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J Vomela

Publications and source records attributed to J Vomela.

At least 19 recordsLinked to original sources
PubMed2006

[Preoperative radiotherapy in hypoxia in the complex treatment of the rectal carcinoma--complications].

INTRODUCTION: Preoperative radiotherapy is considered to be the standard approach in the treatment of the rectal carcinoma. Acute hypoxia decreases partial pressure of oxygen in healthy tissues immediately, but in the tumor after 30 min of duration. There is a higher radioresistance of healthy tissues in this interval because of lower oxygenation compared with normooxic status and the tumor is still relatively good oxygenated. This fact theoretically enables higher doses of radiotherapy and lower adverse effects. The aim of this study was to evaluate short and long term complications after preoperative radiotherapy of rectal carcinoma in hypoxia. PATIENTS AND METHODS: Between April 1991 and October 2000, 127 patients with the rectal carcinoma were treated preoperatively with locoregional accelerated hypofractionated radiotherapy in hypoxic conditions in Masaryk Memorial Cancer Institute. The dosis was up to 8 x 4 Gy. Acute hypoxia was induced during irradiation by ventilation of a hypoxic gas mixture containing 7.8-8.0% oxygen for totally 7-8 min. Operation was performed till 24 hours. RESULTS: There was no complication concerning with breathing of hypoxic gas mixture. A 30 day postoperative mortality was 0.8%. A 30 day postoperative morbidity was 31.7%. An anastomotic leakage occurred in 6.5%. Chronic gastrointestinal disorders occurred in 16.1% patients. CONCLUSION: Preoperative irradiation in hypoxic conditions is safe and efficient procedure. It permits safe administration of doses higher than those tolerated by normooxic conditions. Type and frequency of complications are comparable with other preoperative regimens.

Adult↗
PubMed2003

[Ulnar-carpal impingement after fractures of the distal radius].

The authors describe the group of 23 patients (16 women, 7 men), who were operated during 2000-2003 on ulna-carpal impingement or the syndrome of ulna impact on the basis of "plus variant" of ulna or also "long ulna". There was a fracture of distal radius in anamnesis of all these patients. The condition was solved in 18 patients (mean age 51 years) by reducing the ulna by 4.5 cm on the average (range 2-10 mm). In five patients (mean age 49 years), the radius-ulna desis sec. Sauvé-Kapandij was performed. The results are evaluated with the time lapse of 6 months on the average (range 3-26). The resulting evaluation indicates that in all patients, who were not affected by radius-ulna arthrosis, a simple reduction of ulna resulted in an improvement of the extent of movements and improved subjective complaints. Patients with radius-ulna arthrosis, where the ulna-carpal impingement was solved by radius-ulna desis, suffer from worse long-term functional results. The authors also analyze complications of the interventions. Posttraumatic deformations in the area of distal forearm should be solved early before degenerative changes develop. The is the only way how to expect good results of the operation and favorable effect for the patient.

Adult↗
PubMed2000

[Gastroesophageal reflux disease from the viewpoint of the surgeon].

Surgical treatment of patients with gastroesophageal reflux disease (GERD) represents an alternative approach in relation to the long-term pharmacologic therapy of prokinesis, and secretoinhibitory therapy. It must be considered in cases where the conservative approach has failed. The success of surgical treatment depends on an individual approach to the patient. The factors determining the surgical indication and especially the type of surgery, include age, anatomy of the hiatus and the results of pre-operational examinations of the esophagus. The type of operation depends on the ability of the esophagus to contract and to transfer the propulsion activity. According to the authors, the key examination is represented by the detection of esophageal contractility by use of esophageal manometry. The alternative option is represented by scintigraphic measurement of esophageal transit time by use of a tagged bolus. The patients with disappeared contractility are preferentially treated by conservative therapy due to the high risk of post-operational dysphagia. 80% of patients are treated by the standard procedure of laparoscopic fundoplication by a 360-grade cuff. The cases with decreased contractility or esophageal dysmotility are preferentially treated by partial fundoplication in Toupet's modification. The shortening of the esophagus requires consideration as to chest approach, or Collis' operation. Intestinal metaplasia of the esophagus requires specific procedures. Severe dysplastic changes require the consideration of resection treatment. The gained therapeutic results are evaluated by both, the subjective point of view of the authors, as well as by standard pH measurement and manometry of the esophagus performed 6 weeks after surgery.

Fundoplication↗
PubMed1998

[Cholestasis--an indication for surgical treatment].

Disorders of common bile duct function are among adults relatively frequent. Formal treatment schemes are gradually transformed, and the interdisciplinary co-operation becomes the basic principle. The goal is to recognise the type of the mechanic jaundice, followed by elimination of the obstruction or to ensure biliary drainage without delay. The authors describe indication criteria used on Surgery Department at Bohunice Hospital in Brno. They present their results of treatment of the obstructive jaundice at a group of 576 patients followed during five year period.

Adult↗
PubMed1998

[Aspergilloma].

The authors present the case-history of a patient operated on account of a pulmonary aspergilloma, incl. analysis of postoperative infectious complications. The course is confronted with data in the literature. Based on the professional literature on the subject the authors discuss the contemporary approach to surgical treatment of this disease.

Adolescent↗
PubMed1998

[Use of the Miller-Abbott tube in treatment of early postoperative ileus].

The authors present an account on the use of an intraluminal intestinal stent to treat early postoperative ileus. They demonstrate on a case-history the possibility to combine the tube inserted via jejunostomy and with laparostomy. In the discussion they deal also with the historical development of intubation of the small intestine and support of controlled adhesion formation.

Adult↗
PubMed1997

[Indications for laparoscopic adrenalectomy].

Endocrinological indication for surgical adrenalectomy is relatively rare. There is relatively little information on possibilities how to perform adrenalectomy by a minimally invasive procedure. Minimal invasive surgery made it possible to implement some operations sparing the patient. Adrenalectomy is one of these procedures. Laparoscopic adrenalectomy, which is extremely rare in other countries, as practiced in the Czech Republic, is the subject of the submitted paper.

Adrenal Gland Diseases↗
PubMed1997

[A rare cause of ileus and its laparoscopic treatment].

Stenting is a modern method making possible to open malignant oesophageal stenosis. The technique is associated with various complications. The authors describe the management of a rare stent migration to the aboral part of the GI tract, causing an acute abdomen. Based on their own experience with dislocated stents they recommend, contrary to the literature, an active approach when migration to the aboral of the GI tract occurs. Early stent extraction even when the course is uneventful is advantageous.

Esophageal Neoplasms↗
PubMed1997

[Metal stents in patients with malignant and benign esophageal stenoses].

The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

Esophageal Neoplasms↗
PubMed1996

[Retroperitoneoscopy--a new era].

Retroperitoneoscopy is a minimal invasive surgical technique enabling the diagnostics of the disease, as well as operative treatment of retroperitoneal organs. It is a very promising method especially for urologist, but of interest for general, vascular surgeon or gynecologist. The method is known since the end of sixties. Its routine introduction was enabled by technical advancement of laparoscopic surgery.

Endoscopy↗
PubMed1996

[Retroperitoneoscopic lumbar sympathectomy].

The development of revascularization techniques of the distal lower extremity dramatically diminished the need of lumbar sympathectomy. Which is indicated when patient with rest pain or with a profound gangrene of toes (which does not exceed the line of metatarsal articulation) could not be treated by vascular reconstruction. Lumbar sympathectomy could be done surgically or chemically, the efficiency of which is about 50%. The second to the fourth lumbar sympathetic ganglion could be resected with minimal invasivity, retroperitoneoscopically. This approach to lumbar sympathectomy opens further possibilities for operating in retroperitoneal space. Retroperitoneoscopy is well tolerated by patients.

Endoscopy↗
PubMed1996

[Surgery of inguinal hernia in a clinical department].

The authors stress on the academic surgical departments the necessity of the development of both traditional and minimally invasive techniques of the groin hernia repair. They suggest to make patient selection based on the hernia type (Nyhus Classification) and patient's will and take account of an internal-anesthesiologic aspects. From four currently most often applied minimally invasive techniques they bring attention to the hernioplasty by exclusively extraperitoneal approach, till now seldom used by us.

Hernia, Inguinal↗
PubMed1995

[Thoracoscopy in upper thoracic sympathectomy].

The authors describe their experience with the endoscopic technique of upper thoracic sympathectomy. They evaluate it as an easily performed and safe method which gives great comfort to the patient as well as excellent functional and cosmetic results and involves a minimal burden and ensures rapid convalescence. It enables the surgeon to obtain a perfect orientation in the surgical field as well as safe and perfect preparation of the thoracic portion of the sympathetic nerve. The low cost is also important.

Ganglia, Sympathetic↗
PubMed1995

[A technic for laparoscopic gastrostomy].

The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform.

Gastrostomy↗
PubMed1995

[Hemodynamic changes during laparoscopic cholecystectomy].

The authors investigated in 24 patients with ASA I or II who were subjected to elective laparoscopic cholecystectomy haemodynamic parameters (CI, SI, HR, MAP, SVRI, EF and LCWI), assessed by transthoracic electric bioimpendance. They used a BoMED NCCOM3 apparatus and evaluated data from the period before induction of anaesthesia (considered as control data), after induction of anaesthesia, immediately after insufflation of CO2 into the peritoneum, 30 minutes after insufflation and after desufflation. Insufflation of CO2 into the peritoneum caused a statistically significant drop of CI (p < 0.05), reduction of HR (p < 0.05), a drop of EF (p < 0.05), reduction of LCWI (p < 0.05) and a statistically significant rise of SVRI (p < 0.001). Thirty minutes after insufflation another significant drop of CI occurred and also for the first time of SI (p < 0.05 and p < 0.05 resp.); the mean values of HR and MAP did not differ significantly from control values, SVRI remained elevated (p < 0.05) and EF was permanently reduced (p < 0.05). After desufflation all haemodynamic values with the exception of EF did not differ significantly from control values. The reduced EF (p < 0.05), however, reached as to its absolute value the lower borderline of the physiological range. Based on these results, the authors assume that in patients with a compromised cardiovascular apparatus circulatory complications could develop. In these patients laparoscopic cholecystectomy should be indicated after due consideration.

Cholecystectomy, Laparoscopic↗