- MeSH
- anastomóza chirurgická statistika a číselné údaje MeSH
- chronická pankreatitida * chirurgie MeSH
- COVID-19 komplikace MeSH
- drenáž statistika a číselné údaje MeSH
- gastrointestinální endoskopie statistika a číselné údaje MeSH
- lidé MeSH
- pankreatektomie statistika a číselné údaje MeSH
- pankreatoduodenektomie statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika 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
PURPOSE: Crohn's disease (CD) belongs to chronic disorders with unpredictable disease course. The aim of this study was to identify how genetic testing (NOD2/CARD15) can be used in patients with CD to predict the need for surgical treatment (to define an aggressive type of disease where the patient can profit from early surgery). METHODS: The patients who were tested genetically had undergone a surgery due to CD at the Department of Surgery University Hospital Brno Bohunice between 2010 and 2016. The control group consisted of patients with CD who had been diagnosed with CD at least 5 years prior to the testing and had not required any surgical intervention. The second control group was healthy subjects. RESULTS: In total, there were 117 operated patients for CD, 77 patients with CD that had not undergone surgery for CD and 30 healthy subjects. For patients with at least one genetic mutation, the risk of the necessity of surgical treatment of CD is 1.96 times higher than for patients with no mutation. Patients with two or more mutations were generally operated on at a younger age, in a shorter time after being diagnosed and each patient had a partial resection of the ileum. CONCLUSION: The group of operated patients with CD had a significantly higher distribution of at least one genetic mutation as opposed to the non-operated group. In patients with two or more mutations, the disease course was more aggressive. This group of patients might profit from the conservative top-down or early surgical therapy.
- MeSH
- alely MeSH
- Crohnova nemoc genetika chirurgie MeSH
- dospělí MeSH
- genetická predispozice k nemoci MeSH
- genetické asociační studie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mutace genetika MeSH
- prognóza MeSH
- rizikové faktory MeSH
- signální adaptorový protein Nod2 genetika MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Surgical resection of a part of the intestine is a standard procedure in gastrointestinal surgery and in order to perform this type of surgery successfully, tissue blood flow must be evaluated clearly. There exists a theoretical indication that it would be possible to use infrared thermography (IRT) for this purpose. Therefore, the main objective of the study is the qualitative evaluation of the infrared thermography method as an ancillary method for determining the resection lines and forming an optimal intestinal anastomosis on the porcine model. APPROACH: Blood circulation rate has a close relationship with temperature difference and is also very important for identifying the resection lines on the bowel, the formation of anastomoses, and, subsequently, their adequate healing. Therefore, IRT could be helpful in determining the nonvascular part of the intestine. In order to make a qualitative evaluation of this method, the study also focuses on a comparison of IRT with the contrasting indocyanine green (ICG) imaging method, which is commonly used. MAIN RESULTS: The comparison of two independent imaging methods (IRT and ICG) revealed similar, but not identical, results. Subjective evaluation of the anastomosis performed by the team of three surgeons was more in agreement with the area detected by contactless thermography imaging. Moreover, the proceeding 'dynamic temperature return test', when the particular intestinal part was cooled and its subsequent temperature return was measured, revealed significant results. The time taken to return to the original intestinal temperature was greater for the devascular part of the intestine. SIGNIFICANCE: A thermographic examination could help to detect the correct location of the intestine resection line for further/continuing anastomosis creation.
Background Stomach preparation by ischaemic conditioning prior to oesophageal resection represents a potential method of reducing the risk of anastomotic complications. This study compares the results of the anastomotic complications of cervical anastomosis after oesophagectomy with a short interval after ischaemic conditioning (group S) and a long interval (group L). Methods Subjects undergoing oesophagectomy for carcinoma after ischaemic conditioning were divided into two groups. Group S had a median interval between ischaemic conditioning and resection of 20 days, while for group L the median interval was 49 days. Anastomotic leak and anastomotic stenosis in relation to the interval between ischaemic conditioning and actual resection were followed. Results After ischaemic conditioning, 33 subjects in total underwent surgery for carcinoma; 19 subjects in group S and 14 subjects in group L. Anastomotic leak incidence was comparable in both groups. Anastomotic stenosis occurred in 21% of cases in group S and 7% of cases in group L (not statistically significant). Conclusions A long interval between ischaemic conditioning and oesophagectomy does not adversely affect the postoperative complications. A lower incidence of anastomosis stenoses was found in subjects with a longer interval, however, given the size of our sample, the statistical significance was not demonstrated. Both groups seem comparable in surgical procedure course and postoperative complications.
- MeSH
- anastomóza chirurgická škodlivé účinky metody MeSH
- časové faktory MeSH
- dospělí MeSH
- ezofagektomie škodlivé účinky MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony škodlivé účinky metody MeSH
- nádory jícnu chirurgie MeSH
- netěsnost anastomózy epidemiologie etiologie MeSH
- přivykání k ischémii škodlivé účinky metody MeSH
- senioři MeSH
- stenóza epidemiologie etiologie MeSH
- žaludek chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
This study is focused on the vascular anatomy of the stomach in relation to the gastric pull-up construction. The vascular anatomy was studied on forty-one human specimens. We find out the differences in blood supplement between anterior and posterior wall. It was maked an review of the main trunk arteries of the stomach. To display the vessels of the stomach we used diaphanoscopy, digital shooting in special mode and micro preparation of the vessels. We find out that left gastric artery gives more branches to the posterior wall and right gastroepiploic artery (RGEA) gives more branches to the anterior wall. But brunches of RGEA are longer on the posterior wall than on the anterior. Also we are offering the new classification of the RGEA related to gastric pull-up construction. This classification based not only on the anatomical shapes of RGEA but on the properties of the flow dynamics through the artery.
- MeSH
- anatomická variace MeSH
- arteria gastroepiploica anatomie a histologie MeSH
- gastroplastika metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transiluminace MeSH
- žaludek krevní zásobení diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The Hedgehog pathway is one of the major driver pathways in pancreatic ductal adenocarcinoma. This study investigated prognostic importance of Hedgehog signaling pathway in pancreatic cancer patients who underwent a radical resection. Tumors and adjacent non-neoplastic pancreatic tissues were obtained from 45 patients with histologically verified pancreatic cancer. The effect of experimental taxane chemotherapy on the expression of Hedgehog pathway was evaluated in vivo using a mouse xenograft model prepared using pancreatic cancer cell line Paca-44. Mice were treated by experimental Stony Brook Taxane SB-T-1216. The transcript profile of 34 Hedgehog pathway genes in patients and xenografts was assessed using quantitative PCR. The Hedgehog pathway was strongly overexpressed in pancreatic tumors and upregulation of SHH, IHH, HHAT and PTCH1 was associated with a trend toward decreased patient survival. No association of Hedgehog pathway expression with KRAS mutation status was found in tumors. Sonic hedgehog ligand was overexpressed, but all other downstream genes were downregulated by SB-T-1216 treatment in vivo. Suppression of HH pathway expression in vivo by taxane-based chemotherapy suggests a new mechanism of action for treatment of this aggressive tumor.
- MeSH
- duktální karcinom pankreatu farmakoterapie genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- mutace MeSH
- myši nahé MeSH
- nádory slinivky břišní farmakoterapie genetika MeSH
- přežití po terapii bez příznaků nemoci MeSH
- proteiny hedgehog genetika MeSH
- protoonkogenní proteiny p21(ras) genetika MeSH
- senioři MeSH
- taxoidy aplikace a dávkování terapeutické užití MeSH
- transkriptom účinky léků MeSH
- výsledek terapie MeSH
- xenogenní modely - testy antitumorózní aktivity MeSH
- zvířata MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Plasminogen activator ihnibitor (PAI 1) belongs to the plasminogen activator system, which is part of the metastatic cascade and significantly contributes to invasive growth and angiogenesis of malignant tumors. Its plasma level is normally low but 4G/4G homozygotes have higher concentrations of PAI 1. This genotype may be associated with worse prognosis and proximal location of colorectal cancer than 5G/5G homozygotes. In our prospective evaluation we examined plasma level PAI 1 (using photometric microplate method ELISA) pre-surgery and, subsequently, 6-8 weeks later, from 80 patients. For the PAI 1 rs1799889 -675 4G/5G polymorphism test the PCR amplification was used.Analysis of collected data was confirmed that significantly higher plasma levels of PAI 1 were found in patients before starting therapy, which decreased (p=0.004) after initiation of treatment. Patients with higher plasma level PAI 1 before (p=0.013) and after therapy (p=0.004) had significantly shorter survival. We found no relationship between polymorphisms of PAI 1 (-675 4G/5G) in relation to stage, survival or tumor location. PAI 1 is useful as a negative marker of prognosis and could be advantageous when planning adjuvant treatment of patients with colorectal carcinoma. Although opinions on the importance of polymorphisms of PAI 1 in relation to the prognosis are not uniform, it does seem that their role in the prognosis of patients with colorectal cancer is not essential.
