Biomedical subjects
Publications and source records attributed to Z Krska.
The authors present the case-history of a female patient four years after a low resection on account of carcinoma of the rectum who developed a large secondary in the abdominal wall. After its radical resection the patient is free from systemic or local manifestations of the basic disease and free from complaints.
The authors analyze a group of 100 patients indicated for goitrectomy during the period from 1995-1996. The most frequent indication for surgery was an eufunctional polynodular goitre. The group comprised 86 women and 14 men. Their mean age was 47 years, bilateral affections predominated. The most frequent type of operation was total thyroidectomy. Carcinoma was found in three of the operated patients. The mean period of hospitalisation was 6 days. Postoperative complications were more frequent after total goitrectomies, and with the extent of the operation the number of possible complications increased. The most serious complication in the authors opinion was a lesion of the parathyroid glands, observed in 5% of the patients. Permanent unilateral lesions of the recurrent nerve were recorded in 2% of the operated patients. There was no lethal postoperative complication. The largest operated goitre weighed 625 g (photograph 1). The authors conclude that it cannot be stated that the operation of larger goitres is associated with the highest incidence of postoperative complications. The opposite is rather the case.
The author discusses problems of less well known and less frequent complications of preventive or curative heparin administration. Published findings pertaining to this problem are supplemented by the author's clinical experience. As regards the risk of heparin induced thrombocytopenia, administration of low molecular heparins involves a smaller risk.
In this study we are discussing a necessity of sufficient monitoring and therapy of unexpected perioperative massive blood loss, which a case of 4 of our patients. Cell saver system wasn't available. Complete monitoring system maximum intensive care and a broad substitution is essential in these cases. We have pronounced the influence of massive blood loss on multiorganic postoperative failure as well as a necessity of sufficient time of an intensive care.
Sudden, complete occlusion of the superior mesenteric artery is due often to an embolus than thrombosis. The clinical features are usually the same whether occlusion is the result of embolism or thrombosis. Males are affected more often. Complete thrombotic or embolic occlusion of the mesenteric artery presents mostly as a surgical emergency with all the manifestations of paralysis of the peristaltic mechanism as well as loss of viability of the affected intestine. There are problems in the diagnosis in, the group of higher age patients. The clinical diagnosis is by patients with minimal symptomatology and often with next diseases very complicated and unfortunately to late. The authors described four examples of this problematic.
The authors describe group of 60 patients with diabetic gangrena of lower extremity. In 24 cases was performed primary amputation (14 acral and 10 in thigh for sepsis). In 14 patients was carried out balloon angioplasty, in 6 bypass and in 16 a lumbal sympathectomy. The big amputation was necessary after the revascularization in 9 cases. A treatment of the diabetic foot have to be complex. Before amputation is the angiography necessary. It is enabled also by the balloon angioplasty. Microangiopathy with the good arteriography finding in main limb arteries make acral amputation possible.
Using the latest examination methods the authors have proved relatively wide spread recurrence of thromboembolic complications. Proved were even the mortal forms in urology in case of benign diagnosis as well as relatively considerate operational medical performance. An evident effect of prophylactic, physical and especially pharmacological methods was proved in prevention of thromboembolic disorders. Silent form of deep venous thrombosis were diagnosed to patients with mere physical prophylaxis. On the other side unfavourable effect of low molecular weight heparin on blood loses was not proved even in laboratory picture. Higher risk of thromboembolic complications origin was observed even on the 21st postoperation day. Currently authors consult the appropriateness of individual types of prophylaxis with the different urology illnesses risk groups.
Postoperative thromboses, with no effective prevention currently available, are a serious complication of open-heart surgery. Conventionally, anticoagulants (heparin, coumarine derivatives) are used after prosthetic heart valvular surgery (PHVS), and antiplatelet drugs (ASA) are administered after coronary artery by-pass graft operation (CABG)). Postoperative thrombophilia may be enhanced by an increase in plasma fibrinogen (FBG) levels, from 2.6 +/- 0.4 to 6.0 +/- 1.8 g/l, p < 0.01, as observed following open-heart surgery in CABG pts (n = 19), and from 2.8 +/- 0.5 to 4.2 +/- 1.0 g/l, p < 0.01) in PHVS pts (n = 12) during postoperative days 6 to 10. This increase in FBG in both groups of pts on different antithrombotic regimens significantly correlated with an increase in others plasma proteins alpha-1-antitrypsin A1AT (r = 0.43, p < 0.01), coeruloplasmin, CRPL (r = 0.53, p < 0.01), orosomucoid, ORM (r = 0.37, p < 0.02), and with prolongation of euglobulin clot lysis time (r = 0.42, p < 0.01) during the 21-day postoperative period. A negative correlation was demonstrated between FBG and the plasma levels of transferrin, TRF (r = -0.389, p < 0.02). Whereas FBG, ORM, A1AT, and CRPL are referred to as "positive" acute phase proteins, TRF is a "negative" acute phase protein. It follows from multivariate factor analysis that the reactive increase in these acute phase proteins (incl.FBG) is due to one "common" stimulating factor during the postoperative period. The "common" stimulating factor also raised thrombocyte count.(ABSTRACT TRUNCATED AT 250 WORDS)
Case report of pneumatosis cystoides intestini tenuis in 85 year old patient. The disease seemed to be like pseudoobstructive syndrome and the diagnosis was confirmed intraoperatively according to histologic examination during the procedure. Following conservative treatment was with good results and during the next control the patient was doing well. In this article the therapy, symptomatology and appearance of the disease is discussed.
Application of the cardioplegic solution dramatically improved the results of the operations in ECC. Authors discussed the methods of application of the cardioplegic solution, mainly in the connection with its applications to the sinus coronarius. This is then discussed from another point of view of its use. In the field of the cardioplegy there is referred about new authors' method, and so on the possibility of its use, and the most propriete indications. Described method is available and its parameters, verified clinically and experimentally, are advantageous in the stated situations.
The authors evaluate the advantages and disadvantages of one-stage operations in concomitant cardiac and pulmonary diseases and define the optimal indications for this procedure. The justification of one-stage operations in selected patients is confirmed by the authors' own experience assembled in two patients. One suffered from lung cancer and ischaemic heart disease and the other one from a tuberculoma and ischaemic heart disease. The one-stage operation in both patients was without complications.
The authors submit a report on a 47-year-old man with the syndrome of angina pectoris and history of myocardial infarction who died after a revascularization operation of the heart from left ventricular insufficiency. On necropsy extensive arteritis of the coronary vessels with aortitis was revealed and with arteritis of the small intramyocardial and lienal arteries and arteries in the renal pelvis. They describe in detail the histological finding on the blood vessels, and consistent with some data in the literature, they assume that this disease forms a separate unit. It must be considered in particular in middle-aged men who have signs of coronary ischaemia and risk factors suggesting atherosclerosis, not occur in the case-history.
After cardiac surgery performed with extracorporeal circulation (ECC) involving heart valve prostheses (PHVS, n 12) and after a bypass of the coronary arteries by a venous graft (CABG, n 19), the authors investigated the dynamics of changes of haemostasis on the 1st, 3rd, 6th, 10th and 21st day after operation. As anti-thrombotic treatment after PHVS anticoagulants were used, after CABG thrombocyte inhibitors. On the 1st day after operation in both groups thrombocytes decline, while after the 10th day their numbers increase. From the 6th day there is in both groups a rise of fibrinogen and other proteins of the acute phase (alpha-1-antitrypsin, orosomucoid and ceruloplasmin, while there was a drop of transferrin. On the 3rd and 6th day after operation fibrinolysis activators decline (euglobulin fibrinolysis). These findings suggest an increased risk of thrombophilia during the postoperative period and are probably associated with the release of interleukin-1 after Ecc and the stress of cardiac surgery. In patients with CABG on the 1st day a major drop of thrombocytes occurs, on the 6th day an elevated fibrinogen value was recorded and on the 10th day a reduced fibrinolytic activity, as compared with patients with PHVS. These changes will be, however, associated rather with a greater development of general atherosclerosis in patients with CABG, which leads to a further alteration of haemostasis, rather than with the applied antithrombotic treatment.
The authors present an account on four cases of cardiac myxoma and two cases of a secondary malignant tumour. Despite the low incidence of cardiac tumours this disease must be taken into consideration. The diagnosis was established by echocardiography and angiography. Two-dimensional echocardiography is, however, often sufficient. Early surgical treatment has very favourable results in bening tumours. The prognosis of patients with malignant tumours is very poor and experience with treatment is scanty.
Initial results of evaluation of scintigraphic examinations by means of the isotope 201thallium indicate the importance of this method in cardiosurgery, in particular in the postoperative evaluation of the effect of bypass operations. In patients with an objective improvement on the postoperative scintigrams also subjective improvement of the condition was recorded.
The authors report their experience with the application of decompression of the left ventricle of the heart by means or active suction from pulmonary artery. This way of heart drainage has been so far used in 53 patients, who were operated in extracorporal circulation. The drainage of pulmonary artery proved to be completely successful. It enabled a sufficient decompression of the left heart and prevented most complications which may occur if a direct drainage of the left ventricle of the heart is applied.
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