Treatment results of non-varicose bleeding from upper gastrointestinal tract.

UNLABELLED: Treatment results of non-varicose bleeding from upper gastrointestinal tract are changing by improved endoscopic methods and introduction of new drugs in treatment. OBJECTIVE: Objective of this work was to compare the results in treatment of patients with non-varicose bleeding from upper gastrointestinal tract in two different 5-years periods. MATERIAL: We hospitalised 229 patients with non-varicose bleeding from upper gastrointestinal tract at the Department of Surgery in Faculty Hospital of Martin in the period 1992-1996. (161 men and 68 women, average age 56.7, patients up to 60 were 42.4%). 203 patients were hospitalised in the years 2003-2008 (146 men and 57 women, average age 61.5, patients up to 60 were 54%). METHODS: We compared both groups by retrospective analysis and we evaluated differences by using statistical methods (nonparametric test of independence of the qualitative data). RESULTS: There was only minimal difference in primary conservative and endoscopic haemostasis in both groups. Relaps of bleeding was the same in both groups. Definitive conservative and endoscopic haemostasis was higher by 3.2% in the period 2003-2008 and number of urgent operations decreased by 5.1%. Differences in total mortality were minimal between both groups but postoperative mortality was higher by 5.9% in the years 2003-2008. CONCLUSION: Number of urgent operations decreased due to improved results in definitive conservative and endoscopic haemostasis in the treatment of non-varicose bleeding from upper gastroinestinal tract. There was no significant change in the relaps of bleeding. There were only minimal changes in total mortality between both groups, but postoperative mortality increased in the second period (Tab. 8, Ref. 35).

[Laparoscopic distal pancreatectomy for neuroendocrine pancreatic tumors--initial experience]. / Laparoskopická distálna pankreatektómia pre neuroendokrinné nádory pankreasu--prvé skúsenosti.

INTRODUCTION: Although the first successful laparoscopic distal pancreatectomy in Martin was recorded in 2005, after five years we have successfully established this unique surgical procedure. The aim of this paper is to present two successful laparoscopic distal pancreatectomies in patients with neuroendocrine tumors of the distal pancreas. MATERIALS AND METHODS: Laparoscopic distal pancreatic resection is currently challenging many pancreatobiliary surgeons. Its open alternative is the standard surgery for tumors in the body and tail of pancreas. Laparoscopic distal pancreatectomy meets all aspects of radical oncological resection including lymphadenectomy. Similarly to open resection is often associated with splenectomy, but brings significant benefit to the patient in the form miniinvasivity. The paper gives crucial points of surgical procedure that is still an unique surgery. RESULTS: Although the last 4 months we operated on laparoscopically only 2 patients we present at least the preliminary experience with this method as well as a rich documentation of these procedures. CONCLUSION: Laparoscopic distal pancreatectomy in the hands of an experienced laparoscopic surgeon has the chance to become an alternative to an open surgery.

[Ovarial hyperstimulation syndrome in the differential diagnostics of acute abdomen]. / Ovariálny hyperstimulacný syndróm v diferenciálnej diagnostike náhlej brusnej príhody.

INTRODUCTION: The massive world-wide development of assisted reproduction (AR) technology and marked increase of females with infertility treatment lead to different medical complications. One of them is ovarian hyperstimulatory syndrome (OHSS), potential fatal complication in AR. It demonstrates with abdominal discomfort, nauzea, vomitus, ascites, and general alteration. It can imitate an acute abdomen syndrome, and it can lead to the primary surgical assessment. AIM: The description of OHSS as a cause of an acute abdomen syndrome. METHODS: Authors present a case of OHSS with the symptomatology of acute abdomen, which was handled by surgeon, primarily. CONCLUSION: Consistent patient history, including gynecological history, and careful physical and laboratory examinations with relevant imaging methods lead to the elimination of invasive procedures. OHSS is the most actual in differential diagnosis of acute abdomen in fertile females for that reasons.

[Gastric lymphoma as a cause of massive bleeding in a patient with Castleman's disease]. / Lymfóm zalúdka ako prícina masívneho krvácania u pacienta s Castlemanovou chorobou.

Primary lymphomas of the stomach belong to rare gastrointestinal malignancies. In their etiology very often play role infections caused by Helicobacter pylori. Rare cause of these tumors can be systemic immunopatological disease connected with the immunodeficiency. Authors in their contribution refer about the patient with the gastric lymphoma, in which was Castleman's disease diagnosed by the lymph-nodes biopsy. The patient was hospitalized with massive bleeding from gastric ulcers, which was treated by urgent surgical therapy. The final histological diagnosis was aggressive B-NHL of the stomach.

The significance of clinical markers in the prediction of hemodynamic and cardiac complications of capnoperitoneum in patients at risk.

OBJECTIVES: The aim of this prospective study was to find out the predictive value of concomitant diseases of cardiovascular system (CVS), lungs and kidneys as well as metabolic diseases to be able to anticipate the potential origin of hemodynamic and cardiopulmonary complications as a result of insufflated CO2 peritoneum. METHODS: The study investigated eleven patients at the anaesthetic risk of ASA III-IV and cardiac risk of NYHA II-III in whom elective laparoscopic surgical intervention had been indicated. RESULTS: We have found out that the significance of the increase in biologic ANP markers, catecholamines and PRA was not sufficient to signal the deepening of cardiac dysfunction, latent cardiac failure or hemodynamic disorder (p > 0.01). The courses of regression lines have shown the dependence on the increased IAP (intra-abdominal pressure) of capnoperitoneum in PRA and adrenaline. The reactions of biologic markers correlated with reactions of clinical hemodynamic markers of BP and HR. We have proved that the increased level of IAP causes a significant increase in CVP (p < 0.01) being one of the factors determining the preload of right ventricle (RV) and in coincidence with intact transpulmonary circulation also the optimal function of left ventricle (LV). CONCLUSION: Our investigation of peroperative clinical and biologic markers of hemodynamics and neuroendocrine response to operative stress and development of CO2 peritoneum has proved that the course of laparoscopic operations in patients in the risk group of ASA III-IV and NYHA III does not necessarily have to be deteriorated by complications. It can be assumed that increased values of biologic markers regulate the neurohumoral response in the physiologic range and do not predict a severe CVS dysfunction within its course. (Tab. 2, Fig. 3, Ref. 22.)

[Acute cholecystitis in diabetics]. / Akútne cholecystitídy u diabetikov.

UNLABELLED: Diabetes modifies by its consequences the course of different diseases. OBJECTIVE: In the submitted work the authors compare the course of acute cholecystitis in diabetic and non-diabetic subjects. METHOD: The authors evaluated in a retrospective study a group of 246 patients whom they operated on account of acute cholecystitis. The group comprised 44 (18%) diabetics and 202 (82%) non-diabetic subjects. They compared the two groups in some selected parameters. The significance of differences was evaluated by statistical methods. RESULTS: Significant differences between the groups were found in the pathomorphological finding on the gallbladder, in the incidence of acute cholangitis, comorbidity and early infection to the disadvantage of diabetics. CONCLUSION: The clinical course of acute cholecystitis in diabetics may be masked which is often the reason of inadequate therapeutic radical measures and of subsequent risks of the development of serious perioperative complications. Despite the higher comorbidity in the diabetic-group the perioperative course in the two groups was comparable if early surgery and adequate preoperative preparation were provided.

[Postoperative hypoxemia in aged surgical patients]. / Pooperacná hypoxémia u chirurgických pacientov vyssieho veku.

The authors analyze postoperative hypoxaemia in a group of 48 patients aged 60 years or more after operation in the upper half of the abdomen. Hypoxaemia with values below 8 kPa in the arterial blood stream which are classified as a respiratory insufficiency were recorded in this group in 52%. In the mechanism of development they draw attention to changes which lead to the formation of atelectases and an impaired relationship of ventilation and perfusion. They draw attention to risk factors and polymorbidity in this age group. In their opinion a suitable indicator of impaired pulmonary function before operation are gas levels in arterial blood compared to normal ones. They emphasize a comprehensive approach in prevention and treatment.