Sbornik vedeckych praci Lekarske fakulty Karlovy univerzity v Hradci Kralove. Supplementum最新文献

Authors studied serum and urine zinc levels in a total of 64 malignant melanomas. From them, in 27 patients the melanogenuria has simultaneously been observed, and the cystinuria in 35, respectively. Mentioned examinations were performed during both the recovery and relapsing periods of tumor manifestations. From the values obtained in both serum and urine, no agreement has been issued with the authors believing that the decrease in serum zinc levels and their increase in urine may be prognostically unfavorable. Similar controverting results were obtained in monitoring melanogenuria as well. In contrast, higher pathological cystinuric values resulted in 50% of tumor relapses. The authors preclude this will be the direction for further observation on by far larger group of patients.

Five cases of bronchopulmonary aspergillosis are scrutinized which showed no unambiguous account for any of 6 forms of the disease as described previously. Clinical signs, roentgenograms and bronchoscopy findings testified about the interaction between the aspergillus and the host being in accord with either the aspergilloma or chronical necrotizing pulmonary aspergillosis. Authors preclude the invasive symptomatology represents a developmental and likely initial phase in aspergilloma's onset. Apart from the disease progression, markedly extinctive signs of aspergilloma's activity have in contrast been detected after a period of its duration. In this case, the important signs are associated rather with the occurrence of other microorganisms whose participation was proved in 3 from 5 patients. Authors suggest also the immune status of those affected and the process invasiveness should be taken in mind in providing etiotropic treatment with the impact on the spectrum of microorganisms detected.

CT findings are evaluated in 103 children with vascular lesions (aged up to 15 years), and in 59 children with congenital cerebral and cerebellar malformations. Their maximum has been stated to occur perinatally due to hypoxic and ischemic brain affections. Therefore most of diagnostical problems were related to the differentiation of hypodense immature brain from ischemic changes. Mentioned findings were always correlated with clinical course. Similar confrontations along with earlier CT control examination may be helpful in distinguishing milder transitory postischemic oedema from serious necrotic and malatic changes. In more aged children, vascular lesions are of rare occurrence being different in etiology. More unambiguous CT patterns are obtained in vascular changes with hemorrhagies. Of special importance in their onset is a hypoxic attack with subsequent venous bleeding mainly into the germinative matrix. While well tolerated in premature newborns, the extensive hemorrhagies in on-term ones have worser prognosis, resulting in significant changes on control examination, predominantly hydrocephalus and porencephalia. Atrophies of various extent were the most common consequence of all encephalopathies of vascular origine. In almost a half of congenital brain and cerebellar anomalies, unsignificant findings of smaller middle line cavities were obtained predominantly in pellucide septum. From the serious findings, most frequent were different varieties of dysgenesis, hypogenesis up to agenesis of corpus callosum combined sometimes with either the lipomas or cysts. Another findings consisted in Dandy-Walker's cerebellar malformation, holoprosencephalia and only two patients manifested hydrencephalia and basal meningoencephalocele. Most of diagnostical effort has been made in mainly anomalies associated with ventriculomegalia and/or cystic formations in order to elucidate the eventual communication between the structures mentioned. In addition, CT ventriculo-cysto-orcisternography has also been performed using smaller amount of nonionic contrast. At present, an important portion of CT examinations may be replaced with sonography which is more simple as used in both newborns and toddlers.

The alkaline duodenal or intestinal reflux of contents back to the stomach or postgastrectomy stump is known to result in chronic atrophic gastritis. In accord to several authors, it implies significantly the initiation of carcinoma of postgastrectomy stump. Authors of the present work referred to their routinely provided antirefluent modifications of Roux-en-Y gastrojejunoanastomosis in patients indicated to gastrectomy. Technically important steps of operation have been also reported. The 22-membered total of patients was presented with postsurgery revision results 3 to 36 month postoperatively. The operation mentioned was in accord with preventive DGR query. Remotely, the operation effectiveness should be evaluated as to the prevention of malignancy onset in postgastrectomy stump.

Starting from 1976 to 1983, a total of 114 children was submitted to surgery for chronic appendicitis. The 5 to 13 years postappendectomy results were evaluated in 105 patients. From them, 68 (64.8%) were without complaints, 27 (25.7%) showed the substantial improvement. Of any favourable effect were 3 postappendectomy children, i.e. 2.8%. In one case, a serious postoperative complication occurred, this resulting in the small intestine strangulative ileus 2 mos. after the appendectomy. Different and even contradictory views are discussed in regard with the properly existence, signs, diagnosis and management of chronic appendicitis. The authors estimate chronic appendicitis to be the clinical and by no means the pathologico-anatomical diagnosis. According to them, the children are indicated to the elective appendectomy after preliminary investigation which is focused on the exclusion of other serious diseases similar in subjective complaints.

During the last two decades, the economic aspects of health care acquired an outstanding attentiveness in all developed countries. Simultaneously, the methods have been searched for a more intensive and perfect application of internal health sources, i.e. manpower, materials and money. New approaches in evaluating health care efficacy (conception of health provision as a branch of national economy) have been made. In accord with them, the efficiency of either individual or partial health actions such as health care programs, preventive measures, diagnostical and curative procedures etc.) is measured. All these questions are the up to date topic for Health care of Czechoslovakia which now is far to dispose of sources comparable with the majority of economically developed countries in Europe. At present, they are approximately similar in supplying 1 person health care needs with 500-1000 dol. a year and even more in several countries, whereas Czechoslovakia spends about 200 dol. on health needs of 1 inhabitant a year. This fact is closely connected with relatively low efficacy of our economy incapable to produce the sufficient sources for providing health care on one hand, and on the other it is due both to the budgetary politics as practiced now and the conception of national product division. The shortage in Health care sources is manifested mainly in retardation of material and technical base of health service altogether with low levelled renumeration of health workers consequential in psychologic, social and political problems. The consequences of this condition are reflected negatively in a level of health service provision. This is as far important as the czechoslovac population health status viewed from the so-called strategic health indices (averaged life expectancy, specific mortality, occurrence of cardiovascular diseases and malignancies etc.) is not favourable due to a number of factors, and its improvement will require considerable efforts from both the health workers and community as a whole. Besides the needful enlargement of sources, these complicated questions are resolvable in observing unity of medical, organizational and economical rationality on all levels of health service management and in all health institutions. This is also the way how to improve the efficiency of health care. The term of efficiency in relation to the health services. In economics, the efficiency is the ratio between the achieved result (effect) and the expenditure of a specified amount of resources. Mathematically, this ratio is expressed as follows: efficiency = end-result/costs Linked to the Health care, the efficiency may be understood also differently from its economic term.(ABSTRACT TRUNCATED AT 400 WORDS)

A total of 115 patients with gastroduodenal ulcers submitted to surgery at the Department of Surgery in Hradec Králové between 1975 and 1979 had been reported on retrospectively. Authors emphasized the long term postgastrectomy results providing minimally 10-year-lasted intervals since. After a detailed clinical examination of patients, postgastrectomy results may be evaluated as good ones and comparable to a number of literary experiences. Therefore, they estimate this surgical modality of treatment to be justified and appropriate in respect with contemporary indicatory criteria as well as other therapeutic modalities known to exert influence on gastroduodenal ulcers.

In spite of eminent position of mammary carcinoma as to its diagnosis and treatment in literature sources on mammary diseases, the benign diseases of this location are evidenced unless 3 times as frequent. Uncommon benign lesions of female mammary gland are reported through the period of 3 years. Differential diagnosis misinterpretations are emphasized which may occur even at well equipped institutions. Surgery and detailed histological examinations showed the final character of lesions. Of importance also is the provision of dispensary care. Factors listed which augment the biological capability of malignant reversal.

The hyperlipidemia may be influenced with both the conservative and surgical management. Starting from 1987, authors use Buchwald's (1963) partial ileal bypass method. They report on their experience with 16-membered total of patients. In majority of patients, the PIB was auxiliary operation mostly in relation with vascular reconstructive surgery. No lethality case or serious complication has been stated. All patients showed the substantial decrease in cholesterol and triglyceride levels, these being normalized in majority of patients. Authors are discussing PIB indications. The suggestion is made that this is the most effective of known measures in attempt to achieve a continual decrease in lipids without the serious discomfort for a patient.

Four cases related with the long stenosis of lower part of esophagus are referred to in children. These were stenoses of fibromuscular type, due to achalasia and resulting from etching with sulphuric acid as well as from tumor. The extramucous myotomy, esophagotomy and colonic replacement of long esophageal stenosis were elected. The condition is repairable by esophagomyotomy or esophagotomy when the function of stenotic portion of esophagus is preserved. To prevent postoperative complications such as fistula, diverticulum, gastroesophageal reflux and restenosis, the covering of incision with a patch from gastric fundus is recommended with subsequent fundoplication. Anatomical and functional lesion of esophageal wall in the presence of long stenosis requires its esophagoplasty as well as replacement with the intestinal interposition.