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Biomedical subjects

Z Krska

Publications and source records attributed to Z Krska.

At least 19 recordsLinked to original sources
PubMed2002

[Thromboembolism--present status and perspectives].

The author summarizes contemporary findings on the problem of thromboembolism. He discusses its incidence, economic costs associated with treatment of complications such as arterial and venous thromoembolism. He emphasizes the problem of new types of prevention, in particular pentasaccharides in relation to complications and to other possibilities of prevention and treatment. The results of recent international studies and perspectives in this field are presented.

Europe↗
PubMed2002

[Metastasis as the first sign of thyroid carcinoma].

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.

Adult↗
PubMed2002

[Total tyroidectomy in malignant goiter, significance and problems].

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.

Female↗
PubMed2002

[Invagination--the first manifestation of leiomyosarcoma].

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.

Female↗
PubMed2002

[The plug system and laparoscopic hernioplasty in recurrent inguinal hernia].

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.

Hernia, Inguinal↗
PubMed2001

Does the laparoscopic approach significantly affect cardiac functions in laparoscopic surgery? Pilot study in non-obese and morbidly obese patients.

BACKGROUND: Laparoscopy in bariatric surgery represents a modern method generally associated with lower morbidity and mortality, compared with the traditional surgical approach. However, in patients with impaired cardiovascular function, the laparoscopic approach is limited by the potential adverse hemodynamic impact. We assessed the influence of some laparoscopic procedures on selected cardiac functions in significantly obese patients and in subjects with normal body weight, using transesophageal echocardiography (TEE). PATIENTS AND METHODS: Six subjects with normal body weight (mean BMI 25.3 +/- 3.6 kg/m2), and six patients undergoing laparoscopic gastric banding for morbid obesity (mean BMI 45.8 +/- 7.5 kg/m2) were studied. Heart rate (HR), blood pressure (BP), ejection fraction, cardiac output (CO) and transmitral flow were measured. Parameters were recorded at baseline before the operation (BL), after installation of capnoperitoneum (CP), and after positioning the patient for surgery (SP). RESULTS: Compared to BL, CP and SP were characterized by an increase in HR and BP in both groups of patients. As ejection fraction did not change significantly, the HR changes were accompanied by an increase in CO: (BL 5.8 +/- 2.2 l/min, CP 6.5 +/- 2.6 l/min, SP 6.7 +/- 2.7 l/min, p < 0.05 BL vs CP and SP). Transmitral flow parameters did not change significantly. Hemodynamic changes in subgroups with normal body build and in the obese patients were comparable. There was an increase in CO and pressure-rate product in obese individuals. CONCLUSIONS: Our results suggest that the hemodynamic response to laparoscopic surgery is characterized by an increase in CO (due to increased HR) and BP. In subjects without a manifest cardiovascular disease, neither systolic nor diastolic performance was significantly affected by the introduction of capnoperitoneum and positioning of the patient for surgery. Similar results were observed in obese and non-obese subjects. Phase II of this on-going study is focusing on impact and safety of laparoscopy in obese patients with known cardiovascular disease.

Adult↗
PubMed2001

[Massive intestinal hemorrhage as the first sign of diverticular disease of the colon].

Retrospective and prospective analysis of massive enterorrhagia (m.e.). The aim of the study is the analysis of frequent causes of m.e--diverticular disease of the colon (DDC). The total number of patients with m.e. was 154 and the proportion of DDC in this total group was 17%, i.m. 24 patients. The total number of patients with the acute symptomatic DDC was 198 and the proportion of haemorrhagic DDC in this total group was 13.3%. The dominant form is conservative therapy (88.4%), surgical therapy was performed in 11.6% of cases. Discontinuous types of operations predominated. The analysis of the group and comparison with problems of m.e. in the literature.

Acute Disease↗
PubMed2001

[The acute phase reaction in laparoscopic and open surgery of inguinal hernias].

The acute phase response to tissue injury is art of the wound healing process after surgery. The aim of study was to determine levels of acute phase proteins and levels of thrombocytes in patients with laparoscopic surgery (intraabdominal preperitoneal repair) and in patients with open surgery (tension free repair). Exclusion criteria in both groups of patients: malignity, diabetes mellitus, obesity (BMI > 30), infection, hypoproteinemia, hepatic or renal insufficiency and hypertension. Type of anaesthesia: general. Perioperative preventive antithrombotic medication: LMWH 5 days after surgery. The observed parameters were estimated before, one hour, 2nd and 7th days after surgery. Statistical test: ANOVA, statistical by significant difference p < 0.05. The results of the study demonstrate an increase of acute phase proteins CRP, OROSO and Fb in both groups of patients in comparison to their levels before surgery. In this respect we did not find a difference between the two types of operation. In patients with laparoscopic surgery the observed peak of FBG increase (+69%) was on the 2nd day after surgery followed by a slight drop of values in comparison to the results of open surgery patients with a FBG increase on the 2nd day (+42%) and with continuation on the 7th (%) postoperative day. The peak of CRP values was on the 2nd day in both groups. OROSO values increased even on the 7th day. The same situation occurred with Plt levels (p < 0.05). We suggested, that laparoscopic and open surgery of inguinal hernia repair are both followed by an acute phase response related to the tissue injury and this response perists even 1 week after surgery. But the recovery time of some parameters of the acute phase response (e.g. orosomucoid and fibrinogen levels) to the basical preoperative state is longer in patients with open type of surgery. We do not confirm differences in the degree of risk of postoperative thrombophilia in both types of surgery and suggest, that the prevention of thromboembolic complications is indicated in both types of surgery.

Acute-Phase Proteins↗
PubMed2001

[Videothoracoscopy and video-assisted surgical procedures in penetrating injuries of the thorax].

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.

Adult↗
PubMed2001

[Heparin-induced thrombocytopenia in patients and prevention with low molecular weight heparin].

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.

Abdomen↗
PubMed2000

[The syndrome of the common channel of the choledochal duct and the duct of Wirsung].

The problem of the rare anomaly of pancreatic ad bile ducts--common channel syndrome is discussed. On the demonstrated case the necessity of ERCP in obscure etiology of chronic pancreatitis is suggested and the principle++ of surgical treatment--disconnection of the bile duct and the formation of choledochojejunoanastomosis on the excluded loop--is demonstrated which solved the problem.

Adult↗
PubMed2000

[Manually-assisted laparoscopic surgery].

The authors describe and discuss a new method of minimally invasive surgery--hand-assisted laparoscopic surgery. For the analysis they used recent data from the literature and their own experience. The main advantage is greater safety, better diagnosis by palpation and better preparation in the abdominal cavity. The main disadvantage is the cost of the method.

Humans↗
PubMed2000

[Dysphagia after the Rosetti fundoplication for gastroesophageal reflux].

The authors describe as the possible cause of postoperative severe dysphagia after laparoscopic Rosetti's fundoplication low insertion of the cuff drawn behind the oesophagus to the anterior gastric wall. When the stomach is full the cuff is drawn into a spiral and the latter presses against the cardia and twists the cardia and abdominal oesophagus. For the condition unimpaired swallowing of the first mouthfuls is typical followed by severe dysphagia which can lead even to malnutrition. Common examinations may be normal except for the unaccountable dilatation of the oesophagus. An important role in detection of the cause is played by investigation of the passage of the barium suspension during swallowing with the patient in an upright position. The authors recommend insertion of the cuff as high as possible with careful mensuration of the permeability of the abdominal oesophagus during and at the end of surgery and fixation of the cuff to the diaphragm of diaphragmatic cruri.

Adult↗
PubMed1999

[Long-term results of ileo-rectal anastomosis in familial polyposis].

The authors present their experience with 93 patients operated at the First Surgical Clinic of the General Faculty Hospital and First Medical Faculty, Charles University Prague on account of familial adenomatous polyposis (FAP) assembled during 36 year starting in 1962. They analyze 91 patients followed up in collaboration with the First Medical Clinic of the General Faculty Hospital and First Medical Clinic Charles University Prague. Seventy-two of the patients were operated and in 55 of them an ileorectoanastomosis was made following subtotal colectomy. Two important findings were made. From the group of 91 patients incl. primary patients who suffered already from advanced malignant disease of the large bowel a total of 38.5% died. In the rectal stump after ileorectoanastomosis on average within 16 years after operation in 16.4% of the patients a malignant tumour was found. This leads to the belief that patients should be recommended colectomy with ileoanoanastomosis with an ileal reservoir. This operation was performed during the last five years in nine patients with this condition, using a one-stage or two-stage procedure with temporary ileostomy.

Adenomatous Polyposis Coli↗
PubMed1999

[Splenectomy].

The authors ANALYZE the problem of splenectomy from the historical point of view and also the problem of splenectomy indication. Two different periods separated by a short time interval are compared. Recently the indications for splenectomy have changed because of introduction of new drugs in hematologic treatment. The number of "traumatological" splenectomy remains constant. (Tab. 2, Ref. 18.)

Czech Republic↗
PubMed1999

[Antibiotic prophylaxis in hip joint surgery].

Nosocomial deep wound infections are serious complications after hip joint surgery. Our aim was to determine whether there is a difference in rates of nosocomial infections between group of patients after elective surgery of hip replacement and group of patients with hip replacement after trauma. Both groups of patients had perioperative prophylaxis with amoxycillin. We found that the overall trauma patients infection rate was 0.9 per cent compared with 1.5 per cent for elective surgery infections. In both groups of patients a postsurgery stress was documented according to increase of acute phase proteins (C-reactive protein, orosomucoid and fibrinogen) in plasma for a minimum 10 days after surgery. We conclude, that both groups of patients had benefit from amoxycillin prophylaxis therapy.

Acute-Phase Proteins↗