Biomedical subjects

V Procházka

Publications and source records attributed to V Procházka.

At least 19 recordsLinked to original sources

PubMed2006

[The diagnostics and therapy of hepatic encephalopathy. Recommendations of of the working group on portal hypertension in the Czech Hepatology Society and the J. E. Purkinje Czech Medical Society].

UNLABELLED: Hepatic encephalopathy (HE) is a set of reversible neuropsychic features which occur in connection with hepatic cirrhosis or acute hepatic failure. We distinguish manifest HE (with clinical symptoms) and minimal FE (normal clinical finding, abnormal psychometric or neurophysiologic exam). The diagnosis is clinical or laboratory one. From the auxiliary examinations in common practice the number connection test is sufficient. THERAPY: Presence of hepatic encephalopathy should lead to the consideration of the possibility to solve basic disease by hepatic transplantation. Conservative therapy lies in 1. Basic disease elimination, 2. Measures lowering the ammonia level in blood--optimalization of protein intake, administration of indigestible disaccharides (lactulose, lactitol) and fill sterilisation by antibiotics (Rifaxin, Metronidazol), ornitine-aspartate administration, 3. Influencing the changes in amino acid metabolism (administration of branched chain amino acids--BCAA). Prognosis depends on the advancement of the disease, after hepatic transplantation the clinical symptoms of HE are mostly fully reversible.

Adult↗

PubMed2006

[Diagnostics and therapy of hepatorenal syndrome. Recommendations of of the working group on portal hypertension of the Czech Hepatology Society and the J. E. Purkinje Czech Medical Society].

Hepatorenal syndrome is a functional renal failure in patients with advanced cirrhosis and portal hypertension or acute liver failure. It is caused by extreme vasoconstriction in renal arterial bed. Type I HRS presents as an acute renal failure, while type II HRS is chronic alteration of renal function in patients with refractory ascites. Prognosis of HRS is very poor with survival reaching several weeks in patients with HRS type I. Causal treatment is liver transplantation, other treatment options include use of splanchnic vasoconstrictors (terlipressin) together with plasmaexpansion (albumin) and TIPS. It is important to exclude nephrotoxic medication (non-steroid anti inflammatory drugs, aminoglycosides) and properly treat all infective complications in prevention of HRS.

Hepatorenal Syndrome↗

PubMed2006

[Laparoscopic procedure according to Heller].

Oesophageal achalasia is a rare disorder. For patients in good overall condition, surgical management--myotomy--is one of the treatment options. This study describes the technique of laparoscopic myotomy sured by partial antireflux cuff. 35 patients were operated. Only in 3 cases, further follow-up was required for dysphagia. None of the patients required re-operation. No serious peroperative or postoperative complications were recorded. Importance of peroperative oesophagogastroscopy in assessment of adequate extent of myotomy and in excluding perforations of the oesophageal mucosa is put forward.

Adult↗

PubMed2005

[Could the peroperative manometry of the oesophagus be used for prediction of dysphagia following antireflux procedures?].

A possible development of the postoperative persisting dysphagia, which decreases the quality of life of the operated, remains the main drawback of the laparoscopic antireflux surgery. Among several variations of the antireflux surgical procedures, there is none known to completely eliminate this risk. In this study, supported by the IGA MZ CR ND 7142-3 grant, peroperative measurements of the lower oesophageal sphincter (LES) tone with a concurrent mechanical callibration of the cuff using an oesophageal tube were taken. A complete Nissen-Rossetti cuff was applied in 39 patients. Peroperative increases in the LES tone following the completion of the antireflux cuffs were monitored. The patients continued to be monitored with the aim to detect the onset of dysphagia. In the patient group with the peroperative LES tone increase exceeding 15 mmHg, significantly higher rates of prolonged dysphagia were recorded. In cases of lower LES increases, the rates of dysphagia were low and good functioning to prevent any pathological gastrooesophageal reflux was maintained. No complication with respect to the peroperative oesophageal manometry was recorded. Duration of the antireflux operation conducted with the peroperative manometry was prolonged by 4 minutes, on average. Based on the assessment of the data, the authors demonstrate that the LES tone increase on its own, does not provide for the antireflux efect of the fundoplication procedures and that the patients cannot benefit from its extremely high values. On the contrary, its high values may indicate possible risks of dysphagia in the postoperative period.

Deglutition Disorders↗

PubMed2005

[Laparoscopic management of an infected oesophageal cyst].

Oesophageal cysts are rare congenital anomalies. Most commonly, they are located in the posterior mediastinum, approximately at the level of the distal third of the oesophagus. In most cases, they are diagnosed during childhood as an accidental finding of a symptomatic mediastinal lesion. A CT or MRI, oesophagoscopy and endosonography of the oesophagus are the essential diagnostic methods. In the adulthood, most of the cysts cause problems pushing against the surrounding organs and, therefore, surgical removal is recommended. In this report, a case of a potential complication is described: infection of the oesophageal cyst of the distal part of the oesophagus following a transoesophageal punction. The case resulted in sepsis, which was managed laparoscopically. Entering through the diaphragmatic hiatus,a cyst in the posterior mediastinum was revealed. The cyst was partially resected and its content evacuated. No complications followed. The laparoscopic method is feasible and safe even if the oesophageal cysts are infected. A complete resection of the cyst would be complicated due to a possibility of injuring the oesophagus. A significance of the peroperative oesophagoscopy to verify the oesophagus position in an unclear anatomic situation due to inflammatory infiltration, is highlighted. The above decreases the risk of the oesophageal wall lesion.

Bacterial Infections↗

PubMed2005

[Resection of the pancreatic head and duodenum for the Crohn's disease of the duodenum].

The Crohn's disease rarely affects duodenum. The symptoms are unspecific and its diagnostic process may be difficult. Patients with complications-stenoses and fistules, are indicated for surgical treatment. According to literature, there is no straightforward agreement on the surgical treatment strategy. In most cases, non-resection procedures are indicated. The authors describe a case of a patient suffering from the Crohn's disease of his duodenum and chronic pancreatitis, which was managed using a radical procedure--hemipancreatoduodenectomy.

Crohn Disease↗

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↗

PubMed2003

[Indications for arthrodesis of the knee joint in modern orthopedics].

INTRODUCTION: Indication for arthrodesis of the knee joint is nowadays most frequently failure of a total endoprosthesis, usually septic. A less frequent indication is purulent gonitis, frequently after corticoid administration, the condition after a complicated intraarticular fracture with subsequent arthritis or oncological disease of the bones in the area of the knee joint. MATERIAL AND METHODS: In the course of 2000 to 2002 at the authors' department 15 arthrodeses were implanted. In three cases the indication for arthrodesis was purulent gonitis, in three cases the condition after an open articular injury associated with infectious complications and in the remaining nine cases failure of an endoprosthesis of the knee, incl. seven caused by infection. The patients were three men and 12 women, mean age 64 years (30-75 years). For stabilization of the arthrodesis 9x external fixation was used, 5x plates and 1x intramedullary osteosynthesis. RESULTS: In all cases consolidation of the arthrodesis was achieved. In one case the external fixation had to be replaced by a system of two fixation devices and in one case correction of the axial position of the extremity was made. The presence of external fixation was perceived negatively in particular by female patients. DISCUSSION: Plate osteosynthesis and the use of external fixation devices are relatively quick, cheap and considerate methods of arthrodesis. External fixation must be used in acute virulent infections while plate osteosynthesis can be indicated in its absence. The characteristic of intramedullary fixation is similar, however special nails used for arthrodesis of the knee are several times more expensive than the previous types of stabilization. The advantage is the possibility to use a massive bone graft to fill the defect.

Adult↗

PubMed2002

[Double blind randomized multicentre study of a seven-day eradication regime of Helicobacter pylori by omeprazole, clarithromycin and ornidazole vs. omeprazole, clarithromycin and metronidazole].

Effective eradication regimes of Helicobacter pylori infections are nowadays based on administration of a substance with a strong suppressive effect on production of gastric HCl combined with two antibiotics. As suppressor of gastric HCl production unequivocally some drug from the group of proton pump blockers is used. As to antibiotics, in first line therapy the following are recommended: clarithromycin, amoxicillin, metronidazole. A problem in the eradication therapy of Helicobacter pylori infection in recent years is the increasing resistance to clarithromycin and apparently also metronidazole. In the Czech Republic the resistance to clarithromycin in relation to Helicobacter pylori is stabilized at a level lower than 3.0 %. Resistance to metronidazole was reported in 1992 within the range of 24 % - 26 %, however in 2001 it was already 36.0 %. Therefore the question arises whether it is possible under our conditions to check the increasing metronidazole resistance by a drug which by its spectrum of action resembles metronidazole while it differs from it as to its chemical structure. This is the reason why the authors implemented a trial where metronidazole was replaced by tinodazole (Avrazor, Léciva Co.). The results revealed that in the group treated with tinidazole eradication was achieved after 7-day administration of ornidazole in 93.0 %, in the group where part of the eradication regime was metronidazole eradication was 82.6 %. The tolerance of both drugs was very good. The authors recommend to include the pattern omeprazole 2 x 20 mg, clarithromycin 2 x 500 mg and tinidazole 2 x 500 mg among first line therapeutic regimes.

Adolescent↗

PubMed2001

[Acute hemorrhage of the upper digestive tract--personal experience].

The authors submit a retrospective investigation of 50 patients hospitalized at the intensive care unit of the Medical gastroenterological department, Faculty Hospital Brno treated in 1999 with the diagnosis of acute haemorrhage into the upper digestive tract. In the investigated group the most frequent cause of haemorrhage was portal hypertension (21 patients, 32.8%) and a peptic gastroduodenal lesion (15 patients, 23.4%). During the investigation period 12 patients died (18.8%), 6 developed haemorrhage as a complication of a serious condition (decompensated cirrhosis of the liver). In haemorrhage from oesophageal and gastric varicosities pharmacotherapy is equally important as endoscopic intervention.

Acute Disease↗

PubMed2001

[Long-term follow-up of patients with extensive ulcerous colitis with emphasis on the occurrence of dysplastic changes and colorectal carcinoma].

The chronic course of idiopathic intestinal inflammations is characterized also by a relatively high incidence of complications, local ones affecting the entire large intestine, as well as extraintestinal ones in remote organs. In the submitted paper the authors present the results of a six-year follow-up focused on the incidence of dysplastic changes of the intestinal mucosa and colorectal carcinoma in 46 patients from a group of 220 patients followed up on a long-term basis at the Second Medical Clinic of the Faculty Hospital and Medical Faculty Olomouc because of the extensive type of ulcerative colitis. The incidence of these complications is not high in our group and is only slightly higher than in the general population. As it is however a very serious disease and so far an optimal algorithm for its follow up has not been elaborated, we feel it is useful to investigate this high risk group of patients after 6-24-month intervals according to the confirmed grade of dysplasia of the intestinal mucosa.

Adult↗

PubMed1999

Foreign material as a cause of choledocholithiasis.

BACKGROUND AND STUDY AIMS: There are sporadic reports concerning foreign material as a cause of choledocholithiasis. Gallstones obtained endoscopically from the biliary duct were analyzed to determine their structure and the presence of foreign material. The possible correlation between foreign material in gallstones and clinical data was investigated. PATIENTS AND METHODS: Gallstones were examined qualitatively using a crystallographic analysis by X-ray powder diffraction, and the foreign material which was found was subjected to morphological analysis using polarization microscopy. Patients' clinical data were obtained from clinical records, physical examination and documentation. RESULTS: Out of a group of 54 patients, foreign material was found in CBD stones of six individuals (11.1%). Four of these patients were from the group who had undergone a previous cholecystectomy (29/54, 13.8%), and surgical suturing material was found in these four. On the other hand, in the group who had not undergone the operation, foreign material was found in two patients out of 25 (8%); in one case it was cellulose and in the other case the fibre was not identified. CONCLUSIONS: Foreign material can account for lithiasis in the biliary duct. In contrast to present reports in the literature, we have proved that this is possible even in patients without previous surgical intervention in the pancreatobiliary region.

Adult↗

PubMed1998

[Initial experience with treatment of choledocholithiasis using shock waves].

From March 1996 till August 1997 at the First Surgical Clinic in Olomouc 18 patients with concrements in the biliary pathways were treated by shock waves. All patients were older than 68 years; residual choledocholithiasis was involved which could not be eliminated during ERCP because of the size of the size of the stone. In 125 instances treatment was successfully terminated, i.e. by crushing the stones and their elimination. Only in three patients it was necessary to resolve the situation by surgery. The authors confirmed that it is possible to treat by this method patients with choledocholithiasis and avoid the risk of surgery in particular in older patients.

Aged↗

PubMed1998

[Surgical treatment of a complication of Crohn's disease of the duodenum].

In 1995-1997 at the First Surgical Clinic, Medical Faculty, Palacký University and Faculty Hospital Olomouc three patients were treated on account of obstruction of the pyloroduodenal region caused by Crohn's disease. The condition was treated by anastomosis, possibly with vagotomy, depending on the site of stenosis. Clinical, laboratory and endoscopic control examinations after a 6-month to 3-year interval revealed good results of this approach.

Adolescent↗

PubMed1997

[Acute surgical diseases in spinal injuries with spinal cord lesions].

Authors analyse the group of 22 operated patients admitted to the Spinal Centre of the Traumatological Hospital Brno for instable spinal fracture with the transversal lesion of the spinal cord, in whom the acutely affected abdomen and acute surgical disease manifested. The anamnestic and clinic examination of the abdomen is not reliable in patients with the transversal lesion of spinal cord for valid laws of the spinal cord. Authors evaluate the contribution of new diagnostic imaging techniques and endoscopic methods to determinate the early indication for surgical treatment.

Abdomen↗

PubMed1996

[Present possibilities of correction of biliary tract injuries].

The authors discuss and evaluate contemporary possibilities of repair of injured biliary pathways. As a basis they use their own experience of surgical treatment, endoscopic and percutaneous approach. They present groups of 43 patients treated by surgery, 9 treated by the endoscopic and 7 treated by the percutaneous approach. During treatment classical biliodigestive anastomoses were used, nasobiliary drainage, dilatation and stents. From comparison of the different groups and the therapeutic results the authors conclude that modern endoscopic and percutaneous methods are a great asset to the treatment of injured biliary pathways but only in case of their precise indication. Perfect interdisciplinary collaboration is essential.

Biliary Tract↗

PubMed1996

Melanoses of the gastrointestinal tract.

This article reviews various forms of abnormal pigmentation of gastrointestinal tract with special regard to melanosis coli. Aetiology, pathogenesis of these states are discussed including practical consequence.

Aged↗

PubMed1994

Microsurgical reconstruction of traumatic defects on the lower extremities.

Out of 167 free transfers 90 were applied to the lower extremities, i.e. 75 for injuries, 11 for an osteomyelitis and 4 for cancer. For these transfers were used the following 15 types of flaps; 37 from the forearm, 15 m. latissimus, 12 m. serratus ant. sup., 6 scapular, 4 fibula, 4 from the groin, 2 gracilis, 2 LAF, 1 TFL, 1 TRAM, 1 dorsalis pedis, 1 sartorius, 1 crista iliaca, 1 rectus abdominis, 1 combined latissimus+serratus. The transfer of flaps was satisfactory in 92%. The transfers to the lower extremity included in no case an emergency flap, in the acute phase within 7 days after injury were transferred 5 flaps. There were in addition 32 delayed and 38 secondary flaps. The report deals with important principles of the application of the above described transfers.

Adolescent↗