Biomedical subjects

R Aujeský

Publications and source records attributed to R Aujeský.

At least 19 recordsLinked to original sources

PubMed2004

[Atypical portocaval anastomosis for hemorrhage in portal hypertension].

The success of endoscopy in treating esophageal varices and the later introduction of liver transplantation into the algorithm of therapy for liver failure shifted surgery of portal hypertension out of sight of hepatologists and surgeons. This decline from surgical treatment was further confirmed by introduction of TIPS into clinical practice. It is completely out of question that only liver transplantation is the causal solution of decompensated liver disease and a series of reliable and less invasive methods may be selected for acute treatment of bleeding from varices. However, even at the present time the portal-systemic shunt may be used in its own indication in repeatedly bleeding patients with a good liver capacity, where it can play a role by bridging the time to liver transplantation in a way similar to TIPS or even to provide a final solution, which makes it possible to live the life expectancy in adequate comfort without the risk of bleeding complications. However, it is not always possible to place a surgical shunt on some of the main branches of the portal vein. In such cases, devascularization is often successfully applied. Atypical shunts represent an exceptional alternative, because side feeder veins of the portal vein are rarely of sufficient caliber for placing a hemodynamically significant shunt. The authors describe two cases, in which stubborn anemia-causing bleeding events in portal hypertension were treated with left-side epiploic-renal shunt or anastomosis between the mesenteric and left-side iliac vein.

Aged↗

PubMed2004

[Retroperitoneal liposarcoma--case report].

The authors present surgical therapy of liposarcoma in retroperitoneum. These mesenchymal tumors occur rarely in the population. The strategy for therapy requires determination of the relations to adjacent organs on the basis of precise preoperation examination of the patient. Surgery is considered as the basic therapy, provided radical extirpation of the tumor is possible. Our case report describes a huge liposarcoma in retroperitoneum with histology evolving from myxoid to low differentiated liposarcoma of retroperitoneum. The repeated relapse of the tumor was, as fart as possible, treated by extirpation of the tumor.

Aged↗

PubMed2004

[Complications of extended lung resection procedures following the neoadjuvant therapy].

UNLABELLED: Local tumor expansion in the sense of the tumor invasion into the extrapulmonary structures, which must be removed in one step, preferably en-bloc, together with the primary tumor, is the reason for extending the lung resection procedure. Although verified lymphogenic metastasing into either unilateral, eventually into contralateral mediastinal lymphonodes (stage N2 resp. N3, according to the TNM), remains the commonest indication for the induction therapy in cases of the lung carcinoma, application of the neoadjuvant therapy in cases when extended resections may be expected, is indicated in case the tumor expands into the surrounding structures, which signifies opening of new, unnatural routes of possible lymphogenic and haematogenic dissemination, and thus, a significantly higher risk of the surgical therapy failure. During the period 1995-2002, our team conducted 15 extended lung resection procedures following the preceding induction therapy in patients suffering from the IIB-IIIB stage of the non-small cellular lung carcinoma (NSCLC). The 30-day lethality rate equalled zero. We recorded two rare complications and the postoperative morbidity was acceptable. CONCLUSION: Exhausting staging, the best possible prediction of the tumor behaviour following the surgical procedure and minimal surgical complications remain the prerequisite for good long-term results following the extended lung resections for the lung carcinoma. Application of the neoadjuvant therapy prior to the resection procedure need not increase the risk of surgical complications and, furthermore, may positively affect the disease prognosis.

Carcinoma, Non-Small-Cell Lung↗

PubMed2003

[Gastric lymphoma--case reports].

The authors present the possibilities of present therapy of stomach lymphomas. The disease is treated primarily at hematology-oncology wards or clinics and a surgical treatment has become useful in combination with conservative therapeutic procedures or when complications occur. The authors describe four cases of surgical treatment of the stomach lymphoma, having been operated on at 1st Surgical Clinic of the Faculty Hospital in Olomouc in the years 1998-2002. The case reports document how demanding the surgical intervention in patients with advanced stages of stomach lymphoma is. In conclusion the authors point out the decisive role of correct histopathological diagnosis and the selection of a correct therapeutic procedure depending on the stage of the disease.

Adult↗

PubMed2002

Laparoscopic transhiatal resection of epiphrenic diverticulum.

Our experience with videolaparoscopic operations for hiatus hernia and achalasia, which have almost replaced classical procedures, enabled us to use the same technique for other interventions in the distal third of the thoracic esophagus. Thus, we were able to treat epiphrenic diverticulum using a minimally invasive approach. We report our experience with videolaparoscopic diverticulum resection. The procedure was performed in three patients, all of them elderly men with ventilation limitation and a history of a chest intervention. The procedure included myotomy and an antireflux procedure. No significant complications occurred during the operations or postoperative periods; a minor leak that was successfully managed conservatively occurred in one patient. We conclude that videolaparoscopy could be a possible alternative to the standard classical left-side thoracotomy approach for patients in whom a classical operation is not feasible.

Aged↗

PubMed2002

[Role of modern absorbable suture materials in decreasing the occurrence of early complications after laparotomy].

UNLABELLED: Uncomplicated healing of surgical wounds is one of the most important factors which contribute to the success of operations. In particular dehiscence of laparotomy is an important complication associated with considerable morbidity and lethality. A number of factors which contribute to the healing of the surgical wound at the time of operation cannot be influenced, it is however possible to influence the technique of wound closure and the material used. The authors compare in their study early postoperative and long-term results of closure of laparotomy in three groups of patients where for closure of laparatomy PDSII loop suture was used, continuous suture with Vicryl and classical suture by individual silone stitches. The investigation revealed a significantly lower incidence of early postoperative complications in patients where modern absorbable materials were used, in particular early infections. The incidence of dehiscence of laparotomy or hernia in the scar did not differ significantly although in the group with absorbable materials, contrary to the group with silone, there was no dehiscence of laparotomy without an infectious complication of wound healing. CONCLUSION: Empirical experience and the conclusions of some major investigations indicate that the best method of closure of laparotomy is continuous suture using absorbable material.

Absorption↗

PubMed2001

[Effect of portosystemic anastomosis on the degree of splenic inhibition].

UNLABELLED: Secondary hypersplenism is a well-known complication of portal hypertension. Reduced platelet count is a more alarming sign for the physician than risk for the patient. Improvement of thrombocytopenia is urgent, when portal hypertension with splenomegaly and thrombocytopenia presents with life-threatening haemorrhage from gastroesophageal varices. In this case, treatment aimed at stopping the bleeding may be more beneficial than any intervention on the spleen. In this study, we evaluated long-term effects of an elective distal splenorenal shunt or small diameter H-shunt on splenomegaly and thrombocytopenia in 26 patients with portal hypertension operated for repeated bleeding from oesophageal varices. 25 patients had splenomegaly and 16 patients had thrombocytopenia before shunting. Surgery corrected splenomegaly in 16 patients (64%), platelet counts increased in 13 of 16 patients with thrombocytopenia (81.2%). CONCLUSION: Selective or partial portal decompression is sufficient to alleviate thrombocytopenia and splenomegaly associated with portal hypertension.

Adult↗

PubMed2001

[Are problems with portosystemic shunts still a reality and is shunt selectivity the deciding factor for justifying its use?].

OBJECTIVE: The objective of the work is detailed evaluation of portosystemic shunts. The criterium of suitability and justification is their selectivity and preservation in the course of time. METHODS: The authors used a clinical group of patients who had either a Warren shunt or a mesocaval H-shunt with a limited blood flow (diameter 8 mm). In these patients the blood flow was assessed by dopplerometry in the portal vein and before the shunt, i.e. in the lienal or possibly mesenterial vein. RESULTS: Of 32 shunts made during the last five years it was possible to make 12 assessments (8 Warren and 4 H-mesocaval shunts). An adequate decline in the blood flow in the portal vein was recorded and a corresponding increase in the lienal or mesenteric vein. Even after one year no marked drop in the flow through the portal vein was recorded. CONCLUSION: A distal Warren shunt and H-mesocaval shunt with a restricted blood flow preserve the signs of selectivity even after one year. An adequate blood flow through the liver is also preserved. From this aspect selective shunts are still suitable treatment of portal hypertension. Obviously correct indication is the basic prerequisite of success.

Blood Flow Velocity↗

PubMed2000

[Treatment of esophageal achalasia].

During the past years the authors performed at the First Surgical Clinic, Faculty Hospital Olomouc laparoscopic cardiomyotomy with Dor's plastic operation in 17 patients with achalasia of the oesophagus. From the above number 15 patients were relieved of their complaints, two patients were reoperated. The cause of failure of the operation was in one case previous treatment with botulotoxin, in the other case achalasia grade IV, refractory to this type of treatment. The authors consider laparoscopic oesophago-cardiomyotomy a safe procedure, effective in particular in the earlier stages of the disease. They warn against excessive protraction of surgical treatment, frequently caused by selection of ineffective non-surgical therapy.

Adult↗

PubMed2000

[Significance and possibilities of cytostatic treatment of malignant tumors: testing the effects of cytostatics].

The authors present an account on the initiation of a study concerned with the administration of cytostatics according to the sensitivity of the tumour cells. To assess the sensitivity the MTT test was used. The method is described in the paper. Four groups of tumours were examined by the MTT test: breast cancer, carcinoma of the colon and rectum, of the lungs and oesophagus + stomach. Six cytostatics were tested: 5-fluorouracil, cisplatinum, daunorubucin, paclitaxel, vincristine, and vepeside. Evaluation of the sensitivity of different tumours was based on the median of TCS50. The results of the MTT test were not used so far in the therapeutic protocol in all patients where the examination was made, as in solid tumours, contrary to haemo-blastomas, usually common empirically tested protocols are used. The authors reflect whether individually administered cytostatics according to the MTT test can improve the prognosis of patients with malignant diseases. They assume that long-term follow-up of the patients may provide favourable results in particular because more and more effective cytostatics are becoming available.

Antineoplastic Agents↗

PubMed2000

Oncological problems associated with Barrett's oesophagus.

Reflux oesophagitis does not represent only an isolated collection of symptoms affecting the patients' quality of life but the risk of serious complications including the benign stenosis and carcinoma of oesophagus, too. Barrett's oesophagus (BO) has the highest risk for development of the neoplasia due to reflux oesophagitis.

Barrett Esophagus↗

PubMed2000