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Biomedical subjects

A Jabor

Publications and source records attributed to A Jabor.

At least 37 records · Page 2Linked to original sources
PubMed1999

Evaluation of perioperative stress after laparoscopic and abdominal hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.

OBJECTIVE: To compare the differences in laparoscopic and abdominal hysterectomy in surgery of premalignant and malignant uterine disease. DESIGN: Prospective study. SETTING: Baby Friendly Hospital, Kladno, Czech Republic. SUBJECT: A total 32 patients underwent hysterectomies for premalignant and malignant uterine conditions. INTERVENTIONS: Patients were assigned to either laparoscopic-assisted vaginal hysterectomy or total abdominal hysterectomy (LAVH), with bilateral salpingo-oophorectomy and lymph node dissection. MEASURES: Clinical data and value of total creatine kinase and C-reactive protein were measured. RESULTS: All 32 procedures were successfully completed. There were no major complications. Mean order of CRP concentrations was significantly lower (p = 0.001) in patients with LAHV. Mean order of total CK activities was also significantly lower in these patients (p = 0.003) and the median hospital stay was 4.1 days (p = 0.05). CONCLUSIONS: Laparoscopic procedures were followed by shorter hospital stays and the proposed evaluation of tissue damage using serum enzymes and proteins demonstrates that the laparoscopic approach to hysterectomy and accessory procedures has considerable importance in decreasing perioperative patient stress. The presented results are supported by clinical experience and should have a decisive impact on the chosen approach to the course and duration of convalescence in patients undergoing a hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.

C-Reactive Protein↗
PubMed1999

The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer.

BACKGROUND: The development of new diagnostic and surgical methods has brought a differentiated approach to surgery of endometrial cancer. The aim of this study was to verify the peri-and postoperative differences between laparoscopic and open procedure and prepare protocol for a second phase follow-up multicentric study. METHODS: The study includes 133 women with indications for surgery of endometrial cancer. A prospective multicentric study was undertaken at four centres in the Czech Republic. We evaluated differences in the peri-and postoperative outcomes. Sixty-eight patients treated laparoscopically were compared with 65 patients treated by an open procedure of hysterectomy and lymphadenectomy. RESULTS: Three patients with conversion were withdrawn from the study and another 65 patients (97%) from the laparoscopic group successfully completed the procedures. Laparoscopic and abdominal hysterectomy with lymphadenectomy were performed based on the grade of the tumor and depth of myometrial invasion. Out of both groups, 75 patients underwent pelvic lymphadenectomy and 21 women underwent para-aortic lymph node dissection or sampling. Eleven patients had metastases in the pelvic or para-aortic nodes (11.7% versus 4.7% in the open procedure group). Deep myoinvasion over 50% was more frequently present in the group of abdominally-treated women. The rate of major complications (18 versus 14 cases) was higher in the laparoscopic group, but more wound infections were seen in the open procedure group. CONCLUSION: The study illustrates that the laparoscopic approach to surgery is feasible and it also may be considered for endometrial cancer which typically occurs in at risk and obese women. Recovery time is reduced by avoiding an abdominal incision. Laparoscopic surgery was performed successfully in 65 women and in 8 cases (11.7%) malignant spread outside to the regional lymph nodes was found. However, the selection of patients for laparoscopy should be done considering optimal benefit and safety.

Adult↗
PubMed1999

[Tissue damage in alternative types of hysterectomy: prospective study].

OBJECTIVE: To assess and compare tissue damage during alternative hysterectomies. DESIGN: Prospective clinical study. SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Tissue damage and perioperative parameters were assessed using the enzymatic activity of creatine kinase (CK) and C-reactive protein (CRP). Serum levels of these markers were measured in 127 women who underwent laparoscopic, abdominal and vaginal hysterectomy. RESULTS: The rare of CK activity and CRP were significantly greater in 45 patients who underwent abdominal hysterectomy compared with that in the patients who underwent laparoscopic and vaginal hysterectomies (57 and 25 patients, respectively). CONCLUSION: Clinical experience and metabolic changes indicate that the tissue damage and perioperative stress in patients undergoing laparoscopic hysterectomy is lower than in patients where an abdominal approach is used. Large prospective studies are needed to evaluate the surgical trauma and metabolic changes induced by laparoscopic hysterectomy.

Adult↗
PubMed1998

[The method of calculating the numeric value of the KT/V index in the evaluation of effectiveness of peritoneal dialysis].

BACKGROUND: For evaluation of the adequacy of peritoneal and haemodialyzation treatment the BP/V index is used. In the literature there is so far no uniform view on the procedure of calculation. The objective was to test whether and to what extent the results of different procedures differ. METHODS AND RESULTS: The authors demonstrated that the method of calculation of this index has a marked impact on the result. The greatest discrepancy was due to differences in the distribution volume of urea (or total body water) where the mean difference was 10% of the absolute value. Also the procedure used to assess the residual renal function can influence the result. Differences due to the method of collection of the dialysate for assessment of the urea concentration are insignificant. The mean difference between the maximal and minimal BP/V index, when different methods of calculation are used, was in the same patient 0.45, which is cca 25% of the total value. CONCLUSIONS: The BP/V index must be assessed always by the same method with maximum accuracy. When presenting results or comparing results of different departments, the method of calculation must be stated.

Adult↗
PubMed1998

Anion gap and hypoalbuminemia.

OBJECTIVES: To show how hypoalbuminemia lowers the anion gap, which can mask a significant gap acidosis; and to derive a correction factor for it. DESIGN: Observational study. SETTING: Intensive care unit in a university-affiliated hospital. SUBJECTS: Nine normal subjects and 152 critically ill patients (265 measurements). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Arterial blood samples analyzed for pH, PCO2, and concentrations of plasma electrolytes and proteins. Marked hypoalbuminemia was common among the critically ill patients: 49% of them had serum albumin concentration of <20 g/L. Each g/L decrease in serum albumin caused the observed anion gap to underestimate the total concentration of gap anions by 0.25 mEq/L (r2 = .94). CONCLUSIONS: The observed anion gap can be adjusted for the effect of abnormal serum albumin concentrations as follows: adjusted anion gap = observed anion gap + 0.25 x ([normal albumin] [observed albumin]), where albumin concentrations are in g/L; if given in g/dL, the factor is 2.5. This adjustment returns the anion gap to the familiar scale of values that apply when albumin concentration is normal.

Acidosis↗
PubMed1996

Introduction of a new laboratory test: an econometric approach with the use of neural network analysis.

We designed a simulation model for the assessment of the financial risks involved when a new diagnostic test is introduced in the laboratory. The model is based on a neural network consisting of ten neurons and assumes that input entities can have assigned appropriate uncertainty. Simulations are done on a 1-day interval basis. Risk analysis completes the model and the financial effects are evaluated for a selected time period. The basic output of the simulation consists of total expenses and income during the simulation time, net present value of the project at the end of simulation, total number of control samples during simulation, total number of patients evaluated and total number of used kits.

Chemistry, Clinical↗
PubMed1996

A strategy to promote the rational use of laboratory tests. International Federation of Clinical Chemistry.

These guidelines suggest how clinical chemists may promote rational laboratory use by critically evaluating the tests they offer. This may be done by documenting the clinical uses and limitations of tests in the same way that properly written up method descriptions outline analytical procedures in a particular laboratory. This information can then be promoted on result report forms, in discussion or through investigational protocols or clinical guidelines. For these to be of value they should be the result of clinical and laboratory input reflecting the local practice and facilities. They should be clearly written, easily accessible to the users and updated whenever there is a change of methodology or clinical practice. Much can be achieved by applying common sense to common knowledge and laboratories of all sizes can prepare their own material. However, national scientific societies and other professional organisations can assist local endeavour by avoiding and disseminating educational material on test evaluation, selection and use.

Clinical Laboratory Techniques↗
PubMed1996

A strategy to promote the rational use of laboratory tests. IFCC Education and Management Division Committee on Rational Laboratory Use. International Federation of Clinical Chemistry.

The following guidelines suggest ways in which clinical chemists can promote rational laboratory use by critically evaluating the tests they offer. This may be done by documenting the clinical uses and limitations of tests in the same way that clearly written method descriptions outline analytical procedures in a particular laboratory. This information can then be disseminated on result report forms, during discussion, or through investigational protocols or clinical guidelines. For the information to be of value, it should be the result of clinical and laboratory input reflecting the local practice and facilities. The material should be clearly written, easily accessible to the users, and updated whenever there is a change in methodology or clinical practice. Much can be achieved by applying common sense to common knowledge, and laboratories of all sizes can prepare their own material. In addition, national scientific societies and other professional organizations can assist local endeavors by providing educational material on test evaluation, selection, and use.

Clinical Laboratory Information Systems↗
PubMed1995

Computerized form of Siggaard-Andersen's double chart.

A description of the computer program IEFPlus is given. The program is based on the sodium-potassium double chart for classification of salt-water disturbances presented by Siggaard-Andersen. Input variables of the program are: 1. the concentration of sodium in the plasma, representing the sodium concentration in the Ecf, 2. the relative potassium deficit or excess in the Icf. estimated on the basis of the plasma potassium concentration and the blood pH, and 3. the total water excess or deficit in the body estimated on the basis of the change in body weight. Output variables are: 1. the sodium excess or deficit in the Ecf, and 2. the volumes of the Ecf and Icf (and/or the changes in either one). This simple model is displayed in one screen showing the values of all the essential parameters many of which can be easily changed. A graphic display of the Icf and Ecf volumes is also given. IEFPlus enables the user to predict the effect of sodium and water administration. Similarly the effect of renal or extrarenal water and sodium losses can be taken into account.

Body Water↗
PubMed1995

Modelling of acid-base equilibria.

A quantitative evaluation of metabolic acid-base component is described. The model is based on Stewart's analysis of acid-base chemistry. The metabolic component of acid-base disturbances is divided into four partial metabolic disorders; they can result from abnormal concentrations of chloride, albumin and phosphate disturbances, or from appearance of abnormal unidentified strong anions. The efficiency of the model is sufficient, quantitative partial results are given in the same units as base excess. In complex acid-base disturbances, such as are seen in critically ill patients, a detailed analysis of the specific components of the metabolic acid-base status allows one to plan specific therapeutic interventions.

Acid-Base Equilibrium↗
PubMed1990

[Suitable variables for the evaluation of combined acid-base disorders: residual anions, buffer base sera, proteins and delta bases].

In 254 findings of the acid-base balance ions and proteins, the authors evaluated mutual relations between the acid-base balance and calculation from the anion column. Contrary to the commonly used anion gap value, the authors used concurrently for evaluation buffer base sera, serum protein values and residual anions. The logical result of summarization of these three parameters is the creation of a new term, delta bases, which correlates closely with the resulting metabolic acid-base situation. The optimal relationship of the mentioned parameters to the value of base excess is described by the following equation: BE = 0.805*BBS--0.852*RA--0.204*SProt--15.8 which is consistent with the theoretical value of delta bases.

Acid-Base Equilibrium↗
PubMed1989

[Prognosis in patients in intensive care from the aspect of renal function].

The authors evaluated in 82 patients 228 findings of renal functions. Twenty-nine patients with a total number of 113 findings died. In those who died frequently the values of renal functional parameters were beyond the reference limits, indicating various failures (high serum creatinine, high serum urea, elevated fractional osmolal and water excretion, reduced creatinine clearance). In those who died tubular osmotic diuresis was more frequent, while overflow osmotic diuresis was found mostly in the surviving patients. By means of linear discrimination analysis vectors of parameters were assessed suitable for evaluation of the relationship of renal functions and the prognosis and functional shapes of so-called renal prognostic indicators. In the calculation of renal prognostic parameters the following ones prove useful: serum creatinine (SKrea), creatinine clearance (CKrea), serum osmolality (SOsm), osmolality of urine (UOsm), sodium cation in serum (SNa), fractional excretion of water (FeH2o), of potassium (FeK), osmolal (FeOsm), urinary excretion per 24 hours of creatinine (DuKrea), sodium (DuNa) and potassium (DuK). The best prognostic effectiveness was obtained from the calculation of the renal prognostic indicator (RPU) according to the following equation: RPU = SOsm.0.0178--CKrea.0.944 + FeK.0.854 + + DuKrea.0.0665--DuNa.0.0022 + DuK.0.0047--4.931. The RPU value rises with the deteriorating prognosis of the patients; in those who died it reaches more frequently positive values, in surviving patients the values are negative. By reclassification, using this prognostic index, 82% of the patients with a favourable prognosis and 68% with a poor prognosis (those who died) were correctly classified, i. e. a total of 74% patients.

Critical Care↗
PubMed1989

[Renal function parameters in patients in intensive care].

82 patients treated at a ward of anaesthesiology and resuscitation had 330 renal function tests performed using a computerized programme. While glomerular functions were often preserve or even increased, tubular functions displayed a broad spectrum of disorders. --Nosocomial effects may have a significant role to play there. Extreme changes in regulation as regards impaired ADH involvement are nothing exceptional. Tubular osmotic diuresis and overflow osmotic diuresis are the most frequent types of diuresis, while lower frequency is seen in water diuresis, mixed water and tubular osmotic diuresis, and mixed overflow and tubular osmotic diuresis. The therapeutical effects of the incidence of overflow osmotic diuresis and wider use of aldosterone antagonists are discussed.

Critical Care↗
PubMed1989

Evaluation of renal functions--a computer programme.

The authors describe the operational characteristics of a computer programme, which they developed and routinely use, to facilitate the evaluation of renal function tests data. Upon input of the necessary biochemical parameters the values of the various clearances, fractional excretions and other indices and ratios obtained from renal function tests are calculated. The computer programme provides an output of diagnostic commentaries in text format for further evaluation by the attending physician. The programme is written in FORTRAN IV language.

Diuresis↗