Úvod a cíle: Transplantace jater (OLT) pro hepatocelulární karcinom (HCC) v cirhotických játrech je ideální léčebnou metodou, která odstraňuje tumor i cirhotická játra s dalším maligním potenciálem. Významné zlepšení přežití přináší transplantační léčba zejména pacientům s malým tumorem a s nízkým rizikem rekurence po OLT. Cílem práce bylo retrospektivně zhodnotit přežití pacientů, kteří v našem centru podstoupili OLT pro HCC a identifikovat rizikové faktory podporující rekurenci tumoru po OLT. Soubor pacientů: Do studie bylo zařazeno 81 dospělých pacientů transplantovaných v našem centru pro HCC (skupina HCC). Všichni splnili tzv. extendovaná indikační kritéria (HCC < 6,5 cm) a 61/81 i tzv. Milánská kritéria (HCC < 5 cm). Kontrolní skupinu tvořilo 606 pacientů, kteří ve stejném období podstoupili OLT pro jaterní cirhózu bez tumoru (skupina Ci). Výsledky: Celkové jedno-, tří- a pětileté přežití bylo u pacientů s HCC horší ve srovnání s Ci skupinou (HCC 77 %, 70 % a 66 % vs Ci 93 %, 90 % a 87 %; p < 0,001). Dlouhodobé přežití našich HCC pacientů bylo srovnatelné se zahraničními centry zařazenými do tzv. Metroticket Group (přežití pět let 71,2 % a 10 let 58,4 % při splnění extendovaných indikačních kritérií). K rekurenci HCC po OLT došlo u 13/81 pacientů (16 %). Medián doby mezi OLT a rekurencí byl 182 dnů (101–2 322). Závěr: Vyšší hodnota AFP před OLT, velikost největšího ložiska a přítomnost angioinvaze byly nezávislými prediktivními faktory rekurence. Pro další ­zlepšení ­výsledků je zásadní pravidelný screening rizikových skupin cirhotiků detekující malé tumory a jejich časné odeslání k OLT.

Background and aims: Liver transplantation (OLT) is currently the treatment of choice for hepatocellular carcinoma (HCC) in cirrhotic liver, because it removes the tumour as well as the cirrhotic tissue with malignant potential. However, OLT improves survival especially in patients with a small tumour, who have a low risk of tumour recurrence after OLT. The aim of our study was to retrospectively analyse survival of patients who underwent liver transplantation for HCC in our centre and to identify the risk factors of tumour recurrence after OLT. Patient characteristics: Eighty-one adult patients who underwent liver transplantation in our centre for HCC (HCC group) were enrolled into the study. They all complied with the extended indication criteria (HCC < 6.5 cm) and 61/81 also met the Milan criteria (HCC < 5 cm). The control group consisted of 606 patients transplanted for end-stage liver disease without evidence of tumour (Ci group) within the same period. Results: 1-, 3- and 5-year overall survival was worse in HCC patients compared with the Ci group (HCC 77%, 70% and 66% vs Ci 93%, 90% and 87%, p < 0.001). Long-term survival is comparable with foreign transplant centres in the Metroticket Group (5-year survival 71.2% and 10-year survival 58.4% if the extended criteria are met). 13/81 (16%) patients experienced HCC recurrence, and the median time to recurrence after OLT was 182 days (101–2322). Conclusions: Higher AFP value before OLT, the largest node size and proved angioinvasion represented the independent predictive factors of tumour recurrence. To achieve even better results, regular screening of risk groups of cirrhotic patients resulting in detection of small tumours and their early referral to OLT is crucial. Key words: liver transplantation – hepatocellular carcinoma – recurrence – survival – cirrhosis The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 6. 3. 2014 Accepted: 7. 4. 2014

• MeSH
• alpha-Fetoproteins MeSH
• Survival Analysis * MeSH
• Adult MeSH
• Carcinoma, Hepatocellular * diagnosis   surgery   MeSH
• Liver Cirrhosis * MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local * MeSH
• Tomography, X-Ray Computed MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Waiting Lists MeSH
• Statistics as Topic MeSH
• Neoplasm Grading statistics & numerical data   MeSH
• Liver Transplantation * statistics & numerical data   MeSH
• Patient Selection MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Orthotopic liver transplantation (OLT) currently represents the treatment of choice for early hepatocellular carcinoma (HCC). Preoperatively known HCC (pkHCC) is diagnosed via imaging methods before OLT or before HCC is found postoperatively in the liver explant, denoted as incidental HCC (iHCC). The aim of this study was a comprehensive analysis of the post-transplantation survival of patients with iHCC and the identification of risk factors of iHCC occurrence in cirrhotic liver. METHODS: We retrospectively reviewed 33 adult cirrhotic patients with incidentally found HCC, comparing them with 606 tumor-free adult cirrhotic patients with end-stage liver disease (group Ci) who underwent OLT in our center from January 1995 to August 2012. Within the same period, a total of 84 patients underwent transplantation for pkHCC. We compared post-transplantation survivals of iHCC, Ci, and pkHCC patients. In the group of cirrhotic patients (Ci + iHCC), we searched for risk factors of iHCC occurrence. RESULTS: There was no difference in sex, Model for End-Stage Liver Disease score, and time spent on the waiting list in either group. In the multivariate analysis we identified age >57 years (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.75-8.14; P < .001), hepatitis C virus or alcoholic liver disease (OR, 3.89; 95% CI, 1.42-10.7; P < .001), and alpha-fetoprotein level >6.4 μg/L (OR, 6.65; 95% CI, 2.82-15.7; P = .002) to be independent predictors of iHCC occurrence. Both the 1-, 3-, and 5-year overall survival (OS) and the 1-, 3- and 5-year recurrence-free survival (RFS) differed in iHCC patients compared with the Ci group (iHCC: OS 79%, 72%, and 68%, respectively; RFS 79%, 72%, and 63%, respectively; vs Ci: OS = RFS: 93%, 94%, and 87%, respectively; P < .001). CONCLUSIONS: The survival of iHCC patients is worse than in tumor-free cirrhotic patients, but similar to pkHCC patients. The independent risk factors for iHCC occurrence in cirrhotic liver are age, hepatitis C virus, or alcoholic liver disease etiology of liver cirrhosis and alpha-fetoprotein level.

• MeSH
• Adult MeSH
• Carcinoma, Hepatocellular diagnosis   MeSH
• Liver Cirrhosis surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Liver Neoplasms diagnosis   MeSH
• Incidental Findings * MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Liver Transplantation * MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Abstracts MeSH

Pyogenní absces jater je málo častým onemocněním s vysokou mortalitou, není-li adekvátně léčen. Jeho nejběžnější příčinou jsou onemocnění žlučových cest, může rovněž souviset s portální bakteriémií následkem nitrobřišní infekce. Terapie jaterního abscesu spočívá v podávání antibiotik, u větších abscesů dále v perkutánní drenáži. U menšiny pacientů je indikována chirurgická drenáž či resekce jater. V naší kazuistice prezentujeme případ pacienta s rozsáhlým abscesem jater imitujícím při zobrazovacích vyšetřeních maligní nádor, jehož příčinou byla zcela asymptomatická perforující divertikulitida. Definitivní diagnózu i terapeutické řešení přinesla laparotomie s resekcí perforované části tračníku a drenáží jaterního abscesu.

Pyogenic liver abscess is a rather uncommon disease with high mortality when untreated. Its most frequent causes are biliary tract diseases, it can also be related to portal bacteriaemia resulting from intraabdominal infection. Therapy of liver abscess includes administration of antibiotics with the addition in larger abscesses of percutaneous drainage. Only in a minority of patients is surgical drainage or resection indicated. We present a patient with a large liver abscess resembling malignant tumour in scans which was caused by asymptomatic perforating diverticulitis. Laparotomy allowed definitive diagnosis and a therapeutic solution consisting of resection of the perforating part of the colon and drainage of the liver abscess.

• MeSH
• Diagnosis, Differential MeSH
• Diverticulitis, Colonic diagnosis   complications   MeSH
• Liver Neoplasms diagnosis   MeSH
• Liver Abscess, Pyogenic diagnosis   etiology   surgery   MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Anastomosis, Surgical methods   utilization   MeSH
• Cholangiopancreatography, Endoscopic Retrograde methods   trends   utilization   MeSH
• Choledocholithiasis complications   therapy   MeSH
• Data Interpretation, Statistical MeSH
• Biliary Tract Diseases diagnosis   complications   therapy   MeSH
• Retrospective Studies MeSH
• Liver Transplantation methods   adverse effects   utilization   MeSH

• Publication type
• Abstracts MeSH

• MeSH
• Kidney Diseases, Cystic diagnosis   ultrasonography   MeSH
• Hydronephrosis diagnosis   ultrasonography   MeSH
• Kidney ultrasonography   MeSH
• Humans MeSH
• Kidney Diseases diagnosis   ultrasonography   MeSH
• Ultrasonography, Doppler methods   utilization   MeSH
• Ultrasonography classification   methods   instrumentation   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Pancreas divisum is the most common congenital variant of the pancreas; however, its clinical significance remains controversial. The purpose of our study was to determine the role of pancreas divisum in the development of chronic pancreatitis. METHODS: We compared the clinical presentation, morphological findings, and course of disease of 30 patients with chronic pancreatitis associated with pancreas divisum (there was coexisting chronic alcohol abuse in 18 cases) to those of 57 patients with chronic pancreatitis and no evidence of pancreas divisum (15 with nonalcoholic pancreatitis and 42 with alcoholic pancreatitis). RESULTS: Sex distribution, age at onset of disease, clinical presentation, course of disease, and frequency of complications were not affected by the presence of pancreas divisum. Although the etiology of pancreatitis in patients with pancreas divisum may be attributed to impaired drainage of the majority of the gland through the minor papilla, we observed a relatively low frequency of isolated dorsal duct involvement in our patients irrespective of alcohol use (25% and 28% in patients with and without a history of alcohol abuse, respectively). However, involvement of the ventral duct was commonly observed (75% and 72%, respectively). CONCLUSIONS: The presence of pancreas divisum in our study did not modify the natural course of chronic nonalcoholic or alcoholic pancreatitis. Pancreas divisum is not likely to play a dominant role in the etiopathogenesis of chronic pancreatitis.

• MeSH
• Pancreatitis, Chronic etiology   MeSH
• Adult MeSH
• Financing, Organized MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Pancreas abnormalities   MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

Each year, about 7,000 persons develop colorectal cancer in the Czech Republic. About half of them are shown to have synchronic and metachronic metastases in the liver. Radical liver resection is currently the only effective technique of treatm Recurrence in residual hepatic tissue develops in ore than a half of patients. It is reported that locoregional adjuvant chemotherapy reduces the risk of recurrence in residual hepatic tissue. The mainstay of colorectal carcinoma therapy remai Using the expression of enzymes involved in 5-fluorouracil (5-FU) metabolism, a group of patients can be defined who will benefit from adjuvant 5-FU chemotherapy; as a result, the therapeutic response by the patient can be predicted. To date, there has been no publicationon the expression of 5-FU metabolizing enzymes, as determined in material obtained from malignant tissue of RO resected hepatic metastases of CR-Ca and the effect of adjuvant HAIC into residual hep .

V České Republice ročně nově onemocní kolorektálním karcinomem asi 7000 osob. Asi u poloviny z nich jsou synchronní nebo metachronní metastázy v jatrech. Radikální resekce jater je v současné době jediný efektivní způsob léčby. Rekurenci ve zbytku jaterní tkáně vyvine více než polovina nemocných. Je uváděno, že lokoregionální adjuvantní chemoterapie snižuje riziko rekurence ve zbývající jaterní tkáni. Základem chemoterpie kolorektálního karcinomu zůstává 5 fluorouracil. Z exprese enzymů zúčastněných v metabolismu 5 fluorouracilu (5-FU) lze definovat skupinu pacientů, kteří budou z adjuvantní chemoterapie 5-FU profitovat, tedy lze predikovat léčebnou odpověď pacienta. Nebyl publikován vztah mezi expresí enzymů metabolizujících 5-FU, stanovené v materiálu získaném z nádorové tkáně RO resekovaných jaterních metastáz KR-Ca a efektem adjuvantní HAIC do zbylé jaterní tkáně na rekurenci onemocnění.

• MeSH
• Chemotherapy, Adjuvant MeSH
• Colorectal Neoplasms MeSH
• Neoplasm Metastasis MeSH
• Liver Neoplasms surgery   MeSH
• Predictive Value of Tests MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• gastroenterologie
• hepatologie
• chirurgie
• farmacie a farmakologie
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR