Biomedical subjects
Publications and source records attributed to J Pechan.
The authors described a case of the patient of the idiopatic group of PVT. Due to only a few symptoms, the diagnosis was established late. This was confirmed by the fact, that the patient was not hospitalized. So it was an atypical case of chronic PVT. Portal vein thrombosis belongs to rare clinical conditions. Early diagnosis based on modern technique is possible only if we keep this condition in mind (Tab. 1, Fig. 1, Ref. 23).
OBJECTIVES: To review the cases of cystic renal cell carcinoma and multilocular cystic nephroma, point out the radiographic variations and define further diagnostic work-up. MATERIALS AND METHODS: Between 2003 and 2005 5 patients with suspected cystic renal cell carcinoma were treated surgically (1 pt underwent radical nephrectomy, 1 pt laparoscopic cyst decortication, 3 pts ablation), 2 patients with multilocular cystic nephroma underwent ultrasound guided biopsy. RESULTS: Histopathologic examination confirmed cystic renal cell carcinoma (CRCC) T1aNOM0 Fuhrman grade 1 in 3 cases, T1bN0M0 Fuhrman grade 2 in one case. One patient with suspected tumor inside the cyst wall who underwent laparoscopic cyst decortication was excluded (final histology confirmed organized hematoma in the cyst wall). Biopsy in 2 patients with multilocular cystic nephroma did not confirm the presence of malignant cells. The mean tumor size was 4.2 cm (range 3.7 to 5.5) for CRCC and 4.7 cm (range 4 to 4.5 cm) for multilocular cystic nephroma. All 4 cases of CRCC were clear cell type. CONCLUSION: In conclusion according to the data described and from our study, tumor/cyst co-existence requires further surgical exploration in group 2, 3, 4. Small cystic renal cell carcinomas up to 4 cm in diameter have usually favourable pathology and prognosis, which offers the minimally invasive nephron-sparing treatment options such as excision, ablation or partial nephrectomy (Fig. 9, Ref. 18).
Acute pancreatitis (AP) is a potentially lethal disease. There are numerous studies published on acute pancreatitis. This article presents the results of research of many scientists in the field of acute pancreatitis. The main aim of this article is to present the possible septic complications of acute pancreatitis, its diagnostic and treatment modalities. Early morbidity and mortality are the result of activation of mediators with failure of circulation and other organ systems. The overall mortality of patients with acute necrotising pancreatitis is in the range of 10-15 %. Secondary pancreatic infection and sepsis develop in 40-70 % of patients with 80 % mortality. Pancreatic infection is caused by bacterial contamination of pancreatic necrosis. Infection is usually recorded in the second week of the disease in 24 % and in 71 % during the fourth week of the disease. The incidence of secondary infection and sepsis correlates with the extent of pancreatic necrosis. The prevention of infection and sepsis by systemic administration of antibiotics is considered a principal step in the therapy of acute pancreatitis (Ref 62).
INTRODUCTION AND OBJECTIVE: The authors present the results and follow up of patients with simple parenchymal and peripelvic cysts who underwent retroperitoneoscopic cyst decortication. MATERIAL AND METHODS: The records of 19 patients who underwent 3/4-port retroperitoneoscopic cyst decortication between January 1999 and January 2004 were retrospectively reviewed. All patients admitted to the hospital were symptomatic, the most common presenting syptoms were flank pain (19p) and hematuria (6p). The cyst size ranged from 8 to 15cm (mean size 10cm). 10 cysts were located on the right kidney and 9 cysts on the left kidney. The mean age of patients was 51 years. 16 patients had a simple parenchymal cyst corresponding to Bosniak type I (8 patients underwent cyst aspiration and sclerotherapy with 96 % alcohol in past), 2 patients had peripelvic cyst corresponding to Bosniak type II and 1 patient had a parenchymal cyst Bosniak type II. RESULTS: Retroperitoneoscopic renal cyst decortication was successfully performed in all patients, no conversion was needed. The mean operative time was 70 min (50-90 min) in patients with parenchymal and peripelvic cysts. The mean operative blood loss was 70 ml (50-130 ml) and the mean lenght of hospital stay was 3 days (2-5 days). The follow up ranged from 6 to 48 months and during that period were all patients asymptomatic, with no signs of recurrence. CONCLUSIONS: Retroperitoneoscopic cyst decortication is a safe and effective operative procedure in the treatment of symptomatic renal cysts with the minimal complication rate and excellent results (Tab. 2, Fig. 3, Ref. 30).
In most cases the foreign body can be removed transurethrally with a pair of grasping forceps. In some cases objects have to be cut or resected into small fragments, making it easier to extract the object or wash it out. An open surgical procedure via suprapubic transvesical approach is reserved for large-sized bodies or in cases when endoscopic methods are unsuccessful. The laparoscopic removal is one of further techniques that provide the opportunity to untie the knots (Fig. 6, Ref. 6).
INTRODUCTION: There is still no general agreement as to which patients suffering from attacks of acute biliary pancreatitis should undergo emergent endoscopic retrograde cholangiopancreatography (ERCP) with subsequent endoscopic intervention (endoscopic papilotomy, stent placement etc.). Many authors have described large differences in Procalcitonin (PTC) serum levels in patients suffering from biliary pancreatitis as opposed to patients whose acute pancreatitis is based on toxic etiology. Therefore, we have investigated the correlation of Procalcitonin serum levels with the presence of biliary obstruction in patients undergoing ERCP examination. MATERIAL AND METHODS: From 1.8.2004 to 31.3.2005, 97 patients undergoing ERCP were enrolled into the study. Blood samples were taken from each patient just before their ERCP examinations, and PCT serum levels were subsequently correlated to ERCP findings. RESULTS: ERCP examinations were completed in 90 out of 97 patients. Bile ducts obstructions were confirmed in 61 out of 90 patients and the mean serum level of PTC was 0.078 ng/ml. In the remaining 29 patients ERCP revealed normal findings and the mean PCT value was 0.069 ng/ml. There was no statistical correlation between PCT serum levels and the presence of biliary obstruction on ERCP findings. CONCLUSION: The measurement of PCT serum levels is of no help in the identification of patients, who should undergo emergent ERCP due to acute biliary pancreatitis (Tab. 1, Fig. 1, Ref. 6).
BACKGROUND/AIMS: Early identification of patients with severe forms of acute pancreatitis (AP) and subsequent management of these high risk patients are the most important aims in order to decrease mortality from AP. Procalcitonin (PCT) as a marker for systemic inflammation appears to be a useful marker for early identification of severe forms. METHODOLOGY: 101 patients with confirmed AP have been admitted to department of general surgery. PCT values were measured in each patient on admission and after 12 hours. PCT levels were correlated to the disease's course and prognosis. Results are given through PPV and NPV. Immunoluminometric assay (BRAHMS Diagnostica) was used for measurement. RESULTS: PPV and NPV for prediction of disease's course were better for PCT than for CRP PPV 64.7% versus 36% and NPV 82,6% versus 79.6% and for prediction of fatal outcome PCT reached 75% and 100% for cut off value 5 ng/ml. CONCLUSIONS: PCT seems to be a useful screening parameter for detecting severe AP and for identifying the patients who need ICU treatment, ATB covering and who can benefit from the novel therapies.
BACKGROUND: Relapses have an important meaning in relation to the curative surgical intervention. In RO resections according to UICC classification, the local relapses were classified as the most important factor for survival. Without any doubts the most important of these tumor-biological prognostic factors in patients with colorectal carcinoma is the carcino-embryonal antigen. Up to now, the unquestionable importance of the determination of serum levels of CEA for the detection of relapses is most often described. MATERIAL AND METHODS: This study is retrospective, not randomized. Analyzed were medical records and data of patients, who underwent the surgery of colorectal carcinoma at IInd Department of Surgery, University Hospital, Faculty of Medicine, Comenius University, Bratislava, in period from January 1st, 1986 to December 31st, 1995. In our analysis we evaluate the age and gender of patients, date of the surgery and type of the surgery from the point of acuteness, as well as radicality, staging of the disease, levels of the serum CEA. Serum levels of carcino-embryonal antigen before operation were determined and evaluated. In patients, who remaind in the monitoring at our department we examine CEA in regular intervals. RESULTS: From our group of patients, in 28 patients the relapse of the disease was determined here. Before the first operation, the preoperative level of CEA was examined in 15 patients and in 13 patients it was not. From 15 patients with examined CEA level, 7 patients (46.7%) had increased and 9 patients (53.3%) normal level. In twenty-seven patients CEA level was examined to reveal a relapse. One patient was diagnosed during the acute surgery and CEA was not determined prior this operation. From the remaining 27 patients, CEA level was positive in 20 patients (74.1%) and 7 patients had normal levels (25.9%). From these 7 patients with normal CEA level, in 5 cases it was locoregional relapse and 2 patients have distant metastases. From all patients, in whom the relapse was determined at our department, in 13 patients locoregional relapse was detected and in 15 patients distant metastases were diagnosed. CONCLUSION: Due to the sensitivity of serum level of CEA for detection of relapses, which is higher compared to the primary tumor and also to found lead time 4 months we think the postoperative regular determination of CEA in patients after the curative resection is appropriate. Earlier determination of less progressive relapse is definitely important, although the current long-term survival after the surgery for relapses is not optimistic. Development of surgical procedures as well as alternative treatment can bring better results in less developed relapse of the disease. (Ref. 28.).
The authors describe a case of ureteral avulsion in ureteroscopy and extraction of calculus from the central part of the ureter. They chose a renal autotransplantation for the ureter reconstruction. They share the same opinion as the authors who use renal autotransplantation as the method of choice in irreversible ureteral injury. Ureteral avulsion is the most severe complication of ureteroscopy. The authors described a case of right ureteral avulsion, with subsequent autotransplantation as the final solution. (Fig. 6, Ref. 7.).
Pulmonary embolism and thromboembolic attacks remain the most frequent cause of mortality in patients after general surgery or laparoscopy. The authors review the risk factors, indication of prophylaxis of thromboembolism and the currently used modes of prophylaxis. The so-called low-molecular-weight heparins (LMWH) are the most frequently used modes of prophylaxis. The algorithm of prevention and doses of LMWH used in general surgery and laparoscopy are presented. (Tab. 5, Ref. 17.)
During the period from July 1997 to November 1999, five patients were electively surgically treated at the II Surgical Clinic due to stenosis of biliodigestive anastomoses. All patients were afflicted by stenosis of hepatojejunal anastomoses which were performed at various surgical clinics in order to correct iatrogenic lesions of biliary ducts. Re-operation was performed by use of the mucosa-to-mucosa anastomosis technique without transanastomotic drainage. There were two post-operational complications and no mortality. The authors discuss the safety and effectiveness of biliodigestive anastomoses carried out without transanastomotic drainage, and present the possibilities and indications of endoscopic therapy in these states.
From the 1st January 1986 until the 31st December 1995 397 patients were operated on at the IInd Surgical Clinic of Medical Faculty, Comenius University in Bratislava because of colorectal cancer. Of them 325 patients were operated on electively and 72 patients were operated on as emergency cases. The authors analysed average survival time and the relationship between survival and preoperative level of CEA. The average survival time, without dividing into stages was 37.3 months, not involving patients with perioperative lethality of 43.1 months. 5 years survival without dividing into stages was 36.8%. Average survival of patients without dividing into stages with increased preoperative level of CEA was 28.7 months, in patients without increased level of CEA it was 42.5 months. 5-years survival in patients with normal preoperative level of CEA was 60.5%, in patients with increased level of CEA it was 35.7%. There was highest difference when dividing to subgroups based upon the stage of the disease between groups with stage pT4N0M0 and pT1-4N1-3M0. The positiveness or negativeness of the preoperative level of CE supports the staging of disease and supposes a significant difference in 5-years survival in patients especially in the mentioned stages. Although this difference is obvious, it is not possible to suppose individual prognosis of patients and the necessity of an adjuvant therapy. (Tab. 2, Ref. 31.)
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Etiology, risk factors, outcome and complications of bacteremia in 276 patients with solid tumors were analyzed. A group of 78 patients with solid tumors and surgical therapy only was compared with 172 patients with solid tumors who were treated with chemotherapy only. The most frequently observed risk factors of bacteremia in patients after surgery was urinary catheter insertion, wound as source of bacteremia, age > 60, staphylococci, enterococci and Enterobacteriaceae as etiologic agents. In comparison, viridans streptococci and Pseudomonas aeruginosa as etiologic agents as well as vascular catheters were significantly more frequently found in those treated with chemotherapy only. Patients with bacteremia after surgery only had a lower incidence of septic shock (6.4 vs. 16.9%, P < 0.03) and also lower mortality (5.6 vs. 14.9%, P < 0.04) attributable to shock than patients being treated for solid tumors with chemotherapy only.
Retrospective analysis of 47 patients surgically treated at the IInd Surgical Clinic LFUK due to Crohn's disease and its complications indicates that in 16.3% of patients the diagnosis of Crohn's disease was stated in coincidence with laparotomy which had been indicated due to the suspicion of appendicitis. The reasons of this situation, as well as the recommendation of surgical tactics are analysed. (Tab. 3, Ref. 11.)
Laparoscopic cholecystectomy (L-CHE) is currently considered to be the optimal standard in the therapy of cholecystolithiasis. However, it is choledocholithiasis which is problematic, especially the timing of the solution in relation to L-CHE. In general, the opinion predominates that in preoperatively verified choledocholithiasis the ERCP with EPS and extraction of choleliths should be performed 24-28 hours prior to the elective L-CHE. Surgical removal of choleliths from the main biliary ducts indicated only in a small group of patients. The authors of the study reflect upon the current trends of the choledocholithiasis therapy in the era of laparoscopic cholecystectomy. They present their own set of patients and recommend the procedure of the choledocholithiasis therapy concommitted with cholecystolithiasis with the subjective of the full use of endoscopic methods in the therapy of this disease. (Ref. 14.).
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