Biomedical subjects

J Ochmann

Publications and source records attributed to J Ochmann.

At least 19 recordsLinked to original sources

PubMed1998

Benefit of prophylactic endoscopic sclerotherapy of esophageal varices. A retrospective analysis.

BACKGROUND: The therapeutic schedule in bleeding esophageal varices is today established: emergency endoscopy with sclerotherapy or ligation combined with somatostatin and decreasing portal pressure drug followed by repetitive sclerotherapy or ligation. But the approach to varices that do not bleed is not clear. METHODS: The authors submit the results of a 6-year sclerotherapeutic program. Since January 1989 they have treated 421 patients with varices and have together performed 4,115 endoscopic sclerotherapeutic procedures. Among the 421 patients 95 were treated during acute bleeding and 254 were treated after first bleeding; in 72 patients prophylactic sclerotherapy (PSG) was performed. RESULTS: The procedure was indicated, when grade III or IV varices or high-risk signs and/or hepatic venous pressure gradient (HVPG) > 15 in grade II varices were observed. Prophylactic therapy (not-treated group-NTG) refused next 31 selected patients. The mean follow-up time was 32 months in the PS group and 28 months in NTG (n.s.). Fifteen PSG patients died (21%), while the mortality among the NTG patients (13 = 42% patients) was significantly higher (P < 0.02). CONCLUSIONS: We recommend prophylactic sclerotherapy with 1% polidocanol in patients with advanced varices in liver cirrhosis of varied etiology. We emphasize the need to perform these procedures in a department with adequate experience, where at least 100-200 sclerotherapies per year are performed.

Endoscopy, Digestive System↗

PubMed1997

[Transjugular intrahepatic portosystemic shunt in the treatment of complications in portal hypertension].

Transjugular intrahepatic portosystemic shunt (TIPS) is a side-to-side portocaval shunt for threatening complications of portal hypertension. The purpose of this study was to evaluate in first 33 patients indicated for TIPS insertion in our institution the efficacy, complications, and mortality. Indication was failure of sclerotherapy or ligation in control either of acute (n = 4) or repetitive (n = 25) variceal bleeding and refractory ascites (n = 4). The technical success rate was with 70% (21/30) lower than expected, but the complication rate was also very low. There were no fatal complications, only one subcapsular liver hematome, and in one patient repetitive punction of biliary tract. The 30-days mortality was 10% (2/21) and rebleeding was 15% (3/20), caused always by thrombosis of the shunt. TIPS seems to be a promising therapeutic procedure after failed endoscopic therapy of esophageal varices without the mortality and morbidity of an open surgical procedure. Recent indications for TIPS are acute variceal hemorrhage refractory to endoscopic treatment and recurrent variceal bleeding despite sclerotherapy or band ligation. Promising seems to be TIPS insertion in the treatment of refractory ascites.

Adolescent↗

PubMed1997

[Repeat laparoscopy in the management of biliary leaks after laparoscopic cholecystectomy].

The incidence of bile leaks increased with the introduction of laparoscopic cholecystectomy in surgery. The present paper is focused on biliary leaks-their diagnosis and treatment in a large group of patients, with special emphasis on a miniinvasive approach. Nine biliary leaks were found (i.e. 0.72%). Four leaks resolved spontaneously, five were treated surgically with good results.

Bile↗

PubMed1997

[Laparoscopic inguinal hernioplasty--results in the initial group 2 years after surgery].

The authors evaluate retrospectively after a two-year interval the results of laparoscopic inguinal hernioplasty (L.I.H.) in an initial group of 49 patients (52 hernias) operated by three surgeons using the method of transabdominal preperitoneal plastic operation (TAPP) in 1993, 1994 and 1995. They confirmed the expected favourable results, except for the very high incidence of relapses (6.7%). In view of the small number of patients other conclusions cannot be drawn except analyse the three early failures of L.I.H., indicate technical mistakes made when introducing the new operation and emphasize the necessity to adhere to the known basic technical details when performing this relatively pretentious laparoscopic operation.

Adolescent↗

PubMed1997

[Recurrent source of bleeding in patients with esophageal varices].

During last 7 years were in Endoscopic Centre of Brno Traumatologic Hospital treated 824 patients (624 male, 200 female) with esophageal varices, indicated to endoscopic sclerotherapy, ligation, or tissue adhesive injection. For one or more episodes of bleeding were treated 659 patients and resting 165 received therapy prophylactically. Recurrent acute bleeding from upper GIT occurred from 1 January 1990 to 30 April 1997 in 212 of them. In patients with previously proved esophageal varices were investigated for repetitive acute bleeding in this period 212 of them. In 157 (74%) patients endoscopy confirmed expected repetitive bleeding from esophageal varices, but in 55 (26%) was found bleeding from other source of upper gastrointestinal tract. The bleeding from gastroduodenal ulcers in 18 (8%) patients, in 22 (10%) from apths, Mallory-Weiss syndrome was source of bleeding in 8 (4%) patients, and hemorrhagic gastropathy in 7 (3%) was found. The authors draw attention to the fact that, in their big group patients with esophageal varices, duplicity of source of bleeding occurred in 1/4 patients. They concluded, that in patients with previously proved esophageal varices in necessary to perform in case of recurrent bleeding emergency of urgent endoscopy not only of esophagus, but even of whole upper GIT. Therapeutic mistake can happen in 1/4 of patients, if repetitive bleeding from varices would be expected and automatically treated by balloon tube. The patients could be damaged by delay in the treatment of bleeding from other source.

Acute Disease↗

PubMed1996

[Stress ulcers in patients with polytrauma].

Authors treat in their institution yearly 100-120 patients with polytrauma. In the Endoscopic Centre of the hospital approx. 20 gastroduodenal ulcers are diagnosed yearly in patients with supposed stress etiology. Authors analyze the pathophysiology of origin of stress ulcer, clinical symptoms and acute diagnostics. They evaluate results of early surgical treatment. Authors place the great importance on explicit treatment methods for prevention of stress ulcer origin.

Humans↗

PubMed1996

[Thoracoscopic major pulmonary resection--pro and con].

The first reports of thoracoscopic video-assisted procedures are from 1993. The main reason for this new techniques was that they allow the performance of standard thoracic surgical procedures in a less invasive ways. The operation trauma is minimalised that could be a cause not only of postoperative pain but often also of chronic future problems. The other advantages are the shortened hospitalisation time and earlier end of disablement. On the other hand there are many objective arguments against here. Firstly, the operative technique is not standardised and thoracoscopic lobectomy and pneumonectomy are performed by many modified methods. No regular randomised studies are available that could confirm the positive contribution of thoracoscopy in these cases. It is possible to perform classic thoracotomy by very careful way saving muscles and contemporary observing the requirement of safe operation and to attain the maximally possible result. Resuming information from written and verbal reports in last 3 years we have necessary the impression that the main reason for thoracoscopic reactions was to demonstrate the technical feasibility of this operation which is entirely insufficient reason for acceptance of this technique. Authors suggest that thoracoscopy is in experienced hands and adequately equipped workplaces an accurate and safe method for the diagnosis and in some cases also for therapy of hemodynamic stabile patients with thoracic trauma.

Endoscopy↗

PubMed1996

[Trauma and emergency thoracoscopy].

Authors present their first experience with urgent videothoracoscopy in polytraumatism and in isolated thoracic trauma patients. During the prospective study in 1993-1995 thoracoscopically was treated 41 (18%) from 229 multiple trauma patients including thorax trauma, hospitalised in our Institute. Thoracoscopy underwent 62 (4%) from 1452 patients with simple thoracic trauma. Thoracoscopy has been indicated above all for continued bleeding into peritoneal cavity, for suspected diafragmatic injury and for the diagnosis and treatment of posttraumatic complications. Authors suggest that thoracoscopy is in experienced hands and adequatelly equipped workplaces an accurate and safe method for the diagnosis and in some cases also for therapy of hemodynamic stabile patients with thoracic trauma.

Adult↗

PubMed1995

[Cytokine levels in patients with multiple injuries].

BACKGROUND: The role of cytokines in trauma still has not been satisfactorily elucidated. Multiorgan failure (MOF) development should be also under the direction of cytokines, endotoxin, and other mediators. METHODS AND RESULTS: Therefore we prospectively studied 88 patients with multiple trauma admitted to Traumatological Hospital Brno from June 1, 1992 to May 31, 1993. Extent of the trauma was determined by Injury Severity Score (ISS), Revised Trauma Score (RTS), and TRISS methodology with probability of survival. In study patients was investigated concentrations of interleukin 1, 2, 6, and tumor necrosis factor (TNF). Of above mentioned cytokines were elevated only IL-6 levels at admission and significant correlation with ISS was found (r = 0.32; p < 0.01). MOF developed in 23 patients (12 of them died), but it was not possible to predict the MOF development nor surviving according to admission levels of cytokines. A significant difference was observed in IL-6 levels of MOF patients one day before death (439 +/- 111 ng/l) in comparison with MOF patients, who survived (132 +/- 88 ng/l, p < 0.001). None of 12 MOF patients with IL-6 concentrations above 400 ng/l survived. CONCLUSIONS: We conclude that IL-6, less TNF, seems to play an important role in organism response to multiple trauma, and later elevation in these cytokines levels, especially IL-6 level, in MOF patients mean poor prognosis. We had found a significant correlation between initial IL-6 level and ISS. Other cytokines did not show changes during the study.

Adolescent↗

PubMed1995

Our experience with early integration of laparoscopic cholecystectomy in surgical residency training.

Laparoscopic cholecystectomy is now a method of choice in treating symptomatic cholelithiasis. The aim of this study was to assess an early integration of surgical residents into performing laparoscopic cholecystectomies and the significance of the integration for their training. Since February 1992 laparoscopic cholecystectomy (LC) has been performed in our institutions. During the 1st year 253 LCs were done by 4 surgeons--2 residents (in postgraduate years 3 and 4) and 2 staff surgeons; the 2nd year the team was extended and 301 LCs were performed. The residents operated on 364 cases (66%); the overall conversion rate was 5.4%; in the group of patients operated by residents (R) it was 3.8%; in the group operated by staff surgeons (SS) it was 8.4%. The complication rates did not exceed literature reports. The overall complication rate was 3.4%, in the "R" group 3.0% and in the "SS" group 4.2%. It may be concluded that surgical residents can perform LC without additional complications after initial experience with the open technique and appropriate hands-on laboratory training period before starting LC. Continuous training in advanced open biliary procedures should be assured for senior surgical residents.

Cholecystectomy, Laparoscopic↗

PubMed1994

Dynamics of interleukin 1, 2, and 6 and tumor necrosis factor alpha in multiple trauma patients.

The involvement of cytokines in trauma still has not been satisfactorily elucidated. The development of multiorgan failure, the very serious complication of multiple trauma with high mortality, should also be controlled by cytokines, endotoxin, and other mediators. We therefore prospectively studied 42 consecutive patients with multiple trauma admitted from June to December 1992 to the Research Institute for Traumatology and Surgery in Brno. Study patients were characterized by Injury Severity Score (ISS), Revised Trauma Score, and TRISS methodology. In all patients, tumor necrosis factor alpha (TNF-alpha) and interleukin (IL) 1, 2, and 6 levels were investigated. Of the cytokines, only IL-6 levels were elevated at admission and significant correlation with ISS was observed (r = 0.735; p < 0.001). Multiple organ failure (MOF) developed in 14 patients (seven died) and it was not possible to predict this MOF development nor survival by initial cytokine levels. A significant difference was observed when IL-6 concentrations one day before death (423 +/- 105 pg/mL) were compared with the highest concentrations in MOF survivors (112 +/- 71 pg/mL; p < 0.001). This difference was found also for TNF (528 +/- 314 pg/mL vs. 216 +/- 165 pg/mL; p < 0.05). None of six MOF patients with IL-6 > 400 pg/mL survived. In conclusion, the IL-6 and TNF-alpha levels seem to play a significant role in multiple trauma and their late elevation in patients with MOF conveyed a poor prognosis. A significant correlation between initial IL-6 levels and ISS was observed. Other cytokines did not show dynamic changes during the study.

Adult↗

PubMed1994

[Serum levels of cytokines as a measure of response to stress after various types of elective gallbladder surgery].

The authors investigated the cytokine levels in patients after laparoscopic cholecystectomy (LCHE), conventional open cholecystectomy (OCHE) and complicated open cholecystectomy (KOMPL) in order to assess whether there is a relationship between cytokine levels and the general reaction of the organism, the type and extent of the operation. They did not find an increase of IL-1 or IL-2 levels in any of the patient groups. The IL-6 concentration was slightly raised only in three patients of the OCHE group three hours after surgery and this rise persisted for 24 hours. In the KOMPL group there was a more marked rise of IL-6 in 9 patients within 3 hours after surgery, persisting in 6 patients for 24 hours and in 2 patients for 48 hours. The TNF values were similar; in group OCHE they were slightly elevated in 2 patients 24 hours after operation. In the KOMPL group these values were elevated in 5 patients for 3 hours after surgery and this increase persisted in 2 for 24 hours after surgery. Based on the investigation of cytokine levels, which is a recent indicator for evaluating the reaction of the organism to stress, conclude that laparoscopic cholecystectomy is a minimal stress for the patient and is associated with a zero defence reaction of the organism, if evaluated according to serum cytokine concentrations.

Adult↗

PubMed1994

[Hemopurification methods in the surgical unit].

The authors submit their initial experience with the activities of the hemodialyzation centre at a surgical department. They present an analysis of 79 patients where some hemopurifying procedures or their combinations were applied. These methods make it possible to perform more safely extensive surgery, they improve the care of patients with multiple injuries and extend therapeutic possibilities in acute pancreatitis and hyperbilirubinaemia when they cannot be treated by other methods. From the range of hemopurifying methods they consider the following most suitable for a surgical department: classical acute haemodialysis, hemodiafiltration, haemoperfusion and continuous arteriovenous dialysis.

Acute Kidney Injury↗

PubMed1994

[Is it possible to predict a decrease in portal pressure after administration of ACE inhibitors?].

We have previously shown that angiotensin converting enzyme inhibitor enalapril causes a potent decrease in portal pressure gradient, but only in about one half of patients with portal hypertension and an episode of bleeding esophageal varices in patient's history. Twenty-one consecutive patients after first episode of bleeding from esophageal varices were enrolled in the trial. Patients were treated by sclerotherapy in combination with enalapril. The level of ACE in patients with portal hypertension (10.4, SD 4.5) was significantly higher than in normal population (4.5, SD 1.3 mu kat/l-1) [p < 0.001]. After 3 months treatment decreased ACE to normal or subnormal levels in all 21 patients (2.9, SD 1.5 mu kat.l-1) [p < 0.001], but simultaneously measured hepatic venous pressure gradient decreased more than 3 mm Hg only in 11 (52%). No correlation between changes of portal pressure gradient and changes of ACE concentrations were found. We conclude that patients with portal hypertension have significantly higher serum ACE level with a large decrease after enalapril, but it is not possible to predict the effect of enalapril on portal pressure by estimation of ACE level in serum in individual patient.

Adolescent↗

PubMed1993

[Another source of hemorrhage--risks for patients with esophageal varices].

The authors treated during the past three years 312 patients with oesophageal varices after the first haemorrhage. All patients were treated by endoscopic sclerotization of oesophageal varices and drugs which reduce the excessive portal pressure. After a minimum of two sclerotherapeutic sessions, following control of acute haemorrhage, the authors observed a relapse of haemorrhage from the upper gastrointestinal tract in 38 patients. In 20 of them the relapse of haemorrhage was again from oesophageal varices, but in 18 patients it was of different origin and would not be affected by classical treatment with a Sengstaken tube. The authors draw attention to the necessity of emergency endoscopy in these patients and to the fact that possible postponement of rational treatment, e.g. in duodenal ulcers insertion of a tube, may threaten the patient's life.

Adolescent↗

PubMed1992

[How should treatment of esophageal varices proceed?].

The authors submit their experience and data from the literature on the problem of oesophageal varices. In haemorrhage of varices at present the most successful procedure is endoscopic haemostasis concurrently with intensive treatment focused on the basic disease and replacement of blood losses. In patients with a history of haemorrhage from varices endoscopic sclerotization is generally recommended. The authors supplement it with the promising medicamentous reduction of the portal pressure. Other procedures, i.e. surgery, are indicated only in a minority of patients whose varices do not reposed to haemostasis and medicamentous reduction of high portal pressure. The problem how to proceed in varices which did not bleed so far is still unresolved. The authors recommend individual evaluation and submit their own procedure.

Esophageal and Gastric Varices↗

PubMed1992

[Endoscopic "perestrojka"].

The authors discuss in a brief review the mighty development of invasive endoscopy in the next few years. Based on their own findings as well as data in the literature, they assume that it will be necessary to prepare theoretical as well as practical material for this quite newly developing discipline. It penetrates already at present to all European surgical and gastroenterological departments and changes fundamentally the approach to diagnosis and treatment of diseases of the gastrointestinal tract.

Endoscopy↗

PubMed1992

[The ACE inhibitor, enalapril, in portal hypertension. A prospective placebo controlled study].

The haemodynamic action of long-term (3 months) therapy with enalapril, a potent inhibitor of angiotensin convertase was investigated in 12 patients selected at random, all suffering from portal hypertension and a previous episode of haemorrhage from oesophageal varices. In all these patients after one-week intervals sclerotization of oesophageal varices was made. As controls served a group of 13 patients treated only by sclerotherapy and placebo. In the enalapril treated group after three months the pressure in the wedged hepatic vein (25 +/- 4.8 vs. 21.3 4.8 mm Hg) and the pressure gradient wedged free hepatic vein (17.0 +/- 6.0 vs. 12.6 +/- 3.4 mm Hg) were significantly lower than the initial values (p less than less than 0.01) in the enalapril treated group. A very marked decline (greater than 3 mm Hg) of this pressure was recorded in 50% of the patients. In the group treated by sclerotherapy and placebo the pressure gradient did not decline. During treatment no changes in the systemic haemodynamics and liver tests occurred. None of the patients died during the investigation and the subsequent 6-month period. The authors provided evidence that enalapril reduces the portal pressure in patients with hypertension, although not in all, and can be successfully used for the treatment of patients with oesophageal varices in combination with sclerotherapy.

Adult↗