Biomedical subjects
Publications and source records attributed to L Vrtík.
The authors discuss the important problem of healing, infection of surgical wounds and causes of healing per secundam. Despite efforts on the part of surgeons to close the surgical wound, in particular in old people with polymorbidity, hypoproteinaemia and anaemia, disintegration of the surgical wound may occur which cannot be closed and healing must proceed while the abdomen is open.
The authors analyze in this paper covering a ten-year period (1990-1999) a group of patients with acute perforated diverticulitis. The patients were classified according to Hinchey's classification. During this period 35 patients were operated with a high preoperative morbidity. With regard to the low number of complications of acute diverticulitis the authors do not prefer early preventive resections of non-complicated diverticulitis, but they tend to extend indications, first of all in cases of repeated recurrences, haemorrhage and in case of stenosis. In the IIIrd and IVth stage according to Hinchey's classification dominates Hartmann's operative procedure. But the authors agree with the trend to perform resection with primary anastomosis in the IIIrd stage, especially in cases of a good status of the patient and short duration of the disease. In cases of acute perforated diverticulitis operated in the first 24-hour interval the mortality rate was 23.1%.
The authors discuss the history of treatment of popliteal aneurysm, causes of its development and its surgical treatment. They recommend surgery of an asymptomatic aneurysm with a diameter greater than 2 cm because of possible development of thrombosis with subsequent embolization into the periphery and development of gangrene of the extremity which may end by amputation. Early thrombolysis of a thrombotized aneurysm can be successful and combined with subsequent surgery can save the extremity. When a peripheral aneurysm is detected thorough surgical examination is necessary using ultrasonography, computed tomography and magnetic resonance resp. to detect aneurysms at other sites.
The authors emphasize the advantages of a transverse incision which are beyond doubt, because they provide the surgeon not only with an excellent bilateral view of the operated area, but what is most important, they have the significantly least negative effect on respiratory functions and the composition of blood gases, which is of major importance in patients with chronic respiratory failure. Due to the much smaller retraction forces the incidence of postoperative dehiscences and hernias is smaller. It is an incision which interferes least with the innervation of the abdominal wall and thus is not only less painful but has also better healing parameters. Its closure by a continuous, absorbable, loop-on mucosa double suture is not only simple, but what is most important, it is reliable and associated with a minimum of postoperative complications.
UC being a typical medical disease is encountered by the surgeon only in the stage of toxic megacolon or in case of severe complication during conservative treatment such as perforation, haemorrhage, obstruction or malignity. The authors operated urgently 6 young women with all these complications performing total proctocolectomy, constructing ileal pouch with complete stapling technique. In spite of high rate of complications the results are promising. The best prevention of malignant change and complication is the earlier indication for operative treatment which offers the ideal treatment for patients with UC.
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Thromboembolic disease with its high mortality and morbidity is currently one of the most serious postoperative complications. Its occurrence in high-risk patients in surgical wards is 25-50%. Since 1979, the authors have examined 160 risk patients in whom no prevention had been performed. In this group of patients they detected the occurrence of profound venous thrombosis by means of the accumulation fibrinogen test, targeted phlebography under skiascopic control. At the same time the clinical symptomatology was followed in detail. Since the thrombosis is a multifactorial process, the effective preventive measure must affect and normalize as many disturbed homeostatic processes as possible. Into the group of 176 high-risk patients, the authors introduced a complex prevention into surgical routine residing in classical low-dose heparinization by 5000 u.s.c. with the first dose administered 1 hours prior to surgery, preoperational haemodilution with the administration of minimally 500 ml of Dextran and in preoperation administration of antiaggregants (Acylpyrin). by means of this tactic, the greatest antithrombotic effect is brought about preoperatively and in the first postoperative hours while the patient is protected minimally 5 to 7 postoperative days. Both preoperative and postoperative procedures are monitored by means of a complex haemocoagulation examination of the basic 10 haemocoagulation factors. The occurrence of thrombosis in patients without prevention with minimally 5 thrombogenetic risk factors during the control by means of the accumulation fibrinogen test was 32.4% and during the control by means of targeted phlebography is 24%. The differences are not statistically significant. In the group of patients with prevention the occurrence is 5.6%. In this group the screening is represented by the accumulation fibrinogen test and its positivity is verified by its localization by means of selective phlebography. The occurrence of deep vein thrombosis in the group with prevention and in the control groups statistically highly significant p > 0.0005. Haemocoagulation examination is aimed at the determination of the normalization impact of prevention on the state of hypercoagulation ability associated with the depression of spontaneous fibrinolysis in patients without prevention. The thrombi detected in patients with prevention are localized in short segments of crural veins. Clinically more significant bleeding in the group of patients with prevention occurred only in 2 patients, i.e. in 1%. Complex multifactorial prevention is not only simple and safe for patients, but also highly effective in the group of patients with high risk of postoperative thrombosis. The clinical diagnosis is unreliable and misleading with low sensitivity and specificity. (Tab. 2, Fig. 2, Ref. 28.).
Authors refer about an extremely rare embolisation of a myxoma into the both lower limbs. Despite of late diagnosis an embolectomy after 28 hours was successful.
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