Pneumoperitoneum, pneumomediastinum and subcutaneous emphysema following argon plasma coagulation treatment of colonic angioectasia.

INTRODUCTION: The paper presents unusual symptoms as a complication of therapeutic colonoscopy. CASE REPORT: A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment. CONCLUSION: Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.

Hydroxycinnamic Acids and Their Related Synthetic Analogs: An Update of Pharmacological Activities.

The hydroxycinnamic acid scaffold is extremely versatile with various biological activities. This review will highlight the progress of the biological activities of hydroxycinnamic acids and their related synthetic analogs, including recently reported anti-cancer, anti-inflammatory, and antioxidant activities.

New treatment modalities in the early stage and locally advanced non-small cell lung cancer.

The lung cancer dia-gnosis is still connected with high mortality. Even the new anticancer drugs are not able to preserve long survival in the advanced lung cancer patients. Only a minority of patients is diagnosed with early or locally advanced stages. In the following review, we present interesting data regarding the treatment updates in these potentially curable patients.

Is high age a contraindication to pulmonary resection?

INTRODUCTION: As the population ages, there are increasing numbers of elderly patients diagnosed with operable primary pulmonary malignancy or other lesions requiring pulmonary resection. The objective of the study was to evaluate post-operative outcomes in the elderly group and compare them with younger patients undergoing the same surgery. METHODS: Retrospectively, we evaluated our own set of 424 patients undergoing anatomical pulmonary resection for primary lung cancers and other resectable lesions in 20112020. 328 patients underwent open procedures, and VATS lobectomy was performed 96 times. We evaluated the set of patients in terms of 30-day morbidity and mortality using Clavien-Dindo classification modified for pulmonary resections. We compared the patient subgroups by age (under 55, 5564 years old, 6574 years and over 75 years). RESULTS: A non-biometric Kruskal-Wallis test was used to compare the groups. We have not shown a statistically significant difference in the number of complications (p=0.220). CONCLUSION: Standard surgical treatment for non-small cell lung carcinoma, lobectomy with systematic mediastinal lymphadenectomy, is safe also for a well-indicated group of seniors. With careful preoperative assessments and consideration of the extent of resection, we can expect a comparable rate of complications in the elderly compared to younger patients. Sublobar resection or radiotherapy should be considered in case of patients at risk. For seniors over 70 years of age, comparable outcomes of oncological treatment can be reached, taking into account their shorter life expectancy.

Postpneumonectomy MRSA empyema treated with vacuum therapy - case report and literature review.

INTRODUCTION: Postpneumonectomy empyema is one of serious complications with high mortality and lethality. In this paper, the authors describe the treatment of methicillin-resistant Staphylococcus aureus-induced postpneumonectomy empyema by vacuum therapy in a patient operated on for malignant pleural mesothelioma. CASE REPORT: A 64-year-old patient was operated on at our clinic for epithelioid mesothelioma of the right pleural cavity. We performed extrapleural pneumonectomy with intraoperative hyperthermic intrathoracic chemotherapy. Seven weeks after surgery the patient was readmitted for right pleural cavity empyema caused by methicillin-resistant Staphylococcus aureus (MRSA). Following pleural cavity debridement and mesh explantation we applied vacuum therapy. In total, we performed 4 dressing changes with final application of an antibiotic solution into the pleural cavity and wound closure. The patient showed no evidence of recurrent empyema during subsequent 12-month follow-up and underwent chemotherapy. CONCLUSION: Vacuum therapy is an effective treatment of postpneumonectomy empyema in patients without a bronchopleural fistula; nevertheless, specific postpneumonectomy patient care is required.

Pulmonary metastases in pseudomyxoma peritonei - case report and review of the literature.

Pseudomyxoma peritonei is a rare disease caused by dissemination of cancer forming mucous and gelatinous masses in the peritoneal cavity. Local recurrence is frequent; however, dissemination outside the peritoneal cavity is rare.  Case report: We present the case report of a female patient treated for bilateral pulmonary metastases from pseudomyxoma peritonei. We removed 1 metastasis from her left lung and 12 metastases form her right lung. The patient remained in a good clinical state; however, additional lung metastases developed, as well as a metastasis in L2 vertebra for which the patient underwent a surgical procedure. Conclusion: Cytoreductive surgeries for intrathoracic involvement in pseudomyxoma peritonei with additional hyperthermic cytostatic intrapleural lavage in case of pleural involvement can lead to a longer lifespan in indicated patients.

New Zileuton-Hydroxycinnamic Acid Hybrids: Synthesis and Structure-Activity Relationship towards 5-Lipoxygenase Inhibition.

A novel series of zileuton-hydroxycinnamic acid hybrids were synthesized and screened as 5-lipoxygenase (5-LO) inhibitors in stimulated HEK293 cells and polymorphonuclear leukocytes (PMNL). Zileuton's (1) benzo[b]thiophene and hydroxyurea subunits combined with hydroxycinnamic acid esters' ester linkage and phenolic acid moieties were investigated. Compound 28, bearing zileuton's (1) benzo[b]thiophene and sinapic acid phenethyl ester's (2) α,ß-unsaturated phenolic acid moiety 28, was shown to be equipotent to zileuton (1), the only clinically approved 5-LO inhibitor, in stimulated HEK293 cells. Compound 28 was three times as active as zileuton (1) for the inhibition of 5-LO in PMNL. Compound 37, bearing the same sinapic acid (3,5-dimethoxy-4-hydroxy substitution) moiety as 28, combined with zileuton's (1) hydroxyurea subunit was inactive. This result shows that the zileuton's (1) benzo[b]thiophene moiety is essential for the inhibition of 5-LO product biosynthesis with our hydrids. Unlike zileuton (1), Compound 28 formed two π-π interactions with Phe177 and Phe421 as predicted when docked into 5-LO. Compound 28 was the only docked ligand that showed a π-π interaction with Phe177 which may play a part in product specificity as reported.

Extraction, Antioxidant Capacity, 5-Lipoxygenase Inhibition, and Phytochemical Composition of Propolis from Eastern Canada.

Soxhlet (SE), microwave-assisted (MAE) and ultrasound-assisted (UAE) extraction were compared using ten extraction solvents for their efficiency to extract phenolic and flavonoid antioxidants from Eastern Canada propolis. Extracts were compared for total phenolic (TPC) and total flavonoid (TFC) content, and radical scavenging activities. Anti-inflammatory activity through inhibition of 5-lipoxygenase (5-LO) products biosynthesis in HEK293 cells was also evaluated. The results showed that SE extracts using polar solvents had the highest TPC and TFC. Extracts obtained with ethanol, methanol and acetone were effective free radical scavengers, and showed 5-LO inhibition similar to zileuton. UAE was an effective extraction method since the extracts obtained were comparable to those using SE and the MAE while being done at room temperature. With UAE, extracts of less polar solvents showed similar free radical scavenging and 5-LO inhibition to extracts of much more polar solvents such as methanol or ethanol. Reversed-phase liquid chromatography tandem mass spectrometry confirmed the presence of 21 natural compounds in the propolis extracts based on the comparison of intact mass, chromatographic retention time and fragmentation patterns derived from commercial analytical standards. The current study is the first of its kind to concurrently investigate solvent polarity as well as extraction techniques of propolis.

Splenic abscess as a rare symptom of the extrapulmonary tuberculosis - case report.

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.

[Double incision laparoscopic surgery]. / Laparoskopická chirurgie ze dvou incizí.

INTRODUCTION: Single incision laparoscopic surgery (SILS) is a common alternative to classical laparoscopic surgery. However, material costs of SILS significantly limit the spreading of this method to most of surgical departments in the Czech Republic. Therefore we introduced DILS, which is technically more difficult than 3- to 4-incision laparoscopy but comparable cost-wise and its result approaches the cosmetic effect of SILS. METHODS: We describe the technical approach for DILS. We evaluate our own group of patients who were operated on in 2012-2014. RESULTS: Nine minor complications evaluated as Clavien-Dindo grade I-IIIb were seen in the group of 64 patients undergoing laparoscopic cholecystectomy, appendectomy or TAPP operation of groin hernias using DILS method. DILS-cholecystectomy was converted to multiple-ports laparoscopy 4 times. CONCLUSION: In our group, DILS did not present a higher complication rate than laparoscopic surgery using multiple incisions. This method is well-regarded by the patients in terms of its aesthetic results, and economically it is more advantageous than SILS. KEY WORDS: minimally invasive surgery - SILS - double incision laparoscopic surgery.

NF-κB/p65 expression before and after treatment in rectal cancer patients undergoing neoadjuvant (chemo)radiotherapy and surgery: prognostic marker for disease progression and survival.

Nuclear factor-kappaB (NF-κB), especially p65 subunit, has been associated with origin and progression of cancer as well as with the resistance to radiotherapy and chemotherapy in experimental models. The aim of the present study was to determine expression of NF-κB/p65 in tumor specimens before and after treatment of rectal cancer patients and to evaluate possible relationship between expression of NF-κB/p65 before and after (chemo)radiotherapy, other tumor characteristics and the clinical outcome. Furthermore, NF-κB/p65 was studied in relationship to pathologic response to preoperative (chemo)radiotherapy. Fifty patients with rectal cancer undergoing neoadjuvant (chemo)radiotherapy and surgery were included in the study. Pre-treatment rectal cancer specimens were obtained from diagnostic colonoscopy. Post-treatment rectal cancer specimens were obtained from surgically removed part of the rectum with the tumor. NF-κB/p65 expression was determined by immunohistochemistry and analysis was performed both in biopsies and in post-treatment tumor samples. Cytoplasmic positivity in tumor cells and nuclear positivity in lymphocytes were detected. High NF-κB/p65 positivity in pre-treatment tumor samples was significantly associated with shortened overall survival (OS). Disease-free survival (DFS) tends to be shortened as well. In post-treatment tumor samples, high NF-κB/p65 positivity was neither associated with shortened OS nor with shortened DFS. In post-treatment samples residual tumor cells deeply infiltrating the wall of the rectum with high NF-κB/p65 expression were found. The cells were linked to significantly worse clinical outcome in terms of shortened OS and DFS. NF-κB/p65 positivity did not correlate with pathologic response to preoperative (chemo)radiotherapy. In conclusion, our data suggest that high level of NF-κB/p65 subunit may be associated with more aggressive features of the tumor, higher metastatic potential, and shortened overall survival, but it does not correlate with resistance to (chemo)radiotherapy. Consequently, the level of NF-κB/p65 may help to select those patients who have poor prognosis and are candidates for more intensive anticancer therapy. For these purposes both pre-treatment and post-treatment tumor samples may be used.

Differential expression and processing of matrix metalloproteinase 19 marks progression of gastrointestinal diseases.

Matrix metalloproteinases (MMPs), responsible for extracellular matrix remodelling and processing of numerous soluble and cell-surface proteins, appear to play important roles in pathogenesis of gastrointestinal diseases. MMPs influence migration of inflammatory cells, mucosal destruction, matrix deposition and degradation. In this study, we analysed the expression of MMP-19 in the main forms of gastrointestinal diseases including inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease, and colorectal carcinoma. We identified prominent MMP-19 expression in unaffected areas of intestinal epithelia and macrophages but not in other cells or tissues. Abundant expression of MMP-19 was also found in the endothelium of blood and lymphatic vessels of inflamed intestinal tissue. High MMP-19 immunoreactivity was also associated with macrophages in inflamed areas and myenteric plexuses. In comparison to the intestinal epithelium, all these cell types and compartments appeared to express MMP-19 irrespective of the disease pathogenesis and progression. Intestinal epithelia exhibited striking differential immunoreactivity for MMP-19. While immunoreactivity of monoclonal antibody recognizing the propeptide domain declined in virtually all IBD and colorectal carcinoma samples, other polyclonal antibodies against the hinge region and propetide domain did not show such an obvious decrease. Additional Western blotting analysis revealed that the antibodies against MMP-19 recognize differently processed forms of this MMP. The disappearance of immunoreactivity of the monoclonal anti-propeptide domain antibody does not mean down-regulation of MMP-19, but processing of the immature form. As this processing likely leads to the activation of this MMP, the differential staining pattern may be an important sign of disease progression.

[Segmental duodenectomy (D3, D4) for angiosarcoma]. / Segmentální duodenektomie (D3, D4) pro angiosarkom.

UNLABELLED: A 66-year-old patient was admitted to the Department of Surgery at the Na Bulovce Hospital (First Faculty of Medicine, Charles University in Prague) following an episode of bleeding into the gastrointestinal tract. Gastroscopy found a large, wide-based sessile polypoid mass, exulcerated at its top and filling a major part of the intestinal lumen. Conclusion based on biopsy: malignant mesenchymal tumour - sarcoma. An abdominal CT scan revealed, besides this tumour, also metastases in the spleen. With regard to the malignant nature of the tumour and from fear of gradual bleeding out, we performed segmental resection of the third and fourth part of the duodenum with complete removal of the tumour. The descending (second) part of the duodenum was sewn end-to-end, about 4 cm underneath the ampulla of Vater, with the first loop of the jejunum, with anastomosis using atraumatic, two-layer continuous suture. Splenectomy was performed at the end of the operation. Post-operative course was without complications, the patient was discharged with regular diet and with restored bowel passage on the eleventh day after surgery. FINAL DIAGNOSIS: high-grade duodenal angiosarcoma, multiple metastases from this tumour in the spleen.

[Single-incision thoracoscopic surgery--SITS]. / Videotorakoskopické operace prístupem z jedné incize--SITS.

INTRODUCTION: To report our initial experience with single-incision videothoracoscopic surgery. MATERIAL AND METHODS: Between 2009 and 2011, we performed 31 operations using this approach. Neither intraoperatively nor postoperatively did we observe any complication related to the change in the surgical approach. DISCUSSION: The aim of this relatively newly introduced technique is to be a further decrease in the thoracic wall traumatisation and thus a further decrease in postoperative pain. The reduction in the incidence of chronic pain and paraesthesiae related to surgical trauma, faster recovery of the patient, shorter hospitalization time as well as shorter sick leave are expected. Benefits also include a good cosmetic result. CONCLUSION: Our first experience is encouraging. A more detailed comparison with multiple-incision VTS will need to be assessed in a prospective study.

[The NanoKnife and two successful cases of intracavitary irreversible electroporation of main bronchus tumours]. / NanoKnife a dva úspesné prípady intrakavitální ireverzibilní elektroporatizace nádoru hlavního bronchu.

We have used the method of irreversible electroporation (IRE) twice to treat central non-small cell lung tumours. Both tumours obstructed the right main stem bronchus. Due to a high risk of right-sided pneumonectomy we chose to apply the tissue sparing device called NanoKnife and an alternative IRE method. The first surgery was performed in August 2011 and the second one in June 2012. The first case was an epidermoid carcinoma, 3 cm in size, which completely obstructed the right main stem bronchus on the boundary line with the upper lobar bronchus and caused lung atelectasis. The second case was a carcinoid, 2 cm in size, which grew from the main stem bronchus to the carina. Pneumonectomy was contraindicated due to lung function in the first case, and the other patient preferred the IRE method to radical but risky resection with bronchoplasty. IRE was performed through open thoracotomy. No complications were detected after the surgery in both cases. The first patient was discharged on the 12th postoperative day and the second one on the 5th postoperative day. 98% regression of the tumour was detected by CT scan in the first patient, and complete regression occurred in the case of the second one. 100% apoptosis and "disparition" of the carcinoma in the first case was verified by bronchoscopy and cytology after 6 months. Both patients remain in follow-up after surgery using the IRE method and are without subjective or objective complaints and without any signs of tumour recurrence. NanoKnife and IRE without lung resection resulted in the destruction of lung tumours while preserving the lung parenchyma and pulmonary functions.

[Procedure on low extremities varicose veins using the VNUS-Closure radiofrequency ablation method]. / Operace varixu dolních koncetin radiofrekvencní ablací metodou VNUS-Closure.

From 01-06-2007 to 31-12-2008, the authors operated 334 patients with low extremities varicose veins, using the VNUS-Closure radiofrequency apparatus, in the surgical department of Príbram regional hospital (Oblastní nemocnice v Príbrami, a.s.). Their first experience is very positive, the method is very elegant, safe and miniinvasive. The mean duration of the procedure on a single lower extremity was 29 minutes, the mean duration of hospitalization was one day. Relapses were recorded in 3 patients in the operated area (0.9%), however, in all the subjects, the relaps affected a side venous branch, never the main branch. The relapses were managed with subsequent sclerotization. The method was patient- friendly, reliable and resulted in early return to work, was little painful and had favourable cosmetic outcomes. These were the factors, which made the patients choose the VNUS-Closure endoluminal radiofrequency method.

[NF-kappaB, colorectal carcinoma and radiotherapy: results of a clinical and experimental study]. / NF-kappaB, kolorektální karcinom a radioterapie: výsledky klinické a experimentální studie.

Resistance to radiotherapy often seen in rectal cancer patients requires intensive study of mechanisms taking part in this process. It seems that nuclear factor-kappaB (NF-kappaB), especially its subunit p65, could play an important role in radioresistance. The aims of this study were: 1. to assess expression of p65 in rectal cancer patients and to evaluate its possible predictive role; 2. to determine in in vitro experiments possibilities of p65 modulation and to evaluate, whether this modulation can result in enhacement of efficiency of radiation therapy. We found that the level of NF-kappaB expression may serve as a predictive marker of overall survival. Further we found that inhibition of NF-kappaB activity caused by radiation improves impact of radiation therapy.

[Lung resection for a non-small cell carcinoma (stage IV) with a permanent intracavitary brachytherapy 125I]. / Resekce plic pro nemalobunecný karcinom (stadium IV) s permanentní intrakavitární brachyterapií 125I.

In November 2005, the authors used the lung resection method in combination with peroperative brachytherapy125 for a non-small cell carcinoma, for the first time. The patient had an adenocarcinoma of the right lung T2N2M0, stage IIIA. During the procedure, the team diagnosed advanced stage of the process, the tumor originated in the hilus region of the middle lobe with a metastatic spread into the superior and inferior lobe. Distant unilateral lymphonodes were infiltrated simultaneously. The histological examination confirmed the diagnosis of T2N2M1, however, the original classification was re-assessed and changed to stage IV. Pneumonectomy with lymphadenectomy of all of the macroscopically detectable lymphonodes was completed. The lymphatic drainage sites in the upper and lower mediastinum were covered by seeds of a permanent gama emitter 125I with a total dose of 100 Gy. The patient recovered with no complications and was discharged on the day 8. He was included in the study and will be followed on a regular basis. On the authors' opinion, the method of the lung resection with peroperative permanent brachytherapy has a potential for decreasing the tumor relaps rates, eventually, for improving the patients survival rates and their quality of life. The authors will continue their applied research of this serious problematics, aiming to confirm or refuse the stated hypothesis.

[Contemporary approach to treatment of the posttraumatic empyema of the thorax]. / Soucasné moznosti lécení poúrazového empyému hrudníku.

INTRODUCTION: Empyema of the thorax is a serious morbidity and mortality causative factor in the postoperative period in severe blunt and penetrating thoracic injuries. The posttraumatic empyema of the thorax results, primarily, from secondary infections of the haemothorax. Current therapeutic management of the posttraumatic empyema of the thorax depends on the disease stage. AIM: A retrospektive analysis of the treatment procedures in patients with posttraumatic empyemas of the thorax. MATERIAL, METHODS, RESULTS: A study group included 118 patients with empyemas of the thorax, who were operated during the period from 1996 - June 2005. The commonest type of the empyema was a parapneumonic empyema, present in 86 (73%) subjects. 15 (13%) patients were operated for posttraumatic empyemas of the thorax. In 13 (11%) patients the empyema followed elective intrathoracic procedures (lung or oesophagus resection). In 4 (3%) cases the empyema resulted from intraabdominal inflammatory disorders. The cause of the posttraumatic empyema of the thorax was a secondary infection following repetitive drainages for the pneumothorax in three patients, infection of the retinated haemothorax in two patients and infection of the pleural exudate from a subphrenic absces following a stab injury of the abdomen in one patient. Another patient developed empyema as a complication of the oesophagus perforation by a foreign body. 8 injured patients with ventilation pneumonias developed parapneumonic empyemas. The patients were indicated for surgeries. Videothoracoscopic procedures (VTS, VATS) proved successful in 4 injured patients with empyemas, stage II. Thoracotomy with decortication was conducted in the remaining 11 injured patients (in 3 of them as a VTS conversion). The postoperative course following the decortication in the injured group with the posttraumatic empyema was complicated by a protracted air leak with a partial pneumothorax in two subjects and by a relaps of the pleural exudate in one operated subject. CONCLUSION: 1. Open thoracotomy with empyemectomy and decortication is a standard treatment method in the thoracic empyema, grade III. 2. The videothoracoscopic procedures (VTS, VATS) are indicated in early forms of the grade II of the disorder. 3. The quality and the result of the therapy depend on the following: the management of the focus of the infection, as well as a sufficient lung expansion while the residual pleural cavity is being minimized and also the management of the air leak from the lung.

[Surgeries for blunt and penetrating thoracic injuries]. / Operace u tupého a pronikajícího poranení hrudníku.

INTRODUCTION: Up to 50% deaths due to fatal injuries result from thoracic injuries. Approximately 10-15 % of the injuries require thoracotomy. AIM OF THE STUDY: Indications and outcome of the surgery were assessed, based on the restrospective analysis data from subjects operated for blunt and penetrating thoracic injuries. SUBJECTS, METHODOLOGY AND RESULTS: 85 patients were operated for blunt or penetrating thoracic injuries during the period from 2000 to May, 2006. Urgent procedures for blunt thoracic injuries were performed in 13 subjects, and for penetrating injuries in 52 subjects. Immediate thoracotomy was indicated in 4 subjects suffering from stab injuries of the heart. 16 subjects were operated consequently for posttraumatic intrathoracic complications in blunt thoracic injuries. 4 subjects exited early postoperatively (4.7 %). CONCLUSION: The aim of urgent surgical interventions is to manage the major bleeding source (heart or large vascular injury), lungs, air leakage (tracheal or bronchial injuries) and diaphragmatic injuries. Irreversible hypovolemic shock in penetrating thoracic injuries and serious related injuries in blunt traumas resulted in peroperative and postoperative mortality.