Differential collagen expression in kidney and heart during hypertension.

AIM: The aim of the present study was to investigate the immunohistochemical expression of selected collagen types, namely collagen types I and V and procollagen type III in the renal parenchyma and interstitium and in the myocardium of spontaneously hypertensive rats. MATERIAL AND METHODS: For the present study, we used two age groups of 6- and 12-month-old spontaneously hypertensive rats. An immunohistochemical analysis was conducted with monoclonal antibodies against collagen types I and V and procollagen type III. A semi-quantitative analysis of immunostaining intensity was conducted with the Image J software. RESULTS: In the kidney, all three molecules showed higher expression at the age of 12 months, which was particularly notable for procollagen type III and collagen type V, which stained as highly-positive. In the myocardium, the immunoreactivity of collagen types I and V was stronger in 12-month-old animals, while that of procollagen type III did not change substantially. CONCLUSION: The present study suggests a role of collagen types III and V in hypertensive kidney disease, while also establishing the role of increased expression of collagen types I and V in adverse myocardial remodeling (Tab. 1, Fig. 2, Ref. 48).

[Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma results of a multicenter study]. / Parametrické sledování kvality totální mezorektální excize a chirurgické lécby karcinomu rekta výsledky multicentrické studie.

INTRODUCTION: Tumour size and the quality of its complete surgical removal are the main prognostic factors in rectal cancer treatment. The number of postoperative local recurrences depends on whether the mesorectum has been completely removed - total mesorectal excision (TME) - and whether tumour-free resection margins have been achieved. The surgery itself and its quality depend on the accuracy of preoperative diagnosis and detection of risk areas in the rectum and mesorectum, on the surgeons skills, and finally on pathological assessment evaluating whether complete tumour excision has been accomplished including circumferential margins of the tumour, and whether mesorectal excision is complete. The aim of our study was to implement and standardize a new method of evaluation of the quality of the surgical procedure - TME - in rectal cancer treatment using an assessment of its circumferential margins (CRO) and completeness of the excision. METHODS: The study consisted of two parts. The first, multi-centre retrospective phase with 288 patients analysed individual partial parameters of the diagnosis, operations and histological examinations of the rectal cancer. Critical points were identified and a unified follow-up protocol was prepared. In the second, prospective part of this study 600 patients were monitored parametrically focusing on the quality of the TME and its effect on the oncological treatment results. RESULTS: The proportion of patients with restaging following neoadjuvant therapy increased from 60.0% to 81.7% based on preoperative diagnosis. The number of specimens missing an assessment of the mesorectal excision quality decreased from 52.9% in the retrospective part of to the study to 22.8% in the prospective part. The proportion of actually complete TMEs rose from 22.6% to 26.0%, and that of nearly complete TMEs from 10.1% to 24.0%. CONCLUSION: The introduction of parametric monitoring into routine clinical practice improved the quality of pre-treatment and preoperative diagnosis, examination of the tissue specimen, and consequently improved quality of the surgical procedure was achieved. KEY WORDS: rectal cancer TME - parametric monitoring - quality control.

WILIS IRLE ARITINS, IMPORTANT FOR CEREBRAL PROTECTION IN AORTIC SURGERY - PRIMARY CT ANGIO DATA.

Unilateral selective cerebral perfusion (SCP) is a method for cerebral protection in aortic arch surgery. However variations of the circle of Willis (CoW) could vitiate its protective effect. The aim of our present work was to make a retrospective analysis of 30 patients, in whom CT angio was performed between January and March 2008. Variations of Willis circle, which could compromise the perfusion during unilateral SCP were found in 21 patients (70%). We also found that many patients have significant stenosis of cerebral arteries. Our present study shows the need of extensive preoperative examination and meticulous intraoperative monitoring.

Small carcinomas involving less than one-quarter of the rectal circumference: local excision is still associated with a high risk of nodal positivity.

AIM: A study was carried out to determine the relationship between mesorectal lymph nodal involvement and T stage in a group of patients with a rectal cancer involving less than one-quarter of the rectal circumference, such as might be selected for local excision. METHOD: The data of patients having rectal resection between 2010 and 2014 were prospectively entered in a rectal carcinoma registry. A model for describing tumours involving less than one quadrant of the rectal circumference was created to facilitate the evaluation process. RESULTS: In all, 304 patients were included in the study. In 68 (22.4%) a small tumour (< 1 quadrant involved) was found. Of these, 26.5% had positive mesorectal lymph nodes (N+). In lesions of Stage ypT0 cancer 12.5% patients were node positive, in Stage Tis and T1 tumours there was no case of node positivity, but in Stage T2 and Stage T3 cancers the incidence of node positivity was 27.5% and 64%. CONCLUSION: The study demonstrated that, even for small tumours involving only one rectal quadrant, the risk of lymph nodal involvement was about 25%. Had the patients undergone local excision the treatment would have been incomplete.

[Predicting pN positivity in T3 rectal cancer]. / Moznosti predikce pN pozitivity u T3 nádoru rekta.

INTRODUCTION: Stage pN+ is a factor which determines the strategy for treatment of T3 rectal cancer. The sensitivity of preoperative imaging examinations revealing N+ is not entirely satisfactory. Risk factors that are associated with pT3pN+ stage and that are detectable by preoperative examination have not been reliably identified. The aim of the study is to analyze the predictive factors determining lymph node involvement in T3 rectal cancer. MATERIAL AND METHODS: Patients with rectal resection for (y)pT3 rectal cancer were analysed. All of the surgical interventions were performed at the Department of Surgery, University Hospital in Hradec Kralove, from 1 January 2011 to 28 February 2014. Data were prospectively collected and saved in the Rectal Cancer Oncologic Register. The parameters studied were age, gender, tumour localisation and its circumferential topography, preoperative chemoradiotherapy, absolute number of harvested lymph nodes and the number of positive lymph nodes in each specimen, tumour grading, presence of lymphovascular invasion and perineural invasion, and the depth of tumour penetration. RESULTS: After selection, 89 patients with T3 rectal cancer were included into the study. Resection for cancer of the upper rectum was performed in 22 (24.7%) patients, middle rectum in 37 (41.6 %) and lower rectum in 30 (33.7%) patients. 38 (42.7%) patients underwent primary operation, 41 (46.1%) patients received neoadjuvant chemoradiotherapy, and radiation therapy was administered to only 10 (11.2%) patients. Stage pN+ was found in 51 (57.3%) patients. Statistical analysis was used to identify the risk factors for pN+: lymphovascular invasion (p0.001), angioinvasion (p=0.030) and perineural invasion (p=0.010). On the border of statistical significance for pN+, low grading of the tumour (p=0.084) was found. The depth of penetration of the tumour into the mesorectum was not statistically significant (p=0.230). CONCLUSION: Our study has shown that pN positivity is associated with lymphovascular invasion, perineural invasion and low grading of the tumour. Accurate identification of these factors before treatment, however, remains very difficult.

Primary cilia in gastrointestinal stromal tumors.

The primary cilium is a solitary, sensory, non-motile microtubule-based structure that arises from the centrosome and is projected from the surface of most human cells. The objective of the current pilot study was to conduct an investigation of presence and frequency of cilia in gastrointestinal stromal tumors (GIST).The presence of primary cilia in GIST was evaluated in 9 patients, including 8 primary tumors and 1 liver metastasis. In 2 patients the presence of primary cilia was evaluated not only in the primary tumor, but also in recurrence: in 1 patient in recurrence without previous treatment with imatinib and in 1 patient in recurrence after treatment with imatinib. The primary cilia of GIST cells were immunofluorescently stained with primary monoclonal anti-acetylated tubulin alpha antibody and cell nuclei with DAPI.We observed 9985 nuclei of cells of GISTs and 425 primary cilia in total. The median of frequency of primary cilia in cells of GISTs in all examined samples was 4.26%, in primary tumors was 4.32% and in metastases was 3.64%, respectively. This pilot study provides the evidence of the presence of primary cilia in GISTs in different organs. Primary cilia were identified in all examined cases of GIST, including primary tumors, metastases and recurrent lesions without and with previous treatment with imatinib.

[Evaluation of safe resection margins in rectal carcinoma]. / Problematika stanovení bezpecných resekcních okraju u karcinomu rekta.

The fact that surgically well performed total mesorectal excision with negative circumferential resection margin represents one of the most important prognostic factors in colorectal carcinoma is already well known. These parameters significantly affect the incidence of local tumour recurrence as well as distant metastasis, and are thus related to the duration of patient survival. The surgeons task is to perform mesorectal excision as completely as possible, i.e., to remove the rectum with an intact cylinder of mesorectal fat. The approach of the pathologist to evaluation of total mesorectal excision specimens differs greatly from that of resection specimens from other parts of the large bowel. Besides evaluation of the usual parameters for colon cancer staging, it is essential to assess certain additional factors specific to rectal carcinomas, namely tumour distance from circumferential (radial) resection margins and the quality of the mesorectal excision. In order to accurately evaluate these parameters, knowledge of a wide range of clinical data is indispensable (results of preoperative imaging, intraoperative findings). For objective evaluation of these parameters it is necessary to introduce standardized procedures for resection specimen processing and macro and microscopic examination. This approach is based mainly on standardized macroscopic photo-documentation of the integrity of the mesorectal surface. Parallel transverse sections of the resection specimens are made with targeted tissue sampling for histological examination. It is essential to have close cooperation between surgeons and pathologists within a multidisciplinary team enabling mutual feedback.

[The radicality of surgical resection in rectal cancer. Analysis of factors associated with incomplete mesorectal excision]. / Radikalita resekcní lécby pro karcinom rekta Analýza prediktivních faktoru spojených s nekompletní mezorektální excizí

INTRODUCTION: Circumferential resection margin (pCRM) and the completeness of mesorectal excision (ME) are two independent prognostic factors significantly associated with the radicality of surgical treatment. Positive pCRM and incomplete mesorectal excision are associated with a significantly higher incidence of local recurrence and worse patient prognosis. The aim of this article is to analyze the risk factors associated with incomplete mesorectal excision. MATERIAL AND METHODS: Patients operated on at the Department of Surgery, University Hospital Hradec Kralove between January 2011 and February 2013 were included in the study. The patients data were prospectively collected and entered in the Dg C20 registry. The following factors were analyzed: sex, age, BMI, cN, pT, clinical stage, the involved segment of the rectum, neoadjuvant therapy, circumferential tumour location, the type of surgical approach and the type of surgery. RESULTS: 168 patients were operated on during the above period. 9 (5.3%) palliative stomas and 159 (94.6%) resection procedures were performed in this group of 168 patients. 7 (4.4%) patients were excluded because the quality of excision was not assessed in them. 114 (75%) resections, including 5 intersphincteric resections, were performed in the group of the remaining 152 patients. 10 (7%) were Hartmanns procedures a 28 (18%) were amputation procedures. Out of 152 procedures, 69 (45%) were performed laparoscopically. Positive (y)pCRO was recorded in 26 (17%) patients, predominantly after abdominoperineal resection (APR) - 11 out of 27 (41%), and Hartmanns operation - 6 out of 10 (60%). Incomplete ME was observed in 45 patients (30%), complete ME in 81 patients (53%) and partially complete in 26 patients (17%). Univariate analysis confirmed statistically significant factors associated with incomplete mesorectal excision: (y)pT (P = 0.00027), type of surgery (P = 0.00001) and tumour location (P = 0.00001). Multivariate analysis then confirmed two independent prognostic factors associated with incomplete mesorectal excision. It was the location of the tumour in the distal third of the rectum and the (y)pT stage of the tumour. CONCLUSION: Distal rectum tumor location and higher (y)pT are associated with a higher risk of incomplete mesorectal excision with worse patient prognosis.

[Rectal cancer within 10 cm. Comparison of the radicality of laparoscopic and open surgical techniques with regard to the circumferential resection margin and the completeness of mesorectal excision]. / Karcinom rekta do 10 cm Srovnání radikality laparoskopické a otevrené operacní techniky s ohledem na cirkumferentní resekcní okraj a na kompletnost mezorektální excize.

INTRODUCTION: The issue of achieving radical circumferential margin in laparoscopic rectal surgery has not yet been satisfactorily clarified. In this paper we have focused on circumferential margin assessment and the quality of the mesorectal excision, comparing laparoscopic and open resection for cancer of the middle and lower rectum. MATERIAL AND METHODS: The results of surgical procedures for middle and low rectal cancer were analysed. All the interventions were performed at the Department of Surgery, Teaching Hospital in Hradec Kralove, during the period from January 2011 to December 2012. The data were prospectively collected and entered in the Rectal Cancer Registry. Age, gender, BMI, tumour localisation and topography, the clinical stage, preoperative chemoradiotherapy and response to it, the type of surgery, distal and circumferential margin characteristics, mesorectal excision quality, pT and pN were compared for laparoscopic and open surgery. RESULTS: A total of 161 patients were operated on for rectal cancer during the abovementioned period. 94 patients were included in the trial following selection. Laparoscopy was used in 40 patients and open surgery in 54 patients. Laparoscopic approach was performed in 33 (82.5%) low anterior resections (including four intersphincteric resections), 6 (15%) abdominoperineal amputations and 1 (2.5%) Hartmanns procedure. Open surgery was used for 26 (48.1%) low anterior resections, 21 (38.9%) APR and 7 (13%) Hartmanns procedures. Complete mesorectal excision was achieved in 45% of the laparoscopic resections vs. 46.3% of open resections. Nearly complete excision was performed in 22.5% and 11.1%, respectively. Finally, incomplete excision was described in 30% vs. 38.9%. No available data for TME was detected in three patients. The differences in TME were not statistically significant. Positive circumferential margin was found in 5 (12.5%) patients in the laparoscopy group; on the contrary, in the group undergoing open surgery, pCRO+ was found in 15 (27.8%) patients. Here, too, the results were not statistically significant. When patients without preoperative chemoradiotherapy were excluded, the relationship between ypCRM in the laparoscopy and open surgery group was on the border of statistical significance (Fischer=0.0556). CONCLUSION: As has been shown in our trial, the outcomes of laparoscopic and open approach in rectal cancer treatment are very similar. Particularly, mesorectal excision quality and negative CRM results have proven that the laparoscopic technique is safe and comparable to open surgery in rectal cancer treatment.

[GIST: current knowledge and treatment modalities]. / GIST: Novodobé poznatky a lécebné modality.

GISTs represent a specific group of mesenchymal tumors with unpredictable biological features. Approximately 30% of newly diagnosed GIST tumors are malignant or have a high potential for malignancy. Currently, GISTs are routinely identified using histological, immunohistochemical, and molecular genetic assays. However, clinical diagnosis, particularly of small or intramural GISTs, might be difficult. Endoscopic examinations and fused PET/CT imaging are the most useful techniques for imaging and monitoring the disease progression. Surgical treatment is the first-line treatment and the only method that might lead to full remission in patients with primary GISTs. At the present time, there is no consensus on the issues whether to perform resections in patients with positive margins and resections of metastases. Biological therapy with imatinib mesylate is recommended in patients with newly diagnosed, locally advanced, inoperable, or metastasizing gastrointestinal GISTs that express the c-KIT protein. Treatment may reduce a primary tumor to a size small enough for surgical excision. Current research is focused on the development of new therapies for the treatment of advanced disease and/or disease prophylaxis.

[Primary cilia of cells of cardiovascular apparatus]. / Primární rasinky bunek kardiovaskulárního aparátu.

The primary cilium is a mechanosensory, solitary, non-motile microtubule-based structure that in the quiescent phase of the cell cycle projects from the surface of the majority of human cells, including embryonal, stem and mesenchymal cells, fibroblasts, myoblasts, cardiomyocytes, vascular smooth muscle and endothelial cells. Primary cilia are in increased frequency also present on the surface of endothelial cells in atherosclerotic predilection sites, lipoid streaks and dots and atheromatous plaques. The primary cilium is formed from the mother centriole. Primary cilia are currently studied in mechanobiology of cardiovascular apparatus and their role in cell migration, cell cycle control and atherogenesis. The aim of this paper is to provide a review of the current knowledge on the primary cilia of cells of cardiovascular apparatus.

Survival role of superoxide dismutase 1 on human granulosa luteinized cells in vitro.

OBJECTIVE: Deleterious effects of free radicals do not only result from the amount of free radicals produced but also are related to the efficiency and to the activities of enzymatic antioxidant systems. We investigated the effect of exogenous superoxide dismutase (SOD1) or Cu-chelating agent diethyldithiocarbamate (DDC) on the apoptosis (caspase-3 activity) of human granulosa luteinized cells (hGLC) in vitro. METHODS: The effects of SOD1 and DDC were studied using in vitro culture system, caspase-3 and the total SOD activity in hGLCs were measured using AcDEVD-PNA substrate and Beaushap and Fridovich methods, respectively, after 48 h of the culture period. RESULTS: The activity of SOD1 was the lowest in GLCs treated with 100 µM DDC as compared to control cells and to the cells supplemented with Cu, Zn-SOD or DDC (10 µM). The effect of DDC was associated with elevated caspase-3 activity as compared to control cells. CONCLUSIONS: It was demonstrated for the first time that the supplementation of cultured hGLCs with Cu2+, Zn2+-SOD (200 U/ml) maintains the viability of hGLCs via caspase-3 suppression.

Gastrointestinal stromal tumors: review on morphology, molecular pathology, diagnostics, prognosis and treatment options.

Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial mesenchymal tumors of the gastrointestinal tract. GISTs represent a specific group of mesenchymal tumors with uncertain biological behaviors. These tumors are assumed to originate from progenitor cells, usually unable to self-regenerate, which differentiate towards Cajal cells. Apart from common GISTs that occur predominantly in adulthood, a heterogeneous group of tumors has been described that are morphologically identical with GIST, but have a specific clinical presentation and biological properties. Approximately 30% of newly diagnosed GISTs are malignant or have a high potential for malignancy. Currently, GISTs are routinely identified with histological, immunohistochemical, and molecular genetic assays. However, clinical diagnoses, particularly of small or intramural GISTs, might be difficult. The most useful techniques for imaging and monitoring disease progression are endoscopic examinations and fused PET/CT imaging. Surgical treatment is the first-line treatment and the only method that might lead to full remission in patients with a primary GIST. There is currently no consensus on the issues of whether to perform resections in patients with positive margins or resections of metastases. Endoscopic resection could represent a relatively simple and less aggressive alternative as compared to traditional surgery in the treatment of small sized GISTs. Biological therapy with imatinib mesylate is recommended for patients with newly diagnosed, locally advanced, inoperable, or metastasizing gastrointestinal GISTs that express the c-KIT protein. Treatment may reduce a primary tumor to a size small enough for surgical excision. Current research is focusing on the development of new therapies for the treatment of advanced disease and/or disease prophylaxis.

Fulminant course of metastatic liposarcoma after delivery--case report.

Abdominal liposarcoma is a rare tumor of uncertain prognosis. Radical surgery is possible in about two-thirds of the patients, and the prognosis of patients with inoperable tumors is dismal. Only a few cases of liposarcoma complicating pregnancy have been documented. We report a case of a patient who was diagnosed with metastatic abdominal liposarcoma during the third trimester of the pregnancy. After induced vaginal delivery, palliative surgery was performed and one cycle of systemic combination chemotherapy was administered. Despite the multimodality treatment the patient died of progressive disease within one month after diagnosis. Autopsy revealed high-grade pleomorphic liposarcoma arising from the retroperitoneum with liver and lung metastases.

[Neovascularisation as a cause of recurrence after varicose veins operation]. / Neovaskularizace jako prícina recidivy po operaci varixu dolních koncetin.

AIMS: Following surgical therapy, new varicose veins may develop, in particular at the site of the previous saphenofemoral junction. The objective of this study is the appreciation of the causes of the bad results of surgical procedures in the treatment of varicose veins and the proposal of the possibilities of their prevention. MATERIAL AND METHODS: Retrospective study of the group of 404 patients (573 procedures) with the diagnosis of the recurrence after previous radical surgery was performed. After exclusion of perforator refluxes, the most frequently, the great saphenous vein territory was affected (86%), followed by the small saphenous vein territory (14%). The group of 30 consecutive patients (35 limbs) with saphenofemoral or saphenopopliteal recurrence was selected for this study. Based on preoperative ultrasound and per-operative morphological findings, in 12 patients (14 limbs) - 8 women and 4 men, meticulous histopathological examination of the venous tissue block from the saphenofemoral or saphenopopliteal region, VEGF (Vascular endothelial growth factor) and protein S-100 investigation were performed. RESULTS: In 14 limbs with sonographic and clinical suspition for neovascularisation, this entity was confirmed in 11 of them (79%) which represents 31.42% of the whole group. CONCLUSIONS: The varicose veins recurrences can be observed not only after technically or tactically imperfect primary procedure (which is surely the most common cause of the varicose veins recurrence), but also after the operations performed by the experienced venous surgeon in the perfect way. Neovascularisation explains a certain number of postoperative recurrences despite correctly conducted disconnection of the saphenous termination. The endovascular procedures (endovenous laser or radiofrequency saphenous obliteration) without open groin access can minimise the possibility of this complication.

[Retroperitoneal hemangioma--a case report]. / Hemangiom retroperitonea--kazuistika.

Localization of hemangioma in retroperineum causes late diagnosis of the disease. The tumour is usually detected only when the clinical symptoms caused by the pressure of the surrounding tissues occur. This article presents the case of retroperitoneal hemangioma preoperatively diagnosed as suspect feochromocytoma.

[Contribution to differential diagnosis of intraocular tumors--case report]. / Príspevek k diferenciální diagnostice nitroocních tumoru--kazuistické sdelení.

Authors present the possibilities of different examination methods in cases of intraocular expansions and specific diagnostic methods to determine the actual etiology of the intraocular process in the posterior segment in particular. Of special concern to authors are cases, as is e.g. vitreous hemorrhage, in whose the standard examination methods are not useful. Pars plana vitrectomy with intraocular biopsy of the tissue for histological and cytological examination is very effective method to determine the proper diagnosis. The case report concerns with a 58 years old woman with vitreous hemorrhage and suspect tumor-like lesion, diagnosed by means of ultrasound examination. The pars plana vitrectomy revealed extensive preretinal organized hemorrhage with intravitreal hemorrhage. Samples for cytological examination were taken.