Biomedical subjects

P Smejkal

Publications and source records attributed to P Smejkal.

At least 19 recordsLinked to original sources

PubMed2006

[Simultaneous cardiac and thoracic operations].

BACKGROUND: Optimal surgical strategy in patients with combined disease of heart (mainly ischemic heart disease or critical valve disease) and other thoracic organs (mainly pulmonary carcinoma) is still controversial. METHODS: From 1997 to 2004, 13 simultaneous cardiac and thoracic operations were performed in 13 patients. Most of them were necessary for combinations of symptomatic coronary artery disease (CAD) and bronchogenic carcinoma (BCA). PATIENT CHARACTERISTICS: 11 patients showed CAD, mean preoperative LVEF was 44 %. SURGICAL PROCEDURE: Surgical exposure was performed via sternotomy in 10 patients, the rest of the patients underwent thoracotomy. Seven patients were operated on cardiopulmonary bypass, the others underwent an off-pump procedure. Eleven patients underwent CABG, mean number of anastomoses were 2.1 (range 1-4), two patients underwent aortic valve replacement. One patient underwent radical removal of pulmonary adenocarcinoma with local expansion into the left atrium. For the lung cancer lobectomy was necessary in 8, pneumectomy in 1, extirpation of multiple metastases in 1, resection of the trachea in 1 patient. Histological diagnosis was epidermoid carcinoma in 6, adenocarcinoma in 3, undifferentiated carcinoma in 1, metastasis of Grawitz tumor in 1, pneumoconiosis in 1 patient. RESULTS: No patient died in hospital. One patient had to be re-explored for bleeding. Mean blood loss, duration of intubation and length of hospital stay were not different from other patients who underwent cardiac operation only. CONCLUSION: In accordance with the majority of the data published in the literature, combined procedures did not negatively influence hospital morbidity and mortality. Simultaneous operations eliminate the necessity of a second operation and do not delay the postoperative oncological therapy. Long-term results are primarily determined by histological diagnosis and by the extent of the tumor.

Aged↗

PubMed2006

[The preparation of a patient with long-term anticoagulant cumarin treatment for invasive surgery].

Coumarins belong to drugs widely used and the spectrum of their use is going to grow. From this point of view and/or because the coumarins are adminstrated in patients who are treated for the other diseases--medical or surgical--at the same time, it is necessary to modify, interrupt or replace peroral anticoagulant treatment in the dependence on various aspects. It requires to compound different algorithms for given situations solution. It is always to decide, if the situation is imperative from the view of solution planed, what risk brings proposed treatment and what is the risk of anticoagulant treatment modification.

Anticoagulants↗

PubMed2006

[Paliative managment of oesophageal carcinomas--our experience].

The authors of this presentation explain their experience with methods of paliative care of oesophagus carcinoma. The indication criteria are described and compared advantages and disadvantages of those methods. There is an accent in most frequent method--oesophagus stent implementation. The results in the group of patients after the stent implementation are described, also complications and other solutions.

Adult↗

PubMed2005

[The cystadenocarcinoma of the appendix].

The authors present a case-review of a patient with a large retroperitoneal tumor. A right-sided hemicolectomy with a removal of a large retroperitoneal cyst extending behind the liver up to the diaphragm on the right side, was conducted. Histology confirmed a mucous cystadenocarcinoma of the appendix. Furthermore, the authors discuss this fairly rare type of the GIT carcinoma. This tumor is low-invasive, mucus producing and rarely metastazing. During the tumor progression, the tumorous cells enter the peritoneal cavity and cause, so called, pseudomyxoma peritonei. The treatment principle is to complete a radical surgical removal of the tumor and, furthermore, in case of the pseudomyxoma periotenei, also application of the local peroperative chemotherapy.

Appendiceal Neoplasms↗

PubMed2004

[Successful treatment of chronic hepatitis C in hemophiliacs based on historical development of therapeutic protocols].

Chronic infection with hepatitis C virus is very frequent among hemophilic patients in all developed counties, including the Czech Republic. Because of a possibility of developing serious terminal stages of infection, liver cirrhosis and hepatocellular carcinoma, the tendency in treatment of patients with chronic hepatitis C is to start it as soon as possible and thus reduce the probability of developing these advanced stages of disease which are difficult to treat. Treatment of hemophilic patients with chronic hepatitis C started in the Department of Infectious Diseases, University Hospital Brno Bohunice, in 1996. Used treatment schemes have reflected historical evolution of treatments used to treat chronic hepatitis C. Initially, alpha-interferon (IFN) was administered in monotheraphy (6 patients), later, since 1999, a combination of alpha-IFN and ribavirin was administered (13 patients), and since 2001 a combination of pegylated interferon (PEG-IFN) and ribavirin (3 patients) was administered. In all the patients the individual treatments took 12 month. Sustained negativization of HCV RNA in serum has not been achieved in any patient treated only with alpha-IFN. In patients who were administered the combination of alpha-IFN and ribavirin this effect appeared in 4 from 7 cases without history of treatment with alpha-IFN (57%), one from 2 relapses and one from 3 non-responders. The combination PEG-IFN and ribavirin was effective in the only one patient who relapsed after alpha-IFN and ribavirin and in one from the two non-responders to this combination. The tolerance and safety of treatment was good in haemophilia patients and could be fully compared to those in other patients with chronic hepatitis C.

Antiviral Agents↗

PubMed2004

Treatment of chronic hepatitis C in hemophilic patients.

Chronic hepatitis C infection is common among hemophiliacs in all the developed countries. Since 1996, only alpha-interferon (alpha-IFN) in monotherapy has been used for the treatment of chronic hepatitis C in hemophiliacs (6 patients). In Czech Republic a combination therapy with alpha-IFN and ribavirin has been used since 1999 (13 patients). Finally, a combination therapy with pegylated alpha-IFN (PEG-alpha-IFN) and ribavirin is being used since 2001 (still 3 patients). In all cases, the treatment lasted 48 weeks. A sustained virological response (SVR, defined as an undetectable serum HCV RNA level 24 weeks after the treatment was completed) was not achieved in any of 6 patients treated with alpha-IFN alone. A combination therapy with alpha-IFN and ribavirin yielded better results: four of eight patients still untreated with alpha-IFN (naive patients), one of two relapsers, and one of three non-responders to previous alpha-IFN monotherapy achieved SVR. So far the combination therapy with PEG-alpha-IFN and ribavirin has been used only in 3 patients. SVR was achieved in one patient who had relapsed after the combination therapy with IFN-alpha and ribavirin, and in 1 of 2 non-responders to this therapy. We conclude that the efficacy and tolerability of the treatment of chronic hepatitis C in hemophiliacs did not differ from that of chronic hepatitis C in other patients.

Antiviral Agents↗

PubMed2003

[Appendectomy--classical or laparoscopic?].

The authors demonstrate on a group of 219 patients, who had in last two years the appendectomy performed, results of care while using open and laparoscopic technique. They compare these depending on chosen parameters, which is the usage of analgetic, the time patients have to stay in hospital after performed operation and comparison of spirometry within specific patients before and after operation. Based on these parameters the authors did not prove clear advantages of laparoscopic appendectomy.

Appendectomy↗

PubMed2003

[Molecular study of type 2 von Willebrand disease].

BACKGROUND: von Willebrand disease is an inherited bleeding disorders caused by mutations in the von Willebrand factor gene. We attempted to characterise the phenotype and the genotype in the first five families in Czech Republic affected by this heterogeneous disorder. METHODS AND RESULTS: The level of FVIII was measured by the one stage assay, the vWF:Ag by the immunoelectrophoresis, vWF:RiCo by aggregometry. For the vWF multimer analysis a western blot based technique was used. The vWF binding to FVIII was evaluated by the ELISA method. Two families were classified as the type 2A, one as the type 2B and two as the combined type 1/2N. Based on that knowledge, parts of the vWF gene were selected for genetic analysis. The previously described mutations Arg1374His and Gly1579Arg were identified in two families with the type 2A. In the family with type 2B a substitution Arg1308Cys was detected. In one family with the type 1/2N, two different previously described defects were found on the separate alleles of the vWF gene: a deletion of cytosine 2435 and a polymorphism Arg854Gln. Compound heterzygotes had the type 1/2N phenotype, while a carriers of the deletion had type 1 phenotype. In the second type 1/2N family, only the amino acid substitutions Thr791Me was found explaining the qualitative defect. A mutation underlying the quantitative deficiency needs to be searched for throughout the entire vWF gene. CONCLUSIONS: Based on the characterisation of the phenotype and genotype, five apparently unrelated families with the von Willebrand disease were diagnosed according to the revised classification. Our work represents laboratory basis for further studies into von Willebrand disease in Czech Republic.

Genotype↗

PubMed2003

[Hereditary thrombocytopenia. Differential diagnosis of a case].

Hereditary thrombocytopenias are a heterogeneous group of extremely rare diseases characterized by a reduced number of blood platelets and by bleeding tendency of variable severity. Some of these diseases are exclusive to platelets, while in others the pathology extends to other cell types. Although rare, hereditary thrombocytopenias should be considered in the diagnosis. Hereditary thrombocytopenias have been classified into three groups depending on platelet volume. Hereditary thrombocytopenias with giant platelets form one of these groups. About fourteen clinical entities of inherited giant platelet disorders have been described. Bernard-Soulier syndrome, grey platelet syndrome and May-Hegglin anomaly are the most common giant platelet thrombocytopenias. May-Hegglin anomaly is condition characterized by the triad of thrombocytopenia, giant platelets, and pale-blue inclusions in leukocytes. May-Hegglin anomaly has an autosomal-dominant mode of inheritance. We described clinical and laboratory features of three adult women from one family with recently diagnosed May-Hegglin anomaly. Described cases are probably the first observed cases of May-Hegglin anomaly in the Czech lands.

Adolescent↗

PubMed2002

[Lymphoma of the small intestine].

The authors analyze on a case-history the problem of lymphomas of the gastrointestinal tract. The patient was a female who was operated on account of a suspected perforation. On operation multiple perforations of the small intestine were found. A resection was performed. According to the histological results it was a giant-cell B-lymphoma of the small intestine. The postoperative course was without major complications. The patient was referred to the oncological department without further treatment.

Aged↗

PubMed2002

[Ampulloma of Vater's papilla--case report].

The authors discuss, based on a case-report, the diagnostic problems of malignities of the pancreas and ampulla of Vater. In the same patient they found an interesting complication after laparoscopic cholecystectomy (LCHE). It was a female patient who had LCHE four years previously where an ampulloma of the ampulla of Vater was diagnosed with invasion into the pancreas and a suspect secondary in the lower lobe of the right lung. On operation a pulmonary abscess was detected from a retained concrement. Duodenopancreatectomy which was performed did not reveal any tumour in the pancreatic area.

Adenoma↗

PubMed2001

[Surgery of esophageal achalasia--possible complications].

The authors demonstrate on a group of patients operated by a miniinvasive method possible complications of treatment of achalasia of the oesophagus. On a group of 61 patients they analyze all complications and try to detect their causes. They divide complications into peroperative, early and late postoperative ones. The most frequent peroperative complications are perforation of the oesophagus which are as a rule treated by the laparoscopic route. After surgery the most frequent problem is a relapse of achalasia. The latter is sometimes due to inadequate myotomy. This can be prevented by careful surgical technique along with peroperative endoscopic control.

Adult↗

PubMed2000

Surface-enhanced resonance Raman spectroscopy of porphyrin and metalloporphyrin species in systems with Ag nanoparticles and their assemblies.

The advantages of systems with Ag nanoparticles and their assemblies for surface-enhanced resonance Raman scattering (SERRS) spectral investigation, detection and determination of porphyrin species are demonstrated. SERRS spectral detection limits of the testing porphyrin species (including porphyrin aggregates) in these systems are shown to be, on average, 10(2)-10(3) lower than detection limits by resonance Raman scattering (RRS). Systems with Ag nanoparticles modified by anionic organosulfur spacers enable us to obtain SERRS spectra of unperturbed cationic porphyrin species. In the case of thiopheneacetate-modified Ag particles prepared by laser ablation, no negative effect of the spacer on the spectral detection limit of the porphyrin was observed. Systems with isolated Ag nanoparticles allow for obtaining SERRS spectra of porphyrin species upon excitation into the Soret electronic absorption band which leads to at least a 10-fold decrease in the detection limit.

Metalloporphyrins↗

PubMed1998

[An unusual complication after laparoscopic cholecystectomy].

The authors describe an interesting complication after laparoscopic cholecystectomy. During a complicated operation perforation of a gallbladder, severely altered by inflammation, occurred and part of the concrements escaped into the peritoneal cavity. Several concrements were left in the abdominal cavity. After several weeks of a complicated postoperative development the concrements penetrated into the subcutaneous layer in the lumbar region and finally they were eliminated spontaneously. In the discussion the authors deal with complications of laparoscopic cholecystectomy.

Abdomen↗

PubMed1998

[Combined surgical treatment of portal hypertension].

The bleeding from esophageal varices is at 85-90% cases stopped by conservative (i.e. non surgical) approach. The method of choice is endoscopic sclerotisation or ligation. Less often is necessary to perform TIPS. The rest of cases is necessary to resolve by one of surgical techniques of hemorrhage control--devascularisation operation or perform emmergently porto-systemic shunt. The authors stress the importance of devascularisation operations for theirs simplicity. On the case report they illustrate the advantage of combination of both surgical techniques.

Adult↗

PubMed1997

[Perforation of gastric and duodenal ulcers--laparoscopic sutures].

The authors compare in a small group of patients the results of treatment of perforation of peptic gastroduodenal ulcers. Some patients were treated by suture using a miniinvasive approach and some by classical laparotomy. The first laparoscopic treatment of a perforated ulcer was made at the Third Surgical Clinic in July 1995. Since then up to February 1997 thus eight patients were treated. During the same period seven patients were treated by the classical approach. Comparison of the period of hospitalization, postoperative complications, consumption of analgesics and postoperative temperature in these almost identical groups revealed that the results are more favourable after laparoscopic sutures.

Adult↗

PubMed1996

[Laparoscopic surgery in esophageal achalasia--initial results].

The authors present their initial results of laparoscopic operations on account of achalasia of the oesophagus. The first oesophagocardiomyotomy was performed at the author s department by the laparoscopic approach in September 1994. In the course of one year 20 of these operations were performed. The mean period of complaints before surgery was 5.9 years with a range of 1 to 40 years. Only six patients were operated during the stage of compensated achalasia, the remainder already in the stage of decompensation. As to peroperative complications twice perforation of the oesophagus occurred, in one instance treated laparoscopically and once during conversion by the classical approach. In one instance the a. epigastrica was injured and haemoperitoneum developed and subsequent revision was urgent. All patients were relieved of their dysphagic complaints, one female patient developed minor pyrosis.

Adult↗

PubMed1993

[Laparoscopic cholecystectomy].

The authors present an account of their experience assembled during one year with laparoscopic operations of the gallbladder. They indicated 248 patients for CHE incl. 237, i.e. 95.6%, for laparoscopic CHE. No deaths, no major complications, 6.5% conversions in elective indications, 23% in acute indications. Six patients with residual choledocholithiasis are in the authors' opinion a signal calling for more accurate detection of CHLDL before and during LCHE.

Adolescent↗