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V Kuntscher

Publications and source records attributed to V Kuntscher.

15 recordsLinked to original sources
PubMed2006

[Giant bilateral adrenal myelolipoma associated with congenital adrenal hyperplasia].

BACKGROUND: Myelolipoma is a rare benign tumor formed by mature fat tissue with strata of haematopoiesis. It is mainly asymptomatic, only large myelolipomas manifest themselves by abdominal discomfort, bleeding or by symptoms of oppressing adjacent organs. It is usually localized in the region of the adrenal gland. Myelolipomas are mostly clinically inert, only a small number of them are associated with Cushing's type of endocrine disorders, Conn's syndrome, Addison's disease, etc. PATIENT AND METHODS: The authors present a rare case of a giant bilateral myelolipoma emerging out of the adrenal gland cortex in a congenital adrenal hyperplasia, with steroid 21-hydroxylase deficiency, in a woman with pronounced virilism. The principal diagnostic methods include sonography and computer tomography. The therapy available is either a surgical extirpation in the case of large or growing myelolipomas or observation in the case of small ones (< 5 cm). RESULTS: The condition was resolved by bilateral adrenalectomy with extirpation of both myelolipomas and subsequent hormonal substitution treatment during which there was a gradual regression of virilising symptoms. CONCLUSIONS: The coincidence of myelolipoma and congenital disorder with subsequent overproduction of the adrenocorticotropin hormone and androgens, might be explained by the incipient of myelolipoma through chronic hormonal stimulation of the adrenal gland cortex. However, the etiopathogenesis of myelolipoma is still unclear.

Adrenal Gland Neoplasms↗
PubMed2005

[An inflammatory aneurysm of the abdominal aorta].

Inflammatory aneurysm of the abdominal aorta is a rare disorder, affecting approximately 3-10% of the population with a diagnosis of the abdominal aortic aneurysm. The principal etiological agents of the disorder include bacterial microorganisms, primarily Salmonella, Staphylococcus aureus, and Escherichia coli. However, in many cases the etiology od the disorder remains unclear and, likely, autoimmune and genetic dispositions may play a certain role, as well. The principal diagnostic procedures include ultrasound, CT and MRI examinations. The principal therapeutic procedures include open resection of the inflammatory aneurysm with complete removal of the infectious tissue and its replacement by a prosthesis or a vascular allograft "in situ" or through an extraantomical reconstructive procedure. New procedures also include endovascular therapy which is technically much simpler, less demanding for a patient, however, it may leave a potential infectious focus in the organism with a risk of further septic complications to follow. Therefore, the authors recommend a strictly individual treatment strategy in each patient with this serious disorder. In case of positive cultivation bacteriological findings, extended (a minimum of 6 weeks) antibiotic therapy and regular, long-term patient follow-up with regular visits, are essential.

Aged↗
PubMed2004

Immunosuppresive agents have an influence on ischemia-reperfusion injury in kidneys procured from a non-heart-beating donor: experimental study.

Ischemic-reperfusion injury (IRI) has a considerable influence on the function of kidneys from non-heart-beating donors (NHBD) after transplantation. IRI is accompanied by a marked inflammatory reaction with the production of reactive oxygen species and of the proinflammatory cytokine tumor necrosis factor alpha. The effect on the development of ischemic-reperfusion injury of early treatment of the donor with mycophenolate mofetil and tacrolimus was monitored in an animal model of a NHBD. The study demonstrated that the combination of the two immunosuppressives reduced the production in the NHBD kidney of tumor necrosis factor alpha, an indicator of the degree of inflammatory reaction after reperfusion, to a considerable extent but not of malondialdehyde or reduced glutathione. Pre-treatment of marginal donors with these immunosuppressants may improve the immediate function of transplanted kidneys by reducing cytokine production.

Animals↗
PubMed2004

[Various types of pelvic lymphadenectomy--surgical options--comparison of their significance].

Based on recent literature data, the authors summarize contemporary trends in the surgical therapy for carcinomas in the pelvic region, in particular a significance of the pelvic lymphadenectomy, which has become a standard part of the treatment of the above mentioned disorders. Furthermore, they bring forward new trends in research on lymphatic mapping and the sentinel lymphonode detection.

Humans↗
PubMed2003

Can ischemia-reperfusion syndrome in transplanted kidneys procured from non-heart-beating donors be influenced by adding selenium into the reperfusion solution? An experimental study.

Ischemia-reperfusion syndrome significantly influences the function of a kidney transplanted from a non-heart-beating donor (NHBD). An animal model of NHBD was used to monitor the influence of the exogenous addition of selenium in the perfusion solution (HTK, Custodiol) on the generation of free oxygen radicals between 0 and 120 minutes after transplantation of the NHBD organ. During this interval, the malondialdehyde concentration, an indicator of free oxygen radicals in the venous blood of the transplanted kidney, significantly decreased. The augmentation of the anti-oxidant capacity of the preservation solution might represent a possible improvement in the function of kidneys transplanted from NHBDs.

Animals↗
PubMed2003

Can the ischemia-reperfusion syndrome in transplanted kidneys procured from non-heart-beating donors be influenced by adding selenium into the reperfusion solution? An experimental study.

The ischemic-reperfusion syndrome significantly influences the function of a kidney transplanted from a non-heart-beating donor (NHBD). The animal model of a NHBD was used to monitor the influence of exogenous addition of selenium into the reperfusion solution (HTK, Custodiol) with respect to the formation of free oxygen radicals at 0 to 120 minutes after the NHBD transplantation. This maneuvers produced a statistically significant decrease in malondialdehyde concentration, an indicator of free oxygen radicals in the venous blood of the transplanted kidney. The augmentation of the antioxidative capacity of the preservation solution might be a possible route to improve the function of kidneys transplanted from NHBDs.

Animals↗
PubMed2003

[Abdominal aneurysm resection in aged patients at the Surgery Clinic in Plzen from 1998 to March 2003].

The authors evaluate resection therapy on aneurysms of abdominal aorta in patients of high age (mean 85 years) at the Clinic of Surgery in Plzen. In the period of 1998-March 2003 the authors performed 13 elective resections on aneurysms of abdominal aorta in patients of high age with zero mortality and 21 acute resections with 38% mortality. In the given period of time, 178 resections of aneurysms of abdominal aorta were made in patients younger than 78 years, 57 being acute interventions. Mortality of elective interventions was 2.9%, in acute interventions being 28%. The present groups indicate that mortality of resection therapy sharply increased in relation to circulation instability of the patients in cases of ruptured aneurysm, but nor in relation to age of the patients.

Aged↗
PubMed2002

[Extraanatomic bypass surgery for peripheral arterial vascular disease--is it still justified?].

OBJECTIVE: Our results of extraanatomic bypass surgery in the last 5 years should be analysed in a retrospective study. PATIENTS AND METHODS: 66 extraanatomic reconstructions were performed in 65 patients (52 male, 13 female). Femoro-femoral bypasses (78.8 %) were mainly included in this study, followed by axillo-femoral (bifemoral) and obturator bypasses. The procedures could be divided in 45 (68.2 %) primary and 21 (31.8 %) recurrent operations. 57.6 % of the patients revealed a critical lower limb ischemia. RESULTS: The bypass patency rates were 97 % after one year and 81.1 % after 3 years. 24.2 % of the patients showed immediate postoperative complications, 12.1 % of them major complications (surgical and nonsurgical). No patient died postoperatively or in the first year after operation. The 3-year mortality rate ranged to 10.8 %. Major amputations had to be carried out in 4 patients (6.1 %) during the first year and in one patient later on, so that the total amputation rate amounted to 7.6 %. CONCLUSIONS: Our results prove extraanatomic reconstructions to be a valuable surgical tool in lower limb ischemia with good long-term success. Extraanatomic bypasses are technically simple procedures in the majority of cases and take good care of the patient with low morbidity and mortality.

Adult↗
PubMed2000

[Femorodistal vascular reconstruction at the Surgical Clinic of the Medical School Hospital in Plzen 1993-1999].

The authors evaluate the success of femorodistal vascular reconstructions during the past seven years, in particular their asset for patients. A total of 41 femorodistal reconstructions were implemented in 39 patients (incl. 25 diabetics--64.1%). The annual patency of reconstructions is 85.4%, the five-year patency 68.3%. In 11 (28.2%) of patients subsequently a high amputation of the extremity had to be performed. In more than one third of patients with early and late occlusion of the reconstruction it was not necessary to make an amputation and the patients with an originally critical ischaemia of the extremity suffered from brief claudications. The thirty-day mortality was 2.6% (one patient died from embolism of the pulmonary artery). Femorodistal reconstructions have at present a firm position in vascular reconstruction surgery and are usually the last hope for saving the extremity in patients with critical ischaemia of the extremity. They call, however, for exact indication and a delicate surgical procedure.

Aged↗
PubMed2000

[A kidney harvesting technic from a non-heart beating donor].

The authors describe the technique of collection of kidneys from NHBD. They present their own protocol elaborated in Plzen for collection of kidneys from NHBD. For collection they use a special double-balloon catheter inserted into the aorta to ensure that the perfusion fluid will penetrate into visceral branches of the aorta. For the flow of the perfusion fluid a urinary catheter is used inserted via the femoral vein into the vena cava inferior. Immediately after the beginning of perfusion laparotomy is performed with immediate cooling of the kidney with ice. The authors give an account of their own experience and discuss further technical possibilities as regards collection of kidneys from NHBD.

Cadaver↗
PubMed2000

[Donors with non-beating hearts--a new possibility in expanding the kidney donor program].

In the Czech Republic in recent years a steady decline of renal transplantations was recorded due to shortage of organ donors. The authors present initial experience with the collection of organs from dead non heart beating donors (NHBD). In the course of less than two years this programme was introduced within the framework of a clinical experiment (grant IGA MofH CR ND/4781-3) at the Surgical Clinic, Faculty Hospital in Plzen. A total of 20 kidneys were collected from NHBD and another 12 kidneys were not collected, most frequently because of difficulties in communication and organization. The donors were grouped according to the Maastricht classification. The mean age of donors was 43.3 years, the mean period of warm ischaemia was 22 minutes and the serum creatinine level was 145 mumol/l. Of 20 collected kidneys a normal histological appearance was recorded in 14, the remainder had different degrees of damage due to inadequate rinsing. Based on hitherto assembled experience the authors emphasize perfect team collaboration in collection from NHBD and a precise technique of collection. The next stage of the clinical study will be the preparation proper for clinical transplantation of kidneys from NHBD.

Adult↗
PubMed1996

[Compartment syndrome].

Compartment syndrome most commonly occurs following revascularization of an acutely ischemic extremity. It is not only a danger for patient's extremity but also for his or her life if it is not detected and treated in time. The authors present 37 patients treated during 10-years period at the Department of Surgery, University Hospital in Pilsen for compartment syndrome after acute extremity ischemia due to arterial occlusion or trauma. Twenty-five (67.6%) patients healed without complication. Amputation and mortality rate was 16.2%. The main cause of patient's death was reperfusion injury. The length of ischemia and time of fasciotomy were statistically significant factors for the result of treatment. The authors emphasize the significance of early diagnosis and treatment of compartment syndrome.

Adolescent↗