Robotická chirurgie je celosvětově rychle se rozvíjející operační technika, která přináší řadu výhod ve srovnání s dosud většinově užívanými operačními postupy (kratší doba hospitalizace, rychlejší rekonvalescence, menší bolestivost operačních ran, méně infekcí v ráně, nižší riziko kýly v jizvě a méně konverzí). Článek prezentuje kazuistiku pacienta s diagnostikovaným kolorektálním karcinomem v oblasti hepatální flexury a se solitární jaterní metastázou druhého segmentu (SII). Operační výkon byl proveden robotickým systémem DaVinci Xi v rozsahu pravostranné hemikolektomie s intrakorporální anastomózou side-to-side a robotické resekce druhého segmentu jater, bez nutnosti změny umístění (dokování) robotických nástrojů. Použití miniinvazivní robotické techniky a ERAS protokolu výrazně urychlilo pooperační rekonvalescenci a obnovu pasáže, snížilo potřebu analgetik a pacient byl propuštěn pátý poopeční den.
Robotic surgery is a rapidly emerging surgical technique worldwide, which has a number of advantages in comparison to the majority of surgical procedures used so far (shorter hospital stay, faster recovery, less pain at the surgical site, fewer surgical site infections, lower risk of incisional hernia and fewer conversions). We present a patient with colorectal cancer in the hepatic flexure and solitary hepatic metastasis (segment 2). Right-sided hemicolectomy with intracorporeal side-to-side anastomosis was performed with the DaVinci Xi robotic system, as well as robotic resection of the second hepatic segment, without the necessity of changing the location (docking) of the robotic instruments. Use of the minimally invasive robotic technique and ERAS protocol significantly accelerated postoperative recovery, including recovery of peristalsis, reduced the need for analgesics, and the patient was discharged on the 5th postoperative day.
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION: Glioblastoma (GBM) is the most common malignant primary brain tumor, and methods to improve the early detection of disease progression and evaluate treatment response are highly desirable. We therefore explored changes in whole-brain apparent diffusion coefficient (ADC) values with respect to survival (progression-free [PFS], overall [OS]) in a cohort of GBM patients followed at regular intervals until disease progression. METHODS: A total of 43 subjects met inclusion criteria and were analyzed retrospectively. Histogram data were extracted from standardized whole-brain ADC maps including skewness, kurtosis, entropy, median, mode, 15th percentile (p15) and 85th percentile (p85) values, and linear regression slopes (metrics versus time) were fitted. Regression slope directionality (positive/negative) was subjected to univariate Cox regression. The final model was determined by aLASSO on metrics above threshold. RESULTS: Skewness, kurtosis, median, p15 and p85 were all below threshold for both PFS and OS and were analyzed further. Median regression slope directionality best modeled PFS (p = 0.001; HR 3.3; 95% CI 1.6-6.7), while p85 was selected for OS (p = 0.002; HR 0.29; 95% CI 0.13-0.64). CONCLUSIONS: Our data show tantalizing potential in the use of whole-brain ADC measurements in the follow up of GBM patients, specifically serial median ADC values which correlated with PFS, and serial p85 values which correlated with OS. Whole-brain ADC measurements are fast and easy to perform, and free of ROI-placement bias.
- MeSH
- alkylační protinádorové látky terapeutické užití MeSH
- chemoradioterapie mortalita MeSH
- difuzní magnetická rezonance metody MeSH
- glioblastom mortalita patologie terapie MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- míra přežití MeSH
- nádory mozku mortalita patologie terapie MeSH
- následné studie MeSH
- počítačové zpracování obrazu metody MeSH
- prognóza MeSH
- progrese nemoci MeSH
- retrospektivní studie MeSH
- temozolomid terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Léčba mozkového glioblastomu, de novo i rekurentního, pomocí metody Tumor treating fields (Optune™) je schválenou metodou, která je založena na principu, že prochází-li buňkou střídavý elektrický proud určitých charakteristik, buňka ztrácí schopnost se dělit. Tento princip lze aplikovat i u jiných nádorů. Pilotní studie této metody proběhla v České republice a po 15 letech žije 20 % pacientů, kteří byli do studie zařazeni. Na základě dalších provedených mezinárodních studií byla tato léčba zařazena do kritérií léčby glioblastomu v kategorii 1 podle National Comprehensive Cancer Guidelines. Léčba probíhá neinvazivně a hlavním nežádoucím účinkem je podráždění kůže. Metoda je vhodná pro pacienty po ukončení standardní léčby a v dobrém klinickém stavu, bez výrazné progrese nádoru v době zahájení. Terapie je v některých zemích hrazena ze zdravotního pojištění, v České republice probíhají jednání se zdravotními pojišťovnami o její úhradě.
Tumor treating fields (Optune™) is an approved method to treat both de novo and recurrent glioblastoma. The method is based on the fact that an alternating electric current of given characteristics inhibits cell division. This principle can also be applied in other tumors. A pilot study of this method was performed in the Czech Republic and fifteen years later 20% of the patients are alive. Based on further international studies, this method was included in NCNN Category 1 criteria for glioblastoma treatment. The treatment is non-invasive, and the main side effect is local skin irritation. This technique is suitable for patients that have finished standard therapy and are in good clinical condition without significant tumor progression at the time of treatment initiation. In some countries the treatment is reimbursed by health insurance providers. Currently, there are intensive negotiations with health insurance companies about its reimbursement in the Czech Republic.
- Klíčová slova
- Optune,
- MeSH
- elektrostimulační terapie * metody MeSH
- glioblastom * terapie MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- nádory mozku terapie MeSH
- Check Tag
- lidé MeSH
Schwannom je benigní, pomalu rostoucí nádor, který vyrůstá ze Schwannových buněk, myelinové pochvy axonů periferních, hlavových a autonomních nervů. Prezentujeme případ 63leté pacientky s nodózní štítnou žlázou, která byla doporučena k ORL vyšetření pro objemnou rezistenci na pravé straně krku se známkami impresivního syndromu. Na základě klinického vyšetření a nálezu zobrazovacích metod (UZ, CT, MR) bylo indikováno operační odstranění tumoru a totální tyreoidektomie. Pooperační histologie prokázala schwannom, nejspíše z větve krčního plexu, a makro-normofolikulární koloidně nodózní strumu s ložisky chronické tyroiditidy.
Schwannoma is a benign, slowly growing tumour arising from Schwann cells, i.e. myelin sheath of axons of peripheral, cranial and autonomous nerves. We present the case report of a 63-year-old patient with a nodose thyroid gland who was referred to ENT testing for a large mass on the right side of her neck with signs and symptoms of impression syndrome. The surgical removal of tumour and total thyroidectomy was indicated based on clinical examination and imaging methods (ultrasonography, CT, MRI). Postoperative histology proved schwannoma, most probably originating from a branch of cervical plexus, and macro-normo-follicular colloid nodose goiter with foci of chronic thyroiditis.
- MeSH
- nádory mediastina diagnóza chirurgie patologie MeSH
- nádory nervového systému diagnóza chirurgie patologie MeSH
- nádory štítné žlázy * chirurgie patologie sekundární MeSH
- nemoci štítné žlázy MeSH
- neurilemom MeSH
- senioři MeSH
- štítná žláza chirurgie patologie MeSH
- uzlová struma chirurgie MeSH
- uzly štítné žlázy MeSH
- Check Tag
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare, aggressive brain neoplasm that accounts for roughly 2-6% of primary brain tumors. In contrast, glioblastoma (GBM) is the most frequent and severe glioma subtype, accounting for approximately 50% of diffuse gliomas. The aim of the present study was to evaluate morphological MRI characteristics in histologically-proven PCNSL and GBM at the time of their initial presentation. METHODS: We retrospectively evaluated standard diagnostic MRI examinations in 54 immunocompetent patients (26 female, 28 male; age 62.6 ± 11.5 years) with histologically-proven PCNSL and 54 GBM subjects (21 female, 33 male; age 59 ± 14 years). RESULTS: Several significant differences between both infiltrative brain tumors were found. PCNSL lesions enhanced homogenously in 64.8% of cases, while nonhomogeneous enhancement was observed in 98.1% of GBM cases. Necrosis was present in 88.9% of GBM lesions and only 5.6% of PCNSL lesions. PCNSL presented as multiple lesions in 51.9% cases and in 35.2% of GBM cases; however, diffuse infiltrative type of brain involvement was observed only in PCNSL (24.1%). Optic pathways were infiltrated more commonly in PCNSL than in GBM (42.6% vs. 5.6%, respectively, p <0.001). Other cranial nerves were affected in 5.6% of PCNSL, and in none of GBM. Signs of bleeding were rare in PCNSL (5.6%) and common in GBM (44.4%); p < 0.001. Both supratentorial and infratentorial localization was present only in PCNSL (27.7%). Involvement of the basal ganglia was more common in PCNSL (55.6%) than in GBM (18.5%); (p < 0.001). Cerebral cortex was affected significantly more often in GBM (83.3%) than in PCNSL (51.9%); mostly by both enhancing and non-enhancing infiltration. CONCLUSION: Routine morphological MRI is capable of differentiating between GBM and PCNSL lesions in many cases at time of initial presentation. A solitary infiltrative supratentorial lesion with nonhomogeneous enhancement and necrosis was typical for GBM. PCNSL presented with multiple lesions that enhanced homogenously or as diffuse infiltrative type of brain involvement, often with basal ganglia and optic pathways affection.
- MeSH
- diferenciální diagnóza MeSH
- glioblastom diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfom diagnostické zobrazování MeSH
- magnetická rezonanční tomografie * MeSH
- nádory centrálního nervového systému diagnostické zobrazování MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
PURPOSE: Multiple system atrophy (MSA) is a rare neurodegenerative disease that remains poorly understood, and the diagnosis of MSA continues to be challenging. We endeavored to improve the diagnostic process and understanding of in vivo characteristics of MSA by diffusion tensor imaging (DTI). MATERIALS AND METHODS: Twenty MSA subjects, ten parkinsonian dominant (MSA-P), ten cerebellar dominant (MSA-C), and 20 healthy volunteer subjects were recruited. Fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps were processed using tract-based spatial statistics. Diffusion data were additionally evaluated in the basal ganglia. A support vector machine was used to assess diagnostic utility, leave-one-out cross-validation in the evaluation of classification schemes, and receiver operating characteristic analyses to determine cutoff values. RESULTS: We detected widespread changes in the brain white matter of MSA subjects; however, no group-wise differences were found between MSA-C and MSA-P subgroups. Altered DTI metrics in the putamen and middle cerebellar peduncles were associated with a positive parkinsonian and cerebellar phenotype, respectively. Concerning clinical applicability, we achieved high classification performance on mean diffusivity data in the combined bilateral putamen and middle cerebellar peduncle (accuracy 90.3%±9%, sensitivity 86.5%±11%, and specificity 99.3%±4%). CONCLUSION: DTI in the middle cerebellar peduncle and putamen may be used in the diagnosis of MSA with a high degree of accuracy.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Radiosurgery by Gamma Knife (GK) is an effective treatment for brain arteriovenous malformations (AVM). The aim of the present study was to evaluate late, radiation-induced changes detectable by MRI after AVM radiosurgery in patients treated minimally 10 years prior, with AVM obliteration proven by angiography. METHODS: Thirty-five patients with 37 AVMs were included. AVMs were irradiated 16.6 ± 3.5 years prior with AVM obliteration proven 13 ± 4 years prior. All patients underwent recent MRI examinations, including application of gadolinium-based contrast. RESULTS: In one case, post-irradiative cystic formation with mass effect and signs of hemorrhage requiring surgery was found. Post-gadolinium enhancement at the site of obliterated nidi was apparent in 28 of 37 cases (76 %). In all cases except one, the mean volume of enhancement at the time of review was clearly lower than the volume of the originally irradiated AVM (88 ± 20 %; median 92 %); in one case the extent was 142 % greater than the irradiated AVM. When we compared enhancing and non-enhancing nidi, we found that enhancing nidi were significantly larger than non-enhancing nidi at the time of radiosurgery (4.39 ± 3.35 cc vs. 0.89 ± 0.79 cc, p = 0.004). Enhancement was not influenced by total radiation dose, patient age at the time of irradiation, duration since radiosurgery, or the number of irradiations. Wallerian degeneration was found in nine of 37 cases (24 %); in six cases the optical tracts were affected and visual field defects were proven. In five of nine cases (55.6 %) with Wallerian degeneration previous hemorrhage was present. Dual vascular pathology was found in eight of 35 patients (23 %). CONCLUSIONS: GK radiosurgery for AVM is a safe treatment method although delayed complications may occur. Post-gadolinium enhancement of obliterated nidi may indicate an active post-irradiative process.
- MeSH
- dospělí MeSH
- intrakraniální arteriovenózní malformace diagnostické zobrazování chirurgie MeSH
- krvácení při operaci MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- mladiství MeSH
- mozek diagnostické zobrazování MeSH
- mozková angiografie * MeSH
- pooperační komplikace diagnostické zobrazování MeSH
- radiochirurgie škodlivé účinky MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- amygdala * MeSH
- hipokampus * MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- narkolepsie * MeSH
- Check Tag
- lidé MeSH
