Watch-and-wait (WW) strategy offers an alternative to radical resection with total mesorectal excision (TME) in selected patients with distal rectal adenocarcinoma after achieving complete clinical response (cCR) to neoadjuvant therapy. This approach is based on intensive follow-up, where a multidisciplinary team, especially the surgeon, is confronted with a demanding follow-up regimen including repeated anorectoscopies, per rectum examinations and magnetic resonance imaging. The prediction of pathological complete response in cCR is particularly problematic. The risk of recur-rence (regrowth) in cCR is a key factor, which occurs in 26-36% of patients, especially during the first 3 years of follow-up, and increases the risk of metastasis. Early salvage R0 resection is indicated when regrowth is detected and is feasible in more than 90% of cases. WW offers comparable oncologic outcomes in compliant patients and better functional outcomes compared to TME in patients with pCR.

• Klíčová slova
• complete response, neoadjuvant treatment, organ preserving strategy, regrowth, watch-and-wait,
• MeSH
• adenokarcinom * terapie   patologie   chirurgie   MeSH
• léčba šetřící orgány * MeSH
• lidé MeSH
• nádory rekta * terapie   patologie   chirurgie   MeSH
• neoadjuvantní terapie MeSH
• pozorné vyčkávání * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients treated with acute coronavirus disease 2019 (COVID-19) in intensive care units (ICU) have suffered from neuropsychiatric complications such as anxiety, depression, and confusion. Conditions related to the environment have the potential to worsen these symptoms. In combination with virus-dependent neuroinflammation, they form a "toxic" mixture. Discussion and planning strategies for providing psychological care in the ICU during the pandemic have revealed a great current challenge. CASE SERIES: We share our experience concerning psychological interventions for oncological patients with oxygen saturation depletion. Our observation of two SARS-CoV-2 patients suggests a close time-related association between the increase in inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP) and intensive anxiety in the fast development of breath shortening in acute COVID-19 infection due to brain hypoxia and potential neuroinflammation. CONCLUSION: As cytokine IL-6 regulates induction of CRP gene expression, the changes in IL-6 concentrations associated with anxiety symptoms and breath shortening in the observed cluster can be detected hours earlier than changes in CRP levels, with a diagnostic implication for the clinicians. The SARS-CoV-2 patients with oncological diseases treated in our ICU asked for personal bedside contact with clinical psychologists, considered it irreplaceable and reported this psychological care as beneficial.

• Klíčová slova
• C-reactive protein– neuroinflammation, SARS-CoV-2, anxiety, anxiety– interleukin 6, brain hypoxia, intensive care unit, psychological care,
• MeSH
• COVID-19 * MeSH
• interleukin-6 MeSH
• jednotky intenzivní péče MeSH
• lidé MeSH
• neurozánětlivé nemoci MeSH
• SARS-CoV-2 * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• interleukin-6 MeSH

INTRODUCTION: Postoperative complications in patients with breast cancer delay the initiation of adjuvant therapy, prolong the length of hospitalization and reduce the patients' quality of life. Although their incidence can be influenced by many factors, the connection with the type of drain is insufficiently studied in the literature. The aim of this study was to assess whether there is an association between the use of a different drainage system and the occurrence of postoperative complications. METHODS: The data of 183 patients included in this retrospective study were collected from the information system of the Silesian Hospital in Opava and then statistically analyzed. These patients were divided into two groups according to the type of drain used - a Redon drain (active drainage) was used in 96 patients, and a capillary drain (passive drainage) was used in 87 patients. The incidence of seromas and hematomas, the duration of drainage and the amount of wound drainage were compared between the individual groups. RESULTS: The incidence of postoperative hematomas was 22.92% in the group of patients with the Redon drain, and 10.34% in patients with the capillary drain (p=0.024). The incidence of postoperative seromas was comparable for the Redon drain (39.6%) or the capillary drain (35.6%) (p=0.945). No statistically significant differences were found in the drainage time or the amount of wound drainage. CONCLUSION: A statistically significantly lower incidence of postoperative hematomas was observed when using a capillary drain compared to the use of a Redon drain in patients after breast cancer surgery. The drains were comparable with respect to seroma formation. None of the studied drains was significantly more beneficial in terms of the total drainage time and the total amount of wound drainage. KEY WORDS: breast cancer, postoperative complications, drain, hematoma.

• Klíčová slova
• breast cancer, drain, hematoma, postoperative complications,
• MeSH
• hematom MeSH
• incidence MeSH
• kvalita života MeSH
• lidé MeSH
• nádory prsu * chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• retrospektivní studie MeSH
• serom komplikace   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Diverticulitis of the ileum is an inflammatory complication of diverticulosis. It is an uncommon cause of acute abdomen that can have a very serious course, leading, for example, to intestinal perforation or bleeding. Imaging findings are very often negative and the true cause of the condition is only revealed peroperatively. In this case report, we present a case of perforated ileal diverticulitis in a patient with bilateral pulmonary embolism. This was the main reason for conservative management in the first period of time. After resolution of the pulmonary embolism, resection of the affected bowel segment was performed at the time of the next attack.

• Klíčová slova
• Pulmonary embolism, computed tomography, ileal diverticulitis, intestine perforation, perforation, pulmonary embolism, ultrasonography, ultrasound,
• MeSH
• akutní bolest břicha * komplikace   MeSH
• diferenciální diagnóza MeSH
• divertikulitida * diagnóza   MeSH
• ileum chirurgie   MeSH
• lidé MeSH
• perforace střeva * etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is associated with specific coagulopathy that frequently occurs during the different phases of coronavirus disease 2019 (COVID-19) and can result in thrombotic complications and/or death. This COVID-19-associated coagulopathy (CAC) exhibits some of the features associated with thrombotic microangiopathy, particularly complement-mediated hemolytic-uremic syndrome. In some cases, due to the anti-phospholipid antibodies, CAC resembles catastrophic anti-phospholipid syndrome. In other patients, it exhibits features of hemophagocytic syndrome. CAC is mainly identified by: increases in fibrinogen, D-dimers, and von Willebrand factor (released from activated endothelial cells), consumption of a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13 (ADAMTS13), over activated and dysregulated complement, and elevated plasma cytokine levels. CAC manifests as both major cardiovascular and/or cerebrovascular events and dysfunctional microcirculation, which leads to multiple organ damage. It is not clear whether the mainstay of COVID-19 is complement overactivation, cytokine/chemokine activation, or a combination of these activities. Available data have suggested that non-critically ill hospitalized patients should be administered full-dose heparin. In critically ill, full dose heparin treatment is discouraged due to higher mortality rate. In addition to anti-coagulation, four different host-directed therapeutic pathways have recently emerged that influence CAC: (1) Anti-von Willebrand factor monoclonal antibodies; (2) activated complement C5a inhibitors; (3) recombinant ADAMTS13; and (4) Interleukin (IL)-1 and IL-6 antibodies. Moreover, neutralizing monoclonal antibodies against the virus surface protein have been tested. However, the role of antiplatelet treatment remains unclear for patients with COVID-19.

• Klíčová slova
• COVID-19, Coagulopathy, Endothelial dysfunction, Microangiopathy, SARS-CoV-2,
• MeSH
• COVID-19 * komplikace   MeSH
• cytokiny MeSH
• endoteliální buňky MeSH
• heparin terapeutické užití   MeSH
• koagulopatie * etiologie   MeSH
• kritický stav MeSH
• lidé MeSH
• monoklonální protilátky terapeutické užití   MeSH
• SARS-CoV-2 MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• cytokiny MeSH
• heparin MeSH
• monoklonální protilátky MeSH

Mature T cell lymphomas (MTCLs) have worse prognosis, and in contrast to B cell lymphomas, there is no universal marker like CD20 with exception of ALK and CD30, which are present in proportion of MTCL only. Up to now, ALK is traditionally associated with good prognosis in ALCLs, and there are some evidences that CD30-positive T cell or B cell lymphomas have better prognosis. In our retrospective, population-based analysis, we analyzed the real clinical value of ALK and CD30 in the most frequent MTCL subtypes. Between 2000 and 2017, we identified 732 patients with newly diagnosed ALCL, AITL, or PTCL-NOS. Among them, 207 ALCL patients were with known ALK, whereas 61 AITL and 238 PTCL-NOS with known CD30 expression. There were 69/207 (33.3%) ALK + ALCLs, who displayed better 5-year PFS (65.6% vs. 36.2%) (p .001) and 5-year OS (71.5% vs. 45.9%) (p .002) compared to ALK - ; ALK + patients were significantly younger (median 48 vs. 60 years; p < 0.001). For patients ≥ 60 years, 5-year PFS (38.5% vs. 31.2%) and 5-year OS (38.5% vs. 39.6%) were similar between ALK + vs. ALK - patients. For AITL and PTCL-NOS, there were 44/61 (72.1%) and 120/238 (50.4%) CD30 + samples, and difference in CD30 expression was significant (p .02). AITL patients had 5-year OS of 43.8% vs. 55.7% (p 0.848) and 5-year PFS of 36.7% vs. 29.4% (p .624) for CD30 + vs. CD30 - patients, whereas PTCL-NOS had 5-year OS of 35.7% vs. 34.3% (p .318) and 5-year PFS of 29.3% vs. 22.5% (p.114) for CD30 + vs. CD30 - cases. We conclude that ALK in ALCLs (≥ 60 years) and CD30 expression in PCTL-NOS and AITL have only limited prognostic value.

• Klíčová slova
• ALK, CD30, Peripheral T cell lymphoma, Prognosis,
• MeSH
• antigen Ki-1 * MeSH
• lidé MeSH
• periferní T-buněčný lymfom * patologie   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• tyrosinkinasové receptory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• antigen Ki-1 * MeSH
• tyrosinkinasové receptory MeSH

Appendiceal mucocele is an obstructive dilatation of the appendix, which results from the filling of its lumen with mucus. This is a rare condition that is asymptomatic in half of the patients. Its severity depends on the cause of appendiceal dilatation. In a small percentage of cases, the dilated appendix ruptures, leading to the development of serious complication; this is termed as pseudomyxoma peritonei. Due to the possibility of malignant etiology of the mucocele, surgical resection remains an essential part of the treatment.

• Klíčová slova
• appendiceal mucocele − pseudomyxoma peritonei − appendiceal mucinous neoplasm, ultrasonography − computed tomography,
• MeSH
• apendix * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• mukokéla * diagnostické zobrazování   chirurgie   MeSH
• nádory apendixu * diagnostické zobrazování   chirurgie   MeSH
• peritoneální nádory * MeSH
• pseudomyxom peritonea * MeSH
• radiologové MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Paragangliomas represent a group of neuroendocrine tumours which occur in various localizations. Most of them produce catecholamines, and in advanced cases present with typical symptoms and signs such as palpitations, headache and hypertension. The only curative treatment is radical resection. About one-quarter of paragangliomas are malignant, defined by the presence of distant metastases. There are multiple treatment options for unresectable metastatic tumours. They include radionuclid therapy, chemotherapy, and radiotherapy, although none of them are curative. Cytoreductive surgery can also be considered, especially when the goal is to decrease symptoms related to advanced disease. We present a rare case of a large paraganglioma of the left retroperitoneum. Despite radical surgery, early recurrence of the disease was observed.

• Klíčová slova
• multiple organ resection, neuroendocrine tumours, oncology, paraganglioma, surgery,
• MeSH
• lidé MeSH
• paragangliom * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Functional outcomes and quality of life (QoL) after transanal total mesorectal excision (TaTME) are very important factors in the evaluation of TaTME in comparison with other approaches to TME. The most common functional problems after resection of the rectum include bowel, urologic and sexual dysfunctions. In this study, we present our experience with QoL after TaTME; the results are compared with worldwide literature in the discussion. METHODS: QoL was assessed by a questionnaire. The total of 54 patients were analysed. A general questionnaire for oncological diseases was used - European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, together with EORTC-QLQ-CR29 - a specific questionnaire for colorectal cancer. The Low Anterior Resection Syndrome (LARS) score was also obtained in all patients. Mean follow-up was 42.65 months (range 9-91 months). RESULTS: The mean LARS score in patients undergoing TaTME was 30.7 while a major LARS was observed in 64.2% of those with LARS. Of all of the symptoms in the EORTC-QLQ-C30 survey, the most serious problems which affected patients undergoing TaTME were diarrhoea (30.25), fatigue (23.87) and insomnia (20.37). In the QLQ-CR29 survey the problems included flatulence (50.94), faecal incontinence (45.06) and stool frequency (35.19). The results of EORTC-QLQ-C30 and QLQ-CR29 are quite heterogeneous. CONCLUSION: In this study the QoL of patients with advanced rectal tumours (of whom 81.5% received neoadjuvant therapy) undergoing TaTME is comparable to results in the current literature. The most severe symptoms affecting QoL after TaTME are flatulence, faecal incontinence, and stool frequency. Other serious symptoms include fatigue and insomnia. LARS was recorded in 73.6% of patients undergoing TaTME, mostly a major LARS.

• Klíčová slova
• transanal total mesorectal excision − quality of life − functional outcomes − low anterior resection syndrome − EORTC,
• MeSH
• kvalita života MeSH
• laparoskopie * MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• pooperační komplikace MeSH
• rektum chirurgie   MeSH
• syndrom MeSH
• transanální endoskopická chirurgie * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Pancreatic carcinoma is an aggressive tumor with a grim prognosis. Accurate staging is essential for indicating surgery in patients with borderline resectable tumors. This paper examines the correlation between pre-operation characteristics of tumors found on CT, infiltration of individual resection margins as confirmed by a pathologist, and the survival of patients with resectable pancreatic head ductal adenocarcinoma. This prospective cohort study involved patients operated on for pancreatic head adenocarcinoma, which was clearly resectable based on the staging CT and intraoperative observation between 2011-2014. Only patients without postoperative complications who underwent adjuvant chemotherapy were analyzed. Seventy-nine patients were assessed, of which 16 (20.3%) had R0 resection and 63 (79.7%) had R1 resection. Patients with R1 results had up to 2.7 times higher risk of death than patients with R0 resection. We found a trend towards shorter survival associated with a closer relationship of the tumor to the superior mesenteric vein/portal vein (SMV/PV) wall in the pre-operation CT examination. Patients with a tumor interface between the vein wall of up to 180 ° circumference had up to 1.97 times higher risk of death than patients without (p=0.131). The results of our work confirmed that in our center, even surgically treated, clearly resectable pancreatic head tumors still have a high occurrence of positive surgical margins (R1 resection) and that tumors with R1 resection had statistically significantly reduced survival compared to R0 resection. A trend for shorter overall survival was found after tumor resection depending on the increasing interface between the tumor and the SMV/PV wall, but this result was not statistically significant.

• MeSH
• adenokarcinom * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• míra přežití MeSH
• nádory slinivky břišní * diagnostické zobrazování   chirurgie   MeSH
• pankreatoduodenektomie * MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• resekční okraje MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH