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Biomedical subjects

P Nĕmec

Publications and source records attributed to P Nĕmec.

At least 19 recordsLinked to original sources
PubMed2005

[Combined approach to the treatment of severe aortic stenosis and to three coronary vessel diseases in patients with brain meningioma and severe stenosis of internal carotid artery].

The authors present a case report of a 76-year-old man with a simultaneous finding of severe aortic stenosis, three coronary vessel diseases, severe stenosis of internal carotid artery and brain meningioma. The patient was scheduled for carotid endarterectomy 2 months prior the aortic valve replacement and coronary artery bypass grafting. Brain meningioma was removed 3 months after the cardiac procedure. The authors present a successful interdisciplinary co-operation in the treatment strategy.

Aged↗
PubMed2004

[Transpupillary thermotherapy of choroidal neovascularisation (CNV) among other methods of treatment].

Choroidal neovascularization (CNV) secondary to age-related macular degeneration is a leading cause of vision loss in adults. Although most patients present with occult CNV, treatment has focused on the small percentage of eyes with well-delineated, classic CNV. Transpupillary thermotherapy is a recent advancement in the management of occult CNV. We demonstrated the effectiveness of transpupillary thermotherapy (TTT) for the treatment of occult choroidal neovascularization (CNV). In a retrospective, case selected trial 50 eyes with CNV secondary to age related macular degeneration (AMD) were studied. The eyes with CNV were treated with diode laser (810 nm) TTT. Laser beam sizes ranged between 0.8 and 3.0 mm and power settings between 700-800 mW. Treatment was given in one area for 1 minute. Transpupillary thermotherapy is a potential treatment for CNV. It is able to close choroidal neovascularization while maintaining visual function in patients with classic and especially occult disease.

Aged↗
PubMed2002

[Cataract surgery using silicone oil and its elimination via posterior capsulorhexis].

Elimination of silicone oil after a previous vitreoretinal operation is a routine procedure. This procedure is frequently associated with a complicated cataract operation. The standard procedure of oil elimination in one or two stages assumes repeated sclerotomy. Contemporary findings and the authors' experience indicate the risk of the site of sclerotomy. The authors draw attention to a modification of silicone oil elimination while operating the cataract by posterior capsulorhexy which makes it possible to remove the intraocular tamponade without sclerotomy and to implement at the same time peroperative control of the posterior pole. the technique of elimination of silicone via posterior capsulorhexy makes a perfect peroperative check-up of the state of the posterior eye possible it makes it possible to leave the silicone in the eye if it is necessary to prolong the tamponade of the retina it reduces the risk of complications of further sclerotomy it makes reconstruction of the eye by a single operation possible and reduces thus the traumatization of the eye and the patient.

Capsulorhexis↗
PubMed2002

[Surgical myocardial revascularization--present status] ].

The number of operations increased and except of classical revascularisation with cardiopulmonary bypass and ischaemic heart arrest several new methods were introduced. Less invasive approach, especially without cardiopulmonary bypass is used more frequently due to technical development in stabilizing systems. The use of arterial grafts became a standard. Due to the improvements in surgical technique and postoperative care the significance of traditional risk factors decreased. The early results improve in spite of older patients with more risk factors are operated on every year.

Blood Vessel Prosthesis Implantation↗
PubMed2002

[Ethical questions in organ transplantation].

Increased numbers of organ transplantations entailed several ethical dilemmas. The principles of brain death, clinical signs and a confirmation tests are well established and accepted by the public. The transplantation society laid down the principles of organ allocation, but some ethical controversies may rise in the situation of the significant shortage of the donors. Even if the transplantation law exists, the ethical problems with the opting-in or the opting-out donation are still open to discussion. Also the problems associated with the organ shortage carry several ethical controversies. The tension between increasing demand and steady numbers of procured organs leads to the requirement of enough information. The general public must be informed about the results of the transplantations and about all the ethical aspect of the donation in order to achieve general support for the transplant program.

Bioethical Issues↗
PubMed2001

Peri- and post-operative course of cytokines and the metabolic activity of neutrophils in human liver transplantation.

Peri- and post-operative (up to day 7 after surgery) neutrophil chemiluminescence and the plasma concentrations of interleukin 6 (IL-6), IL-8, IL-10 and tumour necrosis factor alpha (TNF-alpha) were evaluated in the blood of patients undergoing liver transplantation. IL-6, IL-8 and IL-10 levels increased during early reperfusion and then returned to normal mostly within the first post-operative day. TNF-alpha was increased during the whole period observed. Spontaneous as well as activated neutrophil chemiluminescence was depressed in early reperfusion and remained low during the whole period followed. Samples collected during early reperfusion provided positive correlation for IL-6 vs IL-8 as well as for IL-6 and IL-8 vs chemiluminescence. The data were also evaluated with respect to the outcome of transplantation. Since IL-8, IL-10 and TNF-alpha levels increased significantly during the first post-operative week, mainly in a group of patients who developed serious complications within the first month after surgery, we proved a connection between peri- and early post-operative induction of cytokine release and the outcome of liver allograft transplantation.

Adult↗
PubMed2001

Biliary complications in liver transplantation.

OBJECTIVES: Biliary complications (BC) continue to be a major cause of morbidity among liver transplant recipients. The aim of this study was to analyse the incidence, risk factors and management of biliary tract complications at the Centre for Cardiovascular Surgery and Transplantations in Brno. METHODS: Between January 1992 and December 2000, 118 orthotopic LT were performed in 113 patients. Reconstructions of biliary tract included four methods: end-to-end choledochocholedochostomy with a drain in the retained gallbladder in 15 cases, end-to-end or side-to-side choledochocholedochostomy with a T tube in 29 cases, end-to-end choledochocholedochostomy without a T tube in 67 cases and choledochojejunostomy over the drain in 7 cases. Biliary complications were divided into three groups: stenosis, leaks and cholangitis. RESULTS: Biliary complications occurred after 33 LT (27.9%), affecting 28.3% of the recipients. They occurred most frequently when CCwT or CJ types of reconstruction were used (44.8% and 57.1%, respectively) and least frequently in the CCw/oT group of patients (16.4%). The most common type of biliary complication was stenosis which occurred in 20 patients (in 12 at the anastomotic site, in 5 it was caused by external compression and 3 had nonanastomotic strictures); biliary leaks were in 13 patients and cholangitis in 10 patients. Twenty three biliary complications occurred in the early postoperative period and 12 during the follow-up. Endoscopic treatment was used as primary therapy in 17 patients, primary surgical intervention was used in 12 patients and five patients were treated conservatively. Five patients died due to biliary complications (mortality, 15.1%). CONCLUSIONS: It can be concluded that BC is a common cause of morbidity after LT. In the last few years, its frequency has remained constant. Technical failure or local ischemia are major causes. Biliary leaks predominate in the early posttransplant period. Since end-to-end choledochocholedochostomy without a T tube is associated with the lowest incidence of BC, it is considered to be the method of choice. BC can usually be managed endoscopically, although early leaks frequently require reoperation. Aggressive and early management of BC can reduce mortality in patients after LT.

Adolescent↗
PubMed2001

[The piggyback technique in venous outflow tract reconstruction in liver transplantation].

Nowadays, the piggyback technique of venous outflow tract reconstruction has been adopted by an increasing number of transplant teams. From January 1996 to August 2000, we used it in 73 of 84 liver transplantations (86.9%) in our institution. We observed one postoperative complication (1.4%) in direct relation to this technique. The main advantages of the piggyback are 1. maintaining of the haemodynamic stability during the anhepatic phase, 2. avoiding of the veno-venous bypass, 3. diminution of blood loss, 4. easier solution of the graft size mismatch problem, 5. shorter manipulation time and 6. easier retransplantation. Disadvantages of the piggyback technique include 1. more technically demanding recipient's hepatectomy, 2. the potential for venous outflow tract obstruction and 3. possible thrombosis in a blind caval pouch. According to our results and experience in the literature, we consider the piggyback technique as a method of choice for venous outflow tract reconstruction in liver transplantation. It can be used in the majority of patients after gaining some experience.

Anastomosis, Surgical↗
PubMed2000

[Endophthalmitis after cataract surgery].

Endophthalmitis is one of the most serious complications after surgery of cataract. The reported incidence is 0.07 to 0.58%. The authors evaluate a group of 34 cases of endophthalmitis from a total of 13,247 eyes operated on account of cataract in 1990 to 1999 at the ophthalmological department of the Central Military Hospital. They describe the method used and the results. The conclusions are summarized as follows: 1. Early pars plana vitrectomy in developing endophthalmitis improves the chances of maintaining satisfactory visual functions. 2. After the change to ambulatory surgery the authors did not record a higher percentage of postoperative endophthalmitis. 3. As a rule surgical solution of endophthalmitis does not call for IOL.

Cataract Extraction↗
PubMed1999

[Reconstruction of the venous outflow in liver transplantation using the "piggyback" technique].

The piggyback technique in venous outflow tract reconstruction has been proposed as an alternative to the conventional technique in liver transplantation. Between November 1994 and November 1997 this technique was used in 29 patients in our institute. Most of the patients were operated on without veno-venous bypass and we observed no complications concerning venous outflow tract reconstruction and no renal failure. Hemodynamic measurements during the operation showed only an insignificant decrease in cardiac index during the partial clamp on the inferior vena cava. The piggyback technique proved to be a convenient and safe approach to the venous outflow tract reconstruction in a majority of liver transplantations and has been used routinely in our institute.

Adolescent↗
PubMed1998

Phagocyte-induced oxidative stress in patients with haemodialysis treatment and organ transplantation.

The aim of the study was to examine the phagocyte-derived production of reactive oxygen species (ROS), lipoperoxidation and the total radical-trapping antioxidant parameter (TRAP) in patients undergoing regular haemodialysis (HD) followed by kidney transplantation (n = 13). A significant increase in both spontaneous and activated ROS generation was found during the post-transplantation period in days 1-3. This effect was caused mainly by an increased number of neutrophils. On the other hand, the TRAP parameter was decreased in HD patients. After kidney transplantation, the TRAP parameter increased, reaching the level of healthy controls at the end of the first week after surgery. Increase in MDA level was determined after HD and kidney transplantation. It can be concluded from the results obtained that phagocyte mobilisation and increased oxidative stress after HD and kidney transplantation were associated with the insufficient activity of extracellular antioxidant mechanisms resulting in increased lipid peroxidation.

Humans↗
PubMed1998

[Use of drains in the biliary tract in liver transplantation].

Between January 1995 and December 1997 42 liver transplantations were performed in Centre for cardiovascular surgery and transplantation's in Brno. The patients were divided into two groups. The first group consist of 27 transplantations, where the biliary reconstruction was performed by means of choledochocholedochostomy or choledochojejunostomy over a drain. The drain was used on the first 20 patients for initial irrigation and for the decompression of the biliary tree later on. It was used only for the decompression in the last 7 patients of this group. The second group consist of 14 patients, where the choledochocholedochostomy was performed without any drain. The rate of the biliary complications was significantly higher in the first group. Nine biliary obstructions, 6 leaks a and 6 cholangitis occurred. Four patients died in consequence of the biliary complications. There was no biliary complication in the second group. Choledochocholedochostomy without a drain is considered as a method of choice for biliary tract reconstruction in liver transplantation.

Adolescent↗
PubMed1996

[Kidney transplantation at the Brno Transplantation Center].

The transplantation activity in the Brno TC has increased significantly since 1994 and there are now 30 transplantations per 1 million population of the catchment area per year. It is, however, necessary to get more organ donors to attain the national average of 40 renal transplantations per 1 million inhabitants per year, which is also the average value in advanced European countries. With the use of immunosuppression with cyclosporin A the one, five and ten-year survival of grafts increased by 20, 35 and 15% resp., as compared with the period of conventional immunosuppression. The greatest losses of grafts were recorded in the Brno TC during the first year after transplantation and they accounted roughly for 25% during immunosuppression without and immunosuppression with cyclosporin A. The graft losses due to rejection declined from 63 to 21%. However, there was no decline of graft losses for non-immune reasons which accounted during all investigated time intervals for cca 20%. The ratio of graft losses on surgical--urological grounds did not change (before cyclosporin A, 5.9%, and with immunosuppression with cyclosporin A 6.6%). Also graft losses due to the recipient's death declined only insignificantly (14.4% before CyA and 8.4% with CYA). The most frequent causes of death of recipients were infections (40%), followed by cardiac deaths and haemorrhagic conditions (17% in both instances). The high rate of infections is due to aggressive immunosuppressive regimes and large doses of corticoids. Revision of immunosuppressive regimes and protective procedures is necessary. Haemorrhagic conditions such as disseminated coagulopathies remain unexplained so far. The cardiac deaths are associated above all with the rising age of renal transplant recipients and in the majority these deaths could not be prevented (acute myocardial infarctions and sudden deaths at home).

Adolescent↗
PubMed1995

[Advances in transplantation biology and transplantation of vital organs in the era of immunosuppression with cyclosporin A].

Advances in transplantation biology and transplantation of vital organs during the 15 years are described. Immunosuppressive therapy has greatly benefited from the introduction of cyclosporin A into postoperative care of transplant patients. Other immunosuppressive agents recently used are monoclonal antibody OKT 3 and the preparation FK 506. Cadaver kidney transplantation has been improved by HLA-DR antigen typing. A new preservation solution developed at the University of Wisconsin has increased the quality of transplant organs over a prolonged period of preservation. The whole period is marked with successful transplantation of the lung, the heart-lung, the small intestine, parts of the liver, multiorgan transplantation and liver transplantation combined with other organs or cells. Xenotransplantation of the liver and the heart, however, have failed. Renal, cardiac and hepatic transplantations have now become a recognised therapeutic measure for end-stage disease which cannot be treated by drugs.

Cyclosporine↗
PubMed1993

[Transplantation of a horseshoe kidney].

Report of a case, in which a horseshoe kidney was divided and transplanted to two recipients, is described. Both transplantations were successful. This anomaly is not a contraindication to its use for transplantation.

Adolescent↗
PubMed1993

[The effect of creatine phosphate in patients after surgery in ischemic heart disease].

The authors submit their experience with the use of creatine phosphate in patients operated on account of coronary heart disease. They divided 50 consecutive patients into three groups. Group A--controls, group B--creatine phosphate was added to the filling of the apparatus for extracorporeal circulation and group C--creatine phosphate was added to Bretschneider's cardioplegic solution. During operation and during the early postoperative period the CK and CK MB levels were evaluated as well as levels of free acid radicals, the haemodynamic state of the patients, the incidence of ventricular dysrhythmias, the need of defibrillation, histological and histochemical examinations. The authors found a lower CK and CK MB level, a lower percentage of ventricular dysrhythmias and the same haemodynamic results of the operation in patients with a more markedly impaired systolic function of the left ventricle when creatine phosphate was used. Creatine phosphate did not affect the morphology of the heart muscle nor the level of the assessed myocardial enzymes.

Cardioplegic Solutions↗