Abdominal emergencies in surgical oncology.

INTRODUCTION: In general, abdominal emergencies are urgent situations that require a prompt and correct diagnosis and treatment. They involve a broad spectrum of diagnoses and can occur in all age groups. The situation is often modified in oncologic patients according to the extent and level of progression of the primary oncological disease. METHODS: A retrospective study was conducted to analyze the group of adult patients with abdominal emergencies treated in Masaryk Memorial Cancer Institute between 2011-2017. RESULTS: In total, 601 patients underwent emergency surgery during the 7-year period. The causes included gastrointestinal obstruction (43%), intra-abdominal inflammatory complications (33%) and bleeding (17%). Acute appendicitis or cholecystitis was the cause in only less than 4% of all patients. CONCLUSION: The problems of acute abdominal emergencies in oncologic patients are substantially different from those in the general population, particularly in terms of the causes where gastrointestinal obstruction is the leading cause.

[Mixed adenoneuroendocrine carcinoma (MANEC) of the gastrointestinal tract]. / Smísený adenoneuroendokrinní karcinom (MANEC) gastrointestinálního traktu.

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumour of the gastrointestinal tract composed of adenocarcinoma and neuroendocrine carcinoma. This pathologic diagnosis was recently defined by the WHO in 2010. The tumour may appear in various levels of the digestive tract including the oesophagus, stomach, colon and appendix. Biological behaviour of MANEC seems to be quite unpredictable and the prognosis uncertain. The disease may also mimic "simple" carcinoma. Only several tens of cases have been reported so far.Our first case was diagnosed as gastric adenocarcinoma mimicking early gastric cancer in a 47 years old male. The second case was diagnosed incidentally in the appendix of a 69 years old female after operation for gynaecologic cancer. The disease was localised in both patients; the patients underwent radical surgical resections.Treatment options have not been standardised yet, but aggressive therapeutic measures are recommended. The patients may benefit from multimodal anticancer therapy.Key words: mixed adenoneuroendocrine carcinoma - MANEC - gastric cancer - appendiceal cancer.

[Malignant tumors of the small bowel]. / Maligní nádory tenkého streva.

INTRODUCTION: Malignant tumors of the small bowel are relatively uncommon neoplasms; their incidence is around 1.5 per 100,000 inhabitants in the Czech Republic. METHOD: 104 patients underwent a resection of the small bowel because of a primary or secondary tumor over the 10-year period between 20062015 at the Masaryk Memorial Cancer Institute. Data from these patients was reviewed retrospectively. Survival rates were analyzed using the Kaplan-Meier method. RESULTS: We observed 45 primary and 59 secondary tumors. The group of primary malignancies included 12 adenocarcinomas, 14 cases of GIST and 19 cases of NET. Neuroendocrine tumors showed the best prognosis with a 62% probability of five-year survival. Patients with gastrointestinal stromal tumors had a 39% probability of five-year survival and those with adenocarcinomas had a 32% probability of five-year survival. Secondary tumors were caused mostly by metastatic colorectal carcinoma (22 times), malignant melanoma (11 times) and ovarian cancer (10 times). The probability of five-year survival was 15% in the group of secondary tumors. CONCLUSION: Malignant tumors of the small intestine are rare, but their incidence has increased in the last decades. The main prognostic factors include advancement of the tumor and radicality of surgical resection.Key words: small bowel tumors - adenocarcinoma - sarcoma - NET - GIST - lymphoma.

Approaching truly freestanding graphene: the structure of hydrogen-intercalated graphene on 6H-SiC(0001).

We measure the adsorption height of hydrogen-intercalated quasifreestanding monolayer graphene on the (0001) face of 6H silicon carbide by the normal incidence x-ray standing wave technique. A density functional calculation for the full (6√3×6√3)-R30° unit cell, based on a van der Waals corrected exchange correlation functional, finds a purely physisorptive adsorption height in excellent agreement with experiments, a very low buckling of the graphene layer, a very homogeneous electron density at the interface, and the lowest known adsorption energy per atom for graphene on any substrate. A structural comparison to other graphenes suggests that hydrogen-intercalated graphene on 6H-SiC(0001) approaches ideal graphene.

Effect of conventional and intensified milk replacer feeding programs on performance, vaccination response, and neutrophil mRNA levels of Holstein calves.

This study compared conventional and intensified milk replacer feeding regimens on growth, intake, respiratory and fecal scores, vaccination response, and neutrophil mRNA levels. Holstein calves were randomly assigned to a 10-wk study on d 2 of life. Treatments were conventional (CON; n=8) and intensified (INT; n=7) milk replacer feeding programs. Conventional calves were fed a 20.8% crude protein and 21.0% fat milk replacer at 1.25% of birth body weight (BW) from wk 1 to 6 of life and 0.625% of birth BW during wk 7. A 29.3% crude protein and 16.2% fat milk replacer was fed to INT calves at 1.5% of birth BW during wk 1, 2% of current BW from wk 2 to 6, and 1% of current BW during wk 7. All calves were given milk replacer twice daily during wk 1 to 6, once daily during wk 7, and were weaned completely during wk 8. Calf starter intake was measured daily through wk 8. Body weight and withers height were measured weekly. Fecal and respiratory scores were recorded twice daily at feeding. Calves were vaccinated against ovalbumin at the end of wk 1, 3, and 5. Blood samples were collected at the end of wk 1, 3, 5, and 8 for analysis of serum anti-ovalbumin IgG concentration and for isolation of neutrophils. Quantitative PCR was used to measure neutrophil mRNA levels of 7 functionality genes. Treatment did not affect total DMI or anti-ovalbumin IgG response. Intensified milk replacer feeding increased average daily gain, protein intake, fat intake, and feed efficiency compared with the CON feeding program. Compared with CON calves, INT calves had greater fecal scores, indicating looser feces and greater respiratory scores, indicating more respiratory problems. Calves assigned to the INT treatment had increased neutrophil mRNA levels of L-selectin, and at wk 8, neutrophil cytosolic factor 1 was increased and toll-like receptor 4 tended to be increased compared with CON calves. This suggests greater activation of neutrophils in INT calves postweaning, but differences were relatively small and levels of the other 4 genes were unaffected. An INT milk replacer feeding program increased growth, fecal scores, and respiratory scores preweaning, increased mRNA levels of 2 neutrophil genes postweaning, and did not affect vaccination response.

Immune responses in lactating Holstein cows supplemented with Cu, Mn, and Zn as sulfates or methionine hydroxy analogue chelates.

The aim of this study was to compare effects of inorganic sulfate versus chelated forms of supplemental Cu, Mn, and Zn on milk production, plasma and milk mineral concentrations, neutrophil activity, and antibody titer response to a model vaccination. Holstein cows (n=25) were assigned in 2 cohorts based on calving date to a 12-wk randomized complete block design study. The first cohort consisted of 17 cows that had greater days in milk (DIM; mean of 77 DIM at the start of the trial) than the second cohort of 8 cows (32 DIM at the start of the trial). Diets were formulated to supplement 100% of National Research Council requirements of Cu, Mn, and Zn by either inorganic trace minerals (ITM) in sulfate forms or chelated trace minerals (CTM) supplied as metal methionine hydroxy analog chelates, without accounting for trace mineral contribution from other dietary ingredients. Intake and milk production were recorded daily. Milk composition was measured weekly, and milk Cu, Mn, and Zn were determined at wk 0 and 8. Plasma Cu and Zn concentrations and neutrophil activity were measured at wk 0, 4, 8, and 12. Neutrophil activity was measured by in vitro assays of chemotaxis, phagocytosis, and reactive oxygen species production. A rabies vaccination was administered at wk 8, and vaccine titer response at wk 12 was measured by both rapid fluorescent focus inhibition test and ELISA. Analyzed dietary Cu was 21 and 23mg/kg, Mn was 42 and 46mg/kg, and Zn was 73 and 94mg/kg for the ITM and CTM diets, respectively. No effect of treatment was observed on milk production, milk composition, or plasma minerals. Dry matter intake was reduced for CTM compared with ITM cows, but this was largely explained by differences in body weight between treatments. Milk Cu concentration was greater for CTM than ITM cows, but this effect was limited to the earlier DIM cohort of cows and was most pronounced for multiparous compared with primiparous cows. Measures of neutrophil function were unaffected by treatment except for an enhancement in neutrophil phagocytosis with the CTM treatment found for the later DIM cohort of cows only. Rabies antibody titer in CTM cows was 2.8 fold that of ITM cows as measured by ELISA, with a trend for the rapid fluorescent focus inhibition test. Supplementation of Cu, Mn, and Zn as chelated sources may enhance immune response of early lactation dairy cows compared with cows supplemented with inorganic sources.

[Pneumoscrotum: uncommon sign in duodenal perforation (a case review)]. / Pneumoskrotum: nezvyklý symptom pri perforaci duodena (kazuistika).

Therapeutic endoscopy is mostly primary method in treatment of biliary tree obstruction with its various complications. A case review describing an oncological pacient examined for obstructive icterus, with recognised pneumoscrotum after endoscopic examination (ERCP). In discussion we try to point out the need of knowledge of clinical examination, clinical signs of duodenal lesions and optimal treatment measures.

Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal metastases from colorectal cancer in the Czech Republic in 2018.

BACKGROUND: For highly selected patients with peritoneal metastases (PM) from colorectal cancer (CRC), an aggressive surgical approach with intraperitoneal chemotherapy may be beneficial. This management may prolong overall survival, which is well documented by the results of a number of clinical trials. In the Czech Republic, five specialized centers of surgical oncology are able to perform cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). All of these centers provided accurate information on the number of CRS procedures in 2018 in the PM CRC indication. The estimation of the prevalence of peritoneal metastases from CRC is based on data from the Czech National Cancer Registry. PURPOSE: To determine the number of cytoreductive procedures performed in patients with peritoneal metastases from CRC in the Czech Republic in 2018, and to compare it with the number of patients who could hypothetically benefit from this procedure according to statistical data. RESULTS: Twenty-five CRS/HIPEC procedures were performed on patients with peritoneal metastases from CRC in 2018 in the Czech Republic. However, based on the prevalence of peritoneal metastases from CRC in the Czech Republic, cytoreduction with intraperitoneal chemotherapy (CRS/HIPEC) could probably bring benefit to a minimum of 150 patients a year in the Czech Republic. CONCLUSION: In the Czech Republic in 2018, the cytoreduction and HIPEC procedures for peritoneal metastases from CRC were performed in significantly fewer cases than would correspond to the estimated number of potentially curable patients.To increase the awareness of this issue and improve the number of potentially curative cytoreductive procedures, there will be necessary better awareness and closer cooperation among specialized centers, general surgeons, and clinical oncologists.

[Gastrointestinal metastases of malignant melanoma]. / Gastrointestinální metastázy maligního melanomu.

INTRODUCTION: Malignant melanomas are aggressive malignant tumors with major potential for the development of distant metastases. The authors present five case reviews of melanoma intestinal metastases, which were managed surgically. BASE REVIEW 1: A male, 65 y.o.a, underwent planned resection of the small intestine infiltrated with metastases 19 months after he was diagnosed with skin melanoma. During his follow up period, he died of complications of cerebral metastases of the tumor. BASE REVIEW 2: A female, 34 y.o.a, 5 months after the first occurrence of signs of the disease, which included neurological symptoms resulting from a brain metastasis. She was urgently operated for ileus, caused by a jejunal metastis of the tumor. The patient died following dissemination of the primary tumor 2 months after her abdominal procedure. BASE REVIEW 3: A female, 30 y.o.a. 52 months after removal of her skin melanoma, she was urgenty operated for ileus, caused by a jejunal metastasis of the tumor. She had no postoperative complications. BASE REVIEW 4: A female, 68 y.o.a, 26 months after being diagnosed with skin melanoma, underwent planned abdominal revision for multiple intestinal metastases. She died of massive pulmonary embolization on the postoperative Day 6. BASE REVIEW 5: A male, 76 y.o.a, underwent resection of a sigmoid metastasis 72 months after his skin melanoma excision. Further course of the disease shows no signs of the primary disease recurrence, the patient is surviving 153 months after the primary diagnosis establishment, 59 months after the distant large intestinal metastasis resection. DISCUSSION: The authors present literature overview, assessing contribution of surgery in the management of malignant melanomas with GIT metastases. The literature data show that complete resections of all GIT metastatic melanoma foci result in the mean survival time prolongation in selected patients.

Effect of abomasal carbohydrates and live yeast on measures of postruminal fermentation.

Two studies were conducted to evaluate the effects of abomasal carbohydrate infusion on nutrient digestibility and fecal measures. In Exp. 1, 5 Holstein steers were assigned to a Latin square with 1-wk periods and were abomasally infused on a single day at the end of each period with water alone, a single pulse dose of water with 1 g/kg BW oligofructose or cornstarch, or 4 pulse doses of water with 0.25 g/kg BW oligofructose or cornstarch administered every 6 h. Total tract nutrient digestibility was not affected by treatment except for a tendency for a decrease in starch digestibility in response to the 1 g/kg BW dose of cornstarch ( < 0.10). Compared with the control, both oligofructose and starch infusions caused similar decreases in fecal pH ( < 0.05) and increases in fecal short-chain fatty acids ( ≤ 0.01) measured 12 h after the first infusion, with the single 1 g/kg BW infusions causing a greater magnitude of pH change compared with the four 0.25-g/kg BW infusions ( < 0.01). All treatments increased concentration of fecal lipopolysaccharide compared with the control for at least 1 time point following the infusion ( < 0.05), with a greater increase observed for the 0.25 g/kg BW infusions of oligofructose compared with the other treatments ( < 0.05). Results of Exp. 1 indicate that both oligofructose and cornstarch infusions increased carbohydrate fermentation in the intestines and can be used as a method to evaluate the impact of excessive intestinal fermentation on intestinal health. In Exp. 2, 6 Holstein steers received abomasal pulse doses of 0 (control) or 10 g/d live var. (SB) according to a crossover design with 18-d periods. Abomasal infusions of 4 pulse doses of 0.25 g/kg BW oligofructose administered every 6 h were conducted on d 16 of each period. During the baseline period prior to the oligofructose challenge, there were no effects of SB on fecal measures except for an increase in apparent total tract NDF digestibility ( < 0.05), suggesting that SB increased intestinal fiber fermentation. During the oligofructose challenge, SB increased fecal score ( = 0.03) and tended to reduce fecal short-chain fatty acids ( = 0.10). Results of Exp. 2 suggest that abomasal SB modestly stabilized the intestinal environment during increased carbohydrate fermentation.

Breast imaging. A practical look at its capabilities and its limitations.

The film-screen technique is evolving as the standard for mammography. Sonography is the only other method that currently has a defined role in breast imaging. Mammography should be performed at facilities that have received American College of Radiology accreditation or its equivalent, because technical quality assurance is an important part of mammographic practice. Interpretive quality may be assured by outcome audits performed by mammography facilities. Primary care physicians are best suited to encouraging eligible women to undergo screening studies and should consider these recommendations: Refer patients for screening mammography to accredited facilities according to established guidelines. Educate patients about the need for regular screening. Provide annual breast physical examination. Refresh your knowledge on breast health and the techniques of physical examination if necessary. Teach patients breast self-examination techniques. Demand low-cost, high-quality screening mammography; be aware of local variability of charges and quality.

Vaginal douching. Pros, cons, and proper technique.

Vaginal douching is not necessary in routine feminine hygiene. When performed infrequently it is not harmful, but frequent douching may lead to recurrent vaginitis and mucosal irritation or ulceration. Douching should not be performed during pregnancy.

[Prevalence of bronchial asthma, chronic bronchitis and bronchial hyperreactivity in the adult population in the Prague 8 district]. / Výskyt bronchiálního astmatu, chronické bronchitidy a bronchiální hyperreaktivity u dospelých obyvatel Prahy 8.

The prevalence was assessed in a randomized group of 18-year-old and older inhabitants of Prague 8. A total of 8458 internationally tested questionnaires were sent out to a population of 90,458; information was obtained on 7605 (89.9%), 1274 were given a detailed examination by standardized methods. Cumulative prevalence of bronchial asthma (B): 2.3% +/- 0.3% (same in M and F). The highest values at the age of 18-20 years were 3.5%; 3.6% in the age group 21-30 years, the absolutely highest values--4.6%--were recorded in 18-year-old men. Contemporary prevalence of BA: 1.99%. In BA bronchial obstructions were found in 51%, bronchial hyperreactivity in 75%, positive skin tests in 71%, an increase of IgE in 36%. Prevalence of chronic bronchitis (CHB): 14.1%; men 17.6% women--11.3%, highest value--18.9%--in the age group 70-80 years; absolutely highest values were recorded in men aged 70-80 years--20.9%. In CHB there was a bronchial obstruction in 55% and this obstruction was reversible in 40%. In the group CHB bronchial asthma was recorded in 20%. Prevalence of bronchial hyperreactivity (BHR) was estimated from results of broncho-provocative tests and from the calculation according to prevalence of BHR in respiratory diseases. The thus calculated figure was 13.7%. The incidence of bronchial asthma in chronic bronchitis in 1/6 and of bronchial hyperreactivity in more than 1/10 of the adult population are striking facts. It is essential to find the causes of these findings and make effective provisions to counteract them.

[Compression anastomosis in acute resection of the colon]. / Kompresivní anastomóza u akutní resekce tracníku.

The authors draw attention to the possible use of a biofragmentable anastomotic ring (BAR) for anastomosis of the gut, used by the authors for construction of an anastomosis after acute resection of the colon under particularly risky conditions with infection and advanced deterioration of the intestinal wall. In both instances when this alternative method was used the postoperative course was uneventful and the patients were discharged without complications into domiciliary treatment.

[Adenocarcinoma of the appendix--case report]. / Adenokarcinom apendixu--kazuistika.

The authors describe a case with a rare diagnosis of adenocarcinoma of the appendix in an adult female patient. The patient was indicated for surgical revision on account of acute appendicitis with a peroperative finding suspect of malignity of the vermiform appendix. A radical resection of the ileocoecal area was performed along with part of the ascendant colon and appropriate mesocolon as a primary operation. According to the postoperative histological evaluation of the resected portion the diagnosis of adenocarcinoma of the appendix was confirmed.

Effects of abomasal oligofructose on blood and feces of Holstein steers.

Subacute ruminal acidosis can result in increased flow of fermentable substrates to the hindgut, which can negatively affect animal health and productivity. However, animal responses to increased hindgut fermentation independent of subacute ruminal acidosis have rarely been evaluated. This study determined the impact of abomasal dosage of a fermentable carbohydrate on animal performance and blood and fecal variables. Six ruminally cannulated Holstein steers fed a lactating dairy cow ration were used in a crossover design study with 14-d periods. On d 13 of each period, steers were infused abomasally with a pulse dose of 0 (control) or 1 (Oligo) g of oligofructose/kg of BW. Blood samples collected at 0, 3, 6, 9, 12, and 24 h after abomasal oligofructose dose were evaluated for metabolites (blood urea N, ß-hydroxybutyric acid, and NEFA) and systemic inflammatory markers (Cu, serum amyloid A, and haptoglobin). Fecal samples, rectal temperature, heart rate, and respiratory rate were taken at 0, 3, 6, 9, 12, 24, and 48 h after abomasal dosage. Fecal samples were assayed for pH, DM percentage, consistency score (1=liquid to 5=coarse), and organic acid concentrations. Data were evaluated using a model including the fixed effects of treatment, time after dosage, and their interaction. Effects of treatment or treatment × time were not significant for DMI, blood variables, rectal temperature, or respiratory rate. Fecal pH was slightly reduced for Oligo compared with control steers (6.76 vs. 7.02; P=0.04). A treatment × time interaction occurred for fecal DM (P < 0.001). Compared with control steers, DM content of feces was reduced in Oligo steers at 6 h (12.6 vs. 15.2%) but increased at 9 h (16.3 vs. 15.0%) and 12 h (16.5 vs. 15.0). Fecal consistency score was reduced by the Oligo treatment at 6 h (1.44 vs. 2.83; P < 0.001) and 9 h (1.83 vs. 2.67; P=0.005). A treatment × time interaction was detected for fecal concentrations of lactate and acetate (P < 0.05) and tended to occur for propionate and butyrate (P < 0.10). The greatest difference for all organic acids occurred at 12 h, when fecal concentrations of lactate, acetate, propionate, and butyrate were 0.5, 47, 11, and 4.0 mM in control steers and 5.3, 76, 15, and 6.8 mM in Oligo steers, respectively. In summary, abomasal dosage of 1 g of oligofructose/kg of BW increased fecal excretion of microbial fermentation products in steers without causing metabolic acidosis, metabolic disruption, or inflammation.

The effects of hypothermia on coronary artery bypass graft surgery.

This article will discuss how induced hypothermia affects the patient undergoing coronary artery bypass graft surgery. Nursing interventions differ greatly for cardiac procedures done on cardiopulmonary bypass versus off-bypass procedures, such as "keyhole." Induced hypothermia, cardiopulmonary bypass, cardioplegia, and various delivery techniques of cardioplegia, and postoperative hypothermia will be discussed.

Mass mammography screening: using an information system to track participation and identify target populations.

This article describes the 1991 American Cancer Society Greater Tampa Bay Breast Screening Program and an information system developed to track participants from the point of inquiry to mammography results. Information from three sources was linked to create a comprehensive data base, including participant demographics, mammography history, perceived risks of breast cancer, barriers to mammography, and mammography results. This comprehensive data base allowed investigators to describe the 11,134 participants and to assess the program's impact. The analysis suggested that women older than 65 years are underrepresented in this voluntary program. Black women were less likely to participate, as were women in lower income and education groups. To reduce mortality effectively, leaders of mass screening programs need to develop creative strategies for reaching these high-risk groups. Effective information systems can identify program weaknesses and track the impact of changes.

Reproductive anatomy, manipulation of ovarian activity and non-surgical embryo recovery in suni (Neotragus moschatus zuluensis).

Marked disparity in the uterine horn dimensions and relative degrees of caruncle development in suni suggested that exclusive or predominant dextral implantation occurs in association with bilateral ovulatory activity. Daily urinary measurements of pregnanediol-3 alpha-glucuronide revealed an oestrous cycle of approximately 21 days in length. Ovarian activity was controlled for synchronization of oestrus by using progestagen-impregnated intravaginal sponges and multiple ovulations were induced by using exogenous gonadotrophin therapy. An effective transcervical uterine catheterization technique was developed for the non-surgical collection of embryos. The efficiency of embryo recovery performed 5 days after sponge removal was 50.0%.