Biomedical subjects
Publications and source records attributed to Z Krska.
The authors describe and discuss a new method of minimally invasive surgery--hand-assisted laparoscopic surgery. For the analysis they used recent data from the literature and their own experience. The main advantage is greater safety, better diagnosis by palpation and better preparation in the abdominal cavity. The main disadvantage is the cost of the method.
The authors describe as the possible cause of postoperative severe dysphagia after laparoscopic Rosetti's fundoplication low insertion of the cuff drawn behind the oesophagus to the anterior gastric wall. When the stomach is full the cuff is drawn into a spiral and the latter presses against the cardia and twists the cardia and abdominal oesophagus. For the condition unimpaired swallowing of the first mouthfuls is typical followed by severe dysphagia which can lead even to malnutrition. Common examinations may be normal except for the unaccountable dilatation of the oesophagus. An important role in detection of the cause is played by investigation of the passage of the barium suspension during swallowing with the patient in an upright position. The authors recommend insertion of the cuff as high as possible with careful mensuration of the permeability of the abdominal oesophagus during and at the end of surgery and fixation of the cuff to the diaphragm of diaphragmatic cruri.
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The authors present their experience with 93 patients operated at the First Surgical Clinic of the General Faculty Hospital and First Medical Faculty, Charles University Prague on account of familial adenomatous polyposis (FAP) assembled during 36 year starting in 1962. They analyze 91 patients followed up in collaboration with the First Medical Clinic of the General Faculty Hospital and First Medical Clinic Charles University Prague. Seventy-two of the patients were operated and in 55 of them an ileorectoanastomosis was made following subtotal colectomy. Two important findings were made. From the group of 91 patients incl. primary patients who suffered already from advanced malignant disease of the large bowel a total of 38.5% died. In the rectal stump after ileorectoanastomosis on average within 16 years after operation in 16.4% of the patients a malignant tumour was found. This leads to the belief that patients should be recommended colectomy with ileoanoanastomosis with an ileal reservoir. This operation was performed during the last five years in nine patients with this condition, using a one-stage or two-stage procedure with temporary ileostomy.
The authors ANALYZE the problem of splenectomy from the historical point of view and also the problem of splenectomy indication. Two different periods separated by a short time interval are compared. Recently the indications for splenectomy have changed because of introduction of new drugs in hematologic treatment. The number of "traumatological" splenectomy remains constant. (Tab. 2, Ref. 18.)
Authors present the both method of laparoscopic inquinal hernia repair. They prefer laparoscopic praeperitoneal approach using prolene mesh 6 x 11 cm.
Nosocomial deep wound infections are serious complications after hip joint surgery. Our aim was to determine whether there is a difference in rates of nosocomial infections between group of patients after elective surgery of hip replacement and group of patients with hip replacement after trauma. Both groups of patients had perioperative prophylaxis with amoxycillin. We found that the overall trauma patients infection rate was 0.9 per cent compared with 1.5 per cent for elective surgery infections. In both groups of patients a postsurgery stress was documented according to increase of acute phase proteins (C-reactive protein, orosomucoid and fibrinogen) in plasma for a minimum 10 days after surgery. We conclude, that both groups of patients had benefit from amoxycillin prophylaxis therapy.
Immobilization after trauma escalates risk of thrombosis. Our objective was to determine whether there is a difference in rates of deep vein thrombosis (DVT) after immobilization with plastic casts or routinely plaster of Paris in trauma patients. Despite both groups of patients do not show difference in blood coagulation tests (APTT, TT, PT, levels of fibrinogen and of D-dimer in plasma) during time of immobilization the evidence of DVT according to scintigraphy was lower in group of patients with plastic casts (3 per cent to 10 per cent).
The authors present a casuistry of the injury endangering the life, which was caused by the unusual mechanism. The injured person was pulled inside of a conveyer and while shifting, not only his arm and physical (brachial) plexus was damaged, but he was also and especially, strangled by his clothes and he was seriously asphyxiated, which origin was in the first phase unexplainable.
Acute pancreatitis is discussed from the point of view her complications. The survey of local, organ and system complication is demonstrated, and the Atlanta classification is recalled. The complications are demonstrated at the mild acute pancreatitis and also at the severe acute pancreatitis. The complications are demonstrated on the own group of patients (period 1995-1997). Severe respiratory failure came later, but the letality was high. The renale or hepatorenale failure came formerly and equally as DIC were combined with practically absolutely letality.
The authors describe the problematic of postsplenectomy complications. The main group of complications came in the group of haematological indication to splenectomy. The high risk of complications present the haematological malignancy. The most serious illness complications came only in this group.
The problems of central venous catheters is discussed, first of all from the point of view the risk of postcannulation thrombosis. Thrombosis was found at the autopsy in 7 (resp. 13%) patients where pulmonary embolism was the cause of death or basic complications. By two of them no other major thrombosis was found. The main diagnosis, duration of central cannulation, other disease prevention and other problems of the cannulation are discussed.
The author presents analysis of surgical patients decreased in the year 1994. Maximal attention is given to pulmonary embolism and the results are compared with the method of prophylactic regimes. The failure of prophylactic regimes appeared in patients with very bad prognosis, especially with the advanced stadium of tumors, severe complications and high age. The author describes a small group of patients with the "false" failure of prophylactic method in which the method was incorrectly interrupted in the phases of the persistent high grade thromboembolic risk.
The authors present results of the study of the fatal pulmonary postoperative embolism in the years 1995-1997. The maximum attention is given to the risk-factors and type of prevention. Among the biggest risks they are malignancy, reduction of pulmonary parenchyma, ischaemic coronary disease, high age and obesity. Risk factors are described in the relation to basic disease. Further the time factors of the pulmonary embolization and the failure or mistakes of prevention are studied. The postoperative long-term risk of the thromboembolism is confirmed.
Multiple organ failure with thrombophilia is suggested to occur in the course of polytrauma with septicaemia. The aim of the study was to investigate fibrinogen level, other proteins of acute phase response: positive-orosomucoid and negative-transferrin and soluble cytoadhesive molecules in plasma of patients (n = 28) with polytrauma (I-II. stage according to Hannover score) without detectable bacteraemia until 36 hours post injury. The patients treated by massive blood transfusion were excluded. An increase of fibrinogen (Fbg pts 4.34 +/- 2.5 g/l versus control 2.55 +/- 0.55 g/l, p < 0.01), orosomucoid (ORM pts 1.47 +/- 0.8 g/l versus control 0.54 +/- 0.18 g/l, p < 0.01), SE-selectin (sE-sel. pts 92.11 +/- 79.4 g/l versus control 46.6 +/- 29.6 g/l, p < 0.05), sICAM-1 (sICAM pts. 698.3 +/- 54.4 versus control 255.6 +/- 58.0 g/l, p < 0.01) and a decrease of transferrin (Trf pts. 1.77 +/- 0.82 versus control 2.83 +/- 0.71 g/l, p < 0.01) were observed in this patients with polytrauma. We suppose that an increase of fibrinogen and cytoadhesive molecules sE-selectin and sICAM-1 may be induced in patients with polytrauma due to a "non-septic" inflammatory acute phase response in the course of wound healing process after tissue injury too.
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The authors discuss problematic of splenectomy on the historical view and also on the problematic indication to splenectomy. They compare two different periods in the small lapse of time. In the last period was the mowe in the indication spectrum to the splenectomy in the continuity with the application of new hematological medicaments in the practice. The number of "traumatological" splenectomy is constant.
The authors describe the problematic of postsplenectomy complications. The main group of complications came in the group of haematological indication to splenectomy. The high risk of complications present the haematological malignancy. The most serious illness complications came only in this group.