Thyroid tumors at the limit of operability.

Comprehensive information about current thyroid carcinoma treatment options depending on its histology and extent of the disease, focusing on locally advanced findings at the limit of operability. Treatment of such a heterogeneous group requires interdisciplinary cooperation. We provide 6 unique case reports including imaging scans, description of the therapy and description of development of the condition.

Foliar anatomy and microscopy of six Brazilian species of Baccharis (Asteraceae).

We report for the first time the presence of cluster crystals of calcium oxalate within the glandular trichomes and oil bodies in the mesophyll for Baccharis species. Moreover, the comparative leaf anatomy and micro-morphology of six species of Baccharis, namely B. illinita, B. microdonta, B. pauciflosculosa, B. punctulata, B. reticularioides, and B. sphenophylla is investigated by light and scanning electron microscopy. The studied species exhibited differences in their leaf anatomical features such as the morphology of the cuticle, type and occurrence of the stomata, presence or absence of glandular trichomes, shape of the flagelliform trichomes, and the arrangement of the mesophyll tissues. These differences can be helpful in the species identification and classification and could represent informative characters for the reconstruction of the evolution of the genus.

[Ruptures of the diaphragm]. / Ruptury bránice.

INTRODUCTION: The diaphragm is a flat muscle that divides the thoracic and abdominal cavities, and it is one of the most important muscles involved in respiration. Traumas of the diaphragm include its rupture caused by an external force, resulting in blunt or penetrating injuries. Diaphragmatic rupture is associated with the risk of a prolapse (i.e. not a typical hernia) of abdominal organs into the pleural cavity. The rupture may occur due to a blunt injury of the chest or abdomen, or due to penetrating injuries (gunshots, stab wounds, foreign bodies) in the lower part of the chest and epigastrium. Ruptures never heal spontaneously and always require suture of the diaphragmatic defect. Most acute rupture cases are managed using laparotomy; thoracotomy is preferred for lately recognised ruptures to facilitate the removal of adhesions in the thoracic cavity developed between the diaphragmatic defect and a lung. Thirty one patients with diaphragmatic rupture were operated at the 3rd Department of Surgery of the 1st Faculty of Medicine, Charles University and University Hospital Motol between 2006 and 2016. Acute rupture was present in 60% of the cases and chronic in 40%. Right-sided rupture was found in 20% and left-sided in 80%. CONCLUSION: The authors describe surgical treatment of diaphragmatic ruptures. They recommend an early surgical treatment if diaphragmatic rupture is recognized. Generally, the prognosis of the patients depends on availability of professional health care; ideally, these patients should be treated at specialised traumacentres with specialists for abdominal and thoracic surgery. The authors advise against establishing injudicious thoracic drainage in cases where diaphragmatic rupture with herniation of abdominal organs into the thorax may be present.Key words: polytrauma - acute rupture of diaphragm - chronic rupture - suture - patch.

[Development of tracheal resection technique - our experience]. / Vývoj techniky resekcí trachey - nase zkusenosti.

INTRODUCTION: Tracheal resections are very frequent interventions on the trachea in general. In borderline cases where the tracheal resection length is too high, the situation can be resolved by inserting a stent or Montgomerys T cannula. Tracheal stenoses are of benign origin in 94%, and malignant in 6% of cases. We present a summary of tracheal resection interventions for the last 21 years. METHOD: 235 tracheal resections were performed at the authors institution in 1993-2013. In total 221 benign stenosis cases (85 % developed after tracheostomy, 15% developed after intubation) and 14 malignant cases were treated. The patients were divided into two groups: A resection in years 19932002 and B - resection in years 20032013. The comparison of these two time periods is presented with focus on surgical procedures development and recommendations based on experienced complications. RESULTS: Restenosis (early or late) is the most common complication during the process of tracheal resection treatment. Tiny fistulas in the suture can be diagnosed easily by minor air leaking and are treated conservatively without intervention. Fortunately, suture insufficiency is relatively rare. In some cases the restenoses can be resected or treated by stent application or by Montgomerys T-cannula application. Complications were observed in 2% of the treated patients, which is a number presented also by international studies. CONCLUSION: Tracheal resection is definitely an optimal solution for patients suffering from tracheal stenosis. As presented in our study, in the hands of experienced thoracic surgeons tracheal resections is a safe and final solution of tracheal stenosis. KEY WORDS: trachea - stenosis resection.

Análise farmacobotânica de folha e caule de Tanacetum vulgare (L. ) / Pharmacobotanical analysis of leaf and stem of Tanacetum vulgare (L. )

RESUMO Tanacetum vulgare L., conhecida popularmente como catinga-de-mulata, é utilizada na medicina tradicional como vermífugo, digestivo e emenagogo. Objetivou-se analisar a morfoanatomia de folhas e caules dessa espécie medicinal com vistas ao controle da qualidade. Foram utilizadas técnicas usuais de microscopia de luz e eletrônica de varredura. As folhas são compostas, pinatissectas e anfiestomáticas. Tricomas tectores flageliformes simples e glandulares capitados são observados. A nervura central tem formato biconvexo, o pecíolo é côncavo-convexo, a ráque é plano-convexa e o caule é arredondado. Feixes vasculares colaterais, calotas de fibras perivasculares e colênquima lamelar estão presentes na folha e no caule. Os caracteres morfoanatômicos evidenciados contribuem na identificação do táxon e fornecem subsídios farmacobotânicos para o controle da qualidade de drogas vegetais e fitoterápicos.

ABSTRACT Tanacetum vulgare L., popularly known as tansy, is used in traditional medicine as a vermifuge, digestive and emmenagogue. This study aimed to analyze the morphoanatomical leaves and stems of this medicinal plant in order to control the quality. Usual techniques of light and scanning electron microscopy were used. The leaves are composed, pinatissect and amphistomatic. Simple and flagelliform non- glandular trichomes and capitate glandular trichomes are observed. The midrib has biconvex shape, the petiole is concavo-convex, the rachis is plano-convex, and the stem is rounded. Collateral vascular bundles, perivascular fiber caps and laminar collenchyma are encountered in the leaves and stems. Evidenced the morphological and anatomical features contribute to the identification of the taxon and provide pharmacobotanical data for the quality control of herbal drugs.

Assessment of pain threshold in haemophilic patients.

Many patients with haemophilia (PWH) live with persistent end-stage arthritis, as a result of multiple joint haemarthrosis, and experience daily pain. For these people, pain becomes a central aspect of life. The aim of this study was to use mechanical pain thresholds (MPT) to characterize pain perception in different PWH groups. The groups tested were characterized by age, previous bleeding into joints, Hemophilia Joint Health Score (HJHS) and PAIN perception score in the HJHS scoring. A total of 23 PWH (haemophilia A) were included in this study (10 children, 13 adults). A total of 12 PWH suffered from repeated bleeding into some of the tested joints. Data were compared to those collected from 15 age-matched control subjects. The most significant differences in MPTs were found when the PWH were compared to the controls, based on the differences in PAIN score (PAIN score 1 and 2) in all the tested joints, except for the right knee. Similarly, the difference in MPT in ankle joints was confirmed when PWH with and without bleeding were compared to controls. Summarizing the outcomes, we can emphasize the potential usefulness of MPT as an objective tool in evaluating the pain of PWH.

[Recurrent intra-articular bleeding episodes in haemophiliacs. Treatment outcomes in the patients at the university hospital motol in 1985-2005]. / Efekt lécby recidivujícího nitrokloubního krvácení v souboru hemofiliku lécených ve FN v Motole v letech 1985-2005.

PURPOSE OF THE STUDY: Chronic synovitis is a common finding in people with haemophilia. It regularly appears after recurrent episodes of intra-articular bleeding. The bleeding originates from the subsynovial venous plexus underlying the capsule where a lack of thromboplastic activity has been demonstrated. Therefore, the changed synovium appears to be a treatment target. There are several methods which can be used to remove the synovial layer from the joint. The aim of our study was to asses the efficacy of different treatment approaches used in a group of haemophiliacs between 1985 and 2005 in our hospital. MATERIAL AND METHODS: A group of 30 patients with bleeding disorders was evaluated in the study. There were 29 men with haemophilia and one woman with von Wilebrandt factor deficiency. Their age ranged from 6 to 18 (median 13) years. They underwent a total of 68 interventions including surgical synovectomy (n=28), radionuclide synovectomy (n=33) and corticosteroid instillation (n=7). The necessity of a repeat intervention was used as a criterion of successful treatment. RESULTS: In the group of surgical synovectomies, 22% of the patients required repeat operations, in the group of radiation synovectomy, this was 9% and, in the group treated with corticosteroids, this was 43%. The average hospitalisation time was 50 days for surgical procedures (19-133 days) and 7 days for radiation synovectomy procedures (4-13 days). DISCUSSION: In 1994 Merchan presented seven excellent or good results in a group of 10 knees evaluated 1 year after treatment with methylprednisolone. Six years later he reported that "five years after completion of treatment, all results of the observed patients were poor". Generally, corticosteroids will reduce synovitis in the majority of patients but the effect is temporary. A complete remission is a very rare situation under corticosteroid treatment. The experience with surgical synovectomies is not recent and this method is described as carrying a high risk of complications and requiring a high amount of coagulating factor consumption. There are several recent reports on the application of Yttrium-90: in Madrid they evaluated treated joints (knees, ankles and elbows, n = 66) in 44 patients aged from 9 to 39 years. The results were good in less than half of the knees and ankles. The treatment of elbows was more successful. It was recommended to perform synoviorthesis at the early stages of synovitis. In Israel, they reported that a decrease in the number of bleeding episodes was achieved in 80% of 115 patients treated with Yttrium-90; in 15% of them, bleeding in the treated joints stopped completely. In Izmir, Yttrium was used in the treatment of knees, elbows, ankles and also shoulders in children and young adults (3-25 years). The method was found to be safe and effective. Brazilian authors have experience with the treatment of knees, ankles, elbows and shoulders too; they have concluded that this method represents an important resource for the treatment of chronic haemophilic synovitis and markedly reduces joint bleeding frequency and pain, irrespective of the radiographic stage and inhibitor status. While the European Association of Nuclear Medicine (EANM) recommend using 186Re-sulfide for treatment in medium-sized joints, Chinese authors have published a study comparing the effect of using three different doses of 186Re-sulfide in the treatment of chronic synovitis in knees. Their patients have received an amount of radionuclide according to the thickness of their synovial layer measured on MRI, with the result that 22 patients exhibited significant reduction in synovial thickness. A reduction in the number of bleeding episodes was reached in 71% of the patients within an 18-month period. No significant differences were found among the groups receiving different radioactivity doses. In Turkey, 35 elbows, 26 ankles and two shoulders in 49 patients aged between 3 and 30 years were treated with 186Re. The patients were followed up from 6 months to 3 years. At 6 months after the procedure, 81% of the elbows and 86% of the ankles with grade II synovitis were free from bleeding, as well as 53% and 44% of the elbows and ankles with grade III synovitis, respectively. CONCLUSIONS: Radiation synovectomy appears to be the method of choice in the treatment of recurrent bleeding in the joint cavity in people with haemophilia. The efficacy of surgical synovectomy is lower in comparison with radiation synovectomy. Risks associated with surgery and anaesthesia, the need of hospitalisation and a prolonged period of rehabilitation are bothering. On the contrary, the application of corticosteroids cannot be recommended as a good method to treat recurrent haemarthroses.

Anticoagulant drugs increase natural killer cell activity in lung cancer.

BACKGROUND: In preclinical studies in animal models and in initial clinical trials, anticoagulation drugs have been shown to be effective in the prevention and treatment of haematogenous metastasis, and in the prolongation of survival in animal models. However, only a few studies have been performed on the direct influence of anticoagulation drugs on the immune system. OBJECTIVE: The purpose of this study is to determine the effect of warfarin, unfractioned heparin, low molecular weight heparins (LMWHs), and acetylsalicylic acid anticoagulants on the functional activity of natural killer (NK) cells. PATIENTS AND METHOD: Cytotoxic activity in patients with early, operable stages of non-small-cell lung cancer was compared with healthy volunteers. Cytotoxic studies were also carried out in tumor-bearing animals. RESULTS: Lung-cancer patients were characterized by significantly lower NK cell cytotoxicity (7.07 +/- 3.15) than healthy donors (44.12 +/- 10.62, P < 0.001). NK cell activation was found in both in vitro experiments using peripheral blood mononuclear cells (PBMC) from healthy donors and ex vivo in lung carcinoma patients after treatment with unfractionated heparin and fraxiparine. Similarly, potentiation of NK cell activity in Lewis lung carcinoma-bearing mice was found after therapy with unfractionated heparin. NK cell activity is lower in lung cancer patients than in normal subjects. CONCLUSIONS: NK cell activation was increased by LMWHs. Other anticoagulants augment the effector function of NK cells in cancer patients and in an animal model of lung cancer. This is a novel effect of these compounds, which were thought previously to exert their effect only via their anticoagulant properties.

Inhibition of adhesion breast cancer cells by anticoagulant drugs and cimetidine.

Recent studies suggest that anticoagulant drugs and cimetidine therapy in malignancy may improve cancer survival and inhibit the metastatic process. In this study we investigated and compared the effects of anticoagulant drugs (unfractionated heparin, warfarin, acetylsalicylic acid, low-molecular-weight heparins--nandroparinum, enoxaparinum, dalteparinum and reviparinum), cimetidine and combination of cimetidine with anticoagulants on adhesion of highly invasive breast cancer cells lines - BT 549 and MDA-MB-231 (MDA 231)--in vitro. High antiadhesion effect was observed with cimetidine, warfarin and acetylsalicylic acid. Low-molecular-weight heparins had a small antiadhesion effect in independent use. In combination with cimetidine, a potential effect of cimetidine on the antiadhesion was observed. The antiadhesion effect was dependent on the type of the cancer cell line. Different effects between cell lines BT 549 and MDA 231 were observed. The strongest antiadhesion effect was obtained using the combination of cimetidine with acetylsalicylic acid. In the majority of applications of the drugs and their combinations, a proportional antiadhesion effect was dependent on the concentration and time. We suppose that anticoagulant drugs might have higher antimetastatic effect in combination with cimetidine. The choice of anticoagulants can decrease the adhesion, decrease tumor angiogenesis and cause the shortening of blood clotting time. Cimetidine can decrease the adhesion of cancer cells and increase the activity of NK cells. Indeed, according to our results, application of cimetidine and anticoagulant drugs intensifies the antiadhesion effect together with other antimetastatic effects.