Lung malignancies have a substantial impact on cancer incidence and mortality worldwide. Even though many factors involved in the development of the disease are known, many questions remain unanswered. Previous studies suggest that the intestinal microbiota may have a role in developing malignant diseases. According to some findings, the microbiota has proven to be a key modulator of carcinogenic processes and the immune response against cancer cells, potentially influencing the effectiveness of immunotherapy. In our study, we characterized culturable microorganisms associated with non-small cell lung cancer (NSCLC) that can be recovered from rectal swabs and mouthwash. In addition, we also explored differences in the culturable microbiota with two main types of NSCLC - adenocarcinoma (ADC) and squamous cell carcinoma (SCC). With 141 patients included in the study (86 ADC and 55 SCC cases), a significant difference was observed between the two types in seven bacterial species (Collinsella, Corynebacterium, Klebsiella, Lactobacillus, Neisseria, Rothia, and Streptococcus), including the site of origin. The relationship between microbial dysbiosis and lung cancer is poorly understood; future research could shed light on the links between gut microbiota and lung cancer development.

• MeSH
• Adenocarcinoma * MeSH
• Humans MeSH
• Microbiota * MeSH
• Lung Neoplasms * microbiology   pathology   MeSH
• Carcinoma, Non-Small-Cell Lung * microbiology   pathology   MeSH
• Carcinoma, Squamous Cell * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Surgical treatment of early-stage non-small cell lung cancer (NSCLC) yields highest expectations for recovery. However, the frequency of further disease progression remains high since micro-metastatic disease may be undetected by conventional diagnostic methods. We test the presence and prognostic impact of circulating tumor cells (CTCs) in peripheral blood (PB), tumor-draining pulmonary blood (TDB) and bone marrow (BM) samples from NSCLC patients. METHODS: The presence of circulating/disseminated tumor cells (CTCs/DTCs) was detected by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis in PB, TDB and BM samples before surgery in 119 stage IA-IIIA NSCLC patients (Clinical Trial NS10285). RESULTS: NSCLC patients with the presence of carcinoembryonic antigen (CEA) mRNA-positive CTCs/DTCs in TDB and BM had significantly shorter cancer-specific survival (CSS) (P<0.013, resp. P<0.038). Patients with the presence of epithelial cellular adhesion molecule (EpCAM) mRNA-positive CTCs in TDB samples had significantly shorter CSS and disease-free survival (DFS) (P<0.031, resp. P<0.045). A multivariate analysis identified the presence of CEA mRNA-positive CTCs in the PB as an independent negative prognostic factor for DFS (P<0.005). No significant correlation of CTCs/DTCs presence and other prognostic factors was found. CONCLUSIONS: In NSCLC patients undergoing radical surgery, the presence of CEA and EpCAM mRNA-positive CTCs/DTCs is associated with poorer survival.

• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

Prezentujeme kazuistiku 60leté pacientky s anamnézou subtotální resekce žaludku s rekonstrukcí pasáže Roux-Y kličkou, u které byla s odstupem pěti let diagnostikována benigní stenóza společného žlučovodu. Možnosti endoskopie a intervenční radiologie k sanaci žlučových cest v pooperačně změněném terénu proximální části trávicího traktu byly omezené. Po jejích neúspěšných pokusech byla pacientka indikovaná k chirurgické intervenci – biliodigestivní anastomóze. Pooperační průběh byl významně komplikován krvácením a vytvořením žlučové i kolické píštěle. S odstupem času byl nalezen migrovaný drén v tenkém střevě, který byl příčinou zánětlivých změn a nekompletní obstrukce tenkého střeva. Zvýšený intraluminální tlak ve střevních kličkách bránil hojení anastomózy a byl hlavní příčinou komplikací.

We present the case of a 60-year-old patient with the history of subtotal gastric resection and reconstruction of passage using the Roux-Y loop, five years later diagnosed with benign stenosis of the common bile duct. The possibilities of using endoscopy and interventional radiology for the bile duct treatment in the postoperatively altered terrain of the proximal digestive tract were limited. After failure of these methods the patient was indicated for surgery – biliodigestive anastomosis. The postoperative course was significantly complicated by bleeding and formation of bile and colic fistulas. Over time, a migrated stent was found in the small intestine, which was the cause of inflammatory changes and incomplete small bowel obstruction. Increased intraluminal pressure in the intestinal loops inhibited healing of the anastomosis and was a major cause of the complications.

• MeSH
• Anastomosis, Surgical MeSH
• Common Bile Duct surgery   MeSH
• Gastrectomy * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Complications surgery   MeSH
• Anastomosis, Roux-en-Y * adverse effects   MeSH
• Constriction, Pathologic surgery   etiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Anastomosis, Surgical statistics & numerical data   MeSH
• Pancreatitis, Chronic * surgery   MeSH
• COVID-19 complications   MeSH
• Drainage statistics & numerical data   MeSH
• Endoscopy, Gastrointestinal statistics & numerical data   MeSH
• Humans MeSH
• Pancreatectomy statistics & numerical data   MeSH
• Pancreaticoduodenectomy statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related death with a 5-year survival of only 21%. Reliable prognostic and/or predictive biomarkers are needed to improve NSCLC patient stratification, particularly in curative disease stages. Since the endogenous cannabinoid system is involved in both carcinogenesis and anticancer immune defense, we hypothesized that tumor tissue expression of cannabinoid 1 and 2 receptors (CB1 and CB2) may affect survival. METHODS: Tumor tissue samples collected from 100 NSCLC patients undergoing radical surgery were analyzed for CB1 and CB2 gene and protein expression using the quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC). The gene and protein expression data were correlated with disease stage, histology, tumor grading, application of chemotherapy, and survival. Additional paired tumor and normal tissue samples of 10 NSCLC patients were analyzed independently for comparative analysis of CB1 and CB2 gene expression. RESULTS: Patients with tumors expressing the CB2 gene had significantly longer overall survival (OS) (P<0.001), cancer specific survival (CSS) (P=0.002), and disease-free survival (DFS) (P<0.001). They also presented with fewer lymph node metastases at the time of surgery (P=0.011). A multivariate analysis identified CB2 tumor tissue gene expression as a positive prognostic factor for CSS [hazard ratio (HR) =0.274; P=0.013] and DFS (HR =0.322; P=0.009), and increased CSS. High CB2 gene and protein expression were detected in 79.6% and 31.5% of the tested tumor tissue samples, respectively. Neither CB1 gene nor CB1 or CB2 protein expression affected survival. When comparing paired tumor and tumor-free lung tissue samples, we observed reduced CB1 (P=0.008) and CB1 (P=0.056) gene expression in tumor tissues. CONCLUSIONS: In NSCLC patients undergoing radical surgery, expression of the CB1 and CB2 receptor genes is significantly decreased in neoplastic versus tumor-free lung tissue. CB2 tumor tissue gene expression is strongly associated with longer survival (OS, CSS, DFS) and fewer lymph node metastases at the time of surgery. More studies are needed to evaluate its role as a biomarker in NSCLC and to investigate the potential use of CB2 modulators to treat or prevent lung cancers.

• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

Úvod: Meckelov divertikel (MD) je vývojovou abnormalitou a pravým divertiklom tenkého čreva, ktorý môže byť miestom vzniku zhubného nádoru. Najčastejšími tumormi MD sú neuroendokrinné tumory (NET), pričom jednoznačné odporučenie k riešeniu týchto nádorov v tejto lokalite vzhľadom k prevalencii MD a častosti nádorového bujnenia v ňom neexistuje. Posledné poznatky však ukazujú, že ich biologické chovanie je agresívne, nezávislé od veľkosti a svojim chovaním pripomínajú NET ilea. Kazuistika: Prezentujeme prípad 62 ročného pacienta vyšetrovaného pre enterorágiu, u ktorého bol v rámci diagnostiky nájdený adenokarcinóm vzostupného hrubého čreva a viacpočetné ložiská pečene vzhľadu metastáz. Punkčná biopsia ložísk pečene zistila, že sa nejedná o metastázy kolorektálneho karcinómu, ale o metastázy NET nejasného origa. Nasadená bola liečba analógmi somatostatínu a pre anemizáciu pacienta sa vykonala pravostranná hemikolektómia, pri ktorej bol peroperačným nálezom Meckelov divertikel bez makroskopických známok patológie. MD bol zresekovaný a pri histologickom vyšetrení sa v ňom diagnostikoval stredne diferencovaný NET. Záver: Chirurgická terapia je základnou modalitou liečby MD, a to aj v prípade asymptomatickej formy nájdenej peroperačne pri výkone z inej indikácie. Pri náleze NET v MD je nutné radikálne chirurgické riešenie pre riziko skorého metastatického šírenia, pri metastatickom postihnutí pečene sa pre zlepšenie prognózy takisto odporúča agresívny prístup s kombináciou chirurgickej a systémovej liečby.

Introduction: Meckel's diverticulum (MD) is a developmental abnormality and a true diverticulum of the small intestine which can give rise to a malignant tumor. Neuroendocrine tumors (NETs) are the most common tumors arising in MD, but due to the prevalence of MD and its malignancy rate, there is no uniform guideline regarding these tumors. Recent knowledge shows that their biological behavior is aggressive and unrelated to size. Their behavior resembles that of an ileal NET. Case report: A 62-year-old male was examined for enterorrhagia, and an adenocarcinoma of the ascending colon was diagnosed along with multiple liver lesions that resembled metastases. Needle biopsy of a liver lesion was performed and showed the lesions to be NET metastases of unknown origin. Treatment with somatostatin analogs was commenced, and because of the patient's anemization a right hemicolectomy was indicated, during which a normal Meckel's diverticulum was found and resected. Histological evaluation of MD confirmed a moderately differentiated NET. Conclusion: Surgery is the primary modality for treating MD, including cases in which MD is asymptomatic and found incidentally during surgery for other causes. In the case of NET of MD, a radical surgical treatment is needed because of the risk of early metastatic dissemination. When liver metastases are present, an aggressive approach combining surgical and systemic treatment is recommended to improve the prognosis of the disease.

• MeSH
• Colorectal Neoplasms * diagnosis   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Meckel Diverticulum * diagnosis   pathology   MeSH
• Neoplasms, Multiple Primary * MeSH
• Liver Neoplasms surgery   secondary   MeSH
• Neuroendocrine Tumors * surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Úvod: Primárna peritonitída predstavuje zápal peritoneálnej dutiny bez jasného intraabdominálneho zdroja infekcie. Je súčasťou diferenciálnej diagnostiky náhlych príhod brušných a môže byť potencionálne život ohrozujúca. Pneumokoky boli častým patogénom spôsobujúcim primárnu peritonitídu hlavne v preantibiotickej ére, v súčasnosti sú vyvolávajúcim agens skôr zriedka. U dospelých sa pneumokoková peritonitída vyskytuje hlavne u pacientov s predisponujúcimi faktormi, akým je napríklad cirhóza pečene s ascitom. V zdravej populácii je táto diagnóza vzácna a diagnostika je preto náročná, nevyhnutné je v prvom rade vylúčiť sekundárnu peritonitídu. Kazuistika: V našom článku prezentujeme prípad 36-ročnej ženy, osem týždňov po pôrode per vias naturales, ktorá bola prijatá na naše oddelenie pre náhle vzniknuté difúzne bolesti brucha s obrazom septického stavu. Kontrastná počítačová tomografia (CT) abdomenu nenašla patológiu vysvetľujúcu stav pacientky. Zaviedla sa širokospektrálna antibiotická liečba a indikovaná bola laparotómia, pri ktorej sa takisto nenašiel zdroj infekcie, intraabdominálne bol prítomný hnisavý nezapáchajúci výpotok, peroperačne bola vykonaná toaleta dutiny brušnej s lavážou antiseptikom. Kultivácia priniesla monobakteriálny nález Streptococcus pneumoniae. Pri pokračujúcej antibiotickej liečbe a laváži sa stav pacientky po chirurgickej revízii postupne znormalizoval. Záver: Primárna pneumokoková peritonitída je v zdravej dospelej populácii ťažko diagnostikovateľná, imituje sekundárnu peritonitídu, od ktorej musí byť odlíšená. Vo väčšine prípadov je klinické odlíšenie bez operačnej intervencie nemožné. Chirurgická liečba má v diagnostickom i terapeutickom procese primárnej pneumokokovej peritonitídy dôležitú úlohu, rovnako ako správna antibiotická terapia. V rámci diferenciálnej diagnostiky by sa na diagnózu primárnej peritonitídy nemalo zabúdať.

Introduction: Primary peritonitis is an inflammation of the peritoneal cavity in the absence of a localized intra-abdominal source. It is included in the differential diagnosis of acute abdomen and can be potentially life-threatening. Pneumococci were a frequent pathogen causing primary peritonitis especially in the preantibiotic era. Nowadays, they act as an uncommon primary pathogen. Pneumococcal peritonitis in adults is more frequently seen in cases of liver cirrhosis with ascites and other pre-existing conditions. Primary pneumococcal peritonitis is uncommon in healthy individuals and therefore its diagnosis is difficult. Secondary peritonitis has to be excluded. Case report: A 36-year-old woman was admitted to our surgery department with symptoms of severe sepsis. She reported a sudden onset of diffuse abdominal pain and was eight weeks after delivery per vias naturales. A computed tomography scan of the abdomen with intravenous contrast has not demonstrated any pathology explaining the condition of our patient. Empiric anti-microbial therapy with broad-spectrum antibiotics was commenced and a laparotomy was performed, which also did not reveal any source of infection. Purulent odorless fluid was found in the peritoneal cavity. Peritoneal lavage with an antiseptic was performed. Cultures from peritoneal fluid demonstrated a monobacterial growth of Streptococcus pneumoniae. The condition of our patient improved after continued adequate antibiotic therapy and lavage. Conclusion: Primary pneumococcal peritonitis is difficult to diagnose in healthy individuals, since it is mimicking secondary peritonitis that has to be excluded. A clinical diagnose without surgical intervention is impossible in most cases. Surgical treatment has an important role in both the diagnosis and management of primary pneumococcal peritonitis, same as adequate antibiotic therapy. Primary peritonitis should be a part of the differential diagnosis of patients presenting with acute abdominal pain.

• MeSH
• Abdomen, Acute etiology   MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Surgical Procedures, Operative methods   MeSH
• Adult MeSH
• Humans MeSH
• Peritonitis * diagnosis   etiology   therapy   MeSH
• Pneumococcal Infections diet therapy   complications   therapy   MeSH
• Streptococcus pneumoniae MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH