Biomedical subjects

T Bohanes

Publications and source records attributed to T Bohanes.

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

[Detection of the sentinel lymph nodes in lung carcinoma cases using patent blue and its clinical significance].

INTRODUCTION: Views on significance and the most appropriate approach to lymphadenectomy in the non-small-cell lung carcinoma cases, have not been consistent. The method of the sentinel lymphonode identification and biopsy, which has been verified for other tumor types, may become a promising alternative or, at least, a supplement to currently applied procedures in cases of the lung carcinoma. STUDY GROUP AND RESULTS: This prospective, non-randomized study was conducted in the Faculty Hospital in Olomouc between the years 2000-2003. The sentinel lymphonode identification was conducted in the group of 48 patients suffering from the non-small cell lung carcinoma, using the patent blue lymphatic mapping method. The sentinel lymphonode was identified in 40 patients (83.3%), a false negativity of the sentinel lymphonode was detected in 3 cases (7.5%). CONCLUSION: The study proved the clinical benefit of the sentinel lymphonode identification and biopsy method in cases of the non-small cell lung carcinoma using the patent blue dye. Under the circumstance of certain experience with the technology, the reliability of the detection approaches that of the radionuclide sentinel lymphonode detection method. However, the clinical significance of the above method must be further tested on larger patient groups.

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↗

PubMed2004

[Reoperations following laparoscopic fundoplication].

During an eight-year-period, 623 laparoscopic fundoplications were conducted in the Surgical Clinic in Olomouc. Out of the total number, 14 of them were reoperations and 4 reoperations were conducted on patients, primarily operated in other clinics. 9 patients were reoperated for dislocations of the rim transhiatally into the mediastinum, respectively aborally to the gastric fundus. 4 patients were operated for oesophageal constricions in the hiatus region and 2 patients for haemoperitoneum caused by haemorrhaging from a wound after the port removal. The remaining 3 patients had the reoperation indicated for a biliary reflux in the oesophageus, the rim loosening or for a non-standard primary procedure, conducted to treat the oesophageal reflux disorder in another clinic. This study discusses causes of individual complications and their treatment alternatives. The authors point-out prevention of complications based on following certain principles during the laparoscopic fundoplication procedures.

Fundoplication↗

PubMed2004

[Extent of lymphadenectomy in lung resection for carcinoma].

Dissemination of the bronchogenic carcinoma into the lung and mediastinal lymphonodes is considered one of the basic prognostic factors. Correct evaluation of the lymphonodes involvement remains the principal pre-requisite for the choice of the most appropriate procedure and makes a forecast of a particular patient's perspective possible. The preoperative diagnostics of malignant lymphadenopathy is based on a CT examination. Once enlarged lymphonodes are detected, invasive exploration is indicated--either via mediastinoscopy, eventually via thoracoscopy. The final picture of the extent of the tumor dissemination via lymphatics is provided by the final histopathological examination of the lymphonodes removed during the surgical procedure. The minimal extent of lymphadenectomy is still being discussed. Some clinics do not conduct it at all. On the other hand, there are some clinics, where the en-bloc mediastinal lymphonodes dissection remains a common procedure during all lung carcinoma surgical procedures. On the group of 226 patients operated between 1996-1999, the authors assess surgical aspects and complications of the lymphadenectomic procedure within the radical lung resection for the non-spinocellular lung carcinoma. In the subgroup of 73 patients with a confirmed malignancy of the lung lymphonodes, the authors have found no statistical difference in the five-year survival rate which would be connected to lymphadenectomy. Mediastinal lymphadenectomy, with respect to its sound diagnostic and prognostic benefits, remains a necessary part of any curative resection. It proved to improve local control of the tumor, however, it has no clear influence on the survival rate. In small peripheral tumors (T1, T2), its extent may be restricted to systematic sampling of the interlobium, lung hilus and medistinum lymphonodes. On the other hand, in case of advanced tumors after the induction therapy, no other than en-block resection procedures are suitable or even possible.

Carcinoma, Bronchogenic↗

PubMed2003

[Importance of neoadjuvant chemotherapy in the treatment of advanced bronchogenic carcinoma].

BACKGROUND: The basic task of induction (neo-adjuvant) therapy is elimination of occult micrometastatic dissemination found in some cases already in localized stages of non-small cell pulmonary cancer (stage I-IIIA NSCLC). An equally important effect is also cytoreduction in primary tumours which have before the local intervention an intact vascular supply. A difficult problem remains the correct selection of patients who from the long-term aspect may profit from such a procedure. MATERIAL AND METHODS: The authors evaluated perspectively aspects of oncological treatment and circumstances of surgical intervention after induction chemotherapy in 81 and 87 patients resp. in stage IIIA NSCLC evaluated before initiated neo-adjuvant chemotherapy. RESULTS: Complete remission was recorded in 4.9%, partial remission in 50.6%, stabilized disease in 23.5% and progression in 21% patients. Down-staging was recorded in 26%, 70.3% patients were indicated for surgery. In the group of 87 patients operated after induction therapy pneumonectomies predominated--41 (46%), only one operated patient died within 30 days after surgery (1.1%), complications were neither frequent nor serious. The median of survival after radical resection is 26 months. CONCLUSIONS: Neo-adjuvant chemotherapy by modern cytostatics is usually well tolerated and creates satisfactory conditions for successful complete resection. The operation proper may be more difficult but need not be associated with serious complications. By this treatment it is probably possible to influence long-term results not only in stage IIIA but to reduce also the risk of a later more remote metastatic dissemination in some patients operated in lower stages of lung cancer. Our present aim is to test parameters which will be able to predict possible failure of induction therapy, and seek factors predicting risk behaviour of the tumour also in lower stages (stage I and II TNM classification).

Antineoplastic Combined Chemotherapy Protocols↗

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

[Laparoscopic repair of bilateral inguinal hernias: results at the First Surgical Clinic in Olomouc].

OBJECTIVE: The aim of this paper is to evaluate the outcome of the TAPP (transabdominal preperitoneal) repair of bilateral inguinal hernia with one large mesh. METHODS: Eighteen patients with the bilateral inguinal hernia had TAPP repair with one mesh. The operation and the postoperative course has been discussed. RESULTS: None operative complications were noted, postoperatively four groin haematomas and one recurrence were observed. CONCLUSION: TAPP is safe and effective for the repair of the bilateral inguinal hernias.

Female↗

PubMed2000

[Large volume tumors with uncertain biological activity located in the pleural cavity].

The authors discuss specific problems of an exact diagnosis and indication for surgical treatment in patients with large tumours in the pleural space. Our series includes even some rare tumours of varied histogenesis. The biological activity of those tumours is frequently uncertain and causes an unpredictable prognosis. The prognostic conclusion is based on a bioptic diagnosis, established by histological examination. Complete extirpation is essential.

Adult↗

PubMed2000