal hysterectomy type II confirmed that the use of a minimally invasive ultrasonic technique is feasible. Further investigations into the indications of disease where laparoscopic surgery is appropriate in the management of early cervical carcinoma are required.

Adult↗
PubMed2001

Increased urinary pyridinoline cross-link compounds of collagen in patients with systemic sclerosis and Raynaud's phenomenon.

OBJECTIVE: To study concentration changes in collagen degradation markers in patients with diffuse and limited cutaneous systemic sclerosis and patients with scleroderma-related diseases. METHODS: Pyridinoline cross-link compounds were analysed in urine samples using high-performance liquid chromatography. Samples were analysed for pyridinoline (Pyr), deoxypyridinoline (Dpyr) and soft-tissue pyridinoline (stPyr) in patients with diffuse cutaneous systemic sclerosis (dcSSc, n=23) and limited cutaneous systemic sclerosis (lcSSc, n=48) and in patients with scleroderma-related diseases such as primary Raynaud's phenomenon (pRP, n=16) and secondary Raynaud's phenomenon (sRP, n=14). Healthy controls (n=18) and patients with post-menopausal osteoporosis (OP, n=35) were also investigated. RESULTS: Urinary Pyr, Dpyr and stPyr concentrations were significantly higher in patients with Raynaud's phenomenon and systemic sclerosis than in healthy controls. The highest concentrations (two to three times greater than in healthy controls) were found in patients with dcSSc. The stPyr concentration was significantly higher in patients with dcSSc than in those with lcSSc, sRP and pRP. No significant difference in stPyr concentration was found between the healthy controls and the OP group, suggesting that stPyr is derived from soft tissues rather than bone. The extent and severity of skin involvement, measured as a skin score, significantly correlated with the concentrations of stPyr and Pyr, whereas no such correlation was found for Dpyr. CONCLUSIONS: Increased urinary concentrations of piridinoline cross-links reflect alterations in collagen turnover in both Raynaud's phenomenon and systemic sclerosis. The close correlation between stPyr concentration and the extent of skin involvement in systemic sclerosis suggests that this parameter may be useful in monitoring ongoing fibrosis in this disease.

Amino Acids↗
PubMed2001

Laparoscopically-assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results.

OBJECTIVE: To analyse the results of a pilot study and determine the contribution of laparoscopically-assisted lymphatic mapping in patients with endometrial cancer. METHODS AND MATERIALS: In eight cases of early endometrial cancer, patent blue-V was injected laparoscopically into the uterine wall during a surgical staging procedure. RESULTS: A deposition of the blue dye was found in at least one pelvic lymph node in five of eight cases. Blue-colored nodes were observed in a total of 11 lymph nodes. Locations of these nodes included obturator, internal and common iliac sites. Only one blue colored node was positive for disease. An average of 15 lymph nodes were removed in the study group (range, 12-22). Uterine lymphatic vessels with bilateral drainage to the broad and infundibulopelvic ligaments were seen in all cases within 30-60 seconds. CONCLUSION: Our initial experience with laparoscopically-assisted lymphatic mapping confirmed that the use of a minimally invasive technique is feasible. Lymphatic channels in the pelvic areas were seen in every patient. A deposition of blue dye in laparoscopically identifiable lymph nodes was seen only in 62.5% of patients. However, we believe that the lymphatic mapping of the uterine corpus can improve the accuracy of surgical staging in patients with endometrial cancer.

Aged↗
PubMed2001

[Laparoscopic-assisted myomectomy--surgical technique and indications].

OBJECTIVE: To analyze perioperative outcomes of laparoscopically assisted myomectomy. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Hospital Kladno, Czech Republic. MATERIAL AND METHODS: Eight consecutive women with fibromyoma were treated by laparoscopic assisted myomectomy. Laparoscopic surgery was performed based on size of fibromyoma over 6 cm. RESULTS: The application of the operative technique of laparoscopically assisted myomectomy was effective in all out exception. In the studied group the mean operative time and the mean of weight of the specimen were 76 min (range 50-90) and 151.7 g (range 45-220), respectively. In one patient the relaparoscopy for bleeding was necessary. CONCLUSION: Laparoscopic assisted surgery is feasible in women with fibromyoma and may also be considered for myomectomy.

Adult↗
PubMed2001

Increased demand for steroid therapy in hyperprolactinemic patients with rheumatoid arthritis.

The role of increased plasma prolactin (PRL) in rheumatoid arthritis (RA) is not fully explained. The aim of this study was to compare the clinical features and the treatment administered in RA patients with normal and elevated plasma PRL concentrations. Forty-nine patients with rheumatoid arthritis and 16 healthy subjects were included in this study In healthy controls, PRL concentrations were 7.6 micro/l (median), in 34 patients plasma PRL was less than 20 micro/l (9.9 micro/l) and in 15 patients it was elevated, with a median of 26.7 micro/l. No differences in clinical features were found compared with normal or increased plasma PRL. The introduction of corticoid therapy produced a significant difference. Steroid therapy was administered to 93% of the patients with hyperprolactinemia, compared with 59% of those with normal PRL concentrations. Daily prednisone doses higher than 5 mg were administered to 43% of the patients with elevated PRL, compared with 25% of patients with normal prolactin concentrations. In conclusion, the clinical feature of patients with rheumatoid arthritis did not differ in subjects with elevated PRL concentrations and in those with normal concentrations. The difference between these two groups was in the higher demand for steroid therapy in patients with hyperprolactinemia.

Adult↗
PubMed2000

Comparison of two procedures for laparovaginal hysterectomy: a randomized trial.

OBJECTIVE: To compare peroperative parameters of two variants of a laparovaginal hysterectomy in surgical management of gynecological conditions. METHODS: A prospective randomized study of 70 laparovaginal hysterectomies performed by the same two surgeons for disease of female pelvic organs. The following criteria were studied: indication for surgery, previous surgery, duration of the procedure, recovery, hospital stay, blood loss, tissue damage markers, hysterectomy proportions and complication incidence. Statistical analysis was performed using the non-parametric chi(2)-test and non-parametric Fischer's exact probability test when appropriate, with a level of significance P=0.05. RESULTS: Totals of 38 (54.3%) laparoscopy-assisted vaginal and 31 (45.7%) vaginally assisted laparoscopic hysterectomies were performed for fibroma as the main indication. Conversion to laparotomy was applied in only one patient. The VALH group (P=0.01) showed both fewer procedures and shorter hospital stay with insignificant blood loss. CONCLUSION: The two variants of a laparovaginal hysterectomy appear to be safe and appropriate, effective procedures for women with gynecological conditions. Furthermore, vaginally assisted laparoscopic hysterectomy has been shown to be superior to laparoscopy-assisted vaginal hysterectomy in terms of shorter operating time and greater palliative effect upon the complex of uterosacral ligaments. Laparoscopic surgery can alter the relationship between vaginal and abdominal hysterectomy.

Adult↗
PubMed1999

[Perioperative hemorrhage associated with laparoscopic hysterectomy: retrospective study].

OBJECTIVE: To evaluate perioperative bleeding during laparoscopic hysterectomy. DESIGN: Retrospective clinical study. SETTING: Department Gynaecology and Obstetrics, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of perioperative complications and bleeding of patients after laparoscopic hysterectomy were summarized and assessed. The primary hemostatic treatment was electrosurgery. Patients were assessed to efficacy, safety, utility and applicability of vasoconstrictive and local hemostyptic agents. RESULTS: From all laparoscopic procedure were 97.6% successfully completed. There were of nine conversions (2.4%) and twenty-six (6.9%) of severe perioperative complications. The total number of perioperative bleeding was 16 (3.7%) from 376 laparoscopic hysterectomies. The mean order of blood loss was 201.6 ml (range 50-800 ml). CONCLUSION: Clinical retrospective study demonstrates that hemorrhage during and after laparoscopic hysterectomy is most perioperative complication. The laparoscopic approach to hysterectomy appears to be safe and is seen as a good, effective procedure for women with gynaecological conditions of female pelvis organs. Laparoscopic hysterectomy could potentially decrease morbidity historically associated with hysterectomy performed abdominally. Large prospective studies are needed to evaluate the surgical trauma and optimal number of perioperative complications. In conclusion, we think the oozing from the damage tissue during laparoscopic surgery can be successfully arrested and controlled using the laparoscope to apply of local hemostyptic agent.

Adult↗
PubMed1999

[Evaluation of the role of the HPV test in routine clinical practice: prospective study].

OBJECTIVE: To determine the incidence of papillomavirus and to asses the role a HPV DNA in screening of cervical intraepithelial neoplasia. DESIGN: Czech National Collaborative Trial. SETTING: Department of Gynaecology and Obstetrics, Kladno Hospital, Department of Microbiology, KLINLAB, Prague, outpatient clinics (Kladno, Bruntál, Unhost'). METHODS: The study group includes of 3,264 women, their cervical scrapings were sent to KLINLAB during November 1996 to June 1998, because of abnormal results of primary screening. Patients with ASCUS, AGNUS, LSIL, HSIL and/or abnormal colposcopic findings were eligible for this study. Only completely filled in records of a subgroup of 1,158 patients were assessed for sensitivity and specificity for CIN in screening methods. RESULTS: The overall sensitivity of cytology and basic colposcopy were 84.7% and 64.9% respectively. The overall sensitivity of HPV DNA testing was 66%. The sensitivity of cytology of women with minor cytological abnormities for major cervical disease (CIN 2/3 and microinvasive cancer) in this group of patients was only 35%. Combined cytology with HPV DNA test gave an increased sensitivity for major cervical disease of 83%. CONCLUSION: 153 (66.4%) of the cervical intraepithelial neoplasias grade 2/3 displayed negative and borderline or mild cytological changes. The combined use of cytology with HPV testing increased the sensitivity with a reduction of specificity. However, it is evident from these results that HPV DNA testing alone cannot be used as a diagnostic tool but could usefully improve the level of screening CIN in common clinical practice.

Adolescent↗
PubMed1999

Laparoscopic ultrasonic operative technique in surgery of women with endometrial cancer: 2 case reports.

The aim of this study was to introduce a new laparoscopic ultrasonic technique in the laparoscopy-assisted surgical staging of endometrial cancer. The entire laparoscopic phase of the laparoscopic hysterectomy and pelvic lymph node dissection was performed using a 5 mm ultrasonic scalpel and shears. Ultrasonic activated technology was easy to use and allowed the surgeon to perform laparoscopic hysterectomy and lymphadenectomy close to important pelvic structures safer than in other operative techniques. This is only a case report and a larger study to confirm the advantages of the laparoscopic operative technique in surgery of women with uterine malignancy is needed.

Adenocarcinoma↗
PubMed1999

[Laparoscopic hysterectomy using ultrasonic surgical technics: prospective study].

OBJECTIVE: The use of the harmonic scalpel and Laparosonic Coagulating Shears (LCS) for laparoscopic hysterectomy (LH) was evaluated in thirty six women with other gynaecological conditions. DESIGN: Prospective clinical study. SETTING: Department Gynaecology and Obstetrics, Endoscopic Training Centre, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of hysterectomy performed via ultrasonic operative laparoscopy were summarized and assessed. The primary hemostatic treatment was harmonic scalpel and LCS. Patients were assessed to efficacy, safety, utility and applicability of laparosonic operative technique. RESULTS: From all laparoscopic procedure were 91.6% successfully completed. There were three cases which were finished electrosurgically. The mean order of total operating time was 86.03 min and the mean order of blood loss was 170 ml (range 50-400 ml). There were no major complications, only one case of postoperative bleeding from vaginal cuff. CONCLUSION: Clinical prospective study demonstrates that ultrasonic activated technology in laparoscopic hysterectomy is easy to use, cost effective, and affords the surgeon a greater margin of safety. The harmonic scalpel produces surgical incision with concomitant hemostasis. This is only a preliminary report, and further randomised study is needed.

Adult↗
PubMed1999

[Autologous stem cell transplantation in a patient with juvenile chronic arthritis].

In the submitted case-history the authors describe autologous haematopoietic stem cell transplantation (ASCT) in a patient suffering from juvenile chronic arthritis (JCA). ASCT was indicated by rheumatologists and haematologists for refractory polyarticular JCA. Mobilization with cyclophosphamide and granulocyte-colony stimulating factor was effective in terms of CD34+ cell shift to peripheral blood and the good quality autograft reliably led to haematopoetic recovery after megachemotherapy. The peritransplant period was not complicated with life threatening events. Immunosuppressive effect of autotransplant has reduced signs of rheumatoid disease activity and enabled conventional drug dose reduction. Autotransplant of haematopoietic stem cells has a potential to reduce activity of juvenile chronic arthritis.

Adult↗
PubMed1998

The hypothalamic-pituitary response in SLE. Regulation of prolactin, growth hormone and cortisol release.

It has been suggested that neuroendocrine regulation plays an important role in the pathogenesis and activation of autoimmune diseases. The aim of this investigation was to clarify the hypothalamic-pituitary response to a well-defined stimulus under standardised conditions in patients with SLE. Plasma concentrations of prolactin (PRL), growth hormone (GH) and cortisol were determined in venous blood drawn through an indwelling cannula during insulin-induced hypoglycaemia (0.1 U/kg b.w., i.v.) in ten patients and in 12 age-, gender- and weight-matched healthy subjects. Basal PRL concentrations were higher in patients vs healthy controls (12 vs 6 ng/ml, P < 0.01), though still within the physiological range. Insulin-induced plasma PRL and GH were significantly increased both in patients and healthy subjects; however, the increments or areas under the curves were not different in the two groups. Plasma cortisol response showed moderate attenuation in patients. Sensitivity of pituitary lactotrothrops to thyrotropin-releasing hormone (TRH) administration (200 microg, i.v.) was the same in patients and control subjects. In SLE patients with low activity of the disease the sensitivity of pituitary PRL release to TRH administration remained unchanged. The hypothalamic response to stress stimulus (hypoglycaemia) was comparable in patients and healthy subjects.

Adult↗
PubMed1997

Relationship between endocrine, immune, and clinical variables in patients with systemic lupus erythematosus.

OBJECTIVE: To assess the frequency of increased plasma prolactin (PRL) in patients with systemic lupus erythematosus (SLE) and to evaluate its relationship to other hormonal and immune variables. METHODS: Thirty-five patients with SLE with various levels of disease activity were studied. Plasma PRL, cortisol, growth hormone (GH) were determined by radioimmunoassay and interleukin 6 (IL-6) by ELISA: SLE activity was evaluated using the European Consensus Lupus Activity Measurement (ECLAM). RESULTS: Increased plasma PRL concentration (> 20 ng/ml) was recorded in 11 patients (31%). No correlation was found between plasma PRL and GH, IL-6, cortisol, or C-reactive protein, nor was any significant correlation observed between plasma PRL and the ECLAM score. Patients with hyperprolactinemia were, however, found to have been treated with higher doses of prednisone therapy than patients with normal plasma PRL. Further analysis of the relationship of plasma PRL and therapy showed that patients with SLE selected by the attending physician for prednisone therapy in doses > or = 10 mg/day were more frequently hyperprolactinemic. CONCLUSION: Our findings that patients with SLE with a more active form of the disease and who are less responsive to therapy had increased plasma PRL levels more frequently may be indicative of a potential relationship of hyperprolactinemia to severity of disease.

Adult↗
PubMed1995

[Classification and pathogenesis of vasculitides].

Vasculitis is a heterogeneous group of diseases which is characteristic by inflammatory cellular infiltration of the vascular wall often being concomitted by fibrinoid necrosis. The pre-condition for stating the diagnosis is the primary localization of inflammation in the vascular wall. Affliction of vessels can be focal or segmental. Focal vasculitis afflicts merely a part of the vessel's wall perimeter, and aneurysms may develop. Segmental vasculitis refers to a lesion of the entire perimeter of the vascular wall which often leads to stenosis or occlusion of the vessel. Non-specific histologic findings of perivascular infiltrates cannot be considered as evidence of vasculitis. The authors present the classification of vasculitis, its development and relation to etiopathogenesis of the disease, including histopathology and clinical symptoms. (Fig. 1, Tab. 9, Ref. 43.).

Humans↗