Biomedical subjects

L Denemark

Publications and source records attributed to L Denemark.

8 recordsLinked to original sources

PubMed2006

[Technical aspects of the liver resection procedure--options for combinations of individual methods].

INTRODUCTION: The liver resection procedure as a treatment method of benign and malignant hepatobiliary disorders grows more important due to the fact, that its postoperative morbidity and mortality rates have been reduced, a result of the patients selection method, surgical techniques and perioperative care improvements. The aim of this report was to assess combinations of recent liver transsection techniques, based on the authors' own experience and results of recent studies. MATERIAL, METHODS AND RESULTS: From 1999 to May 2005, in the Surgical Clinic of the Faculty Hospital Královské Vinohrady in Prague, the liver resection procedure was completed in 133 patients with benign or primary and secondary malignant tumors. In the liver transsection procedure, the following instrumentation was used, starting from 1999: harmonic scalpels, ultrasonographic dissectors, water jet scalpel, bipolar diathermia, argon coagulation and radiofrequency. The liver tissue dissection using the ultrasonographic dissector or the water jet scalpel in combination with the harmonic scalpel or bipolar diathemic coagulation, reduced the postoperative blood loss in extensive non-anatomical liver resections. This dissection method was also used in some "centrally" located tumors for their non-anatomical resections. The benefit of the combination of the methods is based on sufficient coagulation and interruption of minor vascular branches and bile ducts in the resection line, without intermittent closure of the blood influx to the liver, using a Pringle manoeuvre. The radiofrequency, as a novel method for the liver tumors ablation, was used in anatomical and non-anatomical liver resections to coagulate the liver tissue prior to its transection prior to the R0 resection. The postoperative morbidity rate was 14% (19 patients). Within 30 postoperative days, no death was recorded. CONCLUSION: 1. The above listed liver transsection techniques, employing the ultrasonographic dissector or water jet scalpel, are safe alternative liver resection methods, reducing the blood loss. 2. Diathermic coagulation is an alternative to the harmonic scalpel for intersecting minor intraparenchymatous vascular branches and bile ducts. 3. A combination of the ultrasonographic dissector technique or water jet scalpel with the harmonic scalpel or diathermic coagulation technique, aids the liver resection by closing and interrupting the vessels and bile ducts in the resection line. 4. Radiofrequency and pre-transsectional coagulation of the liver parenchyma reduces the bleeding during the resection procedure and is a method of choice in resections of centrally located tumors, reducing the loss of the functional parenchyma.

Hepatectomy↗

PubMed2005

[Anatomical resection for liver metastases of the carcinoma of the large intestine and the rectum].

UNLABELLED: Resection of the colorectal carcinoma liver metastases is an effective therapeutical procedure with a five-year survival rate in 20-50% of the operated. Opinions on the most optimal type of the resection procedure remain to be controversial. The aim of this study was to assess all indication criteria for anatomical resections of the colorectal carcinoma liver metastases. SUBJECTS AND METHODOLOGY: This retrospective study analyzed 98 patients with liver resection for colorectal metastases. In 31 patients, extensive anatomical resections of the liver were conducted, segmentotomie were conducted in 20 patients and nonanatomical wedge resections in 47 patients. Extensive anatomical resections were conducted in cases of tumorous foci larger than 2cm and located marginally between individual segments of a single lobe, and in cases of multiple tumorous foci affecting a single liver lobe. The nonanatomical resections were conducted in cases of metastases smaller than 2 cm, localized on the liver surface or in cases of multiple peripheral foci, including cases when both liver lobes were affected. RESULTS: In the group with the wedge-type resections, a histologically positive border was found in 4 cases. Postoperative complications were recorded in 10 (19.6%) patients with the anatomical resection and in 9 (19.1%) with the wedge resection. CONCLUSION: 1. Anatomical resection of the liver for the colorectal carcinoma metastases is indicated in cases of larger foci (over 2 cm), located marginally between segments or in multiple metastases affecting a single liver lobe. 2. Anatomical approach to the resection lowers the rates of histologicaly non-radical resections (R 1). 3. The new surgical technique of the liver transsection lowered, even in cases of anatomical resections, the postoperative morbidity rates.

Adult↗

PubMed2003

[Current diagnostic and therapeutic approaches in liver injuries].

PURPOSE OF THE STUDY: The recent improvements in hospital care system (centralized specialized care) and the use of new imaging methods and modern technologies in surgical treatment have greatly enhanced successful outcomes of therapy in liver injury. The aim of the study was to evaluate the contribution of procedures included in the diagnostic-therapeutic algorithms to the treatment of blunt injury to the liver in our patient population. MATERIAL: Our group consisted of 43 patients with blunt injury to the liver who were treated at the Emergency Department between 1998 and 2002. In 28 patients, blunt injury was part of polytrauma, in 7 patients it was associated with thoraco-abdominal injury and, in 8 patients, it was the only trauma sustained. METHODS: The diagnosis and therapy were based on the algorithm currently used for treating liver injury at the Emergency Department. In addition to clinical examination and assessment of the actual status of hemodynamics, spinal computed tomography was carried out to establish the therapeutic procedure. Fourteen patients were treated conservatively according to the criteria of a non-surgical approach and 29 patients underwent urgent surgery. Indications for revision surgery included, apart from signs of ongoing abdominal bleeding related to liver injury, combined spleen and kidney trauma. All patients with thoraco-abdominal involvement had laparotomy; in addition, four underwent thoracotomy including repair of the lacerated lung by suturing and three patients required suturing of a rupture of the right part of the diaphragm. RESULTS: In the patients treated conservatively, 10 showed spontaneous regression of parenchymal hematomas and four had to be treated by suction drainage. Out of 29 patients operated on, five died with signs of an irreversible hemorrhagic shock from multiple trauma and one died of multiple organ failure. DISCUSSION: The principal criterion determining therapy in blunt liver injury is the patient's hemodynamic status; laparotomy is mandatory in intra-abdominal trauma with severe hemoperitoneum or when unstable hemodynamics is due to intraperitoneal bleeding. Non-surgical treatment of blunt liver injury, on condition that the established criteria are observed, has several advantages such as less stress for the patient, fewer intra-abdominal complications and fewer blood transfusions needed. The modern technologies used in the operative procedure are related to both a transient vascular occlusion and a strategy for selective care in liver trauma. CONCLUSION: 1. The treatment strategy in a patient with blunt liver trauma is determined by the patient's hemodynamic status; in a stable patient, spinal CT examination of the thorax and abdomen is mandatory. 2. Urgent laparotomy is indicated when the patient with blunt liver trauma is hemodynamically unstable due to diagnosed hemoperitoneum or suspected intraperitoneal bleeding. 3. Conservative therapy is applied when the criteria for non-surgical treatment are fulfilled. 4. Surgical strategy for blunt liver trauma is based on the extent and localization of the injury, the patient's overall status and severity of associated injuries. Resection of the injured parenchyma is indicated when laceration of a liver lobe occurs. 5. The prognosis of blunt liver injury is influenced, apart from hemorrhagic shock reversibility, by the severity of associated injuries in multiple trauma.

Adolescent↗

PubMed2003

[What are indications for hepatic resection in metastases?].

INTRODUCTION: In the last 20 years the resection of liver metastases became the method of choice in the therapy of malignant tumors, particularly of colorectal cancer. The study was aimed at evaluating indication criteria and operation tactics in liver metastases resection. MATERIALS AND METHODS: The authors retrospectively analyzed a group of 154 patients subjected to liver resection for metastases, having been operated on since 1980 to May 2003. The preoperative indication procedure included a) imaging examination of the liver (CT, NMR, DSA--radiological staging), b) evaluation of tolerance to liver resection to liver resection (ASA, hem-coagulation tests, liver tests, nutritional state), c) examination to exclude the occurrence of extrahepatic tumor (imaging and endoscopic methods). In addition to peroperative examination (surgical staging) and selective vascular exclusion in anatomical resection, the standard operation procedure was supplemented in the last five years with transaction of the liver by means of the harmonic scalpel. From the total number, metastases of colorectal cancer were resected in 116 patients, in 20 gall bladder cancers, in 6 stomach cancers, in 4 breast cancers, in three carcinoids of colon and intestine and in two kidney cancers. Individual patients suffering from metastases of adrenal cancer, pancreas cancer and melanoma, respectively, were also operated on. More extensive anatomical resections were performed in 44 patients, segmentectomy was made in 43 subjects and non-anatomical wedge-shaped resections in 67 individuals. RESULTS: Postoperative complications occurred in 15 (9.8%) patients (subphrenic hematoma, abscess, cholascos, fluidothorax, pulmonary or early infection). Two patients died within 30 days (1.3%) for hemorrhagic shock due to bleeding from duodenal ulcer and from hepatorenal failure). CONCLUSION: 1. Liver resection is indicated is resectable metastases of colorectal cancer. 2. The resection exerts a therapeutic effect in non-colorectal metastases in neuroendocrine tumors, tumor of uropoetic and genital system, breast cancer, sarcoma and melanoma. 3. The preoperative diagnosis should include: a) imaging examination of the liver and the site of primary tumor and possible occurrence of other metastases, b) determination of tolerance to liver resection. 4. The operation tactics includes the peroperative evaluation of operability, radical resection of metastases with 1 cm border of unaffected liver tissue and procedures leading to diminished blood loss and biliary stasis. 5. Anatomical resection is indicated in larger metastases affecting segments of one lobe. Non-anatomical wedge-shaped resection is aimed at removal of peripheral foci.

Adult↗

PubMed2002

[When is resection indicated in primary liver tumors?].

The development of hepatic surgery involved also definition of indications for resection in primary liver tumours. Based on an analysis of a group of 76 patients with primary liver tumours operated in 1978-2001 (up to the end of October) the authors evaluated the indication criteria for resection of primary hepatic tumours. As to benign tumours most frequently haemangiomas were resected (in 35 patients) and follicular nodular hyperplasia in 10 patients. Indication for resection was the symptomatology of the tumour (40x), signs of progression during a check-up examination (13x) or doubts as regards preoperative ruling out of malignity (16x). Hepatocellular adenoma was resected in 8 patients, incl. 7 where the preoperative diagnosis was assessed by bioptic examination. The extent of resection depended on the size and site of the tumour, in haemangiomas and follicular nodular hyperplasia non-anatomical resections predominated (in 27 patients). On account of hepatocellular carcinoma resections were made in 18 patients, incl. 8 who suffered also from cirrhosis which limited the extent of resection. In patients without cirrhosis with carcinoma in one of the lobes an anatomical resection was implemented. Postoperative complications developed in 14 patients (18%), two died (3%) from hepatic failure and pulmonary embolism.

Adult↗

PubMed2002

[Liver transection with the harmonic scalpel in elective liver surgery].

More procedures used in transection of the liver parenchyma include also resection by means of a harmonious scalpel with an enhanced haemostatic effect. Based on analysis of 51 patients operated on account of liver disease using a harmonious scalpel, the authors evaluate its asset to the liver resection technique. The harmonious scalpel was used in transection of the liver in seven patients with benign liver disease (inborn cysts, follicular nodular hyperplasia, haemangioma, hepatocellular adenoma) and in 44 with malignant disease (hepatocellular carcinoma, metastases, most frequently, i.e. 34x of colorectal carcinoma). Anatomical liver resection (hemihepatectomy, lateral bisegmentectomy, segmentectomy) was implemented in 34 patients, and in 17 a wedge-shaped resection. Transection of the parenchyma by a harmonious scalpel was made using 10 mm coagulation scissors, i.e. their blunt blade with a lower oscillation grade. The preoperative blood loss was from 30 to 300 ml. As to postoperative complications 2 patients developed cholascos, 2 fluidothorax, 1 respiratory failure and 2 early infection. Liver resection by means of a harmonious scalpel is a new method of parenchyma transection with adherence to the resection line without damage of the deeper structures, reducing preoperative haemorrhage and minimalizing the extent of resection in liver diseases with impaired regeneration of the parenchyma (cirrhosis). Liver transection by a harmonious scalpel is a safe method where it is essential to respect recommended technical parameters, incl. the necessary time.

Adult↗

PubMed2000

[Liver resection using the harmonic scalpel].

The authors present their initial experience with the use of a harmonious scalpel in resections of the liver. The harmonious scalpel was used as part of the resection technique in 24 patients operated in 1999. Indication for surgery was in five patients benign liver disease (inborn cysts, nodular hyperplasia, haemangioma, hepatocellular adenoma) and in 19 malignant disease (hepatocellular carcinoma and secondaries). Anatomical resection of the liver was performed in 15 patients and in 9 patients a wedge-shaped resection. During resection a combined technique with a harmonious scalpel was used (with coagulation scissors). As to postoperative complications two patients developed cholascos. According to the authors' experience introduction of a harmonious scalpel into the technique of liver resection is the method of choice in particular in non-anatomical resections because of the better control of haemorrhage and safer isolation of bile ducts and blood vessels.

Adult↗

PubMed1999

[Current status of liver resection of metastases of colon and rectal carcinoma].

Based on an analysis of a group of patients with resection of the liver on account of secondaries of colorectal carcinoma the authors evaluate their therapeutic method. Between 1978 and June 1999 at the Surgical Clinic of the Third Medical Faculty Charles University, Prague resections of the liver were made in 222 patients, incl. 57 on account of metastases of colorectal carcinoma. The liver was resected on account of metastases by right-sided lobectomy twice, left-sided lobectomy 1x, right-sided lateral bisegmentectomy 5x, left-sided lateral bisegmentectomy 9x, segmentectomy 16x and in 24 patients a wedge-shaped resection was made (incl. 10 with multiple metastases several times). In another eight patients where a resection could not be performed either alcoholization of the tumour was used or adjuvant chemotherapy was administered. Postoperative complications were recorded in 10%, the 30-day mortality rate was 2%. The mean survival period was 23 months. Resection of the liver on account of a secondary of colorectal carcinoma is a safe and effective therapeutic method.

Carcinoma↗