Biomedical subjects
Publications and source records attributed to K Novák.
The authors present an abridged version of the final report of a State research programme. By introduction of a series of provisions and expedient use of funds available for research it proved possible to reduce the incidence of nosocomial infections in surgical patients from 14% to 12% and in a group with multiple injuries in the surgical intensive care unit from 18% to 10%.
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The authors describe a case of an extensive relapsing mesenterial thrombosis associated with an intestinal infection caused by Salmonella enteritidis. The disease had a fatal course, despite treatment based on contemporary knowledge. The authors discusses the method of treatment, emphasize the necessity of full heparinization and second look operation after extensive resection of the gut. They draw attention to the fact that a relapse of an apparently trivial salmonellosis can influence in a decisive way the results of treatment.
In a group of 110 subject with pneumothorax some factors are evaluated which may influence its impact and urgency. Attention is devoted to the length of the disease before surgical treatment, to the most frequent basic and accessory diseases, methods and complications of therapy, its effect and to economic aspects. Treatment on account of thoracotomy was indicated in 8.2% subjects. A total of six patients died. The authors recorded an increase of artificial pneumothorax. They draw attention to the disproportionately severe sequelae which may be due to apparently insignificant causes. Cure within one week was achieved in two-thirds of the group, the mortality increased steeply with the increasing number of relapses of the disease.
Central nervous system involvement of systemic lupus erythematosus was observed in 34 (36%) of the 94 patients studied between 1970-1990. A review of the diagnostic methods and therapy for central nervous system lupus is presented. The diagnosis of primary cerebral lupus was based on the history, physical examination and on the results of the cerebrospinal fluid analysis, CT-scan and EEG. Intractable headache (22/34), behavioural abnormalities (18/34), cranial neuropathy (16/34) occurred most frequently among neuropsychiatric symptoms. Immunoglobulin analysis of the cerebrospinal fluid proved to be the most sensitive method for detecting clinical activity (in 20/23). Central nervous system involvement was suggested by conventional serological test to a lesser degree. Alterations on CT scan and EEG were found in 17/27 and 14/26 of cases, respectively. IgM, IgA, and IgG indexes (indicators of intratechal immunglobulin synthesis) decreased when the central nervous system events subsided after successful treatment but the CT abnormalities (e. g. atrophy) were not altered.
No significant differences in the acetylene-reducing activity and evolution of H2 and CO2 from nodulated roots of Pisum sativum inoculated with soil Rhizobium populations from two soils with different acidities (Ruzynĕ soil 7.6; Lukavec soil 4.9) were observed. Rhizobium population from Lukavec soil formed nodules, exhibiting a higher H2 evolution. Co-inoculation with the Hup+ strain 128C30 (7 x 10(7) cells per seedling) eliminated, to some extent, the effect of soil populations on physiological activity.
In 1969 to 1989 in the Research Institute of Tuberculosis and Respiratory Diseases in Prague a total of 3583 thoracotomies were performed. Of these during the postoperative period 29 patients were re-operated on account of continuing haemorrhage into the pleural cavity. This is approximately 0.8% of all thoracotomies. Sixteen patients had to be re-operated within 12 hours after operation, 12 patients were re-operated later than 12 hours after operation but within 24 hours, one patient was re-operated later than 24 hours after operation. The cause of haemothorax was in the first place capillary haemorrhage from a lacerated pleura, in the second place haemorrhage from a severe intercostal artery at the very site of the thoracotomy. Other causes of haemorrhage such as haemorrhage from the bronchial artery and its branches are not frequent. None of the patients had to be re-operated on account of haemorrhage from the major arteries of the pulmonary hilus. Administration of small doses of heparin before and after operation did not influence the number of re-operations on account of haemothorax.
During 1985-1988 the authors followed up in a prospective investigation 3240 patients admitted to one of the departments in a Surgical Clinic. In the course of hospitalization 430 (13.3%) patients had at least one infection. Among infections urinary infections predominated which were found in 92% of catheterized patients. As to the aetiology, E. coli was found most frequently. From the whole group 1642 (51%) patients were operated. In the category of clean surgical wounds an early infection was detected in 3.7% of the operated patients; depending on the degree of contamination in the other categories this complication was found in 6.8, 19.5 and 28.0% of the operated patients.
Bronchogenic carcinoma is the most frequent cause of death for malignant tumours. The incidence of the disease is rising steadily. Treatment is effective only in the initial stages of tumour development. So far the most radical treatment is operation. Combination with other therapeutic methods (radiotherapy, chemotherapy) is useful. Unfortunately only a small percentage of lung tumours is detected in the readily treated initial stage. The operability varies between 6 and 9% of newly registered cases. The way to improvement of the position is active detection of tumours in risk groups of the population, more rapid diagnosis and therapy of tumours which sometimes grow extremely rapidly, and a combination of surgical, ionization a chemical therapy.
During a 15-year period, when in the department for thoracic surgery in the Research Institute for Tuberculosis and Respiratory Diseases 1612 resections of the lungs were performed, the authors recorded 18 patients with bronchopleural fistulae. After pneumonectomies and lobectomies the incidence of this complication was recorded in 1.4%. The majority of fistulae was observed after resection on the lungs on account of bronchogenic carcinoma, in two patients after resection on account of a pulmonary aspergilloma. After resection on account of TB and bronchiectas is the authors did not observe bronchopleural fistulae. Treatment of the fistula was in two thirds of the patients of the investigated group conservative with a 33% lethality. In six patients on account of the fistula rethoracotomy was performed with a lethality of 66.6%. The total lethality during treatment of bronchopleural fistulae was 44.4%. The purpose of the present work is to draw attention to the serious character of this post-resection complication and to its possible prevention by preoperative preparation and surgical technique.
Unfounded splenectomy in portal hypertension exposes the patients to several risks. This is apparent from presented case-histories as well as reviews and the authors' experience. The authors emphasize general principles of the approach to surgery of the spleen in portal hypertension.
The occurrence and levels of cathepsin B activity were investigated in primary human lung tumors and lung metastases of renal, colorectal and urinary bladder carcinomas as well as in the associated apparently normal lung parenchyma using a continuous rate enzyme assay with Ac-Leu-Arg-Arg-NHMec (7-(N-acetyl-L-leucyl-L-arginyl-L-arginylamido)-4-methylcoumarin) as the fluorogenic substrate. The inhibition studies of the enzymic hydrolysis of the substrate provided evidence for the catalytic action of the cysteine proteinase cathepsin B (CB) in the lung tumor tissues and the lung parenchyma under the assay conditions used. In the studied group of twenty-four patients with primary lung tumors of all major histological types, the level of CB activity in the tumor tissue was increased twofold and more over that in the associated lung parenchyma in 83% and 75% of cases, when expressed on the basis of wet tissue weight and tissue DNA, respectively. In patients with primary lung adenocarcinoma, the activity of the enzyme in the tumor tissue was elevated over that in the lung parenchyma in all cases studied. In both subgroups of patients with squamous cell lung carcinoma and adenocarcinoma, the mean cathepsin B activity was significantly higher in the tumor tissue than in the lung parenchyma. No obvious correlation was found between the tissue level of cathepsin B activity and the stage of primary lung tumor disease. In a limited number of patients with lung metastases, the level of cathepsin B activity was also higher in the tumor tissue than in the lung parenchyma.
The more frequent incidence of infections after splenectomy, some leading even to OPSI syndrome, is known from the literature and practice. The authors investigated in two groups of 20 splenectomized patients (on account of injury of the spleen or for haematological reasons) in particular changes of immunological indicators. On both groups they revealed a predominating increase of the absolute number of leucocytes, lymphocytes, the phagocytic index of PMN leucocytes, the ratio of active nucleoli, FW. They found also in both groups a predominating reduction of the number of T lymphocytes (p less than 0.05), with a high probability also NK cells, and a reduction of the late type reactivity of the skin test (Immunoskin test USOL, Praha). In patients splenectomized on account of injury the number of B lymphocytes was raised in 50% of the patients. In both groups of patients IgG serum levels were elevated, alpha-1-antitrypsin and haptaglobin levels were reduced. The CRP level in patients with haematological diagnoses was elevated as compared with the group of patients splenectomized on account of injury (p less than 0.05). In both groups after splenectomy a greater susceptibility to respiratory infections was found. On examination patients with a greater risk were detected and included under dispensary care.
The authors report on a successful medical treatment of a 36-year-old woman who had hypothyroidism and pituitary adenoma. Primary hypothyroidism was evidenced by decreased serum thyroxine (23 nmol/l; 1,77 micrograms/dl) and increased plasma thyroid-stimulating hormone (TSH) levels (108 mU/l). Pituitary mass with suprasellar expansion (1 cm in diameter) was proven by computed tomography (CT). The patient had been treated conventionally with 1-thyroxine and this medication was continued during a 1-year follow-up. Not only did she become symptom-free but control CT scanning revealed a large reduction of tumor size and the disappearance of suprasellar expansion.
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Results of a retrospective study from the years 1961 to 1986 have been presented based on hospitalization of 292 patients with benign tumours of the lungs and bronchi verified by histology. The prevailing tumours in the cohort were chondrohamartomas (62.0%) and carcinoids (21.9%). The tumours were localized more frequently inside the parenchyma (75.7%) than inside the bronchi (24.3%). The patients were men in 59.9% and women in 40.1%, the mean age during hospitalization being 48.8 years. In 60.6% of the patients the tumours were detected during an accidental radiographic examination, the tumour increased in size over several years of observation in 22.6% of the patients. A total of 280 patients (95.5%) were surgically treated, the tumour was removed in the bronchoscopic way in nine cases, two patients could not be operated on for advanced processes and one patient refused the operation. In 83.2% of the patients the surgical intervention was smaller than lobectomy, larger interventions prevailed in endobronchial localization making 54% on the whole, bronchial carcinoids being 71% of these.
The authors give an account of twelve cases of inflammatory acute abdominal attacks which complicated the course after abdominal operations. Although rare complications are involved, they are very serious and to a certain extent instructive. In the conclusion the authors summarize some diagnostic, therapeutic and assessment rules for these uncommon situations.
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