Hodnotíme roční anatomické a funkční výsledky operace makulární díry standardní tříportovou 20G pars plana vitrektomií, s peelingem MLI (membrana limitans interna) a s instalací plynové expanzivní tamponády (20% SF6 – hexafluorosulfid, fluorid sírový). Sledovaný soubor tvořilo 32 očí 32 pacientů (3 muži a 29 žen), průměrného věku 69 let (rozmezí 59 až 76). Kromě idiopatické makulární díry (IMD) nebyla přítomna jiná nitrooční patologie. Jako metody objektivizace nitrooční anatomie jsme použili techniky: vyšetření předního segmentu štěrbinovou lampou, biomikroskopii při arteficiální mydriáze a optickou koherentní tomografii (Stratus OCT™, Carl Zeiss). Pro vyšetření funkce centrální oblasti sítnice jsme hodnotili: nejlépe korigovanou zrakovou ostrost do dálky (BCVA) na ETDRS optotypech, BCVA do blízka (Jaegerovy tabulky), multifokální elektroretinografii (MfERG) a reverzní elektroretinografii při šachovnicové stimulaci (PERG). Ke statistickému zpracování výsledků jsme použili neparametrický Wilcoxonův párový test. Výsledky anatomické: k primárnímu uzavření IMD došlo u 29 (90 %), IMD se neuzavřela, ale okraje neuroretiny byly oploštělé u 2 očí (6 %) a jedenkrát byla IMD neuzavřená s neoploštělými kraji (3 %). Výsledky funkční: vstupní BCVA testovaná na ETDRS tabulích se pohybovala v rozmezí 0,1 až 0,5 (1,0 až 0,3 logMAR). Po jednom roce od operace se zraková ostrost zlepšila o 2 a více řádků u 27 očí (84 %), o 3 a více řádků u 18 očí (56 %) a o 4 a více řádků u 5 očí (16 %). Amplitudy PERG (N95) všech očí se pohybovaly mezi 4–9 μV, byly v rozmezí normálních hodnot laboratoře; hodnoty amplitudy N95 12 měsíců po operaci se statisticky významně nelišily od hodnot předoperačních. Statisticky významný rozdíl (zlepšení) bylo v prvních dvou centrálních prstencích MfERG. Jednalo se o hodnoty amplitudy vlny P1 před operací a 12 měsíců poté (Wilcoxon p < 0,01). Rozdíl mezi hodnotami latencí N1 a P1 před operací a 12 měsíců poté nebyl statisticky významný, stejně jako změny mezi hodnotami amplitud vlny N1 před operací a 12 měsíců poté. Vzhledem k příznivým anatomickým a funkčním výsledkům považujeme operační řešení makulární díry cestou PPV s peelingem MLI za bezpečnou techniku. Při indikaci k provedení peelingu je ale třeba zvážit další faktory, zejména dobu trvání IMD, stadium onemocnění, typ nitrooční tamponády a spolupráci pacienta.
We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for idiopathic macular hole, with peeling MLI (membrana limitans interna) and instillation of gas tamponade (20% SF6 – sulfur hexafluoride) The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59–76). There was no other ocular pathology besides idiopathic macular holes (IMD). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT ™, Carl Zeiss). For examination of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, BCVA in the near (Jaeger charts), multifocal electroretinography (MfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. Anatomical results: the primary closure of the IMD occurred in 29 (90 %), the IMD was not closed, but it’s edges were flattened in 2 eyes (6 %), and once time the edges of the IMD were not flattened (3 %). Functional results: the initial BCVA ranged from 0.1 to 0.5 (1.0 to 0.3 LogMAR). After one year of operations the visual acuity improved by 2 or more lines in 27 eyes (84%), of 3 or more lines in 18 eyes (56%), and 4 or more lines in 5 eyes (16%). PERG amplitudes (N95) in all eyes were between 4 to 9 μV (within the normal range of the laboratory), and was not found statistically significant difference between the values before surgery and 12 months after. Statistically significant difference (improvement) was found in the first and the second central ring of the MfERG. Improvement involved the values of P1 wave amplitude before surgery and 12 months after (Wilcoxon p < 0.01). The difference between the values of N1 and P1 latencies before surgery and month 12 was not statistically significant, as well as changes between the values of the amplitudes of waves N1 preoperatively and 12 months later. Due to the favorable anatomical and functional results we consider surgical treatment of macular holes through PPV with peeling MLI as a safe technique. When the indication to perform peeling is considered, there is a need to think about other factors, especially duration IMD, disease stage, type of intraocular tamponade and the patient’s cooperation.
- Keywords
- MfERG, PERG, peeling, MLI,
- MeSH
- Diagnostic Techniques, Ophthalmological instrumentation utilization MeSH
- Electroretinography methods utilization MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Ophthalmologic Surgical Procedures methods utilization MeSH
- Tomography, Optical Coherence methods instrumentation utilization MeSH
- Retinal Perforations diagnosis surgery MeSH
- Statistics as Topic MeSH
- Vitrectomy methods utilization MeSH
- Outcome and Process Assessment, Health Care MeSH
- Visual Acuity MeSH
- Check Tag
- Humans MeSH
Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.
- MeSH
- Hemodynamics * MeSH
- Cardiovascular Diseases * physiopathology therapy MeSH
- Humans MeSH
- Monitoring, Physiologic * MeSH
- Critical Care methods MeSH
- Shock * physiopathology therapy MeSH
- Fluid Therapy * adverse effects methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Profilin 1 is a crucial actin regulator, interacting with monomeric actin and several actin-binding proteins controlling actin polymerization. Recently, it has become evident that this profilin isoform associates with microtubules via formins and interferes with microtubule elongation at the cell periphery. Recruitment of microtubule-associated profilin upon extensive actin polymerizations, for example, at the cell edge, enhances microtubule growth, indicating that profilin contributes to the coordination of actin and microtubule organization. Here, we provide further evidence for the profilin-microtubule connection by demonstrating that it also functions in centrosomes where it impacts on microtubule nucleation.
- MeSH
- Actins metabolism MeSH
- Caco-2 Cells MeSH
- Centrosome metabolism MeSH
- Formins metabolism MeSH
- Gene Knockout Techniques MeSH
- Humans MeSH
- Melanoma, Experimental metabolism pathology MeSH
- Microfilament Proteins metabolism MeSH
- Microtubules metabolism MeSH
- Mice MeSH
- Skin Neoplasms metabolism pathology MeSH
- Polymerization MeSH
- Profilins genetics metabolism MeSH
- Signal Transduction genetics MeSH
- Transfection MeSH
- Tubulin metabolism MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Mice MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
PURPOSE OF THE STUDY The study aimed to find out whether the higher rate of complications described in literature in the case of plate and intramedullary osteosynthesis of clavicle fractures is high enough to discredit one of these methods. MATERIAL AND METHODS In the period from July 2007 to March 2016, a total of 151 osteosyntheses of diaphyseal clavicle fractures were performed in 149 patients (106 men, 43 women). The plate as well as intramedullary techniques were used in this group of patients. The follow-up of 12 months was completed in 125 patients (91 men, 34 women). The age of patients ranged from 15 to 74 years. The postoperative rehabilitation with no load applied started immediately by elevating the arm up to 90 ° abduction for 3 weeks, which was followed by full range of motion exercises. The load was set based on the radiological finding. The number of complications, including the failure of osteosynthesis, was assessed. RESULTS Some kind of a whole range of complications (postoperative discomfort, infection, failure of osteosynthesis, non-union) occurred in 37 patients (29.6%), with osteosynthesis failing in six of them (4.8%), always within 6 months after the surgery. No later failure was reported. A statistically significant difference was observed only when comparing the patients discomfort for individual surgical techniques, with poorer results in case of intramedullary osteosynthesis. (p<0.001). DISCUSSION The dominance of "discomfort" in intramedullary fixation was caused by soft tissue irritation by the edge of material projecting thereto. Once it was removed, the results of both the methods in terms of the number of complications were comparable. In all the cases, either an incorrect indication of respective osteosynthesis techniques, or a technically poor surgical performance were identified as the likely causes of failure of the osteosynthesis. CONCLUSIONS The osteosynthesis always failed due to a wrong indication or technical errors in the execution of osteosynthesis. The intramedullary osteosynthesis is indicated in simple two-part fractures. The plate osteosynthesis can be applied to multiple fragment fractures. In preoperative planning, a suitable method shall be opted for based on the type of the fracture and the basic principles shall be adhered to during the surgery. Key words:clavicle fractures, surgical treatment, plate osteosynthesis, intramedullary osteosynthesis, osteosynthesis failure, non-union.
- MeSH
- Adult MeSH
- Fractures, Bone surgery MeSH
- Fracture Healing MeSH
- Fracture Fixation, Intramedullary adverse effects methods MeSH
- Clavicle * injuries surgery MeSH
- Bone Plates * MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Recovery of Function MeSH
- Postoperative Complications * classification diagnosis etiology surgery MeSH
- Reoperation * methods statistics & numerical data MeSH
- Retrospective Studies MeSH
- Range of Motion, Articular MeSH
- Aged MeSH
- Fracture Fixation, Internal * adverse effects instrumentation methods MeSH
- Patient Selection MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND AND OBJECTIVE: The prevalence of pelvic floor muscle injuries induced by childbirth is higher than 23 % in the general women population. Such injuries can lead to prolapses and other pathologies in future female life. Leveraging computational biomechanics, the study implements an advanced female pelvic floor model for computing the maximum pelvic muscle strain, which serves as an injury risk indicator. The design of experiment method, abbreviated as DoE, is used to compute the maximum strain for boundary values of bony pelvis dimensions, namely the anterior-posterior diameter (abbreviated as APD) and the transverse diameter (abbreviated as TD). This is done in combination with small, medium and large percentiles of fetal head circumference (abbreviated as HC). METHODS: We utilized a previously developed finite element model of a female pelvic floor, as a reference, and enhanced it with new features, including a more detailed tissue geometry and advanced constitutive material models. The APD and TD dimensions were sourced from the set of MRI of 64 nulliparous women. This data was used to estimate the boundary dimensions of the female bony pelvis, combining both small and large values of APD and TD. Together with the 10th and the 95th percentiles for HC, a three-dimensional domain was constructed to assess the maximum pelvic muscle strain. In boundary cases, the maximum pelvic muscle strain was computed across 8 full-factorial design models (each situated at one corner of the domain, thereby combining the minimum and the maximum values of APD, TD and HC). This was done to define a response surface that predicts the maximum pelvic muscle strain within the domain. The accuracy of this response surface prediction was validated using 15 additional intermediate design models. These models were placed at the center of the domain (1 point), the centres of the domain boundary surfaces (6 points), and midway along each domain boundary edge (8 points). RESULTS: The maximum strain results for 8 combinations of APD, TD, and HC were employed to construct a linear response surface as a function of APD, TD, and HC. Tests at an additional 19 domain points served to evaluate the efficiency of the response surface prediction. The response surface demonstrated strong predictability, with an absolute average error of 1.52 %, an absolute median error of 1.52 %, and an absolute maximum error of 11.11 %. HC emerged as the most influencing dimension, accounting for 16 % of influence. CONCLUSIONS: The reference finite element pelvic floor model was scaled to 8 full-factorial female-specific pelvic floor models, which represent the combination of boundary values for APD, TD, and HC. The maximum pelvic floor muscle strain from these 8 models was used to design a response surface. When implementing the DoE approach to construct the response, there was consistent predictability for the maximum perineal muscle strain, as validated by the additional 19 intermediate design models. As a result, the response surface methodology can serve as an initial predictor for potential childbirth-induced pelvic floor muscle injury.
Mitrální regurgitace (MR) je druhou nejčastější chlopenní vadou a její výskyt pozitivně koreluje s následným rozvojem srdečního selhání a úmrtí. Mitrální svorka (MitraClip) je nový katetrizační výkon v léčbě mitrální regurgitace, jehož princip spočívá v mechanickém přiblížení obou okrajů cípů mitrální chlopně analogicky chirurgické technice (Alfieriho steh). K implantaci svorky MitraClip mohou být indikováni nemocní s významnou degenerativní nebo funkční mitrální regurgitací na základě symptomů (NYHA II-IV) a specifických anatomických kritérií zahrnující primárně centrální regurgitační jet v segmentech A2/P2, u funkční mitrální regurgitace dotyk cípů (tzv. koaptace) v délce ≥ 2 mm a hloubku koaptace ≤ 11 mm, u degenerativní mitrální regurgitace tzv. flail gap < 10 mm a flail width < 15 mm. Hlavní vylučovací kritéria zahrnují ejekční frakci levé komory < 25 %, endsystolický rozměr levé komory > 55 mm, plochu mitrálního ústí < 4 cm2, recentní infarkt myokardu či endokarditidu. Výkon je považován za velmi bezpečný a akutní i střednědobé výsledky (do 2 let) jsou příznivé. Cílovou populaci pro implantaci svorky MitraClip dnes tvoří starší nemocní s vysokým rizikem kardiochirurgického výkonu nebo nemocní s funkční mitrální regurgitací a dysfunkcí levé srdeční komory. Vzhledem k tomu, že u funkční mitrální regurgitace je primární problém v dysfunkci levé komory, je dlouhodobý efekt předmětem sledování.
Mitral regurgitation (MR) is the second most commonly encountered valvular lesion and it has been positively correlated with the subsequent development of heart failure and death. MitraClip therapy is a new percutaneous approach for treating mitral regurgitation which involves mechanical edge-to-edge coaptation of the mitral leaflets that is analogous to the surgical Alfieri technique. Indication for MitraClip in patients with severe degenerative or functional mitral regurgitation is based on clinical symptoms (NYHA II-IV) and specific anatomic criteria including a primary central regurgitant jet associated with the A2/P2 segments, in functional MR a coaptation length ≥ 2 mm, a coaptation depth ≤ 11 mm, in degenerative MR a flail gap <10 mm, and a flail width < 15 mm. Key exclusion criteria included LVEF ≤ 25%, LV end-systolic dimension > 55 mm, mitral valve orifice area < 4 cm2, recent myocardial infarction or endocarditis. The safety profile of the procedure appears to be excellent. Acute outcomes are favourable, and mid-term durability (up to 2years) is reasonable. Patients who are older, at higher risk for surgical therapy, or with functional mitral regurgitation (FMR) and depressed ejection fractions will constitute the initial target population for MitraClip therapy. Since FMR is primarily a ventricular problem, it remains to be seen whether a leaflet intervention will have durable efficacy.
- Keywords
- studie EVEREST,
- MeSH
- Heart Valve Prosthesis Implantation * contraindications methods utilization MeSH
- Humans MeSH
- Mitral Valve Insufficiency * surgery MeSH
- Prosthesis Design MeSH
- Randomized Controlled Trials as Topic MeSH
- Aged MeSH
- Practice Guidelines as Topic MeSH
- Cardiac Catheterization MeSH
- Patient Selection MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
BACKGROUND: Carbonic anhydrase IX (CA IX) is a tumor-associated, highly active, transmembrane carbonic anhydrase isoform regulated by hypoxia and implicated in pH control and adhesion-migration-invasion. CA IX ectodomain (ECD) is shed from the tumor cell surface to serum/plasma of patients, where it can signify cancer prognosis. We previously showed that the CA IX ECD release is mediated by disintegrin and metalloproteinase ADAM17. Here we investigated the CA IX ECD shedding in tumor cells undergoing apoptosis in response to cytotoxic drugs, including cycloheximide and doxorubicin. METHODS: Presence of cell surface CA IX was correlated to the extent of apoptosis by flow cytometry in cell lines with natural or ectopic CA IX expression. CA IX ECD level was assessed by ELISA using CA IX-specific monoclonal antibodies. Effect of recombinant CA IX ECD on the activation of molecular pathways was evaluated using the cell-based dual-luciferase reporter assay. RESULTS: We found a significantly lower occurrence of apoptosis in the CA IX-positive cell subpopulation than in the CA IX-negative one. We also demonstrated that the cell-surface CA IX level dropped during the death progress due to an increased ECD shedding, which required a functional ADAM17. Inhibitors of metalloproteinases reduced CA IX ECD shedding, but not apoptosis. The CA IX ECD release induced by cytotoxic drugs was connected to elevated expression of CA IX in the surviving fraction of cells. Moreover, an externally added recombinant CA IX ECD activated a pathway driven by the Nanog transcription factor implicated in epithelial-mesenchymal transition and stemness. CONCLUSIONS: These findings imply that the increased level of the circulating CA IX ECD might be useful as an indicator of an effective antitumor chemotherapy. Conversely, elevated CA IX ECD might generate unwanted effects through autocrine/paracrine signaling potentially contributing to resistance and tumor progression.
- MeSH
- Apoptosis drug effects genetics MeSH
- Cycloheximide administration & dosage MeSH
- Epithelial-Mesenchymal Transition genetics MeSH
- HeLa Cells MeSH
- Cell Hypoxia genetics MeSH
- Carbonic Anhydrase IX administration & dosage genetics metabolism MeSH
- Humans MeSH
- Antibodies, Monoclonal administration & dosage MeSH
- Neoplasms genetics pathology MeSH
- ADAM17 Protein genetics metabolism MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Huntington's disease (HD) is a debilitating neurodegenerative disorder characterized by severe motor deficits, cognitive decline and psychiatric disturbances. An early and significant morphological hallmark of HD is the activation of astrocytes triggered by mutant huntingtin, leading to the release of inflammatory mediators. Fingolimod (FTY), an FDA-approved sphingosine-1-phosphate (S1P) receptor agonist is used to treat multiple sclerosis (MS), a neuroinflammatory disease, and has shown therapeutic promise in other neurological conditions. Our study aimed to investigate the therapeutic potential of FTY for treating HD by utilizing a well-characterized mouse model of HD (zQ175dn) and wild-type littermates. The study design included a crossover, long-term oral treatment with 1 mg/kg to 2 mg/kg FTY from the age of 15-46 weeks (n = 128). Different motor behavior and physiological parameters were assessed throughout the study. The findings revealed that FTY rescued disease-related body weight loss in a sex-dependent manner, indicating its potential to regulate metabolic disturbances and to counteract neurodegenerative processes in HD. FTY intervention also rescued testicular atrophy, restored testis tissue structure in male mice suggesting a broader impact on peripheral tissues affected by huntingtin pathology. Histological analyses of the brain revealed delayed accumulation of activated astrocytes contributing to the preservation of the neural microenvironment by reducing neuroinflammation. The extent of FTY-related disease improvement was sex-dependent. Motor functions and body weight improved mostly in female mice with sustained estrogen levels, whereas males had to compensate for the ongoing, disease-related testis atrophy and the loss of androgen production. Our study underscores the beneficial therapeutic effects of FTY on HD involving endogenous steroid hormones and their important anabolic effects. It positions FTY as a promising candidate for therapeutic interventions targeting various aspects of HD pathology. Further studies are needed to fully evaluate its therapeutic potential in patients.
- MeSH
- Fingolimod Hydrochloride * therapeutic use pharmacology MeSH
- Huntington Disease * drug therapy metabolism MeSH
- Disease Models, Animal MeSH
- Sphingosine 1 Phosphate Receptor Modulators * pharmacology therapeutic use MeSH
- Mice, Inbred C57BL MeSH
- Mice MeSH
- Motor Activity drug effects MeSH
- Sphingosine-1-Phosphate Receptors agonists metabolism MeSH
- Testis drug effects pathology metabolism MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Mice MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Úvod: Sarkom vzniklý v měkkých tkáních po ozáření je vzácnou komplikací radiační léčby nádorů. Byl nejčastěji popsán po léčbě pro karcinom prsu, dále pro non-Hodgkinův lymfom a karcinom děložního čípku. Vzniká v širokém časovém rozmezí po ozáření. V léčbě je nejdůležitější radikální chirurgické odstranění sarkomu s okrajem resekátu bez nádorových buněk. V některých případech následují chemoterapie nebo ozáření. Medián přežití je 23 měsíců, kdy nejdelší přežití je u sarkomů radikálně odstraněných. Kazuistika: Prezentujeme případ pacientky s recidivujícím leiomyosarkomem hrudní stěny po ozáření pro karcinom pravého prsu. Pacientka byla v roce 2006 po záchovné operaci pravého prsu s exenterací axily ve věku 62 let. Po operaci byla nasazena hormonální terapie a následovalo adjuvantní ozáření pravého prsu a přilehlé axily. Ozáření proběhlo na lineárním urychlovači, celková dávka záření byla 50 Gy (2 Gy frakcionovaně 1krát denně, 5 dní v týdnu). 4 roky po operaci byl diagnostikován leiomyosarkom v pektorálním svalu v místě excize tumoru pravého prsu. V letech 2011−2013 bylo provedeno celkem 5 operací recidivujícího sarkomu – 2krát excize tumoru, mastektomie, resekce žebra a nakonec bloková resekce hrudní stěny. Adjuvantní onkologická léčba nebyla indikována. Pacientka, nyní 69letá, je stále v dobré fyzické i psychické kondici, bez generalizace onemocnění. Závěr: Sarkom hrudní stěny je poměrně vzácným následkem radioterapie karcinomu prsu. Základem léčby sarkomů je radikální chirurgické odstranění nádoru. Po operaci většinou následuje ozáření, které však u pacientky po záchovné operaci prsu pro karcinom s ozářením již není možné. Chemoterapie není u sarkomů příliš účinná. Proto je nutné, aby operace byla provedena zkušeným chirurgem dostatečně radikálně. Klíčová slova: karcinom prsu – radioterapie – sarkom po ozáření
Introduction: Sarcoma occurring in soft tissues after radiotherapy is a rare complication of radiation treatment of tumours. It was most often described after treatment for breast cancer as well as for non-Hodgkin lymphoma and cervical carcinoma. The time interval between the radiation therapy and the development of the sarcoma can be very wide. Treatment demands radical surgical resection of the sarcoma with the edge of the resected tissue without tumour cells. In some cases, this is followed by chemotherapy or radiotherapy. The median survival time is 23 months, the longest survival being associated with sarcomas removed in a radical way. Case report: We present the case of a female patient with recurring leiomyosarcoma of the chest wall after radiotherapy for cancer of the right breast. In 2006, this 62-year-old patient was operated on to keep her right breast with axilla exenteration. After the surgery, hormonal therapy was followed by adjuvant radiotherapy of the right breast and the adjacent axilla. We used a linear accelerator and the total amount of radiation was 50 Gy (2 Gy fractionally once a day, five days a week). Four years after the operation, leiomyosarcoma was diagnosed in the pectoral muscle at the site where the tumour of the right breast had been excised. Between 2011 and 2013, a total of five operations of reoccurring sarcoma were performed – two excisions of the tumour, a mastectomy, rib resection and, at last, block resection of the chest wall. Adjuvant oncological treatment was not indicated. The patient, now being 69 years old, is still in a good physical and mental condition without any generalization of the disease. Conclusion: Sarcoma of the chest wall is a relatively rare consequence of radiotherapy for breast cancer. Sarcoma treatment involves radical surgical resection of the tumour whenever possible. The surgery is mostly followed by radiotherapy which, however, is impossible in a patient after breast-preserving surgery for carcinoma with radiotherapy. Chemotherapy is not very effective in sarcomas. Therefore, the operation needs to be performed by an experienced surgeon in a sufficiently radical way. Key words: breast cancer – radiotherapy – sarcoma after radiotherapy
- Keywords
- radiačně indukovaný sarkom,
- MeSH
- Radiotherapy, Adjuvant adverse effects MeSH
- Surgical Procedures, Operative methods MeSH
- Radiation Dosage MeSH
- Leiomyosarcoma * diagnosis etiology chemically induced surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Mastectomy utilization MeSH
- Thoracic Neoplasms * diagnosis etiology chemically induced surgery MeSH
- Breast Neoplasms * diagnosis surgery radiography therapy MeSH
- Tomography, X-Ray Computed MeSH
- Positron-Emission Tomography MeSH
- Signs and Symptoms MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Východisko: Hypertrofie labia minora je kongenitální nebo získaný stav, kdy labia minora (nebo vzácněji pouze jedno labium) protrudují za okraj labia majora. Autoři prezentují chirurgickou techniku volumetrické redukce hypertrofických labia minora spojenou s lipofilingem labia majora. Metody: Mezi lety 2005 a 2014 podstoupilo 27 pacientek chirurgickou redukci labia minora popsanou Altierem a Rouzierem. Indikace chirurgické léčby byly různé: interference s pohlavním stykem, špatná hygiena, potíže při nošení těsných kalhot, potíže při sportovních aktivitách, jako je jízda na kole, estetické potíže. Chirurgická resekce byla spojena s injekcí tukového štěpu do labia majora za účelem ochrany a krytí labia minora. Průměrná doba sledování byla 1 rok. Výsledky: Labia majora, po zvýšení objemu a tuhosti, chrání a zakrývají labia minora, které jsou lehce hypertrofické nebo chirurgicky redukované. Všechny pacientky hlásily zlepšení pohodlí, estetického vzhledu při nošení těsného oblečení a zlepšení své sexuality. V jednom případě jsme zaznamenali „recidivu“ se zvětšením rozměrů labia minora do šířky, i když byly nadále menší, než byla situace před operací, ale byly větší než těsně po operaci. Závěry: Snížení hypertrofie labia minora konzervativními technikami umožňuje dosažení excelentních výsledků ve smyslu estetiky a funkce. Jednoduchý lipofiling labia majora umožňuje zachování a ochranu labia minora prostřednictvím volumetrického zvětšení labia majora.
Background: Labia minora hypertrophy is a congenital or acquired condition in which both labia minora (or more rarely only one) protrude beyond the edge of the labia majora. The authors present a surgical technique of volumetric reduction of hypertrophic labia minora, associated with lipofilling of the labia majora. Methods: Between 2005 and 2014, 27 patients underwent surgical reduction of labia minora, as described by Altier and Rouzier. The indications for surgical treatment varied and were as follows: interference with sexual intercourse; poor hygiene; difficulty wearing tight-fitting pants; difficulty while performing sporting activities such as cycling; aesthetic complaints. The surgical resection was associated with fat graft injection in labia majora in order to protect and cover the labia minora. The mean follow up was 1 year. Results: The labia majora, increased in volume and firmness, cover and protect the labia minora slightly hypertrophic or surgically reduced. All patients reported an improvement in comfort, aesthetic appearance, when wearing close-fitting clothes and an improvement in their sexuality. In one case we recorded a “recurrence”, with an increase of dimensions in width of labia minora, still lower than the preoperative situation but greater than the immediate postop. Conclusions: The reduction of labia minora hypertrophy with conservative techniques allows achieving excellent results in terms of aesthetics and functionality. The simple lipofilling of labia majora allows preserving and protecting the labia minora through a volumetric increase of the labia majora.
