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Biomedical subjects

V Král

Publications and source records attributed to V Král.

At least 19 recordsLinked to original sources
PubMed2004

[Atypical portocaval anastomosis for hemorrhage in portal hypertension].

The success of endoscopy in treating esophageal varices and the later introduction of liver transplantation into the algorithm of therapy for liver failure shifted surgery of portal hypertension out of sight of hepatologists and surgeons. This decline from surgical treatment was further confirmed by introduction of TIPS into clinical practice. It is completely out of question that only liver transplantation is the causal solution of decompensated liver disease and a series of reliable and less invasive methods may be selected for acute treatment of bleeding from varices. However, even at the present time the portal-systemic shunt may be used in its own indication in repeatedly bleeding patients with a good liver capacity, where it can play a role by bridging the time to liver transplantation in a way similar to TIPS or even to provide a final solution, which makes it possible to live the life expectancy in adequate comfort without the risk of bleeding complications. However, it is not always possible to place a surgical shunt on some of the main branches of the portal vein. In such cases, devascularization is often successfully applied. Atypical shunts represent an exceptional alternative, because side feeder veins of the portal vein are rarely of sufficient caliber for placing a hemodynamically significant shunt. The authors describe two cases, in which stubborn anemia-causing bleeding events in portal hypertension were treated with left-side epiploic-renal shunt or anastomosis between the mesenteric and left-side iliac vein.

Aged↗
PubMed2004

[Detection of the sentinel lymph nodes in lung carcinoma cases using patent blue and its clinical significance].

INTRODUCTION: Views on significance and the most appropriate approach to lymphadenectomy in the non-small-cell lung carcinoma cases, have not been consistent. The method of the sentinel lymphonode identification and biopsy, which has been verified for other tumor types, may become a promising alternative or, at least, a supplement to currently applied procedures in cases of the lung carcinoma. STUDY GROUP AND RESULTS: This prospective, non-randomized study was conducted in the Faculty Hospital in Olomouc between the years 2000-2003. The sentinel lymphonode identification was conducted in the group of 48 patients suffering from the non-small cell lung carcinoma, using the patent blue lymphatic mapping method. The sentinel lymphonode was identified in 40 patients (83.3%), a false negativity of the sentinel lymphonode was detected in 3 cases (7.5%). CONCLUSION: The study proved the clinical benefit of the sentinel lymphonode identification and biopsy method in cases of the non-small cell lung carcinoma using the patent blue dye. Under the circumstance of certain experience with the technology, the reliability of the detection approaches that of the radionuclide sentinel lymphonode detection method. However, the clinical significance of the above method must be further tested on larger patient groups.

Aged↗
PubMed2004

[Complications of extended lung resection procedures following the neoadjuvant therapy].

UNLABELLED: Local tumor expansion in the sense of the tumor invasion into the extrapulmonary structures, which must be removed in one step, preferably en-bloc, together with the primary tumor, is the reason for extending the lung resection procedure. Although verified lymphogenic metastasing into either unilateral, eventually into contralateral mediastinal lymphonodes (stage N2 resp. N3, according to the TNM), remains the commonest indication for the induction therapy in cases of the lung carcinoma, application of the neoadjuvant therapy in cases when extended resections may be expected, is indicated in case the tumor expands into the surrounding structures, which signifies opening of new, unnatural routes of possible lymphogenic and haematogenic dissemination, and thus, a significantly higher risk of the surgical therapy failure. During the period 1995-2002, our team conducted 15 extended lung resection procedures following the preceding induction therapy in patients suffering from the IIB-IIIB stage of the non-small cellular lung carcinoma (NSCLC). The 30-day lethality rate equalled zero. We recorded two rare complications and the postoperative morbidity was acceptable. CONCLUSION: Exhausting staging, the best possible prediction of the tumor behaviour following the surgical procedure and minimal surgical complications remain the prerequisite for good long-term results following the extended lung resections for the lung carcinoma. Application of the neoadjuvant therapy prior to the resection procedure need not increase the risk of surgical complications and, furthermore, may positively affect the disease prognosis.

Carcinoma, Non-Small-Cell Lung↗
PubMed2003

Monomer and polymer quinoxaline derivatives for cationic recognition.

Monomeric and polymeric 5-nitroquinoxaline derivatives disubstituted in the 2 and 3 positions with 2-pyrrolyl (A), 2-furyl (B) and 2-thienyl (C) groups were prepared and characterized. The substituted 5-nitroquinoxalines were used as active components in poly(vinyl chloride)-membrane and electropolymerized electrodes that were then tested as possible sensors for various cationic species. In contrast to the difurylnitroquinoxaline-based systems, the monomeric and polymeric dipyrrolyl- and dithienylquinoxaline electrodes displayed a good selectivity for Ag(+) ions, providing a near-Nernstian response in the 10(-5) to 10(-2) mol L(-1) concentration range. The similar potentiometric behavior displayed by the monomeric and polymeric forms of systems A and C supports the contention that the main binding modes displayed by the monomeric forms are retained in the corresponding polymeric structures.

Journal Article↗
PubMed2003

[Histologic findings in protocol biopsies of transplanted kidneys].

Fourty eight patients with cadaveric kidney allografts treated by cyclosporin A (CSA) or tacrolimus (FK506) underwent protocol graft biopsies at 1, 3 and 12 months after transplantation, and 110 biopsy specimens were obtained. Histologic diagnosis was made according to the Banff scheme. The main cause of the graft instability at 1 and 3 months was acute clinical rejection, these biopsies showed all known histological patterns of tubulointersticial and vascular rejection. Acute tubular nephropathy was found in 13% and borderline changes or nephrotoxicity in 8.7% of instable grafts. Specifically, we focused on the occurRence of subclinical rejection and toxic reactions in stable renal allografts. Of these, 36.1% showed histological patterns of acute tubulointersticial and vascular rejection. The Banff score of subclinical rejection was significantly lower than in clinically apparent rejection. CSA and tacrolimus nephrotoxicity were seen in 14.2%, 19.5% and 27.2% of specimens at 1, 3 and 12 months, respectively. In over one half of the identified cases of nephrotoxicity neither increased level of immunosuppression nor features of allograft dysfunction were found. At 12 months, 45.5% of specimens showed mild chronic transplant nephropathy and 18.1% moderate chronic transplant nephropathy. Normal morphology was found in 36.4% of biopsies. We found a high prevalence of subclinical rejection and nephrotoxicity in the studied cohort. We conclude that protocol biopsy is a reliable method in the diagnosis of clinically silent, as well as clinically apparent, disorders of the transplanted kidney.

Biopsy, Needle↗
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↗
PubMed2003

[Gene therapy of liver tumors: results of the first clinical studies].

Only a small percentage of primary and secondary liver tumours is suitable for surgical resection. Gene therapy represents a novel strategy that seems to be effective both, in vitro and in vivo. The use of tumour suppressor gene p53 therapy, suicide gene therapy, immune gene therapy and therapy with replication-competent oncolytic adenoviruses in liver tumours already entered the first clinical trials. In patients with hepatocellular carcinoma, the first clinical trials in phase I and II showed good tolerance and low toxicity to gene therapy. However, the clinical benefit for the patients treated either with wild type p53 or E1B deleted adenoviruses were marginal.

Clinical Trials as Topic↗
PubMed2003

[Solid papillary neoplasia of the pancreas--case report].

Solid papillary neoplasia of the pancreas is a rare tumour that occurs most commonly in young women. This tumour has low malignant potential and favourable prognosis following surgical resection. Therefore it is mandatory to distinguish this tumour from other types of pancreatic tumours. The paper reports the case of a 31-year-old woman with a large solid papillary neoplasia of the head of pancreas where successful pancreatoduodenectomy was performed.

Adult↗
PubMed2003

[Detection of Helicobacter pylori in the saliva of patients with recurrent aphthous stomatitis].

BACKGROUND: Helicobacter pylori participates significantly on the pathogeny of chronic gastritis, duodenal and gastric ulcer, carcinoma and lymphoma of the stomach. There are some more diseases requiring attention--for example cardiovascular, dermatologic, and autoimmune. METHODS AND RESULTS: Helicobacter pylori was detected in saliva and faeces of 28 persons by the Premier platinum HpSA diagnostic set. Levels of IgA and IgG antibodies were determined by EIA and Western Blott methods. Parameters of salivary immunity were investigated as well. Levels of IgG, SIgA, IgM, lysozyme and albumin were determined. Recommended therapy of Helicobacter infection led to an evident clinical improvement and descent of the documented Helicobacter pylori antigen. CONCLUSIONS: Helicobacter pylori infection can probably participate in some cases of relapsing aphtous stomatitis.

Adolescent↗
PubMed2002

Laparoscopic transhiatal resection of epiphrenic diverticulum.

Our experience with videolaparoscopic operations for hiatus hernia and achalasia, which have almost replaced classical procedures, enabled us to use the same technique for other interventions in the distal third of the thoracic esophagus. Thus, we were able to treat epiphrenic diverticulum using a minimally invasive approach. We report our experience with videolaparoscopic diverticulum resection. The procedure was performed in three patients, all of them elderly men with ventilation limitation and a history of a chest intervention. The procedure included myotomy and an antireflux procedure. No significant complications occurred during the operations or postoperative periods; a minor leak that was successfully managed conservatively occurred in one patient. We conclude that videolaparoscopy could be a possible alternative to the standard classical left-side thoracotomy approach for patients in whom a classical operation is not feasible.

Aged↗
PubMed2002

[Role of modern absorbable suture materials in decreasing the occurrence of early complications after laparotomy].

UNLABELLED: Uncomplicated healing of surgical wounds is one of the most important factors which contribute to the success of operations. In particular dehiscence of laparotomy is an important complication associated with considerable morbidity and lethality. A number of factors which contribute to the healing of the surgical wound at the time of operation cannot be influenced, it is however possible to influence the technique of wound closure and the material used. The authors compare in their study early postoperative and long-term results of closure of laparotomy in three groups of patients where for closure of laparatomy PDSII loop suture was used, continuous suture with Vicryl and classical suture by individual silone stitches. The investigation revealed a significantly lower incidence of early postoperative complications in patients where modern absorbable materials were used, in particular early infections. The incidence of dehiscence of laparotomy or hernia in the scar did not differ significantly although in the group with absorbable materials, contrary to the group with silone, there was no dehiscence of laparotomy without an infectious complication of wound healing. CONCLUSION: Empirical experience and the conclusions of some major investigations indicate that the best method of closure of laparotomy is continuous suture using absorbable material.

Absorption↗
PubMed2001

Open-tubular electrochromatography of organic phosphates on a sapphyrin-modified capillary.

Sapphyrin coating of the inner wall of the capillary results in a distinct interaction of the phosphate residue-possessing compounds as proven by a seven-membered model mixture of nucleoside mono- and diphosphates and ATP. Modification of the inner surface of the capillary not only alters the endoosmotic flow (as would have been expected) but brings about an electrochromatographic effect based on the interaction of tested phosphate moiety-bearing solutes with the immobilized sapphyrin layer. Elution of the sample can be achieved by using either 25 mM borate-acetate buffer in which monophosphates are not only separated from each other, but also selectively separated from di- and triphosphates (ATP). With the other two buffer systems tested, i.e. borate-phosphate and Tris-HCl, better selectivity (though smaller interaction with the capillary coating) was observed. The coating is relatively stable (can be used for 20 subsequent runs at least), simple to materialize, and in spite of a strong UV absorbancy of sapphyrin at the wavelength used (254 nm), decreases the limit of detection by no more than one order of magnitude as compared to the untreated capillary. Resolution factors (calculated to the preceding peak) are in most cases better in the electrochromatographic separation mode as compared to the separation in the untreated capillary, which reflects both the decrease in the electroosmotic flow and the interaction with the capillary wall coating.

Chromatography, Micellar Electrokinetic Capillary↗
PubMed2001

Novel porphyrin-cryptand cyclic systems: receptors for saccharide recognition in water.

Two macrocyclic porphyrin sandwich systems, 4 and 5, together with the linear compound 6 have been prepared and examined as saccharide receptors. The cyclic porphyrin-cryptand conjugates 4 and 5 bind saccharides efficiently in highly competitive media with a preference for trisaccharides probably due to a complementary topology of hydrophobic and hydrophilic solvating regimes with respect to the sugar guests.

Bridged Bicyclo Compounds, Heterocyclic↗
PubMed2001

Noncovalent interactions of peptides with porphyrins in aqueous solution: conformational study using vibrational CD spectroscopy.

Noncovalent interactions of poly(L-lysine) (PL), oligopeptides L-lysyl-L-alanyl-L-alanine and (L-lysyl-L-alanyl-L-alanine)(2) with meso-tetrakis(4-sulfonatophenyl)porphine (TPPS), and poly(L-glutamic acid) (PLGA) with meso-tetrakis(1-methyl-4-pyridyl)porphine tetra-p-tosylate (TMPyP) in aqueous solutions have been studied using combination of spectroscopic methods: Vibrational circular dichroism (VCD) spectroscopy in the mid-infrared region provides a direct information on conformational changes of the polypeptides and oligopeptides caused by interactions with porphyrins; ultraviolet-visible absorption, fluorescence, and electronic circular dichroism (ECD) reveal the aggregation characterization of the porphyrin part of the complexes. Interactions of TPPS with tripeptide, hexapeptide, and PL containing about ten amino acid residues in the molecular chain are accompanied with the changes of VCD patterns in the amide I' region. In these cases, the conformation of the oligopeptide part of complexes is obviously influenced by interactions with TPPS and partial changes of random coil structure are observed in VCD. When PL was composed of the hundreds of lysine residues, just a weak intensity decrease was detected and the shape of VCD spectrum typical for the random coil structure was preserved. As follows from the uv-vis absorption and fluorescence spectra, porphyrin molecules are attached to peptides by electrostatic interaction as a monomer or dimer and interaction between porphyrin and peptide depends on the polypeptide chain length. For the PLGA-TMPyP system with PLGA containing from tens to hundreds of glutamic acid residues in the chain, the VCD spectra were unchanged when TMPyP was presented in the aqueous solution of PLGA and random coil conformation of PLGA-TMPyP aggregates was preserved.

Biocompatible Materials↗
PubMed2001

[Effect of portosystemic anastomosis on the degree of splenic inhibition].

UNLABELLED: Secondary hypersplenism is a well-known complication of portal hypertension. Reduced platelet count is a more alarming sign for the physician than risk for the patient. Improvement of thrombocytopenia is urgent, when portal hypertension with splenomegaly and thrombocytopenia presents with life-threatening haemorrhage from gastroesophageal varices. In this case, treatment aimed at stopping the bleeding may be more beneficial than any intervention on the spleen. In this study, we evaluated long-term effects of an elective distal splenorenal shunt or small diameter H-shunt on splenomegaly and thrombocytopenia in 26 patients with portal hypertension operated for repeated bleeding from oesophageal varices. 25 patients had splenomegaly and 16 patients had thrombocytopenia before shunting. Surgery corrected splenomegaly in 16 patients (64%), platelet counts increased in 13 of 16 patients with thrombocytopenia (81.2%). CONCLUSION: Selective or partial portal decompression is sufficient to alleviate thrombocytopenia and splenomegaly associated with portal hypertension.

Adult↗
PubMed2001

[Hyperparathyroidism in clinical practice. Personal experience].

The period of six years is discussed by the authors during which 39 patients were confirmed having primary or secondary hyperparathyroidism. All of them finally underwent the surgical procedure. The possibility of immunoreactive PTH measurement has been highly appreciated. Despite that key position of the experienced surgeon remains of the utmost importance.

Adult↗
PubMed2001

[Laparoscopic repair of bilateral inguinal hernias: results at the First Surgical Clinic in Olomouc].

OBJECTIVE: The aim of this paper is to evaluate the outcome of the TAPP (transabdominal preperitoneal) repair of bilateral inguinal hernia with one large mesh. METHODS: Eighteen patients with the bilateral inguinal hernia had TAPP repair with one mesh. The operation and the postoperative course has been discussed. RESULTS: None operative complications were noted, postoperatively four groin haematomas and one recurrence were observed. CONCLUSION: TAPP is safe and effective for the repair of the bilateral inguinal hernias.

Female↗