Biomedical subjects
Publications and source records attributed to J Leypold.
The authors present their initial experience with percutaneous endoscopic gastrostomy and draw attention to its advantages and risks. As a basis they use their own group of patients, most of them in a very poor condition where it proved possible to ensure by this method enteral nutrition on a long-term basis.
Since the year 1989 the authors, surgeons, performed more then 1600 ERCP. In the period of 1992 to 1995 urgent ERCP was indicated in one hundred cases when block of papila Vateri, cholangitis or acute pancreatitis were suspected. Our results in ERCP were: cholangitis with common bile duct stones 14, pancreatitis acuta biliaris 53, pancreatitis acuta nonbiliiaris 28, other diagnosis 1. In 4 cases, ERCP was unsuccessful. Endoscopic papillosphincterotomy (EPS) was indicated in all patients after the successful ERCP with pancreatitis or cholagitis. We achieved success in urgent EPS in 92%. No patient died owing to ERCP or EPS. From our point of view urgent ERCP and EPS are important diagnostical and therapeutical methods in patients with cholangitis and pancreatitis biliaris which may be performed as soon as possible. (in our cases all patients undergo ERCP and EPS no later than six hours after their admission to the hospital). In case of nonbiliaris pancreatitis we prefer and have good results with EPS too, but our number of these patients is too small to be generalized. (Tab. 5, Ref. 13.).
The authors describe their own experience with the surgical treatment of the upper thoracic aperture syndrome-TOS-during the period of 14 years. During this period on account of this diagnosis at the Surgical Clinic in Brno 112 patients were operated, whereby the resection of the first rib was always done by the transaxillary approach. The authors describe in detail the symptomatology, diagnosis and surgical treatment. They emphasize the advantages of the transaxillary approach. In the conclusion the authors discuss the fact that only in 45% of the operated patients the symptoms disappeared. This leads to reflections on more strict criteria for the surgical treatment of this syndrome.
The study is based on the evaluation of a study group consisting of 61 patients who underwent surgery for liver tumors in the 2nd Surgical Clinic in Brno between 1994 and 1996. Liver resections were carried out in 39 patients, port-systems for regional chemotherapy were implanted in 29 patients. In recent years, port-systems have been inserted even in liver resections in indicated cases. The median survival after liver resection for hepatocellular carcinoma was 43 months, for colorectal carcinoma metastases it was 32 months. The in-hospital mortality was 3.4%.
A carotic-subclavian bypass is an extraanatomical reconstruction. It is one of the possibilities how to connect the ipsilateral common carotid and subclavian artery. The authors evaluate carotic-subclavian bypasses made during the past 11 years at the Second Surgical Clinic in Brno. In all twelve cases carotico-subclavian bypasses were involved, in none of the patients a subclavian-carotid bypass was involved or direct anastomosis. The author discusses in detail preoperative complaints, associated diseases, postoperative complaints. In his opinion absolute indications for surgery are neurological symptomatic affections even of one trunk, incl. subclavian steal syndrome. They indicate asymptomatic affections for surgery if at least two trunks are affected. The greatest pitfall of the operation is in their opinion the selection of the length and type of vascular prosthesis. They find that the interval patency rate 100% and the cumulative patency rate 85% evaluated by the method of "Life table analysis" with a standard error of patency rate of 9% are comparable with similar reports from abroad.
The authors describe in their paper possibilities of surgical and intervention treatment of an aneurysm of the lienal artery, their advantages and disadvantages. They evaluate the results of treatment of aneurysms of the lienal artery in three patients treated at the Second Surgical Clinic in Brno in 1993-1996. In the first patient the aneurysm was resected concurrently with splenectomy. In the second patient resection of the aneurysm with end to end anastomosis of the lienal artery was made. In the third patient the method of artificial embolization of the aneurysm of the lienal artery was used. The results are good. The first two patients were discharged ten and nine days resp. after surgery and are in a good clinical condition. The third patient had treatment in four sessions within two months and the final effect is a completely embolized aneurysm of the lienal artery with a preserved blood supply of the spleen and its intact function. The authors maintain that when dealing with an aneurysm of the lienal artery the surgeon has several possibilities and it is up to him which possibility he will chose with regard to anatomical conditions, the patients general condition and his own abilities and possibilities. The authors recommend if possible to preserve the spleen as a functioning organ or to preserve at least its immunological function.
The authors evaluate in the submitted paper the results of surgical treatment of embolization into the bifurcation of the abdominal artery at the Second Surgical Clinic in Brno during 1990-1996. A total of 5 patients was involved whereby in all a cardiac cause of the embolization was obvious. The authors deal also with the time which has elapsed between the development of complaints and surgery, the type of anaesthesia, average length of operation. The operation is implemented concurrently by two teams as antero- and retrograde simultaneous bi-transfemoral embolectomy. The authors emphasize the importance of the metabolic condition of the patient as well as cardiac and renal functions before, during and after surgery. They consider the application of peroperative haemodialysis essential. During the postoperative period it is important to find the objective cause of the cardiac deficiency and treat it. Their results--a 40% mortality are comparable with those of other specialized departments. By comparison with a similar group treated at the same department twenty years previously the authors find a decline in the incidence of this disease and explain this phenomenon by an increased number of cardiosurgical operations in this area.
As a cause of septic shock, peritonitis biliaris is a very serious condition. We stress the risks of its development and necessity of postoperative drainage in laparoscopic cholecystectomy. The risks include a cholascos which may develop after some radical procedures of a "non-operative" nature on the liver parenchyma and bile passages (transperietal or endoscopic procedures).
The results of 3061 laparoscopic cholecystectomies made by 58 surgeons in nine departments--feasibility 88.9%, low morbidity rate (n = 2071) 11.8%, high morbidity rate 2.48%, mortality rate 0.22%, residual choledocholithiasis 1.36%, preoperative use of endoscopic methods 1.0%, revision in a total of 1.8%--are as a rule less favourable than summarized statistical data from abroad. Similarly as in data abroad the incidence of biliary lesions is not satisfactory--0.65%. The incidence of fistulas (0.13%) revisions on account of haemorrhage (0.29%) and surgical preoperative accidents (0.24%) was lower. Departments which use thermocoagulation have a significantly lower incidence of lesions (0.14% - p < 0.06) than teams working with electrocoagulation.
Early results of an initial non-selected group of 50 laparoscopic cholecystectomies (mean hospitalization 3.5 days, 6% conversions, no serious complications, no revisions, morbidity due to minor complications 6.3% and saved costs of postoperative hospital treatment 44.6%) confirm that this operation is feasible, safe, preferred by patients and well tolerated economical definitive treatment of cholecystolithiasis. On these grounds it is becoming a method of first choice. The safety of patients is ensured by steady care of the surgeon and his adequate training according to generally accepted principles.
The authors describe one possible way of endoscopic haemostasis, i.e. by bipolar coagulation. First they give an account of the principle of the method and technique of coagulation. Then they demonstrate on their own group of patients with haemorrhage into the gastroduodenum a 71% effectiveness of haemostasis by this method. In another 10% a temporary effect was achieved with the possibility of effective supplementation of the blood volume and thus an improved prognosis of surgery. In case of failure, in particular haemorrhage according to Forest Ia, they warn against any delay of surgery.
The authors present their own experience with the use of a hot-jet coagulator in resections of the liver. The principle is based on contact-free transmission of thermal energy by means of a current of hot air to achieve haemostasis and tissue coagulation. They mention the use of the apparatus in animal experiments and in resections of the liver in nine patients. They recommend the procedure as one possibility of haemostasis where conventional methods do not affect haemostasis.
The authors present the experience of their department with resections of the liver. Their main attention is focused on indications and the technique of operation. During the period from 1981 to April 1990 at the Surgical Clinic in Brno 50 resections of the liver were made. Thirty patients with benign diseases were operated and 18 patients with malignant diseases. The group comprised only those resections where at least one liver segment was removed. In two patients re-resection on account of a tumour relapse was performed. For arrest of haemorrhage from the resection area the authors recommend in addition to careful surgical treatment also the use of fibrin glue.
Patient with gastric volvulus of secondary type due to paraesophageal hernia is reported. The possibility of gastric volvulus has to be considered in light of the severity of the condition and its relatively rare occurrence. Contrast esophagography and swallow in the lateral projection will confirm the diagnosis.
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