Biomedical subjects
Publications and source records attributed to S Trca.
Presentation and analysis basis questions and changes of thromboembolic disease prophylaxis in the surgical specialities from point of view the developments in last 30 years. Demonstration of the basic and modren methods of deep venous thrombosis prophylaxis. Recommendation of the 7th conference ACCP-CHEST 2004.
Laparoscopic pancreatic procedures are still at the stage of evaluation with regard to their indications and the technical variation used. Laparoscopic pancreatic surgery is currently used for staging malignant pancreatic tumours, for the resection of benign pancreatic tumours and for the occasional management of inflammatory disorders of the pancreas. Insulinomas are rare tumours with incidence per year of 0.1-0.4 per 100,000. Ist Surgical clinic, IIIrd Internal clinic and Radiological clinic are cooperating since 1971. On the list of IIIrd Internal clinic are 80 patients with insulinoma. Since 1971 at Ist Surgical Clinic 66 patients have been operated. In our article are diagnostic and therapeutic problems discussed. Laparoscopic pancreatic procedures are still at an evaluation stage regard to their indications and techniques. Authors give report about first experience with successful laparoscopic enucleation of insulinoma in case 83 year old woman (Fig. 3, 4). The operative time was 90 min. Drainage is necessary. CT guided drain in cavity of seroma is shown (Fig. 5).
The authors present on the basis of case report the problematic of thyroid gland cancer where was manifest long-term (3 years) clinical only as the resistance on the right part of the neck in the trigonum submandibular. Histological examination confirmed the metastasis of thyroid gland papillocarcinoma. Total thyroidectomy was performed and the same type of cancer in both lobes was confirmed. The patient has been 2 years after surgery and radiotherapy (radioiodine) without recurrence.
Surgical operation of the thyroid gland is a basic operation in the treatment of malignant diseases of thyroid gland. At present, total removal of the thyroid gland (total thyreoidectomy = TTE) has been the most frequently used means of the surgical intervention. TTE has been a unique surgical method for thyroid cancer. The aim our study was to confirm the increasing number of radical operations, how often surprising and unexpected histological findings of carcinoma appear, the incidence rate of carcinoma among the patients being operated on for goiter, which histological findings are most frequently encountered and the survival rate of the patients with carcinoma of the goiter. In our retrospective study, we have collected a set of 233 patients with goiter from 1997 until 1999. Nineteen patients from this group had thyroid cancer: 16 females, 3 males, average age 55.5 years. The histological findings represents 14 papillary carcinomas, 3 folicullar carcinomas, 1 medullary carcinoma and 1 malignant lymphogranuloma. TTE was performed in any case where there was suspicion of thyroid cancer before the operation. In the case of one sided operations, when we had no suspicion of thyroid cancer but histological investigation found cancer, we had to remove the opposite lobus (TTE). However, we have found an increasing rate of thyroid cancer. The unexpected histological finding of carcinoma was reported in 69% of the cases. The number of these cases was higher in the middle 2000 (83%). Clinical stage la, microcarcinoma, was found in 52.9% of papillary carcinomas, and further oncological treatment was not indicated. The number of proper radical operations has been increasing. The high rate of unexpected histological findings of thyroid carcinoma is the main reason for early indication for operation of goiter and the radical extent of the primary operation.
The authors describe in their paper one of the less frequent ileus acute abdominal events in adult age--invagination. At the same time they comment also on the rare cause of invagination, a leiomyosarcoma of the small intestine. In the discussion they mention the relationship of this tumour to gastrointestinal stromal tumours.
A total of 1511 patients were operated on at the 1st Department of Surgery Charles University in Prague during 1996 through 2000. Of this number, 81.3% underwent surgery for primary and 18.7% for recurrent inguinal hernia. Among the patients with recurrences, 81% had the first, 15% patients the second, and 4% at least the third episode of recurrent hernia. A total of 604 patients were operated on during 1999-2000, when a plug system (Bard Mesh Perfix Plug) was introduced into surgery protocols. Of this number, 113 patients had a recurrent hernia with an identical ratio of recurrences. The following plastic surgery interventions were carried out during the latter period: McVay-Lotheissen (54.2%), TAPP (26.5%), PHS (13.2%), Plug (3.3%), and Lichtenstein (2.6%). The following interventions were used when operating recurrences: McVay-Lotheissen (20.3%), TAPP (31%), PHS (21.2%), Plug (16.8%), and Lichtenstein (9.7%). During the 1-24-month follow-up period, recurrences occurred 1x after the TAPP procedure, 1x after McVay-Lotheissen, and 1x after the Lichtenstein procedure (95% and 88% patients who underwent plug and Lichtenstein procedures, respectively, were included in the follow-up). Comparison of plug vs. TAPP in patients with recurrent hernia (Plug/TAPP): mean age of patients: 62/45 years, length of operation: 66/48 minutes, overall post-operative morbidity: 9.4%/3.6%, hospitalization: 4.3/1.8 days, return to the working process 28 days (range 9-38 days) vs. 7.2 days (range 2-15 days). Both procedures can be considered safe and reliable interventions for treatment of recurrent inguinal hernia. They meet the requirements for elastic strength (more the plug procedure), closure, and bridging of defects even in several layers. The plug system can be implanted under local anaesthesia, it is capable of bridging large defects in a firm and elastic manner, and appears to be a very suitable solution for large defects in patients with advanced biological age. In these indications, the plug system brings many benefits but also the risk of more open access and greater "quantity" of materials. TAPP appears to be more suitable in younger patients with recurrences and large defects. We evaluate favourably in particular, all aspects of the postoperative period. An experienced team of surgeons is needed to achieve good results in both procedures.
The authors present an account on their own experience with laparoscopic splenectomy which is used at the First Surgical Clinic, First Medical Faculty and General Faculty Hospital in Prague since 1996. In 1996 to 2002 the authors performed at the Surgical Clinic a total of 66 splenectomies. This number included on account of injury of the spleen, tumour or cyst 12 splenectomies by the open route. The remaining ones were indicated for haematological reasons in collaboration with the haematological department of the First Medical Clinic of the First Medical Faculty and General Faculty Hospital in Prague and the Institute of Haematology and Blood Transfusion in Prague. 23 splenectomies for haematological reasons were made by the classical open route. In 31 patients the splenectomy was performed by the laparoscopic route. In all haematological reasons were involved. In the group operated at the First Surgical Clinic LSE was indicated because of ITP 15x, for spherocytosis 8x, for haemolytic anaemia 7x, for eliptocytosis 1x. In eight patients at the same time laparoscopic cholecystectomy was performed. In the group subjected to classical splenectomy infection in the surgical wound was recorded in 11%, re-operations on account of a suppurative complications in the abdominal cavity were made in 13% and on account of haemorrhage in 11%. In the group of laparoscopic splenectomies the authors did not record infection at the site of the inserted trocars, there were no suppurative complications in the abdominal cavity. In four laparoscopic operations the authors converted the operation on account of haemorrhage four times (11%), once on account of major adiposity of the omentum, in five postoperative revision on account of haemorrhage was necessary (16%), incl. one case of profuse haemorrhage. Therefore the authors sought a way how to prevent haemorrhage. Based on their own experience they recommend to apply clamps to the trunk of the lienal artery. The time of operation was reduced by the application of clamps to the lienal artery to 60-80 mins. and the peroperative blood losses dropped to 20-30 ml. The morbidity declined and the patients are discharged into domiciliary care on the 4th day after operation, to be on the safe side. No late complications of the operation were recorded.
Morbidity and mortality after hip fractures is often a result of deep vein thrombosis and pulmonary embolism. Therefore, prophylaxis for venous thrombosis is recommended in patients undergoing osteosynthesis of upper end of lower extremity or arthroplasty of the hip. Study compared efficacy of UFH and LMWH in prevention of thromboembolic disease. The most important part of the study is the prospective trial, which describe group of 81 patients, undergoing operation for hip fracture. These patients suffered fracture of the neck of femur (35) or intertrochanteric fracture (46). For prevention of DVT was used UFH or LMWH. The evaluation was exercised by laboratory tests, Doppler test and by phlebography in cases, where was suspicion of phlebothrombosis. All patients were controlled for two months after operation. Died eleven patients; in every case was PE or cause of death or main complication. Nine of dead was operated for pertrochanteric fracture, another two for fracture of the neck. Prevention drug was UFH in nine dead patients; eight of them suffered pertrochanteric fracture. The most often death sated in fourth and fifth weeks after operation. It means, that the risk of PE continue for a several weeks. It appears, that the prevention use of UFH is not sufficient.
Diagnosis and treatment of the penetrating injury of the chest is quite difficult. In all types/sizes of hospitals/these injuries has to be immediately treated in surgery departments. Often decision about the optimal treatment of these injuries is quite difficult. In this paper experience with 37 cases of penetrated trauma is presented. Authors defined adequate criteria for selection of the chest tube, videothoracoscopy, video-assisted thoracic surgery (VATS), emergency thoracotomy and thoracophrenolaparotomy.
Prospective study implicates problems of heparin-induced thrombocytopenia (HIT). This is one of the most important complications in heparin treatment and prophylaxis. The set was formed of patients with severe diagnosis and larger intra-abdominal operation that was associated with relative high risk of thrombotic event. That's why there was need of heparin prophylaxis. We used Enoxaparin in dose 0.2-0.4 ml subcutaneously. The controlled parameters were platelet counts, detection of antibodies using ELISA Assay method (GTI-PFA), indirect platelet immunofluorescent test for monitoring platelet disorders. We had no known case of clinical symptoms of HIT. The change in platelet counts was due to postoperative course, or binding on blood transfer or basic haematological disease. The test detecting antibodies was positive in eight percent without clinical correlation, without important thrombocytopenia. Low-molecular-weight heparin has certain advantages over unfractionated heparin, as well know from clinical and laboratory monitoring in other studies, including larger safety (in relationship with HIT) with very effective prophylaxis.
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The authors present a casuistry of the injury endangering the life, which was caused by the unusual mechanism. The injured person was pulled inside of a conveyer and while shifting, not only his arm and physical (brachial) plexus was damaged, but he was also and especially, strangled by his clothes and he was seriously asphyxiated, which origin was in the first phase unexplainable.
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