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Biomedical subjects

R Roka

Publications and source records attributed to R Roka.

At least 73 records · Page 4Linked to original sources
PubMed1985

[A new procedure for reconstruction of the voice--neoglottis of small intestine].

The fundamental concept in vocal rehabilitation after laryngectomy is the tracheo-hypopharyngeal shunt. The usual contemporary methods possess numerous disadvantages. In order to improve the results a syphon-fashioned shunt with free transplanted jejunum between the tracheal stump and the hypopharynx is created (stimulated by K. Ehrenberger). Aspiration can be avoided by means of the autonomic peristalsis of the implant. The procedure has been performed in 7 cases. One developed necrosis of the loop. The other patients possess a clear voice.

Esophagus↗
PubMed1985

Transsternal operations in thyroid cancer.

Large thyroid carcinomas extending into the anterior mediastinum were removed from six patients by a transsternal surgical approach (partial median sternotomy). Transcervical mediastinal dissection offers obscure exposure and therefore entails the risk of the operation not being radical. The transsternal procedure was used as an alternative to remove affected lymphatic and fatty tissue from an additional nine patients. Sternal metastases were extirpated from 10 patients. Irrespective of the stage of the tumor, the indications for a transsternal approach to onocologically radical extirpation of tumors and mediastinal lymphatic fatty tissue should be more liberal, particularly with differentiated and medullary thyroid carcinomas. The prognosis for differentiated carcinomas is improved by radioiodine treatment, and optimal conditions for this therapy are ensured by the most radical possible removal of the tumor with its affected lymph nodes and sternal metastases. In the case of mixed differentiated/anaplastic and medullary carcinomas, this operative procedure ensures favorable conditions for other adjuvant forms of therapy. Although it was not possible to extend the life expectancy of patients suffering from anaplastic carcinomas, their quality of life was at least improved by the prevention of mechanical dyspnea caused by the mediastinal tumor.

Adult↗
PubMed1983

[The significance of the 5th gland as a cause of primary hyperparathyroidism. Case report and review of the literature].

Of 140 patients surgically treated for primary hyperparathyroidism one patient had persistent hypercalcemia due to an abnormal and ectopic fifth parathyroid gland (0.7%). The possibility of an abnormal fifth gland as the cause of primary hyperparathyroidism should be considered when four glands of normal size and histology have been found in the neck, and of such a gland should be thought in all patients with diffuse hyperplasia after subtotal parathyroidectomy suffering from persistent hyperparathyroidism. The fifth gland is usually found in the lower neck or upper mediastinum, frequently within the thymus. If present, it should be excised by transcervical thymectomy during first operation. In reoperations sternal splitting should be performed.

Adenoma↗
PubMed1982

[Free intestinal grafts for oesophageal reconstruction: indications, technics and results].

Autotransplantation of intestinal segments for oesophageal reconstruction using microsurgical techniques has been reported in the literature in 137 patients. In 8 patients (5.8%) arterial thrombosis occurred, necessitating removal of the transplant in 6 patients (4.4%); two of them (1.5%) died of sepsis. Altogether 6 patients (4.4%) died postoperatively. Salivary fistulae are reported in 15 patients (10.9%) and these usually resolved spontaneously. This technique seems satisfactory for the reconstruction of oesophageal defects in patients with recurrent cancer in whom the classical procedures are no longer feasible.

Burns, Chemical↗
PubMed1982

[Resection of intrathoracic oesophageal cancer by blunt dissection without thoracotomy (author's transl)].

The resection of thoracic oesophageal cancer by blunt finger-dissection and stripping is a further palliative procedure at the disposal of the surgeon. This method represents an alternative to intubation or bypass without resection. The advantages are the better functional results and at least palliative removal of the tumour. This method should be used, however, if there is the possibility of carrying out radical resection from the oncological point of view, with the aim of curing the patient. The technical details are described and the indications and results discussed on the basis of six case reports.

Adenocarcinoma↗
PubMed1982

[Esophageal carcinoma: a one-time procedure with stomach transposition as a therapeutic concept (author's transl)].

From December 1979 until October 1981 29 patients with malignant esophageal stenosis were treated in surgical department I of the University of Vienna. The tumor was located in 3 patients in the upper third of the esophagus in 17 cases in the middle, and in 9 in the lower third. The tumor stage permitted curative treatment (exstirpation of the esophagus) in 25 cases; in the remaining 4 patients bypass procedures were performed (retrosternal, antethoracic). In 6 cases the esophagus was excluded by blunt dissection without thoracotomy. For esophageal replacement the stomach was used in all cases in isoperistaltic fashion with cervical anastomosis. Of 13 cervical anastomotic leaks 11 healed spontaneously within 2 weeks. Five patients died, 3 of them because of respiratory failure. Using the stomach for replacement is a safe method with excellent functional results.

Esophageal Neoplasms↗
PubMed1982

[Are fractures of the upper ankle joint to be treated conservatively? (author's transl)].

By means of 796 fractures of the upper ankle-joint, the treatment and results of the therapy according to the conservative-viewpoints are going to be discussed. Comparing the results after operative treatment, conservative therapy today is only justified with fractures of th type A and B under the presumption that there is no subluxation of the talus of the latter mentioned. Bimalleolar fractures of the type A can also be treated conservatively with good results if the inner-ankle fracture has not resulted in the destruction of the ankle-fork. All other fractures should have open reduction and internal fixation. Special attention shall be paid to the reconstruction of the complex fibula-syndesmosis.

Adolescent↗
PubMed1982

[Roentgenologic findings following total transposition of the stomach as a replacement for long segments of the esophagus].

Thirty-seven patients, in whom the stomach had been transposed in order to replace a long segment of the oesophagus, were studied. Radiologically important early complications and the late results of this surgical technique were correlated. Twenty-five patients were observed radiologically and clinically for a period of three to 20 months. The study was directed at the morphology of the transposed stomach and of the anastomosis, and particularly at the problem of gastro-oesophageal reflux. Knowledge of the operation site is essential for evaluating the transplant (pleura defect). Radiological examination is the most suitable method for evaluating the cervical extra-thoracic anastomosis in the early post-operative phase (six to ten days). It is also effective at a later stage for the early recognition of fibrotic stenosis which will require treatment. An attempt has been made to define an ideal situation following gastric transposition which will usually correspond with a good clinical result.

Adult↗
PubMed1982

[The significance of bilateral diagnostic lymphadenectomy in thyroid cancer. Tactical operative procedure in the 1st intervention].

In 101 patients with differentiated (papillary n = 74, follicular n = 20, or medullary n = 7) thyroid cancer and lymph node metastases a modified radical neck dissection (unilateral or bilateral) had been performed. After the examination of the lymph nodes in several stations the retrospective analysis showed positive nodes within the internal jugular vein (= central reservoir) in 96% of all cases independent of the tumor site. Only tumors in dorsal parts of the thyroid or in the isthmus (4%) showed other modes of lymphatic spread. Therefore during the first exploration the bilateral excision of the lymph nodes of the internal jugular vein (= diagnostic lymphadenectomy) by Kocher' incision is representative whether an extensive lymphatic spread has occurred.

Adenocarcinoma↗
PubMed1981

[Hyperparathyroidism in chronic renal insufficiency new clinical and surgical aspects (author's transl)].

The therapy of secondary hyperparathyroidism in chronic renal disease has been improved by the availability of active 1-alpha-hydroxylated vitamin D derivatives. However, in cases with progressive secondary hyperparathyroidism which have not been brought under control conservatively, surgical intervention is still required. Total parathyroidectomy with autologous transplantation of parathyroid tissue in the forearm has recently been recommended as the optimum surgical approach to secondary hyperparathyroidism. Recent literature is reviewed and personal clinical experience is reported in this paper, followed by a presentation and discussion of the pathophysiology of hyperparathyroidism in chronic renal failure, various means of conservative treatment, indications for parathyroidectomy, surgical aspects and technique of cryopreservation, as well as a standardized therapeutic regimen for pre- and postoperative treatment with calcium and 1-alpha-hydroxylated vitamin D analogues.

Calcium↗
PubMed1981

[Development and results of adrenal autotransplantation (author's transl)].

56 cases of adrenalectomy and autotransplantation of human adrenal tissue have been reported in the literature since 1955. The most common indication was bilateral adrenal hyperplasia. A reduction in postoperative corticosteroid substitution and a return to almost physiological function on discontinuation of long-term substitution can be achieved. Recurrent disease is easily cured by partial excision of the transplanted tissue, situated usually in small muscle pockets, under local anaesthesia. The loss of adaptation to circadian rhythm and stress are adverse effects. Further development of this technique, which is still relatively rarely implemented, may make it more universally applicable for a wider indication of bilateral adrenalectomy, without loss of adrenal function.

Adrenal Cortex↗
PubMed1981

Results following surgical treatment of hyperthyroidism.

In the years 1965-1978 1,222 patients with different types of thyrotoxicosis underwent surgical treatment at the 1st Department of Surgery, University of Vienna. Wherever possible a sparing selective surgical approach was considered preferable: autonomous adenoma (45%) enucleation resection or subtotal uni-lateral resection; multinodular toxic goiter (36%) and Graves disease (5%) uni- or bilateral subtotal resection. The remaining 5% were rather rare types of goiter (recurrent goiter, thyroiditis, adenocarcinoma). Overall mortality due was 0.7%. One-hundred and seven patients (8.76%) were over 70 years old at the time of the operation. Post-operative death occurred in the group of patients with toxic adenomas (2.7%). Four-hundred and ninety-five patients were followed up from 3-13 years postoperatively: the rate of recurrent thyrotoxicosis was 4.4%, 4.8% of the patients with hypothyroidism. In this paper the significance of the rapid effect of surgery in cases of hyperthyroidism is discussed and the results are compared with findings in other studies.

Female↗
PubMed1981

[Hyperparathyreoidism and chronic lymphocytic leukemia (author's transl)].

A 55 year old patient with chronic lymphocytic leukemia is reported in whom hypercalcemia occurred associated with hypophosphatemia and elevated parathyroid hormone levels (C-terminal assay). Bone histology gave further evidence for hyperparathyroidism. During neck and mediastinal exploration numerous lymph nodes were exstirpated. Although pathologic parathyroid tissue could not be identified it is concluded from postoperative normalisation of calcium levels that hyperparathyroidism had been cured by surgery. The patient died the seventh postoperative day on bronchopulmonary infection. Early differential diagnostic evaluation of the rare symptom hypercalcemia in chronic lymphocytic leukemia is postulated.

Diagnosis, Differential↗