BACKGROUND/AIMS: To assess the biliary manometric perfusion test (BMPT) for evaluating success in treating benign biliary strictures. METHODOLOGY: During 2003 to 2010, 29 patients were subjected to BMPT after percutaneous balloon dilatation treatment. Intrabiliary pressure less than 20cm of water was considered the success threshold. Results of BMPT evaluation were retrospectively compared with a similar group where the standard clinical test was used for evaluating treatment success. The clinical test group included 21 patients treated for biliary strictures from 1994 to 2006. RESULTS: The two groups were statistically similar by age and gender. The BMPT group was tested without complications and pressure inside the biliary tree was less than 20cm of water in 27 of 29 patients. Subsequently, catheters were removed from all 27. Three patients required re-interventions 13 days, 11 months and 32 months later. Kaplan-Meier survival analysis showed that the probability of biliary patency at 3 year was 82.2%. There was no significant difference between groups by this measure (log rank test, p=0.624). CONCLUSIONS: The manometric test is an alternative for evaluating success in treating benign biliary strictures. It is simple, less time-consuming, economical, safe, effective and more comfortable for patients than the clinical test.

• MeSH
• Cholangiography MeSH
• Cholestasis physiopathology   radiography   therapy   MeSH
• Adult MeSH
• Drainage MeSH
• Kaplan-Meier Estimate MeSH
• Catheterization MeSH
• Contrast Media MeSH
• Middle Aged MeSH
• Humans MeSH
• Manometry MeSH
• Young Adult MeSH
• Recurrence MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Constriction, Pathologic physiopathology   radiography   therapy   MeSH
• Pressure MeSH
• Catheters, Indwelling MeSH
• Biliary Tract physiopathology   radiography   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

BACKGROUND/AIMS: Tumor recurrence develops in 45-80% of patients after liver surgery for colorectal liver metastases. To assess the significance of preoperative tumor marker levels for disease free interval (DFI) and patient survival (PS) after liver surgery. METHODOLOGY: Preoperative serum levels of carcinoembryonic antigen--CEA, CA 19-9, CA 72-4, thymidine kinase (TK), tissue polypeptide antigen (TPA) and tissue polypeptide specific antigen (TPS) were evaluated in 173 patients operated on for colorectal liver metastases (CLM). Liver resection was performed on 114 patients and radiofrequency ablation on 59 patients. RESULTS: Preoperative serum levels of TPA (cut off level = 53 IU/L, Hazard ratio = 4.5, Wilcoxon test: p < 0.01, Log-Rank test: p < 0.03) and TPS (cut off level = 81 IU/L, Hazard ratio = 5.1, Wilcoxon test: p < 0.007, Log-Rank test: p < 0.009) were important for PS and DFI after liver resection (TPA: cut off level = 53 IU/L, Hazard ratio = 3.5, Wilcoxon test: n.s., Log-Rank test: n.s.; TPS: cut off level = 81 IU/l, Hazard ratio = 2.6, Wilcoxon test: p < 0.02, Log-Rank: p < 0.06). TPA serum levels were important for PS (Wilcoxon test--p < 0.003, Log-Rank test--p < 0.0002) and DFI after RFA (Wilcoxon test--p< 0.001, Log-Rank Test--p < 0.0001). TPS serum levels also correlated with PS (Wilcoxon test--p < 0.005, Log-Rank test--p < 0.003) and DFI after RFA (Wilcoxon test--p < 0.001, Log-Rank Test--p< 0.0001). CONCLUSIONS: TPA and TPS are important predictive markers for PS and DFI after liver resections and radiofrequency ablations for CLM.

• MeSH
• Catheter Ablation MeSH
• Colorectal Neoplasms surgery   blood   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Biomarkers, Tumor blood   MeSH
• Liver Neoplasms surgery   blood   secondary   MeSH
• Statistics, Nonparametric MeSH
• Predictive Value of Tests MeSH
• Preoperative Care MeSH
• Prognosis MeSH
• Proportional Hazards Models MeSH
• Prospective Studies MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

OBJECTIVES: The objectives of this study were to describe the prevalence of diabetes mellitus (DM) in European nursing homes (NHs), and the health and functional characteristics of diabetic residents (DMR) aged 60 years and older. DESIGN: Between 2009 and 2011, the Services and Health for Elderly in Long TERm care (SHELTER) project, a 12-month prospective cohort study, was conducted to assess NH residents across different health care systems in 7 European countries and Israel. METHODS: The study included 59 NHs in 8 countries with a total of 4037 residents living in or admitted to a NH during the 3-month enrollment period. The multidimensional InterRAI instrument for Long-Term Care Facilities (InterRAI-LTCF) was used to assess health and functional status among residents. Descriptive statistics and linear, ordinal, and logistic regression were used to perform the analyses. RESULTS: We found a 21.8% prevalence of DM among NH residents. Residents with DM (DMRs) were significantly younger compared with non-DMRs (82.3, SD ± 7.7; 84.6, SD ± 8.4; P < .001). DMRs were more frequently overweight or obese, and presented more often with ischemic heart disease, congestive heart failure, hypertension, and stroke than residents without DM. DMRs also took more drugs, had pressure ulcers (PU) or other wounds more often, and more frequently had urinary incontinence (UI); they also reported worse self-perceived health. DM independently of other factors increased risk of PU occurrence (odds ratio 1.38; 95% confidence interval [CI] 1.02-1.86; P = .036) and decreased probability of higher pain scores (B = -0.28; 95% CI -0.41 to -0.14; P < .001). DM was not associated with ADL dependency, cognitive impairment, and depression in NH residents. CONCLUSION: Prevalence of DM in European NH residents is comparable to US national NH surveys, and to UK and German NH data based on glucose-level testing. DMRs compared with non-DMRs have more comorbid conditions, and a particularly higher incidence of cardiovascular diseases and obesity, PU, and severe UI. DMRs should be regarded as a specific group of residents who require an interdisciplinary approach in medical and nursing care.

• MeSH
• Diabetes Mellitus diagnosis   epidemiology   MeSH
• Long-Term Care MeSH
• Homes for the Aged * MeSH
• Geriatric Assessment MeSH
• Cohort Studies MeSH
• Diabetes Complications diagnosis   epidemiology   MeSH
• Quality of Life * MeSH
• Middle Aged MeSH
• Humans MeSH
• Linear Models MeSH
• Logistic Models MeSH
• Survival Rate MeSH
• Multivariate Analysis MeSH
• Statistics, Nonparametric MeSH
• Nursing Homes * MeSH
• Prevalence MeSH
• Prognosis MeSH
• Prospective Studies MeSH
• Sex Distribution MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• Age Distribution MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Europe MeSH

Cíl: Kardiovaskulární onemocnění (KVO), která vznikají v důsledku aterosklerózy, patří nejen na území České republiky mezi nejčastější příčiny morbidity a mortality. Genetická dispozice pro vznik KVO se umocňuje v přítomnosti klasických rizikových faktorů, které jsou ovlivnitelné. Naším cílem bylo zjistit, zda se míra rizikových faktorů ischemické choroby srdeční (ICHS) liší již v populaci zdravých potomků pacientů po předčasném infarktu myokardu oproti kontrolní skupině vyšetřovaných. Metodika: Oslovili jsme dospělé děti (n = 127; věk 28,7 ? 6,5 let) nemocných s předčasnou manifestací ICHS, kteří byli vyšetřeni v rámci studie EUROASPIRE IV. Vyšetření potomků i kontrolní skupiny (n = 199; věk 28,9 ? 5,3 let) bylo zaměřeno na stanovení rizikových faktorů ICHS. Výsledky: Potomci měli častěji arteriální hypertenzi (18,9 vs 8,0 %, p = 0,003) a větší zastoupení měli kuřáci (37 vs 24,1 %, p = 0,01). Hladina triglyceridů (1,13 vs 0,99 mmol/l, p = 0,05) a LDL-cholesterolu (2,7 vs 2,45 mmol/l, p = 0,01) byla vyšší ve skupině potomků, HDL-cholesterol byl v obou skupinách srovnatelný (1,60 vs 1,67 mmol/l, p = 0,17). Zvýšená glykemie nalačno byla častěji ve skupině potomků (5,5 vs 1,5 %, p = 0,05). Nikdo z vyšetřených nesplňoval kritéria pro diagnózu diabetes mellitus. Tepenná tuhost aorty byla vyšší ve skupině potomků oproti kontrolní skupině (6,2 vs 5,8 m/s, p = 0,001). Vypočtené celkové kardiovaskulární riziko dle systému SCORE bylo rovněž vyšší ve skupině potomků oproti kontrolní skupině – aktuální riziko vztažené na věk 40 let: 0,35 (0,19–0,64) vs 0,20 (0,13–0,47), p < 0,0001 a riziko vztažené na věk 60 let: 3,35 (2,23–5,36) vs 2,40 (1,58–4,11), p < 0,0001. Závěr: Populace potomků má dle našich výsledků větší zastoupení kuřáků a hypertoniků. Dále mají vyšší hladinu LDL-cholesterolu, triglyceridů a častěji porušenou glykemii nalačno. Nepříznivá genetická dispozice společně s nevhodným životním stylem přispívá k vyšší pravděpodobnosti kumulace rizikových faktorů, a tedy i vyššímu riziku manifestace kardiovaskulárního onemocnění. V praxi bychom se měli u těchto predisponovaných jedinců snažit o snížení kardiovaskulárního rizika a implementaci zdravého životního stylu.

Goal: The cardiovascular diseases (CVDs) developing as the result of atherosclerosis are among the most frequent causes of morbidity and mortality within the Czech Republic and elsewhere. Genetic predisposition for cardiovascular diseases is amplified in the presence of routine risk factors which can be influenced. Our aim was to establish whether the level of the risk factors for ICHS already differs in the population of healthy descendants of the patients after early myocardial infarction, as opposed to the control group of examined individuals. Methodology: We approached adult children (n = 127; age 28.7 ? 6.5 years) of the patients with early manifestation of ICHS, who were examined within the study EUROASPIRE IV. The examination of both the descendants and the control group (n = 199; age 28.9 ? 5.3 years) focused on identifying the risk factors for ICHS. Results: Descendants presented arterial hypertension more often (18.9 vs 8.0 %, p = 0.003) and there were more smokers among them compared to the control group (37 vs 24.1 %, p = 0.01). The levels of triglycerides (1.13 vs 0.99 mmol/l, p = 0.05) and LDL-cholesterol (2.7 vs 2.45 mmol/l, p = 0.01) were higher in the descendant group, HDL-cholesterol was similar in both groups (1.6 vs 1.67 mmol/l, p = 0.17). Increased fasting glycemia occurred more frequent in the descendant group (5.5 vs 1.5 %, p = 0.05). None of the examined participants met the criteria for the diagnosis of diabetes mellitus. Aortic stiffness was higher in the descendant group as opposed to the control group (6.2 vs 5.8 m/s, p = 0.001). The total calculated cardiovascular risk based on the SCORE system was also higher in the descendant group as compared to the control group – the current risk related to the age of 40 years: 0.35 (0.19–0.64) vs 0.20 (0.13–0.47), p < 0.0001 and the risk related to the age of 60 years: 3.35 (2.23–5.36) vs 2.40 (1.58–4.11), p < 0.0001. Conclusion: The population of the descendants includes, based on our results, a greater number of smokers and hypertensive patients. They also have higher levels of LDL-cholesterol, triglycerides and impaired fasting glycemia more frequently. Unfavourable genetic predisposition along with unfitting lifestyle contributes to a higher likelihood of accumulation of risk factors, and therefore to a higher risk of a cardiovascular disease manifestation. In practice we should try, with regard to these predisposed individuals, to lower their cardiovascular risk and implement a healthy lifestyle.

• MeSH
• Adult Children * MeSH
• Adult MeSH
• Hypertension diagnosis   MeSH
• Myocardial Infarction prevention & control   MeSH
• Cardiovascular Diseases * prevention & control   MeSH
• Smoking MeSH
• Blood Glucose analysis   MeSH
• Cholesterol, LDL MeSH
• Humans MeSH
• Linear Models MeSH
• Young Adult MeSH
• Disease Susceptibility * MeSH
• Statistics, Nonparametric MeSH
• Motor Activity MeSH
• Primary Prevention MeSH
• Risk Factors MeSH
• Case-Control Studies MeSH
• Life Style MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH

Aim: The aim of this observational cross-sectional study was to determine the differences in attitudes of nurses toward patient aggression according to the type of workplace. Predictors of attitudes of nurses was also surveyed. Methods: A survey was undertaken among 61 nurses from internal and surgical wards and 56 nurses from psychiatric wards. In this survey, three questionnaires were used to measure attitude toward aggression; experience in the prevalence of aggression and factors contributing to aggression of patients. For determining the associations between variables and predictors of attitudes, the multiple regression analyses were used. Results: Nurses from psychiatric wards reported being more frequently confronted with all types of patient aggression. They also reported more significant influence of patient variables contributed to the incidence of violence within the psychiatric sector. Nurses from all types of wards perceived patient aggression as being destructive or offensive and not serving a protective or communicative function aggression. Perceptions of frequency of patient aggression were not confirmed as the significant predictors of nurses' attitudes in psychiatric sector. Physical violence (behaviour that will harm or cause injury) and sexual assault or rape were identified as the significant predictors of nurses' attitudes worked in internal and surgical departments. Conclusion: The study confirmed differences in predictors of attitudes of nurses toward patient aggression according to the type of workplace.

• Keywords
• interní oddělení nemocnice,
• MeSH
• Aggression * psychology   MeSH
• Surgery Department, Hospital MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Linear Models MeSH
• Workplace Violence psychology   statistics & numerical data   MeSH
• Statistics, Nonparametric MeSH
• Psychiatric Nursing MeSH
• Nursing Staff, Hospital * psychology   statistics & numerical data   MeSH
• Attitude of Health Personnel * MeSH
• Cross-Sectional Studies statistics & numerical data   MeSH
• Surveys and Questionnaires MeSH
• Psychiatric Department, Hospital MeSH
• Regression Analysis MeSH
• Risk Factors MeSH
• Age Factors MeSH
• Nurse-Patient Relations * MeSH
• Nurse Clinicians psychology   statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

Potřebná dávka tyroxinu k zajištění eutyreoidního stavu u pacientů po totální tyreoidektomii se může lišit v závislosti na více faktorech. Nejvýznamnější z nich je hmotnost, roli ale hrají i další fyziologické (zejména věk, výška, pohlaví, strava) a patologické či s dalšími nemocemi související faktory (užívání léků, poruchy absorpce a farmakokinetiky tyroxinu). Ve skupinách 219, respektive 144 pacientů po totální tyreoidektomii pro Gravesovu-Basedowovu nemoc a nízkorizikový karcinom štítné žlázy s již normální hladinou tyreotropinu jsme zkoumali vliv věku, příčiny operace a pohlaví na potřebu tyroxinu. Zjistili jsme, v souladu s většinou studií, nižší potřebnou dávku tyroxinu ve vyšším věku. Rozdíl mezi muži a ženami jsme nepotvrdili, zde jsou ale výsledky ostatních prací kontroverzní.

The dose of levothyroxine required for maintaining euthyroid state in patients after total thyreoidectomy may vary depending on several factors. The most important of them is the weight, but there are other physiological (age, height, gender, diet) and pathological or other diseases related factors (drug use, impaired absorption and pharmakokinetics f thyroxine). In groups of 219 and 144 patients after total thyreoidectomy for Graves ́disease and low risk thyroid cancer (with already normal levels of thyreotropine) respectively, we investigated the influence of age, the cause of operation and gender on the need of thyroxine. We found, in accordance with the majority of studies, a lower dose of thyroxine required in the higher age. The difference between men and women was not confirmed, but the results of other works are also controversial.

• MeSH
• Adult MeSH
• Graves Disease surgery   MeSH
• Hormone Replacement Therapy * MeSH
• Hypothyroidism drug therapy   blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Linear Models MeSH
• Adolescent MeSH
• Young Adult MeSH
• Thyroid Neoplasms surgery   MeSH
• Statistics, Nonparametric MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Body Weight MeSH
• Thyrotropin blood   MeSH
• Thyroxine * administration & dosage   MeSH
• Thyroidectomy MeSH
• Age Factors * MeSH
• Age Distribution MeSH
• Drug Dosage Calculations MeSH
• Dose-Response Relationship, Drug MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Comparative Study MeSH

Cíl: Hodnocení léčebných výsledků, radiační toxicity a prognostických faktorů ovlivňujících délku přežití bez progrese u pacientů s nízkostupňovými gliomy ozářených na gama noži. Soubor a metodika: Celkově 88 pacientů jsme ozářili na gama noži hypofrakcionačním režimem. Medián minimální aplikované dávky do plánovacího cílového objemu byl 25 Gy (12–35). Předepsaná minimální dávka byla zohledněna následujícími faktory: počtem frakcí, předchozí radioterapií, plánovacím cílovým objemem (PTV) a věkem. Radiační toxicita a závažnost příznaků (neurological functional class, NFC) byla hodnocena systémem RTOG/EORTC. Ve skupině pacientů jsme sledovali několik faktorů ovlivňujících přežití bez progrese (PFS) po léčbě a radiační toxicitu (stupeň nádoru, věk, objem, biologicky efektivní dávku, předchozí radioterapie, závažnost neurologických příznaků před ozářením). Užili jsme univariační (Kaplan-Meier s Log-rank testem) a multivariační analýzu (Coxovu regresi) k detekci rozdílů v křivkách přežití a k detekci faktorů spojených s toxicitou. Výsledky: Desetileté přežití bez progrese bylo zaznamenáno u 78 % pacientů. Dle očekávání jsme detekovali vyšší procento déle přežívajících bez progrese u pacientů s histopatologickým stupněm I (5leté přežití 91 %, 10leté přežití 88 %) než u pacientů s histopatologickým stupňem II (5leté přežití 79 %, 10leté 67 %); p = 0,010 Log-rank; p = 0,025 Cox). Ze zmíněných faktorů byly jako příznivé detekovány: věk < 30 let (p = 0,044 Log-rank), BED 85–110 Gy, tj. prostřední kategorie (p = 0,019 Log-rank), bez předchozího ozáření (p = 0,032 Log-rank; p = 0,075 Cox). Ve skupině jsme zaznamenali toxicitu stupeň 3 u 10 % případů. Z analyzovaných faktorů nebyl ve vztahu ke komplikacím žádný statisticky signifikantní. Závěry: Ozáření na gama noži může být léčbou pro objemově vhodné recidivy či rezidua nízkostupňových gliomů s relativně dlouhodobým příznivým léčebným efektem.

Objective: To evaluate treatment results, radiation-related toxicity and prognostic factors for progression free survival (PFS) in patients with low-grade glioma irradiated by Leksell Gamma Knife. Materials and methods: A total of 88 patients underwent hypofractionated stereotactic irradiation to treat low-grade glioma. The median minimum applied dose to the planning target volume (PTV) was 25 Gy (12–35). The dosage was prescribed with respect to the several conditions: number of fractions, previous irradiation, planning target volume and age. The radiation toxicity and severity of symptoms (neurological functional class [NFC]) were evaluated according to the RTOG/EORTC system. We analyzed variables affecting progression-free survival (PFS) after treatment and radiation-induced late toxicity (grade, age, volume, biologically effective dose, previous radiotherapy, NFC score before treatment). We used univariate analysis (Kaplan-Meier with log-rank test) and multivariate analysis (Cox regression) to detect differences in survival curves, as well as correlation analysis to detect variables associated with toxicity. Results: 10-year PFS was 78%. As expected, we found a greater surviving proportion among grade I patients, (91% surviving at 5 years, 88% at 10 years) than grade II patients (79% surviving at 5 years, 67% at 10 years), p = 0.010 log-rank, p = 0.025 Cox. Among the other variables we detected as significant positive prognostic factors: age < 30 years (p = 0.044 log-rank), BED 85–110 Gy, which is an intermediate category, (p = 0.019 log-rank), and not previously irradiated (p = 0.032 log-rank, p = 0.075 Cox). In our group of patients we observed grade 3 late toxicity in 10% of cases. Among the variables analyzed we found none associated with incidence of toxicity. Conclusion: Radiosurgery is a treatment modality for small residual or reoccurrence volumes of low-grade glioma with relatively long-term local control.

• MeSH
• Glioma diagnosis   classification   radiotherapy   MeSH
• Evaluation Studies as Topic MeSH
• Humans MeSH
• Meta-Analysis as Topic MeSH
• Disease-Free Survival MeSH
• Prognosis MeSH
• Disease Progression MeSH
• Radiosurgery methods   utilization   MeSH
• Statistics as Topic MeSH
• Stereotaxic Techniques instrumentation   utilization   MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Humans MeSH

OBJECTIVES: Subjects in the Prevention of Colorectal Sporadic Adenomatous Polyps (PreSAP) trial (PRESAP/NCT00141193/www.clinicaltrials.gov) were studied to determine efficacy and safety at a year 5 assessment. METHODS: In this randomized, placebo-controlled, double-blind trial, 1,561 subjects with diagnosed colorectal adenomas removed within 3 months of the study's initiation were assessed after ~ 3 years on celecoxib followed by 2 years off. Studied in 107 primary and secondary care settings, subjects were stratified by cardioprotective aspirin use and randomized to receive orally 400 ng celecoxib (933 subjects) or placebo (628 subjects) once daily. Efficacy was measured by colonoscopy at years 1, 3, and 5, and safety was measured by investigators for the on-treatment period and collected by subject self-report over 2 years post-treatment. RESULTS: At year 5, the primary outcome measure was the rate of new adenomas measured cumulatively from baseline. This rate was statistically significantly lower in the celecoxib group (51.4%) than in the placebo group (57.5%; P<0.001). Similarly, the cumulative rate of new advanced adenomas was significantly lower in the celecoxib group (10.0%) than in the placebo group (13.8%; P=0.007). However, the year 5 interval measure, which was not cumulative and did not take the rates of previous years into account, showed that after 2 years off treatment, the celecoxib group (27.0%) was 1.66 times more likely to have new adenomas than the placebo group (16.3%; P<0.0001). Similarly, the percentage of patients with new advanced adenomas was significantly higher in the celecoxib group (5.0%) than in the placebo group (3.8%) (P=0.0072). The evaluation of safety from baseline through year 5 indicated that the risks of serious cardiac disorders (relative risk (RR) 1.66; 95% confidence interval (CI) 1.01-2.73), selected renal/hypertension events (RR 1.35; 95% CI 1.09-1.68), and general vascular (RR 1.34; 95% CI 1.08-1.68) and cardiac disorders (RR 1.59; 95% CI 1.12-2.26) were higher in those taking celecoxib than in those on placebo. CONCLUSIONS: The year 5 cumulative measures of the incidence of new and advanced adenomas were significantly lower in the celecoxib group than in the placebo group, but the year 5 interval rates of these measures were significantly lower in the placebo group than the celecoxib group, perhaps suggesting a release of cyclooxygenase-2 inhibition. Consistent with what has been previously reported, increased risk of renal/hypertension events and cardiac disorders associated with celecoxib therapy mandates caution in patient selection.

• MeSH
• Administration, Oral MeSH
• Aspirin therapeutic use   MeSH
• Time Factors MeSH
• Double-Blind Method MeSH
• Adenomatous Polyposis Coli drug therapy   prevention & control   MeSH
• Risk Assessment MeSH
• Cyclooxygenase 2 Inhibitors therapeutic use   MeSH
• Confidence Intervals MeSH
• Neoplasm Invasiveness pathology   MeSH
• Colonoscopy methods   MeSH
• Colorectal Neoplasms drug therapy   prevention & control   MeSH
• Middle Aged MeSH
• Humans MeSH
• Linear Models MeSH
• Neoplasm Recurrence, Local MeSH
• Follow-Up Studies MeSH
• Statistics, Nonparametric MeSH
• Drug Administration Schedule MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sex Factors MeSH
• Neoplasm Staging MeSH
• Age Factors MeSH
• Treatment Outcome MeSH
• Dose-Response Relationship, Drug MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH
• Geographicals
• Israel MeSH

Úvod: Z klinického hlediska je zjevné, že karcinom rekta a karcinom kolon jsou ve svém průběhu a léčbě odlišné nosologické jednotky. Cílem bylo analyzovat a objasnit rozdíly mezi chováním jaterních metastáz karcinomu kolon a karcinomu rekta. Studie těchto faktorů je důležitá pro stanovení přesné prognózy a indikace jejich co nejefektivnější terapie a léčby karcinomu kolon a karcinomu rekta jako systémového onemocnění. Metoda: Do našeho souboru bylo zařazeno 223 pacientů s metastatickým postižením jater kolorektálním karcinomem, kteří byli operováni na Chirurgické klinice LF UK a FN Plzeň od 1. 1. 2006 do 31. 1. 2012. Z celkového počtu 223 jedinců bylo 145 (65 %) mužů a 78 (35 %) žen. Jednalo se celkem o 275 výkonů. Resekční výkon byl proveden u 177 pacientů a ošetření pomocí radiofrekvenční ablace (RFA) v celkem 98 případech. Soubor byl rozdělen do kategorií podle lokalizace primárního tumoru na C (kolon) čítající 58 pacientů, S (c. sigmoideum) čítající 61 pacientů a R (rektum) čítající celkem 101 pacientů. Analýza významnosti jednotlivých studovaných parametrů (věk, pohlaví, TNM klasifikace, grading, typ operačního výkonu) byla provedena pomocí ANOVA testu. Celkové přežití (OS), bezpříznakové přežití (DFI) nebo období bez známek onemocnění (NED) bylo hodnoceno za pomoci Kaplan-Meierových křivek, které byly porovnávány pomocí Log-Rank a Wilcoxon testů. Výsledky: Z hlediska porovnávání primárního origa jaterních metastáz kolorektálního karcinomu bez ohledu na jejich ošetření (resekce i RFA) z naší studie vyplývá, že metastázy karcinomu rekta mají statisticky významně časnější recidivu (kratší NED/DFI). V případě ostatních faktorů byl pro prognózu časné recidivy statisticky významný lokálně pokročilý nález u primárního nádoru kolon a sigmoidea, dále podstoupená R2 resekce jaterních metastáz a pozitivita uzlinových metastáz v případě primárního nádoru kolon a sigmoidea. Dále jsme prokázali, že u nemocných s primárním postižením rekta nemá na DFI po resekci metastáz jater vliv pozitivita uzlinových metastáz ani lokální pokročilost primárního nádoru. Další studované faktory (časový odstup diagnózy orgánových metastáz od primární operace, grading, pohlaví či věk) nebyly pro prognózu OS i DFI (souhrnně u kolorektálního karcinomu) prokázány jako statisticky významné. Závěr: Z naší studie je zřejmé, že u karcinomu rekta a karcinomu kolon lze ve vztahu k jejich jaterním metastázám předpokládat různé chování se specifickými prognostickými faktory. Tyto rozdíly nejsou dosud plně objasněny a vyžadují další zkoumání a rozdělení, a to nejen na základě histopatologických, imunohistochemických a klinických faktorů, ale i molekulárně biologických parametrů. Klíčová slova: metastázy karcinomu kolon − metastázy karcinomu rekta − prognostické faktory − celkové přežití – jaterní metastázy

Introduction: From the clinical point of view, rectal cancer and colon cancer are clearly different nosological units in their progress and treatment. The aim of this study was to analyse and clarify the differences between the behaviour of liver metastases from colon and rectal cancer. The study of these factors is important for determining an accurate prognosis and indication of the most effective surgical therapy and oncologic treatment of colon and rectal cancer as a systemic disease. Method: 223 patients with metastatic disease of colorectal carcinoma operated at the Department of Surgery, University Hospital in Pilsen between January 1, 2006 and January 31, 2012 were included in our study. The group of patients comprised 145 men (65%) and 117 women (35%). 275 operations were performed. Resection was done in 177 patients and radiofrequency ablation (RFA) in the total of 98 cases. Our sample was divided into 3 categories according to the location of the primary tumor to C (colon), comprising 58 patients, S (c. sigmoideum) in 61 patients, and R (rectum), comprising 101 patients. Significance analysis of the studied factors (age, gender, staging [TNM classification], grading, presence of mucinous carcinoma, type of operation) was performed using ANOVA test. Overall survival (OS), disease-free interval (DFI) or no evidence of disease (NED) were estimated using Kaplan-Meier curves, which were compared with the log-rank and Wilcoxon tests. Results: As regards the comparison of primary origin of colorectal metastases in liver regardless of their treatment (resection and RFA), our study indicated that rectal liver metastases showed a significantly earlier recurrence than colon liver metastases (shorter NED/DFI). Among other factors, a locally advanced finding, further R2 resection of liver metastases and positivity of lymph node metastases were statistically significant for the prognosis of an early recurrence of the primary colon and sigmoid tumor. Furthermore, we proved that in patients with primary rectal carcinoma, DFI (after the resection of liver metastases) was not influenced by the positivity of lymph node metastases of primary tumor or locally advanced primary tumor. The other factors studied (time from diagnosis of organ metastases to primary operation, grading, sex or age) were not shown to be statistically significant for the prognosis of OS and DFI (colorectal cancer in total). Conclusion: As proven by our study, rectal cancer and colon cancer are two different nosological units with specific prognostic factors with respect to their liver metastases. These differences have not been fully understood yet and require further exploration and classification based not only on histopathological, immunohistochemical and clinical factors, but also on molecular biological parameters. Key words: colon carcinoma metastases − rectal carcinoma metastases − prognostic factors − overall survival – liver metastases

• MeSH
• Survival Analysis MeSH
• Surgical Procedures, Operative statistics & numerical data   MeSH
• Adult MeSH
• Kaplan-Meier Estimate MeSH
• Catheter Ablation statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymphatic Metastasis MeSH
• Neoplasm Metastasis MeSH
• Liver Neoplasms * surgery   secondary   MeSH
• Rectal Neoplasms * complications   mortality   MeSH
• Colonic Neoplasms * complications   mortality   MeSH
• Statistics, Nonparametric MeSH
• Disease-Free Survival MeSH
• Recurrence MeSH
• Reoperation MeSH
• Retrospective Studies MeSH
• Neoplasms, Second Primary MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Neoplasm Staging MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Cíl: Analyzovali jsme přežívání nemocných po TIPS (transjugulární intrahepatální portosystémové spojce) ve Fakultní nemocnici Hradec Králové dle věku, etiologie jaterní nemoci, Childova-Pughova skóre a indikace k výkonu. Soubor nemocných a metodika: Od září roku 1992 do srpna roku 2010 byl ve Fakultní nemocnici v Hradci Králové vytvořen TIPS 848 nemocným. Ti byli rozděleni do skupin dle výše jmenovaných kritérií. Přežívání jsme analyzovali pomocí Kaplan-Meierových křivek. Rozdíly mezi skupinami jsme posuzovali pomocí log-rank testu. Výsledky: Jeden měsíc po TIPS nepřežívá 10 % nemocných, 5 let přežívá 40 % nemocných a 10 let 20 % nemocných. Statisticky významné rozdíly jsme našli mezi skupinami dělenými podle Childovy-Pughovy klasifikace (A vs B p = 0,0053; B vs C p < 0,0001), indikace k výkonu (indikace prevence recidivy krvácení se liší od indikace pro refrakterní ascites p = 0,0001 i od indikace zástavy akutního krvácení p = 0,026); etiologie jaterní nemoci (nemocní s alkoholovou cirhózou se liší od nemocných s Buddovým-Chiariho syndromem p < 0,0001 i od nemocných s chronickou virovou hepatitidou p = 0,024). Závěr: Přežívání nemocných po TIPS ovlivňuje Childovo-Pughovo skóre, indikace k výkonu a etiologie jaterní nemoci.

Aim: To analyze survival of patients after TIPS (transjugular intrahepatic portosystemic shunt). Patient sample and metho­dology: Between September 1992 and August 2010, TIPS was created in 848 patients of the University Hospital Hradec Kralove. These patients were divided into groups. Survival was analyzed using Kaplan-Meier survival curves. Differences between groups were eval­uated using log-rank test. Results: Ten percent of patients do not survive one month after TIPS, 40% of patients survive 5 years and 20% of patients survive 10 years. There were statistically significant differences between groups divided according to Child-Pugh classification (A vs B p = 0.0053; B vs. C p < 0.0001), indication for surgery [prevention of bleeding recurrence differed from refractory ascites (p = 0.0001) and the indication to stop acute bleeding (p = 0.026)]; aetiology of the liver disease [patients with alcoholic cirrhosis differed from patients with Budd-Chiari syndrome (p < 0.0001) and from patients with chronic viral hepatitis (p = 0.024)]. Conclusion: Survival of patients after TIPS is influenced by Child-Pugh score, indication and aetiology of the liver disease.

• Keywords
• Childovo-Pughovo skóre, indikace, jaterní onemocnění, transjugulární intrahepatální portosystémová spojka,
• MeSH
• Budd-Chiari Syndrome epidemiology   surgery   MeSH
• Financing, Organized MeSH
• Liver Cirrhosis epidemiology   surgery   MeSH
• Kaplan-Meier Estimate MeSH
• Humans MeSH
• Survival Rate MeSH
• Liver Diseases etiology   therapy   MeSH
• Hypertension, Portal complications   MeSH
• Retrospective Studies MeSH
• Portasystemic Shunt, Transjugular Intrahepatic MeSH
• Age Factors MeSH
• Hepatitis, Viral, Human epidemiology   surgery   MeSH
• Patient Selection MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH