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Biomedical subjects

J Orel

Publications and source records attributed to J Orel.

At least 19 recordsLinked to original sources
PubMed1997

Renal transplantation--choice of anesthesia.

The appropriate anesthesia for renal transplantation (RT) requires minimal toxicity for patient and transplant besides of sufficient pain relief and correction of vital functions. Since 1990 for this reason prolonged epidural anesthesia (PEA) was used for 42 RT. The catheterization of epidural space was performed on the spine level Th9-Th12. Lidocaine and Bupivacaine solutions were used for epidural block. Sedation during the operation was performed only with low doses of Diazepam and Sodium Oxybutyrate. After the operation epidural catheters were used for pain relief during 2-5 postoperative days. Less cardiodepressive effect, stable intraoperative hemodynamics and absence of serious post-operative pulmonary complications were observed in patients operated under PEA. Also less toxic action of PEA for recipient as well as for renal allograft was marked. Obtained results show that PEA might be the preferable method for RT due to its lower toxicity, significantly less number of postoperative complications.

Anesthesia, Epidural↗
PubMed1996

Postoperative radiotherapy for radically resected N2 non-small-cell lung cancer (NSCLC): randomised clinical study 1988-1992.

In the period 1988-1992, 74 consecutive radically resected patients with NSCLC were randomised to postoperative radiotherapy or surgery alone in order to evaluate the influence of postoperative radiotherapy on survival. There were 61 males and 13 females, aged 35-80 years, median 59 years. Their distribution by stage was as follows: pT1N2 = 19, pT2N2 = 54, pT3N2 = one patient; histology: 32 squamous, 32 adeno and 10 large cell carcinomas; surgery: atypical resection in six, lobectomy in 27, bilobectomy in ten, and pneumonectomy in 31 patients. In 27 patients, only one lymph node in a single mediastinal lymph node site was affected; in 31 patients more than one lymph node in one site; in 16 patients more sites were affected. In 35/74 patients radiotherapy of hilar and mediastinal sites with 3000 cGy in 2 weeks was performed. On December 31, 1994, 19 patients (26%) were still alive; 39/55 patients died of the following causes: locoregional failure-10(26%), distant metastases- 25 (64%), other tumor-unrelated causes-four patients (10%). Five-year survival rates did not show statistically significant differences between the irradiated and surgically treated patients only with respect to sex, pTNM stage, histology and frequency of locoregional failure. The number of metastatic mediastinal lymph nodes was the only significant prognostic factor (P < 0.005) in both randomised groups.

Adult↗
PubMed1989

The role of ifosfamide and cyclophosphamide in the multi-modality treatment after surgery for cure for small-cell bronchial carcinomas (SCLC).

For the optimisation of the therapy for small cell bronchial carcinomas (SCLC), surgery is used to eliminate the primary tumor and its regional lymph nodes and chemo- and radiotherapy for the general treatment of micrometastasis. After patho-histological examination of the operation specimen, randomization for two arms is performed for a standard chemotherapy (CAV) or a sequential chemotherapy using three different drug combinations. Thereafter all disease-free patients receive prophylactic cranial irradiation (PCI). Preliminary evaluations in December 1987, of 112 patients from 19 cooperating departments show that the survival rate projected for 2 yr of 43 patients at stage pT1-3 N0 M0 is 76%, of 43 patients at stage pT1-3 N1 M0 it is 63% and of 26 patients at stage pT1-3 N2 M0 it is 38%.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Combination of surgery and chemotherapy for small-cell bronchial carcinoma.

In several test model systems using spontaneous metastasizing experimental tumours, convincing data indicate the importance of the tumour burden left after surgery for the efficacy of the combination of surgery and chemotherapy. Early removal of the primary tumour by radical surgery for cure seems to improve the conditions for chemotherapy. Since 1979, in nine different departments of thoracic surgery, patients with small-cell carcinoma of the lung (SCCL) have been randomized after surgery for cure to receive a new sequential intermittent polychemotherapy (sq.CT) of 3 different alternating drug combinations given intermittently over 1 year, or one 4-drug combination chemotherapy (CT) given intermittently over 3 years. The calculation of their life table curves at 1 August 1984 indicated an improvement in the 4-year survival rate of 23 patients receiving sq.CT to about 50%, compared with a survival rate of about 30% for 29 patients receiving CT. The number of patients is still too small for firm conclusions to be drawn, but it is concluded that surgery for SCCL seems to be an advisable measure for the efficacy of aggressive intermittent long-term polychemotherapy. However, this can only be proved in large cooperative studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

[Intensive care of thoracic surgery patients].

An intensive treatment of patients undergoing thoracic surgery is important, foremost because of the extensity of the surgical procedures and the generally poor condition of the patients. As a first stage of preoperative preparation an evaluation of the functional capacity of the vital organs (heart, lungs and kidneys) is performed, and the most important infection's focci of the oro-pharynx, tracheobronchial tree, urinary tract and skin have to be detected and treated. Respiratory physiotherapy before the surgery improves the ventilatory function, enabling the patient to breath regularly and effectively cough, wherewith a bronchial spasm is prevented and bronchopulmonary infection limited. Before surgery any hypovolaemia, anaemia, hypoproteinemia and dysproteinaemia should also be corrected; in such patients the parenteral alimentation (hyperalimentation) through the central venous catheter, is also important. Immediately following the operation a continuous supervision of vital functions (usually managed by well-experienced surgical nurses) is very essential. Isothermia, isovolemia, a correct oxygenation and analgesia should be maintained permanently. To loose sight of hypoventilation and hypoxia can likely induce respiratory insufficiency. Symptoms indicating tracheal intubation and mechanical ventilation should be watched for and treated at the right moment. Following the surgery, prevention of pulmonary atelectasis and pneumonia, providing an effective thoracic drainage, and respiratory physiotherapy is of utmost importance. The prophylaxis of postoperative pulmonary embolism in particularly jeopardized patients consists in the administration of heparin. Antibiotics in accordance with antibiogram (material: samples taken by a catheter or by bronchoscope from the lung directly).

Humans↗
PubMed1982

[The choice of methods and the goals of surgical treatment of carcinoma of the esophagus].

The hitherto experience in treatment of patients with carcinoma of the oesophagus has shown that survival rates are considerably longer after resection than following the radiation therapy or palliative procedures. In our group of patients, a ratio of 16.-2:4.4 months was observed. Resection of the oesophagus with primary oesophagogastric anastomosis is the most simple method with one anastomosis only. This method was uniformly used in all our patients. Reconstruction with interposition of the colon is technically more demanding. We have utilized it in two cases only. Resection of the oesophagus and staged reconstruction are less troublesome for the patient and decrease the operative risk, but markedly prolong the entire therapeutic procedure. The technique employed in lesions involving the cardia and distal part of the oesophagus includes a left transthoracic and transdiaphragmatic approach. In higher oesophageal carcinoma, mobilization of the stomach is made through laparotomy and followed by a right transthoracic and, if need be, right transcervical resection of the oesophagus. The majority of surgeons share the view that resection of the oesophagus with a malignant lesion is potentially curative, but many of them, however, regard this procedure as affording exclusively palliation. In our series, the five-year survival rate was 21.7%. The treatment of choice should employ the simplest technique available for a radical resection and reconstruction in one stage, account for the lowest postoperative morbidity and mortality possible and afford a prompt relief of dysphagia. We also advocate a deliberate palliative resection for ist being the only palliative procedure which markedly increases the survival of patients.

Aged↗
PubMed1981

The use of oesophageal pH-monitoring for the evaluation of gastrooesophageal reflux after resection of the cardia and total gastrectomy.

We intended to estimate the applicability of oesophageal pHmetry for the evaluation and diagnosis of reflux oesophagitis after resection of the cardia and total gastrectomy. We applied the system of glass calomel electrode type GK 282 C (Radiometer-Kopenhagen). The pH probe was introduced transnasally in the remnant of the stomach or into the jejunum. Its position was controlled by fluoroscopy. Then the probe was drawn for 5 cm subsequently to the final position of 5 to 10 cm above the oesophagogastric or oesophagojejunal anastomosis. During the examination the patients were sitting or lying backward. Afterwards the reflux was provocated by Valsalva's and Müller's maneuvers and in head down position. If necessary the patient swallowed 50 cc. of 0,1 N HCl solution. We examined 37 patients. Among 29 patients after gastrooesophageal resection the reflux was stated in 18 cases (in 6 cases faint in 3 moderate and in 9 severe). The proof of the reflux failed in all 8 cases after total gastrectomy. In these cases the method is unsuitable for the evaluation of jejunooesophageal reflux because of a too fast passage of the swallowed 0,1 N HCl solution through the jejunum. It prevents the creation of the necessary acidity gradient between the oesophagus and the jejunum during the examination. We proved by this method the reflux in 14 out of 24 patients with regurgitation in the history and in 4 out of 11 without it. We consider the method to be safe, simple and successful in the assessment of gastrooesophageal reflux which must be evaluated in combination with the results of clinical, X-ray and endoscopical examinations.

Cardia↗
PubMed1980

[Dilemmas in thoracic surgery].

Advances in ventilation physiology have brought solutions to fundamental problems of thoracic surgery and suggested ways of coping with problems of surgical technique and cilincal pathology. The domain of thoracic surgery should cover all those areas requiring specific surgical approach to endothoracic organs, with particular emphasis on special preoperative and postoperative care of such patients. This applies to thoracic trauma as well. A specialist in general surgery the thoracic surgeon needs additional training in this specific field. Departments of thoracic surgery must be organized as special units of lagre medical centres, each serving an area of no less than one million inhabitants. We are moreover convinced that pediatric cases ought to be dealt with bu a skillful thoracic surgeon regularly working with children. In the field of surgery of lung carcinoma the effects of radicality and the influence of positive mediastinal lymph nodes on surgical outcome, as well as the selection of patients for postoperative radiotherapy are currently under discussion. Operative management of pulmonary tuberculosis is becoming simpler, the disease occurs in atypical forms and secondary complications, above all aspergillosis, are on the increase. The choice of thoracotomy for various intrathoracic interventions calls for greater selectivity. Tracheal resection with primary anastomosis has been fully accepted, whereas prosthetic reconstruction is still subject to major dilemmas. Surgical stabilization of the chest following trauma, as an alternative to internal pneumatic fixation, ought to be considered more often in the future. In the management of gastroesophageal reflux surgery tends to prevail over conservative methods of treatment, wherebu the correct choice of tests for the evaluation of reflux is a matter of great significance. Numerous problems accompanying gastroesophageal resection for carcinoma still await solutions.

Humans↗
PubMed1978

[Late results of esophageal and cardial resection for cancer during the past 15 years].

Out of 196 patients--that we performed recestion on for cancerous esophagus and cardia, 30 are still alive by June 1977. 18,7% patients lived more than 5 years, and today 15 patients have been alive for more than 5 years. The majority of operated patients died due to advanced cancerous illness and metastasis, and less than half in number due to local recidive. By for largest percentage of them had soon after operation started to live normal lives, had no problems with taking in food, had improved physically and psychologically and started their jobs anew. All but one of alive patients are mobile, four of them partially. Two thirds do same or lighter jobs, eat normally and are in good condition. The most frequent problems are pain which are mostly temporary, and pyrosis due to reflux. We can conclude that the quality of life of operated patients is in major cases good, and cure by operation the only way for permanent recovery or fast and best method to palliate patients troubles.

Cardia↗
PubMed1977

[Mediastinal pancreatic pseudocyst].

This article presents a case of pseudocyst of the pancreas, clinically manifested as a benign tumor of the mediastinum. The cyst had spread from the retroperitoneum into the posterior lower mediastinum behind the oesophagus. The diagnosis was proved by the histological examination of the Wall and by analysis of amylase of the cyst contents, for the intraoperatively discovered cyst of the pancreas, the wide drainage into the pleural cavity has been an effective procedure. According to the data of the literature the mediastinal location of the pseudocyst of the pancreas is very rare.

Diagnosis, Differential↗