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J Vokurka

Publications and source records attributed to J Vokurka.

At least 19 recordsLinked to original sources
PubMed2004

Iatrogenic perforation during an endoscopic examination of the gastrointestinal tract.

OBJECTIVE: The study was aimed to highlighting the situations leading to increased risk of iatrogenic perforation during an endoscopic examination of the GIT. The optimization of surgical care procedure following intestinal perforation was suggested as well. METHODS: We analysed 3897 colonoscopic examinations performed during the past 5 years. We have found 6 cases (0.15 %) of iatrogenic colon perforation. RESULTS: All six cases of iatrogenic GIT perforations were followed by surgical revision. A suture was done twice, stomy three times, resection once, and restomisation also once. CONCLUSIONS: Polypectomy of thick polyps with a wider base and more rigid consistency is dangerous. The longer is the time and stronger the coagulation, the higher is the chance of iatrogenic perforation. Therefore we recommend laparoscopically assisted procedure. (Ref. 10.)

Colon↗
PubMed1999

[Laparoscopically-assisted endoscopic polypectomy].

OBJECTIVE: Make it possible to implement safe polypectomy of polyps of the large intestine with a diameter at the base greater than 1 cm located in the intestinal lumen above the peritoneal fold. METHOD: After laparoscopy under general anaesthesia endoscopic polypectomy is performed under laparoscopic control. The large intestine is sutured to the site of the base of the removed polyp using laparoscopic technique. RESULTS: Removal of large polyps of the large bowel with a base diameter greater than 1 cm without the need of laparotomy. CONCLUSION: Laparoscopically assisted polypectomy is a safe and effective method for the removal of large bowel polyps with a large base.

Colonic Polyps↗
PubMed1998

Bone and temporal fascia graft for the closure of septal perforation.

OBJECTIVES: To assess the reliability of temporal fascia and bone graft for the closure of septal perforation. STUDY DESIGN: Prospective longitudinal non-randomized. METHODS: The repair of septal perforation was performed using endonasal dissection; suture of the borders of the perforation on at least one side, and interposition of a graft of temporal fascia with bone, either a perpendicular plate of ethmoid (six) if available or mastoid cortex (three) if not. RESULTS: All patients had closure without re-perforation. Eight out of nine patients had complete closure of the perforation (88.8 per cent). These patients had perforations of less than 3 cm in diameter. The ninth patient had a perforation of more than 3 cm diameter (3.5 x 2.5 cm), and obtained a closure of about 80 per cent of the original perforation. The remaining perforation was in the posterior part of the nose. The patient was relieved of his symptoms (crusting and bleeding). This incomplete closure was most probably due to migration of the graft immediately after surgery. There was no morbidity of the donor site or the ear in the mastoid cortex graft group of patients. This is to our knowledge the first report of the use of the mastoid cortex as a graft in septal perforation. CONCLUSIONS: We consider that the graft of temporal fascia with bone is very reliable, and the use of bone ensures closure while avoiding the complications of a lax septum in large perforations. The technique is suitable for perforations up to 2.5 cm diameter. Perforations larger than 3 cm in diameter are more difficult to close, but closure of the anterior part of the perforation will relieve the patient from the most annoying symptoms.

Ethmoid Bone↗
PubMed1998

Surgical treatment of anterior septal deviations.

Anterior septal deviations are very difficult to handle because their location causes valvular obstruction, and any small residual deviation can cause a high degree of obstruction. The commonly performed submucous resection is not a suitable technique to handle this deformity. The maxilla-premaxilla technique offers a better approach. The surgical technique for anterior septal deviation differs from the standard septoplasty in several steps. A modified technique to treat this particular pathology is described in detail. This technique is highly reliable, and simplifies the access to a difficult-to-handle deformity.

Humans↗
PubMed1997

Intrathyroidal lymphoepithelial cyst. A report of two cases not associated with Hashimoto's thyroiditis.

Two cases of intrathyroidal lymphoepithelial cyst are described. Both of them were solitary, one being found incidentally in a patient operated on for a multinodular goiter, the other being clinically obvious as a cold nodule. They exhibited features of cysts of branchial cleft origin, i.e. squamous cell lining epithelium and abundant lymphoid tissue with reactive germinal centers. The thyroid gland parenchyma showed a discrete lymphoid infiltration consistent with the diagnosis of focal lymphocytic thyroiditis. In the first case a single epidermoid solid cell nest was found. The histogenesis of intrathyroidal lymphoepithelial cysts remains unclear, but their origin from cystically degenerated ultimobranchial body remnants (solid cell nests) seems to be most probable. This assumption is supported by a similar immunohistochemical profile of solid cell nests and epithelial cells lining the cysts and also by the presence of one solid cell nest in the proximity to the cyst in one of our cases.

Adult↗
PubMed1997

[Endoscopic and surgical treatment of acute bleeding gastroduodenal ulcers].

One of the basic problems of the treatment of acute bleeding from gastroduodenal ulcers concerns the correct timing of individual therapeutic steps. From 1992 to 1990 the I. Surgical Clinic in Brno performed the total of 438 urgent gastrofibroduodenoscopies, the most frequent finding being bleeding from the lesions in the area of the duodenal bulb. Endoscopic stoppage of bleeding was successful in 87.7% of patients. Failures in stopping the bleeding occurred in 18 cases and lead to urgent surgical intervention. On the basis of gained experience we recommend the following algorhithm in patients with acute bleeding from gastroduodenal ulcers: urgent endoscopy-endoscopic stoppage of bleeding. Relapse of bleeding requires endoscopic control with a new attempt of endoscopic therapy, in the case of failure it is urgent to intervene surgically. (Tab. 4, Ref. 14.)

Acute Disease↗
PubMed1997

Surgery of the thyroid gland.

Since the year 1987 to 1996 all kinds of thyroid surgeries were performed at the ENT Department. Altogether 604 patients underwent 655 surgeries. Total lobectomy or total thyroidectomy represented the most common procedures. Due to a gentle surgical technique, which we call "preparation", good results were achieved in the morbidity of laryngeal recurrent nerve (permanent palsy in 0.6%), and in perioperative or postoperative bleeding (0.3% of wound revisions, 0.5% of blood transfusions). Postoperative hypoparythyroidism was found in 4.7% patients. There is no correlation between postoperative hoarseness and laryngeal recurrent nerve palsy. Laryngeal endoscopy immediately after surgery is the most valuable diagnostic procedure.

Female↗
PubMed1996

[A modified approach in laparoscopic cholecystectomy].

The author gives an account of his experience with the insertion of trocars during laparoscopic cholecystectomy. It leads to a better cosmetic effect of the operation. Careful selection of patients before surgery prevents possible complications. The described procedure is suited only for an experienced surgical team which performs laparoscopic operations as a matter of routine.

Cholecystectomy, Laparoscopic↗
PubMed1993

[Surgical endoscopy--analysis of 6 years' activity].

Fibroscopy of the digestive system which in the majority of developed countries is quite common is in our country still not available in an adequate extent. The authors evaluate their experience in a surgical department covering a six-year period. A total of 4436 fibroscopic examinations were made incl. 3821 gastroscopies 615 ERCP and examinations of the papilla Vateri. They describe their experience with urgent endoscopy on account of haemorrhage into the GIT, pancreatitis or cholangitis. They emphasize the advantages of a maximal extension of endoscopic methods and their advantages, as compared with classical examination methods.

Adolescent↗
PubMed1991

Benign cyst of the paramedian pontine tegmentum.

A benign ovoid cyst, without an epithelial lining, localized in the paramedian pontine tegmentum, was examined by computed tomography (CT) and magnetic resonance imaging (MRI) (25 x 15 x 15 mm) and successfully operated upon. The one-and-a-half syndrome (horizontal gaze palsy to the right and paralysis of adduction of the right eye) and ipsilateral "peripheral" VII nerve palsy dominated the clinical picture. Fenestration, 5 mm in diameter, of the cyst wall through the floor of the IV ventricle was performed and 2.6 ml of clear, colorless fluid was evacuated. Inspection of the cyst, using the operating microscope, revealed a smooth, white, glistening cavity with no evidence of other pathological tissue. Duraplasty was performed with allogenic pericardium. Neurological symptoms improved immediately after surgery. Light and electron microscopy of the cyst wall revealed a fibrillar astroglial network and fragments of ependyma at the ventricular side of the biopsy.

Adolescent↗
PubMed1991

[Emergency endoscopy in the diagnosis and treatment of hemorrhage in the upper part of the gastrointestinal system].

The authors describe, based on an analysis of 2970 patients subjected to endoscopy, the advantages of urgent endoscopy performed within six hours after admission to the surgical department. They refute former statements that urgent endoscopy is endoscopy performed within 24 or 48 hours. They discuss the different approach of endoscopists to different types of haemorrhage and to the time factor and emphasize the prognostic considerations of the endoscopist.

Emergencies↗
PubMed1990

[Recurrent peptic ulcer--surgical complications].

Recurrent ulcer is serious complication of surgical treatment. Resection, reconstructive operations under conditions of severe adhesions, inflammatory infiltrates and abscesses are exacting and often connected with complication. In the period of 1978-1987 the authors carried out 64 reoperations for recurrent peptic ulcer, incl. 39 cases, whom they had to operate urgently. 19 patients were reoperated on account of penetration and peroperation of the ulcer, 11 because of massive haemorrhage, and 9 patients because of gastrocolic fistulae. In reoperations, subtotal resection of the stomach with vagotomy was carried out in 66%. In 4 patients reoperated repeatedly, Zollinger-Ellison's syndrome was found and resection of the pancreas was performed simultaneously. The mortality rate in the group, including patients reoperated urgently, was 21.9% (i.e. 14). The authors emphasize that the main aim of reoperation must be long-term therapeutic results without recurrences of ulcers and without serious functional disturbances.

Adult↗
PubMed1989

[Congenital duplication of the external auditory canal].

An anomaly of the external auditory meatus in a two-year-old child manifested by a fistula in the area of the right parotid gland. From the histological aspect a non-epithelized fistula was involved through which cerumen and epithelia accumulating in the closed part of the duplicated external auditory meatus were drained, the latter being discovered only on reoperation of an originally assumed cervicoaural fistula.

Child, Preschool↗
PubMed1989

[The vestibulospinal reflex and its tests].

Examination of vestibulospinal reflexes is an integral part of investigation of the balance apparatus activity. Four tests were selected to verify its utility and reliability, i.e. Romberg (stand II) and Hautant's tests for examining tonic reflexes, Fukuda's stepping test and writing test to monitor how the vestibular apparatus affects coordinated movement. The latter was, however, eliminated from clinical usage due to its unreliability. The final assessment of vestibulospinal reflexes is made more precise by simultaneous evaluation of the three remaining tests.

Humans↗