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T Skalický

Publications and source records attributed to T Skalický.

13 recordsLinked to original sources
PubMed2006

[A partial relaps of a colorectal carcinoma metastatic process following liver surgery--a multifactorical study].

In the period of November 1999 - June 2003 78 patients with colorectal liver metastases (CLM) were operated at Department of Surgery, University Hospital in Pilsen. In multifactorial analysis there were evaluated these clinical parametres: age of patient, sex, localisation of primary tumor, Dukes classification, grading, staging and histology of primary tumor, histologicaly free resection margin, chemotherapy or actinotherapy after colorectal operation, type of liver resection, complications after liver surgery, radicality of liver surgery, lateralisation of liver metastatic process, number of metastases, blood transfusions, repeated liver surgery, volume of metastases. Kaplan-Meier method was used for evaluation of survival rate and disease free interval (DFI). Statistical analysis of studied clinical parametres was performed by Log-rank test and Wilcoxon test. The medium DFI after liver surgery was 16 months for all the patients (range 0-55 months), the medium DFI for patients after radical surgery was 18 months. The medium survival time after liver surgery for all the patients was 30 months (range 1-57 months), for patients after radical surgery it was 32 months, and for patients after palliative surgery the medium disease free interval was 29 months (range 5-30 months). The 4-year survival rate after the liver surgery was for all the patients 37%. The factors statistically significant for a disease free interval after liver surgery were bilaterality of metastatic process, the microscopically free resection line, radical surgical treatment versus RFA and unilaterality of metastatic process. The authors proved followed factors as statistically significant for survival rate: grading of colorectal cancer and age of patients. The prediction of early recurrence enables us to choose adequate surgical therapy or its extension by oncological therapy. More thorough follow up of patients with tendency to early recurrence of CLM helps to early diagnosis of relaps and it increases the posssibility of repeated liver surgery.

Carcinoma↗
PubMed2006

[Diagnosis and treatment of liver injuries].

AIM: The aim is to specify contemporary diagnostic and therapeutic procedures of liver injuries. METHODOLOGY: The authors present a trial group of 117 patients with various stages of liver injuries hospitalized at the Traumacentrum Surgical Department of the Faculty Hospital in Plzen from 1.1.2000 to 31.9.2005. 61 injured (52.1%) were treated conservatively, 56 (47.9%) surgically, who underwent 87 procedures, in total. RESULTS: 10 polytrauma patients exited (8.5%) from a haemorrhagic shock (group Moore IV-VI). Six subjects (5.1%) had complications on hospitalization. Average hospitalization lasted 18 days (1-69 days). CONCLUSION: The basic diagnostic tools in liver injuries include "bed side" ultrasonography, spiral computer tomography, in more complicated traumas also MRI, angiography or endoscopic retrograde cholangiography. As a treatment strategy, conservative methods prevail in haemodynamically stable patients, regardless of the liver injury stage. The objective of the surgical management is to provide "damage control surgery", i.e. the first procedure is aimed at life-saving, no time-demanding surgical procedures (e.g. liver tamponade), management of hypothermia, haemocoagulation and metabolic acidosis.

Adolescent↗
PubMed2006

[Prognostic factors of early recurrence of colorectal liver metastases and their usage in clinical praxis].

Liver surgery for colorectal liver metastases (CLM) is very often followed by recurrence. The prediction of early relapse of CLM is important for successful treatment, long disease free period and for long survival of patients, because it could help us to choose adequate surgical and oncological treatment. The authors present contemporary overview of the prognostic factors of early CLM recurrence and their possible use in prognostic scoring systems. These could be very helpful in clinical practice.

Colorectal Neoplasms↗
PubMed2005

[Injuries to the biliary tract during cholecystectomy].

Injuries to the biliary tract during both the laparoscopic or the open cholecystectomic procedures, remain among the most serious iatrogenic injuries with high morbidity and mortality rates. The higher the number of the laparoscopic cholecystectomies, the higher the number of the injuries to the biliary tract. Early peroperative recognition of these injuries is a prerequisite for successful biliary tract reconstructions. Mucosal hepaticojejunoanastomosis according to Roux is the golden standard of the reconstrucion treatment. Stenoses in anastomoses followed by development of cholangitides are considered serious postoperative complications. In these cases, endoscopic and transparietal dilation with plastic stents implantation is the method of choice. Technically exacting reoperations then follow. The authors present a trial group of 11 patients, who were treated in the Surgical Clinic of the Faculty Hospital in Plzen for biliary tract injuries during cholecyctomic procedures (8 were laparoscopic and 3 open), from 01-01-2000 to 01-09-2004. Severe inflammatory changes in the region of the Calot triangle, were the commonest cause of the biliary tract injuries during primary operations. In most cases (N = 8) the injury was diagnosed and managed immediately during the primary procedure. Hepaticojejunoanastomosis according to Roux was the principal procedure used to repair the biliary tract (N = 8). Postoperative morbidity reached 36.4%, 2 elderly patients exited (18.2%) due to septic multiorgan failure on the 15th day and the 7th month after the surgical procedure. Multidisciplinary approach of a team of experienced surgeons, endoscopists and radiologists in the hepatobiliary region is a fundamental prerequisite for long-term successful outcomes of technically exacting reconstructive procedures of the hepatobiliry tract.

Adult↗
PubMed2005

[The liver splenosis in a patient following a procedure for the malignant seminoma].

Splenosis is characterized by a presence of islets of the splenic tissue in the abdominal and, rarely, also in the thoracic cavity, most frequently as a consequence of the splenic injury. The authors describe a case of splenosis in a patient followed-up after surgery and radiotherapy for the testicular seminoma and who, 42 years ago, had splenectomy for polytrauma. With respect to the location of the splenosis in the hepatic region, the differential diagnosis was difficult, bearing in mind a possibility of the malignancy relaps. Although splenosis was highly suspected, based on the results of the examinations conducted, with respect to the preexisting malignancy, the tumor was excised. The histopathologist confirmed the diagnosis of splenosis. This case is rare in the literature, considering the time gap between the diagnosis of splenosis and the trauma.

Diagnosis, Differential↗
PubMed2004

[Penetrating aortic ulcer with severe gastrointestinal bleeding].

Primary aortointestinal fistula is a rare reason for gastrointestinal bleeding and mainly caused by a communication between the digestive tract and an aortic aneurysm. The penetrating aortic ulcer has been recently recognized as an independent pathological entity. It may penetrate through the aortic wall, leading to fistula into adjacent organs. We report the case of a 78-year-old woman who was admitted to our department with massive gastrointestinal hemorrhage. Endoscopy did not reveal the cause of hemorrhage. The diagnosis was made by computed tomography showing a primary aortoduodenal fistula without aortic aneurysm. The patient was successfully operated on. During urgent operation we found the penetrating atherosclerotic ulcer as the cause of the aortoduodenal communication. Primary aortoenteric fistula has a fatal outcome unless it is diagnosed accurately and urgently treated by surgical intervention. Contrast-enhanced computed tomography is the primary imaging modality to specify the diagnosis.

Aged↗
PubMed2004

[Is liver resection or radiofrequency ablation indicated in breast carcinoma metastases?].

AIM: Until recently, metastasizing of the breast carcinoma to the liver has been considered the sign of the disease process generalization with a poor therapeutic prognosis. Therefore, the aim of this work was to assess any positive effects of liver resections in cases of patients with metastases with respect to the patients' survival rate and the relapse rate of the disorder. METHODOLOGY: From January 2000 until September 2003, 13 women aged 55.8 years on average (39-71 years of age) underwent surgery in the Surgical clinic of the Faculty Hospital in Plzen for liver metastases of the breast carcinoma. The average period of time from the date of the primary surgery for the breast carcinoma till the breast carcinoma liver metastasis appeared, was 4.3 years (3 months to 9 years). The breast carcinoma liver metastases were solitary in 11 cases and in two cases the metastases were multiple. The authors conducted four right-sided hepatectomies, three segmentectomies, two left-sided lobectomies, three radiofrequence ablations (RFA), one combined surgery--the liver resection and RFA, in total. In seven cases, the histological examination proved a ductal carcinoma and in six cases a lobular carcinoma. Following the surgery, all female patients underwent curative chemotherapy. None of the patients died earlier than 30 days after the surgery. In case of one patient during the complicated hepatectomy, the ductus hepaticus communis was iatrogenically injured, and the situation was solved using hepaticojejunoanastomosis according to Roux. The data were statistically evaluated according to the Kaplan-Meier long-term survival rate and the mestases relapse rate curve. A twelve-month and a thirty-month survival rate were 100%, and 66.7%, respectively. A probability of the relapse anywhere in the body is rated 0% and 71.5%, respectively for the same periods of time following the liver surgery for the breast carcinoma. CONCLUSION: Based on the authors' own findings and in conjunction with the current literature data, it is clearly evident that surgical therapy (liver resection, eventually RFA) followed by adjacent chemotherapy is the therapeutic method of choice in cases of patients suffering from the breast carcinoma liver metastases. The above method represents the only chance for a considerable extension of a quality life for women suffering from the breast carcinoma liver metastases.

Adult↗
PubMed2004

[Mesenteric fibromatosis. Case report].

The authors describe a case of a young patient, who underwent a by-pass surgery for ileus of the small intestinal loops due to a wide-spread tumor of the mesentery, conducted in a different hospital. The patient was then re-operated in the Faculty hospital in Plzen, the tumor was successfully removed en-block and the pathologist came to a conclusion and diagnosed mesenterial fibromatosis. The case is being discussed from the point of view of the rarely occurring intraabdominal fibromatosis.

Fibroma↗
PubMed2004

[Radiofrequence ablation in contemporary surgery--our experience].

Radio-frequency ablation (RFA) is one of the methods used in multimodale treatment of liver tumors. The opportunities for the use of RFA are more wide recently. Authors present their own experience with RFA in the treatment of liver tumors and also its use in the treatment of parenchymatous abdominal organs injury. They compare the different operative approaches for RFA with concentration to their advantages.

Aged↗
PubMed2002

[Liver resection technique using the harmonic scalpel].

The authors present their one-year experience with the use of a harmonious scalpel (HS) in resections of the liver on account of malignant and benign disease. The advantages of HS is safe coagulation and section of the vessels and bile ducts at the site of dissection of the liver parenchyma, without unnecessary coagulation "sideways", and in particular the use of HS significantly reduces the need of blood transfusions during resection. In some instances transfusions are not necessary at all. A certain disadvantage of HS in liver resections is restriction of coagulation of vessels under 2-3 mm in diameter and a longer time of operation which is however compensated by minimal blood losses. In the conclusion the authors recommend HS as the technique of choice in resection of the liver.

Hepatectomy↗
PubMed2002

[Initial experience with radiofrequency ablation in non-resectable secondary liver tumors].

The authors evaluate their initial experience with a newly introduced ablation method--radiofrequency ablation (RFA) in non-resectable liver metastases. Within an 11-month interval (February-December 2001) the authors made a total of 20 RFA. A total of 37 hepatic secondaries were destroyed. There was only one complication--suppuration in the surgical wound. The success rate of the method was 90%.

Adult↗
PubMed2001

[Surgical treatment of thyroid diseases at the Surgical Clinic of the University Hospital of Plzen 1994-2000].

The authors operated in 1994-2000 at the Surgical Clinic, Faculty Hospital Plzen a total of 793 patients on account of thyroid disease. This group comprised 57 patients with malignant thyroid disease. The mean age of the operated patients was 48.8 years (range 12-89 years). Three patients (0.38%) died within 30 days after operation. The postoperative morbidity was 6.1%. A lesion of the recurrent nerve was recorded during the postoperative period in 24 patients (3.03%) and had a declining trend. Postoperative hypoparathyroidism was recorded in 5.8% (n = 46) injuries of the neighbouring organs in 1.02% (n = 8), oedema of the larynx in 18 patients, i.e. 2.3%. On the whole the authors observed a decline of postoperative complications during the investigation period, the number being lowest in 2000 associated with the number of performed thyroid operations and a change of the surgical strategy.

Adolescent↗