Biomedical subjects

J Horejs

Publications and source records attributed to J Horejs.

At least 19 recordsLinked to original sources

PubMed2005

[Laparoscopic diagnosis and treatment of organic hyperinsulinism--our first experience].

Laparoscopic pancreatic procedures are still at the stage of evaluation with regard to their indications and the technical variation used. Laparoscopic pancreatic surgery is currently used for staging malignant pancreatic tumours, for the resection of benign pancreatic tumours and for the occasional management of inflammatory disorders of the pancreas. Insulinomas are rare tumours with incidence per year of 0.1-0.4 per 100,000. Ist Surgical clinic, IIIrd Internal clinic and Radiological clinic are cooperating since 1971. On the list of IIIrd Internal clinic are 80 patients with insulinoma. Since 1971 at Ist Surgical Clinic 66 patients have been operated. In our article are diagnostic and therapeutic problems discussed. Laparoscopic pancreatic procedures are still at an evaluation stage regard to their indications and techniques. Authors give report about first experience with successful laparoscopic enucleation of insulinoma in case 83 year old woman (Fig. 3, 4). The operative time was 90 min. Drainage is necessary. CT guided drain in cavity of seroma is shown (Fig. 5).

Humans↗

PubMed2005

Non-recognized cause of intrathoracic bleeding.

The authors present a case report of bleeding from the small dissection of descending aorta. Patient, 71 year old woman, with severe comorbidities (nephrotic syndrome based on membraneous glomerulonephritis, diabetes mellitus, lung emphysema, hepatopathy, polyneuropathy and others). One month after last stay in hospital chemotherapy et corticotherapy. In while on heparin during hospitalization at nephrologic department, patient developed right side haemothorax and haemomediastinum. An urgent transfer to surgical department with cardiopulmonary resuscitation was performed. The suspection of aneurysm on CT angioscan was non confirmed. The damage of oesophagus due to previous endoscopy (for chest pain) was non confirmed, too. During surgery masive sanquine effusion of mediastinum and right side haemothorax was found. The drainage and redrainage of the chest was performed. The cause of bleeding was not found. Critically ill patient had died and on autopsy a small dissection of thoracic aorta was found as a cause of bleeding. The problems of diagnosis and therapy are discussed. (Fig. 2, Ref. 7.)

Aged↗

PubMed2005

[Duodenal stump closure--still a live problem. A case report].

Included is a case study of duodenal peptic ulcer bleeding. The patient was treated by Finsterer-Bancroft modification of II-type gastric resection. An early reoperation was indicated by reason of duodenal stump leak. The situation solved by means of duodenostomy. The authors discuss causes of duodenal stump insufficiency. Possibilities of prevention of this complication - which are cited in literature - are mentioned. Duodenostomy is a legitimate optimal solution of duodenal stump suture insufficiency.

Digestive System Surgical Procedures↗

PubMed2005

[Embolism of the upper mesenteric artery].

The article presents a case report of a 53-year-old man, who underwent abdominal surgery for the ischemic vascular necrosis of the small bowel and right colon of the embolic aetiology and who has had several serious comorbidities. Resection of the major part of the small bowel and right hemicolectomy with high jejunostomy and transversostomy was performed. Not only has the patient very well tolerated the first surgery, but he tolerated also the other one with recovery of passage continuity. The other surgery was necessary due to mycotic infection in the right atrium (vegetations at the heart pacing electrode). After 5 months the patient died because of generalisation of mycotic infection. The problem of mesenteric vascular occlusions is discussed.

Acute Disease↗

PubMed2005

GIST of pancreas.

Authors present the case (from the year 2003) of a 38 years old patient, female with large tumor in the abdominal cavity. Preoperative differential diagnostic examination showed either tumor of pancreas or left liver lobe. The surgery confirmed large tumor body of the pancreas. Histological and immunohistochemical examination determined gastrointestinal stromal tumor (GIST) of the pancreas from autonomous nerves with malignant character. Tumor was radically removed. In the postoperative period regular follow up was done at the department of oncology, abdominal ultrasound every 3 months, CT scan every 6 month. 2.5 years after operation the patient has no problems, CT scan is without signs of recurrent diseases. The analysis of GIST was performed in agreement with contemporary knowledge. According to the references, our case report GIST of pancreas is the first of this kind (till 2003).

Adult↗

PubMed2005

[Severe necrotizing pancreatitis during pregnancy].

A case report of 28-year-old pregnant women (34 week of pregnancy) with acute pancreatitis is presented. Likely cause of pancreatitis in the patient was extreme combined hyperlipidemia. The subject underwent seven complicated surgeries and with a necessity of prolonged intensive post-operative care. A year apart from the episode of acute pancreatitis both the patient and her baby are doing well. Pancreatic function has been restored and plasma lipid levels are, with appropriate medication, within normal ranges. Analysis of the problematic the relationship between hypertriglyceridemia, pregnancy and acute pancreatitis.

Adult↗

PubMed2004

[Jejunal perforation by a plastic biliary stent after injury].

The authors present case of patient with biliary stent dislocation after chest injury and fracture of VIII. rib. Polymorbid patient with cirrhosis, chronic pancreatitis, portal hypertension (Child Plugh B) and biliary stent insertion came with acute abdominal pain and inflammatory signs. Progressive signs of acute abdomen have led to laparotomy. Perforation of duodeno-jejunal-loop due to dislocated biliary stent, small loop adhesions and thickened intestine wall were found. Postsurgical period was complicated with obstructive ileus, cholecystitis and cholangiolitis and the second biliary stent was inserted. Present-day status of the patient is satisfactory.

Bile Ducts↗

PubMed2003

Severe late complication of appendicitis. Case report.

BACKGROUND: Diffuse necrotizing soft-tissue infections are severe due to their rapid progression; there is a vital need for settling proper early diagnosis. The task of the clinician is mainly in distinguishing localized infection from the diffuse process. CASE PRESENTATION: In our case report we demonstrate a 32 yr old man with a curious development of severe necrotizing infection of submucosis with gas production as a conclusion of perforation of Schloffer's tumour, which developed after appendectomy carried 20 years ago. CONCLUSIONS: In case of diffuse necrotizing soft-tissue infections only immediate surgical revision can confirm initial stages of severe forms of infection.

Abdominal Abscess↗

PubMed2002

[Treatment of metastatic liver tumors].

We had operated 72 patients for hepatic metastatic malignancies from 1991 to 2000. In 66 cases were colorectal metastases. Extend of operations were from no anatomical resections, segmentectomies to hemihepatectomies. Operating lethality was 5.5% and long time survival only 10%. In the same period we took arterial port for 22 patients for regional chemotherapy. Response rate was 20% patients. The first experience with radiofrequency ablation (we had 12 ablation procedure) show, that minimal invasive treatment (RFA) is good procedure for high-risk patients. If the patient is able to hepatic resection it will be still standard for treatment.

Humans↗

PubMed2002

[Choice of surgical procedure in operations for chronic pancreatitis--personal experience].

The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.

Chronic Disease↗

PubMed2001

[Post-resection dumping syndrome (case report)].

During the last twenty years a significant reduction of the number of gastric resections on account of peptic ulceration occurred due to better therapeutic possibilities in gastrodudodenal ulcers and due to changes in the epidemiology of gastric tumours. However, resections are made, frequently on account of complicated cases of unsuccessful treatment of ulcers in "treatment at any cost". This problem was frequently the subject of professional discussions. Therefore we consider it important to remind young colleagues of the omitted chapter of possible pathological conditions which develop after gastric resections. The latter include a group of vasomotor, gastrointestinal and humoral symptoms which develop as a result of the loss of reservoir function and the function of the closing mechanism of the pyloroantral part of the stomach after gastric resections in derivation surgery. In addition to data in the literature reporting that dumping syndrome is encountered only in 2-3% of any gastric operation the authors describe two of their own observations and the results of their surgical treatment.

Adult↗

PubMed2001

[Local staging of rectal carcinoma--comparison of endorectal ultrasonography and CT].

Correct staging of adenocarcinoma of the rectum is mandatory before any therapeutic choice is made. Important features are infiltration of the perirectal fatty tissue (T3 and T4) and the presence of locoregional lymphatic spread. Computed tomography with rectal air insufflation (CT) was compared with transrectal ultrasonography (TRUS) in 212 patients. Results of the preoperative examinations were compared with histological findings. The CT examination in evaluation of perirectal spread had an accuracy rate of 76%, sensitivity of 86% and specificity of 62%, the corresponding figures for TRUS were 83%, 91% and 66%. The accuracy, sensitivity and specificity of CT for nodal involvement were 51%, 57% and 50% and of TRUS 60%, 68% and 59%. These findings confirm that TRUS is more accurate than CT in local tumour staging (T) and in detecting nodal spread (A).

Adenocarcinoma↗

PubMed2000

[6 years' personal experience with duodenum-sparing procedures in chronic pancreatitis].

The First Surgical Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment of pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional cases MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 15 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was performed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 111 patients a drainage and duodenum sparing operation was performed. Of these in 46x according to Neger, 9x according to Frey, 10x modification of these operations, 37x Partington-Rochelle's procedure. The authors did not record postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patient s co-operation round 87% while after longitudinal drainage of the duct a satisfactory result was recorded in 78% of the operated patients. The authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deterioration of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 170 operated patients one patient with decompensated diabetes died. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.

Chronic Disease↗

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

Determination of the size of a foreign body in the eye using image analysis of its roentgenogram.

The case of a computer-enhanced image analysis of X-ray pictures of a pellet in the orbit of a man who sustained a shotgun injury to his right eyeball is presented. The man was shot accidentally during a pheasant hunt. Two hunters were shooting simultaneously but they were using three different sizes of pellet--3.0, 3.5 and 4.0 mm. One of the pellets hit a third man in the eye. He sustained serious injury with a resultant loss of sight in this eye despite immediate medical treatment. Unfortunately the pellet could not be removed from the orbit, but it was necessary to establish who was responsible for the injury. The problem lay in determining the specification and size of the pellet at that moment. The problem was solved using computer-enhanced video image analysis of the X-ray pictures of the pellets. The image processor LUCIA G (http(/)/www.lim.cz) was used.

Adult↗

PubMed1996

[Complications of arterial ports].

The authors present an account on an unusual complication of an arterial port inserted via the a. gastroduodenalis after four doses of cytostatics thus administered after a non-anatomical resection of the right liver lobe on account of a metastasis of carcinoma of the colon. The latter caused necrosis of the hepatoduodenal ligament and formation of a fistula into the biliary tree, fistula into the venous portal circulation and thrombosis of the hepatic artery.

Antineoplastic Agents↗

PubMed1995

[Ovarian teratoma (case report)].

Case-history of an accidentally detected teratoma, during X-ray examination because of back pain in a 44-year-old female patient. The teratoma contained a premolar and hair.

Adult↗

PubMed1995

Body fat assessment by a new bipedal bioimpedance instrument in normal weight and obese women.

The aim of the study was to evaluate a new bioimpedance method for assessment of body fat employing bipedal electrodes instead of those attached to both upper and lower extremities. The new analyzer (TBF-105, Tanita Corp., Tokyo, Japan) enables simultaneous measurements of body weight and total body resistance in a subject standing on the stainless steel electrodes. The instrument was tested in both normal weight and obese women. Fat mass estimated by bipedal bioimpedance was highly correlated with that determined by hydrodensitometry (n = 145, r = 0.945, p < 0.001). Fat mass estimated by bipedal bioimpedance significantly correlated not only with subcutaneous fat measured as a sum of 10 skinfolds (r = 0.758, p < 0.001) but also with visceral fat determined as an area on CT scan (r = 0.780, p < 0.001). Anthropometric variables did not substantially influence the differences revealed in fat mass determined by bipedal bioimpedance and by densitometry. An overestimation of total fat mass by bipedal bioimpedance has not been revealed in severely obese individuals, even in those with higher fat accumulation in the limb region. In conclusion, our data have demonstrated that the new bioimpedance instrument employing bipedal electrodes represents a reliable tool for rapid body fat assessment in both normal weight and obese women.

Adipose Tissue↗