Biomedical subjects

R Gürlich

Publications and source records attributed to R Gürlich.

At least 19 recordsLinked to original sources

PubMed2006

[Planned laparoscopic procedures in clinical practice].

Several recent randomized studies have proved that laparoscopic technique is feasible, safe and has been associated with better cosmetics, less pain, faster recovery, lower incidence of infectious complications, and shorter postoperative stay. However, these advantages are not substantial for patients with malignant diseases. New published randomized trials (laparoscopic gastrectomy, colectomy, nephrectomy) have proved that long-term survival data did not show any detrimental effect of laparoscopy in comparison with historic studies of open resections.

Abdomen↗

PubMed2006

[Laparoscopic rectopexis].

INTRODUCTION: Rektopexis is an effective treatment method of rectal prolapses. Our retrospective study assessed the laparoscopic rectopexis results. METHODOLOGY: From 01-01-2003 to 31-11-2005, 10 patients were indicated for the procedure of laparoscopic retropexis. A "Vypro" mesh (Johnson&Johnson) was used to suspend the rectum. We fix it to the sacrum and to the rectum with an anchor (Eanchr, Johnson&Johnson). The follow-up examinations were conducted 2-30 months after the procedure. We assessed mortality rates, morbidity rates, the prolaps relapses incidence rates, obstipation incidence rates. RESULTS: The laparoscopic procedure was completed in 9 patients. In one case, we converted. The mortality and serious postoperative morbidity rate was 0%. The mean duration of hospitalization was 7 days. During the follow-up, no patient relapsed. One female patient complained of mild postoperative obstipation, which, however, did not require surgical revision. CONCLUSION: Laparoscopic rectopexis is a modern, safe and effective method of the prolaps of the rectum treatment.

Female↗

PubMed2006

[Prediction and monitoring of severe acute pancreatitis].

Twenty to thirty percent patients with acute pancreatitis develop severe acute pancreatitis with high mortality and morbidity rate. Markers of severity of acute pancreatitis are clinically important for the early diagnosis of complications. We reviewed the literature for markers of acute pancreatitis. On their relevance for prediction of severe pancreatitis are given. Several markers can predict severe cases of acute pancreatitis with a different positive and negative predictive value. Useful predictors of severity may include serum procalcitonin and urinary trypsinogen activation peptide at the admission, serum interleukins-6 and -8 at 24 h, and serum C-reactive protein (CRP) in 48 hours interval. The valuable marker for daily monitoring appears to be serum procalcitonin.

APACHE↗

PubMed2005

The postoperative stress response and its reflection in cytokine network and leptin plasma levels.

The objective of the present report was to clarify the postoperative stress response of some inflammatory markers, namely of proinflammatory cytokines and leptin levels during uncomplicated postoperative periods. The results were compared with the dynamics of these parameters during intraabdominal sepsis. We followed 20 patients after a planned resection of colorectal cancer in stage Ib-IV with uncomplicated healing and 13 obese men after laparoscopic non-adjustable gastric banding. These were compared to 12 patients with proven postoperative sepsis. The control group consisted of 18 healthy men. The observed parameters included serum levels of cytokines, tumor necrosis factor-alpha (TNFalpha), interleukin-1 beta (IL-1 beta), interleukin-1 receptor antagonist (IL-1 ra), IL-6, IL-8, soluble receptor of interleukin-2 (sIL-2R) and leptin. It was found that during the first 24 h after resection there was a significant increase in the serum concentration of IL-6 up to 1125+/-240 ng/l, which declined within the next 48-72 h. Serum concentration of TNFalpha was highest 18-24 h after resection (205+/-22 ng/l) and after banding (184+/-77 ng/l). IL-1 beta had a stable serum concentration without significant elevation. Serum concentration of IL-8 after resection rose to 520+/-200 ng/l after 36-48 h. Maximal cytokine levels after gastric banding were quantitatively lower (IL-6 414+/-240 ng/l, TNFalpha 184+/-77 ng/l) than after resection. We found significant elevation of plasma leptin concentration (32+/-10 ng/ml) 24 h after banding compared with preoperative values (18+/-5 ng/ml, p 0.05). Leptin levels 48 and 72 h after banding rapidly returned to the level before operation. During abdominal surgery leptin shows to be an acute phase reactant. Proinflammatory cytokines can be main regulatory factors of leptin during this period. Significant correlation between leptin and TNFalpha (similarly demonstrated by other authors in models of bacterial inflammation) indicates that TNFalpha can be the crucial regulator of leptin generation in the early postoperative period. On the basis of our results we recommend to observe IL-6 and IL-8 at 24-72 h after the surgery in patients with a high risk of early postoperative septic complications.

Bacterial Infections↗

PubMed2005

[Laparoscopic diagnosis and treatment of organic hyperinsulinism--our first experience].

Laparoscopic pancreatic procedures are still at the stage of evaluation with regard to their indications and the technical variation used. Laparoscopic pancreatic surgery is currently used for staging malignant pancreatic tumours, for the resection of benign pancreatic tumours and for the occasional management of inflammatory disorders of the pancreas. Insulinomas are rare tumours with incidence per year of 0.1-0.4 per 100,000. Ist Surgical clinic, IIIrd Internal clinic and Radiological clinic are cooperating since 1971. On the list of IIIrd Internal clinic are 80 patients with insulinoma. Since 1971 at Ist Surgical Clinic 66 patients have been operated. In our article are diagnostic and therapeutic problems discussed. Laparoscopic pancreatic procedures are still at an evaluation stage regard to their indications and techniques. Authors give report about first experience with successful laparoscopic enucleation of insulinoma in case 83 year old woman (Fig. 3, 4). The operative time was 90 min. Drainage is necessary. CT guided drain in cavity of seroma is shown (Fig. 5).

Humans↗

PubMed2005

[Prevention, diagnosis and treatment of iatrogennic lesions of biliary tract during laparoscopic cholecystectomy. Management of papila injury after invasive endoscopy. Part 1. Prevention and diagnosis of bile duct injuries].

INTRODUCTION: Endoscopic invasive procedures in 70th and 80th years leaded to decrease reoperations on biliary tree. Iatrogenic injury of the biliary tract have increased in incidence in the first decade with the introduction of laparoscopic cholecystectomy. Athough a number of factors have been identified with a high risk of injury ( and number of technical steps have been emphasized to avoid these injury, the incidence of the bile duct injury has reached at least double the rate observed with open cholecystectomy. Cholecystectomy is most frequently performed abdominal operation and the most serious complication associated with this procedure is accidental injury to the common bile duct (0.3-0.4%). This preventable technical error has tradicionally been thought to occur in one or more of three situations: 1. When the operator attempts to clip or ligate a bleeding cystic artery and also clips the common hepatic duct (Fig. 3a). 2. When too much traction has been exerted on the gallbladder so that the common bile duct has tented up into an albow, which was either tied off with ligature or clipped (Fig. 3b). 3. When anatomic anomalies were not recognized and the wrong structure is divided, for example, when the cystic duct winds anterior to the common bile duct and enters on the left side, or when the cystic duct joins the right hepatic duct rather than the junction of the common hepatic and the common bile ducts (Fig. 1, 2, 3cd). In anatomical incertain cases is discussed about cholangiography and cholecystocholangiography during laparoscopy cholecystectomy. Most patients sustained a bile duct injury are recognized in the weeks folloving laparoscopic cholecystectomy. Careful preoperative preparation should include control of sepsis by draining any bile collections or fistulas and komplete cholangiography. Long-term results are best achieved in specialized hepatobiliary centres performing biliary reconstruction with a Roux-Y hepaticojejunostomy. Success rates over 90% have been reported from several centres to date with intermediate follow-up. Papila injury increased with introduction of a invasive endoscopy. Risk of deadly retroperitoneal inflamation is very high. Injury require same surgery procedure as duodenum injury. OWN EXPERIENCES: In an article a review of experiences of the 1st surgery department of General hospital in Prague since 1971 in 1 017 reoperations on biliary tree was carried out. There was in 311 patients 164 hepatohepatostomies and 147 hepaticojejunostomies used (Tab. 1). By laparoscopic injuries were high hilar injuries (Bismuth IV) in last decade and hepaticojejunostomy was done in all cases. Died 6%, long term results are acceptable by injured patients with hepaticohepaticostomies in 70%, by hepaticojejunostomies in 90%. Reoperated were 10% patients (Tab. 1). Remnant patients were dilated endoscopicaly. Postoperatively morbidity was high, above 26%. In years 1995-2003 were 8 patients with papila injury and inflamation in retroperitoneum operated as a injured duodenum (Tab. 2). CONCLUSIONS: Better experiences with treatment of injured biliary tree and papila are in centres interested in hepatobilliary surgery which knowledge anatomy of hilus of liver and can make wide hepaticojejunostomy. Transfer of drained injured patient to centre is possible.

Ampulla of Vater↗

PubMed2005

[Prevention, diagnosis and surgical treatment of injuries of the biliary tract during laparoscopic cholecystectomy. Treatment of papilla injuries caused by invasive endoscopy. Part 2. Surgical treatment of biliary tract injuries].

INTRODUCTION: Introduction of endoscopic invasive procedures in the 70th and 80th years leaded to decrease reoperations on biliary tree. latrogenic injury of the biliary tract have increased in incidence in the first decade with the introduction of laparoscopic cholecystectomy. Athough a number of factors have been identified with a high risk of injury (and number of technical steps have been emphasized to avoid these injury, the incidence of the bile duct injury has reached at least double the rate observed with open cholecystectomy. Most patients that sustained a bile duct injury are recognized in the weeks following laparoscopic cholecystectomy. Careful preoperative preparation should include control of sepsis by draining any bile collections or fistulas and complete cholangiography. Long-term results are best achieved in specialized hepatobiliary centers performing biliary reconstruction with a Roux-Y hepaticojejunostomy. Success rates over 90% have been reported from several centres to date with intermediate follow-up. Introduction of an invasive endoscopy. Very dangerous is injury after endoscopic papilotomy. OWN EXPERIENCES: In an article of a review of experiences of the Ist Department of Surgery of General hospital in Prague since 1971 in 1 017 reoperations on biliary tree has been carried out. There were in 311 patients 164 hepato-hepatostomies and 147 hepaticojejunostomies used (Tab. 1). By laparoscopic injuries in the last decade were hilary injuries (Bismuth IV) and hepaticojejunostomy was done in all cases. Died 6%, long-term results are acceptable by injured patients with hepatico-hepaticostomies in 70%, by hepaticojejunostomies in 90%. Reoperated were 10% patients. Remnant patients were dilated endoscopically. Postoperatively morbidity was high, above 26%. In years 1995-2003 were 8 patients with papila injury and inflammation in retroperitoneum operated as a injured duodenum (Tab. 2). CONCLUSIONS: Better experiences with treatment of injured biliary tree and papila are in centres interested in hepatobiliary surgery which know anatomy of hilus of the liver and can see wide hepaticojejunostomy. Transfer of drained injured patient to centre is possible.

Ampulla of Vater↗

PubMed2005

[Reconstruction procedures following pelvic exenterations].

OBJECTIVE: Review of reconstruction procedures following pelvic exenterations. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Department of Urology, 1st Department of Surgery, Faculty Teaching Hospital and 1st Medical Faculty of the Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSIONS: Reconstruction procedures are important part of pelvic exenterations. The procedures are crucial for following quality of life. Currently the most frequently used techniques for isolated pelvic floor support are omental flaps (carpets), for combined reconstruction of pelvic floor and vagina TRAM (transverse rectus abdominis musculocutaneus flap). Reconstructions prolong operation time; however they are accompanied with low morbidity and some techniques decrease total morbidity of exenterative procedure. Total and posterior exenterations require sigmoideostomy in vast majority of cases. Low rectal anastomosis might be used in cases of supralevator procedures. They cause high morbidity especially in patients following radiotherapy. In these patients temporary diverting colostomy is being recommended. A bowel segment is usually used for urinary diversion following total or anterior exenteration. Golden standard remain the incontinent ureteroenterostomies using ileum or colon transversum. Currently continent diversions are considered more often due to encouraging results and good quality of life. Heterotopic diversions, with continent conduit and cutaneous stoma, are frequently used. Risk of serious complications, especially fistulas and stoma stenosis, after all types of diversions is possible to reduce by using appropriate bowel segment not handicapped by previous radiotherapy.

Colostomy↗

PubMed2005

[Pathophysiology of postoperative dysfunctions of the intestinal motility. A review].

The postoperative motility dysfunction (POI) is a frequent secondary complication of surgical procedures. The POI results from a number of simultaneous factors of both local and systemic nature. Activation of inhibitory neural reflexes and a mediator response to the surgical procedure are among the main ones. Neurohumoral response of the organism to painful stimuli and the effect of the opioid medication used during the perioperative period, are the modulating factors. The intraabdominal procedure with manipulation with the intestine results in activation of the mediator response, followed by increased levels of cytokines and other mediators, inhibiting the smooth intestinal musculature contractility. The extent of the traumatization of the tissue is a principal factor affecting the extent and duration of the POI.

Gastrointestinal Motility↗

PubMed2005

[The risk of malignancy after organ transplantation].

Improvements in immunosuppressive therapy during the past decade brought about improvements of the long term tolerance of organ allografts. However, the long-term immunosuppressive therapy has an important limitation, because it can increase the risk of cardivascular diseases, infections and tumors. As compared with age-matched healthy population, organ-transplant recipients have an increased incidence of tumors.

Humans↗

PubMed2005

[Exenteration procedures in the pelvis].

Exenteration pelvic procedures are surgical options for treatment of locally advanced pelvic tumors. Due to the procedure's success rates, it has become a standard therapeutic procedure, when indicated. From the medical point of view, the following factors characterize the level of seriousness of these procedures: the fact that the procedure is extensive, its complicated reconstruction phase and high postoperative morbidity rates. From the patient's point of view, it is characterized by a principal change in the quality of life. In this case review the authors present their experience with a multidisciplinary approach to these procedures.

Adult↗

PubMed2005

[Laparoscopic distal resection of the pancreas].

During the last two years, reports on laparoscopic procedures of the pancreas have been on increase. Laparoscopic resection of the pancreatic cauda is indicated, primarily, for benign cystic lesions of the cauda of the pancreas and for neuroendocrine tumors of the pancreas (mainly insulinomas). We have not recorded any report on the above procedure in the Czech literature. Therefore, in our case review, we have described laparoscopic distal resection of the pancreas with splenectomy for a pseudopapillary tumor of the pancreas.

Adult↗

PubMed2005

Gonococcal infection as a cause of acute abdomen.

Gonococcal infection in the postantibiotic era continues to cause disseminated and severe disease in some patients. The differential diagnosis of pain in the lower abdomen in young women is difficult. Our case report described a 19-year-old patient who presented with acute abdomen as a result of Gonococcal infection, assessed as a local complication, pelveoperitonitis: pelvic inflammatory disease. The message of our case report is sexually transmitted infections should invariably be considered in young women and searched for accordingly.

Abdomen, Acute↗

PubMed2004

[Results of the large intestine resection in elderly patients].

The colorectal carcinoma incidence increases with age. The radical resection procedure significantly extends the survival period, when compared with other therapeutic approaches. The tissue damage may exceed the organ reserve capacity in cases of the elderly patients and may result in higher postoperative morbidity and mortality rates. The aim of this study was to compare the results and the surgical risks of the large intestine carcinoma resection procedure in elderly patients, compared to younger patients with the same diagnosis. THE PATIENT GROUP AND METHODOLOGY: The retrospective study summons up the clinical results of 3778 patients from all over the Czech Republic, who underwent primeoperations for the following diagnoses: C18--a malignant neoplasm of the large intestine, and C19--a malignant neoplasm of the rectosigmoideal junction, in 2001. The results are compared with our own patient group in the same time-period. The results were assessed according to the following age-group criteria: 21-59 yrs., 60-69 yrs. and over 70 yrs. of age. We assessed the following factors: age, diagnosis, incidence of early postoperative complications and duration of patients hospitalization. RESULTS: The patients in the 21-59 year-group and in the group over 70 years of age, had significantly different rates of early postoperative complications (12.3% vs 17.6%, p < 0.001). The rate of complications was twice as high in urgent procedures compared to planned procedures in all age groups (p < 0.001). The average hospitalization lasted 14.8 +/- 10.9 days. We discovered statistically significant differences in the duration of hospitalization among all three age groups respectively (p < 0.01). CONCLUSION: Based on our results, we believe the age itself not be an indication-limiting factor for the radical resection procedure for the large intestine carcinoma. The elderly patients benefit from its oncological radicality with acceptable rates of the postoperative complications risks. We believe even extensive surgical procedures to be feasible in cases of appropriately indicated elderly patients, and their surgical risks to be acceptable considering the expected benefits for the respective patient.

Adult↗

PubMed2004

[Initial experience in exenteration interventions in the pelvis].

OBJECTIVE: Discussion of experiences with pelvic exenterations. DESIGN: Case-report. SETTING: Department of Obstetrics and Gynecology, Department of Urology, Department of Surgery, Department of Pathology, Department of Clinical Oncology, General Teaching Hospital and Ist Medical Faculty of the Charles University, Prague, Czech Republic. METHODS: Presentation of 4 cases of pelvic exenterations. Discussion with published data. RESULTS: Altogether four cases of pelvic exenterations are presented, one case of supralevator total exenteration for recurrent cervical cancer, one case of infralevator total exenteration for recurrent vaginal cancer, one case of supralevator anterior exenteration in the treatment of locally advanced cancer of urinary bladder, and one case of supralevator posterior exenteration for recurrent vaginal cancer.

Adult↗

PubMed2004

[The onset of physiological activity in the stomach in the postoperative period. A comparative study with a prokinetic preparation, Ganaton].

UNLABELLED: Postoperative gastroparesis decreases patient's postoperative comfort. The aim of this prospective study was to assess efficacy of the peroperatively administered prokinetic preparation Ganaton (Itopridi hydrochloridum, Abbott) on the postoperative gastroparesis. METHODOLOGY: This prospective study was conducted in the Ist Surgical Clinic of the 1st Medical Faculty in Prague in 2001-2001. The total of 64 patients took part in this study. The patients underwent either a non-adjustable bandaging of the stomach via laparoscopy for a severe obesity, or a laparoscopic cholecystectomy. In the postoperative period, a subjective status of each patient, as well as objective examinations (auscultaion, gas excretion, stool excretion) and a percutaneous electrographic record were recorded. RESULTS: The patients after both the gastric bandaging and the laparoscopic cholecystectomy, demonstrated faster restoration of the physiological stomach contractions frequency in the group with itopride, compared with the placebo group. CONCLUSION: The prokinetic preparation was well tolerated and the authors did not record any undesirable side-effects. The preparation significantly speeded up restoration of the physiological stomach contractions frequency compared with the placebo group. Based on our results, its administration is a suitable part of the prophylaxis and treatment of the postoperative gastroparesis.

Adult↗

PubMed2004

[Therapeutic approach for treatment of postoperative ileus].

The postoperative motility disorder of the gastrointestinal tract (POI) is a transient, however a frequent reaction of the gastrointestinal tract to intraabdominal procedures. The cause of the onset of the POI is multifactoral and, therefore, the treatment must also cover all known pathophysiological causes. The management of the POI includes the following basic measures: employment of the minimally invasive surgical techniques, prophylactic administration of the prokinetics, early postoperative mobilisation of the patient and early enteral nutrition.

Humans↗

PubMed2004

[Preoperative biliary drainage in the pancreatic head carcinoma].

UNLABELLED: Hemipancreatoduodenectomy has remained afflicted with high postoperative morbidity rates. Preoperative icterus is considered a significant risk factor. Therefore, a preoperative biliary drainage has been considered a standard preoperative procedure. This study aims to assess the preoperative drainage of the biliary tract significance with respect to the postoperative complications rates. SUBJECTS AND METHODOLOGY: This retrospective study includes 304 patients after completed hemipancreatoduodenectomies, who were operated in the 1st Surgical Clinic of the 1st Medical Faculty of the Charles University and the General Faculty Hospital in Prague between January 1990 and December 2002. In this trial group, 144 patients had underwent preoperative drainage of the biliary ducts and 160 patients underwent surgical procedures without the preoperative drainage. RESULTS: In the trial group, no significant difference in the gender rates, the history of the risk factors, the surgical procedure duration, the perioperative blood loss and the disease stage was detected. The patient trial group with the preoperative drainage of the biliary ducts completed was statistically significantly older (p = 0.05), had higher serum bilirubin levels recorded (118, respectively 81, p = 0.01), had more complications recorded postoperatively (42.4%, respectively 25%; p = 0.05), and more infectious complications (29%, respectively 13%; p = 0.05) when compared with the trial group without the preoperative drainage completed. Upon comparison of the both groups, we have not detected any statistically significant differences regarding the time interval between the diagnosis and the surgical procedure, the hospitalization duration or the mortality rates. CONCLUSION: The operated who had had the internal drainage of the biliary ducts conduted preoperatively, suffered from more complications in total as well as from more infectious complications, compared with the patients without the drainage. On the other hand, the patients who had had the preoperative drainage completed were older and had had higher preoperative bilirubin levels. With respect to the above results we strongly advise the patients with the pancreatic head carcinoma to early consult a hepatobiliary surgeon. As far as the examination algorithm is concerned, we strongly recommend using not only the spiral CT, but also non-invasive methods of examination (the MRI and the MRI cholangiography).

Bile Ducts↗