[Use of ultrasonography in surgery]. / Perspektivy vyuzití ultrasonografie v chirurgii.

OBJECTIVE: To draw attention to the perspectives of application of ultrasonography in surgery. METHOD: Based on their own experience and data in the literature the authors draw attention to contemporary possibilities to use ultrasound in surgery. This concerns in particular the following areas: abdominal sonography, injuries, examination of small areas, peroperative sonography, laparoscopic sonography, intraluminal sonography, Dopplerometric examination of the vessels, use during transplantations and in neurosurgery. RESULTS AND CONCLUSIONS: While urologists use sonographic examinations commonly, only a small percentage of surgeons are familiar with this method. The authors explain the necessity of greater involvement of surgeons in this area which is consistent with the development of surgery and trends abroad.

Mathematical model of the male urinary tract.

The paper presents a simplified (but not trivial) mathematical model of the interaction between the urine flow and the male urethra and bladder, respectively. Urine is assumed to be a Newtonian fluid. The flow is considered to be non-stationary, isothermal and turbulent. The urethra and bladder wall, featuring elastic properties, experience large displacements and strains. The dynamic forces are included in the urethra wall motion. When fully extended the urethra attains the shape of an axisymetric tube. An iterative method based on the uncoupled approach is developed.

The value of examining blood supply in prostate cancer using Doppler frequency analysis.

Stating the contribution of Doppler ultrasound examination (DU) of prostatic vascularisation towards timely diagnosing prostate cancer. 87 patients with bioptically proven prostate cancer and 10 healthy young men of control group were examined by transrectal ultrasound in B mode, colour flow mapping (CFM) and Doppler frequency analysis. (DFA) The distribution of vessels in prostate is not specific for carcinoma and using CFM, it is impossible to distinguish normal tissue from carcinoma. DU combined with other methods as rectal palpation, PSA, transrectal sonography in B mode may, however, increase carcinoma suspicion, and quicken the indication of considered bioptic puncture.

[Treatment of infertility in nonobstructive azoospermia using the TESE method (testicular sperm extraction)--clinical results]. / Lécba neplodnosti u neobstrukcní azoospermie metodou TESE (Testicular Sperm Extraction)--klinické výsledky.

Sperm was found in 56.6% of TESE cycles in 27 men with non-obstructive azoospermia. Using testicular sperm, 30% oocytes were fertilized. Embryos were transferred in 11 cycles. Twins were delivered in the 34th week of pregnancy. Two further pregnancies are ongoing. The pregnancy rate was 27% per ET. Testicular biopsy in all azoospermic men is recommended in special IVF centers not only for histological examination but also for ICSI procedure with testicular sperm which could be provided at the same time.

[Treatment of male infertility after oncologic therapy: preventive autologous sperm preservation versus testicular biopsy and oocyte fertilization with testicular spermatozoa]. / Lécba neplodnosti muzu po onkologické lécbe: preventivní autokonzervace versus biopsie varlete a oplodnení oocytu testikulárními spermiemi (TESE).

The prognosis of oncological therapy of some malignancies is favourable. Unfortunately the majority of young patients remain sterile. Sperm cryopreserved before treatment was successfully used in IVF-ICSI (in vitro fertilization-intracytoplasmic sperm injection) cycles. Testicular biopsy (TESE) was performed after successful oncological treatment in three men without previous sperm cryopreservation. No spermatozoa were found for oocyte fertilization. TESE could not ensure sperm recovery in all patients after oncological treatment. Sperm cryopreservation should be highly recommended to all patients before any treatment is offered.

[Treatment of infertility in non-obstructive azoospermia using the TESE (testicular sperm extraction) method--clinical study]. / Lécba neplodnosti u neobstrukcní azoospermie metodou TESE--klinická vysetrení.

Testicular sperm extraction (TESE) was performed in 27 men in 30 cycles. All men were examined for genetics, serum hormonal status, biochemical status of semen samples. All men were examined by an urologist. No prognostic evaluation able to provide information about the prognosis of TESE procedure was found. Even a high FSH level, testicular hypotrophy or previous histological examination cannot exclude any patient from testicular biopsy.

Biochemical findings in the ejaculate of men with non-obstructive azoospermia.

In men with non-obstructive azoospermia, testicle biopsy can provide isolated sperm which can be used for fertilization of an oocyte. The male seminal plasma was examined for adequate biochemical parameters and then tested as potential diagnostic parameters for prediction of sperm presence in non-obstructive azoospermia. Sperm was obtained by preparation of the testicular tissue. Biochemical parameters in men with found sperm were compared to findings obtained from men without sperm in the testicular tissue. The following parameters were analysed: fructose, lactate dehydrogenase, total acid phosphatase, Zn, K, Na, Cl, pH. No statistically significant differences were found in both groups under study. Biochemical examination of the ejaculate cannot provide any prediction of sperm retrieval in non-obstructive azoospermia.

Infertility treatment of men with non-obstructive azoospermia.

Male infertility can be treated by several methods with varying degree of success. We present evidence that "open" testicular biopsy is favorable for men suffering from non-obstructive azoospermia (NOA). Moreover, any NOA patient may be subjected to this treatment even though his past histopathological examinations suggest that it is likely no sperm will be found in the testicular tissue. Thus, we recommend the testicular sperm extraction (TESE) procedure for NOA patients.

[Surgical treatment of hydronephrosis]. / K moznostem operacního resení hydronefróz.

The objective of the study was to find the most suitable method of surgery of primary hydronephrosis and congestive horseshoe kidney, based on the authors own experience. The result was the finding that plastic resection operations according to Anderson-Hynes and flap operations in long stenoses and horseshoe kidneys meet the demands which are the prerequisite of favourable therapeutic results.

[Adrenal incidentalomas. Clinical experience]. / Incidentalomy nadledvin. Klinické zkusenosti.

In the course of two years the authors treated 27 patients with incidentally detected adrenal tumours. Detailed morphological and laboratory examination revealed four cases of non-classical late type adrenogenital syndrome (AGS) and two pheochromocytomas. From the submitted paper ensues that it is essential to provide interdisciplinary comprehensive treatment in departments which have sufficient experience with this problem.

[Personal experience with peroperative study of testicular blood flow in laparoscopic surgery of varicocele]. / Nase zkusenosti s peroperacním sledováním prokrvení varlete pri laparoskopické operaci pro varikokélu.

Although the authors did not detect in 27 patients operated since October 1996 laparoscopically for varicocele, although the spermatic artery was ligatured a deteriorated blood supply of the testis, they evaluated the blood flow through the spermatic artery in the rete testis by coloured Doppler mapping during temporary peroperative ligature of the spermatic artery. In 14 patients the occlusion did not cause any changes of the blood supply of the testis, in one patient during occlusion of the artery the Doppler signal in the rete testis disappeared, after release of the ligature the blood flow reappeared in the coloured Doppler mapping. The authors conclude that in the great majority of men the blood supply of the testis is ensured by collateral circulation. If the ligature of the spermatic artery is inevitable they recommend to check during operation the blood supply of the testis in the rete testis by dopplerometry.

[Laparoscopic surgery of varicoceles and its effect on testicular hemodynamics and spermiogenesis]. / Laparoskopická operace varikokély a její vliv na hemodynamiku varlete a spermiogenezi.

Between December 1993 and October 1996 the authors performed laparoscopic operations of varicocele in 75 patients incl. 53 for concurrent subfertility. In all patients before operation by Doppler sonography and coloured Doppler mapping venous reflux was detected. The volume of the testis was also assessed by sonography. In subfertile patients changes of the spermiogram were assessed. After operation the blood supply was evaluated (the resistive index), the volume of the testes, the duration of the operation and changes in the spermiogram. The authors did not detect a significant difference between the group of 27 patients where with the vein also the artery was ligatured and the group of 48 patients where only the vein was ligatured. The patients were not damaged by ligature of the artery.

[Ultrasonographic changes in prostatic tissue after thermotherapy]. / Zmeny prostatické tkáne po termoterapii v ultrazvukovém obraze.

The authors evaluated in 13 patients the peroperative and postoperative effect of thermotherapy by transrectal ultrasonography. In all patients for a period of 60 minutes by means of a transurethral cooled catheter a temperature of 50 degrees C was applied. In the two-dimensional B picture in all patients a hypoechogenic border round the urethra was observed which gradually became defined as a canal of varying width. Changes in the blood supply of the prostate were not detected by the authors. The functional equivalent of these changes was an improved uroflowmertric finding and IPPS score.

[Personal experience in the diagnosis and monitoring of therapy in metabolic disorders with risk of crystallization in patients with recurrent urolithiasis]. / Nase zkusenosti s diagnostikou a monitorováním lécby metabolických poruch a rizik krystalizace u pacientu s recidivující urolitiázou.

A ten-year experience with diagnosis and therapy of metabolic abnormalities and crystallization risks in patients with recurrent urolithiasis is presented. Since 1985, more than 900 persons with recurrent urolithiasis have been examined at the Metabolic Centre of the Hospital in Sternberk. The patients were examined routinely at ambulance or during hospitalization; the examination consisted of repeated urine and blood collections after the diet with various content of calcium and salt. All initial data (case history, physical finding, biochemistry, radiodiagnostics) were processed by a semi-expert computing program SOFT which was also used for monitoring of the therapy. Then the patients were divided into individual risk groups (Pak). Of all probands, the group of 130 patients (satisfying the strict criteria of the study) was selected and the data obtained was processed statistically. The group of 130 patients with recurrent urolithiasis (all of them were drug-treated) was compared to the group of 50 individuals with urolithiasis treated by diet and regimen measures. The patients given drugs showed a significantly increased crystallization inhibitors concentration in urine and reduced crystallization promotors, or relative saturation of some lithiatic substances. The paper analyzes the effect of the mostly administered drugs on crystallization risks and some less known "metabolic" indications of application of some drugs are recommended. It is concluded that the dietary, drinking and regime measures are basic for a good therapy of patients with urolithiasis, but patients with recurrent urolithiasis should be applied a selective metaphylaxis of drugs after routine metabolic examination. This finding is supported by a low number of recurrent urolithiasis.

[Endosonography of the ureter--initial experience with a new method]. / Endosonografie mocovodu--první zkusenosti s novou metodou.

The authors had the opportunity to examine four patients, using a new intraureteral sensing unit and to study the basic ultrasonographic picture of the whole ureter. In addition to the ascendent application of the sensing unit they used also the descendent approach during percutaneous lithotripsy and peroperative exploration of the ureter during ureterotomy. The authors assume that the method will prove useful in particular for detection and assessment of the position of renal vessels before endopyelotomy in hydronephrosis.

[Extracorporeal lithotripsy in the treatment of biliary tract calculi]. / Vyuzití extrakorporální litotrypse v lécbe kamenu zlucových cest.

The authors subjected to the effects of a shock wave 20 concrements of the biliary pathways. Their size varied but was within the range of 8-30 mm. Their chemical composition and crystalline pattern from which ensues the hardness of the concrement was verified by the method of X-ray diffraction. It was confirmed that the apparatus MEDILIT 5 which uses discharges of electric sparks between two electrodes deposited under water is able to destroy concrements of the biliary pathways to a maximum size of 3 mm. This effect is independent on the chemical composition of the concrements, their hardness and size up to a diameter of 30 mm.

[Ultrasonographic examination in the follow-up of patients after kidney transplantation]. / Prínos ultrasonografického vysetrení pro sledování nemocných po transplantaci ledviny.

The authors followed-up in 1988-1994 a total of 134 patients after renal transplantation by ultrasonographic examinations in the B mode, Doppler frequency analysis and coloured Doppler mapping. They summarize the basic sonographic pictures during a normal development after transplantation and in case of surgical and non-surgical complications. They evaluate sonography as the basic examination method which is not quite specific for different complications but makes it possible to detect them in the initial stage and to indicate in time further examinations and treatment.

[Color doppler mapping in the diagnosis of prostatic carcinoma]. / Význam barevného dopplerovského mapování v diagnostice karcinomu prostaty.

The authors examined 70 patients with histologically confirmed prostate carcinoma in different stages by transrectal ultrasonography in the B mode and by ultrasonography by colour flow mapping and pulsed Doppler. They investigated the distribution of the blood supply, resistance index (RI) and pulsatility index (PI). It did not prove possible to find an association between the blood supply and stage T nor with grading G. A certain relationship was observed between the blood supply and the progression of the tumour. In newly detected growing tumours and in progressing tumours not responding to treatment the blood supply was more ample. On the other hand, in all stationary tumours reacting well to treatment the blood supply was reduced.

[Personal experience in treatment of urolithiasis using the MEDILIT M6 extracorporeal lithotriptor]. / Nase zkusenosti s lécbou urolitiázy extrakorporálním litotryptorem MEDILIT M6.

The authors report on their experience with the destruction of kidney stones with the lithotriptor MEDELIT M6 of Medipo Co. BRNO on the development of which they participated. They checked 878 patients where the instrument was used and where the condition of a half-year interval after the operation had been met. In these patients 119 operations were made 87% of which were successful. No serious complications occurred; after operation they observed in 17% of the patients complications ensuing from a block of the ureter by the passing stones. The extracorporeal lithotriptor MEDELIT M6 is a reliable instrument with a low rate of defects and cheap operation which makes accurate X-ray and sonographic focusing on the stone possible as well as adequate disintegration of the concrement without damaging surrounding tissues. It is comparable with instruments of the same generation manufactured abroad.