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Biomedical subjects

V Krtek

Publications and source records attributed to V Krtek.

At least 19 recordsLinked to original sources
PubMed1999

[Current status of liver resection of metastases of colon and rectal carcinoma].

Based on an analysis of a group of patients with resection of the liver on account of secondaries of colorectal carcinoma the authors evaluate their therapeutic method. Between 1978 and June 1999 at the Surgical Clinic of the Third Medical Faculty Charles University, Prague resections of the liver were made in 222 patients, incl. 57 on account of metastases of colorectal carcinoma. The liver was resected on account of metastases by right-sided lobectomy twice, left-sided lobectomy 1x, right-sided lateral bisegmentectomy 5x, left-sided lateral bisegmentectomy 9x, segmentectomy 16x and in 24 patients a wedge-shaped resection was made (incl. 10 with multiple metastases several times). In another eight patients where a resection could not be performed either alcoholization of the tumour was used or adjuvant chemotherapy was administered. Postoperative complications were recorded in 10%, the 30-day mortality rate was 2%. The mean survival period was 23 months. Resection of the liver on account of a secondary of colorectal carcinoma is a safe and effective therapeutic method.

Carcinoma↗
PubMed1997

[Surgical treatment of hepatic metastases].

The authors analysed the possibilities of surgical treatment of hepatic secondaries in a group of 69 patients where resection of the liver was performed. Most frequently secondaries of carcinoma of the large intestine and rectum were resected (40 patients). As to different operations in 12 patients left-sided lateral lobectomy; right-sided lateral lobectomy was performed in 8, segmentectomy in 26 and in 23 wedge-shaped resection. During the postoperative period local complications developed in 5 patients and two were treated on account of pneumonia. The mean period of survival in patients operated on account of secondaries of the large intestine and rectum was 19 months.

Humans↗
PubMed1996

[Clinical significance of IgM anti-HCV determination in chronic hepatitis C].

BACKGROUND: In the majority of patients with acute viral hepatitis C the early antibody IgM anti-HCV in serum is positive. However, a substantial portion of the patients with chronic hepatitis C has also positive IgM anti-HCV as a sign of the continuing replication of the virus. The objective of the work was to assess the presence of IgM anti-HCV in patients with confirmed chronic hepatitis C, in subjects with HBsAg negative chronic hepatitis and in excluded blood donors. Moreover, the authors assessed the relationship between IgM anti-HCV positivity and the activity of serum transaminases and whether the presence of IgM anti-HCV has an impact on the histological finding in the liver. METHODS AND RESULTS: 88 patients were examined (44 women and 44 men), average age 48 years. In 47 subjects histological examinations of the liver were made. IgG anti-HCV were assessed by the Monolisa anti-HCV Sanofi Pasteur test and IgM anti-c22 by an Abbott kit IgM HCV EIA: With regard to the results of the serological examination the patients were divided into three groups which were mutually compared. Group 1 comprised 24 patients with a positive IgG and IgM anti-HCV, group 2 38 patients with a positive IgG anti-HCV only and group 3 26 patients with a negative IgG and IgM anti-HCV. Of 88 examined patients 62 had positive IgG anti-HCV (70%). Of 62 IgG anti-HCV positive subjects 24 (39%) had positive IgM anti-c22. A total of 24 patients had blood transfusions (39%) but only 9 of them had positive IgM anti-c22 (37.5%). The mean ALT serum activity was significantly higher in subjects with positive IgM than in those without IgM (p = 0.006), however, for AST the difference was not significant (p = 0.09). Comparison of patients with a confirmed histological finding in the liver revealed that two-thirds of patients with a positive IgM anti-c22 either suffered from cirrhosis or chronic active hepatitis, while anti-HCV positive patients without IgM anti-c22 had cirrhosis or chronic active hepatitis only in one third of the cases. CONCLUSIONS: The results suggest that in chronic hepatitis C some 40% of the patients have positive IgM anti-c22; these subjects have a significantly higher serum ALT activity and a more advanced histological finding in the liver than subjects without IgM anti-c22. Assessment of IgM anti-c22 is important not only for diagnosis but also for treatment of chronic HCV infection with antiviral drugs.

Chronic Disease↗
PubMed1996

[Indications for resection of the liver in benign and malignant diseases].

Based on the analysis of a group of 184 patients where resection of the liver was performed, the authors describe the procedure of the preoperative examination and indications for resection. The diagnostic algorithm comprises in addition to ultrasonography, computed tomography supplemented by selective angiography. In central foci moreover magnetic resonance is used. From the total number of patients operated during the period from 1978 to 1993 in 58 the resection was on account of benign disease (most frequently cysts), in 61 on account of primary liver tumours (most frequently haemangiomas) and in 65 on account of metastases in the liver (most frequently from colorectal carcinoma). The early postoperative mortality was 2.8% (five patients).

Algorithms↗
PubMed1994

[Liver resection from the viewpoint of the internist].

Resection of the liver as the most suitable mode of treatment of hepatocellular carcinoma is successful, if the principles of secondary prevention are enforced when following up known cirrhotic patients, and the hepatoma is detected in the initial stage with a defined focus of 2-4 cm in diameter. Alternative treatment can be direct under ultrasonographic control and administration of 96% alcohol, or a combination of the two procedures or the use of cytostatics. In benign focal hepatic processes such as hepatocellular adenoma, haemangioma, focal nodular hyperplasia, nowadays resection is usually not used if the benign character of the tumour is beyond doubt. An exception is hepatocellular adenoma, where the risk of haemorrhage is enhanced. Special attention should be paid to surgery of a single or few metastases in the liver found during surgery of colorectal carcinoma or during the follow-up of operated patients. Sometimes thus the quality of their lives is improved and prolonged.

Carcinoma, Hepatocellular↗
PubMed1990

[Early diagnosis and rational therapy of primary carcinoma of the liver. Principles of secondary prevention].

The programme of secondary prevention of primary carcinoma of the liver focused on patients with confirmed cirrhosis of the liver can be applied readily under our conditions. It should become a rational supplement of the oncological programme. The basic objective is the detection of a small focus of the tumour in hepatic tissue not larger than 2-3 cm in diameter, based on regular clinical and laboratory examinations of cirrhotic patients (the result of alpha-fetoprotein is emphasized) and in particular ultrasonography. This is followed by the morphological verification of the tumour either by aimed biopsy during laparoscopy or by aspiration cytology with ultrasonographic control. Supplementation by CT or aimed angiography is also useful. In case of a positive finding the method of choice is above all a restricted resection. On the other hand, treatment with absolute alcohol is increasingly used. It is instilled under ultrasonographic control during repeated sessions into the tumourous focus and its regression is followed up to complete disappearance. This treatment can be combined with subsequent resection. The authors give an account of their own experience.

Carcinoma, Hepatocellular↗
PubMed1989

[Tuberculous peritonitis].

The authors present the clinical picture of the tuberculous peritonitis and stress the potentialities of differential diagnosis. They drew on their diagnostic experience with tuberculous peritonitis occurring in the 1978-1987 period, and on their analysis of the clinical course of the disease in 7 patients (3 were under 40 years of age). The diagnosis should make use of laparoscopy supplemented with biopsy taken from the peritoneal wall using the "hot biopsy method", which enabled to achieve exact morphological verification. Nowadays, delayed or incorrect diagnosis can result in a serious clinical course of this rare complication of the disease.

Adult↗
PubMed1985

Primary sclerosing cholangitis. Light and electron microscopy of hepatic tissue in two cases.

In an 18 year-old woman presenting with an intra- and extrahepatic form of sclerosing cholangitis needle biopsy of the liver revealed, in addition to a conspicuous proliferation of biliary ductules and mild inflammatory infiltrations of the portal tract, piece-meal necroses and focal intralobular inflammatory changes. In the second case - a 49-year-old man - presenting with an extrahepatic location of stenoses there were infrequent proliferating biliary ductules in the enlarged fibrotic portal tracts. Ultrastructural investigations revealed in both patients adverse regressive changes in the epithelium of proliferating biliary ductules, seen as microvillous damage on the luminal surface, dilation of the endoplasmic reticulum and mitochondrial swelling; in the second patient there was, moreover, electrondense material in epithelial cytoplasm, probably corresponding to bile components. In the first patient predominated among ultrastructural changes increase of cytoskeletal filaments in some epithelia and pronounced reduplication of the basement membranes of small biliary ducts. These "cholestatic" modifications, expressed in different form in the two patients, were accompanied by dilatation and damage, sometimes total disappearance of microvilli of biliary canaliculi.

Adolescent↗
PubMed1985

[Light and electron microscopy findings in alcoholic liver damage].

Large centrolobular hepatocytes and the formation of alcoholic clear cells are regarded as changes of prognostic significance in chronic alcoholism. Electron microscopically these cells reveal an increase of the endoplasmic reticulum. Special attention is paid to ultrastructural peculiarities of Mallory bodies, inflammatory changes and fibrosis.

Endoplasmic Reticulum↗
PubMed1985

Sarcoidosis of the stomach. Endoscopic diagnosis and possibilities of conservative treatment.

Previously, the diagnosis of gastric sarcoidosis was only possible in retrospect - on the basis of the histology of the excised part of the stomach, since most patients with a suspected malignancy of the stomach or ulcerative haemorrhages underwent surgery. The diagnosis was verified by a positive Kveim test. Contemporary possibilities of endoscopic diagnosis, together with bioptic verification, permit conservative treatment as an alternative that spares the patient a resection of the stomach. Experience with such a conservative approach is, however, as yet somewhat scanty. The authors submit the case of a 31-year-old patient, in whom sarcoidosis of the stomach - initially identified at our department during 5000 routine fibroendoscopies of the upper digestive tract - was diagnosed endoscopically and bioptically and confirmed by the Kveim test. Prednisone (30 mg a day) was administered in decreasing doses - at present, the patient is on a maintenance dose of 5 mg a day. His digestive complaints quickly disappeared, he gained weight and returned to his job. Objectively, too, the macroscopic changes in the gastric mucosa regressed, although granulomas persist to a lesser extent in biopsy findings. With conservative treatment regular endoscopic and biopsy checkups are essential.

Adult↗