The spleen is one of the most commonly injured organ in blunt traumas to the chest and abdomen. Splenic injury can be a serious complication of fracture of the left 9th to 11th rib. The authors present a case report of a 65-year-old male patient with a blunt trauma to the left chest and abdomen, diagnosed with multiple left rib fractures, left hemothorax and splenic injury with a small subcapsular hematoma with no signs of active splenic bleeding. Due to hemodynamic instability and a large volume of blood loss via the chest drain, the patient was indicated for emergency left thoracotomy. A perforation in the lower lobe of the left lung caused by rib fractures was found, which was treated with sutures. Furthermore, the diaphragm was examined, two ruptures were identified from which blood was coming out, and thus a phrenotomy was performed. The bleeding central splenic rupture came as a big surprise. A spleen preserving surgery was impossible, therefore a splenectomy had to be performed, followed by chest wall stabilization with splints. Transthoracic approach to manage the splenic injury through phrenotomy should not be used as a standard. In a selected group of patients with concomitant chest and upper abdominal organ injuries, the use of this surgical approach appears to be highly beneficial. Key words: splenic injury, splenectomy, thoracotomy, rib fractures, diaphragmatic rupture.

• MeSH
• fraktury žeber * chirurgie   MeSH
• hematom MeSH
• lidé MeSH
• poranění břicha * MeSH
• senioři MeSH
• splenektomie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Minimally invasive distal pancreatectomy (MIDP) includes both laparoscopic and robotic distal pancreatectomy (RDP). MIDP is often adopted first due to the absence of the requirement of a complex reconstruction. In recent years, an increase in the use of robotic surgery has been noted. METHODS: The authors present initial experience with RDP and retrospective analysis of data from prospectively collected database. RESULTS: Between September 2021 and October 2022 five patients undergoing RDP with splenectomy performed in the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital were included from a prospectively maintained database. The age was from 20 to 70 years. No conversion was required. One patient underwent reoperation due to staple-line hemorrhage. Postoperative hospital stay was from 4 to 14 days. The follow-up period was from 2 to 14 months. CONCLUSION: Our first experience demonstrates RDP is a safe and efficacious approach for tumors of pancreatic body and tail in selected patients. A larger number of patients is needed to obtain more accurate results.

• Klíčová slova
• MIDP, RDP, minimally invasive distal pancreatectomy, robotic distal pancreatectomy,
• MeSH
• délka pobytu MeSH
• dospělí MeSH
• laparoskopie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory slinivky břišní * chirurgie   MeSH
• pankreatektomie metody   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony * metody   MeSH
• senioři MeSH
• splenektomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Talaromycosis (penicillinosis) is multiresistent opportunistic mycosis. The infection can be inapparent and it can simmulate malignant tumor dissemination in some patients. CASE: We present a case of 33-years-old patient with mucinous adenocarcinoma of left ovary, initially FIGO IIC. The patient had had hysterectomy, bilateral adnexectomy, omentectomy and port-site metastasis extirpation. Six cycles of 1st chemother-apy paclitaxel and carboplatin had been administered to patient follow-ing the surgery. Positron emission tomography / computed tomography (PET/CT) scan after the treatment, had shown metabolic activity infiltrat-ing both lung apexes, supposedly with no dis-ease correlation, and hypermetabolic foci in spleen, suspicious of be-ing metastases. Pa-cient showed no clinical symp-toms, nor markers of inflammation elevation. Initially elevated serum tumor markers CA125 and CA72-4 had decreased after the treatment. Bronchoalveolar lavage cytology described presence of inflammatory infiltration with fungiform-ing hyphae - most probably an aspergillosis. Mannan and galactomannan serology was negative. In regard to splenectomy plans, treatment with voriconazol was initiated empirically. Result of fungi cultivation out of bronchoalveolar lavage was finalized later, show-ing sporadic presence o Penicillium sp. with resistance to antimycotic treatment except for amphotericin B. Liposomal amphotericin B treatment was administered in two cures, 28 days in total. Immunomodulatory treatment of secondary cellular immunodeficiency and vaccination against encapsulated bacteria was given to the patient. Splenectomy was performed 6 months after the end of chemother-apy treatment. Histopathology showed chronic granulomatous inflammation without mycotic hyphae, with no evidence of tumor cells. After the splenectomy, patient was treated by surgical incision and drainage and by klindamycin for intraabdominal abscess in left hypogastric area. CONCLUSION: Patient is under follow up by oncologist, immunologist and gynecologist 12 months after the splenectomy, she is surveilled by PET/CT and serum tumor markers. Talaromycosis can be clinically inapparent in spite of its dissemination. It can be present in diffuse, granulomatous and mixed form. Therapeutic agent is sometimes limited to amphotericin B due to its resistence. Liposomal form of amphotericin B is recommended regard-ing its pharmacokinetic properties. In case of dissemination, administration period of more than 14 days is recommended, even in inapparent form. Immunomodulatory treatment is recommended due to opportunistic infection.

• Klíčová slova
• talaromycosis – opportunistic infection – amphotericin B,
• MeSH
• amfotericin B terapeutické užití   MeSH
• antifungální látky terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• mnohočetná fungální léková rezistence MeSH
• mucinózní adenokarcinom farmakoterapie   mikrobiologie   patologie   chirurgie   MeSH
• mykózy farmakoterapie   mikrobiologie   chirurgie   MeSH
• nádory sleziny farmakoterapie   mikrobiologie   sekundární   chirurgie   MeSH
• nádory vaječníků farmakoterapie   mikrobiologie   patologie   chirurgie   MeSH
• oportunní infekce farmakoterapie   mikrobiologie   chirurgie   MeSH
• Penicillium * MeSH
• splenektomie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• amfotericin B MeSH
• antifungální látky MeSH
• liposomal amphotericin B MeSH Prohlížeč

OBJECTIVE: To describe a case of coincidental finding of splenosis during gynecological laparoscopic surgery. DESIGN: Case report. SETTING: Department of gynecology and obstetrics, Hospital of Frýdek-Místek. CASE REPORT: We describe the case of coincidental perioperative finding of pelvic tumorous mass that was later histologicaly verified as accsessory spleen or splenosis. CONCLUSION: Ectopic spleen is mostly random finding with no symptoms observed. Rarely it can cause pelvic pain or mimick adnexal malignity or endometriosis. It is neccesery to keep this rare diagnosis in mind, mainly at patients with splenic trauma or splenectomy in their medical history to preserve immunological function of this splenic tissue.

• Klíčová slova
• Pelvis, accesory spleen, splenosis,
• MeSH
• diferenciální diagnóza MeSH
• gynekologické chirurgické výkony MeSH
• lidé MeSH
• pánev MeSH
• splenektomie škodlivé účinky   MeSH
• splenóza * diagnostické zobrazování   etiologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Extrapulmonary tuberculosis can involve any organ or tissue. It is a rare disease in the Czech Republic with an incidence rate of 0.62 cases per 100.000 persons. It affects mostly immunocompromised patients. The most common sites include lymph nodes, the urogenital system, skin, joints, bones and serous epithelium - the peritoneum, pleura, and pericardium. Splenic involvement is rare. Mycobacterium is a slow growing intracellular parasite. The diagnostic process is very difficult; microbiological diagnosis is critical. CASE REPORT: An 84 years old female patient with subcapsular splenic rupture with no trauma history as a cause of anemia. Splenic abscess was diagnosed during surgical revision and splenectomy. Tuberculosis was suspected based on subsequent histological analysis, which was confirmed after nine weeks of peritoneal fluid culture. The surgical procedure and postoperative hospitalization were not associated with any complications. The patient was referred to the respiratory clinic for further treatment. CONCLUSION: The diagnosis of extrapulmonary tuberculosis including splenic localization should always be considered. A sample from the affected tissue or effusion must be collected in the case of unclear perioperative findings and sent for complete bacteriological testing, including mycobacterial culture. If a tuberculous splenic abscess is found, the therapeutic process should involve its complete drainage in combination with long-term anti-TB medication.

• Klíčová slova
• Mycobacterium tuberculosis, abscess, splenectomy, splenic tuberculosis,
• MeSH
• absces * etiologie   MeSH
• lidé MeSH
• nemoci sleziny * etiologie   MeSH
• ruptura sleziny * MeSH
• senioři nad 80 let MeSH
• splenektomie MeSH
• tuberkulóza * komplikace   diagnóza   MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: Wandering spleen is a rare cause of recurrent abdominal pain in children that is difficult to diagnose. Splenopexy should be preferred to splenectomy. CASE REPORT: The patient, a 4 years old girl on growth hormone therapy, was referred to the Department of Paediatric Surgery for an assessment of episodes of abdominal colic and frequent vomiting. Sonography did not indicate any pathology, gastrointestinal contrast study showed an altered shape of the gastric outlet, and upper endoscopy diagnosed a prepyloric membrane. Open surgery was indicated based on these examinations, revealing a large wandering spleen and dilated stomach and small bowel loops oppressed by the long splenic suspensory ligaments. Pyloroplasty was performed with the antral membrane excision and shortening of the long gastrosplenic ligament and placement of the spleen into the left hypochondrium. No complications occurred in the postoperative period. Four months later the patient was hospitalised again for abdominal colic pain. Surgical revision of the abdomen revealed the wandering spleen in the mesogastrium. Even though the spleen was the cause of the second surgery, we decided to preserve the spleen. Partial splenectomy was done, fixing the large spleen into an extraperitoneal pocket in the left hypochondrium. The postoperative course was uneventful. Blood flow to the spleen is regularly monitored by Doppler ultrasound. Vaccination was indicated at the office of haematology according to the scheme for splenectomy patients; however, prophylactic antibiotic therapy was not needed given the good function of the preserved part of the spleen. CONCLUSION: Extraperitoneal fixation of the spleen seems to be a good choice for patients with a wandering spleen, particularly for children and adolescents.

• Klíčová slova
• Wandering spleen, extraperitoneal fixation of the spleen, relapsing abdominal pain in children,
• MeSH
• bloudivá slezina * chirurgie   MeSH
• bolesti břicha MeSH
• laparoskopie * MeSH
• lidé MeSH
• předškolní dítě MeSH
• splenektomie * metody   MeSH
• torzní deformity MeSH
• Check Tag
• lidé MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The diagnosis of immune thrombocytopenia consists in the combination of laboratory and clinical pictures of thrombocytopenia while eliminating other disorders characterized by low levels of thrombocytes. The treatment initiation in patients with ITP is recommended when the thrombocyte count has dropped below 20-30 × 109/l, when hemorrhagic manifestations occur and depending on the patient's risk profile. Corticoids and IVIG are used as first-line treatment. Second-line treatment includes splenectomy, immunosuppressive therapy and administration of thrombopoietin receptor agonists. A new drug in the treatment of ITP is fostamatinib. Key words: corticoids - eltrombopag - fostamatinib - immune thrombocytopenia - IVIG - rituximab - romiplostim - sustainable remission - splenectomy.

• MeSH
• idiopatická trombocytopenická purpura * diagnóza   terapie   MeSH
• lidé MeSH
• počet trombocytů MeSH
• rituximab MeSH
• splenektomie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• rituximab MeSH

Autoimmune hemolytic anemia (AIHA) is caused by auto-antibodies directed against self red blood cell (RBC) surface antigens. A consequence may be an intravascular hemolysis mediated by activated complement or extravascular hemolysis caused by destruction of complex of RBC with autoantibody in spleen and liver. The basic classification subdivides AIHA in primary/idiopathic and secondary with known underlying disease. A classification according to the thermal range of antibody recognizes warm AIHA, cold aglutinin disease (CAD), mixed AIHA and paroxysmal cold hemoglobinuria. Pathogenesis of AIHA consists of a defective antigen presentation to immunocompetent cells, insufficient process of T-lymphocyte tolerance to autoantigens and induction of autoantibody production by B-lymphocytes. For the diagnosis of AIHA are essential direct and indirect antiglobulin tests. The first-line therapy for warm AIHA is still administration of corticosteroids. For non-responding patients, second-line treatment includes rituximab or splenectomy. Combination of other immunosuppressive drugs represents a third-line treatment for resistant/relapsing patients. Rituximab is a treatment of choice for patients with CAD. Key words: anemia hemolytic - autoimmunity - corticosteroids - diagnosis - pathogenesis - rituximab - splenectomy - treatment.

• MeSH
• autoimunitní hemolytická anemie * diagnóza   farmakoterapie   imunologie   MeSH
• autoprotilátky MeSH
• hormony kůry nadledvin MeSH
• lidé MeSH
• rituximab terapeutické užití   MeSH
• splenektomie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• autoprotilátky MeSH
• hormony kůry nadledvin MeSH
• rituximab MeSH

Transgenic mice expressing green fluorescent protein (GFP) are useful in transplantation experiments. When we used ubiquitin-GFP (UBC-GFP) transgenic mice to study the availability of niches for transplanted hematopoietic stem and progenitor cells, the results were strikingly different from the corresponding experiments that used congenic mice polymorphic in the CD45 antigen. Analysis of these unexpected results revealed that the hematopoiesis of UBC-GFP mice was outcompeted by the hematopoiesis of wild-type (WT) mice. Importantly, UBC-GFP mice engrafted the transplanted bone marrow of WT mice without conditioning. There was a significant bias toward lymphopoiesis in the WT branch of chimeric UBC-GFP/WT hematopoiesis. A fraction of immature Sca-1+ cells in the spleen of UBC-GFP mice expressed GFP at a very high level. The chimeric hematopoiesis was stable in the long term and also after transplantation to secondary recipient mice. The article thus identifies a specific defect in the hematopoiesis of UBC-GFP transgenic mice that compromises the lymphoid-primed hematopoietic stem cells in the bone marrow and spleen. Stem Cells 2018;36:1237-1248.

• Klíčová slova
• Bone marrow transplantation, Cell competition, Extramedullary hematopoiesis, Green fluorescent protein, Hematopoiesis, Lymphopoiesis, Stem cell niche, Stem cells, Transgenic mouse,
• MeSH
• chiméra MeSH
• hematopoetické kmenové buňky metabolismus   MeSH
• hematopoéza MeSH
• kostní dřeň metabolismus   MeSH
• lymfocyty metabolismus   MeSH
• lymfopoéza MeSH
• myši inbrední C57BL MeSH
• myši transgenní MeSH
• slezina metabolismus   MeSH
• splenektomie MeSH
• thymus metabolismus   MeSH
• transplantace hematopoetických kmenových buněk * MeSH
• ubikvitin metabolismus   MeSH
• zelené fluorescenční proteiny metabolismus   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• ubikvitin MeSH
• zelené fluorescenční proteiny MeSH

Spleen tyrosine kinase (Syk) signaling is central to phagocytosis-based, antibody-mediated platelet destruction in adults with immune thrombocytopenia (ITP). Fostamatinib, an oral Syk inhibitor, produced sustained on-treatment responses in a phase 2 ITP study. In two parallel, phase 3, multicenter, randomized, double-blind, placebo-controlled trials (FIT1 and FIT2), patients with persistent/chronic ITP were randomized 2:1 to fostamatinib (n = 101) or placebo (n = 49) at 100 mg BID for 24 weeks with a dose increase in nonresponders to 150 mg BID after 4 weeks. The primary endpoint was stable response (platelets ≥50 000/μL at ≥4 of 6 biweekly visits, weeks 14-24, without rescue therapy). Baseline median platelet count was 16 000/μL; median duration of ITP was 8.5 years. Stable responses occurred in 18% of patients on fostamatinib vs. 2% on placebo (P = .0003). Overall responses (defined retrospectively as ≥1 platelet count ≥50 000/μL within the first 12 weeks on treatment) occurred in 43% of patients on fostamatinib vs. 14% on placebo (P = .0006). Median time to response was 15 days (on 100 mg bid), and 83% responded within 8 weeks. The most common adverse events were diarrhea (31% on fostamatinib vs. 15% on placebo), hypertension (28% vs. 13%), nausea (19% vs. 8%), dizziness (11% vs. 8%), and ALT increase (11% vs. 0%). Most events were mild or moderate and resolved spontaneously or with medical management (antihypertensive, anti-motility agents). Fostamatinib produced clinically-meaningful responses in ITP patients including those who failed splenectomy, thrombopoietic agents, and/or rituximab. Fostamatinib is a novel ITP treatment option that targets an important mechanism of ITP pathogenesis.

• MeSH
• aminopyridiny MeSH
• chronická nemoc MeSH
• dospělí MeSH
• idiopatická trombocytopenická purpura farmakoterapie   MeSH
• kinasa Syk aplikace a dávkování   terapeutické užití   MeSH
• lidé MeSH
• morfoliny MeSH
• oxaziny aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• počet trombocytů MeSH
• pyridiny aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• pyrimidiny MeSH
• splenektomie MeSH
• trombocyty účinky léků   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• aminopyridiny MeSH
• fostamatinib MeSH Prohlížeč
• kinasa Syk MeSH
• morfoliny MeSH
• oxaziny MeSH
• pyridiny MeSH
• pyrimidiny MeSH