[Open or laparoscopic cholecystectomy in patients with chronic heart failure--no differences in the postoperative response].
Explore the source record for details and available documents.
Analysis of Variance↗
Biomedical subjects
Z Krska
Publications and source records attributed to Z Krska.
[Idiopatic bowel disease].
On the basis of retrospective five years analysis the authors process the problematic of idiopatic bowel disease--Morbus Crohn and ulcerative colitis. They pay main attention to surgical issue--types of operations, differences between acute and elective surgery, perioperative problems and results.
Adolescent↗
[Meckel's diverticulum].
In the original revue the problematic of Meckel's diverticulum and its complications is presented. Questions of the disease story, anatomy and embryology are described. The complications-analysis of Meckel's diverticulum is realized and the possibilities of diagnostic procedures and therapeutic modalities at the symptomatic and asymptomatic diverticulum are discussed.
Humans↗
[Venous thrombosis prophylaxis in surgery--beginnings, contemporary state, ACCP consensus, future prospects].
Presentation and analysis basis questions and changes of thromboembolic disease prophylaxis in the surgical specialities from point of view the developments in last 30 years. Demonstration of the basic and modren methods of deep venous thrombosis prophylaxis. Recommendation of the 7th conference ACCP-CHEST 2004.
Humans↗
[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↗
[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↗
[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↗
Non-recognized cause of intrathoracic bleeding.
The authors present a case report of bleeding from the small dissection of descending aorta. Patient, 71 year old woman, with severe comorbidities (nephrotic syndrome based on membraneous glomerulonephritis, diabetes mellitus, lung emphysema, hepatopathy, polyneuropathy and others). One month after last stay in hospital chemotherapy et corticotherapy. In while on heparin during hospitalization at nephrologic department, patient developed right side haemothorax and haemomediastinum. An urgent transfer to surgical department with cardiopulmonary resuscitation was performed. The suspection of aneurysm on CT angioscan was non confirmed. The damage of oesophagus due to previous endoscopy (for chest pain) was non confirmed, too. During surgery masive sanquine effusion of mediastinum and right side haemothorax was found. The drainage and redrainage of the chest was performed. The cause of bleeding was not found. Critically ill patient had died and on autopsy a small dissection of thoracic aorta was found as a cause of bleeding. The problems of diagnosis and therapy are discussed. (Fig. 2, Ref. 7.)
Aged↗
[Embolism of the upper mesenteric artery].
The article presents a case report of a 53-year-old man, who underwent abdominal surgery for the ischemic vascular necrosis of the small bowel and right colon of the embolic aetiology and who has had several serious comorbidities. Resection of the major part of the small bowel and right hemicolectomy with high jejunostomy and transversostomy was performed. Not only has the patient very well tolerated the first surgery, but he tolerated also the other one with recovery of passage continuity. The other surgery was necessary due to mycotic infection in the right atrium (vegetations at the heart pacing electrode). After 5 months the patient died because of generalisation of mycotic infection. The problem of mesenteric vascular occlusions is discussed.
Acute Disease↗
GIST of pancreas.
Authors present the case (from the year 2003) of a 38 years old patient, female with large tumor in the abdominal cavity. Preoperative differential diagnostic examination showed either tumor of pancreas or left liver lobe. The surgery confirmed large tumor body of the pancreas. Histological and immunohistochemical examination determined gastrointestinal stromal tumor (GIST) of the pancreas from autonomous nerves with malignant character. Tumor was radically removed. In the postoperative period regular follow up was done at the department of oncology, abdominal ultrasound every 3 months, CT scan every 6 month. 2.5 years after operation the patient has no problems, CT scan is without signs of recurrent diseases. The analysis of GIST was performed in agreement with contemporary knowledge. According to the references, our case report GIST of pancreas is the first of this kind (till 2003).
Adult↗
[A case of strangulation ilieus of the ascending colon].
Authors present case of strangulation ileus of ascendent colon as a quite rare reason of bowel obstruction. Patient's clinical status has been affected by his social background. And they document importance of proper anamnesis and clinical examination in era of modern investigation methods that may be misinterpreted and entice surgeon from early operative intervention.
Colon, Ascending↗
[Severe necrotizing pancreatitis during pregnancy].
A case report of 28-year-old pregnant women (34 week of pregnancy) with acute pancreatitis is presented. Likely cause of pancreatitis in the patient was extreme combined hyperlipidemia. The subject underwent seven complicated surgeries and with a necessity of prolonged intensive post-operative care. A year apart from the episode of acute pancreatitis both the patient and her baby are doing well. Pancreatic function has been restored and plasma lipid levels are, with appropriate medication, within normal ranges. Analysis of the problematic the relationship between hypertriglyceridemia, pregnancy and acute pancreatitis.
Adult↗
[Expense analysis of the proximal femoral fractures treatment].
The aim of this paper was to provide estimated average costs of the hip fractures in the national scale by means of the analysis of the treatment expenses of 256 injured patients who were operated in the 1st Surgical Clinic of the General Teaching Hospital in Prague in 2002. Particular cost items as operation costs, price of the implant, hospitalization expenses by the categories and price of blood derivates were figured out. The follow-up treatment after hospital discharge like price per bed, expenses for general practicioner etc. was considered as well. Each patient was observed for the period of one year after the operation. As a result we came to the total sum of 120,000 Kc per one patient per year. The way to reduce hip fractures treatment cost does not certainly lead to deterioration of medical care quality but to proper treatment of osteoporosis which is the principal cause of these injuries.
Aged, 80 and over↗
Hemodynamic response to laparoscopic cholecystectomy--impacts of increased afterload and ischemic dysfunction of the left ventricle.
The authors describe the results of intra-operative hemodynamic monitoring during laparoscopic cholecystectomy in patients with ischemic left ventricular dysfunction and with significant aortic stenosis. The results in the groups composed of 13 and 12 patients were compared with the findings in 10 young, non-obese, non-smokers without significant cardiovascular history and with normal findings during resting transthoracic echocardiography. Monitoring itself was conducted using transesophageal echocardiography 1) after the induction of anesthesia, 2) after the induction of capnoperitoneum, and 3) after setting the operative anti-Trendelenburg position. The measurements were performed at least in triplicate and the results were processed using ANOVA test. Significant differences were identified in the time course patterns of heart rate, mean arterial pressure, dual product (pressure-rate-product), and cardiac output. In terms of pathophysiology, we believe that the most important achievement was the identification of different time course patterns of individual parameters in the respective groups. The results in the group of patients with aortic stenosis were based particularly on the different time course of the mean arterial pressure, while the results in patients with ischemic disease were more dependent on the time course of the heart rate. Very interesting is a drop of peripheral vascular resistance after positioning of these patients which could be explained only partially by a beta-blocking or ACEI medication. In clinical terms, the most important finding was probably that no complications occurred in the entire group of 35 patients, of which 25 suffered from severe organic cardiopathies.
Aortic Valve Stenosis↗
[Pancreatic carcinoma and diabetes mellitus].
BACKGROUND: The aim of the present study was to evaluate the relationship between Pancreatic Cancer and Type 2 Diabetes Mellitus, which represents a higher risk of many human tumors. In patients with Pancreatic Cancer, Type 2 Diabetes Mellitus occurs approximately in 30%. METHOD AND RESULTS: Fifty patients with newly diagnosed Pancreatic Cancer were analysed in a retrospective pilot study where the staging of the tumor and the case history of the patients were studied. This data were compared in three groups of patients: the control group without diabetes, one with Impaired Fasting Glucose, and patients with Diabetes Mellitus. Incidence of Diabetes Mellitus and that of Impaired Fasting Glucose were also followed in patients with Pancreatic Cancer and Colorectal Cancer. The retrospective study confirmed the late diagnosis of Pancreatic Cancer. The tumors were actually in clinical stage IV in 50% of the patients. Diabetes Mellitus was present in 34% of patients with Pancreatic Cancer; in 44% of these patients the Impaired Fasting Glucose was also diagnosed while the normal glucose status was seen in 22% of patients. Incidence of Impaired Fasting Glucose and that of Diabetes Mellitus in groups of patients with Pancreatic Cancer and Colorectal Cancer was studied. Diabetes Mellitus was present in 12.5% patients with Colorectal Cancer. CONCLUSIONS: In spite of modern diagnostic methods, the early diagnosis of Pancreatic Cancer remains a great problem. Incidence of Diabetes Mellitus in patients with Pancreatic Cancer was significantly higher in comparison with the Colorectal Cancer group (P0.01). A significant number of patients with Impaired Fasting Glucose were also present in the group with Pancreatic Cancer. Analysis of the relationships between Pancreatic Cancer and Impaired Glucose Metabolism could contribute to the early diagnosis of this serious malignant disease.
Adult↗
[Jejunal perforation by a plastic biliary stent after injury].
The authors present case of patient with biliary stent dislocation after chest injury and fracture of VIII. rib. Polymorbid patient with cirrhosis, chronic pancreatitis, portal hypertension (Child Plugh B) and biliary stent insertion came with acute abdominal pain and inflammatory signs. Progressive signs of acute abdomen have led to laparotomy. Perforation of duodeno-jejunal-loop due to dislocated biliary stent, small loop adhesions and thickened intestine wall were found. Postsurgical period was complicated with obstructive ileus, cholecystitis and cholangiolitis and the second biliary stent was inserted. Present-day status of the patient is satisfactory.
Bile Ducts↗
Surgical treatment of haemorrhoids according to Longo and Milligan Morgan: an evaluation of postoperative tissue response.
OBJECTIVES: To compare by prospective randomised trial the postoperative tissue reaction of stapled vs. conventional haemorrhoidectomy. PATIENTS AND METHODS: Fifty patients with stage III haemorrhoids underwent surgery for haemorrhoids. Group 1 (n = 25) had the Milligan-Morgan procedure; Group 2 (n = 25) had a stapled haemorrhoidectomy. All patients underwent measurements of endothelial dysfunction markers including E-selectin, P-selectin and intercellular adhesion molecule (ICAM). Acute-phase proteins including C-reactive protein, orosomucoid and fibrinogen were also measured. Estimations were made prior to surgery, immediately afterward surgery and on the first and fifth postoperative days. Assessment of clinical outcome was made one month after the surgery. RESULTS: There was a postoperative increase of acute-phase reactants in both groups. The patterns of the cures of the monitored parameters appeared similar in both groups. Lower values were found in Group 1, but the difference was not statistically significant except the level of fibrinogen on day 5, which was significantly higher in Group 2. E-selectin, P-selectin and ICAM showed similar time curves. Statistical analysis found the differences to be significant only when individual days were compared and not for the types of surgery. Raised ICAM and P-selectin on the fifth postoperative day was found in both groups. In Group 1, pain assessment by patients remained in the lower part of the pain rating scale, while in Group 2 it did not start declining until one week after surgery and became normal in the third to fourth weeks. In Group 1, the duration of hospitalization and the duration of incapacity for work were 50% of the values in Group 2. CONCLUSION: Patients having stapled haemorrhoidectomy have less pain and experience more rapid recovery when compared to classical haemorroidectomy. This was mirrored by the acute-phase protein CRP and fibrinogen levels postoperatively. There was no significant difference in other acute-phase reactants monitored, nor was there any difference in parameters of endothelial dysfunction. The techniques differ in extent of pain and duration of hospital stay and incapacity for work.
E-Selectin↗
[Thromboembolism--present status and perspectives].
The author summarizes contemporary findings on the problem of thromboembolism. He discusses its incidence, economic costs associated with treatment of complications such as arterial and venous thromoembolism. He emphasizes the problem of new types of prevention, in particular pentasaccharides in relation to complications and to other possibilities of prevention and treatment. The results of recent international studies and perspectives in this field are presented.
Europe↗