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P Drác

Publications and source records attributed to P Drác.

At least 19 recordsLinked to original sources
PubMed2004

[Percutaneous osteosynthesis of scaphoid fractures: preliminary results].

PURPOSE OF THE STUDY: To evaluate the results of percutaneous osteosynthesis of scaphoid fractures and to verify whether this approach is more effective than conservative treatment. MATERIAL: A total of 25 patients were treated by percutaneous osteosynthesis at the Emergency and Accident Department of the University Hospital in Olomouc from March 1, 2002, till March 31, 2003. According to the Herbert classification, five had type A2 fractures, four had type B1 and 16 had type B2 fractures. The surgery was performed at 20.6 days on average after injury. HBS screw (Martin) fixation was used in 22 patients, a 3.5 mm cortical screw and a 4.0 mm cancellous bone screw (Poldi 5 set, Kladno, CZ) were inserted in one and two patients, respectively. The wrist was immobilized with a brace in 11 patients. After a short hospitalization, the patients were referred to an out-patient department for follow-up. METHODS: We evaluated the duration of postoperative immobilization, necessity to initiate assisted rehabilitation, length of follow-up at the out-patient department and the functional outcome. The control group comprised of 43 patients who were treated between March 1999 and December 2001. Only patients with type A, B1 or B2 scaphoid fractures managed conservatively were included. Nine patients were excluded because, during treatment, they were converted to conventional open osteosynthesis through the palmar approach. RESULTS: In the study group, the average postoperative immobilization with a brace was 17 days; assisted rehabilitation was initiated in 50% of the patients and resulted in excellent functional outcomes; the average follow-up was 10.3 weeks. In one patient, the fractured scaphoid failed to heal. In the control group, the average postoperative immobilization was 7.5 weeks; assisted rehabilitation was started in 53% of the patients and 23% reported persistent complaints; the average follow-up was 11.4 weeks. DISCUSSION: To achieve a good outcome of percutaneous osteosynthesis of a fractured scaphoid, it is important to make a precise diagnosis based on CT scan. This approach is suitable for type A2, B1 and B2 fractures. A good outcome of surgery depends on the correct insertion of a screw among fragments in order to achieve adequate compression among fragments. The necessity of postoperative immobilization and its manner and duration are current issues of discussion. CONCLUSIONS: Our preliminary results show that, in indicated fractures types, the percutaneous osteosynthesis of a fractured scaphoid provides better functional outcomes than conservative treatment.

Adolescent↗
PubMed2004

[Non-union in os scaphoideum and its surgical treatment: overview of literature].

Authors present an overview of surgical methods used for the treatment of os scaphoideum with a focus on currently most frequent operations. In the period between January 1998 and March 2004, the authors performed 100 operations on the scaphoid bone, of this 54times primary fixation and 46times surgery for non-union in 42 patients. The most frequent method was resection of non-union, implantation of tri-cortical bone graft and internal fixation (17times). This method is considered by the authors optimal in non-unions in the middle third of the bone without signs of avascular necrosis of the roximal pole. In 8 patients with signs of avascular necrosis of the proximal pole and in non-unions in the proximal third, reconstruction was done by vascularized bone graft after Zaidemberg. In case of the finding of a minimal sclerotic line without deformation or shortening of the bone the method of choice was compression of the non-union by a screw (Herbert screw, HBS, Synthes screw) in 8 patients. Intramedullary cancellous bone graft and internal fixation was used in 8 patients. However, the authors do not consider it as an optimal treatment as it does not guarantee preservation of the length of the bone until the healing of the non-union. This surgery was used by the authors only as an alternative when it was not possible to choose another method. Extirpation of the distal scaphoid bone (twice) and proximal carpectomy (twice, of this once together with the dennervation after Wilhelm) were performed in non-unions with marked osteoarthritic changes of the radiocarpal joint. In one patient the proximal pole was excised and replaced by tendon graft. The authors do not have experience in limited intercarpal arthrodesis, but most other authors currently prefer proximal carpectomy to this technically demanding operation.

Adolescent↗
PubMed2003

[Importance of neoadjuvant chemotherapy in the treatment of advanced bronchogenic carcinoma].

BACKGROUND: The basic task of induction (neo-adjuvant) therapy is elimination of occult micrometastatic dissemination found in some cases already in localized stages of non-small cell pulmonary cancer (stage I-IIIA NSCLC). An equally important effect is also cytoreduction in primary tumours which have before the local intervention an intact vascular supply. A difficult problem remains the correct selection of patients who from the long-term aspect may profit from such a procedure. MATERIAL AND METHODS: The authors evaluated perspectively aspects of oncological treatment and circumstances of surgical intervention after induction chemotherapy in 81 and 87 patients resp. in stage IIIA NSCLC evaluated before initiated neo-adjuvant chemotherapy. RESULTS: Complete remission was recorded in 4.9%, partial remission in 50.6%, stabilized disease in 23.5% and progression in 21% patients. Down-staging was recorded in 26%, 70.3% patients were indicated for surgery. In the group of 87 patients operated after induction therapy pneumonectomies predominated--41 (46%), only one operated patient died within 30 days after surgery (1.1%), complications were neither frequent nor serious. The median of survival after radical resection is 26 months. CONCLUSIONS: Neo-adjuvant chemotherapy by modern cytostatics is usually well tolerated and creates satisfactory conditions for successful complete resection. The operation proper may be more difficult but need not be associated with serious complications. By this treatment it is probably possible to influence long-term results not only in stage IIIA but to reduce also the risk of a later more remote metastatic dissemination in some patients operated in lower stages of lung cancer. Our present aim is to test parameters which will be able to predict possible failure of induction therapy, and seek factors predicting risk behaviour of the tumour also in lower stages (stage I and II TNM classification).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

[Blunt injuries of the iliac artery--case reports].

The authors describe three patients with blunt injuries of the iliac artery. They mention the causes and mechanism of their development, symptomatology, diagnosis and treatment. They draw attention to early diagnosis and an active approach; they discuss the type of vascular prosthesis and mention alternative therapeutic procedures. In all patients surgical treatment (resection and prosthesis of the affected part) led to favourable long-term results.

Adolescent↗
PubMed2001

[Non-penetrating thoracic injuries].

The authors compare the causes and severity of non-penetrating chest injuries during two three-year periods: 1986-1989 and 1996-1999. Within the 10-year interval the incidence of blunt chest injuries increased by almost 124%, the mean age of the casualties reduce by five years and the most frequent cause were road accidents. Chest injuries are in more than half the casualties part of multiple injuries or polytraumatism. During the period 1996-1999 the authors recorded more serious intrathoracic injuries, incl. severing of the v. azygos in three patients. With regard to the danger associated with delay it is essential that these casualties should be taken from the site of the accident directly to a specialized department.

Adolescent↗
PubMed2001

[Fractures of the sternum].

PURPOSE OF THE STUDY: Assessment of the authors' group of patients with a fracture of sternum and comparison with available literary findings. MATERIAL AND METHODS: In a group of 188 patients with a blunt injury of chest who were hospitalised in the Faculty Hospital in Olomouc in the period of 1996-1999 there were 7 cases with the diagnosis of the fracture of sternum. In this group of patients we observed the cause of injury, occurrence of associated injuries, the potential of diagnostic methods, method of treatment and duration of hospitalization. RESULTS: Mostly they were patients with an isolated fracture of the sternum or with an associated injury requiring only a short-term hospitalization. One patient with a rupture of v. azygos died from the sequelae of other multiple injuries. Another patient sustained a fracture of sternum together with a massive hemothorax and hemomediastinum. On the basis of circulation stability this patient was treated conservatively. For details see the case report. Six patients were subsequently transferred to out-patient department and are now without complaints. DISCUSSION: The most beneficial examination for the diagnosis of the fracture of sternum remains lateral radiograph of the chest. With regard to potential injuries of mediastinal organs it is necessary to perform ap radiograph of the chest and ECG, in indicated cases also CT of the chest, angiography and echocardiography, if need be. In patients treated for a fracture of sternum the duration of hospitalization and mortality is determined by the severity of the associated injuries. Surgical treatment is considered rarely in fractures with a greater dislocation or in injuries or mediastinal organs. CONCLUSION: The incidence of the fracture of sternum has recently increased. Isolated injuries of the chest do not pose any diagnostic or therapeutic problem. Of much greater severity are associated injuries of lungs and mediastinal organs which require a precise diagnosis and careful observation of the patient.

Adult↗
PubMed2000

[Classic carcinoids of the appendix].

Nine classic carcinoids smaller than 2 cm, situated elsewhere than at the base of the appendix have been diagnosed in the Department of Pathology of the University Hospital in Olomouc during the period from 1994 to 1999. Appendectomy including removal of the mesenteriolum was performed in all cases. The literature mentions favourable prognosis of patients with small appendiceal carcinoids--100 per cent 5-year survival rate. Tumours greater than 2 cm recur and metastasise. These tumours require oncological therapy in cases with unresectable metastases. This worsens the 5-year survival rate to 21-42%.

Adolescent↗
PubMed1999

Aneurysm of the subclavian artery.

In this case report about a female patient with a true aneurysm of the left subclavian artery (SAA), the authors would like to present the symptoms, possibilities of diagnostics and management of this rarely appearing pathology. The diagnosis of a randomly found aneurysm in a symptom free patient was confirmed by spiral AGCT. Classical surgical procedure was indicated for the patient. With a combined supra- infraclavicular approach the partial resection of the aneurysm and its revascularization by a ePTFE prosthetic interposition were performed. A histological investigation showed nonspecific changes in the aneurysm wall. Two years after the operation the patient is without any complications and with complete functional vascular reconstruction and optimal limb function.

Aneurysm↗
PubMed1980

[Rhinophyma].

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Aged↗