Native nephrectomy in patients with autosomal dominant polycystic kidney disease in the kidney transplant program - single-center retrospective results of 2000-2020.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disease that leads to chronic renal failure in about half of patients. It is a multisystemic disease with a predominance of kidney involvement, which significantly worsens the patient's health. Controversial issues include the indication and the timing and technique of nephrectomy of native polycystic kidneys. METHODS: A retrospective observational study focused on the surgical aspects of patients with ADPKD who underwent native nephrectomy at our institution. The group included patients operated on in the period 1/1/2000-31/12/2020. A total of 115 patients with ADPKD were enrolled (14.7% of all transplant recipients). We evaluated the basic demographic data, type of surgery, indications and complications in this group. RESULTS: Native nephrectomy was performed in 68 out of a total of 115 (59%) patients. Unilateral nephrectomy was done in 22 (32%) patients and bilateral in 46 (68%). The most common indications were infections (42 patients, 36%), pain (31 patients, 27%), hematuria (14 patients, 12%), gastrointestinal reasons (1 patient, 1%), respiratory reasons (1 patient, 1%), obtaining a site for transplantation (17 patients, 15%) and suspected tumor (5 patients, 4%). CONCLUSION: Native nephrectomy is recommended in symptomatic kidneys, or in asymptomatic kidneys when it is necessary to obtain a place for kidney transplantation, and in kidneys where a tumor is suspected.

Fecal microbiota transplantation - new possibility to influence the results of therapy of cancer patients.

BACKGROUND: The intestinal microbio-me is essential for the function of the human body, it affects not only metabolism and digestion, but also the immune and neurobehavioral systems. The composition of the human intestinal microbio-me has been of interest to many scientific teams around the world in recent years, aided by the rapid development of molecular genetics methods. Intestinal microbio-me imbalance (so-called dysbio-sis) can help develop several pathological conditions such as autoimmune diseases or can be involved in the process of carcinogenesis. Microbio-me research in oncology has so far focused most on the effect of intestinal microbio-me composition on the effectiveness of checkpoint inhibitors. Differences in the relative proportions of individual bacterial strains and the overall microbio-me diversity in patients treated with checkpoint inhibitors appear to be related to the efficacy of this therapy. Many projects are currently studying the possibility of manipulating the composition of the intestinal microbio-me, especially by means of fecal microbial transplantation (FMT). Two published clinical studies have confirmed that it is possible to overcome resistance to checkpoint inhibitor therapy in malignant melanoma with this method and to re-establish a clinical response after FMT. One of the problems of this effort is the significant diversity in the composition of the microbio-me in different populations. Therefore, knowledge of the microbial composition in a particular population is of key importance. The Department of Oncology of the 1st Faculty of Medicine at Charles University and the General University Hospital in Prague is part of this effort, where a program to investigate intestinal microbio-me composition in patients with non-small cell lung cancer, renal cell carcinoma and malignant melanoma during checkpoint inhibitor therapy has been running for several years. PURPOSE: The aim of the publication is to demonstrate the current information and the importance of fecal transplantation in oncology and also to present our currently ongoing research project.

Future of lung cancer treatment.

The evolution of lung cancer treatment is an example of new perspectives in clinical oncology. Genomically determined targeted therapy of non-small cell lung cancer (NSCLC) is developing very rapidly with the gradual identification of new target structures and the concomitant development of innovative drugs are a great promise for the future. The historical development of systemic treatment of NSCLC is a model example of the path to accurate (precise) treatment. The innovation of the treatment has led to the shift from (non-targeted) cytostatic treatment to targeted therapy and immunotherapy. The targeted treatment and immunotherapy with checkpoint inhibitors have led to breakthrough prolongation of survival in patients with advanced NSCLC. According to a recent European Society for Medical Oncology (ESMO) recommendation, NSCLC is therefore one of the diagnoses where an examination using the next-generation sequencing panel should be performed as a standard.

Hand-assisted laparoscopic nephrectomy in morbidly obese patients.

INTRODUCTION: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. METHODS: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were ana-lyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. RESULTS: The patient age was 3867 years; the cohort included 2 females and 5 males, the body weight was 117155 kg and the BMI was 40.3501 kg/m2. Surgery time was 7398 minutes, blood loss was 20450 ml, and hospital stay was 57 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48-110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years.  Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

Gastrointestinal Toxicity of Immunotherapy.

Immunotherapy is a standard modern therapeutic modality of clinical oncology. Due to the specific nature of affecting the immune system of the oncology patient, modern immunotherapy brings new and sometimes difficult to recognise autoimmune adverse reactions. One of the organ systems most commonly affected by autoimmune inflammation is the gastrointestinal system. The incidence of autoimmune enterocolitis in patients undergoing immunotherapy ranges from 1 to 25% depending on the type of drug administered (checkpoint inhibitor) and whether the patient is being treated with monotherapy or combination immunotherapy. The clinical signs (diarrhoea) and severity of gastrointestinal toxicity of immunotherapy are stratified on a four-step scale. The intensity of pharmacotherapy for these adverse events is determined by the degree of severity. Most side effects are reversible and well-managed with corticosteroid therapy. If symptoms are not relieved within 3-5 days with high doses of corticosteroids, immunosuppressive therapy with the anti-TNF inhibitor infliximab at 5mg/kg should be given every 2 weeks until the signs of toxicity have disappeared. Early initiation of adequate corticotherapy for these auto-immune conditions induced by immunotherapy is essential to the success of this supportive therapy. Therefore, general awareness of the potential pitfalls of checkpoint inhibitor therapy should be well understood and anticipated. Just as we are looking for biomarkers to predict the effect of immunotherapy, we should also focus on research into predicting the toxicity of immunotherapy. The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Depression, anxiety in ovarian cancer patient.

OBJECTIVE: A summary article, which is concluding available data about the psychological alterations, especially depression and anxiety, in ovarian cancer patients. DESIGN: Revue article. SETTING: Department of Obstetrics and Gynaecology, University Hospital in Hradec Králove. DISCUSSION: Depressive symptoms could arise as a consequence of the stress, which is the response to oncological diagnosis, treatment or relapse of the oncological disease. This depressive condition is raising concerns in patients, family and health care professionals because it is significantly contributing to morbidity and at the same time is leading to the increase of the health care costs. In general the alteration of the physical and mental functions is reducing the average life expectancy. The patients with serious gynecological cancer diagnosis are requiring psychological support, which is not always satisfactory from their family. It would therefore be desirable to establish professional centers or clinics providing counseling and psychotherapy. CONCLUSION: The summary of the available research data about depression in a women with gynaecological cancer has pointed out not only connection between depression and ovarian cancer, but has also underlined the importance of this problematic for daily praxis and further intensive research.

Gynecological and urological aspects of pelvic vasculitis.

OBJECTIVE: To review contemporary knowledge of isolated vasculitis in urology and gynaecology. DESIGN: A review. SETTING: Department of Obstetrics and Gynaecology, University Hospital Hradec Kralove. METHODS: To present own experience and an overview of recent literature. CONCLUSION: Vascular system inflammation is a very important and broadly studied medical condition. It can affect either veins or arteries. In pelvic veins it can significantly increase the risk of thromboembolic complications, while in the case of arteries; the clinical significance is still unknown. We still do not know what does the histopathological proven isolated vasculitis in this area mean. Is it just a local finding, or should we look for systemic vasculitis? Unlike most of non-symptomatic gynecological vasculitis, urological cases are often accompanied by severe symptoms depending on the anatomical location of the process. This work presents a basic overview and includes our experience with this issue. Our thesis does not include the vasculitis in pregnancy.

Primary retroperitoneal Ewings sarcoma.

The Ewings sarcoma (EWS) family tumors are small, round, cell tumors with different degrees of neuroectodermal differentiation with a peak incidence in children and young adults. About 10-20% of cases are extraskeletal EWS.

High-Dose Rate Brachyther-apy in the Treatment of Early Stages of Penile Carcinoma.

BACKGROUND: Interstitial low dose rate brachyther-apy is established organ spar-ing treatment of T1- T2 penile carcinoma. Experience with high-dose rate brachyther-apy is limited in this indication. MATERIALS AND METHODS: Twenty-six patients with early penile carcinoma were treated by high-dose rate brachyther-apy at dose 18 × 3 Gy per fraction twice daily between 2002- 2018 at the Department of Oncology and Radiother-apy, University Hospital in Hradec Kralove. Breast interstitial brachyther-apy template was used for fixation and precise geometry reconstruction of stainless hollow needles. RESULTS: Median follow up was 85 months (range 7- 200 months). Acute reaction usually consisted of grade 2 mucositis that dissolved dur-ing 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed necrosis of the glans requir-ing partial amputation. Currently, there are 24 patients alive without signs of dis-ease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse. CONCLUSION: Hyperfractionated interstitial high-dose rate brachyther-apy with 18 × 3 Gy per fraction twice daily is a promis-ing method in selected patients with penile carcinoma and deserves further evaluation in a larger prospective study. Key words penile neoplasms -  conservative treatment -  brachyther-apy This work was supported by programm Progres Q40. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 1. 2019 Accepted: 15. 1. 2019.

Importance of basal fibroblast growth factor levels in patients with ovarian tumor.

OBJECTIVE: Evaluation of importance of serum levels of basic fibroblast growth factor (bFGF) in patients with ovarian cancer, patients with border-line ovarian tumor, patients with benign ovarian cyst and women with normal ovarian tissue. DESIGN: Prospective clinical study. SETTING: Department of Gynecology and Obstetrics, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove. METHODS: Measurement of serum levels of bFGF by ELISA using reagents of company R&D Systems prior to treatment in a total of 74 consecutive coming women. RESULTS: Serum level of bFGF from peripheral blood before treatment was significantly higher (p < 0.05) in patients with newly diagnosed ovarian cancer (n = 22), Med = 10.35 pg/ml (1.2-46.2 pg/ml) compared to patients with a border-line ovarian tumor (n = 9), Med = 5.4 pg/ml (1.6-6.8 pg/ml), patients with benign ovarian cyst (n = 24), Med = 5.2 pg/ml (0.1-67.2 pg/ml), and to women with normal ovarian tissue (n = 19) Med = 4.3 pg/ml (0.9-13.4 pg/ml). There isnt strong linear correlation (Spearmans rank correlation coefficient = 0.208791) between the serum level of bFGF and CA125 collected from peripheral blood before primary surgery or neoadjuvant chemotherapy in a group of patients with ovarian cancer (n = 14). We have not found significance correlation between age and serum levels of bFGF in patients with ovarian cancer, with border-line ovarian tumor, with benign ovarian cyst and in women with normal ovarian tissue. CONCLUSION: Serum levels of bFGF in patients with ovarian cancer are significantly higher than in patients with a border-line ovarian tumor, with benign ovarian cyst and in women with normal ovarian tissue regardless of age of patients.

Urinary Tract and Gynecologic Malignancies.

BACKGROUND: The close anatomical relationship of the urogenital system is a significant, and sometimes limiting, factor in oncogynecology. Reducing adverse effects (treatment-associated toxicity) is an integral part of cancer treatment. Radical surgery, as well as oncological therapy, which represent milestones in the treatment of such malignancies, may require tailoring the extension of the intervention in order to preserve other non-gynecological structures. Despite the progress in minimally invasive surgery, and evolution of radiotherapy and systemic therapy, treatment-related complications remain; indeed, their increasing prevalence in women raises questions about quality of life. AIM: Here, we highlight the modalities used to treat gynecological cancer and discuss the most common urological adverse effects related to these interventions. Knowledge of side effects, as well as methods of prevention, is fundamental if we are to preserve quality of life. CONCLUSION: reatment of gynecological cancer is based on cooperation between members of the multidisciplinary team. From this point-of-view, combination of two radical modalities (mainly surgery and radiotherapy) remains problematic. However, the patients prognosis, and plans for other possible oncological therapies, play an essential role in management of urological adverse effects related to cancer treatment. Key words: gynecologic neoplasms - complication - urinary tract - quality of life This work was supported by project PROGES Q40. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 27. 9. 2018 Accepted: 21. 10. 2018.

Plasma filtration for the controlled removal of liposomal therapeutics - From the apheretic site of view.

INTRODUCTION: Nanoparticle-based drug delivery systems can overcome the dose-limited toxicity of cytostatics. Pegylated doxorubicin-containing liposomes (PLD) are able to reduce cardiotoxicity. PLD quickly (in 2 days) attains therapeutic concentration in tumorous tissue (kinetic targeting), while its distribution in normal tissue, which is a cause of mucocutaneous toxicity (MCT), is delayed. We examined PLD extracorporeal removal effectivity, using plasma filtration (PF) to determine whether the drug could be withheld prior to its organ distribution responsible for MCT toxicity. METHODS: Nine patients suffering from platinum-resistant ovarian cancer were treated with a infusion of 50 mg/m2 of PLD/cycle - for four cycles q4w. Over 44 (46)-47 (49) hours postinfusion, the patients (14 cycles in total) underwent PF using the cascade method. Doxorubicin blood concentration was monitored by the HPLC method during 116 h. Individual pharmacokinetic parameters of doxorubicin were estimated. RESULTS: Over 44 (46)-47 (49) hours postinfusion, a single one-volume plasma filtration removed 35 (22-45) % of the remaining doxorubicin amount in the body. Symptoms of MCT - PPE-like syndrome (grade 3) appeared in one patient. Only one adverse reaction (1/14-7%) - short-term malaise and nausea - was reported as being related to PF. CONCLUSION: PF does remove a clinically important amount of doxorubicin in a kinetic targeting approach, which can be a useful tool for the increased efficacy and tolerability of therapy with PLD. There were no serious signs of drug toxicity and/or PF-related adverse events.

[Contemporary technicqes in diagnostic patients with vaginal microbiota]. / Soucasné vyuzití technik v diagnostice recidivujícího vulvovaginálního dyskomfortu.

OBJECTIVE: Review of literature dealing with the specificity of the vagina from the standpoint of microbial colonization. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynecology, Department of Clinical Microbiology, University Hospital and Medical Faculty in Hradec Kralove, Charles University Prague. METHODS: Analysis of the literature review and personal experience dealing with vaginal microbiota.

[Expression of ATP-binding Cassette Proteins Pgp, MRP1, and MRP3 in Malignant and Benign Ovarian Lesions]. / Exprese ABC transportéru Pgp, MRP1 a MRP3 u maligních a benigních zmen vajecníku.

BACKGROUND: This study was designed to compare the expression of PgP (P-glycoprotein), MRP1 (multidrug related protein), and MRP3 in ovarian cancer patients, patients with benign ovarian tumors, and healthy women, and to evaluate the correlation between the expression of ATP-binding cassette proteins Pgp, MRP1, and MRP3 with stage, grade, and histological type. PATIENTS AND METHODS: Tissue specimens from 212 women who underwent surgery at the Department of Obstetrics and Gynecology at University Hospital Hradec Králové were subjected to immunohistochemical staining for Pgp, MRP1, and MRP3. RESULTS: The expression of Pgp and MRP1 was higher in ovarian tumor cells than in the cells lining the ovarian cyst. The lowest level of expression was found in normal ovarian tissue (p < 0.001). Histological subtype of epithelial ovarian cancer correlated with the expression of PgP, MRP1, and MRP3. The lowest level of Pgp and MRP1 expression was found in endometrioid ovarian cancers (p = 0.151; p = 0.013). Patients with advanced ovarian cancer (FIGO III + IV) had higher MRP1 expression than those with early stage ovarian cancer (median MRP1 FIGO I + II 80%; CI 60-100; FIGO III + IV 100%; CI 90-100; p = 0.100). An association was observed between MRP1 and tumor grade (p < 0.001). CONCLUSION: Pgp and MRP1 expression was higher in ovarian tumor cells than in cells lining the ovarian cyst. The lowest level of expression was found in normal ovarian tissue. ATP-binding cassette proteins play an important role in ovarian cancer pathogenesis.Key words: ATP-binding cassette proteins - ovarian cancer - P-glycoprotein (Pgp) - multidrug related protein 1 (MRP1) - multidrug related protein 3 (MRP3) - drug resistanceThis work was supported by the Czech Ministry of Health NT 14107-3/2013.The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 9. 11. 2015Accepted: 30. 8. 2016.

[Immunoscore and Its Predictive Value for Colorectal Cancer]. / Immunoscore a jeho prediktivní hodnota u kolorektálního karcinomu.

Recent studies suggest that immune  classification (immune-score) in cancer patients has a prognostic value in some cases that seems to be superior to the AJCC/ UICC TNM  classification. The clinical outcome can vary significantly among patients with a particular diagnosis within the same TNM stage. Immunoscore methodology quantifies and detects different types of immune cells in tumor tissue, and also determines the density of their infiltration and localization at the tumor site. Currently within an international collaboration of 23 centers in 17 countries (including our department), immunoscore is being evaluated in more than 7,000 colorectal cancer patients in terms of the tumor microenvironment, focusing on the presence of immune cells both in the tumor tissue and the tumor invasive margin. Immunoscore results are assessed in correlation with: 1. patients response to the treatment, 2. rate of progression, disease prognosis and other immune parameters. It appears that the TNM classification and tumor invasiveness is statistically dependent on the immune response of the patient (there is an inverse correlation between the density of the infiltration of CD8⁺, CD3⁺ lymphocytes and the tumor stage). High densities of T-lymphocytes (CD8⁺, CD3⁺) both in the core and the invasive margin of the primary tumor are associated with longer term asymptomatic survival, overall survival, lower risk of relapse and reduced likelihood of metastases. The project of the international collaboration aims to introduce immunoscore in routine diagnostics.

[Prognostic significance of Pgp, MRP1, and MRP3 in ovarian cancer patients]. / Prognostický význam Pgp, MRP1 a MRP3 u pacientek s karcinomem ovaria.

OBJECTIVE: To evaluate the correlation of resistance proteins Pgp (P-glycoprotein), MRP1 (Multidrug Related Protein, Multidrug Resistance-Associated Protein) and MRP3 with clinical - pathological factors and to find the clinical outcome of these data in ovarian cancer patients. DESIGN: Prospective study. SETTING: Department of Gynecology and Obstetrics, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové. METHODS: 133 patients with epithelial ovarian cancer who underwent primary surgery from 2006-2010 had specimens stained with imunohistochemistry for Pgp, MRP1, MRP3. RESULTS: The histological subtype of epithelial ovarian cancer correlated with the expression of PgP, MRP1, and MRP3. The lowest incidence of Pgp and MRP1 expression was documented in endometrioid ovarian cancers (P = 0.151, P = 0.013). Patients with advanced ovarian cancer (FIGO III+IV) had higher MRP1 expression than those with early stage ovarian cancer (Med MRP1 FIGO I+II 80%; CI: 60-100; FIGO III+IV 100%; CI: 90-100; P = 0.100). An association was observed between MRP1 and tumor grade (Med MRP1 G1 80% (CI: 0-100), G2 80% (CI: 30-100), G3 100% (CI: 90-100); P < 0.001). There was no relationship between the size of the residual tumor after primary surgery and any resistance proteins. Patients with complete response after primary treatment had lower levels of LRP, Pgp, and MRP1 expression than other patients. Patients with higher Pgp and MRP1 expression had relapse of disease during the following 24 months more often than patients with lower Pgp and MRP1 expression. FIGO stage, histological type, debulking efficiency, and Pgp and MRP1 expression correlated with poor patient survival (P < 0.001, P < 0.001, P < 0.001, P = 0.040, P = 0.026). CONCLUSION: We found prognostic significance of Pgp, MRP1 and MRP3 expression in ovarian cancer patients. MRP1 have some additional prognostic value for the clinical outcome of patients with ovarian carcinoma.

ATM and TGFB1 genes polymorphisms in prediction of late complications of chemoradiotherapy in patients with locally advanced cervical cancer.

The purpose of our study was to evaluate a possible correlation between genetic polymorphisms in ATM and TGFB1 genes and late toxicity of chemoradiotherapy for locally advanced cervical cancer. Fifty five patients with FIGO stage IIB and higher without a disease recurrence with a mean follow up of 6 years were included. Late toxicity was assessed by EORTC/RTOG late toxicity criteria. Univariate and multivariate logistic regression model was used for statistical analysis. Degree of association between polymorphisms and late toxicity of chemotherapy was assessed on the basis of phi-coefficient (φ) as well. We did not find any association between 5557G>A polymorphism in the ATM gene or single TGFB1 polymorphisms and late toxicity. TGFB1 compound homozygosity (-1552delAGG, -509C>T, L10P) was a significant predictive factor of grade III-IV and any grade of complications in both univariate and multivariate logistic regression analyses and statistical significance of association between polymorphisms and late toxicity of chemoradiotherapy was confirmed also by the evaluation of phi-coefficient (φ). We conclude that haplotypes instead of single nucleotide polymorphic sites in the genes may better characterize the individual radiosensitivity.

Cellular and humoral immunodeficiency in breast cancer patients resistant to hormone therapy.

In view of the fact that insufficiency in immune response often correlates with poor prognosis, research in recent years has focused on the task of describing the precise status and function of the immune system and its possible effect on cancer patients. Although more than two thirds of treated patients respond to endocrine therapy, most patients with metastatic breast cancer develop a resistance to it. Estrogen modulates angiogenesis, partially through its effects on vascular endothelial growth factor (VEGF). It also appears that transforming growth factor-beta (TGF beta) could be another factor contributing to this resistance. TGF beta is a highly immunosuppressive factor that inhibits natural and specific immunity against tumors and stimulates the production of VEGF. The purpose of the study was to monitor immune responses in patients with hormone receptor-positive breast cancer who were resistant to hormone therapy. The examination of cellular components (CD4, CD8, HLA-DR, NK cells) and humoral immunity (IgG, IgG subclasses, IgA, IgM,). TGF beta and VEGF production were monitored with special attention, along with an analysis of the changes that occurred during the hormonal treatment. 68 patients included in the research project were implemented with routine cancer treatment with endocrine therapy. Basic parameters (the histological type and grade, the degree of expression of estrogen receptors (ER) and progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), and the proliferative marker) were established. Patients were evaluated by a cancer clinical immunologist to exclude immune disorders, allergic or autoimmune origin. TGF beta and VEGF were measured by ELISA and antitumor cellular immunity (CD4, CD8) was measured by flow cytometry. Patients who failed in the first line of hormone therapy treatment were considered as resistant to hormone therapy.Depression in cellular immunity was found especially in patients with resistance to endocrine therapy. In addition, immunoglobulin plasma levels were decreased (mainly IgG4 subtype). Most patients showed clinical symptoms of immunodeficiency (frequent infections of respiratory or urinary tract, herpetic infections). Significant increases in TGF beta and VEGF plasma were also detected.The correlation of these factors with resistance to hormonal therapy and the state of anticancer immunity could be helpful in the task of predicting resistance to hormonal therapy and could contribute to the selection of targeted immune therapy in cancer patients in the future.

[Can be considered the primary fallopian tube cancer an enigma at the beginning of the third millenium?]. / Lze povazovat i na zacátku tretího tisíciletí primární karcinom vejcovodu za enigma?

OBJECTIVE: To analyze differences between primary fallopian tube cancer and ovarian cancer. DESIGN: Overview study. SETTING: Department of Obstetrics and Gynecology, The Fingerland Department of Pathology, Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital Hradec Kralove. METHODS: Overview study focused on analysis of data of primary fallopian tube cancer. CONCLUSION: The incidence of primary fallopian tube cancer was thought to be very low in the past but it is very difficult to assess the primary origin in the case of advanced disease (ovary versus fallopian tube). Tumorogenic potential of endosalpinx in relation to epithelial tumours is much more bigger. According to the current knowledge, the vast majority of high-grade serous carcinomas of the "ovary" in fact arise in the mucosa of fimbrial portion of fallopian tube.

[Hypersensitivity reactions to carboplatin and paclitaxel - our five-years experiences]. / Hypersenzitivní reakce po podání karboplatiny a paklitaxelu - nase petileté zkusenosti.

OBJECTIVE: To analyze hypersensitivity reactions to carboplatin and paclitaxel in patients treated with systemic administration of chemotherapy (carboplatin and/or paclitaxel). DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove. METHODS: One hundred-forty patients treated with systemic administration of chemotherapy were enrolled to our study between years 2008 and 2012. The presence and the grade [grade (G) 1-5; 1 = moderate, 5 = death] of hypersensitivity reactions (HSRs) were evaluated, as well as the influence of some clinical parameters on development of HSR. RESULTS: In total 29 HSRs in 21 patients were analyzed. To carboplatin were reported 19 (66%) HSRs: 13 (45%) HSRs of G1-G3 and 6 (21%) HSRs of G4. To paclitaxel were reported 10 (34%) HSRs: 9 (31%) HSRs of G1-G3 and 1 (3%) HSR of G4. The number of administered cycles of carboplatin to develop G1-G4 resp. G1-G3 HSR was higher in comparison with number of cycles to develop HSR of the same grade to paclitaxel(p = 0.001, resp. p = 0.01). CONCLUSION: HSR to carboplatin is unlike paclitaxel affected by the number of administered cycles. This fact should be included in the clinical management of patients treated with intravenous chemotherapy using carboplatin.