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Biomedical subjects

K Lukás

Publications and source records attributed to K Lukás.

18 recordsLinked to original sources
PubMed2005

[How endoscopy has changed in recent 60 years].

Sixty years ago only semi flexible instruments were used for the endoscopic examination of the gastrointestinal tract. They were developed by the German physician Rudolf Schindler together with George Wolf, the producer of medical instruments in 1932. They construct optical gastroscope with a system of lenses in the flexible distal end and with the rigid metallic proximal part. Those instruments were used in gastroscopy till the sixties when the era of fibroendoscopy with the use of glass fibre optic has started. In 1957 Basil Hirschowitz with his co-workers introduced a flexible gastroscope--a fibroscope. The next years brought improvement in the size of image, its brilliancy, possibility to control the distal end and a bioptic channels was added. Working length was elevated and since 1970 the instrument has been used as ezofago-gastro-duodenoscope. At the end of millennium a new technology was developed--videoendoscopy. Experience with the prototype of videoendoscope was published in 1984 (Sivak a Fleischer, Classen a Phillip). In the nineties of the previous century Paul Swain constructed the first prototype of wireless endoscopic capsule. A single chip camera with low electricity consumption was presented in 2000. Endoscopy has developed in recent years considerably and its progress will definitely continue.

Endoscopes, Gastrointestinal↗
PubMed2004

[The esophagus: organic and functional disorders--findings in literature in recent years].

Esophagus is often unregarded, being considered only a pathway for the food. As our knowledge has been rising, esophageal diseases become more frequently diagnosed. Gastroesophageal junction represents the region of contact between two different types of epithelium. Exact delimitation of the border is often very difficult. Also the region of cardia has not been yet precisely defined. The important component of the refluxate, which can impair the esophageal mucosa, is the duodenal content. One of the elemental causes of the reflux disease is probably transient relaxation of the lower esophageal sphincter, which is triggered by the central nervous system. When inflammatory changes are present in cardia, gastric carditis is diagnosed. Histological changes in cardia are related to the presence of Helicobacter pylori infection and also to the gastroesophageal reflux disease. If the aetiology of Helicobacter pylori infection cannot be proved, non-helicobacter solitary carditis is diagnosed. Barrett's esophagus represents an acquired serious impairment of the esophageal mucosa. Barrett's esophagus diagnose depends on the existence of histological changes in the biopsy samples form esophageal mucosa. The most effective treatment of the Barrett's esophagus is the early and long-lasting curing of the esophagus reflux disease. The conservative curing is based on the long-term suppression of gastric acid production by antisecretorics (most effective are inhibitors of proton pump). Functional gastric disorders represent an important group with the most recent international classification done in 1999 (Roma II).

Esophageal Diseases↗
PubMed2004

[The large intestine--literature review of recent years].

Diagnose of the idiopathic inflammatory bowel disease depends on the set of clinical, radiological, endoscopic and histological criteria. Proctitis, proctosigmoiditis, and the left-sided colitis represent 60 to 80 percent of newly diagnosed cases of colitis. For the medical management of the inflammatory bowel diseases aminosalicylates, corticosteroids, topical corticosteroids, immunosuppressants are used. The complication of highest risk represents the toxic magacolon or periannal fistulas in patients with Crohn's disease. Pre-neoplastic epithelial changes (dysplasia) are diagnosed by pathologists according sets of cytological and architectonic markers. Indeterminate diarrhea related to the antibiotics administration is comparatively common. Roman criteria II classify functional intestinal disorders, represented by a set of isolated symptoms or various combinations of symptoms without identifiable organic, biochemical, sonographic or endoscopic abnormalities of the intestinal or biliary system, lasting minimally 12 weeks (not necessarily continuously) during the preceding year, as a persisting or recurrent distress. About 20 percent of patients with diverticular disease of the colon have some clinical manifestations.

Humans↗
PubMed2002

[Laparoscopic fundoplication in the treatment of Barrett esophagus].

UNLABELLED: Barrett's esophagus (BE) the serious complication of gastroesophageal reflux disease (GERD) is discussed. BE has been defined as the complete intestinal metaplasia of distal esophagus. The most serious complication of BE is esophageal adenocarcinoma. We present our results with the group of patients with GERD from the years 1998-2000. We prospectively followed 67 patients with GERD (group A) and 8 patients with GERD/BE (group B). All patients underwent laparoscopic fundoplication. The average length of the Barrett's segment was 4.3 cm. Average time of the surgery was 75 min. Nissen fundoplication was used in seven cases in group B, in one case we used Rossetti laparoscopic fundoplication. The postoperative endoscopic controls were performed at two months after surgery and then every one-year. RESULTS: In one case we observed the complete reepithelization with the mixed spinocelullar and columnar components. We didn't observe any one case of histological deterioration. There was on any difference between two groups regarding the subjective complains. Six patients form group B reported complete disappearing of pyrosis. Two patients reported significant improvement, with very rare pyrosis or dysphagia. Our experience (together with the literature) proved the surgical antireflux therapy is very safe, very effective and with very long lasting effect. The effectivity of surgical therapy is increased by the laparoscopy. Described laparoscopic approaches can lead to the reepithelization of Barrett's metaplasia or, at least, they can diminish the symptoms without any long-term medication. Surveillance endoscopy and biopsy are strictly recommended in all patients with BE and also in the patients with BE after antireflux surgery. The intervals depend on the grade of dysplasia in metaplastic epithelium.

Barrett Esophagus↗
PubMed2001

[Acute states in gastroenterology: spontaneous bacterial peritonitis and the acute intestinal pseudoobstruction syndrome].

Our article concentrates on two acute states, which develop less dramatically but their after-effects may be very serious: Spontaneous bacterial peritonitis and Ogilvie's syndrome. Spontaneous bacterial peritonitis is a bacterial infection of the ascitic fluid without any intraperitoneal source of infection. Ascites is a condition of the disease but need not be clinically manifested. Spontaneous bacterial peritonitis comes usually during heavy hepatic impairment. Diagnosis can be set according: 1. Positive cultivation of ascitic fluid, 2. PMN levels higher than 250/mm3, 3. No infection, which may require a surgical intervention is apparent. Liver disease, which brings about the spontaneous bacterial peritonitis can be: 1. Chronic (e.g. alcoholic cirrhosis), 2. Subacute (e.g. alcoholic hepatitis), 3. Acute (e.g. fulminant hepatic failure). Mortality of this form of peritonitis can reach up to 46%. The most frequent etiological factor is alcohol and viral hepatitis, the most frequent agents are E. coli and Klebsiella pneumoniae. The disease is most effectively cured by cefalosporins of the third generation. With inadequate treatment, prognosis may be poor. Intestinal pseudoobstruction syndrome has clinical symptomatology of a serious impairment with ileus without signs of any mechanical intestinal obstruction. Syndrome can be classified according to its development: 1. Acute form--acute intestinal pseudoobstruction syndrome--Ogilvie's syndrome, 2. Chronic form--chronic intestinal pseudoobstruction syndrome. Pathogenic mechanism of the syndrome is not known. The disease is related to immobility, administration of some drugs, electrolyte imbalance and concomitant diseases (most frequently malignant tumors). Clinical symptomatology dominates nausea, vomiting, diffuse abdominal pain, constipation or diarrhoea. For diagnostics the first step should be termination of all medication, which could have causing affects, then taking native abdominal X-ray picture where gaseous intestinal distension can be prominent (coecum distended up to 9-12 cm). Identification of fluid surfaces is not usual. Endoscopic examination can exclude obstruction in the distal part of gut minimally. The most frequent complication is perforation of coecum. Pharmacological treatment relays on prokinetics. The basic intervention remains decompression by a rectal catheter or an effective coloscopic decompression with subsequent introduction of a cannula. Mortality of the disease fluctuates between 43 and 46%.

Acute Disease↗
PubMed2000

[Occurrence of reflux esophagitis in patients with chest pain and a normal selective coronary angiogram].

BACKGROUND: Chest pains are related to coronary disease, and to several other disorders, among which the most commons are the oesophageal diseases. The aim of the work was the identification of the reflux oesophagitis in patients with chest pain and normal selective coronary angiogram. METHODS AND RESULTS: In the examined group 65 patients (42 females, 23 males) of the average age 55.2 years were included. All of them underwent endoscopic investigation with biopsy from the terminal part of the oesophagus. Endoscopy picture was evaluated according Savary-Miller classification. Biopsy samples were histologically examined and evaluated according our proper classification of the reflux oesophagitis (1st degree: mild, 2nd degree: medium, 3rd degree: heavy, 4th degree: ulcerous). Endoscopical finding was normal in 59 patients (90.8%), reflux oesophagitis of the 1st degree in 2 patients (3.1%) 2nd degree in one patient (1.5%), 3rd degree in 2 patients (3.1%), 4th degree in one patient (1.5%). Histological changes which can be included into the picture of so called microscopic oesophagitis were found in 49 patients (75.4%). The rest of patients had the histology picture normal. CONCLUSION: In 75.4% of patients with chest pain and negative selective coronary angiogram histological examination revealed structural changes corresponding with oesophagitis, mostly of the mild type.

Chest Pain↗
PubMed1999

[Esophageal reflux disease--comments on confusion in terminology, diagnosis and therapy].

Oesophageal reflux disease is a serious condition with an impact on the entire population. The provoking factor of the disease is gastroesophageal reflux which itself is not a disease but a normal physiological process. Reflux is described as pathological it is damages the oesophagus and respiratory tract. Oesophageal reflux disease develpomeps when antiferlux mechanisms fail, it is the consequence of impaired motility where the crucial role is played by dysfunction of the lower oesophageal sphincter. The most frequent consequence and manifestation of gastrooesophageal reflux is reflux oesophagitis which may be macroscopically obvious (endoscopically positive) or detectable only on histological examination (endoscopically negative--microscopic). Symptoms of reflux disease do not correlate with the severity of the disease. Some cases of roflux eosophagitis may be symptom-free. The diagnosis of oesophageal reflux disease is based in particular on an aimed case-history, endoscopy, histology and pH-metry. An open problem remains the relationship of reflux disease and the presence of Helicobacter pylori infection. In tratment either selective treatment (one drug) is used or graded (upward or downward) treatment. The upward therapeutic strategy (strating treatment with proton pump inhibitors) is as a rule economically more effective than the traditional downward strategy (strating treatment with less intensely acting drugs). Tretment is of long-term (maintenance treatment) which may be medicamentous or surgical. In oesophageal reflux disease there still remain controversial areas which must be elcudated as its incidence is rising and it is considered a disease of the 21st century.

Gastroesophageal Reflux↗
PubMed1997

[Reflux disease].

Reflux disease is a very frequent condition; its most frequent symptom, pyrosis, is found daily in 7% of the population. The disease is dut to the aggressive action of the gastroesophageal reflux "faced" by defensive oesophageal mechanisms. Reflux disease is classified as endoscopically positive with an obvious finding of oesophagitis and endoscopically negative with a normal endoscopic finding but detectable histological changes. Complications of the disease include strictures, ulcers, haemorrhage and Barrett's oesophagus. In the therapeutic regime provisions are used, medicamentous treatment (antacids, sucralphate, prokinetics, antagonists of H2 receptors and proton pump inhibitors) and surgical treatment. In the therapeutic strategy two procedures are possible: 1. the method of choice (treatment with a single drug) and 2. stepwise therapy a) step-up-the basis are regime provisions and gradually drugs are added, b) step-down-treatment is started with the most effective drug, the proton pump inhibitor, and is reduced gradually). Treatment has a short-term character (treatment of the acute attack) and long-term (maintenance treatment). Contemporary therapeutic possibilities improve the prognosis of the disease and the quality of life of patients with reflux disease to the quality level of the normal population.

Gastroesophageal Reflux↗
PubMed1995

[Local production of eicosanoids in patients with ulcerative colitis].

BACKGROUND: Eicosanoids act obviously as mediators of inflammation in ulcerative colitis. The objective of the submitted paper was to assess relations between intraluminal concentrations of prostaglandin E and leukotriene B4 and the activity of ulcerative colitis evaluated according to clinical, endoscopic and histological criteria. METHODS AND RESULTS: In 56 patients with ulcerative colitis the PGE concentration was assessed in the rectal dialysate (3H Prostaglandin E Radioimmunoassay Kit Ca-501, Clinical Assay Cambridge USA). In 35 patients with ulcerative colitis the authors assessed the LTB4 concentration in the rectal dialysate (Leukotriene B4 3H Assay RPN 70, Amersham, G. Britain). The authors proved a statistically significant correlation between the intraluminal PGE concentration and the activity of ulcerative colitis according to clinical criteria (p < 0.1), endoscopic criteria (p < 0.05) and histological criteria (p < 0.01). The intraluminal LTB4 concentration correlated significantly with the activity of ulcerative colitis according to clinical criteria (p < 0.05). When comparing LTB4 values with the activity of the disease according to endoscopic and histological criteria, a tendency of rising LTB4 values with increasing activity of the disease is apparent. However, a significant relationship was not found; this can be explained by the fact that relatively small groups of patients were investigated with a relatively great scatter of LTB4 concentrations. CONCLUSIONS: During the period of active ulcerative colitis the intraluminal PGE concentration rises and correlates with the clinical, endoscopic and histological activity. There is also a rise of the intraluminal LTB4 concentration which correlates with the clinical activity of the disease. A high eicosanoid concentration is found in cases with a severe course and complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Amyloid light-chain amyloidosis with primary involvement of the cardiorespiratory system--2 case reports].

The authors describe the cases of two women suffering from AL amyloidosis with affection of the heart muscle in particular. In one of the patients there were also massive amyloid deposits in the lungs which is an exceptional finding. The observations confirm the adverse prognosis of amyloidosis, the rapid progression of the disease after the onset of symptoms of cardiac failure. The first cardial manifestation in both patients were palpitations. The first patient, but not the second one, had a myeloma confirmed on necropsy.

Amyloid↗
PubMed1993

[Pneumatosis cystoides intestini tenuis--case report].

Case report of pneumatosis cystoides intestini tenuis in 85 year old patient. The disease seemed to be like pseudoobstructive syndrome and the diagnosis was confirmed intraoperatively according to histologic examination during the procedure. Following conservative treatment was with good results and during the next control the patient was doing well. In this article the therapy, symptomatology and appearance of the disease is discussed.

Aged↗
PubMed1993

[The intestinal pseudo-obstruction syndrome].

Intestinal pseudoobstruction is a syndrome characterized by manifestations and signs of intestinal obstruction without evidence of a lesion obstructing the intestinal lumen. It is divided into primary and secondary forms and into acute and chronic forms. Various diseases, incl. malignant tumours, can be manifested by this syndrome. In its therapy prokinetically acting preparations are used with a favourable effect of colonoscopic decompression.

Humans↗
PubMed1991

[Bronchopulmonary changes in patients with idiopathic intestinal inflammation].

The authors examined a total of 64 patients with idiopathic inflammatory bowel diseases, 33 patients with Crohn's disease and 31 patients with proctocolitis to assess the possible frequency of pulmonary complications. An impaired ventilation was recorded in 33% patients with Crohn's disease and 25% patients who proctocolitis, in both groups an obstructive ventilation disorder predominated. In four patients (12.5%) with Crohn's disease cytological examination of bronchoalveolar lavage revealed alveolitis. The authors draw attention to relatively frequent bronchopulmonary complications of non-specific inflammatory bowel disease which are usually clinically silent.

Adult↗
PubMed1988

Benign hypergammaglobulinemic purpura in a patient with ulcerative colitis and peripheric arthritis.

A 32-year-old patient is described presenting with ulcerative colitis and oligoarthritis who later developed benign hypergammaglobulinemic purpura. This diagnosis was confirmed by clinical investigation, immunological findings as well as by histological and immunofluorescent examination. He was successfully treated with steroids and azathioprin. The relevant literature is reviewed.

Adult↗