INTRODUCTION: A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT: The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION: In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nefrektomie * metody MeSH
- odběr tkání a orgánů metody MeSH
- roboticky asistované výkony * metody MeSH
- transplantace ledvin * metody MeSH
- žijící dárci * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Partial nephrectomy (PN) has become the dominant treatment modality for cT1 renal tumor lesions. Tumors suspected of malignant potential are indicated for surgery, but some are histologically classified as benign lesions after surgery. This study aims to analyze the number of benign findings after PN according to definitive histology and to evaluate whether there is an association between malignant tumor findings and individual factors. METHODS: The retrospective study included 555 patients who underwent open or robotic-assisted PN for a tumor in our clinic from January 2013 to December 2020. The cohort was divided into groups according to definitive tumor histology (malignant tumors vs. benign lesions). The association of factors (age, sex, tumor size, R.E.N.A.L.) with the malignant potential of the tumor was further evaluated. RESULTS: In total, 462 tumors were malignant (83%) and 93 benign (17%). Of the malignant tumors, 66% were clear-cell RCC (renal cell carcinoma), 12% papillary RCC, and 6% chromophobe RCC. The most common benign tumor was oncocytoma in 10% of patients, angiomyolipoma in 2%, and papillary adenoma in 1%. In univariate analysis, there was a higher risk of malignant tumor in males (OR 2.13, 95% CI 1.36-3.36, p = 0.001), a higher risk of malignancy in tumors larger than 20 mm (OR 2.32, 95% CI 1.43-3.74, p < 0.001), and a higher risk of malignancy in tumors evaluated by R.E.N.A.L. as tumors of intermediate or high complexity (OR 2.8, 95% CI 1.76-4.47, p < 0.001). In contrast, there was no association between older age and the risk of malignant renal tumor (p = 0.878). CONCLUSIONS: In this group, 17% of tumors had benign histology. Male sex, tumor size greater than 20 mm, and intermediate or high R.E.N.A.L. complexity were statistically significant predictors of malignant tumor findings.
- MeSH
- angiomyolipom patologie chirurgie MeSH
- dospělí MeSH
- karcinom z renálních buněk chirurgie patologie epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory ledvin * chirurgie patologie MeSH
- nefrektomie * metody MeSH
- oxyfilní adenom patologie chirurgie MeSH
- předoperační období MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Thank you very much for your comment [...].
- MeSH
- beta-alanin * aplikace a dávkování MeSH
- karnosin * MeSH
- lidé MeSH
- potravní doplňky * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Vysokoprůtokový priapismus, taktéž v literatuře nazývaný jako neischemický nebo arteriální, tvoří pouze cca 5 % všech případů priapismu. Jeho nejčastější příčinou je tupé perineální nebo penilní trauma. Výsledkem poranění je lacerace kavernózní tepny nebo jejích větví, což vede ke vzniku píštěle mezi tepnou a lakunárními prostory kavernózních těles. Výsledný zvýšený průtok krve má za následek přetrvávající erekci. Tento typ priapismu je možné léčit i konzervativně, přičemž optimální časový interval zahájení aktivní intervenční léčby je stále předmětem diskuzí.
High-flow priapism, also referred as non-ischemic or arterial priapism, accounts for only about 5% of all priapism cases. Its most common cause is a blunt perineal or penile trauma. The trauma results in laceration of cavernous artery or its branches, leading to the formation of a fistula between artery and lacunar spaces of cavernosal bodies. Increased blood flow results in persistent erection. This type of priapism can also be treated conservatively, but optimal time interval for initiating active interventional treatment remains a subject of discussions.
- MeSH
- angiografie MeSH
- antibakteriální látky terapeutické užití MeSH
- cyklistika zranění MeSH
- dospělí MeSH
- erektilní dysfunkce * diagnostické zobrazování etiologie patologie terapie MeSH
- lidé MeSH
- priapismus * diagnostické zobrazování etiologie patologie terapie MeSH
- sportovní úrazy patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Intraoperative floppy iris syndrome (IFIS) is a cataract surgery complication that remains a challenge for eye surgeons. It is caused by the antagonism of alfa-1-adrenergic receptors within the dilator muscle of the iris, thus preventing the iris from dilation during a cataract surgery. The long-term blocking alfa-1 adrenergic receptors by the chronic use of a number of systemic medications may lead to permanent anatomical atrophy of the dilator muscle of the iris. The most common drugs associated with the development of IFIS are tamsulosin and other alpha-1 adrenergic receptor antagonists prescribed to patients with low urinary tract symptoms (LUTS). There are other systemic medications that have been reported to have increased risk for IFIS. It is crucial for the ophthalmologist to identify the high-risk patients prone to develop IFIS. Its presence may complicate the course of cataract surgery, ultimately negatively affecting visual outcome. Cataract surgery should be performed by an experienced eye surgeon using alternative pharmacological and surgical techniques. Interdisciplinary cooperation is essential to mitigate potential complications. Patients should be informed by their physicians about the need to report a medication history to their eye specialists, especially before cataract surgery.
- MeSH
- adrenergní receptory MeSH
- alfa blokátory škodlivé účinky MeSH
- fakoemulzifikace * MeSH
- iris MeSH
- katarakta * chemicky indukované MeSH
- lidé MeSH
- nemoci duhovky * chemicky indukované diagnóza MeSH
- peroperační komplikace chemicky indukované MeSH
- sulfonamidy škodlivé účinky MeSH
- syndrom MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The dipeptide carnosine is a physiologically important molecule in the human body, commonly found in skeletal muscle and brain tissue. Beta-alanine is a limiting precursor of carnosine and is among the most used sports supplements for improving athletic performance. However, carnosine, its metabolite N-acetylcarnosine, and the synthetic derivative zinc-L-carnosine have recently been gaining popularity as supplements in human medicine. These molecules have a wide range of effects-principally with anti-inflammatory, antioxidant, antiglycation, anticarbonylation, calcium-regulatory, immunomodulatory and chelating properties. This review discusses results from recent studies focusing on the impact of this supplementation in several areas of human medicine. We queried PubMed, Web of Science, the National Library of Medicine and the Cochrane Library, employing a search strategy using database-specific keywords. Evidence showed that the supplementation had a beneficial impact in the prevention of sarcopenia, the preservation of cognitive abilities and the improvement of neurodegenerative disorders. Furthermore, the improvement of diabetes mellitus parameters and symptoms of oral mucositis was seen, as well as the regression of esophagitis and taste disorders after chemotherapy, the protection of the gastrointestinal mucosa and the support of Helicobacter pylori eradication treatment. However, in the areas of senile cataracts, cardiovascular disease, schizophrenia and autistic disorders, the results are inconclusive.
Chronická pankreatitida (ChP) je vážným onemocněním, které výrazně ovlivňuje kvalitu života a může mít závažné dlouhodobé následky, jako jsou karcinom pankreatu nebo sekundární diabetes mellitus. Asociovaná exokrinní insuficience pankreatu vede k malnutrici s váhovým úbytkem, nicméně hlavním příznakem pacientů s ChP jsou abdominalgie, které jsou často velmi silné. Pokud v léčbě bolesti není úspěšná primární farmakologická terapie (substituce pankreatických enzymů, analgetika), může být CP řešena endoskopicky, pomocí litotrypse extrakorporální rázovou vlnou (ESWL – extracorporeal shockwave lithotripsy), jejich kombinací či chirurgicky. Zde prezentujeme případ pacienta s algickou obstruktivní ChP, u kterého jsme stav úspěšně řešili kombinací litotrypse extrakorporální rázovou vlnou a endoskopie.
Chronic pancreatitis (CP) is a serious condition with a great impact on the quality of life, and it can lead to some serious long-term consequences such as pancreatic cancer or secondary diabetes mellitus. Associated pancreatic exocrine insufficiency leads to malnutrition with weight loss; however, the main symptom of the disease is abdominal pain, often very severe. The primary treatment option for painful CP is pharmacotherapy (pancreatic enzyme replacement therapy, analgesics). If this is not effective, CP can be treated via endoscopy, extracorporeal shockwave lithotripsy (ESWL), their combination, or surgery. We present a case of painful chronic obstructive pancreatitis in a patient successfully treated with ESWL in combination with endoscopy.
- MeSH
- alkoholická pankreatitida MeSH
- cholangiopankreatografie endoskopická retrográdní MeSH
- chronická pankreatitida * terapie MeSH
- diagnostické zobrazování MeSH
- diklofenak terapeutické užití MeSH
- lidé MeSH
- litiáza * chirurgie MeSH
- litotripse * přístrojové vybavení škodlivé účinky MeSH
- pirinitramid terapeutické užití MeSH
- senioři MeSH
- výsledek terapie MeSH
- vývody pankreatu chirurgie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
Celosvětově dochází ke stárnutí populace. Zdravotní péče by se měla na tuto situaci připravit a hledat možnosti, jak vylepšit, prodloužit a zkvalitnit život stárnoucí populace. Stárnutí je spojeno se změnami fyziologických funkcí, jako jsou například změny v aktivitě kosterního svalstva, úbytek svalové hmoty a snížení silové aktivity, změny v kostní tkáni či pokles senzorických a kognitivních funkcí. Deteriorace lidského organismu ve stáří může být spojena právě se sníženými tkáňovými koncentracemi karnosinu, kdy dochází k snížení ochrany membrán buněk před oxidačním poškozením. Zdá se, že konzumací potravin bohatých na karnosin nebo obohacením diety β-alaninem by bylo možné tyto degenerativní procesy zpomalit. Aminokyselina β-alanin je jedním z celosvětově nejpoužívanějších sportovních doplňků, které zlepšují výkon při cvičení, protože je prekurzorem karnosinu, který důležitý pro činnost příčně pruhovaného svalstva. Tato práce má za cíl informovat o suplementaci β-alaninem, prekurzorem karnosinu, která představuje jednu z mála prokázaných dietních intervencí, které by mohly pomoci nejen v boji proti stárnutí a úbytku svalové hmoty, ale i v prevenci dalších onemocnění – senilní katarakty, neurodegenerativních onemocnění a onemocnění periferních tepen a žil.
Globally, the population is ageing. Healthcare should prepare for this situation and look for ways to improve, prolong and improve the quality of life of the ageing population. Ageing is associated with changes in physiological functions, such as changes in skeletal muscle activity, loss of muscle mass and reduced strength, changes in bone tissue and a decline in sensory and cognitive functions. Deterioration of the human body in old age may be associated with reduced tissue concentrations of carnosine, whereby the protection of cell membranes from oxidative damage is reduced. It seems that by consuming foods rich in carnosine or by enriching the diet with β-alanine, these degenerative processes could be slowed down. The amino acid β-alanine is one of the world‘s most widely used sports supplements to improve exercise performance because it is a precursor of carnosine, which is important for striated muscle function. This paper aims to report on supplementation with β-alanine, a precursor of carnosine, which represents one of the few proven dietary interventions that could help not only in the fight against aging and muscle loss, but also in the prevention of other diseases such as senile cataracts, neurodegenerative diseases and peripheral artery and vein disease.
- MeSH
- beta-alanin * terapeutické užití MeSH
- karnosin * terapeutické užití MeSH
- katarakta prevence a kontrola MeSH
- kognice účinky léků MeSH
- lidé MeSH
- onemocnění periferních cév prevence a kontrola MeSH
- sarkopenie prevence a kontrola MeSH
- stárnutí účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
AIMS: With the introduction of magnetic resonance imaging in the diagnosis of prostate cancer and its use in targeted prostate biopsy, an increased incidence of anterior-predominant prostate cancer (APC) has been observed. METHODS: We enrolled 200 patients who underwent radical prostatectomy at our department between 12/2017 and 04/2019. We evaluated tumour location in the individual segments of the prostate, index tumour location and volume, and compared the postoperative stage, Gleason score, grade group (GG), and the presence of extraprostatic extension (EPE) in APC and posterior prostate cancer (PPC). We assessed the rate of MRI scans prior to prostate surgery as well as the influence of family history and PSA on the presence of APC. RESULTS: We found a significantly higher rate of anterior tumours than previously reported (37%) and confirmed that these tumours are diagnosed with a significantly larger index tumour volume (P=0.003). We also showed that a mere 6.76% of APCs were low-risk tumours not requiring radical treatment. Furthermore, anterior tumours were found significantly more often (P=0.001) in patients who underwent preoperative MRI. No differences were observed between PSA values, family history, presence of EPE, or locally advanced disease in APC vs. PPC. CONCLUSIONS: The frequency of anterior tumours is higher than previously thought, and they include tumours requiring radical treatment. When these tumours are neglected, it may lead to patient undertreatment with impact on their life prognosis. Thus, we consider the use of MRI-targeted prostate biopsy to be a necessity both for ruling out APC in the case of repeatedly negative prostate biopsies and, in particular, before patient inclusion in active surveillance.
