Biomedical subjects
Publications and source records attributed to C Neoral.
The authors describe their experience with laparoscopic fundoplication the way they have made it in first 18 ill persons at the Ist. Department of Surgery in Olomouc. They find the advantage of this operational technique in outstanding overlook and anatomical orientation in the oesophageal hiatus, reduction of post operative discomfort, shortening of recovery and the length of hospitalisation. In indicated cases we consider this procedure to be optimal.
Advanced achalasia with serious additional complications is quite rare. It should be seen mostly in individuals who were already unsuccessfully operated. The way definitively solving both dysphagia and the complications of advanced achalasia is the resection of oesophagus. Authors are showing their experience and according to the clinical appearance of the disease and histological examination of the whole extirpated thoracic oesophagus they are discussing acceptability of the extirpation of the whole thoracic oesophagus using regardful technique without thoracotomy. (Tab. 2, Fig. 3, Ref. 8.)
The authors discuss the problem of relapses of gastric cancer, the conditions of its development and its possible treatment. As a basis they use experience with the treatment of 167 patients operated on account of this condition at the First Surgical Clinic in Olomouc in 1986-1993. In these patients 77 radical operations were performed, 25 developed a relapse of the tumor. Only in two patients it was possible to perform another resection--total gastrectomy. In these two re-resected patients the mean survival period was 9 months, in the remainder only two months. The authors conclude that in relapses of gastric cancer even several months' survival are a success.
The authors evaluate the advantages and shortcomings of cervical anastomosis of the oesophagus by means of stapler according to the following criteria: 1. difficulty of implementation, 2. immediate results--fistulae, 3. long-term results--stenoses, 4. costs. The authors operated, using a stapler, 26 patients who developed in four instances /15.4%/ a fistula. By comparison with a retrospective group of 21 patients with eight fistule /38%/ where the anastomosis was sutured manually, they found that by using a stapler the number of complications declined. A disadvantage is the high price of staplers.
Method of interrupted ischaemization of the liver afflicted with metastases from colorectal cancer is not definitively evaluated yet. Using the literary reports the authors proposed (in cooperation with MEDIN) a instrument for compression of the liver artery, economically easy available. The reability of this instrument was tested in model conditions and his safety to the tested artery was proved on the experimental animal.
The cause of large solitary hepatic metastasis is mostly the colorectal cancer, rarely also the cancer of breast, kidney, gynecologic organs, the melanoblastoma and the nonepithelial tumors of the stomach. These metastases, when they are proved as solitary, especially with long interval after removing the primary tumor, are well indicated for liver resection till hemihepatectomy. The authors treated successfully a large metastasis of malignant schwannoma, eight years after resection of the stomach with the primary tumor. Morphologic characteristics and biologic activity of primary tumors of this kind are discussed.
Patients with advanced achalasia, accompanied by severe complications can be seen only rarely today. In these patients, resection of the esophagus has to be considered. The modern technique of extirpation of the whole thoracic esophagus without thoracotomy is a sparing intervention capable to solve the problem of dysphagia as well as the complications of advanced achalasia. The authors describe their favourable experience with this technique in three patients. The evidence for such radical treatment appears from the clinical picture and the microscopical findings in the resected specimens.
The authors present an account of their experience with retrosternal oesophagocoloplasty as a palliative by pas in inoperable carcinoma of the oesophagus. They differentiate secondary and primary indications. So far they used this operation in 27 patients. The total lethality is 33%, the mean survival period is 8 months. Some patients with the unilateral paresis of the left recurrent nerve have laryngoesophageal dysfunction with the danger of aspiration during swallowing. The shape, position and function of the paretic vocal cord can be favourable influenced by the administration of hydrophile gel into the vocal cord by the endoscopic route.
Serum amino acids level examination of the oesophagus carcinoma patients admitted to I Surgical Clinic of Teaching Hospital in Olomouc from 1/1/1990 to 31/7/1991 were carried out by the authors. The standard values were found with the group of patients with resectionable tumor or with a tumor in non-advanced stage on the one hand and on the other hand there were some lower values with the patients with a tumor in an advanced stage. In this way two groups of the sick were examined--the first one with benign oesophagus stenosis accompanied by nutritional disorder, the second with resectionable lung carcinoma without nutritional disorder. Serum amino acids level examination is therefore considered to be rather an indicator of the important factor of a possible surgical treatment of a tumor.
In morphological study on the dead bodies the authors have followed with coloured injections of stomach arteries of pyloroanthral region under "physiological" pressure the vascular supply of mobilized stomach applied for the substitution of chest gullet. They found that the right gastroepiploic artery is much more important compared with right gastric artery, and further, that the gastric tube formed from the great curvature is much better supplied than the whole stomach. These conclusions correspond with clinical experiences with esophagogastroplastics.
The reliability of HPI measurement was studied in animal experiment. The portal vein of experimental dogs was narrowed by application of a metallic coil. The induced portal hypertension with important hepatofugal collaterals appeared to be a suitable model for the study of changes in HPI. A decrease in the index was statistically significant and corresponded to the hemodynamical efficiency of collateral circulation. The original experiment verified the reliability of HPI for an assessment of direct perfusion of the liver by portal blood.
Prehepatic portal hypertension is mostly caused by an inflammatory closure (thrombosis) of the portal vein in the perinatal period. This form of portal hypertension is characterized by the following considerable facts: patients' liver is not damaged and a divergent collateral circulation (hepatofugal and hepatopetal) is formed. Due to the latter, portal circulation may improve spontaneously and no clinical signs of the disease are manifested. Most patients, however bleed rependedly from the cardioesophageal varices with various frequency and various severity. A direct surgical intervention had been successful in about 50% of cases. At present, it is almost replaced by endoscopic sclerotization giving compatible results. The pathogenetically based surgical method is the portosystemic shut that is necessary in 20% of patients, mostly as a secondary intervention. Pathophysiological sequelae of the shunt are less severe than in cirrhotic patients due to intact liver of patients with PPH and to favorable possibility of recirculation of portal blood via the hepatic artery. An appropriate therapeutical strategy accounts for favorable long-term prognosis of patients with prehepatic portal hypertension.
The authors describe their experience with liver resection by means of an suction knife. In animal experiments, the optimal value of under-pressure for an effective and non-destructive function the knife was tested and the healing process in the vicinity of the cut surface was followed. This simple device was developed that allows evaluation of the results of liver resection (segmentectomy to hemihepatectomy) in clinical practice. The method was applied in ten out of twenty patients in which liver resection was performed in the last fourteen months. The inexpensive device functioned to the authors full satisfaction.
In a long-term experiment on dogs the lumen of the portal vein was reduced to one fifth by insertion of a metal spiral. The thus created disorder of the portal circulation was succeeded by the development of abundant hepatofugal collaterals and the development of mild portal overpressure without clinical manifestations. The altered portal circulation was followed up by dynamic hepatobiliary scintigraphy for a period up to 12 months. It was revealed that the curve of isotope movement through the liver was altered in a way suggesting slower perfusion of the liver by portal blood. This observation resembles those in patients with prehapatic portal hypertension and their confirmation. The investigation is documented by morphological, X-ray and isotope methods.
Achalasia of the esophagus is combination of dysfunction of the lower esophageal sphincter and disorder of the peristaltic movement of the esophageal body. Both components influence one another in a negative way, but the first usually prevails. That is why satisfactory and long-term results can be obtained in most of patients with non-advanced achalasia by Heller's myotomy. In a small group of patients with disease of megaesophagus-type (disorder of the motility of the esophageal body prevails) and in patients in which their disease reach for various reasons the stage of advanced (decompensated) achalasia, the resection-surgery is etiopatogeneticly justified. At the Ist and IInd surgical clinic in Olomouc 331 patients with achalasia have been operated so far. 29 patients treated by resection of a shorter or longer portion of the aboral esophagus, in 2 patients the whole thoracic esophagus was extirpated without thoracotomy. Resection was in principle indicated as secondary treatment. To substitute the esophagus the stomach in various operative modifications was used in two thirds of the patients, in the remaining patients interposition by a segment of the small or large intestine was carried out.
The authors describe two observations of primary hyperaldosteronism, caused by a cortical adrenal adenoma (Conn's adenoma). Both patients were treated by unilateral adrenalectomy from lumbotomy. (In the second patient subtotal resection). The problem is discussed from the aspect of morphological diagnosis and location with emphasis on the primary importance of CT. The surgical operation is aimed and simple without the necessity of peroperative confirmation of the morphological background of the syndrome.
Report is given on a group of dogs the portal vein of which was narrowed to 1/5 by putting on a metal spiral. A disorder of the circulation of the portal blood induced in this way was followed by opening of the effective hepatofugal collaterals and forming of slight portal hypertension without clinical manifestation. The changed portal circulation was studied by means of dynamic hepatobiliary scintigraphy within 12 months. It was found out that the curve of progression of the isotope through the liver had been changed in a way which corresponded to slowing of perfusion of the liver by the portal blood. It is analogous to observation of patients with PPH and its verification. The study is documented by morphological, X-ray and isotopic methods.
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