- Publikační typ
- abstrakt z konference MeSH
BACKGROUND/OBJECTIVE: Hormone receptor (HR) status is one of the key factors in determining the treatment of breast cancer. Previous studies suggested that HR status may change in metastatic tissue. However, available studies focused mainly on primary biopsies and there are only few trials comparing HR status in the primary tumour and the metastasis using material from complete resection. The aim of the study was to determine the frequency of HR alterations in metastatic breast cancer. MATERIALS AND METHODS: The study retrospectively examines a total of 50 patients who underwent brain, lung, or liver metastasectomy for metastatic breast cancer between January 2000 and January 2019. RESULTS: HR conversion was observed in a total of 30 cases (60.0%), while HER-2/neu (human epidermal growth factor receptor 2) discrepancy surprisingly occurred only in one case (2.0%). A change in immunophenotype occurred in 28% of cases. Triple-negativity was more frequent in brain metastases (p = 0.039). CONCLUSIONS: We have confirmed that HR conversion between the primary tumour and its metastases occurs in a significant number of cases, which has important implications for further treatment decisions.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Castleman ́s disease is an extremely rare heterogenous lymphoproliferative pathology with a mostly benign behavior. It is a localized or generalized lymph node enlargement of an unknown aetiology. Unicentric form is typically a slow-growing solitary mass occurring mostly in the mediastinum, abdominal cavity, retroperitoneum, pelvis and neck. Aetiology and pathogenesis of CD is probably diverse, varying in different types of this heterogeneous disease. MATERIALS AND METHODS: Authors present a review of this issue based on their extensive experience. The aim is to summarize the crucial factors in the management of diagnostics and a surgical treatment of the unicentric form of Castleman ́s disease. One of the key issues in the unicentric form is precise preoperative diagnostics and thus choosing the right surgical treatment strategy. Authors highlight pitfalls of the diagnosis and surgical treatment. RESULTS: All histological types such as a hyaline vascular type, plasmacytic type and a mixed type are presented as well as options of surgical and conservative treatment. Differential diagnosis and malignant potential is discussed. CONCLUSION: Patients with Castleman ́s disease should be treated in the high- volume centers, with a great experience in major surgical procedures as well as with preoperative imaging diagnostic techniques. Specialized pathologists and oncologists focusing on this issue are also absolutely necessary to avoid misdiagnosis. Only this complex approach can lead to excellent outcomes in patients with UCD.
- Publikační typ
- systematický přehled MeSH
- MeSH
- lidé MeSH
- výkony cévní chirurgie * trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodní články MeSH
Výdutě v oblasti viscerálních tepen jsou spíše méně častou problematikou v praxi cévního chirurga. Jejich nedostupnost klinickému vyšetření, často asymptomatické chování, avšak s možností ruptury se závažnými důsledky pro život nemocného je činí komplexním diagnostickým i terapeutickým problémem. Autoři formou kazuistiky rupturované výdutě arteria hepatica communis shrnují základní charakteristiky těchto aneuryzmat, možnosti jejich diagnostiky a léčby.
Visceral artery aneurysms are rare findings in the practice of vascular surgeons. Their inaccessibility to physical examination, asymptomatic nature in many cases, but also an inherent risk of rupture that can be life threatening, make them a complex diagnostic and therapeutic problem. By presenting a case report of a ruptured common hepatic artery aneurysm the authors summarize basic characteristics of these aneurysms, as well as diagnostic and treatment options.
- MeSH
- arteria hepatica * chirurgie diagnostické zobrazování patologie MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- prasklé aneurysma * chirurgie diagnostické zobrazování MeSH
- senioři MeSH
- smrt MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
BACKGROUND: The etiopathogenesis of abdominal aortic aneurysm (AAA) is still unclarified, but vascular inflammation and matrix metalloproteases activation have a recognized role in AAA development and progression. Circulating lipoproteins are involved in tissue inflammation and repair, particularly through the regulation of intracellular cholesterol, whose excess is associated to cell damage and proinflammatory activation. We analyzed lipoprotein metabolism and function in AAA and in control vasculopathic patients, to highlight possible non-atherosclerosis-related, specific abnormalities. METHODS: We measured fluorometrically serum esterified/total cholesterol ratio, as an index of lecithin-cholesterol acyltransferase (LCAT) activity, and cholesteryl ester transfer protein (CETP) activity in patients referred to vascular surgery either for AAA (n=30) or stenotic aortic/peripheral atherosclerosis (n=21) having similar burden of cardiovascular risk factors and disease. We measured high-density lipoprotein (HDL)-cholesterol efflux capacity (CEC), through the ATP-binding cassette G1 (ABCG1) and A1 (ABCA1) pathways and serum cell cholesterol loading capacity (CLC), by radioisotopic and fluorimetric methods, respectively. RESULTS: We found higher LCAT (+23%; p < 0.0001) and CETP (+49%; p < 0.0001) activity in AAA sera. HDL ABCG1-CEC was lower (-16%; p < 0.001) and ABCA1-CEC was higher (+31.7%; p < 0.0001) in AAA. Stratification suggests that smoking may partly contribute to these modifications. CEC and CETP activity correlated with CLC only in AAA. CONCLUSIONS: We demonstrated that compared to patients with stenotic atherosclerosis, patients with AAA had altered HDL metabolism and functions involved in their anti-inflammatory and tissue repair activity, particularly through the ABCG1-related intracellular signaling. Clarifying the relevance of this mechanism for AAA evolution might help in developing new diagnostic parameters and therapeutic targets for the early management of this condition.
- MeSH
- adenosintrifosfát MeSH
- aneurysma břišní aorty * MeSH
- antiflogistika MeSH
- ateroskleróza * MeSH
- cholesterol metabolismus MeSH
- cholesterolacyltransferasa metabolismus MeSH
- HDL-cholesterol MeSH
- homeostáza MeSH
- lecitiny MeSH
- lidé MeSH
- lipoproteiny metabolismus MeSH
- metaloproteasy metabolismus MeSH
- transportní proteiny pro estery cholesterolu MeSH
- zánět metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Úvod: Infekce cévních rekonstrukcí je vzácná, ale závažná komplikace v cévní chirurgii, spojená s vysokou morbiditou a mortalitou. Včasná diagnostika infekce cévní rekonstrukce je důležitá pro správnou a včasnou chirurgickou a antibiotickou léčbu, která zlepšuje výsledek. Taktika a technika operačního řešení infekcí cévních rekonstrukcí se za poslední dvě dekády změnily a tento trend lze pozorovat i v naší retrospektivní studii. Metody: Retrospektivní analýzou jsme vyhodnotili skupinu nemocných s protetickými cévními rekonstrukcemi založenými na chirurgické klinice FN v Plzni v období 2003–2021. V analyzovaném 19letém období jsme z celkového souboru 2090 založených periferních bypassů řešili 23 infikovaných cévních rekonstrukcí a z celkového souboru 1940 centrálních rekonstrukcí na břišní aortě a v pánevním řečišti řešili 27 infikovaných rekonstrukcí. Výsledky: Incidence infekcí periferních cévních rekonstrukcí v období 2003–2021 na našem pracovišti dosáhla 1,1 % s časnou mortalitou 8,7 % a centrálních cévních rekonstrukcí za stejné časové období 1,4 % s časnou mortalitou 33 %. Závěr: Výsledky naší retrospektivní studie jsou srovnatelné se zkušenostmi jiných pracovišť prakticky ve všech parametrech. Shodně naše pracoviště přešlo na in situ náhrady explantovaných rekonstrukcí a potvrzujeme dobrou zkušenost se stříbrem impregnovanými protézami.
Introduction: Vascular graft infection is a rare but serious complication in vascular surgery, associated with high morbidity and mortality. Early diagnosis of vascular graft infection is important for proper and timely surgical and antibiotic treatment that improves the outcome. The tactic and techniques of surgical treatment of vascular graft infection have changed over the last two decades, and this trend can also be observed in our retrospective study. Methods: We evaluated a group of patients with prosthetic vascular reconstructions performed at the Department of Surgery, University Hospital in Pilsen in the period of 2003–2021 using retrospective analysis. In the analyzed 19-year period, 23 infected vascular grafts were managed out of a total of 2090 performed peripheral bypasses, and 27 infected vascular grafts were managed out of a total set of 1940 central reconstructions. Results: The incidence of peripheral vascular graft infections at our Department of Surgery in the period of 2003–2021 reached 1.1% with the early mortality rate of 8.7%; 1.4% central vascular graft infections occurred in the same time period with 33% early mortality. Conclusion: The results of our retrospective study are comparable virtually in all parameters with the experience of other departments. Consistently, our department switched to in situ replacements for explanted vascular grafts and we can confirm good experience with silver impregnated grafts.
BACKGROUND/AIM: Patients with unresectable liver colorectal cancer metastases are treated with neoadjuvant chemotherapy often accompanied by biological therapy aimed at reducing the mass of metastases and thus increasing the chances of resectability. Bevacizumab comprises an anti-VEGF (vascular endothelial growth factor) humanized IgG monoclonal antibody that is used for biological therapy purposes. It acts to inhibit angiogenesis, thereby slowing down the growth of metastases. Due to its being administered systematically, bevacizumab also exerts an effect on the surrounding healthy liver parenchyma and potentially limits the process of neovascularization and thus regeneration of the liver. Since the remnant liver volume forms an important factor in postoperative morbidity and mortality following a major hepatectomy, we decided to study the effect of bevacizumab on vascular and biliary microarchitecture in healthy liver parenchyma and its ability to regenerate following major hepatectomy. MATERIALS AND METHODS: We performed an experiment employing a large animal model where a total of 16 piglets were divided into two groups (8 piglets in the control group and 8 piglets in the experimental group with bevacizumab). All the animals were subjected to major hepatectomy and the experimental group was given bevacizumab prior to hepatectomy. All the animals were sacrificed after 4 weeks. We performed biochemical analyses at regular time intervals during the follow-up period. Histological examination of the liver tissue was performed following sacrifice of the animals. RESULTS: No statistical difference was shown between groups in terms of the biochemical and immunohistochemical parameters. The histological examination of the regenerating liver tissue revealed the higher length density of sinusoids in the experimental group. CONCLUSION: Bevacizumab does not act to impair liver regeneration following hepatectomy.
- MeSH
- bevacizumab farmakologie terapeutické užití MeSH
- hepatektomie MeSH
- humanizované monoklonální protilátky farmakologie terapeutické užití MeSH
- kolorektální nádory * farmakoterapie patologie chirurgie MeSH
- lidé MeSH
- modely nemocí na zvířatech MeSH
- nádory jater * farmakoterapie sekundární chirurgie MeSH
- patologická angiogeneze farmakoterapie MeSH
- prasata MeSH
- regenerace jater MeSH
- vaskulární endoteliální růstový faktor A MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. METHODS: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. RESULTS: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). CONCLUSIONS: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.
- Publikační typ
- časopisecké články MeSH
