Total mesorectal excision for rectal cancer - laparoscopic versus robotic approach.

INTRODUCTION: The primary goal of this study was to evaluate peroperative and early postoperative results of laparoscopic and robotic surgery for rectal cancer with total mesorectal excision (TME) and with primary anastomosis. METHODS: 404 patients were enrolled in the study, divided in two cohorts and compared retrospectively: a laparoscopic group (n=236) versus a robotic (TME + primary coloanal anastomosis) group (n=168). The evaluated cohorts were comparable in sex, age, BMI, ASA score, distal tumor margin from anal verge and neoadjuvant chemoradiotherapy. More advanced tumor stages were observed in the robotic group (p=0.009). RESULTS: The duration of robotic resection was significantly longer compared to laparoscopic resection (p.

Risk factors of low anterior resection syndrome after miniinvasive restorative rectal resection.

INTRODUCTION: Over the last decades outcomes for rectal cancer surgery have improved with increasing survival and lower recurrence rates. Nevertheless, functional disorders are still frequent. Low anterior resection with total mesorectal excision (TME) in patients with rectal cancer has improved oncological outcomes. However, most of them will have significant changes in quality of life, including varying degree of bowel dysfunction. Aim of this study was to analyse prevalence of LARS (low anterior resection syndrome) in patients with rectal cancer after miniinvasive restorative resection and to define its risk factors. METHODS: Between March 2016 and June 2018, patients who underwent elective miniinvasive (laparoscopic or robotic) rectal resection were enrolled. Bowel dysfunction was evaluated by LARS questionnaire and filled out 6, 12, and 24 months after primary operation or after ileostomy closure. 98 patients completed the questionnaires - 58 laparoscopic operations, 34 robotic and 6 open procedures. 69 patients underwent TME, tumor-specific mesorectal excision 21 patients. 8 patients underwent transanal TME. The clinical characteristics, surgical perioperative and postoperative outcomes did not differ between these groups. Only, significantly more patients underwent neoadjuvant radiotherapy in the robotic group (p=0.004). RESULTS: 59.8% patients reported major LARS 6 months after surgery and 29.7% after 24 months. Protentional risk factors are age (p.

Fluorescent angiography in colorectal surgery, the influence of augmented reality in the operating room on the anastomotic leakage after low rectal resection.

INTRODUCTION: Near-infrared (NIR) fluorescence angiography (FA) is an augmented reality (AR) technique. When used in the operating room, it allows colorectal surgeons to visualize and evaluate intestinal blood flow in real time, identify lymph nodes, ureters, or peritoneal metastases. Evaluation of perfusion with FA in augmented reality mode has an impact on reducing the ALR (anastomotic leakage rate) in rectal resections. METHODS: Data analysis of patients after minimally invasive surgery (MIS) for middle and lower rectal adenocarcinoma with total mesorectal excision (TME) using fluorescent angiography (FA) with indocyanine green (ICG) (100 patients, 20152019) were subsequently compared with a historical control group (100 patients) operated on for the same diagnosis before the introduction of the FA-ICG method (20122015) using minimally invasive approach (MIS). The patients were operated on consequently at one workplace. RESULTS: In fifteen patients (15%), the resection line was shifted due to insufficient perfusion detected by FA-ICG. The incidence of AL was lower in the group with FA compared to the group without FA (9% vs. 19%, p=0.042, χ test). A retrospective analysis of the group revealed a significant risk factor (RF) for the anastomotic leak, namely diabetes (p=0.036) and, among others, a protective factor, application of the transanal drain (NoCoil) (p=0.032). CONCLUSION: The introduction of new procedures and the use of new technologies, such as the use of the FA method in the AR mode in resections of the rectum with TME for cancer can lead to a reduction in the incidence of anastomotic leakage.

[Fluorescence angiography in the detection of anastomotic perfusion during rectal and sigmoid resection - preliminary report]. / Fluorescencní angiografie v detekci kvality perfuze anastomózy u resekce sigmoidea a rekta - zhodnocení prubezných výsledku.

INTRODUCTION: The aim of the study was to evaluate the results of fluorescence angiography for assessing anastomotic perfusion after resection of the sigmoid colon and rectum since its introduction into clinical practice at the authors´ workplace and to evaluate the incidence of necessary resection line repositioning based on the quality of perfusion, and also to record any complications in anastomotic healing. METHOD: Retrospective unicentric analysis of prospectively collected data from patients with resection of the sigmoid colon and rectum with primary anastomosis. The patient set included 50 patients, 27 males and 23 females; the median age was 64.5 years (33-80). Forty-four patients were indicated for resection for cancer of the sigmoid colon or rectum, while 6 patients had a benign disease. Twenty-nine patients underwent total mesorectal excision with coloanal mechanical or hand-sewn anastomosis and 21 underwent resection of the sigmoid colon or upper rectum with mechanical anastomosis. Prior to the construction of the anastomosis, assessment of perfusion of the anastomotic segments by near infrared (NIR) indocyanine green (ICG) fluorescence angiography was performed in all patients. The quality of perfusion of the mesocolon and bowel wall and its impact on moving the resection line and complications of anastomotic healing 30 days postoperatively were all evaluated. RESULTS: Assessment of perfusion using fluorescence angiography was technically successfully performed in all 50 patients. In 5 cases (10%) the resection line had to be moved for signs of poor perfusion of the bowel wall. Postoperatively, healing of the anastomosis was complicated in four patients (8%). Dehiscence was recorded in 3 patients (10.3%) with total mesorectal excision and in 1 patient (4.8%) after resection of the sigmoid colon and upper rectum. CONCLUSION: The presented results indicate that fluorescence angiography may lead to a decrease in the incidence of anastomotic dehiscence after colorectal resections by mapping in detail the perfusion of the anastomosed segments.Key words: fluorescence angiography - indocyanine green - anastomotic leak - colorectal resection.

The use of optical coherence tomography in chiasmal compression.

The objective of this prospective study is to explore the benefits of optical coherence tomography (OCT) in cases of optic chiasm (OC) compression by measuring the thickness of the Retinal Nerve Fiber Layer (RNFL) and the Ganglion Cell Layer (GCL). MATERIAL AND METHODS: 16 patients (32 eyes) with chiasmal compression were included in the study. They presented no other pathology of the visual pathway or of the eye globe. The second inclusion criterion was a subsequent indication of decompressive surgery, either by transcranial or transnasal approach. Measurements of visual acuity, visual field, RNFL and GCL were performed once preoperatively and three times postoperatively (one week, 3 and 6 months postoperatively). The observed peripapillary and perifoveal regions were divided into quadrants. The degree (grade 0-5) of chiasmal compression was determined on preoperative brain MRI (magnetic resonance imaging). In need of some data analysis, participants were split into a group with no or minimal (grade 0-1) and with substantial pressure (grade 2-4) on OC. RESULTS: The median global peripapillary RNFL was 87 μm, the perifoveal nasal GCL 41,2 µm and the temporal 44,2 µm. There was a pronounced preoperative RNFL thinning in nasal (63,5 μm) and temporal (65 μm) quadrant, in comparison to the age-matched normative database for RNFL thickness in the OCT protocol. There is a statistically important connection between bitemporal hemianopia and RNFL, resp. GCL. Larger perimetric outages is related to important OC compression, seen on MRI. CONCLUSION: There exists a correlation between the thickness of the peripapillary RNFL, resp. perifoveal GCL, and visual field defects in chiasmal compression. Thinner preoperative RNFL does not present a statistically important limiting factor for better functional outcomes after surgical decompression. Horizontal asymmetry of perifoveal GCL is an indicator of compressive ophthalmopathy. The grade of preoperative OC compression presents another important prognostic factor.

[Pars Plicata Vitrectomy in Premature Newborns for Retinal Detachment as a Result of Retinopathy of Prematurity, our Results]. / Pars plicata vitrektomie u nedonosených novorozencu pro odchlípení sítnice v dusledku retinopatie nedonosených, nase výsledky.

INTRODUCTION: The aim of this work is to evaluate our own results of surgical treatment of retinal detachment in immature newborns. Retinopathy of prematurity (ROP) is one of the most complicated ocular disorders, both in terms of diagnosis and therapy. It is a potentially blinding illness that arises from the incomplete development of the bloodstream of the neuroretina of preterm infants. Currently, the most effective therapy is ablation of the avascular retina by laser photocoagulation or cryocoagulation. Despite this treatment, the immature retina may develop it´s detachment. METHODOLOGY: We report 2 case-reports, retrospective results of 4-eyes in 2 patients with severe ocular and overall complications of prematurity. The ocular background of preterm babies was investigated in arteficial mydriasis by an indirect ophthalmoscope, and later with the RetCam photographic device. The ROP stages were evaluated according to the ICROP classification. All eyes were treated with cryo-retinopexy at the threshold stage of ROP, followed by intraocular surgery for progression of traction retinal detachment. The surgical technique was a 3-port 25-G PPV (pars-plicata vitrectomy) with insertion of ports 1.5 mm from limbus. The PPV was performed using the Constellation (ALCON) operating unit, controlling the intraocular pressure for 15 torr. The assessment of visual acuity was performed according to the scale: no light perception (no response of the child to light), light sensitivity (positive or negative reaction to illumination), fixation of light. RESULTS: The retina stayed attached in all operated eyes, more in each case-report. CONCLUSION: Contemporary vitreoretinal surgery allows for the anatomical success of traction retinal detachment surgery during ROP already in neonatal age.Key words: retinal detachment, retinopathy of prematurity, PPV, surgery.

Attempts to compare the effectiveness of blocking factors and enhancing antibodies in vivo and in vitro.

Sera from rats carrying tolerated skin allografts were tested for the presence of blocking activity in vitro. Sera with blocking activity had no effect on transplantation tolerance induction in newborn animals. Immunological enhancement of tumor growth was procured by passive transfer of serum from tolerant animals bearing skin allografts. It made no difference whether or not the serum contained blocking activity in vitro. These results suggest that there is no relationship between blocking factors and enhancing activity in vivo.

Epidemiology of paratuberculosis in wild ruminants studied by restriction fragment length polymorphism in the Czech Republic during the period 1995-1998.

In two studies carried out during the period 1995-1998, paratuberculosis was diagnosed in domestic and wild ruminants in the Czech Republic. The isolated Mycobacterium avium subspecies paratuberculosis strains were analysed by standardised restriction fragment length polymorphism (RFLP) [Pavlik, I., Horvathova, A., Dvorska, L., Bartl, J., Svastova, P., du Maine, R., Rychlik, I., 1999. J. Microbiol. Methods 38, 155-167]. In December 1992, 19 late pregnant Charolais heifers were imported to the Czech Republic from Hungary (original import from France to Hungary). One 11-month-old heifer roamed in the wild in a range of approximately 15-20km for 7 months from November 1993 to May 1994. Upon capture, the animal showed clinical signs of paratuberculosis (emaciation and diarrhoea). Seven other animals from the same herd were infected with the identical RFLP type B-C1 of M. paratuberculosis. During the period 1995-1996, samples were taken and examined from the small intestine and corresponding lymph nodes of 84 wild ruminants: 19 red deers (Cervus elaphus) and 65 roe-deers (Capreolus capreolus). These wild ruminants originated from 44 different locations within the same district from as the infected escaped heifer. Five M. paratuberculosis strains were isolated: one strain of RFLP type B-C1 from a stag and three strains of RFLP type B-C1 and one strain of RFLP type B-C9 from roe-deer. The three wild ruminants (one stag and two roe-deer) infected with the same RFLP type B-C1 were detected in the same area as the heifer, suggesting that this was the likely infection source. However, the infection source of the roe-deer infected with strain of RFLP type B-C9 was obviously different, and the stags that escaped from the farm were purchased from an area infected with this RFLP type. In the second study carried out during 1997-1998 in the whole Czech Republic (divided into 76 districts), 718 wild ruminants were examined from 90% of the districts. M. paratuberculosis was isolated from 25 (3.5%) animals from the wild, from farms and from game parks: 7.1% of 132 red deers, 1.5% of 336 roe-deers, 3.9% of 178 fallow deers (Dama dama), and 4.2% of 48 moufflons (Ovis musimon). This study discovered three RFLP types (B-C1, D-C12 and M-C16). A surprising finding was that of M. paratuberculosis (RFLP type B-C1) infection in roe-deer and a fallow deer in their natural habitat. The infection source was determined to have originated from two imported Holstein and Limousine cattle herds infected with the same strain. In the case of a mother and daughter roe-deer infected with RFLP type M-C16 and a fallow deer infected with RFLP type D-C12, all roaming in their natural habitat, the infection source was not discovered. The highest incidence of clinically ill wild ruminants was found in farmed red deer, and no relationship was found between the RFLP type or ruminant species and clinical status of animal.

Paratuberculosis in farmed and free-living wild ruminants in the Czech Republic (1999-2001).

Due to the occurrence of the infection of Mycobacterium avium subspecies paratuberculosis among domestic ruminants and the rapid development of farmed deer industry and the market of cloven-hoofed game we have carried surveys of paratuberculosis, beginning in 1997, in the most common four species of wild ruminants in the Czech Republic [Pavlik et al., Vet. Microbiol. 77 (2000) 231-251]. From 1999 the prevalence of paratuberculosis has been slightly reduced in all three types of husbandry of wild ruminants. Nevertheless paratuberculosis has been diagnosed in wild ruminants in three districts, in four game parks and in five farms. M. a. paratuberculosis was isolated from 128 (5.3%) out of 2,403 wild ruminants of four animal species: 106 red deer, 2 roe deer, 4 fallow deer and 16 mouflons. In red deer farms, the highest number of clinical paratuberculosis cases was in yearling deer. RFLP type B-C1 of M. a. paratuberculosis predominated during the second period (1999-2001) in all types of husbandry with no relationship to wild ruminant species. New "cattle" RFLP types B-C5 and B-C16 of M. a. paratuberculosis were described in infected farmed red deer and one "intermediate" RFLP type R-I4 in fallow deer from one game park. The survival of M. a. paratuberculosis was found to be 4 months during winter in the pasture after destocking of all cattle infected with paratuberculosis. We found that non-vertebrates, wild ruminants or non-ruminant wildlife can be vectors and potentially become a risk factor in the spread of M. a. paratuberculosis infection.

Human urinary bladder carcinoma cell line (T24): immunological studies and search for oncornavirus in T24 cell population and derived clones.

Cytotoxicity of mononuclear cell (MNC) preparations isolated from peripheral blood of patients with urinary bladder carcinomas of a transitional (BTCC) or squamous (BSCC) type and from blood of control subjects was examined on the target cells of T24 cell line. In pilot experiments the percentage of cytotoxic MNC preparations was found to be similar in patients with tumors of BTCC (European, 56%;African, 60%) and BSCC (54%) type. Cytotoxicity of MNC prepared from control subjects was detected in 10% of cases or less. These data suggest an antigenic cross-reactivity between urinary bladder carcinomas of transitional and squamous cell type. The cytotoxic MNC from peripheral blood of patients with BTCC and control subjects were fractionated by adherence in nylon wool columns, and the cytotoxicity of adherent and nonadherent MNC subpopulations was examined. In the majority of cytotoxic MNC preparations from both donors with and without BTCC, the cytotoxic activity was associated with nonadherent MNC. Comparison of immunosensitivity of T24 cell population with the cloned T24 subpopulations indicated that clones with various digrees of immunosensitivity are present in the T24 cell population. However, immunosensitivity of the clones was never higher than the immunosensitivity of the T24 cell population. A search for oncornavirus particles produced spontaneously or after treatment with virus production activators performed with regard to the possible association of oncornaviruses and antigens responsible for cell-mediated cytotoxicity gave thus far negative results.

Full value documentation in the Czech Food Composition Database.

BACKGROUND/OBJECTIVES: The aim of this project was to launch a new Food Composition Database (FCDB) Programme in the Czech Republic; to implement a methodology for food description and value documentation according to the standards designed by the European Food Information Resource (EuroFIR) Network of Excellence; and to start the compilation of a pilot FCDB. SUBJECTS/METHODS: Foods for the initial data set were selected from the list of foods included in the Czech Food Consumption Basket. Selection of 24 priority components was based on the range of components used in former Czech tables. The priority list was extended with components for which original Czech analytical data or calculated data were available. Values that were input into the compiled database were documented according to the EuroFIR standards within the entities FOOD, COMPONENT, VALUE and REFERENCE using Excel sheets. Foods were described using the LanguaL Thesaurus. RESULTS: A template for documentation of data according to the EuroFIR standards was designed. The initial data set comprised documented data for 162 foods. Values were based on original Czech analytical data (available for traditional and fast foods, milk and milk products, wheat flour types), data derived from literature (for example, fruits, vegetables, nuts, legumes, eggs) and calculated data. CONCLUSIONS: The Czech FCDB programme has been successfully relaunched. Inclusion of the Czech data set into the EuroFIR eSearch facility confirmed compliance of the database format with the EuroFIR standards. Excel spreadsheets are applicable for full value documentation in the FCDB.

[Subjective visual perception after laser treatment of myopia on two types of lasers]. / Subjektivní zrakové vnímání po laserové operaci myopie provedené na dvou typech laseru.

AIM: Comparison of subjective evaluation of patients with low and moderate myopia undergoing photorefractive keratectomy (PRK) and Laser in Situ Keratomileusis (LASIK) on two types of excimer lasers: Schwind Esiris and Schwind Amaris. PATIENTS AND METHODS: Patients were divided into two groups according to the type of laser that was used. Group A comprised of 23 patients (14 females, 9 males) of average age 33.1 years (range 21-51 years), with an average spherical equivalent before operation of -3.5D. Using the excimer laser Esiris (Schwind, Germany), 10 patients had undergone PRK and 13 LASIK. Group B comprised of 32 patients (21 females, 11 males), of average age 31.9 years (range 22-48 years). Median spherical equivalent before operation was -3.05D. With the excimer laser Amaris (Schwind, Germany) 17 patients had undergone PRK and 15 LASIK. For the subjective evaluation we set up a questioner consisting of 21 questions that were aimed on the quality of vision under various illumination types and intensities, vision under various distances, activities and also questions concerning superficial sensitivity of the anterior segment of the eye. RESULTS: We detected a 100% satisfaction one year after refractive laser treatment with both laser types. Statistical improvement was evident by one month after treatment in both patient groups and upto 12 months it progressively increased. Statistically significant differences were noted one month after treatment, where patients in group B were more satisfied in questions concerning quality of vision, distance vision, while watching TV and driving during daytime and during the night. During further follow-up, results were comparable between both groups. CONCLUSIONS: Temporary patient satisfaction treated with laser Amaris is apparently due to the result of a more sparing treatment and thus fewer changes in the corneal stroma.

Detection of 6 specific monocyte antigens MoP-1 to MoP-6.

Using 36 monocyte samples, an assay was performed with 42 antimonocyte sera, by means of a micromonocytotoxic test, the results of which were evaluated statistically through computation of the correlation coefficient r 6 specific monocyte antigens were detected and labelled MoP-1 to MoP-6, their frequencies varying from 5.58% to 41.67%. These antigens belong probably to one single system. Among the individual samples of monocytes no more than 2 of these antigens could be demonstrated per sample, in 11 of the 36 no antigen could be revealed at all. The difficulties of these studies are pointed out, they are due mainly to the instability of antimonocyte sera which often lose their activity during storage in a frozen state.

[The effect of heating and drugs on HL-A antigens and their reactions with cytotoxins]. / Die Wirkung von Erwärmung und chemischen Stoffen auf die HL-A-Antigene und ihre Reaktion mit Zytotoxinen

In some instances the heating of lymphocytes for 2 to 3 minutes at 56 degrees C enhances HL-A antigens or makes it possible to detect these antigens by a twostage microlymphocytotoxic test on preheated lymphocytes only. Similar phenomenons are observed in some tannin (1: 40 000) or 0.1% phenol-treated lymphocytes and after the addition of these solutions during the first stage of the lymphocytotoxic test. Prolonged heating at 56 degrees C leads to nonspecific polyreactivity of lymphocytes, giving false results with all sera. For similar reasons also higher concentrations of tannin and phenol solutions were found dissatisfactory for the pretreatment of lymphocytes. The pretreatment of lymphocytes with 36-0.5% formaline induces full inhibition of specific cytotoxic reactivity of HL-A antigens and their absorption ability with regards to respective HL-A sera. The addition of formaline at 0.06-0.3% concentration during the first and second stages of the test and at the end of the second stage (or simultaneously with eosine) gives also negative results of the cytotoxic test owing to the inhibitory effect of formaline on rabbit complement and HL-A antigens.

Enhancement of the specific cytotoxic reactivity of HLA antigens on lymphocytes stored at +4 degrees C for 24 hours.

The lymphocytes of some patients (especially with malignancies) as well of healthy subjects, which had been isolated on the day of blood withdrawal from the heparinized blood, show negative or slightly positive reaction with some corresponding HLA sera; after 24 h of storing in the refrigerator at +4 degrees C the lymphocytes tend to restore the cytotoxic reactivity of HLA antigens, and thus, a strongly positive reaction can be recorded. The cause of this phenomenon may be ascribed to the anticomplementary effect of the lymphocyte suspension in barbital buffer.