Biomedical subjects
Publications and source records attributed to K Havlícek.
The case report dissertates upon successful treatment of iatrogenic perforation of distal oesophagus with subcutaneous emphysema, pneumoperitoneum and pneumomediastinum. The endoclips and classic conservative treatment were used in therapy. The patient was treated 3 hours after the injury, no early or late complications related to perforation were noted.
There is discussed case of malignant paraganglioma with cervical lymph node metastasis that was complicated by mistake during peroperative histology. Peroperative histological examination revealed metastasis of medular carcinoma of thyroid gland. Total thyroidectomy was performed. Postoperative histological assessment revealed metastasis of carotic paraganglioma. Tumour was resected together with carotic arteries. Their reconstruction was performed during second procedure.
There discussed casuistics of the 64 years old man, who underwent urgent resection of perforated subrenal aortic aneurysm that expanded to both iliac arteries. Aortobifemoral bypass and packing of retroperitoneum were performed. The patient was operated for periprothetic abscess and aorto-enteric phistula three months later. Phistula was closed, infected prothesis was resected and replaced by new prothesis. Omentoplasty was added.
Mesenteric artery embolisation is serious complication of heart diseases. Its mortality is almost 95%. Diagnostics of mesenteric artery embolisation is based not only on clinical examination, but also on CT scan. Presence of the gas in portal and mesenteric venous basin is very suspected from vascular ileus. This sign can be very helpful in diagnostics and consequently in treatment of this disease. Late diagnostics and treatment of vascular ileus has fatal prognosis.
BACKGROUND: Carcinoma of the breast is the most commonly diagnosed women cancer. Less than 1% of the patients diagnosed with breast cancer initially present with axillary metastases as their only clinical manifestation. CASUISTIC: We report case of 58 years old woman with occult breast carcinoma in which extensive axillary node metastasis was the first manifestation. DISCUSSION: Breast cancer presenting with axillary metastases and no clinical apparent primary tumour in the breast is an uncommon form of stage II or IV of this disease. Ultrasonography, mammography, MRI and excisional biopsy are indicated for detecting occult primary tumours. The appropriate treatment of the breast after an axillary presentation of occult breast carcinoma continues to be a controversial issue. Complete axillary lymph node dissection is indicated in all patients. As a local treatment of the breast is indicated irradiation of the breast or total mastectomy or subcutaneus mastectomy with application of the breast prothesis. CONCLUSION: Axillary metastasis is rare first sign of breast cancer. Diagnostics of the occult breast carcinoma is difficult. The treatment of occult breast carcinoma is still controversial.
Authors present their experience with combined trombolytic-surgical treatment of acute ischaemia of low extremity based on trombosis of popliteal artery aneurysm. This treatment was performed in three patients. Authors compare results of intraarterial catheter pharmacological trombolysis of infrapopliteal arteries with indirect surgical trombolysis.
INTRODUCTION AND AIM: The authors discuss paliative treatment using coated and bare metallic stents in a prospective randomized study for inoperable oesophageal carcinomas. The aim of this study is to assess the following parameters in both treatment groups: duration of the stents functionality, survival rates, complications rates and histological findings. METHODS: From 1999 to 2003, the total of 60 patients with oesophageal and cardial carcinomas were randomized. They had either bare (N-31 subjects) or coated (P-29 subjects) stents introduced. The patients were followed-up at one-month intervals. RESULTS: No statistical differences between the groups were found when the above parameters were assessed. DISCUSSION: The complications rate depended on the patients survival period in both stent types. Survival rates depended on the disease stage of the local tumorous process and on the individual patient's condition prior to the treatment. CONCLUSION: The study showed that the metallic selfexpandible stents treatment method may become a widely used paliative procedure in patients with malignant dysphagia, however, it has not proved any differences in complication rates depending on the stent coating.
AIMS: Following surgical therapy, new varicose veins may develop, in particular at the site of the previous saphenofemoral junction. The objective of this study is the appreciation of the causes of the bad results of surgical procedures in the treatment of varicose veins and the proposal of the possibilities of their prevention. MATERIAL AND METHODS: Retrospective study of the group of 404 patients (573 procedures) with the diagnosis of the recurrence after previous radical surgery was performed. After exclusion of perforator refluxes, the most frequently, the great saphenous vein territory was affected (86%), followed by the small saphenous vein territory (14%). The group of 30 consecutive patients (35 limbs) with saphenofemoral or saphenopopliteal recurrence was selected for this study. Based on preoperative ultrasound and per-operative morphological findings, in 12 patients (14 limbs) - 8 women and 4 men, meticulous histopathological examination of the venous tissue block from the saphenofemoral or saphenopopliteal region, VEGF (Vascular endothelial growth factor) and protein S-100 investigation were performed. RESULTS: In 14 limbs with sonographic and clinical suspition for neovascularisation, this entity was confirmed in 11 of them (79%) which represents 31.42% of the whole group. CONCLUSIONS: The varicose veins recurrences can be observed not only after technically or tactically imperfect primary procedure (which is surely the most common cause of the varicose veins recurrence), but also after the operations performed by the experienced venous surgeon in the perfect way. Neovascularisation explains a certain number of postoperative recurrences despite correctly conducted disconnection of the saphenous termination. The endovascular procedures (endovenous laser or radiofrequency saphenous obliteration) without open groin access can minimise the possibility of this complication.
INTRODUCTION: Serious blunt injuries are accompanied with the worsening of the mechanics of ventilation due to the chest and lung injuries alone as well as with a systemic inflammatory response (SIRS) that always affects the lungs. The development of an injury-induced respiratory failure is multifactorial and timely pharmacological intervention is likely to contribute to the treatment algorithm, thus improving prognosis in some patients with a serious chest trauma. THE OBJECTIVE OF THE STUDY: The objective of this study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response of the body (SIRS) in serious blunt chest injuries. The study also intends to identify whether the administration of indomethacin could reduce SIRS score and prevent multiorgan dysfunction and multiorgan failure. METHODS: 126 patients with blunt chest injuries were evaluated during 33 months. The patients were divided into four groups, depending on the extent of trauma severity assessed by means of ISS (Injury Severity Score). Randomly selected patients in each group were administered--in addition to standard therapy--indomethacin in usual doses. All tests were carried out at a significance level alpha of 0.05. RESULTS: The onset of SIRS in the subgroup with indomethacin was statistically significantly postponed in groups I. and II. Groups ISS I to III showed a statistically markedly shorter time of SIRS duration in the subgroup with indomethacin. The first increase in inflammatory markers (acute phase proteins) was statistically significantly postponed in the group ISS I without the administration of indomethacin. Groups ISS II through IV did not show a statistically significant differences in the first onsets of inflammatory markers. The evaluation of all four groups did not detect any statistically significant differences in the duration of the inflammatory markers increase in the subgroup with indomethacin and in a control group. There was no statistical significance in the average time of ventilation support. An average hospitalization time was shorter in the subgroup ISS II with indomethacin. There was found statistically significant difference. Of the patients included in our file seven died during the monitored period. Lethality is thus 5.6%. A multiorgan failure was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup. CONCLUSION: We proved that the factors that can be affected by the blockade of cyclooxygenase display statistically significant changes in subgroups with the administration of indomethacin. No changes were recorded with regard to acute phase proteins whose synthesis is not mediated by prostaglandins. The administration of indomethacin positively affects the development of SIRS, reduces and diminishes its effects as well as impact on the impaired body.
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The authors present their experiences with new miniinvasive treatment of varicose veins--endovenous diode laser system. The results of 60 procedures treating truncal varices are reported with special concern to percutaneous access technique under ultrasound guidance. This new concept based on haemodynamic ultrasound findings is compared to the traditional surgical technique of cross-sectomy and stripping.
INTRODUCTION: Mortality rate of bleeding into the upper GIT has remained relatively unchanged during the past 30 years, i.e. about 30%, even though the development of new technologies brought along substantial changes in diagnostic and therapeutic procedures. METHODOLOGY: This work deals with the surgical solution of bleeding into the upper GIT of peptic etiology. It covers a 5-year period (from January 1, 1999 until October 1, 2003) during which time the Regional Hospital in Pardubice admitted 1,310 patients with bleeding into the upper GIT of peptic etiology. 190 of them were hospitalized at the Surgical Clinic due to the developing hemorrhagic shock; the others were hospitalized at the Clinic of Internal Medicine. If it failed urgent endoscopy to stop the bleeding, the patient was referred to undergo an urgent surgery. If the bleeding was stopped by endoscopy yet it recurred after certain time, a second endoscopic homeostasis was attempted. If it failed, an urgent surgery was indicated. RESULTS: A total number of 24 patients underwent an acute surgery. A frequently used procedure was stomach resection, type BII, which was applied to a total number of 12 patients. However, this type of urgent surgery was accompanied with a relatively high number of complications. Reoperation had to be performed 4 times (33.3%). In one case (8.3%) for recurrent bleeding. In 12 patients one of the other procedures was performed: an injection and a trunkal vagotomy (3x), an injection and the ligation of the gastroduodenal artery (2x), proximal jejunum resection (1x), an injection accompanied with fundoplication according to Nissen-Rosseti (1x). Two of the patients who received this other group of procedures had to be reoperated for recurrent bleeding (16.7%). DISCUSSION: The decision about a suitable surgical procedure applicable to bleeding into the upper GIT after the failure of endoscopic homeostasis poses a substantial problem. It is necessary to choose from more radical procedures--resection--that stop bleeding reliably, yet their execution in an acute condition (often coinciding with the patient's hemorrhagic shock) results in a relatively large number of complications; and from less radical procedures that feature a smaller number of post-surgical complications yet that can be burdened with a larger percentile number of recurrent bleeding. Nearly the same number of serious recurrent bleeding in this study indicates that the appropriate choice of a procedure (according to the patient's current condition, ulcer localization, and associated diseases) makes both approaches (resection vs. a less radical procedure) similar as to the number of necessary reoperations after bleeding. CONCLUSION: The development of endoscopic methods introduced significant changes in the diagnostic-therapeutic algorithm of bleeding into the upper GIT. Nevertheless, the choice of an appropriate surgical procedure continues to present a relevant surgical issue.
BACKGROUND: Axillary lymph node staging is the most powerful predictor of survival in breast cancer women. Sentinel lymph node biopsy (SLNB) is more accurate method in evaluation of axillary lymph node staging than complete axillary lymph node dissection (CALND) because of more precious histological and imunohistochemical assessment of the first draining lymph nodes. Furthermore, SLNB eliminates complications resulting from CALND. MATERIAL AND METHODS: SLNB is either performed using blue dye technique or using of combination of blue dye and radioguided technique. We prefer two days protocol in application of Tc 99 radiocolloid. There were used both techniques for detection sentinel lymph nodes and results were compared. RESULTS: There were performed 21 SLNBs using blue dye technique, Group A, and 20 SLNBs using combination of blue dye and radioguided technique, Group B, from October 2001 to November 2003. Sentinel lymph nodes were not detected in Group A in two cases, false negativity occurred two times in this group. Sentinel lymph nodes were detected in all cases in Group B and there was no false negativity present in this group. CONCLUSION: Combination of blue dye and radioguided technique is more precious in detection of sentinel lymph node than blue dye technique itself. Two days protocol of application of Tc 99 radiocolloid enables performing this method even in hospitals, where the Department of Nuclear Medicine is not available.
This article presents the results of the first year of the grant study that deal with preemptive treatment of yeast infection in surgical ICU. This research included patients with a large number of risk factors (ten and more). These risk factors indicated in the chart. 147 patients reached a score of ten and more points. This number was divided in two groups. In the first group there were 87 patients who received treatment of itraconazol by prescribed scheme. They were hospitalized in ICU for 11.6 days, on average. The first group did not display any positive hemoculture and also other microbial culture from intravenous cannula. No patients fell from ill candida sepsis. Itraconazol was not administered to the 60 patients, who were hospitalizated 11.8 days, on average. Positive hemoculture or yeast sepsis with connection invasive yeast infection was proven in six cases (10%). No patient died in direct connection with yeast infection in either groups. The presented results show a reduction in the number of developing yeast infections and mainly yeast sepsis in patients undergoing preemptive treatment with itraconazol.
Authors in their theoretical report discuss problems of traumatic haemoperitoneum resulting from blunt abdominal injury including diagnostics and therapy. They put the stress on diagnostic-therapeutic algorithm. It is emphasized the necessity of immediate US of the abdomen and at the haemodynamically stable patients helical CT scan. Classification of injured certain abdominal cavity organs is mention and suggested unification of these classifications. It is highlighted conservative treatment of traumatic haemoperitoneum with regular monitoring including monitoring of intralpha abdominal pressure and abdominal compartment syndrome. Damage Control Surgery System, as a new strategy, is discussed in a part regarding operative management.
The aim of this article is to evaluate the occurrence of complications following diagnostic and therapeutic ERCP's and their treatment. It is based on data collected between January 1, 1998 and December 31, 2002, during which time period the Surgical Clinic in Pardubice completed 18 surgical procedures on patients experiencing post-ERCP complications. The article also provides an analysis of the individual types of complications, their specific surgical procedures, and the results. The discussion passage deals with the theoretical possibility of applying conservative treatment that is applicable in certain types of perforation occurrences, with special concern focused on the occurrence of fatal retroperitoneal phlegmona.
The authors compare the results of using classical monopolar electrocoagulation with ultracision during laparooscopic cholecystectomy. The results from the 5 surgery departments in the Czech Republic are elaborated.
INTRODUCTION: Frequency and severity of the blunt chest injuries are increasing. Rather high letality is caused by the injury and following systemic inflammatory response. OBJECTIVE: The aim of the study is to verify the efficacy of pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries. The aim is also to find out if the administration of indomethacin as a cyclooxygenase inhibitor could prevent multiorgan dysfunction (MODS) and multiorgan failure (MOF). MATERIAL AND METHODS: Patients were divided into 4 groups according to trauma severity (Injury Severity Score). The group I. contains patients with ISS up to 17. There is no premise of the SIRS development. In the group II. there were patients with ISS 18-30, which means polytrauma group due to new definition. In the group III. there were patients with ISS 31-40 (severe trauma). Group IV. contains critically injured patients (ISS 41 and higher). Some patients involved in our study were given indomethacin (as cyclooxygenase inhibitor in arachidonic acid cycle) together with standard therapy. RESULTS: 65 patients were included into study in last 14 months, 22 patients were given indomethacin. The group with indomethacin administration has later increase of inflammatory markers in groups III. and IV. This increase also takes less time in groups II. and III. Shorter time of mechanical ventilation support in group III. in patients with indomethacin was significant. SIRS is present in time of admission approximately in 44%. All patients have low antioxidants level. 5 patients died in our group, letality was 7.7%. All the died patients came from the subgroup without indomethacin, however only one death caused by MOF. CONCLUSION: From the results of the first 14 months of the study we can conclude that certain number of patients with serious blunt thoracic trauma could benefit from indomethacin administration.