Biomedical subjects
Publications and source records attributed to K Soudek.
The authors reflect, based on two case-histories, on problems of diagnosis and operation of undiagnosed post-traumatic diaphragmatic hernias. In one instance a perforation of the diaphragm was missed during operation of a piercing heart injury and in the second case the operation was made only after incarceration of the stomach and spleen one year after a blunt chest injury.
The authors describe the course of acute haemorrhagic necrotizing pancreatitis complicated by prolonged septicaemia, the formation of abscesses, acute haemorrhage and a intestinal fistula--"Critically ill patient". Early surgical elimination of necrotic septic foci is the prerequisite of effective treatment and cure. In the diagnosis CT and magnetic resonance prove most useful. With the latter so far little experience as been assembled. Ultrasonographic visualization technique is insufficient for the diagnosis of focal changes in the area of the pancreas.
Haemorrhage into the small intestine accounts only for cca 1% of all haemorrhages into the gastrointestinal tract. Profuse haemorrhage is very rare, it occurs in malignant tumours, sarcomas and also haemangiomas. Preoperative diagnosis is practically impossible not only because the small intestine is not readily accessible for examination but in case of profuse haemorrhage also because of lack of time. Therefore a decision on early laparotomy has to be taken.
The author describes his experience with the treatment of chronic non-specific inflammations of the small and large intestine in elderly patients. They are difficult to diagnose as they are less frequent at that age. They are operated late, only when there are already serious complications (peritonitis, toxic megacolon, intractable haemorrhage and septicaemia) and the mortality is high. The author recommends therefore to pay more attention to this condition in advanced age groups.
The authors describe the case of a practical amputation of the proximal portion of the left forearm which occurred at a time when the development of microsurgical technique was in its initial stages in the CSSR and which was resolved at he level of a district institute of national health. The authors describe the surgical procedure, postoperative treatment and complications. The authors discuss general principles which should be respected in the event of similar injuries under present conditions.
The authors describe the case of an intramural duodenal haematoma caused a high ileus after a seven-day post-traumatic interval. The authors recommend surgical revision, in particular in children because the mechanism of injury is the same in intramural haematoma and in duodenal perforation. Only thus it is possible to prevena a fatal course, while the operation is easy and healing after drainage of the haematoma is rapid.
The authors describe rare complications of advanced colorectal carcinoma--duodenocolic fistulae, which unless removed by surgery, soon kill the patient. The authors draw attention to the clinical picture where rapidly developing dehydration, anaemia and general cachexia predominate. After short-term preoperative preparation (adequate parenteral nutrition, transfusion of blood and blood derivatives, antibiotics etc.), the authors recommend, consistent with data in the literature, radical surgery, i.e. right-sided pancreatectomy with right-sided hemicolectomy or at least right-sided hemicolectomy with excision of the fistula on the duodenum and intense postoperative care. Bypass operations are recommended as palliative operations where radical operation is not possible for some reason. A malignant duodenocolic fistula as a complication of an advanced malignant disease in a very exhausted patient may fail even after a radical, technically perfect operation and intense preoperative and postoperative care.
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