Distal pancreatectomy.

NTRODUCTION: Distal pancreatectomy is a standard surgical procedure for selected benign, premalignant, and malignant lesions localized in the pancreatic body or tail. Surgical resection remains the only curative option for patients diagnosed with adenocarcinoma of the pancreas. PATIENTS AND METHODS: Perioperative and postoperative clinical courses were retrospectively assessed in patients, who underwent distal pancreatectomy during the 2011‒2021 period. RESULTS: During the 2011‒2021 period, a total of 112 distal pancreatectomies were performed. 67 patients (59.8%) underwent laparoscopic distal pancreatectomy, and 45 patients (40.2%) open laparotomy. The conversion was necessary for 13 patients (11.6%). Distal pancreatectomies performed laparoscopically were associated more often with biochemical leak and the development of grade B fistula, on the other hand grade C fistula developed only in patients operated by open laparotomy (LPT). The mean operating time was slightly longer in the laparoscopic group (227.1 min vs 214.6 min). The mean estimated blood loss was significantly higher in the LPT group (540.4 ml vs 191.9 ml). The mean hospitalization time was slightly longer in the LPT group (11.8 days vs 9.3 days). The rates of early reoperations were comparable between both groups (6 vs 5). CONCLUSION: Laparoscopic techniques are preferred in centers around the world to bring patients benefits by using a minimally invasive approach. These techniques are also preferred in our center, in nearly 60% of all distal pancreatectomies performed during 10 years, but on the other hand, there is a much more careful approach chosen in cases of malignant disease to achieve adequate radicality (Tab.4, Ref. 20).

Rare Benign Focal Lesions of the Liver: Report of 2 Cases and Literature Review.

Introduction: Benign lesions of the liver are very common findings, usually randomly discovered, especially during examinations for other indications. The frequent use of imaging modalities may be responsible for the statistical increase in the incidence of these findings. Case Presentation: In this publication, we present the cases of 2 female patients with benign liver lesions, the occurrence of which is considered rare, and only a few dozen cases have been described worldwide. In both cases, clinical symptoms, diagnostic approach, and surgical treatment are presented. Conclusion: Due to increasing availability of imaging methods, the occurrence of previously considered rare benign liver lesions increases as well. In many cases, the malignant potential of these findings remains unclear. Decision-making process should include a multidisciplinary board.

Pancreatic stiffness and anthropometric parameters in healthy volunteers.

PURPOSE: The aim of this study was to define the values of percutaneous ultrasound shear-wave and strain elastography of the pancreas in healthy volunteers. METHODS: This is a single-center prospective study conducted on volunteers who underwent examination of percutaneous point shear­wave elastography and strain elastography. Both the shear-wave speed (Vs) and strain histogram were measured 3 times and median values were evaluated. Relevant recorded clinical data were age, sex, and height. RESULTS:  From May 2020 to October 2021 a total of 90 patients (21 male, 69 female) were included in the study. Their average age was 26 years (from 22 to 65). The average SWM in kPa was 6.07 (2.58-17.29). The average value of SE was 134.44 (78.51-184.35). Most of the patients had BMI in the range of normal weight with an average value of 22.75 (17.5-28). The average depth of the localization of the pancreas was 4.5 cm. The effect of BMI on the strain histogram was significant (p < 0.05). We found a significant relationship between the strain histogram and the depth of localization of the pancreas (p < 0.01). CONCLUSION:  We described normal values for pancreatic stiffness using ultrasound elastography by 2D-SWE and strain elastography. Our results indicate changes in values depending on BMI and depth of the pancreas. (Tab. 1, Fig. 5, Ref. 19).

Rare cause of spontaneous spleen bleeding: a case report and literature review.

Rupture of the spleen is a serious medical condition manifesting as a sudden abdominal event, potentially life-threatening. Spontaneous spleen rupture is a rare condition. Atraumatic rupture of the spleen is a very unlikely condition. Risk factors include splenomegaly, hemato-oncological diseases, and infections, such as malaria or infectious mononucleosis. Extremely rare is splenic rupture described in autoimmune disease or vasculitis. There has been no reported case of spontaneous splenic rupture as a first manifestation of Churg- Strauss syndrome so far.

Cancer stem cell marker expression and methylation status in patients with colorectal cancer.

The number of individuals diagnosed with colorectal cancer (CRC) has been on an alarming upward trajectory over the past decade. In some countries, this cancer represents one of the most frequently diagnosed types of neoplasia. Therefore, it is an important demand to study the pathology underlying this disease to gain insights into the mechanism of resistance to treatment. Resistance of tumors to chemotherapy and tumor aggressiveness have been associated with a minor population of neoplastic cells, which are considered to be responsible for tumor recurrence. These types of neoplastic cells are known as cancer stem cells, which have been previously reported to serve an important role in pathogenesis of this malignant disease. Slovakia has one of the highest incidence rates of CRC worldwide. In the present study, the aim was to classify the abundance of selected stem cell markers (CD133, CD166 and Lgr5) in CRC tumors using flow cytometry. In addition, the methylation status of selected genomic regions of CRC biomarkers (ADAMTS16, MGMT, PROM1 (CD133), LGR5 and ALCAM) was investigated by pyrosequencing in a cohort of patients from Martin University Hospital, Martin, Slovakia. Samples from both primary tumors and metastatic tumors were tested. Analysis of DNA methylation in the genomic regions of indicated five CRC biomarkers was also performed, which revealed the highest levels of methylation in the A disintegrin and metalloproteinase with thrombospondin motifs 16 and O6-methyguanine-DNA methyl transferase genes, whereas the lowest levels of methylation were found in genes expressing prominin-1, leucine-rich repeat-containing G-protein-coupled receptor 5 and activated leukocyte cell adhesion molecule. Furthermore, tumor tissues from metastases showed significantly higher levels of CD133+ cells compared with that in primary tumors. Higher levels of CD133+ cells correlated with TNM stage and the invasiveness of CRC into the lymphatic system. Although relatively small number of samples was processed, CD133 marker was consider to be important marker in pathology of CRC.

Establishment of PANDA - a new human pancreatic ductal adenocarcinoma cell line with 3D cell culture technology.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive type of malignancy with one of the worst prognoses amongst any type of cancer. Surgery is applicable only to the limited number of patients with locally resectable tumors and currently represents the only curative treatment option. Treatment with chemotherapy and radiotherapy can only extend patient survival. Despite advances in conventional therapies, the five-year survival of PDAC remained largely unchanged. New in vitro and in vivo models are therefore urgently needed to investigate this type of cancer. Here, we present the establishment and characterization of a novel pancreatic cancer cell line, isolated from a patient with PDAC. Cell line abbreviated as PANDA (PANncreatic Ductal Adenocarcinoma) was established with an optimized 3D culture protocol published previously by our group. The new cancer cell line "PANDA" represents a novel in vitro approach for PDAC cancer research and new therapy testing.

Preoperative stenting in insulinoma located nearby pancreatic duct: a case report and literature review.

Insulinoma is a rare functional neuroendocrine tumor of pancreas. The only recommended treatment is surgical removal. We present a case of a 46-year-old female patient who underwent the enucleation of insulinoma localized nearby pancreatic main duct after preoperative endoscopic insertion of pancreatic stent. The tumor was safely identified during the surgery and was enucleated without injury of pancreatic duct or postoperative complications.

[Rare diagnostics of infective endocarditis after kidney transplantation]. / Raritná diagnostika infekcnej endokarditídy po transplantácii oblicky.

INTRODUCTION: Infective endocarditis in a patient after kidney transplantation is a serious infective complication which increases the risk of loss of the graft and also the mortality of patients. The most important predisposing factor is the immunosuppressive therapy - mainly induction immunosuppression.Material and case description: 250 patients underwent kidney transplantation throughout the period of 12 years in the Transplant Center Martin. This set of patients included 5 patients (2 %) after heart valve replacement. We present the case of a patient after kidney transplantation with development of endocarditis of the bioprosthesis of the aortic valve one month after successful kidney transplantation. Diagnostics of endocarditis by standard procedures (examination by transthoracic echocardiogram, transesophageal echocardiography, hemocultures) was unsuccessful. We rarely diagnosed endocarditis only by PET-CT examination with a consequent change of the antibiotic treatment and successful managing of this post-transplant complication. CONCLUSION: Endocarditis after kidney transplantation is a serious complication which significantly worsens the mortality of patients. The risk of development of infective endocarditis after transplantation is also increased by induction, mainly by antithymocyte globulin. Diagnostics only by PET-CT examination is rare; however, in this case it fundamentally changed the approach to the patient and led to a successful treatment.