Biomedical subjects
Publications and source records attributed to J Marek.
At the Third Surgical Clinic, Charles University Prague a Nd:YAG laser, manufactured locally, MEDICALAS, was used to remove a hepatic tumour with a diameter of 3 cm. The authors used a continuous mode, a wavelength of 1064 nm, a non-contact focusing terminal and output of 100 W. The patient was discharged, healed, on the 11th day after operation. The operation which had no complications was the first of its kind in Czechoslovakia.
Pheochromocytoma is still a dangerous disease which is often difficult to diagnose. Evidence of the wide spectrum of its clinical picture was found in a group of 13 patients who were examined in the last 5 years. Drawing on their experience, the authors evolved a scheme of diagnostic examination. The primary biochemical examination involves the determination of urinary excretion of free catecholamines adrenaline, noradrenaline and dopamine simultaneously with their methylated metabolites metanephrine and normetanephrine, which help to make a more exact diagnosis in cases where the results of free catecholamines are not clear. Patients with pheochromocytoma lack diurnal rhythm of catecholamine excretion and thus the collection is made twice - by day and night. The determination of plasma catecholamines provides additional information. Only half the patients were found to have the level of vanillylmandelic acid increased. A significantly increased dopamine excretion points to the malignant form of the disease. The localization is established with the aid of computed tomography and, if needed, also by the determination of plasma catecholamines through selective cavae sampling. The final step serving to verify the diagnosis involves analysis of catecholamines in tumour tissue.
The studied group comprised 38 boys and girls aged from 7 months to 5 years with chronic pyelonephritis. Counts of B and T-cells and serum concentrations of IgG, IgM, IgA were determined. A significant depression was noted of the per cent proportion of T-cells in relation to the control group of healthy children with a significantly lower IgM concentration without significant changes in IgG and IgA levels.
Immunohistological tests for pepsin and gastricsin were carried out in bioptic samples of 51 patients with carcinoma of the stomach. Pepsin was detected in only 2 cases (4%), gastricsin in 26 patients (55%). Compared to the histological picture, the rate of incidence of gastricsin showed no difference between the intestinal and diffuse types of this tumour. In all examined cases, only gelatinous carcinomas were negative. Nor were any differences found in the cardia, the body or antrum. Surprisingly, these enzymes were found in the cytoplasma of neutrophylic granulocytes in the inflammatory infiltrate of the mucosal and tumorous stroma. Intestinal metaplasia of the epithelium was always negative even in the neighbourhood of positive tumours. The detected changes are evidence against the possibility of different histogenesis of the diffuse and intestinal forms of carcinoma of the stomach as well as against the possibility that intestinal metaplasia in a chronic inlammation of the stomach could be regarded as a direct first stage of the intestinal form of carcinoma of the stomach. In cases of metastases of unknown origin, pepsin and gastricsin cannot serve as markers due to their insufficient organ and cell specificities.
There were investigated 42 nephrectomy and heminephrectomy specimens with proved vesicoureteral reflux and 113 specimens of various forms of obstructive nephropathy (17 cases of primary obstructive megaureter, 50 cases of pyeloureteral junction stenosis and 12 tumorous, 16 iatrogenic and 18 stone obstructions of the ureter). Macroscopic and microscopic findings and the distribution of immunohistologically determined Tamm-Horsfall protein were estimated. The comparison revealed that despite of some differences there are in some case many similarities on the histological level caused by common sharing of main pathogenetic and etiologic factors i.e. intrarenal reflux and/or urinary tract infection. The most difficult differential diagnostic problems may arise mainly in the group of primary obstructive megaureter and in some patients with the stenosis of pyeloureteral junction. In dubious cases macroscopic picture and clinical data have to be thoroughly evaluated.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Hypogonadal men of different aetiology were administered testesterone undecanoate (Andriol, Organon) and methyltestosterone (Agovirin coated tablets, Spofa) for three months alternatively. By means of specific radioimmunoassays excretion of testosterone and methyltestosterone respectively in the urine was observed in 20 and 5 patients respectively. The course of excretion of both the preparations is possible to illustrate by decreasing curves with apparent half-lives 1.74 and 3.90 day respectively. Analogous observation of testosterone excretion after three-month administration of testosterone isobutyrate (Agovirin depot) to five female-to-male transsexual patients was observed. Excretion course shows the maximum on 27th day after the treatment was discontinued and it is not possible to illustrate it by a monotonous curve.
Clinical examination and blood pressure measurement over the ankle in 31 patients with acromegaly, showing signs of active disease, did not reveal manifestations of obliterative arterial disease in the lower limbs. Sixteen of the patients had a normal blood pressure; in none of them did the authors find a deviation of blood flow in the foot and in the calf at rest and during reactive hyperaemia following 5-minute ischaemia. Fifteen patients with hypertension were found to have increased resting blood flow in the foot and calf and increased blood flow in the foot during reactive hyperaemia.
Fetal echocardiographic findings were compared with autoptic ones in 11 from 22 fetuses and neonates with prenatal diagnosis of a congenital heart malformation. Pregnancy was interrupted on mother's desire in 7 from these 11 cases and completed by delivery in 4 cases. Diagnosed heart anomalies included ectopia (2), double outlet right ventricle with other malformations (2), tetralogy of Fallot (1), complete atrioventricular canal (1), syndrome of visceral symmetry (levoisomerism) with aortic atresia and common atrium as well as ventricle (1) and pulmonary atresia with a dysplastic tricuspid valve (1). Autoptic verification of a broad spectrum of heart malformations diagnosed in utero showed a developing potential of fetal echocardiography. A prenatal diagnosis of malformation enables to interrupt pregnancy in indicated cases. A complete morphological examination has particular demands on pathologist's attitude and training.
Based on experience with the examination of 33 children with total anomalous pulmonary venous return (TAPVD), the authors submit on account of basic echocardiographic (ECHO) findings and the examination procedure in TAPVD. The findings of two-dimensional ECHO reveal a typical enlargement of the right atrium and ventricle; in the four-chamber projection the pulmonary veins do not enter the left atrium but they join behind the left atrium. The site of the orifice of TAPVD in supracardial TAPVDS is found from a suprasternal approach, in intracardial TAPVD in the four-chamber projection, in infradiaphragmatic TAPVD from a subcostal approach. Doppler echocardiography reveals an impaired venous flow in the confluent on the pulmonary veins and in structures into which the pulmonary veins lead. ECHO makes it possible to assess the diagnosis of TAPVD by a non-invasive approach, to find the site of the orifice and indicate operation without the use of invasive examination methods.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Reports are presented demonstrating a technique for dissolving thrombus in coronary arteries and bypass grafts by using prolonged selective infusion of urokinase via an infusion wire. This allows one to pass a steerable guide wire through the culprit stenosis and perform angioplasty on a distal lesion which could not be previously seen.
UNLABELLED: During a 3-year period, intravenous streptokinase (IV STK) was given to 110 consecutive patients ages 34-78 in the course of acute myocardial infarction (AMI) in three community hospitals served by the same paramedic system. 1.5 million units of IV STK was given over 30 minutes. Half of the patients were brought to the hospital by paramedics. The average time from onset of pain to administration of IV STK was 107 minutes in the paramedic group and 182 minutes for the others. Of 110 patients, 98 (89%) showed clinical evidence of reperfusion and 94 of 106 patients (89%) showed angiographic reperfusion. Angiography was performed from 1 to 10 days post-AMI. Mean time to angiography was 6 days for the first 58 patients and 2 days for the last 52 patients. In-hospital mortality was 2 of 110 patients and there was 1 late death at 8 months for an overall 3-year mortality 2.7%. Of 86 patients, 83 (96%) working before their infarct are working now. Of 107 survivors, 96 (90%) are Functional Class I. CONCLUSIONS: (1) IV STK is safely administered in a high percentage of AMI patients. (2) IV STK is safely administered in community hospitals. (3) Paramedics act as an early warning system and allow for earlier treatment than patients presenting without paramedic involvement. (4) Successful coronary reperfusion with IV STK results in low mortality rates and minimizes functional disability. (5) A system-wide approach to reducing time to treatment in AMI may be the most influential factor in affecting morbidity and mortality.
Explore the source record for details and available documents.
The occurrence of blood isoantigens, demonstrated using an immunofluorescence technique in urothelial tumours of 40 blood group A, B, or AB patients who had been treated and followed up during the years 1977-1983, has been compared with their histological grading and clinical course. In both of the 2 papillomas and 35 grade I papillocarcinomas, a positive expression of the relevant isoantigens could be demonstrated, while all of the 19 grade III papillocarcinomas just as the 22 anaplastic carcinomas always proved negative. In a group of 34 grade II papillocarcinomas, 21 of the tumours proved positive and 13 negative; with all tumours showing signs of invasiveness being always negative. Correlation of these results with the clinical courses of the disease did not exhibit such unequivocal results, even though, in a group of 7 patients who had died of a generalized urothelial carcinoma verified by post-mortem, all of the 19 examinations that have been performed proved, with the exception of one, to be negative. These results confirm the fact that identification of blood isoantigens may help to reach a more accurate prediction of the biological behaviour and prognosis of urothelial carcinomas, especially, among grade II papillocarcinomas since loss of the antigen expression appears to be related to the tumour's capacity of invading the mucous stroma.