Biomedical subjects

J Schützner

Publications and source records attributed to J Schützner.

At least 19 recordsLinked to original sources

PubMed2006

Initial single-center experience with sirolimus after lung transplantation.

BACKGROUND: Standard immunosuppression after lung transplantation includes calcineurin inhibitors, mycophenolate mofetil, and steroids. Long-term survivors of lung transplantation are often confronted with chronic kidney disease, by definition related to the intake of calcineurin inhibitors. Sirolimus has been increasingly proposed as an alternative immunosuppressive agent due to its absence of nephrotoxicity, which could be used in selected patients. METHODS: We prospectively administered sirolimus as an alternative to calcineurin inhibitors in 10 lung transplantation recipients with persistent drug nephrotoxicity. They were switched from tacrolimus to sirolimus. Four patients also had bronchiolitis obliterans syndrome. The conversion scheme consisted of an immediate stop of tacrolimus and an 6 to 8-mg loading dose of sirolimus, followed by 4 mg/d. After 5 days, the sirolimus dose was adjusted to maintain trough levels between 12 and 18 ng/mL or 6 and 12 ng/mL for combined sirolimus and tacrolimus. Patients were monitored for renal and graft function as well as clinical status. RESULTS: A significant decrease in creatinine was observed after 1 week of treatment (P = .011). Azotemia decreased after 1 month, remaining stable (P < .01). Pulmonary function tests did not show significant modification from before sirolimus, inception in patients with or without bronchiolitis obliterans syndrome. There were seven infections. One patient died of complications related to bronchiolitis obliterans. CONCLUSION: Sirolimus was a useful alternative immunosuppressant, allowing significant tacrolimus withdrawal in transplant recipients with renal impairment. Sirolimus administration allowed recovery of renal function with low morbidity; it was useful for rescue of chronic renal impairment after lung transplantation.

Bronchiolitis Obliterans↗

PubMed2006

[Simultaneous cardiac and thoracic operations].

BACKGROUND: Optimal surgical strategy in patients with combined disease of heart (mainly ischemic heart disease or critical valve disease) and other thoracic organs (mainly pulmonary carcinoma) is still controversial. METHODS: From 1997 to 2004, 13 simultaneous cardiac and thoracic operations were performed in 13 patients. Most of them were necessary for combinations of symptomatic coronary artery disease (CAD) and bronchogenic carcinoma (BCA). PATIENT CHARACTERISTICS: 11 patients showed CAD, mean preoperative LVEF was 44 %. SURGICAL PROCEDURE: Surgical exposure was performed via sternotomy in 10 patients, the rest of the patients underwent thoracotomy. Seven patients were operated on cardiopulmonary bypass, the others underwent an off-pump procedure. Eleven patients underwent CABG, mean number of anastomoses were 2.1 (range 1-4), two patients underwent aortic valve replacement. One patient underwent radical removal of pulmonary adenocarcinoma with local expansion into the left atrium. For the lung cancer lobectomy was necessary in 8, pneumectomy in 1, extirpation of multiple metastases in 1, resection of the trachea in 1 patient. Histological diagnosis was epidermoid carcinoma in 6, adenocarcinoma in 3, undifferentiated carcinoma in 1, metastasis of Grawitz tumor in 1, pneumoconiosis in 1 patient. RESULTS: No patient died in hospital. One patient had to be re-explored for bleeding. Mean blood loss, duration of intubation and length of hospital stay were not different from other patients who underwent cardiac operation only. CONCLUSION: In accordance with the majority of the data published in the literature, combined procedures did not negatively influence hospital morbidity and mortality. Simultaneous operations eliminate the necessity of a second operation and do not delay the postoperative oncological therapy. Long-term results are primarily determined by histological diagnosis and by the extent of the tumor.

Aged↗

PubMed2006

[Granulomatous myopathy in patients with sarcoidosis and myasthenia gravis].

Granulomatous myopathies are extremely rare. The finding of epithelioid granulomas in muscle biopsy indicates mostly an involvement of the skeletal muscle in systemic sarcoidosis. In this report we provide description of five patients with previously diagnosed sarcoidosis (pulmonary or cutaneous), in which a clinically significant muscle weakness developed. We aim at demonstrating the value of muscle biopsy for further treatment of the patients, since clinically indistinguishable myopathies can arise not due to the involvement of muscles in the granulomatous process, but due to the corticosteroid-induced changes (chronic steroid myopathy). The demonstration of a selective atrophy of type II muscle fibers can provide the clue for distinguishing the patients, in which the corticosteroid treatment should continue, from those, in which the treatment should be modified. Further, we discuss a rare finding of granulomas in muscle biopsies of two patients with myasthenia gravis (MG) associated with thymoma. Although it is difficult to explain the pathogenesis of this event, MG should be considered in the differential diagnosis of granulomatous myopathies. Moreover, the finding of granulomas along with lymphocytic infiltration in MG muscle should lead to a search for an underlying thymic neoplasm.

Adult↗

PubMed2005

[Our strategy in the therapy of myasthenia gravis].

Surgical treatment of myasthenia gravis has at the 3 (rd) Department of Surgery, 1 (st) Medicine Faculty of Charles University in Prague a multiyear tradition which has originated in the 60's of the 20 (th) century. Since that time we carried out over 1 000 operations on the thymus, especially thymectomy for myasthenia gravis (MG) and with lesser frequency for thymomas. Thymectomy combined with exenteration of fatty tissue from the front mediastinum belongs to basic MG surgery. According to our experience an optimal approach to the thymus is given by partial sternotomy. A jugular approach is not regarded as enough radical. Videothoracoscopic approach and operation are possible but take more time, however they are the method of choice at some workplaces. The combined conservative and surgical treatment brings in 80 % of the cases an obvious improvement or deletion of the symptoms of the disease.

Adult↗

PubMed2005

[Transplantation of the lung lobe].

Absolute deficiency of suitable donors and disproportions in the implant size and the pleural cavity size, limit the lung transplantation numbers and result in high mortality rates on lists. The waiting lobar lung lobes transplantation technique may help to resolve the problem of increasing the rate of satisfied patients. This work presents a case of the first lobar lung transplantation in the Czech Republic in the patient with exogenous allergic alveolitis.

Brain Death↗

PubMed2005

[Pulmonary resections and prolonged air leak].

BACKGROUND: The aim of our study was to determine risk factors for prolonged air leak after pulmonary resections. METHODS AND RESULTS: Two hundred and five patients were operated at our department between January 2003 and March 2004. Prolonged air leak (PAL) was defined as an air leak lasting 7 days or more of postoperative chest tube drainage. PAL occurred in 17 (8.3%) patients and it lasted 10.1+/-3.5 days. COPD remained the only variable predicted for PAL (p<0.05). This complication significantly prolongs the length of hospitalization (p<0.01). CONCLUSIONS: COPD patients have significantly higher risk for PAL following pulmonary resection. Intraoperative prevention of the air leak requires meticulous surgical technique, stapler use and application of pericardial bovine strips.

Adult↗

PubMed2005

[Contemporary trends in the thoracic surgery view to the history, perspective].

The development of thoracic surgery in Czechoslovakia is very closely connected with the 1st Medical Faculty of the Charles University in Prague. The first Czech surgical clinic was established in Prague at this medical faculty in 1882. Professor Vilém Weiss was the first Head of the clinic. The Second Surgical Clinic in Prague was established in 1922 and Docent, later Professor, Academic Jirí Divis was the second head of this clinic. Jirí Divis is rightfully considered the founder of the Czechoslovak School of Thoracic Surgery. Whereas pulmonary tuberculosis was the main problem thoracic surgery faced in the first half of the 20th century, pulmonary carcinoma is the main issue addressed in thoracic surgery in the second half of the 20th century and currently. What new treatments can we currently offer our patients? Bronchoplastic procedures (so-called sleeve resections) have developed and carcinomas of the tracheobronchial tree-carina- can be treated in a similar manner. Development in the technology has brought staplers--machines for surgical suture. Staplers allow performing volume reductive pulmonary resections as one of the treatment options for advanced pulmonary emphysema. Introduction of the pulmonary transplantation method in practice on 22.12.1997, when Professor Pafko and his team performed the first pulmonary transplantation in Czech republic, was a major breakthrough in pulmonary surgery. The minimal invasive technique for thoracic surgery has developed further. Video-assisted thoracoscopy is now an integral part of thoracic surgery. Introduction of PET-CT examination brought great benefit to a wide range of medical disciplines, including thoracic surgery. Where may the future development in surgery and thoracic surgery take us? We are finding that specialisation is vital in the development of all surgical disciplines. In certain borderline or technically complex operations, thoracic and mediastinal surgery requires cooperation with cardiac surgeons. Thoracic diseases should therefore be centralised in centres with sufficient experience and resources for further development of the discipline.

Czech Republic↗

PubMed2005

[Comparison study on the use of tubular and spiral thoracic drains following lung resections. A prospective study].

INTRODUCTION: Purpose of this prospective study was to compare two types of chest drains- standard bore tubes with new concept of flexible spiral drains. METHODS: From January to March 2005 twenty eight patients after lobectomy or bilobectomy were prospectively randomised. We used two different drains types (flexible spiral- Blake silicon drains, Ethicon) and standard chest drains (Dahlausen GmbH) in all patients. Front drain (diameter 24 Fr) was inserted in the sixth intercostal space anterior axillary line and dorsal one (diameter 28 Fr) in midaxillary line of the sixth intercostal space. Half of the patients had front drain spiral one and second group had a convetional chest tube. Postoperative variables included: tidaling, bubbling, fluid level and its characteristics, wound infection and technical complications of inserted drains. RESULTS: Mean daily amount of fluid in front drains was 61 ml in spiral drains vs. 78 ml in standard drains. Spiral drains were removed after median of 3.7 days, vs. 4.4 days in standard chest tube group. Mean daily amount of fluid of dorsal drains group was 220 ml in spiral drains group vs. 213 ml in standard drains. Spirals drains were removed after median of 4.5 days vs. 3.6 days in standard chest tube group. There was no significant difference in technical complications between drains. CONCLUSION: Spiral drains are as safe and effective as conventional tubes after lung surgery. Their only present disadvantage is low cost-effectiveness compare to standard bore tubes.

Adult↗

PubMed2004

Cyclosporine-related neurotoxicity in a patient after bilateral lung transplantation for cystic fibrosis.

Cyclosporine (CsA) is a widely used immunosuppressant following solid organ transplantation. CsA administration is associated with a number of systemic complications, including neurotoxicity. A 33-year-old man with cystic fibrosis, who underwent bilateral lung transplantation, presented with severe neurotoxic symptoms leading to coma in association with CsA administration combined with high doses of methylprednisolone for treatment of an acute rejection episode. After discontinuation of CsA, a quick resolution of his clinical status was observed, as well as of the pathological findings on magnetic resonance imaging (MRI). CsA was replaced with tacrolimus leading to an uneventful course.

Adult↗

PubMed2004

[Is a scalpel required to perform a thoracotomy?]].

The purpose of this prospective study was to determine whether electrocautery as a means of creating thoracic wound result in increased wound infection rates. Seventy-three patients were randomized prospectively into two groups. Group A-coagulation, where the first half of the incision was done with scalpel and the second half with coagulation-fulgurate. Group B-cut mode, where half of incision was done with scalpel and half with blend cut mode. All wound complications were recorded and divided into infectious (grade 1: induration and erythema with no secretion, grade 2: grade 1 and serous secretion, grade 3: contaminated wound with pus formation) and non-infectious complications (haematoma with its evacuation). Scalpel and electrosurgical thoracotomy incision in elective surgery are similar in terms of early and late wound complications when used to perform anterolateral thoracotomy. Therefore, the choice of which method to use remains only a matter of surgeon preference.

Adult↗

PubMed2004

[Role of the surgeon in the treatment of myasthenia gravis and thymoma].

Surgical treatment of myasthenia gravis at the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague, has long tradition. It originated in sixties of the 20th century. Over 1000 operations of a thymus has been carried out since that time, especially thymectomy for myasthenia gravis (MG) and for less frequent thymomas. The complete removal of thymus--thymectomy accompanied with exenteration of the fat in frontal mediastinum belongs to the principal MG surgery. According to our experience, the optimal approach to the thymus is a partial sternotomy. The jugular approach is not regarded as sufficiently radical. Videothoracoscopic approach and operation are possible but they are longer. They represent a method of choice at some workplaces. The combined MG treatment (conservative medicamentous and surgery treatment) brings in 80% a visible improvement and a deletion of symptoms of the disease.

Humans↗

PubMed2004

[Specific features of lung collection from a donor with a beating heart: criteria and technique].

Lung transplantations remain the latest organ transplantation gaining a broad spectrum of clinical applications. It has become an approved treatment method for patients suffering from lung disorders in the terminal phase. The number of transplantations is limited by a lack of suitable organs, increasing patients waiting lists mortality rates. This article provides information on criteria required for the lung collections to be accepted, and also, a detailed description of the combined lung and heart collection technique for unilateral of bilateral lung transplantations. The above technique has been used routinely, undergoing several modifications, in the Czech Republic since 1997, when the lung transplantation programme commenced. 60 lung collections from exited donors were performed until the end of 2003. The aim of the information provided in this article, is to aid mutual cooperation with M.D.s caring for the donor and cooperation of surgeons of all teams, participating in the multiorgan transplantation, which will finally allow the number and quality of the collected organs to be increased.

Brain Death↗

PubMed2004

[Lung transplantation for primary pulmonary hypertension].

Significant advances in the treatment of primary pulmonary hypertension (PPH) have been achieved in the past decade. Continuous intravenous prostacyclin and lung transplantation are complex and effective approaches in the therapy of PPH. Indication, technique, postoperative care and results of lung transplantation for PPH are discussed.

Humans↗

PubMed2004

[Treatment of benign stenoses of the large airways at the Faculty Hospital Praha-Motol during 1998-2003].

The authors present diagnostic and therapeutical results in the group of 80 patients with benign stenoses of large airways, who were hospitalized at the TRN ward (Department of TB and respiratory disorders) of the Faculty hospital Motol in Prague between the years 1998-2003. 62 patients sufferred from stenoses in cosequence of their tracheal intubation or tracheostomy. In 18 cases the stenoses resulted from other disorders or pathological condidtions (Wegener's granulomatosis, status post lung transplantation, etc.) 38 patients were sent for surgery. Up until the date of the assessment (September 2003), 8 of them had had a relaps of the condiditon. 6 operated subjects had their restenosis corected using bronchological methods, 2 subjects had to undergo reoperation, which is 5.2% of the total number of the operated subjects. The remaining 42 patients were treated using the interventional bronchological methods (electrocauther, laser, stents) which proved curative in 35 patients, i.e 44% of the whole group. In 7 inoperable patients the above methods failed, 6 of them having a permanent tracheostomy and one female-patient exited 2 days after an incomplete recanalization. In the subgroup of 18 patients with other than postintubation stenoses, stent operations were the most frequent (12 times), 4 patients were cured using other methods of interventional bronchology, and resection of the stenosis was indicated in two cases. Up until the date of the assessment, 65 subjects had survived and 15 exited. 5 of them died 3-14 months (median of 4 months) following the surgical procedure of other disorders than of the respiratory airways stenoses. 10 unoperated patients, with a single exception, also died due to other causes than the tracheobroncheal lesions (the survival rate median was 9 months). Following the initial freeing of the airways, the authors call for considering a surgical therapeutical option in each case. Provided the surgical approach was contraindicated, the interventional bronchological methods would replace it appropriately.

Adolescent↗

PubMed2004

[Computer tomography and staging of bronchogenic carcinoma. Prospective study].

BACKGROUND: The aim of our study was to determine validity of computed tomography in staging of non-small cell lung cancer. METHODS AND RESULTS: Sixty-two patients with NSCLC were operated at our department between March and September 2003. Lymph nodes with the shortest diameter over 10 mm on CT were considered abnormal. Primary tumor was correctly determined by CT scans in 77 % of cases, lymph nodes involvement in 63 %. Stage of NSCLC was correct in 53% of all patients. Negative predictive value for N1 and N2 was 80 %, resp. 88 %. CONCLUSIONS: Even with improvement in CT technology, validity of CT in staging of NSCLC remains low. We consider that mediastinoscopy can be avoided in the presence of normal mediastinal CT findings due to high negative predicative value of nodal improvement.

Carcinoma, Bronchogenic↗

PubMed2003

[Benign clear cell tumors of the lung--sugar tumors].

The authors present the case reports of rare benign clear cells tumors of the lung (CCLT) and drawn attention, that examination from frozen sections can be misleading and definitive histological verification can be done on basis of immunohistochemical analysis and can be different from frozen sections examination.

Diagnosis, Differential↗

PubMed2003

[Surgical treatment of primary pulmonary hypertension--lung transplantation].

Significant advance in the treatment of the primary pulmonary hypertension (PPH) has been achieved in the past decade. Continuous intravenous prostacyclin and lung transplantation have become complex and effective approaches in the therapy of PPH. Indication, technique, postoperative care and results of lung transplantation for PPH are discussed.

Humans↗

PubMed2003

[A surgeon's view on the importance of positron emission tomography--PET (with emphasis on lung neoplasms)].

OBJECTIVE: PET became a successful method in preoperative evaluation of patients with cancer. We question whether PET scan can answer critical surgeons' requests such as distinguish benign and malign lesions, evaluation of cancer dissemination, evaluation of the pleural effusions, and also to detect early cancer recurrence. METHODS: Between September 1999 and December 2001, 39 patients underwent a PET scan and we evaluated its benefit in further treatment of patients. Standard PET techniques were used. RESULTS: In 20 patients (52%) results of PET scan were in correlation of clinical diagnosis and stage of cancer disease, partial difference between FDG-PET and clinical diagnosis was in 8 patients (20%), next treatment was changed in 11 patients (28%). CONCLUSION: We conclude, that dedicated PET could be valuable tool in the diagnosis and staging of cancer disease, especially in verifying cancer dissemination, recurrence of the cancer. PET scan can be misleading in evaluation of the mediastinal lymphnodes and pleural effusions.

Fluorodeoxyglucose F18↗