Biomedical subjects

M Bortlík

Publications and source records attributed to M Bortlík.

6 recordsLinked to original sources

PubMed2002

[Choice of surgical procedure in operations for chronic pancreatitis--personal experience].

The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.

Chronic Disease↗

PubMed2002

[Adverse effects of nonsteroidal antirheumatic agents on the digestive tract].

In this review the authors focus on the adverse GIT events during long-term treatment with non-steroid anti-inflammatory drugs, and explain pathogenesis of the NSA induced gastropathy and enteropathy. The risk groups of patients and prophylactic and therapeutic modalities are discussed. There are indices that most of the NSA gastric ulcers don't induce clinical symptoms, and massive bleeding may be the first clinical manifestation. This is why the clinical symptoms cannot be used as predictors of NSA gastropathy. It seems, on the author's clinical experience, that more than half cases of massive non-variceal bleeding from upper GIT is induced by non-steroid anti-inflammatory drugs and acetylsalicylic acid. NSA-gastropathy often presents with multifocal ulcers and erosions in the antrum of the stomach. The course of massive bleeding induced by NSA is associated with high rate of lethality.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

[Toxic megacolon].

Toxic megacolon belongs to the severe acute complications of inflammatory bowel diseases. The frequency is 1.6-21.4% among patients with ulcerative colitis and 0.3-2% in those with Crohn's disease. The main characteristics of toxic megacolon are toxemia, sepsis and distension of the colon due to the diminished muscular tone, loss of motor activity and increased amount of colonic gas. Sepsis and/or perforation of the large bowel can complicate this situation. The most important diagnostic procedure is the abdominal X-ray. Should the diameter of colonic distension exceed 60 mm, the diagnosis of toxic megacolon has been confirmed. Conservative treatment of toxic megacolon consists of water and electrolyte replacement, total parenteral nutrition, administration of corticosteroids and broad-spectrum antibiotics and repeat patient's prone positioning. If medical therapy is not successful during the first 72 hours, surgical intervention is indicated. The most common procedure is subtotal colonic resection with creation of an ileostomy. Patients with toxic megacolon should be managed at specialised centers, where cooperation of experienced gastroenterologists, surgeons and intensive care experts is possible.

Humans↗

PubMed2001

[Nonvariceal acute upper digestive tract hemorrhage--therapeutic approach].

Nonvariceal acute upper gastrointestinal hemorrhage continues to be a frequent cause for hospital admission, consumes considerable financial resources and belongs to diagnoses associated with significant morbidity and mortality. Despite the progress in endoscopic and intensive care therapies the mortality remained unchanged. It results from the increasing number of high risk patients, namely the older ones with significant comorbidity. The cornerstone of therapeutical success is considered to be the adequate hemodynamic and ventilatory stability, initiation of pharmacotherapy with proton pump inhibitors and eventually somatostatin, and in particular, the early endoscopy using modern methods of hemostasis. In case of two unsuccessful endoscopic sessions the surgical approach is justified.

Acute Disease↗

PubMed2000

[Fixation of a non-adjustable gastric band using an anterior gastric wall cuff (randomized study)].

We have been concerned with bariatric surgery at the First Surgical Clinic of th General Faculty Hospital, First Medical Faculty, Charles University Prague since 1983. In 1983-1986 vertical gastroplasties were made, between 1986 and 1993 non-adjustable gastric bands were provided by the laparotomic approach. Since 1993 when we were the first to implement a gastric band operation (GB) by the laparoscopic route, this method is used as the standard method. In 1993-1998 we made at the First Surgical Clinic 517 laparoscopic GB operation on account of morbid obesity in patients with a body mass index of 34-49 kg/m2. The group comprised 449 women and 59 men. The most frequent late complication in our group of morbidly obese patients who had a laparoscopically administered GB was in 5.1% enlargement of the proximal pouch above the GB by dilatation of its wall or slippage of the anterior wall proximally under the GB with a subsequent disorder of gastric evacuation and vomiting. We tried to reduce the incidence of this complication by fixing the GB by a cuff made from the anterior gastric wall. To test the effectiveness of the suggested fixation of the non-adjustable GB by a cuff we implemented in 1998-1999 a prospective randomized study in a group of 80 morbidly obese patients divided into experimental group n1-GB + C with the cuff and a control group n2-GB - C without a cuff. We investigated the incidence of the mentioned complication and the changed volume of the pouch above the GB after one year. Endoscopic assessment of the size of the pouch above the GB after surgery and after one year revealed that in group n1-GB + C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB - C the mean increase of the volume was 33.6 ml, i.e. 154.1% of the original size (p < 0.001). Based on the assembled results and aware of the fact that small groups were involved, we should like to express the assumption that the suggested modification, i.e. fixation of a non-adjustable GB by a cuff made from the anterior gastric wall can reduce the incidence of the complication of slippage of the anterior gastric wall proximally above the bandage.

Adult↗

PubMed2000

[6 years' personal experience with duodenum-sparing procedures in chronic pancreatitis].

The First Surgical Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment of pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional cases MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 15 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was performed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 111 patients a drainage and duodenum sparing operation was performed. Of these in 46x according to Neger, 9x according to Frey, 10x modification of these operations, 37x Partington-Rochelle's procedure. The authors did not record postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patient s co-operation round 87% while after longitudinal drainage of the duct a satisfactory result was recorded in 78% of the operated patients. The authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deterioration of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 170 operated patients one patient with decompensated diabetes died. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.

Chronic Disease↗