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Biomedical subjects

P Labas

Publications and source records attributed to P Labas.

At least 19 recordsLinked to original sources
PubMed2001

Could deep vein thrombosis be safely treated at home?

BACKGROUND: The aim of this prospective study was to analyse the group of patients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecular weight heparin), compression, intensive mobilization. METHODS: 106 consecutive patients with the diagnosis of DVT were treated at home with enoxaparin (Clexane Rhône-Poulenc) administered subcutaneously (1 mg/kg) b.i.d. for a minimum of 7 days. All patients wore elastic second degree compression stockings during the whole treatment and for further 12 months, and were encouraged to walk 1-2 kms daily. In this group of 106 patients the upper limit of thrombosis was iliofemoral vein--45 pts (42.4%), femoral or popliteal vein--33 pts (31%), crural veins--28 pts (26%). The diagnosis was done by compression ultrasonography, by contrast phlebography, platelet scintigraphy (Tromboscint test). RESULTS: Perfusion gammagraphy of the lungs was done in 54 patients where thrombosis was localised in the popliteal and iliofemoral veins. In 28 patients there were signs of non-fatal pulmonary embolism (52%), but only 7 pts (25%) suffered from mild non-specific clinical signs; 21 pts (75%) with the diagnosis of pulmonary embolism were symptom-free. 8-12 weeks after this treatment, control sonography and phlebography were done in 75 pts (71%), in 53% (40 pts), we found partial, and in 32% (24 pts) total recanalisation. In the rest of 11 pts (15%) there were no signs of recanalisation. Compared with the group of patients treated by the classical method (UH, immobilisation) in the period from January 1995 to February 1997, out of 48 pts where the recanalisation was retrospectively analysed, 17 pts (36%) did not show any signs of recanalisation. The difference is significant (p < 0.01). In this group of 54 pts, 4 died of PE (post mortem verified) compared with no death in the group treated with LMWH and mobilisation. The difference is not significant (p < 0.9). Eighty six patients (81%) out of 106 were satisfied and pleased with home treatment and mobilization. From this group of patients treated with LMWH and forced mobilisation 46 were investigated after one year by duplex scan. None of these patient had recurrence, but 7 pts (15%) had pathological reflux (more than 0.5 s) in the deep venous system, majority of them--5 pts on the popliteal vein. CONCLUSION: Home treatment of DVT is possible and effective, safe and cost-effective. On the average, 40 percent of expenses per patient were saved when compared with hospital stay in spite of more expensive LMWH. The patients who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group. A long-term (12 months at minimum) of compressive stocking (45 mmHg) with activation of the muscle-venous pump by forced mobilisation can prevent recurrence and decrease the percentage of the post-thrombotic syndromes. (Ref. 15.)

Ambulatory Care↗
PubMed2000

Transoral application of EEA stapler after subtotal oesophagectomy.

OBJECTIVE: To describe a new transoral technique of cervical oesophagogastric and oesophagojejunal anastomoses using the EEA stapler. DESIGN: Prospective clinical study. SETTING: University Hospital, Bratislava, Slovakia. SUBJECTS: Two patients with squamous cell carcinoma of the middle and distal third of the oesophagus. INTERVENTIONS: Transhiatal subtotal oesophagectomy without thoracotomy, and cervical oesophageal anastomosis by transoral EEA stapling. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Transoral stapling was successful in both patients with no anastomotic leaks. The patients were discharged on the 14th and 21st postoperative days, respectively. CONCLUSIONS: Transoral stapling of the cervical anastomosis gave good results in two patients. More development and evaluation are needed.

Anastomosis, Surgical↗
PubMed2000

The home treatment of deep vein thrombosis with low molecular weight heparin, forced mobilisation and compression.

BACKGROUND: The aim of this prospective study was to analyse a group of patients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecular weight heparin), compression and intensive mobilisation and to evaluate its feasibility, efficacy and safety from possible risks of pulmonary embolism. METHODS: From March 1997 to September 1999, 96 consecutive patients with diagnosed DVT were enrolled in a prospective study and treated at home with enoxaparin (Clexane Rh ne-Poulenc) administered subcutaneously at doses depending on body weight (1 mg/kg) b.i.d. for a minimum of seven days. Oral anticoagulants were started two days before discontinuing LMWH and given later for three months according to the haemocoagulation parameters. All patients wore elastic second degree compression stockings during the whole period of treatment and for 12 months there after. They were encouraged to walk 1-3 km daily. The sites of thrombosis were ilio-femoral vein--38 patients (40%), femoral or popliteal vein--32 patients (33%), crural veins--26 patients (27%). According to our surgical criteria two years ago 17 patients would have been operated on and trombectomy performed. The diagnosis was made by compression ultrasonography using a colour duplex scanner (Acuscan 125), by contrast phlebography, and platelet scintigraphy (Tromboscint test). Perfusion-ventilation scintigraphy of the lungs was performed only if there were clinical signs or even a suspicion of pulmonary embolism and on all patients with iliofemoral thrombosis. Perfusion gamagraphy of lungs was carried out on 51 patients where thrombosis was localised in proximal veins. RESULTS: In 27 patients there were signs of non-fatal pulmonary embolism (53%), but only seven patients (26%) suffered mild non-specific clinical signs; 20 patients with diagnosed pulmonary embolism (74%) were symptom-free. Out of 96 patients, three admitted to hospital (3%), 67 (70%) injected LMVH themselves and felt comfortable. Eight to 12 weeks after this treatment control sonography and phlebography were carried out in 70 patients to assess the localisation and progress of the thrombosis. In 51% (36 patients) partial and 31% (22 patients) total recanalisation was found. Five out of 96 complained of minor bleeding (5%). No thrombocytopenia was noticed. The first five days on home treatment were crucial. All patients were able to walk and live at home without difficulty. None of our patients with proximal deep vein thrombosis used a vena cava filter. CONCLUSIONS: Home treatment of DVT is possible and is effective, safe and less costly on average and per patient 40% in costs was saved compared with those of a hospital stay in spite of the greater expense of LMWH. The patients who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group.

Anticoagulants↗
PubMed1999

[True aneurysms of the popliteal artery--surgical treatment].

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.

Aneurysm↗
PubMed1999

[Pathophysiologic aspects of chronic venous insufficiency].

Knowledge of the pathophysiology of the venous circulation and its evaluation before treatment determines not only the best therapeutic plan, but at the same time makes it possible to avoid operations which are not necessary and a priori doomed to lead to a relapse. The basic therapeutic principles in the treatment of chronic venous insufficiency after evaluation and localization of the functional disorder by an objective examination method (duplex sonography, phlebography ...) are: a) compression, b) severing of pathological points of insufficient perforators, orifices of both saphenous veins, c) antireflux operation of the deep veins with preference of the popliteal vein. Any therapeutic procedure which does not have the aim to reduce venous hypertension is a priori doomed to failure and very soon a relapse develops. From this aspect it is not important to remove chaotically and extensively superficial varicosities (surgically or by sclerotherapy) but to severe the insufficient perforators and the insufficient orifices of saphenous veins surgically or by sclerotherapy.

Chronic Disease↗
PubMed1999

[Ambulatory treatment of deep venous thrombosis using low-molecular heparin, compression and mobilization].

From data in the literature as well as the authors' own experience ensues that diagnosed and objectively confirmed deep venous thrombosis can be successfully treated in out-patients departments by low-molecular heparin and compression with full mobilization without any major risk of pulmonary embolism and without the need of hospital admission (65 out-patients). Despite the high price of low-molecular heparin, treatment is economical as it does not require monitoring of haemocoagulation for hospital admission. Partsch et al. 1997 proved unequivoca lambda y that the rate of new attacks of pulmonary embolism during treatment is significantly lower than during classical treatment with non-fractionated heparin and immobilization.

Ambulatory Care↗
PubMed1998

[Anti-reflux surgery of the popliteal vein].

Any effective therapy of chronic vein insufficiency resides in the replacement or at least reduction of the pathological reflux causing venous hypertension. The aim of our study is to indicate the significance of the reconstruction of the damaged valves in the profound venous system, namely in the most critical popliteal area. On the basis of the experimental works of Wilson et al. (1991) we have introduced his technique of anti-reflux operation by the technique of invagination after the prolongation of the popliteal vein by three-fold average of its diameter by means of the axillary vein with a valve. This operation was performed in 6 patients on 7 veins. The operation lasted 3 hours in average without marked operative and post-operative complications. On the seventh day after operation, the full sufficiency is investigated by means of descendent phlebography in 5 newly formed valves and in two valves a particular insufficiency is developed. 4 patients yield a full recovery of ulcers, one patient slipped out from evidence, however sclerotisation of insufficient perforators leads quickly to recovery of dermal defects. Reconstruction of prothrombotically damaged valves is practically impossible and thus, valvuloplastic operation constructed from vascular wall in the target segment is not only possible but effective at the same time. (Fig. 3, Ref. 13.)

Adult↗
PubMed1998

[Nutritional status in patients after reconstructive surgery of the upper digestive tract--status after 3 years].

The authors present an analysis of the nutritional status of eleven patients after reconstruction operations of the upper digestive tract (9 men and 2 women, aged 27-67 years, 7 times gastric resection, 4 times resection of the oesophagus), almost in all instances on account of malignant tumours. During the investigation the patients were given dietary advice incl. on the need of a higher vitamin and mineral intake. Three years after surgery the nutritional status of the investigated subjects did not change significantly as compared with the status before surgery but some trends were detected (decline of the serum calcium and albumin concentrations). Based on the results assembled in this small group the authors support views reported in the literature that reconstruction surgery of the upper digestive tract is safe as regards the patient's nutritional status.

Adult↗
PubMed1998

[Compressive sclerotherapy monitored by ultrasound].

Echosclerotherapy and sonographic control of aimed sclerotherapy resp. is a major advance in the treatment of chronic venous insufficiency. It facilitates not only aimed administration of highly active substances but ensures above all prevention of serious complications. Functional examination of the venous system helps to locate relatively accurately the sites of pathological reflux which are in the first place responsible for the development of the whole symptomatology and it prevents the administration of excessive amounts of sclerotizing substances into intact portions of the venous system. Similarly as Baccaglini et al. (1995) the authors achieved by compressive sclerotherapy with monitoring by ultrasound occlusion of up to 90% important reflux sites such as the saphenofemoral and saphenopopliteal orifice which are to a great extent responsible for serious clinical symptoms.

Chronic Disease↗
PubMed1997

[Transverse laparotomy closed with continuous absorbable loop sutures].

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.

Absorption↗
PubMed1997

[One day surgery--personal experience].

The authors present their own experience with surgery carried out in the out-patient department in 1985-1996. It is a modern, effective, reliable and above all economical therapeutic method, because it maintains the standard of surgery while saving the costs of hospitalisation. It is a very attractive method for patients who want to return to work as soon as possible. As many as 87% patients were satisfied with surgical treatment of the anus and rectum.

Adult↗
PubMed1997

Urgent proctocolectomy in ulcerative colitis.

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.

Adolescent↗
PubMed1997

[Long-term results of anti-reflux surgery of the popliteal vein].

The pathophysiological cause of chronic venous insufficiency with trophic dermal changes is a valvular lesion in the deep and perforating venous system which develops in as many as 72% during recanalization of thrombi. The reduction of reflux by valvuloplasty in the popliteal section with discontinuation of the insufficient perforating vessels (sclerotization) leads promptly not only to marked subjective relief, but on a long-term basis it improves the trophic state of the skin and healing of refractory ulcerations. The technique of valvuloplasty by invagination of the venous wall after its prolongation by the axillary vein with a functional valve rules out venotomy and the use of alien material for suture which would damage the intima, and thus reduces to a minimum the possibility of postoperative thrombosis.

Adult↗
PubMed1996

[Sclerosing agents in clinical practice].

BACKGROUND: The objective of all forms of sclerotization by substances irritating the endothelium is the production of a permanent fibrous venous occlusion and reflux points controlling the abnormal flow of venous blood. The high percentage of relapses after surgery-as high as 65% within five years after surgery was the authors' motivation for the evaluation of results of two sclerotization technique: Sigg's Swiss method using Aethoxysclerol as the sclerotizing substance and Fegan's English method using S.T.D. substance. METHODS AND RESULTS: In 1974 to 1994 the authors sclerotized a total of 3161 patients, 84% women (mean age 43.7 years-range 15 to 78) and 16% men (men age 47.3 years-range 17 to 73). In 1973 to 1983 they used Sigg's technique with Aethoxysclerol (0.5 to 4% concentration). This group comprised 1325 patients. In 1983 to 1994 they used only the English technique described by Fegan, using S.T.D. The latter group comprised 1836 patients. In patients where there were doubts about the condition of the deep and perforating venous system they used as a diagnostic method aimed phlebography under sciascopic control (134 patients-4.2%) and as to non-invasive examination methods duplex sonography (235 patients-7.45%) and light reflex rheography (50 patients-1.5%). Comparison of the results did not reveal any statistically significant differences. The best effect was achieved with rapid and complete healing of ulcerations in chronic venous insufficiency in as many as 93/92%. More complications were recorded when using S.T.D., such as necroses at the site of administration, temporary teleangiectasias and hyperpigmentations, the statistical significance being p < 0.05. The most frequent complication when using Aethoxysclerol were collapses in hypotensive patients, the statistical significance being similar. CONCLUSIONS: The authors evaluate the two techniques as simple, effective and safe. They can be used as alternatives of surgical treatment. The advantage is that treatment is ambulatory, it leaves the vena saphena intact in situ and does not involve anaesthetic and surgical risks.

Adolescent↗
PubMed1996

[Comprehensive prevention of postoperative thrombosis].

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.).

Anticoagulants↗
PubMed1996

[Intracavitary thrombosis--unusual complications in ulcerative colitis].

The statement of echocardiographic differential diagnosis of intracavitary masses is not simple even for an experienced echocardiographist. It is mainly caused by the resemblance in echo-densities of thrombi and myxoma. Atypical localization of masses makes the differential diagnosis even more difficult. Authors report a case of a 30 year-old man with the history of ulcerative colitis, in whom sepsis occurred as a complication of an inflammatory bowel disease. They report the diagnosis of thrombus in the right atrium, probably of infectious genesis, formed on the endocardium which had been damaged by a catheter tip and potentiated by activated coagulatory system. In the documented period, histological examinations of colonoscopic and peroperative biopsies were performed repetitively. Neither these examinations answered the question of differential diagnosis between ulcerative colitis and Crohn's disease. The authors report an echocardiographic diagnosis and they follow-up the genesis and subsequent disappearance of the pathological mass in the right atrium which was finally diagnosed as a thrombus. The final diagnosis was based on the clinical follow-up and disappearance of the mass. (Fig. 3, Ref. 7.).

Adult↗
PubMed1995

[Advantages of continuous resorbable mattress sutures in closing extensive laparotomies].

In a group of 170 patients the mean time taken to close the abdominal cavity was 10 minutes, suppuration and fistulation resp. was observed in 2% of patients after 6 weeks. In 1.1% dehiscence occurred and in 3.5% hernia in the scar. All this applies to patients with severe malignity and hypoproteinaemia. Smead Jones technique of a continuous absorbable suture without knots is not only quick, safe, effective, cheap but also reliable in risk patients and obese patients with impaired healing, but only when its basic principles are respected: reliable anchoring and termination in fasciae, regularly alternating distances of stitches.

Absorption↗