- MeSH
- bariatrická chirurgie * škodlivé účinky MeSH
- diabetes mellitus 2. typu * komplikace chirurgie MeSH
- duodenum chirurgie MeSH
- kardiovaskulární nemoci * chirurgie MeSH
- lidé MeSH
- morbidní obezita * komplikace chirurgie MeSH
- obezita komplikace chirurgie MeSH
- rizikové faktory MeSH
- výsledek terapie MeSH
- žaludeční bypass * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Primary melanoma of the duodenum is an extremely rare, aggressive and life-threatening malignant neoplasm. Published data regarding the effectiveness of current treatment strategies is limited, and our knowledge relies mostly on sporadic case reports. The diagnosis of primary duodenal melanoma is challenging and is based on the patient's medical history and findings from physical examination and radiological and endoscopic imaging as well as proper and careful pathological examinations of the tumor. Despite the many advances in cancer treatment, the prognosis for patients with this type of melanoma remains extremely poor. Delayed diagnosis at advanced disease stage, the general aggressive behavior of this neoplasm, the technical difficulty in achieving complete surgical resection, along with the rich vascular and lymphatic drainage of the intestinal mucosa, all have a negative impact on patients' outcome. In the present review, we aimed to collect and summarize the currently available data in the literature regarding the pathogenesis, clinical features, diagnosis, management and long-term outcomes of this rare, malignant tumor, in order to expand knowledge of its biological behavior and investigate optimal therapeutic options for these patients. Additionally, we present our experience of a case involving a 73-year-old female with primary duodenal melanoma, who was successfully treated with complete surgical resection.
Radiofrequency ablation (RFA) is a routinely used, safe, and effective method for the tissue destruction. Often, in case of its application in malignant conditions, the extent of tissue destruction is insufficient due to the size of the target lesion, as well as due to the risk of heat-induced damage to the surrounding organs. Nevertheless, there are conditions requiring superficial precise-depth ablation with preservation of deeper layers. These are represented, for example, by mucosal resurfacing in case of Barrett's esophagus or treatment of recurrent mucosal bleeding in case of chronic radiation proctitis. Recently, new indications for intraluminal RFA use emerged, especially in the pancreatobiliary tract. In the case of intraductal use of RFA (e.g., biliary and pancreatic tract), there are currently available rigid and needle tip catheters. An expandable balloon-based RFA catheter suitable for use in such small-diameter tubular organs could be of benefit due to possible increase of contact between the probe and the target tissue; however, to prevent excessive tissue damage, a compatible generator suitable for low-impedance catheter/tissue is essential. This project aimed to develop a radiofrequency ablation generator and bipolar balloon-based catheter optimized for the application in the conditions of low-impedance tissue and (micro)endoluminal environment. Subsequent evaluation of biological effect in vivo was performed using duodenal mucosa in Wistar rat representing conditions of endoluminal radiofrequency ablation of low-impedance tissue. Experiments confirming the safety and feasibility of RFA with our prototype devices were conducted.
- Klíčová slova
- duplikatura duodena, syndrom velkého břicha,
- MeSH
- ascites diagnóza etiologie terapie MeSH
- biologické markery krev moč MeSH
- chirurgie trávicího traktu * metody využití MeSH
- diferenciální diagnóza MeSH
- duodenum abnormality chirurgie patologie MeSH
- gastroenterologie MeSH
- histologické techniky využití MeSH
- kojenec MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody využití MeSH
- prognóza MeSH
- ultrasonografie metody využití MeSH
- vrozené, dědičné a novorozenecké nemoci a abnormality * diagnóza etiologie terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. METHODS: Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. RESULTS: There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). CONCLUSIONS: In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.
- MeSH
- biologické markery analýza MeSH
- diabetes mellitus 2. typu komplikace chirurgie MeSH
- dospělí MeSH
- duodenum chirurgie MeSH
- glykovaný hemoglobin analýza MeSH
- hmotnostní úbytek MeSH
- jejunum chirurgie MeSH
- krevní glukóza analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolický syndrom etiologie prevence a kontrola MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- následné studie MeSH
- prognóza MeSH
- senioři MeSH
- žaludeční bypass metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Anastomotic leakage is a severe complication in gastrointestinal surgery. It is often a reason for reoperation together with intestinal passage blockage due to formation of peritoneal adhesions. Different materials as local prevention of these complications have been studied, none of which are nowadays routinely used in clinical practice. Nanofabrics created proved to promote healing with their structure similar to extracellular matrix. We decided to study their impact on anastomotic healing and formation of peritoneal adhesions. We performed an experiment on 24 piglets. We constructed 3 hand sutured end-to-end anastomoses on the small intestine of each pig. We covered the anastomoses with a sheet of polycaprolactone nanomaterial in the first experimental group, with a sheet of copolymer of polylactic acid with polycaprolactone in the second one and no fortifying material was used in the Control group. The animals were sacrificed after 3 weeks of observation. Clinical, biochemical and macroscopic signs of anastomotic leakage or intestinal obstruction were monitored, the quality of the scar tissue was assessed histologically, and a newly developed scoring system was employed to evaluate the presence of adhesions. The material is easy to manipulate with. There was no mortality or major morbidity in our groups. No statistical difference was found inbetween the groups in the matter of level of peritoneal adhesions or the quality of the anastomoses. We created a new adhesion scoring system. The material appears to be safe however needs to be studied further to prove its' positive effects.
- MeSH
- adheze tkání etiologie prevence a kontrola MeSH
- anastomóza chirurgická MeSH
- duodenum chirurgie MeSH
- hojení ran MeSH
- mikroskopie elektronová rastrovací MeSH
- modely nemocí na zvířatech MeSH
- náhodné rozdělení MeSH
- nanovlákna terapeutické užití ultrastruktura MeSH
- nemoci peritonea etiologie prevence a kontrola MeSH
- netěsnost anastomózy prevence a kontrola MeSH
- polyestery MeSH
- prasata MeSH
- testování materiálů MeSH
- tkáňové podpůrné struktury * MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
AIM OF STUDY: Duodenum-preserving resection of the pancreatic head (DPRPH) with Roux-en-Y pancreatojejunostomy is a procedure used to remove focal pathological lesions of the pancreatic head. Although predominantly used in adult patients, it is both safe and effective in children. The aim of this study was to review our experience with this procedure, with focus on its indications, complications and long-term outcomes. METHODS: A retrospective analysis of pediatric patients who underwent DPRPH between 1994 and 2015 was performed. Patient files were reviewed for demographic, diagnostic, operative and histological details, postoperative complications. Patients were contacted telephonically and sent questionnaires to determine long-term outcomes. RESULTS: The study cohort consists of 21 patients, 14 girls and 7 boys, with an average age of 11.72 years (range 3 months to 18.6 years), who underwent DPRPH with end-to-end anastomosis of the jejunum to the pancreatic body (Roux-en-Y anastomosis). In four cases the head and also part of the body of the pancreas was resected. In the remaining 17 cases, only the head of the pancreas was resected. Indications for DPRPH were solid pseudopapillary tumor of the pancreas (n = 10), trauma (n = 8), pancreas divisum (n = 1), focal congenital hyperinsulinism (n = 1) and pancreatic cyst (n = 1). The length of follow-up ranged from 1 to 22 years (average 9.66). One patient developed a biliary fistula, which closed spontaneously within 2 weeks after stent insertion. A recurrence of abdominal pain was reported in two patients, occurring at 7 months after the operation in one patient and at 1 year in the other. Pancreatic endocrine insufficiency did not occur in any of the 21 patients. Seven patients currently require a low fat diet, five of which need pancreatic enzyme supplementation. An additional two patients need enzyme supplementation without dietary restriction. CONCLUSION: DPRPH is a safe and effective procedure for the treatment of large focal pathological lesions of the pancreatic head in children. As a less invasive procedure than pancreatoduodenectomy, it is more appropriate for the developing child.
- MeSH
- časové faktory MeSH
- dítě MeSH
- duodenum chirurgie MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- nádory slinivky břišní chirurgie MeSH
- následné studie MeSH
- pankreas chirurgie MeSH
- pankreatektomie metody MeSH
- pankreatikojejunostomie metody MeSH
- pooperační komplikace prevence a kontrola MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- Rouxova Y-anastomóza metody MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Východiska: Ampulární adenokarcinom patří mezi vzácnější nádorová onemocnění trávicího traktu. U premaligních lézí převládá terapie endoskopická. Dle některých autorů i časné karcinomy (ohraničené na sliznici) je možné řešit endoskopicky. U maligních lézí postihujících hlubší vrstvu (submukózou počínaje) má zásadní význam léčba chirurgická. Cílem článku je podat současný pohled na možnosti chirurgické léčby nádorů Vaterské papily s prezentací vlastního souboru pacientů. Materiál a metody: V období let 2012–2016 podstoupilo celkem 17 pacientů resekční výkon pro nádor Vaterské papily. Pacienti absolvovali standardní stagingové vyšetření, byli předvedeni před multioborovou komisí a poté byli indikováni k chirurgickému resekčnímu výkonu. Mezi hlavní sledované parametry patřil typ operačního výkonu, 30denní morbidita a mortalita, histopatologický výsledek a následná onkologická léčba. K histologickému vyhodnocení resekátu po pankreatoduodenektomii (PD) byl užit Leedský protokol. Výsledky: U 9 pacientů byla provedena PD a v 8 případech transduodenální chirurgická ampulektomie (transduodenal surgical ampullectomy – TSA). TSA převažovala u polymorbidních pacientů. Ze všech histologických preparátů (n = 17) byl u 4 pacientů zjištěn adenom s high-grade dysplazií, diagnóza adenokarcinomu byla stanovena ve 13 případech. Adjuvantní onkologickou léčbu následně podstoupilo 8 pacientů, z toho 2 pacienti adjuvantní chemoterapii a 6 pacientů kombinaci chemoradioterapie. Závěr: Premaligní léze Vaterské papily lze převážně řešit endoskopicky. Pokud není možné technické provedení endoskopického výkonu, je indikována léčba chirurgická. Při průkazu adenokarcinomu je preferována PD. U rizikových a polymorbidních pacientů, kde není podezření na postižení spádových uzlin, připadá v úvahu i provedení TSA. Endoskopická ultrasonografie je metoda volby při stanovení stagingu nádorového onemocnění Vaterské papily a má významnou roli při volbě mezi provedením endoskopické, lokální chirurgické excize (TSA) nebo radikální resekce (PD). Výsledky našeho souboru pacientů prokazují oprávněnost provedení TSA především u starších a polymorbidních pacientů, kde v histologickém zpracování resekátu u těchto výkonů převažovaly časné T stadia s příznivějším gradingem tumoru.
Background: Adenocarcinomas of ampulla of the Vater are relatively uncommon tumors of the gastrointestinal tract. In premalignant lesions endoscopic treatment predominate. According to some authors even early adenocarcinomas (limited to mucosa) can be solved endoscopically. In malignant lesions affecting deeper layers (including submucosa) surgical therapy is the most important. The article summarises the current view for a surgical treatment of ampullary adenocarcinomas and presents results concerning our group of patients. Materials and Methods: In 2012–2016 a total number of 17 patients underwent resection for a tumor of ampulla of the Vater. Patients underwent standard staging, were presented before a multidisciplinary committee and referred to a surgical treatment. The main measured parameters were the type of surgical procedure, 30-day morbidity and mortality, histopathologic result and subsequent oncologic treatment. The Leeds Pathology Protocol was used to evaluate the specimens after pancreaticoduodenectomy (PD). Results: PD (n = 9) was a more often performed procedure than the transduodenal surgical ampullectomy (TSA) (n = 8). TSA predominated in polymorbid patients. Histological results (n = 17) established adenoma with high-grade dysplasia in 4 patients, the diagnosis of adenocarcinoma was set in 13 patients. Eight patients underwent adjuvant oncologic therapy (2 had adjuvant chemotherapy, 6 had combination of chemoradiotherapy). Conclusion: Premalignant neoplasias of ampulla of the Vater can be mostly solved by endoscopy. If endoscopic resection is not possible surgical therapy is indicated. PD is preferred procedure in the diagnosis of adenocarcinoma. In high-risk and polymorbid patients, with no suspicion for a metastatic lymph nodes, TSA can be considered. Endoscopic ultrasonography is the imaging modality of choice for local staging of ampulla of the Vater and has important role in deciding between endoscopic, local surgical excision (TSA) or radical resection (PD). Our results confirmed rightfulness to perform TSA especially in elderly or polymorbid patients, where in histopathologic specimens evaluation in TSA procedures early T stage and more favorable grading predominated.
- MeSH
- adenokarcinom MeSH
- ampulla Vateri * diagnostické zobrazování chirurgie patologie MeSH
- duodenum anatomie a histologie chirurgie patologie MeSH
- endoskopie trávicího systému MeSH
- lidé MeSH
- nádory duodena * diagnóza chirurgie terapie MeSH
- pankreatoduodenektomie MeSH
- prognóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
