Biomedical subjects
Publications and source records attributed to J Zizka.
We present two sibs with a distinctive phenotype and with stippled calcifications of the tarsal bones and sacro-coccygeal spine. They represent an apparently "new" form of chondrodysplasia punctata.
Aortic dissection is primarily localized in the thoracic aorta. Dissection of the abdominal aorta is exceedingly rare, especially in the absence of a blunt abdominal trauma. Two cases of a primarily infrarenal aortic dissection were diagnosed by US, CT and angiography. The patients were treated by stent graft placement. The stent grafts were introduced via a femoral arteriotomy through the introducer sheath and were placed so that they occluded entry and reentry of aortic dissection. The stent graft placement caused total obliteration of a false channel of the dissection immediately after endoprosthesis deployment. The patients were followed-up by CT and angiography at 16 and 3 months after surgery without complication.
A cyst of the choroid plexus of the left lateral ventricle with intermittent blockage of the foramen of Monro and initially with invagination of the III ventricle in a child is described. In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ballvalve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. Choroid plexus cysts localised in the anterior part of lateral ventricles are very rare, and all reported cases have been in male patients. According to the literature our case is only the third ever described in a child.
Endoluminal transfemoral repair of an abdominal aortic aneurysm by a stent graft placement requires a segment of the nondilated infrarenal aorta of at least 15 mm long for safe stent graft attachment. The possibility of endoluminal treatment of a juxtarenal abdominal aortic aneurysm with partially covered spiral Z stent was assessed in experiment and in three clinical cases. In the experiment, the noncovered spiral Z stent was placed into the abdominal aorta, across the origins of renal arteries and mesenteric arteries, in six dogs. In the clinical cases, a partially covered stent graft was attached in 3 patients with the juxtarenal abdominal aortic aneurysm (of the group of 12 patients with abdominal aortic aneurysm). The stent grafts were attached with proximal uncovered parts across the origins of the renal arteries. In experiment, the renal artery occlusions or stenoses were not observed 36 months after stent placement, and in clinic, 3 patients with the juxtarenal aortic aneurysm were successfully treated by stent graft placement. There were no signs of flow impairment into the renal arteries 14 months after stent graft implantation. This approach can possibly expand the indications for endoluminal grafting in the treatment of juxtarenal aortic aneurysms in patients who are at high risk for surgery.
Accurate preoperative examination and early diagnosis of possible recurrence of the disease play an important role in successful therapy of colorectal carcinoma. At present, modifications of classical examination are being applied, too. In this paper the first experience in using the CT pneumocolon for diagnosing the colorectal cancer is presented. The method improves the diagnostic possibilities of the classical CT examination technique. It enables to image the morphology of the tumour in the air insufflated colon lumen, tumour infiltration outside intestinal wall, localization of organs in the presupposed operation field and possible infiltration of lymph-nodes or liver metastases. The examination has proved easy to be performed with minimal patient's discomfort.
Endovascular treatment of aneurysms of the abdominal aorta is based on intravascular bridging of the aneurysm using of an endovascular prosthesis. The prosthesis must be safely anchored above and below the sac of the aneurysm in the non-dilated artery. Therefore the indication of endovascular treatment depends on the morphology of the aneurysm. The objective of the work was to analyse the morphology of the aneurysm with regard to the possibility of endovascular treatment. The morphology of the aneurysm was evaluated with regard to the angiographic examination and examination by computed tomography. The following parameters were investigated: diameter and length of the proximal and distal neck, diameter of the sac in two planes, diameter and tortousity of the iliac arteries, tortousity of the infrarenal aorta. A total of 70 patients with aneurysms of the abdominal aorta were examined. The patients were divided into three groups according to the morphology of the aneurysm. I. infrarenal aneurysms not affecting common iliac artery (n = 20) 28.5%, II. infrarenal aneurysms affecting common iliac artery (n = 38) 54.2%, III. juxtarenal aneurysms regardless of the affection of common iliac arteries (n = 12) 17.1%. Of the total of 70 examined patients 24 (34.2%) with infrarenal aneurysm and 6 (8.57%) with juxtarenal aneurysm were suitable for endovascular treatment.
BACKGROUND: A transjugular intrahepatic portosystemic shunt (TIPS) is the creation of a percutaneous portosystemic anastomosis which is used as an alternative method of surgical portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.
The clinical and electrophysiological data in 48 cases of congenital stationary night blindness (CSNB) are analysed. The existence of the complete (with only the cone part of the dark adaptation curve) and incomplete (some rod activity also present) form of this anomaly has been confirmed. The Schubert-Bornschein's type of ERG responses corresponds to the complete CSNB. After 12 years of observation period in some patients the diminution of both the a and b potential of the ERG curves but not the extinction of the ERG potentials has been found. PERG curves and PVEP responses in CSNB are normal. Two pedigrees of CSNB are presented. The first reflects the autosomal dominant mode of heredity in 4 generations, in the second pedigree (5 generations) it is not possible to estimate the mode of heredity.
The authors present their initial clinical experience with endovascular treatment of an aneurysm of the abdominal aorta using of a polyester covered spiral Z stent. Since May 1995 they treated by the endoluminal route 13 patients with aneurysms of the abdominal aorta and 1 patient with thoracic aneurysm. In patients with a subrenal aneurysm (n = 10) the stent graft was anchored below renal arteries origins. In patients with a juxtarenal aneurysm (n = 3) the stent graft was anchored across the renal arteries origins. All patients were followed up by angiography, computed tomography and ultrasonography. In one patient with a subrenal aneurysm dislocation of the stent graft during implantation occurred. In the remaining patients it proved possible to exclude the aneurysm successfully. One patient with an juxtarenal aneurysm died 6 days after surgery. The cause of death was not associated with the aneurysm or surgery. In patients with juxtarenal aneurysms the authors did not observe changes of renal functions or occlusion of the renal artery in the course of 12 months.
Twins were diagnosed by ultrasound in a 29-year-old woman. The cesarean delivery revealed at first a mature girl with a large benign sacrococcygeal teratoma and then a healthy boy. X-ray and CT examinations of the teratoma showed pelvic and lower limb bones. A mature teratoma-tridermoma (weight 475 g) containing the underdeveloped lower half of a human body was confirmed during surgery and verified morphologically. The fraternal twins, i.e., the girl operated upon and her brother, have been followed for 5 years and are without any complaints. They have normal neurological function.
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The extent of RHG-band variation of short arms of human acrocentric chromosomes was investigated in a group of 100 subjects by visually comparing the variants with the size of reference bands 7p22, 21q22 and 11q13. Marked differences were found among the chromosomes in the distribution of variants; the largest mean size of RHG-band was associated with chromosome 21, whereas the variants of chromosome 22 had the smallest band size. The study further showed that the involvement of acrocentric chromosomes in satellite association did not depend upon the size of RHG-band variants.
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