Publications (30) View all
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Article: [Eversion carotid endarterectomy: evaluation of results after changing the operation technique].
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ABSTRACT: Stroke is the third most common cause of mortality, and carotid artery stenosis causes up to 30% of all ischemic strokes. Eversion CEA (ECEA) has been proposed as an acceptable alternative to the standard bifurcation endarterectomy in many patients. This study was designed to analyze the long-term durability of ECEA in symptomatic and asymptomatic patients. Data were retrospectively reviewed to determine the incidence of major adverse cardiovascular events (MACEs) within 30 days of surgery, late survival, and the incidence of restenosis. From January 1999 to June 2010, 344 ECEAs were performed on 324 patients (34% female, 38% symptomatic). The mean follow-up period was 30 months. MACEs occurred in 28 patients (8.6%). The overall incidence of stroke or death after ECEA was 1.7% and 0.9% at discharge. The overall incidence of stoke or death after CEA was 4.3% and 21% (14 strokes, 69 deaths, 8 of which were stroke-related). The overall occurrence of any restenosis (> 50%) after CEA was 4.3% (14 of 324 procedures).Casopís lékar̆ů c̆eských 01/2011; 150(1):41-3. -
Article: [The influence of surgical complications on renal graft function].
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ABSTRACT: Kidney transplantation is the method of choice for patients with end stage kidney disease. Surgical complications remain a serious clinical problem and can lead to loss of graft function. Analysis of surgical complications in patients after single kidney transplant from cadaver donors and their influence on the function of the transplanted graft. Patients after a single kidney transplant from a cadaver donor (n = 566) between 1/2006-4/2009 in the Institute of Clinical and Experimental Medicine. Individual surgical complications did not affect the delayed onset of graft function. A significantly higher serum creatinine in the 3rd month was observed in the group of patients with urinary leak (p = 0.02) compared with a group of patients without complications. The serum creatinine at 6th month was not affected by any surgical complication. Serum creatinine at 12th month was statistically significantly higher in the group of patients with lymphocele (p = 0.028) compared with a group of patients without complications. The surgical complications which had a significant effect on one year graft survival were infectious wound complications in the recipient (p < 0.05), renal artery stenosis (p < 0.05) and renal vein thrombosis (p < 0.01). The onset of graft function was not affected by surgical complications. The group of patients with urinary leak had higher serum creatinine in 3rd month and patients with lymphocele in 12th month. Infectious wound complications, renal artery stenosis and renal vein thrombosis decrease the 1-year graft survival.Casopís lékar̆ů c̆eských 01/2011; 150(1):75-8. -
Article: [Plasma citrulline concentration--a reliable noninvasive marker of functional enterocyte mass].
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ABSTRACT: Small bowel disease encompasses a broad range of pathological states starting with functional disorders through inflammatory disease to morphological injury with possible intestine loss. Some of these conditions result in major loss of function presenting as intestinal failure. The term intestinal failure refers to a condition whereby the bowel is unable fulfil its basic function in the process of digestion and absorption of nutrients. Unlike other organs, where reliable laboratory markers of injury or failure are available, no such tests are currently on hand for the bowel. Determination of the plasma citrulline level is a reliable marker for assessing the mass of functional intestinal tissue. Citrulline is an amino acid formed almost exclusively in enterocytes and not present in food proteins. The liver has only a minimal effect on citrulline production. Eighty percent of citrulline is converted in the kidney to arginine. Its impaired renal clearance results in increased citrulline levels. Clinically relevant are decreased citrulline levels as they reflect a lack of functional mass of enterocytes. The aim of the present review is to summarize current knowledge and to define the value of determining plasma citrulline levels for the diagnosis of intestinal failure and, possibly, for monitoring the bowel function.Casopís lékar̆ů c̆eských 01/2010; 149(4):160-2. -
Article: [Intraarterial peroperative thrombolysis in therapy of the acute limb ischemia].
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ABSTRACT: Acute limb ischemia is serious situation, jeopardizing limb salvage, causing embolization or thrombosis of the native arteries or vascular graft. Immediate surgical revascularization with balloon thromboembolectomy is indicated in patient with acute ischemia stage IIB of the Rutherford classification. Unfortunately, operative thromboembolectomy is frequently incomplete, with persistent thrombus remaining in the majority of patients. Residual thrombus compromises the clinical outcome, leading to poor revascularization and an increased risk of tissue loss. On depending of amount of the residual thrombus after surgical thromboembolectomy, we can choose one of the three options of intraoperative thrombolysis. This article summarized indication and technical realisation of intraoperative thrombolysis and describe cause report of the first patient treated with this method in our country. The combined use of intraoperative thrombolytics following mechanical thromboembolectomy is safe and efficacious method in patients with acute vascular occlusion.Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2011; 90(1):55-8. -
Article: [Clinical experience with cold-preservation of venous and arterial allografts. long-term outcomes].
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ABSTRACT: Venous and arterial allografts extend the possibilities of peripheral arterial disease as well as vascular prosthesis infections treatment. Between 10/1997 and 1/2009 we used 112 allogeneic vessels (30 arteries, 82 veins) in 104 patients. Venous allografts were used for 82 reconstructions in 75 patients (M/F 41/34, aged 41-85 years, median 66 years) with critical limb ischemia and no suitable autogenous venous material. Arterial allografts were used in 9 patients (M/F 8/1, aged 56-77 years, median 63 years) with aortoiliac prosthetic infections or mycotic abdominal aortic aneurysms and in 20 transplanted patients (M/F 11/9, aged 32-67 years, median 56 years) with aortoiliac atherosclerotic disease. Patients survival rate after allovenous bypasses was 92% at 1 year and 78% at 3 years. Limb salvage rate was 67% at 1 year and 53% and 3 years. Secondary patency rate was 48% at 1 year and 27% at 3 years. Patient survival rate after alloarterial bypasses was 86% at 1 year and 69% at 3 years. No signs of arterial grafts aneurysmal formation and no need for secondary intervention of any arterial reconstruction was observed during the follow up period in any patient after alloarterial transplantation. Cold-stored venous and arterial allografts are suitable alternative conduits for limb salvage procedures, vascular prosthesis infections as well as for arterial reconstructions in transplanted patients.Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2010; 89(1):45-54.
