[Surgery of external hernias at the 3rd Surgical Clinic from 1993 to 1997]. / Operace zevních kýl na III. chirurgické klinice v letech 1993 az 1997.

In 1993 to 1997 at the IIIrd Surgical Clinic of the First Medical Faculty Charles University 1271 patients with the diagnosis of external hernia were operated. For classical operations the term herniorrhaphia (HR) is used, for operations with a mesh hernioplasty (HP). For the present study 204 patients were selected operated in 1996 (half the operations were done by the "classical" method, the other half using a supporting mesh). The mean age of the patients was 57 years. For evaluation the sex, age, height, body weight, employment, risk factors, site and type of hernia, number of recurrences before operation, type and period of administered antibiotic, prevention of thrombosis, type of anaesthesia, complications, duration of operation and hospitalization were recorded. After analyzing the results the authors reached the following conclusions: 1. At present there practically does not exist any patient with hernia contraindicated for surgery. 2. For treatment of external hernias a polypropylene net (Prolen) is suitable and its price is reasonable. 3. In obese patients we indicate surgery using a net. 4. In risk patients antibiotic prophylaxis is indicated. 5. Heparinization increases the risk of development of haematomas, therefore in heparinized patients drainage of the wound is recommended. 6. Patients after surgery for hernias in the Czech Republic were hospitalized in 1996 for an unnecessarily long time according to the authors' experience.

Changes in abdominal wall after mesh implantation in rats.

On an incisional hernia model, we evaluated tissue reactions to three types of non-absorbable foreign materials, Prolene, Gore-Tex and flax, used for covering defects of the abdominal wall muscles in Wistar strain rats. The examinations were carried out in five 14-days intervals between the 35th and 91st days after the intervention. Our results with Gore-Tex showed the lowest tissue response, the lowest inflammatory cellular as well as fibroplastic reaction, it also completely covers the artificially made wall defect and induces no considerable peritoneal adhesion. In defects filled with Prolene mesh, we also observed no considerable cellular response and scarring. However, considerable peritoneal adhesions were found and the defect was filled to a great extent with lipidic tissue with irregularly distributed Prolene fibres. The use of flax material is least suitable since it induces extensive inflammatory reactions, which occur even after a very long time after the operation. Prolene was, as a matter of fact, second to Gore-Tex in the experimental evaluation of the biological tolerance. However, with respect to its ten times lower price, it can be recommended as a material of the first choice for covering defects of the abdominal wall in clinical use.

Our experiences with combination of enzyme therapy and laser therapy in enthesopathies.

The present communication brings a contribution to the confrontation of two treatment methods in enthesopathies (painful overload syndromes). In group A, 26 patients were treated by a combination of systemic enzyme therapy (SET) and non-invasive laser therapy. In group B, 13 persons were treated only by therapeutic laser. The average age in group A and B was of 39.3 and 41.8 years, respectively. The representation of men and women in the two groups was almost identical. The intensity of the pain prior to the treatment and after the treatment, specified by each patient with the help of a ten-grade scale, was evaluated by the variance analysis. The combined treatment by the SET and therapeutic laser was statistically significantly more efficient (p = 0.02). On the other hand, there was also a significant difference between the two groups in baseline values of average pain intensities. These values were of 7.0 and 5.2 in groups A and B, respectively. The average value of the pain intensity in all the 39 patients was of 6.6 prior to the treatment and it was reduced to 3.5 after the treatment.

Assessment of metals and metalloids in skin derivatives of volunteers from capital city of Prague, Czech Republic.

Instrumental neutron activation was employed to determine 12 elements (Al, As, Co, Cr, Cu, Fe, Hg, Mn, Mo, Sb, V, Zn) in derivatives of the epidermis (human scalp hair, public hairs and toenails) from 188 women and 74 men of the population of the Capital City of Prague. Statistically significant differences are discussed, occurring during the comparison of groups arranged in terms of various factors (type of material analyzed, age, sex, environmental exposure of the dwelling and/or occupation locality, type of occupation--mental or manual, smoking, alcohol consumption, allergy, hysterectomy and selected diseases). Statistically significantly increased levels of elements in materials coming from Prague areas with higher environmental burden are considered as the most valuable result.

[Preparatory courses for applicants for medical studies]. / Prínos prípravných kurzu zájemcum o studium medicíny.

From 1991, the First Medical Faculty of the Charles University arranges for applicants for the medical study two-semester preparatory courses paid by the applicants. Their purpose is to improve knowledge of high-school physics, chemistry and biology with orientation to model questions published by the faculty [1, 2, 3]. Variants of 100-questions sets for the examination are generated by a computer and they are altered every year [4]. Two types of preparatory courses are available. Type A--every Monday and Tuesday between 17.00 and 18.45, physics and chemistry in odd weeks, biology and Latin in even weeks. Latin is not a discipline considered during the admission examination, however, managing of its basic knowledge facilitates not only understanding problems considered in the other disciplines, but it is particularly useful for learning the special terminology in the first year of the study of medicine. Course of type B is held once a month, on Saturdays between 8.30 and 14.00 and it is particularly designed for applicants residing beyond the capital city of Prague. In the course of 10 semesters implemented, 980 and 1,410 students passed through courses of type A and B, respectively [5, 6]. The purpose of our analysis was to evaluate the difference between results of admission procedure of applicants who participated and of those who did not participate in the preparatory course. Basic data were yielded by the Department of Students of the Deans Office. We considered the number of applicants, their results in the course of their four years of study at high schools and the number of points acquired in physical, chemical and biological tests. We furthermore obtained applications for preparatory courses in school years 1993/94 and 1994/95. The results were processed with the help of data base programs Access and Excel (Microsoft). In each of the years of interest, the applicants were divided into four groups depending on the type of the study: 1--medicine (L) and 2--stomatology (S) or depending on whether 3--they were registered in preparatory courses or 4--not. The analysis carried out resulted in the following conclusion: a--both groups of applicants (registered and not registered in preparatory courses) had comparable study results during the last four years of their high-school study; b--in the admission procedure, students, who passed through preparatory courses, achieved undoubtedly better results in comparison with those who did not pass through these course, which holds in medicine as well as stomatology; c--there was about the same improvement of knowledge of physics, chemistry and biology in both types of the preparatory courses.

Effects of hemodialysis on bone mineral as followed by using neutron activation analysis.

The purpose of the study was to bring a contribution to the knowledge of physiology and pathophysiology of the bone mineral heteroionic exchange with respect to sodium ions and metabolic diseases, particularly bone diseases. The instrumental neutron activation analysis was employed to follow the ratio of contents Na/Ca in bone samples from dialyzed patients. A formerly elaborated method for the determination of the Na/Ca ratio in undecalcified bone tissue sections obtained from material embedded in polymethylmethacrylate was used. In the reference group the Na/Ca ratio was of 0.021 +/- 0.003, that in patients with the renal osteopathy was of 0.030 +/- 0.007. Results obtained in patients with different types of the renal osteopathy depending on the intensity of the impairment were discussed.

[Dynamic scintigraphy of the esophagus in young persons with functional algesic-dyspeptic disorders of the upper digestive tract]. / Dynamická scintigrafie jícnu u mladých jedincu s funkcními algicko-dyspeptickými potízemi horního typu.

The authors examined a group of 30 young people aged 19-23 years who suffered from chronic algic dyspeptic complaints of the upper type persisting for 3-36 months. The prerequisite for inclusion into the group were normal results of endoscopy, the physical finding and standard biochemical examinations. In all these patients dynamic scintigraphy of the oesophagus was made. A quite normal finding was recorded only in three patients (10%). In the remaining 27 (90%) major or minor abnormalities were recorded. This is in marked contrast with the results of dynamic scintigraphy of the oesophagus in 19 healthy volunteers of the same age. In the latter a normal finding was obtained in 15 (79%) and deviations from it only in four subjects (21%). Dynamic scintigraphy of the oesophagus is a simple easily performed method which in a selected group of patients has become an objective criterion of their chronic complaints.

[Results of radionuclide ventriculography and correlation with echocardiography and angiography]. / Výsledky radionuklidové ventrikulografie v korelaci s echokardiografií a angiografií.

In a group of 24 patients with coronary artery diseases, correlations of left ventricle end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV), and ejection fraction (EF) measurement results were assessed. Compared results were obtained with radiological angiography (RTG), echocardiography (USG), and radionuclide ventriculography (RNVG). In RNVG, the left ventricle volume was calculated using a geometrical method (GEO), a sample method with measurement of left ventricle position depth from a scintigraphic image (VZ1), and a sample method with assessment of left ventricle position depth from body height and body weight (VZ2). Interpersonal variability of RNVG evaluation was assessed simultaneously. Compared with RTG, the best correlation of EDV measurement was attained with GEO (r = 0.83) and VZ2 (r = 0.82). These methods correlate best also in ESV measurement (r = 0.91). The best correlation of EF values was obtained with USG, while r = 0.85 when using GEO and VZ2. A very low correlation was found in SV (r values from 0.39 to 0.50). The studied methods usually overestimate low values and underestimate higher values. To the EF value of 50 per cent corresponds in USG the value 48 per cent, in GEO and VZ2 the value 42 per cent. The values of EDV, ESV, and SV obtained with USG and RNVG correlate well with RTG, while the values of SV are, due to a low correlation, practically useless. Interpersonal variability of RNVG methods evaluation is minimal. (Tab. 6, Ref. 30.)

Swallowing function and gastric emptying in patients undergoing replacement of the esophagus.

In order to assess functional changes after esophagectomy, esophageal transit scintigraphy and gastric emptying measurements were performed in a group of 10 patients after esophagus substitution by the tubulized stomach, and in a group of 12 patient with an interposed colon. The swallowing function of the rest of the esophagus was preserved in 15 out of 22 patients. The best results were obtained on using a liquid bolus in an upright position, the worst function was found on using a solid bolus in a supine position. Reflux at the level of the anastomosis with the esophagus was detected in only 7 out of 22 patients. The gastric emptying rate was normal in 4 out of 12 examined patients. Scintigraphic methods proved to be suitable for the detection of functional changes after surgery. The function tests performed proved that substitution of the esophagus by either tubulized stomach or interposed colon provides the patient with adequate comfort, provided that he adopts certain habits.

[BCG immunotherapy in malignant lymphogranuloma]. / BCG imunoterapie u maligniho lymfogranulomu.

The authors investigate within the framework of a multicentre, randomized and stratified investigation the influence of non-specific BCG immunotherapy in adult patients with Hodgkin's disease. The thus created data base was processed according to the Protocol of a prospective study. Supplementary BCG treatment was compared in a group of 112 patients with the fate of 114 patients in a control group without immunotherapy. Although the mean period of complete remission in the group of vaccinated patients regardless of the clinical stage of the disease was 94 months and in the control group 74 months, the difference was not statistically significant. The five-year survival was 93% in vaccinated patients and 91% in the control group. The probability of 10-year survival does not differ substantially in vaccinated patients (88%) and in non-vaccinated patients (85%). There was no difference in the work capacity of patients in the two groups. Immunotherapy was not selected, when testing prognostic factors by Cox' regression analysis, into any of the prognostically favourable models.

[Detection of functional changes in the myocardium after chemotherapy using radionuclide ventriculography in patients with testicular tumors]. / Detekce funkcních zmen myokardu radionuklidovou ventrikulografií u nemocných s testikulárními nádory po chemoterapii.

Radionuclide ventriculography performed in a group of 26 patients with testicular tumors treated with the combinations PVB (cisplatinum, vinblastine, bleomycin) and PAV (cisplatinum, adriamycin, VP-16) showed in both groups at a virtually unchanged ejection fraction an increased diastolic and residual volume of the left ventricle, compensated by an increased systolic volume and higher heart rate. The functional changes develop more slowly after administration of the combination PAV and were found to persist in both groups for more than 2 years after termination of therapy. These changes do not become clinically manifest in patients with good myocardial function before onset of therapy, yet in patients with an a priori changed myocardial function they may develop into therapy complications.

The clinical contribution of a uniform diagnostic and therapeutic protocol in Hodgkin's disease.

In the period between 5 July, 1968 and 31 December, 1986, a total of 138 patients with Hodgkin's disease were treated at the Institute of Biophysics and Nuclear Medicine of the -- School of General Medicine of Charles University in Prague. In the initial period between 5 July, 1968 and 31 December, 1977 a 10-year survival of 28% and a disease-free survival of 64% were achieved in 29 selected patients. In the next period, the patients were diagnosed and treated according to the uniform protocol used by all centres in the Czech Socialist Republic concentrated in the Lymphoma Cooperative Group. In the whole follow-up period, 5-year and 10-year survival rates of 78% and 75%, respectively, were achieved in 112 surviving persons. The corresponding survival rates in complete remission are 65.5% and 62.5%, respectively. When compared to survival of our patients treated up to 1974, the 5-year survival increased from 40% to 70% in 1986. Improvement of therapeutic outcome is due to more effective treatment. Increased diagnostic accuracy and, thus, also improved disease classification, enables the choice of optimal treatment. The treatment efficacy is documented by restoration of the working capacity in more than a half (51.17%) of patients in our group.