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Biomedical subjects

M Pesková

Publications and source records attributed to M Pesková.

At least 73 records · Page 4Linked to original sources
PubMed1996

[The surgery patient with gastroduodenal ulcers].

The authors evaluate the contemporary change of indications for surgery of gastroduodenal ulceration. From a group of 670 patients operated in the course of three years at the Second Surgical Clinica of the General Faculty Hospital in Prague 46 patients were subjected to acute surgery. Among these operations surgery on account of perforating pyloric ulcers (34%) predominated followed by bleeding duodenal ulcers (23%). In the remaining patients with a prolonged history of conservative treatment the authors observed a more complicated local situation (infiltrate, penetration) which influenced not only the surgical operation but also the pretentiousness of postoperative care, but unfortunately also a higher lethality rate-18.3%. In the conclusion the authors reflect on the possibility of earlier indication of surgery in particular in ulcers poorly controlled by conservative treatment or those after haemorrhage treated successfully by conservative treatment.

Female↗
PubMed1996

[Acute pancreatitis--the need for an active approach. Experience in our department].

The authors draw attention to the rising incidence of acute pancreatitis, based on their own observations. They present very briefly the last version of the classification of acute pancreatitis, the so-called Atlanta classification of 1992. They summarise methods of conservative treatment of acute pancreatitis which they used as a basis for elaborating their own therapeutic pattern. In the presented group in 1995 19 patients with the diagnosis of acute pancreatitis were treated which was diagnosed based on the clinical condition, biochemical results, US and CT examination of the pancreas. CT examination is considered most important. In three instances acute non-complicated pancreatitis was involved, seven times acute accumulation of fluid in the pancreas and eight times acute necrosis of the pancreas. In 13 men and 6 women the mean age was 54.3 years. As to the aetiology, acute pancreatitis was 9 times of biliary origin, 6 times due to alcohol abuse, twice due to ERCP, once after chemotherapy and in one case the cause was not revealed. All patients with acute necrosis of the pancreas were operate by laparostomy, zip closure was used and repeated surgical revisions were made. Of 19 patients 8 died (all with acute necrosis of the pancreas). In antibiotic prevention of secondary infection of the pancreas in acute pancreatitis cefazoline proved most useful. Aprotinine administration to inhibit proteases is according to the authors effective only during the first 48 hours after the onset of the disease.

Acute Disease↗
PubMed1996

[Unexpected major perioperative blood loss (case analysis)].

In this study we are discussing a necessity of sufficient monitoring and therapy of unexpected perioperative massive blood loss, which a case of 4 of our patients. Cell saver system wasn't available. Complete monitoring system maximum intensive care and a broad substitution is essential in these cases. We have pronounced the influence of massive blood loss on multiorganic postoperative failure as well as a necessity of sufficient time of an intensive care.

Adult↗
PubMed1996

[Acute mesenteric occlusion (analysis of 4 cases)].

Sudden, complete occlusion of the superior mesenteric artery is due often to an embolus than thrombosis. The clinical features are usually the same whether occlusion is the result of embolism or thrombosis. Males are affected more often. Complete thrombotic or embolic occlusion of the mesenteric artery presents mostly as a surgical emergency with all the manifestations of paralysis of the peristaltic mechanism as well as loss of viability of the affected intestine. There are problems in the diagnosis in, the group of higher age patients. The clinical diagnosis is by patients with minimal symptomatology and often with next diseases very complicated and unfortunately to late. The authors described four examples of this problematic.

Acute Disease↗
PubMed1996

[Results of surgical treatment of pancreatic carcinoma].

Experiences in pancreatic surgery revealed substantial mortality decrease in pancreatic resections and these procedure became treatment of the first choice for resectable pancreatic tumors in last ten years. Our results support this experience, we performed pancreatic resections in 51% of 155 patients we operated on in last five years, with mortality rate not exceeding 5%. Morbidity of pancreatic resections remains low in comparison with palliative procedures and resections provide better quality of life even in advanced disease. Together with adjuvant chemotherapy there is a possibility to offer an acceptable treatment for pancreatic tumors.

Adult↗
PubMed1995

[Surgical and technical aspects of regional chemotherapy by means of an arterial catheter port].

Metastases of colorectal carcinoma seem the most common liver tumors in our patients. Up to date clinical studies reveal in these the best results with intraarterial chemotherapy employing continuous or intermittent infusions of fluoropyrimidins. These require permanent vascular access. Techniques of implantation in normal an abnormal vascular anatomy, methodology of catheter patency maintenance, port maintenance and salvage of malfunction catheter feature as a group of new, technical and surgical problems. Together with the simultaneously solved problems as effective anticancer agents option and way of their administration they jointly condition a favourable effect of regional chemotherapy. The technical and surgical aspects result in further indication criteria for intraarterial chemotherapy, which is then conducted in a close cooperation of a surgeon and clinical oncologist.

Antineoplastic Agents↗
PubMed1995

[Dermatofibrosarcoma protuberans--the need for a radical approach].

The authors present the case-history of a young patient with rapid growth of a relapsing skin tumor--dermamtofibrosarcoma protuberans (DFSP)--in the scar of a previous minor dermal excision. DFSP is a malignant skin tumour, frequently relapsing in the scar after excision, rarely metastasizing into lymph nodes and the lungs. The patient was treated by a major radical excision and a dermal flap plastic operation with subsequent adjuvant actinotherapy. With regard to possible relapses, the authors recommend long-term dispensarization of patients.

Adult↗
PubMed1995

[Prospective randomized comparison of the effects of pefloxacin and clindamycin with cefoxitin after hepatobiliary and pancreatic operations].

The authors present their experience from a prospective randomized study of therapeutic effects of a combination of pefloxacine (Abaktal) and klindamycin with cefoxitine in patients after hepatobiliary and pancreatic surgery. The therapeutic results in both investigated groups were evaluated in more than 95% patients as excellent, without statistically significant differences. The authors provided evidence of a comparable effectiveness of a combination of pefloxacine with klindamycin and the effectiveness of cefoxitine in patients after the above mentioned types of surgery, while treatment was cheaper when a combination of pefloxacine and klindamycin was used and moreover there was the possibility of oral administration of these preparations, as soon as the patients' condition made it possible.

Anti-Bacterial Agents↗
PubMed1995

[Thromboembolic complications in urology].

Using the latest examination methods the authors have proved relatively wide spread recurrence of thromboembolic complications. Proved were even the mortal forms in urology in case of benign diagnosis as well as relatively considerate operational medical performance. An evident effect of prophylactic, physical and especially pharmacological methods was proved in prevention of thromboembolic disorders. Silent form of deep venous thrombosis were diagnosed to patients with mere physical prophylaxis. On the other side unfavourable effect of low molecular weight heparin on blood loses was not proved even in laboratory picture. Higher risk of thromboembolic complications origin was observed even on the 21st postoperation day. Currently authors consult the appropriateness of individual types of prophylaxis with the different urology illnesses risk groups.

Humans↗
PubMed1994

[Regional chemotherapy in the treatment of biliary tract tumors].

BACKGROUND: Subjective complaints of patients with tumours of the biliary tree are late, early diagnosis is difficult and frequently impossible, the therapeutic results are unsatisfactory and the prognosis is poor. Surgical intervention is in more than 90% palliative, the tumours are not radiosensitive and their sensitivity to systemically administered cytostatics is low. The perspective of some patients was improved by implantation of bilioduodenal endoprostheses. The objective of the submitted work was to assemble experience with this method in patients with tumours of the upper portions of the biliary tree. METHODS AND RESULTS: Between January 1991 and May 1993 75 patients (42 females and 33 males, aged 48-65 years) with malignancies of the upper and middle part of the biliary tree were treated. Bilioduodenal endoprostheses (BDE) were inserted endoscopically in 70 patients. In 21 of them stenting was combined with regional chemotherapy via an implantable portho catheter. For patients with BDE alone, the median survival time was 18 months, for those with BDE and chemotherapy the median survival was 23 months (p < 0.01). 5-fluorouracil in monocombination was as potent as in combination with carmustine and/or doxorubicin. CONCLUSIONS: Endoscopic implantation of a bilioduodenal endoprosthesis with subsequent regional administration of 5-fluorouracil is an important therapeutic procedure in the treatment of malignant tumours of the upper and middle biliary tree.

Aged↗
PubMed1994

[Surgical treatment of morbid obesity].

The authors present their experience with surgical treatment of morbid obesity. Up to 1986 they used above all gastroplasties vertical and horizontal--to influence morbid forms of obesity; from 1986 they use the method of gastric bandage with very good results as regards weight losses. The mean body weight losses are 38.1 kg in 12 months. In 1993 the authors were the first, worldwide, to make gastric banding by the laparoscopic route with the same effect on body weight loss but with the possibility to reduce to a minimum the surgical stress of the patient and to reduce possible early and late postoperative complications. The laparoscopic technique makes it also possible to shorten the time of hospitalization.

Adult↗
PubMed1993

[Pneumatosis cystoides intestini tenuis--case report].

Case report of pneumatosis cystoides intestini tenuis in 85 year old patient. The disease seemed to be like pseudoobstructive syndrome and the diagnosis was confirmed intraoperatively according to histologic examination during the procedure. Following conservative treatment was with good results and during the next control the patient was doing well. In this article the therapy, symptomatology and appearance of the disease is discussed.

Aged↗
PubMed1993

[Surgical treatment of afferent loop syndrome].

Included is a case study of the afferent loop syndrome after subtotal gastric resection for a peptic ulcer. A 60 year old woman was successfully treated by the ligature of the afferent loop with the anastomosis between efferent loop and the duodenum. By means of this modification the following aims were achieved: 1 elimination of the antiperistaltic function of the afferent loop anastomosed "from the left", 2-replacement of resected stomach by means of anastomosis between the efferent loop and the duodenum.

Afferent Loop Syndrome↗
PubMed1993

Pepsinogen polymorphism in human gastric mucosa in relation to gastric diseases.

The human stomach mucosa contains two main group of gastric proteinases. Both pepsinogen A (PGA) and pepsinogen C (PGC) consist of molecular variants, isozymogens, which can be separated electrophoretically, PGA was found to consist of five isozymogens (Pg1-Pg2), and PGC of two isozymogens (Pg6 and Pg7). Five hundred zymograms were examined and electrophoretic mobility of pepsinogens from patients with gastric cancer was found to be higher than from other gastric diseases. The ratio of isozymogens Pg3 to Pg5 differs in to great extent in various disease. Patients with ulcer disease have this value higher than 1, but patients with gastric cancer lower than 1. Patients with gastric ulcer have lower occurrence of Pg1 and SMP in antrum. In patients with gastric carcinoma lower concentration of PGA and also ratio PGA to PGC are observed.

Gastric Mucosa↗
PubMed1993

[Short-term hospitalization and ambulatory care of patients with advanced hemorrhoidal disease].

The authors describe possible non-surgical treatment of extensive haemorrhoids grade 3 and 4, using Barron's rubber band ligation. To make comparison of therapeutic results possible Dennison's Sheffield classification is used. In the mentioned new approach indications for ambulatory treatment or short-term hospitalization in patients with an advanced grade of internal or external haemorrhoids are extended. From a group of 145 patients treated by this method 126 were free of subjective complains during a check-up 12 months after termination of treatment.

Ambulatory Care↗
PubMed1993

[Risk of development of colorectal carcinoma in patients with ulcerative colitis].

In patients with ulcerative colitis of prolonged duration and major extent there is according to the majority of investigations an increased risk of development of colorectal carcinoma; the magnitude of the risk which is of major importance for clinical practice, however, differs according to different authors. The present study comprises 189 patients with ulcerative colitis, 103 men and 86 women, perspectively followed up for a period of 12.5 years (8.0-24.5). In 60 patients the distal form was present, in 68 left-sided colitis and in 61 pancolitis. The patients were monitored systematically--clinically colonoscopically and endoscopically. The intervals between these check-ups were gradually shorter when the disease persisted for 10 or 12 years, i.e. the patients were checked once to twice a year. The endoscopic findings were focused in particular on evidence of dysplasia. The follow-up system was modified with regard to individual conditions. In the course of the follow-up colorectal carcinoma was detected in 9 patients (4.8%) with a persistence of the disease for 9-25 years (in one patient after 9 years, in 5 after 10-20 years and in 3 after longer periods). In three instances the left-sided form was involved, in 6 pancolitis. Dysplastic changes were mostly medium grade and were found at least once in all patients. The preoperative diagnosis of carcinoma was established for certain in three patients, there was major suspicion in four patients. In two patients the carcinoma was detected only on operation (in active forms of the disease). All carcinomas were resectable, 4 times DUKES A, 4 times B, once C. As to the remaining 180 patients, 32 were operated on account of colitis; in 28 at least once dysplasia was proved, with a rising trend as the disease had a prolonged duration. These results confirm the increased risk of carcinoma in ulcerative colitis with a long duration and with a major extent and justify systematic colonoscopic and endobioptic follow-up of these patients.

Adolescent↗