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M Ryska

Publications and source records attributed to M Ryska.

At least 19 recordsLinked to original sources
PubMed2006

Temporary liver blood-outflow occlusion increases effectiveness of radiofrequency ablation: an experimental study on pigs.

AIM: To evaluate the feasibility of liver blood outflow (LBOF) occlusion and its impact on the effectiveness of radiofrequency ablation (RFA). METHODS: The experiment was performed on 10 pigs. The animals were divided into groups A and B according to RFA protocol. In group A (n=5) the RFA time was that taken to reach the target temperature of 105 degrees C, whereas group B (n=5) had a constant RFA temperature of 105 degrees C and constant time of 8min. The liver blood flow (LBF) was quantified using Doppler ultrasonography before LBOF occlusion and after that. RFA were performed using an expandable 3cm RF needle. Two liver ablations created in different liver lobes were compared; the first ablation was created before balloon inflation and the second one was created under LBOF occlusion. The time required for RFA procedure, liver ablation volumes, shape and microscopic changes of the thermoablated zones were recorded. RESULTS: The LBF dropped significantly in all liver vessels after balloon inflation. The volume of the ablated area was 8.2+/-2.2cm(3) and increased significantly after LBOF occlusion to 17.4+/-3.8cm(3) (p<0.001), in group A. A significant enlargement of the ablated area with occluded LBF was registered in group B, it was 6.7+/-2.8cm(3) versus 19.4+/-1.8cm(3) respectively (p<0.01). CONCLUSIONS: Temporary LBOF occlusion led to a significant reduction in liver blood flow, enlargement of the thermoablated area volume and homogeneity of the coagulated zones.

Animals↗
PubMed2006

[Prediction of treatment outcome after adjuvant loco-regional chemotherapy following liver resection for colorectal metastases--preliminary results].

INTRODUCTION AND AIM OF STUDY: Czech Republic leads the worldwide league in colorectal cancer's occurrence. Colorectal liver metastases are detected in about a half of patients with colorectal cancer. Liver resection of colorectal metastases is currently the only potentially curative treatment with a chance for a long-term survival rate. Until now there has remained a question of whether adjuvant HAIC can improve the treatment results of radical resection. The aim of our study is to verify predictive efficiency of thymidylátsyntasis (TS), dihydropyrimidindehydrogenasis (DPD) and thymidinfosforylasis (TP) in patients undergoing adjuvant hepatic artery infusion chemotherapy (HAIC) following radical liver resection for colorectal metastases. METHODS: From 1990 to 2005 80 patients underwent 84 liver resections for colorectal metastases. R0 resection was achieved in 60 events. Ten patients who underwent R0 resection both for primary cancer and for colorectal liver metastases and who were given portcatheter for HAIC were included in this study. Adjuvant chemotherapy contained 5-fluorourycil (1200 mg/m2) combined with oxyliplatinum and leukovorin. Whole dose was administered via hepatic artery. The samples were procured both from healthy liver tissue and from metastases for imunohistochemical and molecular biological analysis. RESULTS: The recurrence of disease was verified in 2 of 10 included patients (20%). We detected neither occurrence of death nor serious complication in early postoperative course in none of ten patients. Low expression of TS was found in both events and very high expression of DPD in one event was detected. DISCUSSION: High expression of DPD in one of these patients could contribute to lower outcome of adjuvant chemotherapy. Low expression of TS in both patients responds to the written statement regarding contribution of adjuvant chemotherapy only in patients with high TS level. CONCLUSION: The expression of TS and DPD responds to expected outcome of HAIC. Low number of patient does not permit statistic evaluation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

[Pancreatectoduodenectomy for multiple duodenal diverticula. Case report].

The authors present a case report of a 61-years old female with 12 month history of deteriorative chronic pain located in epigastrium and propagating to her back, tabescence and upper dyspeptic syndrome. The first grade oesophagitis and duodenogastric reflux were verified endoscopically. There were adequate biliary tree as well as pancreatic duct and two high-volumed parapapillar diverticula and the third one in the region of D 3 depicted by ERCP and enteroclysis. Neither ultrasound nor computed tomography detected any pancreatic or hepatic pathology. All the alternatives of internal medical treatment resulted in no effect. The surgical treatment lied in performance of pylorus-saving pancreatoduodenectomy (Traverso-Longmire). Five months after operation the patient suffers from no ailments and prospers in general. The authors render an account of duodenal diverticula surgical treatment.

Diverticulum↗
PubMed2006

[Atypically localised hepatic haemangioma as a cause of dyspeptic syndrome].

INTRODUCTION: Haemangioma is a benign mesenchymal tumor growing from the endothehum of blood vessels. Most hepatic haemangiomas are asymptomatic while symptomatic haemangioma are usually manifested by non-specific pain dyspeptic syndrome, quite rarely also by hemorrhage, or icterus Symptomatic haemangiomas or large haemangiomas with fast growth, are indicated for surgical treatment. CASE REPORT: The authors present a 50-year-old patient with chronic dyspeptic condition and pressure pain in the epigastria. USG, CT, MR, CT angiography and EUS have all shown two lesiones (haemangioma of the left hepatic lobe, a tumor in the left subphrenic area of uncertain origin). We proposed an operational solution, and, surprisingly, the finding was a single haemangioma (2 parts-- intra- and extraparenchymatous--connected by a vascular bridge). We then performed left lobectomy. DISCUSSION: In the diagnosis of haemangioma, MR is a method of choice with high specificity and sensitivity. Why did not it yield the correct diagnosis? The structure, the signal and the type of postcontrast enhancement of the second lesion corresponded to a haemangioma, but the extraparenchymatous location and also the considerable remoteness from the liver invalidated this possibility before operation. Regarding to the differential diagnostics of the lesiones in the subphrenic area, which according to the imaging techniques are not related to the hepatic parenchyma, it is advisable to consider the possibility of the incidence of pedunculated hepatic haemangioma.

Dyspepsia↗
PubMed2006

[Manual and robotic laparoscopic liver resection. Two case-reviews].

INTRODUCTION: Laparoscopic resection of the liver, compared to other laparoscopic procedures of the abdominal cavity, have become used in a clinical practice only in recent years. No literature data on robotic liver resections are available. METHODS: The authors completed 2 laparoscopic resections of the liver. The first case included a 61-year old male indicated for the procedure with a low differenciated hepatocellular carcinoma lesion in SII and SIII segments, measuring 6 cm in a diameter, in a Child A cirrhotic remodellation terrain. In-line RFA-assisted and HandPort-assisted manual laparoscopic left-sided lobectomy was completed. Histological findings confirmed the diagnosis and the R0 resection. Robotic laparoscopic resection of the focal nodular hyperplasia (FNH) lesion, growing from SII and SIII segments and measuring 7x7x5 cm was completed in the other case of a 29-year old female patient. RESULTS AND CONCLUSION: Both patients healed without complications, the hospitalization lasted 8 and 7 days, respectively. HandPort-assisted manual laparoscopic resections of the left liver lobe appears a safe method. The patient may benefit from a smaller entrance into the abdominal cavity, compared with open abdominal procedures. Experience in liver and laparoscopic surgery is a prerequisite, which is also supported by literature data. A pilot study must be conducted in order to assess benefits of robotic laparoscopic liver resections.

Adult↗
PubMed2005

Hemodynamic parameters in a surgical devascularization model of fulminant hepatic failure in the minipig.

Animal models of fulminant hepatic failure (FHF) are important for studying the pathophysiology of this process and for evaluation of the efficacy of artificial and bioartificial liver support systems. In experiments, hemodynamic parameters were monitored in a group of minipigs with FHF induced by surgical devascularization, and compared with those in a control group. During the experiment, animals were analgosedated and were on mechanical lung ventilation. Crystalloid and colloidal solutions were administered and norepinephrine in continuous infusion was applied if mean arterial pressure (MAP) decreased below 60 mm Hg despite adequate intravascular volumes. An increase in heart rate, and decreases in MAP and systemic vascular resistance, compared with the baseline, occurred in the FHF group from 6 h after surgery. A comparison of FHF and control groups revealed no significant differences in systemic vascular resistance and MAP until after 12 h after surgery (systemic vascular resistance index: 953 FHF vs. 1658 controls; p < 0.05; MAP: 58.1 FHF vs. 76 controls; p < 0.05). No significant differences in CI were seen between the FHF group and controls. FHF animals survived for about 13 h after surgery, i.e. a period, which we consider long enough to test a support device. The parameters are believed to be quite adequate, as we were able to maintain satisfactory hemodynamic stability in all experimental animals with induced acute hepatic failure.

Animals↗
PubMed2005

[Long-term follow up of renal function after orthotopic liver transplantation].

BACKGROUND: Renal dysfunction in patients after the orthotopic liver transplantation (OLT) is frequent and it significantly contributes to the morbidity and mortality. The aim of our work was to assess the level of glomerular function (GFR) within the first to fifth year after OLT. METHODS AND RESULTS: Serum creatinine concentration (Skr), creatinine clearance (Ckr) and predicted value of creatinine clearance using the Cockcrofta a Gaulta formula (CG) were assessed in 75 patients. Normal values of the given parameters (Skr <110 umol/l, Ckr > or = 1.3 ml/s/1.73 m2) were found only in 16% of all patients. Significant decrease of GFR (Ckr < 0.5 ml/s/1.73 m2) was found in 24% of cases, acute renal failure, which required transitory haemodialysis developed in 4% of patients. In 60% of patients various degree of GFR decrease was found without the necessity of haemodialysis. CONCLUSIONS: Level of renal functions was not significantly related to the blood pressure or serum lipids concentration. An important factor appeared to be the level of renal function before OLT. Because the level of renal function after OLT can significantly influence the post transplantation development, regular follow up of GFR is recommended.

Adolescent↗
PubMed2005

[Living relative donor for liver transplantation in paediatric recipient].

Paper refers the first in Czech Republic liver transplantation in a child with the donor being the close living relative - the father. Indication was the chronic liver failure caused by biliary atresia after the Kasai procedures, which enabled the child to survive two years. Liver segments II. -III were transplanted with favourable postoperative development. Within the following twenty months the nutrition status and the psychomotor development of the child significantly improved. Authors discuss present situation and results of the paediatric liver transplantation in the world.

Biliary Atresia↗
PubMed2004

Exploratory laparoscopy at suspicion of acute appendicitis. Review.

Exploratory laparoscopy has been used since 1910 and is one of the new tools for diagnosing appendicitis on a routine basis. It can be looked upon as "semi-invasive" in comparison to on one hand ultrasonography/CT/MRI and on the other open laparotomy. According to the literature, mostly in retrospective studies, laparoscopy might reduce the frequencies of unnecessary appendectomies in 20-30 percent and an accuracy of diagnosis of appendicitis of 95-99 percent. This means that laparoscopy has a sensitivity of 92 percent in diagnosing acute appendicitis, including all cases of mucosal inflammation only. This means, however, that about one in 11 appendicitis is missed and it is still a question as to whether an appendix that looks normal at laparoscopy for acute right iliac fossa pain should be removed, or whether if it is not removed, there is a risk of missing an early case of appendicitis later leading to perforation and peritonitis? Mucosal inflammation obviously can never be determined in the appendix is left in place. However, a summery of available data seems to favour that it is distinctly uncommon that explorative laparoscopy misses any acute appendicitis that requires appendectomy. If there are cases of acute appendicitis not requiring appendectomy can only be known in prospective studies. A Cochran review was published in early 2002 and analysed 45 randomized trials, 39 of which had been carried out in adults, comparing both therapeutic and diagnostic outcomes of patients undergoing open or laparoscopic surgery for suspected appendicitis. Diagnostic outcomes favoured the laparoscopic approach in that both the negative appendectomy rate and "the frequency of an unestablished diagnosis" were reduced, most significantly in women in their reproductive years. However, in the conclusion the authors sounded a note of caution about the quality of some of the research data they had analysed, and recommended that more blinded studies be performed. Because there is a belief that laparoscopic appendectomy is less likely to cause intraperitoneal adhesions than open surgery, they also recommended longer follow-up studies to assess the relative incidences of obstruction due to adhesions resulting from the two techniques. Therefore, the conclusion can be drawn that in all equivocal cases laparoscopy is better than laparotomy as the initial step in year 2003. However, there is still a lack of data comparing non-invasive modern techniques such as ultrasonography and CT with laparoscopy, and the value of laparoscopy after the best available ultrasonography or CT.

Acute Disease↗
PubMed2004

Morphological changes of small bowel graft in Wistar rats after preservation injury.

OBJECTIVE: In our study we decided to define the harvesting and preservation injury of the graft using Park's scheme for the quantification of morphological changes. METHODS ANIMALS: Male Wistar rats (n=25) weighting 322+/-18 g. Harvesting preservation technique: Proximal jejunum (5-7 cm) was flushed with 5 ml of HTK solution and preserved for 0, 1, 6, 9 and 12 hours at 4 degrees C in the same solution. Biopsies for light microscopic evaluations were obtained after the preservation period. Park's scheme was used for the quantitative assessment of histological changes. t-test for two independent samples was used to evaluate statistical significance. RESULTS HISTOLOGY: The extent of the preservation injury in the samples obtained at 0 hours was of grade 0 and increased to 1.84 after 12 hours of preservation time. At 0 hours of preservation a degree of 0 (s=0: no changes) was observed, after 1 hour, a degree of 0.50 (s=0.47: slight changes, similar to 0 time), after 6 hours a degree of 1 (0.97, s=0.41: discrete subepitelial oedemas in villi apexes), after 9 hours a degree of 2 (1.74, s=0.64: extension of subeppitelial spaces in villi apexes), and after 12 hours a degree of 2 (1.83, s=0.64: more extension of subepitelial spaces) was observed, except for these findings, there were also changes of grade 3 (massive subepitelial edema and sequestration of the mucosa from lamina propria) in the 12-hour group. A statistically significant (p=0.05) difference was found between all groups except for 9 and 12-hour groups. CONCLUSIONS: HISTOLOGY revealed increasing preservation injury with a increasing duration of preservation and its dynamic. (Tab. 1, Fig. 2, Ref: 6.)

Animals↗
PubMed2004

[A model of acute hepatic failure in a minipig from the surgical and anesthesia point of view].

AIM: The aim of this study was to create an easily reproducible model of the acute hepatic failure (ASJ) in a minipig, which may allow to test supporting eliminating systems. The aim of this report was to describe the surgical technique with the anaesthesiological procedure and to demonstrate the experimental results on a group of the laboratory animals. METHODOLOGY: The ASJ was mocked using surgical devascularization of the liver: a ligature of the a. hepatica propria and v. portae, creating a portocaval anastomosis end-to-side. The animals were analgosedated during the experiment and were on a ventilatory support. Biochemical indicators of the hepatic failure, the ICP and the haemodynamics parameters were monitored. Hypoglycaemia with levels below 3.5 mmol and any increase of the intracranial pressure (ICP) were considered the onset of the hepatic failure. MATERIAL: 20 minipigs weighing 25-30 kg and divided in 3 groups, were included in the experiment: I--10 animals were assigned to the acute hepatic failure (ASJ) group, II--5 animals with the mock acute hepatic failure (ASJ), whose ICP was monitored in conjunction with the standard monitoring and III. 5 animals without the acute hepatic failure (ASJ)--a control group. RESULTS: We proved significant differences in the AST levels (33.44 +/- 39.96 vs. 1.56 +/- 0.50 mmol/l), the lactate levels (2.97 +/- 1.16 vs. 1.18 +/- 0.61 mmol/l), and the ammonium levels (264.3 +/- 93.05 vs. 42.5 +/- 12.98 micromol/l) in the acute hepatic failure (ASJ) group compared with the control group (p < 0.01) 6 hours after the surgery and significant changes in the glycaemia levels and the intracranial pressure (ICP) measurements 4 hours after the surgical procedure. Increase in the pulse frequency, the blood pressure, decrease of the mean arterial pressure (MAP) and decrease in the systemic venous resistence index (SVRI) in the acute hepatic failure (ASJ) group was recorded 6 hours after the procedure compared with the initial findings, with significant differences between the acute hepatic failure (ASJ groups and the control group as late as during the 12th hour following the procedure (SVRI: 953 ASJ vs. 1658 control, p - 0.05, MAP: 58.1 ASJ vs. 76 control, p - 0.05). No statistically significant differences in the heart index between the acute hepatic failure (ASJ) group and the control group were recorded. The animals with the acute hepatic failure (ASJ) survived 13 hours following the surgical procedure, on average.

Animals↗
PubMed2003

[Surgical treatment of liver metastases of non-colorectal tumors].

INTRODUCTION: Surgical resection is the only potentially curative treatment for metastatic cancer to the liver. Therapeutic guidelines for treatment of colorectal liver metastases are well defined, but it remains difficult to establish therapeutic guidelines for heterogeneous group of noncolorectal liver metastases. METHODS: 20 patients with liver metastases of different origin were preoperatively indicated for multimodal therapy and were operated between 1998-2002 at our department. All patients could be divided in 4 homogenous groups according to origin of primary tumour. Group of metastatic Grawitz tumour, breast carcinoma, digestive tumours and a group of different tumours. Preoperative assessing of metastatic extent allowed application of multimodal strategy to each patient. RESULTS: 26 multimodal procedures (6 hemihepatectomies, 6 nonanatomical resections, 4 segmentectomies and bisegmentectomies, 5 implantation of port catheter, 5 cytodestructive procedures) were performed at 20 patients. There were no perioperative death. Postoperative complication was seen in 20% of patients. Actuarial survival rates were 65%, 35% and 15% at 1, 2 and 3 years with median survival 15.6 month. CONCLUSION: Low morbidity and satisfactory survival rates justify a multimodal approach to the surgical management of noncolorectal liver metastases.

Female↗
PubMed2003

[Liver transplantation--present status worldwide and in the Czech Republic].

Since 1983 liver transplantation (LT) has been accepted as clinical method of treatment, namely of patients with "end stage liver disease", it is patients with the incurable phase of liver disease which excludes spontaneous recovery or successful conservation therapy, but which is not the terminal state. Patients, indicated for LT should be therefore in generally good condition, but with a prospect of survival with conservative treatment lower than one year. The most frequent indication in adults is the hepatic failure resulting from viral hepatitis and cholestatic diseases. In children younger than 2 years it is atresia of biliary ducts, in older children metabolic diseases and fulminant failure predominate. Children with secondary liver impairment resulting from a cystoid fibrosis or a hepatic malignancy are recommended for LT only rarely. About 8000 liver transplantations are performed annually in the world, about one sixth is in child recipients. Contrary to LT in adults, such operation in children has several risk moments. The liver splitting or grafting of a hepatic segment from a living relative donor belongs to the most complicated surgical techniques. At the end of nineties, in the advanced centers, one-year survival reached 85 to 90% with high probability of improving quality of life. In the Czech Republic 60 to 70 liver transplantations are performed annually in two centers (Prague, Brno) with comparable results.

Adult↗
PubMed2001

The role of ERCP in management of biliary complications after liver transplantation.

Biliary complications remain to pose a serious problem in patients after liver transplantation. In the past, they occurred in as many as 50% of patients, and were associated with a height mortality. This has changed and at present the incidence of this complications is lower. The authors present their own series and discuss the role of ERCP in the management of complications.

Biliary Tract Diseases↗
PubMed2000

Liver transplantation in Eastern Europe.

The aim of this report is to evaluate the development of liver transplantation in eastern Europe until mid-1998. Representatives of gastroenterological and hepatological societies of the respective countries answered a questionnaire about the most descriptive items of the issue of liver transplantation. The Baltic countries, together with 6 southern Balkan countries, Moldovia, and Belarus, have not developed a program of liver transplantation. In Ukraine, 7 transplantations were performed, with 3 early deaths. In Russia, 31 liver transplantations were performed, with 8 of the last 12 patients surviving short term. In Slovenia, 1 of 2 patients, and in Yugoslavia, 8 of 9 patients survived. In Croatia and Slovakia, 2 patients each died immediately after surgery. The number of liver transplantations is increasing in both Hungary and Poland. In Hungary, 63 transplantations were performed, with a 1-year survival rate reaching 85%; in Poland, 55 adults and 29 children underwent transplantation, with an actuarial 1-year survival rate of 70%. In former East Germany, 4 centers developed their programs since 1992. A total of 196 transplantations were performed, with 1-year survival rates varying from 80% to 89%. The total spectrum of indications for transplantation was standard, with a greater proportion of hepatocellular cancer compared with Eurotransplant statistics. In the Czech Republic, the first liver transplantation was performed in 1983, but it was not until 1994 that the number of procedures increased steeply. Until mid-1998, a total of 182 transplantations were performed. At the Prague Institute for Clinical and Experimental Medicine, we performed 94 transplantations, with a 1-year patient survival rate of 90.6%. There has been rapid development over the last 3 years in the 3 countries of Central Europe. The progress is influenced by the sweeping political and economic changes.

Adult↗
PubMed1998

[Conversion of drainage of a pancreatic transplant from the urinary bladder to the intestine in a recipient].

The most frequently used surgical technique in transplantations of the pancreas is to connect the duodenum of the graft with the urinary bladder of the recipient. Introduction of this method led during the last five years to marked improvement of results. On the other hand duodenocystoanastomosis is a frequent cause of metabolic and urological complications in patients after transplantation. The authors present the case-record of a female patient after combined transplantation of the pancreas and kidney where surgical conversion of the drainage of pancreatic juice from the urinary bladder to the gut was necessary.

Anastomosis, Surgical↗