Transabdominal two-cavity approach for radical nephrectomy combined with inferior vena cava thrombectomy for malignant thrombus caused by renal cell carcinoma: a case series.

BACKGROUND: Advanced renal cell carcinoma in some cases causes malignant intravascular thrombus with the potential for growth into the inferior vena cava or even the right atrium. Renal cell carcinoma is accompanied by malignant intravascular thrombus in up to 10% of cases. We present an overview of three patients diagnosed as having renal cell carcinoma with malignant intravascular thrombus requiring radical nephrectomy combined with inferior vena cava thrombectomy. CASE PRESENTATION: Three patients diagnosed as having renal cell carcinoma were indicated for renal cell carcinoma combined with inferior vena cava thrombectomy between 2014 and 2017 at our department: a 69-year-old white Caucasian woman, a 74-year-old white Caucasian woman, and a 58-year-old white Caucasian woman. According to the Novick classification of inferior vena cava tumor thrombus, there was one infrahepatic (level II) and two supradiaphragmatic (level IV) malignant intravascular thrombi. The average age of these patients was 67 years (range 58-74 years). All patients underwent radical nephrectomy combined with inferior vena cava thrombectomy through transabdominal approach. In patients with level IV malignant intravascular thrombus, transesophageal echocardiogram was used to guide the placement of the inferior vena cava cross-clamp above the diaphragm. In one patient the pericardium was opened to place a cross-clamp above a tumor just below the right atrium. There were no postoperative mortalities to date with an average follow-up of 23 months (range 2-48 months). To date, no patient has demonstrated recurrent inferior vena cava malignant intravascular thrombus requiring secondary inferior vena cava thrombectomy or any other treatment. A comparison of estimated blood loss and transfusion rate was not significantly different in all three cases. CONCLUSION: Despite the technical complexity of the procedure, caval thrombectomy combined with radical nephrectomy currently represents the only radical treatment for renal cell carcinoma accompanied by malignant intravascular thrombus with good mid-term oncological outcomes.

ACTION OF NEW 3-HYDROXYPYRIDINE DERIVATIVES WITH ANTI-NAUPATHIA PROPERTIES ON CENTRAL NEURONS.

Experiments with cats showed that microinjections into the lung of new 3-hydroxypyridine derivatives SK-119 and IBKhF-27 had a direct action on 50 and 84 % of medial vestibular nucleus (MVN) neurons respectively. The inhibitory response to the compounds was observed 6 and 25 times more frequently than exciting; inhibition by IBKhF-27 was observed 1.9 times more frequently than by SK-119. Also, microinjections of SK-1 19 and IBKhF-27 acted directly on 44 % and 81 % of cat's Purkinje cells, respectively. In case of Purkinje cells, the inhibitory reaction was seen 5.5 and 25 times oftener than exciting, respectively, and inhibition by IBKhF-27 occurred 2.1 times more frequently than by SK-119. Investigations of rat's cerebellum sections evidenced that 5 mM of IBKhF-27 inhibited population responses of Purkinje cells 95 1 3 %. In the presence of specific noncompetitive NMDA-receptor antagonist (MK-801, 100 pM) the depressive effect was annulled almost fully by 96 * 2 %. It follows that IBKhF-27 nearly entirely inhibits synaptic transmission from cerebellar parallel fibers to Purkinje cells, while MK-801 has a similarly strong anti-depression effect that testifies the involvement of the NMDA-receptor complex predominantly.

[Study of neuroprotective, antihypoxic and antiamnesic effects of new mixture of tripeptides].

A new mixture of tripeptides (NMT: H-Lys-Asp-Glu-OH, H-Asp-Glu-Pro-OH, H-Asp-Glu-Arg-OH) in doses of 150 and 300 mg/kg per day produces clearly pronounced neuroprotective effect in rats with brain ischemia and decreases neurologic deficiency 1.1 times more effectively than reference drug semax. NMT (10, 50 and 150 mg/kg) had marked antihypoxic effect on mice in hermetic and altitude chamber. NMT in doses of 10 and 50 mg/kg was more effective than semax in hermetic chamber (1.3 and 1.5 times, respectively) and in a dose of 150 mg/kg in altitude chamber (1.9 times). NMT (50 and 150 mg/kg) had also marked antiamnesic effect on model amnesia caused by scopolamine in rats and was more effective (1.5 and 1.4 times, respectively) than semax in equal doses. NMT (50 and 150 mg/kg) also had marked antiamnesic effect on model amnesia caused by maximal electroshock and complex extreme factors in mice and in both doses was 4 times more effective than semax on the first model and in a dose of 150 mg/kg was 2.9 times more effective on the second model. NMT (50 mg/kg) increased the amplitude of transcallosal evoked potential in rat brain by 69% and was more effective than semax in equal dose. Thus, NMT is a promising neurotropic drug with neuroprotective, antihypoxic and antiamnesic activity.

[STUDIES OF THE ANTIHYPOXIC AND ANTIAMNESTIC EFFECTS OF MELATONIN IN ANIMALS].

Experiments with mice showed that in a multitude of acute hypoxia models (normobaric hypoxic hypoxia with hypercapnia, hypobaric, hemic and histotaxic) the antihypoxic action of a single intra-abdominal dose of melatonin surpasses greatly amtisol, the standard antihypoxic agent. Single melatonin injection produced a strong antiamnestic action on various amnestic models (scopolamine-induced, acute normobaric hypoxia with hypercapnia, and a combination of extreme factors) which was much better than of pyracetame, a well-known nootropic (mind-stimulating) drug. Increase of the melatonin dose from 1 mg/kg to 20 mg/kg amplified both the antihypoxic and antiamnestic effects. Melatonin inhibited orthodromal population responses in surviving sections of rat's hippocampus (by 24 ± 3% at 2 mM; by 72 ± 6% at 5 mM). Besides, the inhibiting action of lusindol, a blocker of melatonin receptors MT1 and MT2--was virtually fully neutralized. Therefore, melatonin inhibits transmission within the Schaffer collateral--CA1 pyramidal neurons synapse by stimulation of melatonin receptors MT1 and MT2; higher melatonin concentrations (0.5 to 5 mM) enhance its effectiveness.

[VESTIBULAR AND THERMOPROTECTIVE PROPERTIES OF A NEW ACTOPROTECTOR].

In experiments with rats, a new 3-hydroxypyridine (3-HP) derivative--2-ethyl-6-methyl-3-hydroxypyridine L-asparaginate (30 mg/kg)--exhibited a strong vestibuloprotective effect which was better than of promethazine (50 mg/kg), a well-known vestibuloprotector Besides the new actoprotector was competitive with another 3-HP derivative, namely, mexidol (ethyl-methyl-hydroxypyridine succinate) (100 mg/kg). Moreover, a distinct thermoprotective effect of 2-ethyl-6-methyl-3-hydroxypyridine L-asparaginate (30 mg/kg) in mice was not worse than that of mexidol or metaprot (ethylthiobenzimidasol, former name bimethy), an actoprotector with good thermoprotective properties. To conclude, owing to the membrane-protective and antioxidative qualities, the vestibuloprotective and thermoprotective properties of 2-ethyl-6-methyl-3-hydroxypyridine L-asparaginate are better or competitive with the reference preparations.

[Study of some pharmacological properties of a new adenine derivative].

It is established that the new compound, 9-[2-(4-isopropylphenoxy)ethyl]adenine (9-IPE-adenine) in a dose of 10 mg/kg per day produces neuroprotective effect in rats with brain ischemia model. 9-IPE-adenine decreased the neurologic deficiency 1.2 times more effectively (p < 0.05) than the reference drug mexidol in analogous dose, and had equal effect with this drug at 25 mg/kg per day on the neurologic deficiency and survival of animals. Electrophysiological studies in hippocampal slices in rats showed that 9-IPE-adenine depressed orthodromic population spikes in CA1 area by 42 ± 4%. Non-competitive antagonist of NMDA receptor complex MK-801, in contrast to D-AP5 (competitive NMDA receptor antagonist) and CNQX (competitive AMPA receptor antagonist), enhanced the depressive effect of the new drug more than two times. These ese results are indicative of the ability of 9-IPE-adenine to modulate the ion channel of NMDA receptor complex.

[Urine derivation after radical cystectomy]. / Derivace moci po radikální cystektomii.

INTRODUCTION: Radical cystectomy, performed both for the treatment of cancer and other conditions, needs to be followed by ensuring the derivation of urine. The aim of this work is to summarize the possibilities of urine derivation after cystectomy, their advantages, disadvantages and long-term results. METHODS: A review article summarising relevant literature and the team of authors own experience. CONCLUSION: This work compares advantages and risks of different types of urine derivation following radical cystectomy.

[The antiamnestic effect of nootropic substances in rats].

It has been established in experiments in rats that some nootropic substances (oxyracetam, aniracetam, nooglutil, mexidol, new 3-hydroxypyridine derivative SK-170, piracetam and noopept) produce marked antiamnestic effect on various models of amnesia (induced by microwave irradiation, acute hypoxia, and motion sickness). At the same time, meclophenoxate exhibited antiamnestic effect in the first and second models of amnesia, while 9-aminoacridine derivative HTOS-404 was only effective in the model of amnesia caused by microwave irradiation. The antiamnestic effect of nooglutil and SK-170 was caused to a significant degree by activation of non-NMDA receptors of excitatory amino acids (generally AMPA receptors), while the effect of mexidol was related to GABA(A) receptors.

[Comparative studies of antihypoxic, neuroprotective and analgesic action of succinate-containing drugs].

Experiments with mice showed that, unlike reamberin (100 mg/kg), mexidol (100 mg/kg) and cytoflavin (1 ml/kg) act as antihypoxants in pressure and hermetic chambers but not in case of acute hemic and histotoxic hypoxia. Amtisol succinate (100 mg/kg), a reference antihypoxant, excels the other tried succinate-containing drugs in all models of acute hypoxia except the hermetic chamber. In addition, the neuroprotective action of mexidol (100 mg/kg/d) and cytoflavin (100 ml/kg/d) in rats with induced ischemic stroke which was stronger than that of reamberin and amtisol succinate (100 mg/kg/d). Besides, mexidol (100 mg/kg) but not cytoflavin (1 ml/kg), reamberin or amtisol succinate (100 mg/kg) had a distinct analgesic effect in rabbits. On the neuronal level, mexidol interacts with the GABAA- benzodiazepine-receptor complex in nearly 60% cells and inhibits ion currents through the NMDA-receptor ion channels in nearly 80% neurons.

[Actiprotective and antihypoxic action of new heteroaromatic antioxidants].

Expernents with mice showed that most of 15 new heteroaromatic antioxidant compounds possess aciprotective and antixopixic properties. Based on results of treadmill and swimming tests, actiprotective action of IBKhF-1, 11 and 14 surpassed greatly bemythil and bromanthane in ordinary conditions. Inhibitor of gluconeogenase tryptophan cancelled largely the stimulatting action of highly effective and active IBKhF-1, 2 and 11 on physical performance during treadmill exercise. Consequently, gluconeogenesis activation is one of the major components of the actiprotective action of these antioxidants. In addition, IBKhF-1, 11 and 14 excelled bemythil and bromanthane in the extreme conditions of running in hyperthermia and swimming in acute hypoxia combined with hypercapnia. IBKhF-2 and 14 were better than amtisol (standard antihypoxic agent) and bemythil against acute hypoxia in pressure chamber, whereas IBKhF-4 and 14 excelled these agents in thermal chamber.

[Antihypoxic and antiamnesic effects of mexidol and semax].

Upon single administration, mexidol and semax only in doses of 100 and 0.05 mg/kg, respectively, produced an antihypoxic effect on mice in the altitude chamber and hermetic chamber tests. Preventive course administration of mexidol and semax for 6 days gave significant antihypoxic effect on the model of acute hypobaric hypoxia in mice in doses of 75 and 0.1 mg/kg per day, respectively, in which the same preparations upon single administration were ineffective. Neither mexidol nor semax upon single administration were effective on the models of acute hemic and histotoxic hypoxia. On various models of amnesia (except that induced by the maximal electroshock) in mice, both mexidol and semax exhibited marked antiamnesic effects comparable with that of the reference nootrope drugs piracetam and oxyracetam. Mexidol showed a linear, while semax exhibited a bell-shaped reversible dose-effect relationships. Mexidol and semax inhibited the ortho- and antidromic population response spikes of CA1 pyramidal neurons of survival hippocampal slices in rats. It was estimated that mexidol (in contrast to semax) increased oxygen consumption in rat brain mitochondria and had a linear dose-effect relationship in a concentration range of 1-5 mM. It is concluded that mexidol should be used in high doses (for both single and course administration) for obtaining antihypoxic and antiamnesic effects, while semax requires a thoroughly controlled choice of dosage.

[Evaluation of the tumor extension before planned radical prostatectomy: a prospective study]. / Moznosti stanovení lokálního rozsahu karcinomu prostaty pred plánovanou radikální lécbou: prospektivní studie.

BACKGROUND: Study compares results of preoperative diagnostic methods with measurements of tumor extension in a specimen obtained by radical prostatectomy. METHODS AND RESULTS: One hundred forty-six patients with clinically identified cancer were enrolled in the study and subjected to radical prostatectomy. Each patient underwent transrectal sonography (TRUS), Power Doppler sonography with 3D reconstruction (3D-PDS), and the risk of the occurrence of locally advanced tumor was assessed using Partin tables. In subgroups of localized and locally advanced tumor, individual preoperative parameters were compared. ROC curves were generated for individual preoperative parameters and the area under the curve (AUC) was calculated. Multivariate logistic regression analysis was performed to determine independent predictors of extraprostatic tumor extension. A statistically significant difference between patients with localized and locally advanced tumor was observed in PSA levels (p < 0.014), PSA density (p < 0.004), DRE (p < 0.037), TRUS (p < 0.003), and 3D-PDS (p < 0.000). The highest AUC value was found for 3D-PDS 0.776, TRUS 0.670, and PSA density 0.639. According to multivariate analysis, independent preoperative predictors of extraprostatic tumor extension were PSA density, preoperative Gleason score 7, and 3D-PDS finding. CONCLUSIONS: Power Doppler sonography with 3D reconstruction represents the most reliable preoperative diagnostic tool in determining locally advanced tumor. Together with PSA density and the presence of aggressive tumor (Gleason score > or =7) in prostate biopsy, it is one of independent predictors of locally advanced prostate cancer.

[Inovative techniques in partial laparoscopic resection of the kidney for adenocarcinoma]. / Inovativní techniky pri laparoskopické parciáilní resekci ledviny pro adenokarcinom.

Authors present the first case of laparoscopic partial resection of the kidney for RCC using modern technique of tissue sealing with FloSeal, which was used in this indication for the first time in the Czech Republic. The other most useful innovative point was the usage of tail-clipped sutures from resorbable material "Lahodny", which are suitable for suturing in renal parenchyma. Despite the relatively long time of warm ischemia, the function of rest of the kidney is more than satislying.

Porcine surfactant (Curosurf) for acute respiratory failure after near-drowning in 12 year old.

This case report describes rapid and persistent improvement after one single dose of porcine surfactant (Curosurf) 0.5 ml/kg(-1) (40 mg/kg) intratracheally for adult respiratory distress syndrome (ARDS) with severe oxygenation failure 8 h after freshwater near-drowning in a 12-year-old girl.

The value of the MACE (Malone antegrade colonic enema) procedure in adult patients.

BACKGROUND: We report our experience with the Malone antegrade colonic enema (MACE) procedure in adult patients suffering from urinary incontinence and intractable constipation with or without fecal soiling. STUDY DESIGN: Since June 1990, the MACE procedure was initiated in 4 female and 12 male patients 14-54 years old (mean age, 29.9 years) with different pathologic conditions (myelodysplasia, n = 7; anorectal anomaly, n = 3; spinal cord lesion, n = 4; neuropathic disease of unclear cause, n = 2). Three surgical techniques were used: reversed and in situ appendix and tapered ileum). Complex simultaneous urologic continence procedures were performed in nine patients. Two patients had undergone previous operations in the lower urinary tract. RESULTS: After 6.6 years of followup (average, 41.7 months), eight patients (50%) were still using the MACE successfully. They were completely clean day and night and were relieved of symptoms of constipation. Eleven complications related to the MACE procedure occurred in seven patients (44%). Eight patients abandoned the procedure for various reasons. The failure rate was higher in chronically constipated patients without fecal soiling. CONCLUSIONS: The MACE procedure is associated with a high failure rate when used in adults, but it may be possible to identify a subgroup of patients in whom the procedure could be beneficial. Success would depend on overcoming technical problems and difficulties with patient compliance.