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Ferda J, Frölich M, Ferdová E, Heidenreich F, Charvát R, Mírka H. Neovascularization, vascular mimicry and molecular exchange: The imaging of tumorous tissue aggressiveness based on tissue perfusion. Eur J Radiol 2023; 163:110797. [PMID: 37018901 DOI: 10.1016/j.ejrad.2023.110797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
Angiogenesis in healthy tissue and within malignant tumors differs on many levels, which may partly be explained by vascular mimicry formation resulting in altered contrast material or different radiopharmaceuticals distributions. Failed remodulation results in changes in the molecular exchange through the capillary wall and those consequences affect the behavior of contrast agents and radiopharmaceuticals. One of the most indicative signs of malignant tissue is the increased permeability and the faster molecular exchange that occurs between the extracellular and intravascular spaces. Dynamic imaging can help to assess the changed microenvironment. The fast-distribution of molecules reflects newly developed conditions in blood-flow redistribution inside a tumor and within the affected organ during the early stages of tumor formation. Tumor development, as well as aggressiveness, can be assessed based on the change to the vascular bed development, the level of molecular exchange within the tissue, and/or indicative distribution within the organ. The study of the vascular network organization and its impact on the distribution of molecules is important to our understanding of the image pattern in several imaging methods, which in turn influences our interpretation of the findings. A hybrid imaging approach (including PET/MRI) allows the quantification of vascularization and/or its pathophysiological impressions in structural and metabolic images. It might optimize the evaluation of the pretreatment imaging, as well as help assess the effect of therapy targeting neovascularization; antiVEGF drugs and embolization-based therapies, for example.
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Affiliation(s)
- Jiří Ferda
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic.
| | - Matthias Frölich
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic; Klinik für Radiologie und Nuklearmedizin, Universitäts Klinikum Mannheim
| | - Eva Ferdová
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
| | - Filip Heidenreich
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
| | - Radim Charvát
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
| | - Hynek Mírka
- Department of the Imaging, University Hospital Pilsen and Charles University Medical Faculty in Pilsen, Czech Republic
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Eberlová L, Mírka H, Liška V. Domestic pig head and neck arteries from the viewpoint of imaging methods and experimental surgery. Rozhl Chir 2023; 101:571-576. [PMID: 36759203 DOI: 10.33699/pis.2022.101.12.571-576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The aim of this paper is to summarize the current knowledge of the anatomy of domestic pig head and neck arteries for the needs of experimental surgery and imaging methods in biomedical research and translational medicine. The potential of this large animal model seems to be valuable also for the xenotransplantation of certain organs. Demands for the knowledge of morphological differences between analogous human structures and particular breeds are growing also in connection with the need for more precise planning of experiments or interpretation of the results. Deepening anatomical knowledge is allowed also by the development of imaging methods. The search was performed using the keywords “domestic pig” and “arteries of the head and neck“ in the MEDLINE database, PubMed interface.
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Ferda J, Hes O, Hora M, Ferdová E, Pernický J, Rudnev V, Pecen L, Topolčan O, Mírka H. Assessment of Prostate Carcinoma Aggressiveness: Relation to 68Ga-PSMA-11-PET/MRI and Gleason Score. Anticancer Res 2023; 43:449-453. [PMID: 36585198 DOI: 10.21873/anticanres.16181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM To test the correlation of 68Ga-PSMA-11 uptake and the expression of PSMA (prostatic specific membrane antigen) with the Gleason score, apparent diffusion coefficient (ADC) and pharmacokinetic parameters obtained from dynamic contrast agent-enhanced MRI/PET. PATIENTS AND METHODS Forty newly diagnosed, therapy naïve patients with prostatic carcinoma (PC) (mean age of 56.7, range=34-79), who were referred for 68Ga-PSMA-11-PET/MRI for primary staging and had undergone radical prostatectomy (RAPE) were included in this prospective study. Their blood samples were tested for serum levels of prostate-specific antigen (PSA) and proPSA. The patients' prostates were evaluated using whole-mount sections, which helped determine the extent and grade of the tumor; tests were performed to determine immunohistochemical PSMA expression. RESULTS A correlation between PSMA expression and the accumulation of 68Ga-PSMA-11 was found using the Spearman correlation coefficient (p=0.0011). A stronger correlation was found between Gleason patterns 3 or 4 and PSMA expression (p=0.06). Furthermore, the correlation of Gleason score with the overall 68Ga-PSMA-11 accumulation within the tumor or non-tumor tissue was found to be significant (p=0.0157). A significant relation was found only with the Kep elimination rate constant, which was stronger in Gleason pattern 4 than in Gleason pattern 3. A weaker correlation was found between the accumulation of 68Ga-PSMA-11 and Ktrans in Gleason pattern 4: the most significant relation being between ADCmin and Gleason pattern 3 and 4 (p=0.0074). The total size of the tumor correlated with levels of proPSA (p<0.0001), and its extra prostatic extension correlated with levels of proPSA (p<0.0001). CONCLUSION 68Ga-PSMA-11 correlates well with the expression of PSMA. Gleason pattern 3 and 4 had a higher correlation with 68Ga-PSMA-11 levels than did Gleason pattern 5. Either no correlation, or a weak correlation, was established with pharmacokinetics.
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Affiliation(s)
- Jiří Ferda
- Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic; .,Institute of Anatomy, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Ondřej Hes
- Šikl's Institute of Pathological Anatomy, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Milan Hora
- Department of Urology, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Eva Ferdová
- Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Jan Pernický
- Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.,Institute of Anatomy, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Vladimir Rudnev
- Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.,Institute of Anatomy, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Ladislav Pecen
- Division of Immunochemical Diagnostics, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Ondřej Topolčan
- Division of Immunochemical Diagnostics, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic
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Ferda J, Ferdová E, Vítovec M, Glanc D, Mírka H. The imaging of the hypoxic microenvironment in tumorous tissue using PET/CT and PET/MRI. Eur J Radiol 2022; 154:110458. [DOI: 10.1016/j.ejrad.2022.110458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
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Vodička J, Geiger J, Židková A, Andrle P, Mírka H, Svatonˇ M, Kostlivý T. Acute Mediastinitis - Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience). Ann Thorac Cardiovasc Surg 2022; 28:171-179. [PMID: 35264480 PMCID: PMC9209895 DOI: 10.5761/atcs.oa.21-00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy. Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment. Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times. Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.
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Affiliation(s)
- Josef Vodička
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Alexandra Židková
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Andrle
- Department of Stomatology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Svatonˇ
- Department of Pneumology and Phthisiology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomáš Kostlivý
- Department of Otorhinolaryngology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
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Jiřík M, Hácha F, Gruber I, Pálek R, Mírka H, Zelezny M, Liška V. Why Use Position Features in Liver Segmentation Performed by Convolutional Neural Network. Front Physiol 2021; 12:734217. [PMID: 34658919 PMCID: PMC8518428 DOI: 10.3389/fphys.2021.734217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Liver volumetry is an important tool in clinical practice. The calculation of liver volume is primarily based on Computed Tomography. Unfortunately, automatic segmentation algorithms based on handcrafted features tend to leak segmented objects into surrounding tissues like the heart or the spleen. Currently, convolutional neural networks are widely used in various applications of computer vision including image segmentation, while providing very promising results. In our work, we utilize robustly segmentable structures like the spine, body surface, and sagittal plane. They are used as key points for position estimation inside the body. The signed distance fields derived from these structures are calculated and used as an additional channel on the input of our convolutional neural network, to be more specific U-Net, which is widely used in medical image segmentation tasks. Our work shows that this additional position information improves the results of the segmentation. We test our approach in two experiments on two public datasets of Computed Tomography images. To evaluate the results, we use the Accuracy, the Hausdorff distance, and the Dice coefficient. Code is publicly available at: https://gitlab.com/hachaf/liver-segmentation.git.
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Affiliation(s)
- Miroslav Jiřík
- Department of Cybernetics, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
- New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Filip Hácha
- Department of Cybernetics, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
- Department of Informatics, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
| | - Ivan Gruber
- Department of Cybernetics, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
- New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
| | - Richard Pálek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Hynek Mírka
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- Department of Radiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Milos Zelezny
- Department of Cybernetics, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czechia
| | - Václav Liška
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
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Ferda J, Vendiš T, Flohr T, Schmidt B, Henning A, Ulzheimer S, Pecen L, Ferdová E, Baxa J, Mírka H. Computed tomography with a full FOV photon-counting detector in a clinical setting, the first experience. Eur J Radiol 2021; 137:109614. [PMID: 33657475 DOI: 10.1016/j.ejrad.2021.109614] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES to assess the feasibility of CT with an integrated photon-counting-detector system (PC-CT) in the body imaging of clinical patients. METHODS 120 examinations using photon counting detector CT were evaluated in six groups: 1/ a standard-dose lung, 2/ low-dose lung, 3/ ultra-high resolution (UHR) lung, 4/ standard-dose abdominal, 5/ lower-dose abdominal, 6/ UHR abdominal CTA. All CT examinations were performed on a single-source prototype device equipped with a photon counting detector covering a 50 cm scan field of view. Standard dose examinations were performed with the use of detector element size of 0.4 mm, ultra-high-resolution examinations with the detector element size of 0.2 mm, respectively. The stability of the system during imaging was tested. The diagnostic quality of the acquired images was assessed based on the imaging of key structures and the noise level in five-point scale, the effective dose equivalent, dose length product and noise level, and also relation to body mass index and body surface area were compared with three similar groups of CT images made with energy integrating high end scanner. The parameters were evaluated using Wilcoxon test for independent samples, the independence was tested using Kruskal-Wallis test. RESULTS When PC-CT images radiation dose is compared with the similar imaging using energy integrating CT, the PC-CT shows lower dose in ultra-high resolution mode, the dose is significantly lower (p < 0.0001), the standard dose examinations were performed with the comparable radiation doses. PC-CT exhibited the significantly higher ratio between parenchyma signal and background noise both in lung and in abdominal imaging (p < 0.0001). CONCLUSIONS PC-CT showed imaging stability and excellent diagnostic quality at dose values that are comparable or better to the quality of energy integrating CT, the better signal and improved resolution is most important advantage of photon counting detector CT over energy integrating detector CT.
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Affiliation(s)
- Jiří Ferda
- Department of the Imaging, University Hospital Pilsen, Alej Svobody 80, 323 00, Pilsen, Czechia.
| | - Tomáš Vendiš
- Department of the Imaging, University Hospital Pilsen, Alej Svobody 80, 323 00, Pilsen, Czechia
| | - Thomas Flohr
- Computed Tomography Development, Siemens Healthcare GmbH, Computed Tomography, 91301, Forchheim, Germany
| | - Bernhard Schmidt
- Computed Tomography Development, Siemens Healthcare GmbH, Computed Tomography, 91301, Forchheim, Germany
| | - André Henning
- Computed Tomography Development, Siemens Healthcare GmbH, Computed Tomography, 91301, Forchheim, Germany
| | - Stefan Ulzheimer
- Computed Tomography Development, Siemens Healthcare GmbH, Computed Tomography, 91301, Forchheim, Germany
| | - Ladislav Pecen
- Department of the Imaging, University Hospital Pilsen, Alej Svobody 80, 323 00, Pilsen, Czechia
| | - Eva Ferdová
- Department of the Imaging, University Hospital Pilsen, Alej Svobody 80, 323 00, Pilsen, Czechia
| | - Jan Baxa
- Department of the Imaging, University Hospital Pilsen, Alej Svobody 80, 323 00, Pilsen, Czechia
| | - Hynek Mírka
- Department of the Imaging, University Hospital Pilsen, Alej Svobody 80, 323 00, Pilsen, Czechia
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Rosendorf J, Mírka H, Boudová L, Liška V, Třeška V. Hepatic pseudolymphoma: a surprising finding in a case with suspected generalisation of lung cancer. Rozhl Chir 2020; 98:469-472. [PMID: 31948246 DOI: 10.33699/pis.2019.98.11.469-472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pseudolymphoma is a rare focal lesion which occurs in different locations. Only about 50 cases of liver pseudolymphoma have been reported so far. The diagnostic process is challenging. The lesion can resemble different malignancies using various imaging methods. No typical laboratory markers are available. The right diagnosis is usually made on the basis of histological examination. CASE REPORT A 67 years old female patient with lung fibrosis was undergoing assessments for a malignant-appearing focal lesion of the left lung and a focal liver lesion of unknown etiology. Upper lobectomy of the left lung proved lung carcinoma. The liver lesion was suspected for being metastatic, therefore a liver resection followed. The biopsy revealed hepatic pseudolymphoma. It took 150 days from the first positive CT scan until the liver resection. Currently, the patient shows no signs of recurrence. CONCLUSION Hepatic pseudolymphoma is a rare disease and we have only little experience with it so far. The diagnostic process is challenging, which is clear from the presented case. Only histological and immunohistochemical examinations ruled out a malignancy. A long-term observation of the patient is indicated.
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Rosendorf J, Mírka H, Michal M, Pálek R, Šleisová G, Třeška V, Liška V. Benign liver angiomyolipoma: a case study. Rozhl Chir 2020; 99:91-94. [PMID: 32349491 DOI: 10.33699/pis.2020.99.2.91-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Hepatic angiomyolipoma is a rare mesenchymal tumor. It consists of vessels, fatty tissue and muscle tissue. These can appear in various ratios. While the kidney is the most common localization of angiomyolipoma, only about 300 cases have been described in the liver so far. It is a tumor of uncertain behavior. Most of the patients suffering from the lesion is asymptomatic. It is often preoperatively misdiagnosed using various imaging methods given its similarity to other hepatic tumors. CASE REPORT Our 64 years old female patient was being examined for dull abdominal pains with no other symptoms. Her close relatives suffered from no malignancies. Imaging exams showed a liver lesion highly suspicious for hepatocellular carcinoma. However, the patient showed no elevation of typical oncomarkers. We performed left lateral sectionectomy. A grey solid focal lesion was found in the resected tissue. Histological and immunohistochemical evaluation determined the diagnosis of angiomyolipoma. The postoperative period was uncomplicated. The patient has been followed at an office for hepato-pancreato-biliary diseases, with no signs of recurrence until the present. CONCLUSION Hepatic angiomyolipoma is a rare disease. The diagnostic process can be challenging as illustrated by the presented case. Even though the working diagnosis proved false, the chosen treatment was appropriate and delivered good results. Long-term postoperative follow-up is required.
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Rosendorf J, Pálek R, Mírka H, Třeška V, Liška V. Injuries of the small and large intestine. ACTA ACUST UNITED AC 2019; 98:315-320. [PMID: 31462053 DOI: 10.33699/pis.2019.98.8.315-320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Patients with abdominal trauma appear frequently. The most vulnerable organs in these patients are the liver and the spleen. Injuries of the small and large intestines are relatively less frequent. The diagnostic process of these injuries is complex and requires an analysis of all results. Therefore it is highly probable that the final diagnosis can be delayed and so can be delayed an indication of surgical exploration of the abdominal cavity, which can have serious consequences on the morbidity and mortality of these patients with intestinal trauma. METHODS We collected our data using the WinMedicalc 2000 software. We searched for patients hospitalised in years 20082017 in the Department of Surgery, Faculty of Medicine in Pilsen subjected to surgical revision of the abdominal cavity for intestinal trauma. RESULTS Our set comprised 41 patients, including 30 men and 11 women. The mean age of the patients was 41 years, 4 of the patients were children. Twenty-three of the patients suffered from polytrauma, while 9 of the patients had a relatively isolated injury of either the small intestine or the colon. Six of the patients died. The small intestine was injured in 17 patients, the colon was injured in 14 patients and both were injured in 10 patients. The intestinal injury was diagnosed in 17 cases based on CT imaging (performed 31 times in total); 23 cases were diagnosed in the peroperative period. CONCLUSIONS We assessed a set of patients with an intestinal injury in terms of specific diagnosis, severity of trauma, diagnostic process and treatment. The results are similar to the results of studies in large sets of patients. Even though imaging methods can help to reach the right diagnosis, they are insufficient as a sole diagnostic method, and physical examination plays a major role.
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Bajcurová K, Novák P, Korčáková E, Mírka H, Geiger J, Rajal P, Daum O, Podolcová M. Submucosal mucoid as a late complication after appendectomy-A case report. Int J Surg Case Rep 2019; 58:37-40. [PMID: 31003092 PMCID: PMC6475718 DOI: 10.1016/j.ijscr.2019.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Shortly after an operation infection, intraabdominal abscess, seroma, haemorrhage or development of paralytic ileus may occur. Postoperative adhesions, nonspecific abdominal pain without signs of obstruction, incisional hernia and appendicitis or mucocele in appendiceal stump present common late complications. We present a unique case of a late complication after appendectomy. PRESENTATION OF CASE The case report describes a unique expansion in the ascending colon of a young athlete with long-lasting abdominal pain in the lower right quadrant. Colonoscopy showed a lesion in a wall of the ascending colon. Computed tomography (CT) confirmed a cystoid formation of high content density in a wall of the caecum. A right hemicolectomy was performed. Histology showed a lesion located in the submucosa with intestinal lining and stroma rich in lymphoid cells. These are the typical attributes of the wall of the appendix. Other parts of the wall were not demonstrated, and there was no communication with the lumen of the native bowel. CONCLUSION A submucosal cavity filled with acellular matter, which were probably disintegrated epithelioid structures, and calcifications were found in the ascending colon, while no intestinal cell atypia or dysplasia was found. The case cannot be classified under any previously presented diagnosis.
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Affiliation(s)
- Kristýna Bajcurová
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic.
| | - Petr Novák
- Department of Surgery, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic
| | - Eva Korčáková
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic
| | - Petr Rajal
- Department of Internal Medicine, Klatovy Hospital, Plzeňská 929, 339 01, Klatovy II, Czech Republic
| | - Ondřej Daum
- Pathological-anatomical Šikl Institute, Charles University Medical School in Pilsen, Teaching Hospital in Pilsen, Dr. E. Beneše 13, 305 99, Pilsen, Czech Republic
| | - Marcela Podolcová
- Radiological Department, Klatovy Hospital, Plzeňská 929, 339 01, Klatovy II, Czech Republic
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Třeška V, Brůha J, Skalický T, Liška V, Fichtl J, Mírka H, Korčáková E. Radiofrequency ablation of colorectal liver metastases. Rozhl Chir 2019; 98:399-403. [PMID: 31842569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20-30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. METHODS RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs.
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Brůha J, Treska V, Mírka H, Hosek P, Fichtl J, Skalický T, Bajcurová K, Ludvík J, Duras P, Lysák D, Liska V. Growth of colorectal liver metastases is not accelerated by intraportal administration of stem cells after portal vein embolization. Rozhl Chir 2019; 98:159-166. [PMID: 31159549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Future liver remnant volume (FLRV) is a crucial factor impacting resectability of colorectal liver metastases (CLM). In case of low FLRV, augmentation can be done by performing portal vein embolization (PVE). However, there is a risk of progression of CLM between PVE and resection. Intraportal application of autologous hematopoietic stem cells (HSC) is a possibility to accelerate the growth of FLRV. The effect of thus applied SC on CLM progression still remains unclear, though. METHODS 63 patients underwent PVE between 2003 and 2015. In 20 patients a product with HSC was applied intraportally on the first day after PVE (PVE HSC group). HSC were gained from peripheral blood (10 patients) or bone marrow (10 patients). FLRV and volume of liver metastases (VLM) were evaluated by CT volumetry. The gained data were statistically evaluated in relation to the disease free interval (DFI), overall survival (OS), achievement of CLM resectability and progression of extrahepatic metastases. We compared the PVE HSC group with the group of patient undergoing simple PVE. RESULTS No significant difference in FLRV and VLM growth was observed between the study groups. The percentage of exploratory laparotomies was smaller in the group with PVE and HSC application. Patients with simple PVE had a significantly higher incidence of extrahepatic metastases during follow up. We did not observe any significant differences in DFI and OS between the groups. CONCLUSION HSC application did not accelerate CLM growth in comparison with PVE alone. PVE and HSC application had a higher percentage of patients undergoing liver resection and a lower incidence of extrahepatic metastases.
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Procházková K, Mírka H, Trávníček I, Pitra T, Kolár J, Roušarová M, Hošek P, Bajcurová K, Ferda J, Staehler M, Brookman May SD, Hes O, Hora M. Cystic Appearance on Imaging Methods (Bosniak III-IV) in Histologically Confirmed Papillary Renal Cell Carcinoma is Mainly Characteristic of Papillary Renal Cell Carcinoma Type 1 and Might Predict a Relatively Indolent Behavior of Papillary Renal Cell Carcinoma. Urol Int 2018; 101:409-416. [PMID: 30199877 DOI: 10.1159/000492719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to determine the proportion of cystic tumors according to preoperative CT (Bosniak III, IV) among surgically treated patients with histologically confirmed papillary renal cell carcinoma (pRCC) and to assess progression rates among patients with and without cystic appearance on imaging. METHODS A total of 138 patients with pRCC histology surgically treated in the period of January 2007-March 2017 were included. Clinical and radiological characteristics, type of surgery, histopathology results, and follow-up data were recorded and statistically evaluated. RESULTS Forty-one cases (29.7%) of cystic lesions (10× BIIF, 14× BIII, 17× BIV) were detected by CT. Patients with pRCC1 significantly more frequently presented with cystic appearance on CT (33/78; 42.3%) in comparison to other papillary types (8/60; 13.3%; p = 0.0002). During a median follow-up time of 49.4 months, only 2 patients with cystic lesions progressed after surgery. CONCLUSIONS Cystic appearance on imaging methods is mainly a characteristic of pRCC1 (42.3%). Cystic morphology on imaging might predict a relatively indolent behavior of all pRCC types. Preoperative scoring systems including tumor growth patterns (cystic vs. solid) are needed for further classification.
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Affiliation(s)
- Kristýna Procházková
- Department of Urology, Charles University and University Hospital, Pilsen, Czech
| | - Hynek Mírka
- Department of Imaging Methods, Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ivan Trávníček
- Department of Urology, Charles University and University Hospital, Pilsen, Czech Republic
| | - Tomáš Pitra
- Department of Urology, Charles University and University Hospital, Pilsen, Czech Republic
| | - Jirí Kolár
- Department of Urology, Charles University and University Hospital, Pilsen, Czech Republic
| | | | - Petr Hošek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Kristýna Bajcurová
- Department of Imaging Methods, Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Jiří Ferda
- Department of Imaging Methods, Charles University and University Hospital, Pilsen, Czech Republic
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Campus Grosshadern, Munich, Germany
| | - Sabine D Brookman May
- Department of Urology, Ludwig-Maximilians University, Campus Grosshadern, Munich, Germany
| | - Ondřej Hes
- Department of Pathology, Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Milan Hora
- Department of Urology, Charles University and University Hospital, Pilsen, Czech Republic
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Tupý R, Mírka H, Mraček J, Přibáň V, Hes O, Vokurka S, Ferda J. Tumor-related Perfusion Changes in White Matter Adjacent to Brain Tumors: Pharmacodynamic Analysis of Dynamic 3T Magnetic Resonance Imaging. Anticancer Res 2018; 38:4149-4152. [PMID: 29970543 DOI: 10.21873/anticanres.12707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To verify perfusion differences in white matter adjacent to glioblastomas and metastatic tumors in dynamic contrast-enhanced (DCE) 3T-magnetic resonance imaging (MRI) using gradient echo (GRE) T1 techniques. MATERIALS AND METHODS A retrospective comparative study was carried out on adults with glioblastoma (n=67) and brain metastases (n=31). In each patient, conventional 3T-MRI and DCE-MRI with 25 acquisitions of GRE-T1 were performed. The initial area under the contrast-uptake curve (iAUC) and transfer constant (Ktrans) in peritumoral regions of the white matter were evaluated using T1 pharmacodynamic modeling software. RESULTS Statistically significantly higher relative iAUC (p<0.001) and Ktrans (p<0.01) values were recorded for peritumoral white matter near glioblastomas compared to that near metastases: 2.29 (SD=1.11) and 2.12 (SD=1.05) vs. 0.96 (SD=0.31) and 1.18 (SD=0.35), respectively. CONCLUSION In comparison to Ktrans, the iAUC obtained by DCE-MRI is more suitable for assessing glioblastomas because it better reflects pharmacokinetic peritumoral changes. Increased iAUC in white matter near to tumor generally indicates glioblastoma, however, a low level does not exclude it.
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Affiliation(s)
- Radek Tupý
- Department of Medical Imaging, Charles University Hospital in Pilsen, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Medical Imaging, Charles University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jan Mraček
- Department of Neurosurgery, Charles University Hospital in Pilsen, Pilsen, Czech Republic
| | - Vladimír Přibáň
- Department of Neurosurgery, Charles University Hospital in Pilsen, Pilsen, Czech Republic
| | - Ondřej Hes
- Sikls Pathology Department, Charles University Hospital in Pilsen, Pilsen, Czech Republic
| | - Samuel Vokurka
- Department of Oncology and Radiotherapeutics, Charles University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jiří Ferda
- Department of Medical Imaging, Charles University Hospital in Pilsen, Pilsen, Czech Republic
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Mik P, Tonar Z, Malečková A, Eberlová L, Liška V, Pálek R, Rosendorf J, Jiřík M, Mírka H, Králíčková M, Witter K. Distribution of Connective Tissue in the Male and Female Porcine Liver: Histological Mapping and Recommendations for Sampling. J Comp Pathol 2018; 162:1-13. [PMID: 30060837 DOI: 10.1016/j.jcpa.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023]
Abstract
The pig is a large animal model that is often used in experimental medicine. The aim of this study was to assess, in normal pig livers, sexual dimorphism in the normal fraction of hepatic interlobular and intralobular connective tissue (CT) in six hepatic lobes and in three macroscopical regions of interest (ROIs) with different positions relative to the liver vasculature. Using stereological point grids, the fractions of CT were quantified in histological sections stained with aniline blue and nuclear fast red. Samples (415 tissue blocks) were collected from healthy piglets, representing paracaval, paraportal and peripheral ROIs. There was considerable variability in the CT fraction at all sampling levels. In males the mean fraction of interlobular CT was 4.7 ± 2.4% (mean ± SD) and ranged from 0% to 11.4%. In females the mean fraction of the interlobular CT was 3.6 ± 2.2% and ranged from 0% to 12.3%. The mean fraction of intralobular (perisinusoidal summed with pericentral) CT was <0.2% in both sexes. The interlobular CT represented >99.8% of the total hepatic CT and the fractions were highly correlated (Spearman r = 0.998, P <0.05). The smallest CT fraction was observed in the left medial lobe and in the paracaval ROI and the largest CT fraction was detected in the quadrate lobe and in the peripheral ROI. For planning experiments involving the histological quantification of liver fibrosis and requiring comparison between the liver lobes, these data facilitate the power analysis for sample size needed to detect the expected relative increase or decrease in the fraction of CT.
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Affiliation(s)
- P Mik
- Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, Pilsen, Czech Republic
| | - Z Tonar
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, Pilsen, Czech Republic.
| | - A Malečková
- European Centre of Excellence NTIS, Faculty of Applied Sciences, University of West Bohemia, Univerzitní 22, Pilsen, Czech Republic
| | - L Eberlová
- Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, Pilsen, Czech Republic
| | - V Liška
- Department of Surgery and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, Pilsen, Czech Republic
| | - R Pálek
- Department of Surgery and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, Pilsen, Czech Republic
| | - J Rosendorf
- Department of Surgery and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, Pilsen, Czech Republic
| | - M Jiřík
- European Centre of Excellence NTIS, Faculty of Applied Sciences, University of West Bohemia, Univerzitní 22, Pilsen, Czech Republic
| | - H Mírka
- Department of Imaging Methods and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, University Hospital in Pilsen, Czech Republic
| | - M Králíčková
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, Pilsen, Czech Republic
| | - K Witter
- Institute of Anatomy, Histology and Embryology, Department for Pathobiology, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria
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Pálek R, Liška V, Eberlová L, Mírka H, Svoboda M, Haviar S, Emingr M, Brzoň O, Mik P, Třeška V. [Experimental processing of corrosion casts of large animal organs]. Rozhl Chir 2018; 97:222-228. [PMID: 29792720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Corrosion casts (CCs) are used for the visualization and assessment of hollow structures. CCs with filled capillaries enable (with the help of imaging methods) to obtain data for mathematical organ perfusion modelling. As the processing is more difficult in case of organs with greater volume of the vasculature, mainly organs from small animals have been cast up to now. The aim of this study was to optimize the protocol of corrosion casting of different organs of pig. Porcine organs are relatively easily accessible and frequently used in experimental medicine. METHOD Organs from 10 healthy Prestice Black-Pied pigs (6 females, body weight 35-45 kg), were used in this study (liver, spleen, kidneys and small intestine). The organs were dissected, heparin was administered into the systemic circulation and then the vascular bed of the organs was flushed with heparinized saline either in situ (liver) or after their removal (spleen, kidney, small intestine). All handling was done under the water surface to prevent air embolization. The next step was an intraarterial (in case of the liver also intraportal) administration of Biodur E20® (Heidelberg, Germany) resin. After hardening of the resin the organ tissue was dissolved by 15% KOH and the specimen was rinsed with tap water. Voluminous casts were stored in 70% denatured alcohol, the smaller ones were lyophilized. The casts were assessed with a stereomicroscope, computed and microcomputed tomography (CT and microCT), a scanning electron microscope (SEM) and high-resolution digital microscope (HRDM). RESULTS High-quality CCs of the porcine liver, kidneys, spleen and small intestine were created owing to the sophisticated organ harvesting, the suitable resin and casting procedure. Macroscopic clarity was improved thanks to the possibility of resin dying. Scanning by CT was performed and showed to be a suitable method for the liver cast examination. MicroCT, SEM and HRDM produced images of the most detailed structures of vascular bed. Despite the fact that SEM seems to be an irreplaceable method for CCs quality control, it seems that this modality could be partly replaced by HRDM. MicroCT enabled to obtain data about three-dimensional layout of the vascular bed and data for mathematical modelling of organ perfusion. With regard to the quality of the CCs, they could also be used to teach human anatomy. CONCLUSIONS The protocol of the corrosion casting of the porcine liver, kidneys, spleen and small intestine CCs was optimized. Thanks to different imaging methods, the CCs can be used as a source of data on three-dimensional architecture of the vascular bed. These data can be used for mathematical modeling of organ perfusion which can be helpful for example for optimization of organ resections.Key words: corrosion casts microvasculature Biodur E20® domestic pig animal model.
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Liška V, Třeška V, Mírka H, Vyčítal O, Brůha J, Haidingerová L, Beneš J, Tonar Z, Pálek R, Rosendorf J. [Experimental promotion of liver regeneration after portal vein branch ligation]. Rozhl Chir 2018; 97:239-245. [PMID: 29792723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Portal vein embolization or ligation (PVE/PVL) is part of most multi-stage liver procedures in the case of low future liver remnant volume (FLRV). PVE initiates compensatory hypertrophy of non-occluded liver parenchyma. This hypertrophy is stimulated by an increased volume of portal blood in the non-occluded veins. PVE results in adequate FLRV growth necessary for resection only in 63-96% patients. The aim of this publication is to summarize the possibilities of influencing liver regeneration after PVE/PVL in an experiment using cytokines (TNF-α, IL-6), a monoclonal antibody against TGF-β1 (MAB TGF-β1) and mesenchymal stem cells (MSC). METHODS The experimental model of PVE/PVL was chosen as best compatible for potential use in human medicine. 9 (control group), 9 (TNF-α group), 8 (IL-6 group), 6 (MSC group) and 7 piglets (MAB TGF-β1 group) were enrolled in individual studies. We performed laparotomy with PVL of the right-sided liver lobes under general anaesthesia. The following amounts of substances were applied in the non-occluded portal vein branches immediately after PVL: physiological solution (control group), recombinant porcine TNF-α (5 μg/kg), recombinant porcine IL-6 (0.5 μg/kg) and MSC (8.75, 14.0, 17.0, 17.5, 43.0 and 61.0 x 106 MSC). MAB TGF-β1 was applied 24 hours after PVL (40 μg/kg). Biochemical parameters were analysed repeatedly and FLRV ultrasound assessments were performed in the postoperative period. The experiments were ended on postoperative day 14 by sacryfiing the animals under general anaesthesia. Liver samples of hypertrophic and atrophic liver parenchyma were analysed. RESULTS Repeated ultrasound assessments of the effects of MSC, TNF-α, IL-6 and MAB TGF-β1 compared with the physiological solution in the control group demonstrated statistically significant acceleration of FLRV growth in the experimental groups. For MSC, maximum growth was observed between postoperative days 3 and 7, on day 7 for TNF-α, between days 3 and 7 for MAB TGF-β1 and on day 7 for IL-6. Serum levels of AST and ALT increased after PVL and MSC whereas other biochemical parameters showed no statistically significant differences. We identified individual MSC using immunohistochemistry in the hypertrophic tissue of the MSC group. A statistically significant difference was observed in the number of binucleated hepatocytes, with their increased concentration in the IL-6 group. CONCLUSION Application of IL-6, TNF-α, MAB TGF-β1 and MSC seems to provide suitable stimulation for achieving faster FLRV growth. Nevertheless, many controversial questions still remain to be answered with respect to the mechanism of their respective effects.Key words: liver regeneration portal vein embolization large animal experiment mesenchymal stem cells cytokines.
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Mírka H, Ferda J, Baxa J. Assessment of myocardial enhancement during coronary CT angiography in critically ill patients. Eur J Radiol 2016; 85:1909-1913. [PMID: 27435494 DOI: 10.1016/j.ejrad.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022]
Abstract
There are still challenges and unmet needs for the imaging techniques, such as conditions of uncertain origin in patients with clinically serious, life-threatening conditions with unknown cause that are not associated with dominant chest pain, ECG changes or other symptoms indicating a possible primarily cardiac or coronary cause. The contribution of the myocardial enhancement evaluation of urgent cardiac CTA scans significantly improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. When incorporating the myocardial enhancement assessment into the imaging algorithm of an emergency department, emphasis is placed on a uniform imaging procedure and a uniform evaluation approach. The color coded images of the myocardial enhancement in emergency situations helps identify the most serious pathologies and shorten the time to adequate targeted therapy in patients.
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Affiliation(s)
- Hynek Mírka
- Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň, Czech Republic; Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Alej Svobody 76, 304 60 Plzeň, Czech Republic.
| | - Jiří Ferda
- Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň, Czech Republic.
| | - Jan Baxa
- Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň, Czech Republic.
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Brůha J, Liška V, Pálek R, Mírka H, Hošek P, Korčáková E, Bajcurová K, Fichtl J, Skalický T, Třeška V. [Comparison of percutaneous and open approach to radiofrequency ablation of colorectal liver metastases in Teaching Hospital Pilsen in 20012015]. Rozhl Chir 2016; 95:107-111. [PMID: 27091618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is a well-established method for palliative therapy of unresectable liver tumors. We use an open or percutaneous approach for the treatment of colorectal liver metastases (CLM). METHOD Clinical data of patients undergoing percutaneous or open RFA for CLM between January 2001 and January 2015 were included in the retrospective study. We evaluated clinical factors for overall survival (OS), no evidence of disease (NED) and non-ablation in relation to tumor sizes and numbers, type of approach and type of used probes. RESULTS 147 patients underwent RFA for CLM in this time period. Mean age was 65 years. 168 RFAs were performed in total. OS was influenced by a high number of censors. OS for the first and third years was 93.6% and 61% with no statistical differences between the percutaneous and open approach. NED was significantly shorter in patients with the percutaneous approach. NED was not influenced neither by size nor number of the lesions. A higher risk of non-ablation was observed as statistically significant in patients with percutaneous RFA. A higher, although not statistically significant, risk of non-ablation was also observed for larger metastases. Patients with percutaneous RFA showed a shorter stay in the hospital and fewer complications. CONCLUSION RFA is an alternative approach to the treatment of unresectable CLM. In our study the open approach was associated with a lower risk of non-ablation. Percutaneous RFA showed a lower risk of complications and a shorter stay in the hospital. KEY WORDS radiofrequency ablation percutaneous RFA colorectal liver metastases CLM palliative therapy.
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Třeška V, Kolářová L, Mírka H, Daum O, Matějů J, Liška V, Koubová A, Sedláček D. Alveolar echinococcosis - a rare disease with differential diagnostic problems. Rozhl Chir 2016; 95:240-244. [PMID: 27410758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Alveolar echinococcosis is a life-threatening zoonotic parasitic disease. Its incidence is rare. In some cases, the correct and timely diagnosis can be difficult. CASE REPORT The authors present the case of a young patient with liver, diaphragm and lung involvement. The suspicion of echinococcus infection was made on the basis of medical history, clinical symptoms, and a combination of ultrasonography, computed tomography, magnetic resonance imaging tests and serological methods. The patient underwent multimodal treatment with albendazole and en-bloc resection of the liver, lung and diaphragm. The definitive diagnosis of alveolar echinococcosis was determined from samples of the resected tissues using histopathology and polymerase chain reaction methods. The patient has been followed regularly and is on life-long treatment with albendazole. CONCLUSION The precise diagnosis and multimodal therapy of alveolar echinococcosis is fundamental from the point of view of patient long-term survival. KEY WORDS alveolar echinococcosis - diagnosis - multimodal treatment - follow-up.
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Houdek K, Třeška V, Čertík B, Mírka H, Korčáková E, Moláček J, Šulc R, Čechura M. Initial experience of follow up of patients after the endovascular treatment of abdominal aortic aneurysms using contrast-enhanced ultrasound. Cor Vasa 2015. [DOI: 10.1016/j.crvasa.2015.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Třeška V, Duras P, Mírka H, Skalický T, Vyčítal O, Brůha J, Opatrný J, Liška V, Sutnar A. [Chemoembolization with Drug Eluting Beads (TACE DEB) in patients with primary unresectable hepatocellular carcinoma (HCC)]. Rozhl Chir 2014; 93:63-69. [PMID: 24702289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The incidence of HCC is growing all over the word. Liver resection and transplantation are the methods of choice in only 25% of patients, representing radical treatment approaches. TACE is a method of palliative treatment in patients with primary unresectable disease. MATERIAL AND METHODS 35 patients (27 men and 8 women) of an average age of 73.4 ± 7.2 years with HCC of average cumulative diameter 83.8 ± 36.3 mm were treated by TACE DEB with Doxorubicin. Solitary and multiple lesions were presented in 28 and 7 patients, respectively. 31 patients were classified as Child A, and 4 as Child B. One year overall survival, disease-specific, disease-free interval and their correlation with patients age, gender, as well as the number and cumulative diameter of tumours and complications after procedure were evaluated. RESULTS 30-day mortality and morbidity rate was 0 and 8.6%, respectively. The so-called postembolization syndrome developed in 25.7% of patients. Repeated TACE was performed in 14 (40%) patients due to tumour progression. In two patients (5.7%) we performed liver resection after TACE. According to the RECIST criteria there was no complete response, partial response was presented in 17.1, stable disease in 37.1 and progression of disease in 25.7% of patients. One year overall survival, tumour-specific survival and disease-free survival was 69.7%, 88.9 and 49.3%, respectively. Better overall survival (p < 0.02) was achieved in patients < 75 years old. Worse disease-free interval was observed in patients with complication after TACE (p < 0.01). No significant differences were found in the other evaluated parameters. CONCLUSION TACE is the method of palliative treatment in patients with unresectable HCC. There is no progression of HCC in one-half of patients after TACE. Better results are achieved in younger patients and in patients with no complications of procedure.
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Hora M, Stránský P, Trávníček I, Ürge T, Eret V, Kreuzberg B, Baxa J, Mírka H, Petersson F, Hes O, Ferda J. Three-tesla MRI biphasic angiography: a method for preoperative assessment of the vascular supply in renal tumours—a surgical perspective. World J Urol 2012; 31:1171-6. [DOI: 10.1007/s00345-012-0870-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/03/2012] [Indexed: 12/22/2022] Open
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Narsanská A, Treska V, Mírka H, Mukensnabl P, Chlumská A. [Caroli disease--dilatation of intrahepatic bile ducts]. Rozhl Chir 2011; 90:281-284. [PMID: 21838130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Caroli disease is a rare congenital condition characterized by a non-obstructive saccular or fusiform multi-focal segmental dilatation of the intrahepatic bile ducts and the frequent formation of the intrahepatic calculi. It can affect the entire liver with manifestations in the childhood, or only some segments, which may be an asymptomatic condition found accidentally in the adulthood. In other cases, the condition is manifested primarily with tract infections. The authors of the three case reports describe pitafalls of the diagnosis and treatment of the segmental Caroli disease, which is manifested in the adulthood. The treatment was a resection of the affected liver segments.
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Ferda J, Ferdová E, Mírka H, Baxa J, Bednářová A, Flohr T, Schmidt B, Matějovič M, Kreuzberg B. Pulmonary imaging using dual-energy CT, a role of the assessment of iodine and air distribution. Eur J Radiol 2011; 77:287-93. [DOI: 10.1016/j.ejrad.2009.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 08/01/2009] [Accepted: 08/03/2009] [Indexed: 11/30/2022]
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Treska V, Skalický T, Sutnar A, Liska V, Ferda J, Mírka H, Slauf F, Duras P, Kreuzberg B. [Portal vein branch embolization in patients with primary inoperable liver tumors]. Rozhl Chir 2010; 89:456-460. [PMID: 21121156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Portal vein embolization (PVE) is indicated in patients with insufficient liver remnants following liver resections for tumor disorders. Therefore, due to PVE, the number of primary operable patients is higher. Insufficient growth of the liver parenchyma or malignant progression remain the PVE cons. AIM OF THE STUDY To date outcomes of PVE are assessed based on the authors' own experience and literature data. In particular, the authors focus on difficulties with PVE, i.e. its failures. METHODS 40 patients (35 with colorectal carcinoma metastases, 2 with breast carcinoma metastases and one with ovarian carcinoma metastases, 2 with hepatocellular carcinoma) were indicated for PVE due to insufficient liver reserve following planned liver resection. RESULTS Liver resections were completed in 22 subjects, 42.6 days (mean value) after PVE. In 14 (35%) subjects, the liver resection could not be performed (11x tumor progression, 3x insufficient liver tissue growth). In four subjects, only radiofrequency ablation was performed. At year one, two and three after the procedure, the survival rate is 83.7, 69.7 and 52.3% (resp.) of the subjects, while the survival rate following exploration and in unoperated subjects was 22.2% (25 subjects) (p < 0.001). A one-year, resp. two-year relapse--free survival rate was 30.3, resp. 7%. CONCLUSION PVE has become an established procedure in stage liver procedures, due to its potential to facilitate operability of primary and secondary liver tumors. In order to improve the outcomes, attention must be paid to the post- PVE growth of the liver parenchyma and further assessment of oncological treatment approaches during the pre- and post- PVE period, with the aim to reduce liver and extra-liver malignant progression rates prior to the liver resection procedure.
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Affiliation(s)
- V Treska
- Chirurgická klinika FN a LF UK v Plzni.
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Ferda J, Novák M, Mírka H, Baxa J, Ferdová E, Bednárová A, Flohr T, Schmidt B, Klotz E, Kreuzberg B. The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography. Eur Radiol 2009; 19:2518-22. [PMID: 19585123 DOI: 10.1007/s00330-009-1495-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/18/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to assess virtual unenhanced brain computed tomography (CT) images obtained by dual-energy CT angiography (CTA) for the detection of intracranial bleeding. In total, 25 patients were included in the study (average age 53.2 years, range 25-75 years, 14 male, 11 female), all with intracranial bleeding on unenhanced brain CT and who underwent additional CTA performed on a dual-source CT in a dual-energy acquisition mode. The two X-ray tubes were operated at 140 and 80 kV, respectively. Data were analyzed using dual-energy evaluation software. Virtual unenhanced images were calculated by removing the relative iodine content from each voxel. The virtual unenhanced images were evaluated by a radiologist blinded to the findings of the conventional images related to the presence of intracranial bleeding. The image quality and contrast-to-noise ratio (CNR) between bleeding and brain tissue were assessed. The virtual image quality was found to be sufficient in 96%. The agreement in detection of intracranial bleeding on virtual and conventional unenhanced images reached 96% in per-lesion analysis and 100% in per-patient analysis. The averaged CNR reached 2.63 in virtual unenhanced images and 3.27 in conventional. Virtual unenhanced images are sufficient for the detection of intracranial bleeding.
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Affiliation(s)
- Jirí Ferda
- Radiodiagnostic Clinic, Charles University Teaching Hospital Plzen, Alej Svobody 80, 30640, Plzen, Czech Republic.
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Skalický T, Treska V, Sutnar A, Liska V, Molácek J, Mírka H, Ferda J, Ohlídalová K, Slauf F, Novák M. [Surgical treatment of benign liver tumours--indications and results]. Zentralbl Chir 2009; 134:141-4. [PMID: 19382044 DOI: 10.1055/s-2008-1076871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors present their results on the treatment of benign liver tumors. 65 patients were operated upon in the University Hospital in Pil-sen from 2000 until July 2006. Benign liver lesions were rather rare compared to malignant tumours, for which 273 patients were treated within the same period. The most often found benign -lesions were hepatocellular adenoma, focal nodular hyperplasia (FNH) and hemangioma. Sometimes, it was not possible to make a correct diagnosis preoperatively. The surgical procedures used for benign tumours were mostly enucleation and non-anatomic parenchyma-saving resection (55.4 %). Morbidity in this group was 26.5 %, mortality 0 %.
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Affiliation(s)
- T Skalický
- Chirurgische Klinik, Fakultätskrankenhaus Pilsen.
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Liska V, Treska V, Mírka H, Skalický T, Sutnar A, Ferda J. [Treatment strategy in non-parasitic benign cysts of the liver]. Rozhl Chir 2008; 87:512-516. [PMID: 19110943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors present the problems of treatment of benign non-parasitic cystic liver diseases. Recent diagnostic and treatment strategy is demonstrated at the cohort of 25 patients (16 women and 9 men), who were operated on Department of Surgery, Medical School and Teaching Hospital Pilsen, Charles University Prague between years 2002-2007. The average age was 59.9 years (38-86 years). We performed 15 laparoscopic fenestrations, 5 opened fenestrations, three enucleations of cysts and one left lobectomy and one central liver resection. The resections were performed because of diagnostic uncertainty to verify histological character of leasions at patients after previous operation of gastrointestinal tract for malignancy. Histological diagnosis was proved in 16 cases solitary liver cyst, in 7 cases of polycystic liver disease, one biliary cystadenoma and one retentive cyst. The reoperation of symptomatic solitary liver cyst was performed in one patient after 12 months from primary operation. The average follow-up of patients after surgical treatment was 41 months (5-96 months). Solitary liver cysts are indication to laparoscopic fenestration with biopsy in case of evidence of symptoms. Polycystic liver diseases are treated conservative and surgical treatment is indicated at outstanding and apparent symptomatology of this disease, where is possible to demonstrate preoperatively one or more dominant cysts.
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Affiliation(s)
- V Liska
- Chirurgická klinika, FN Plzen-Lochotín, LF UK v Plzni.
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Sutnar A, Skalický T, Treska V, Hess O, Mírka H, Michal M, Novák P, Liska V. [Liver cystadenoma with ovarian stroma--a case review]. Rozhl Chir 2008; 87:259-262. [PMID: 18595544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cystadenoma with ovarian type of stroma is a rare liver tumor. Authors discuss diagnostic difficulties and troublesome therapy with potential complications at unfavourable central localization in the liver of 46 years old woman.
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Ferda J, Hora M, Hes O, Reischig T, Kreuzberg B, Mírka H, Ferdová E, Ohlídalová K, Baxa J, Urge T. Computed tomography of renal cell carcinoma in patients with terminal renal impairment. Eur J Radiol 2007; 63:295-301. [PMID: 17324547 DOI: 10.1016/j.ejrad.2007.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 01/19/2007] [Indexed: 01/20/2023]
Abstract
PURPOSE An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. MATERIALS AND METHODS Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. RESULTS Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. CONCLUSIONS With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.
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Affiliation(s)
- Jirí Ferda
- Department of Radiology, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen, Czech Republic.
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Treska V, Skalický T, Liska V, Mírka H, Smíd D, Vachtová M. [Pyogenic abscesses of the liver]. Rozhl Chir 2007; 86:284-7. [PMID: 17695033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Pyogenic abscesses of the liver represent a serious nosologic unit with high morbidity and mortality rates. Their diagnostics is based on ultrasonography, computer tomography or MRI, or positrone emission tomography. The principal treatment procedure includes percutaneous draining of the abscess cavity under the ultrasound or CT control. The authors present a group of 83 subjects hospitalized from 2000 to 2006 for pyogenic abscesses of the liver. Obstruction of the bile ducts, acute cholecystitis and resections of the liver or pancreas for malignancies were recorded as the commonest causes of the abscesses. Percutaneous drainage was the treatment method of choice in 67.5% of the subjects and it included management of the causative factors and administration of antibiotics. The hospitalization period was affected by the following factors: septic conditions (p < 0.04), ALT levels (p < 0.003) - cut off 3.0 mkat/l, the abscess diameter, which may have required reoperation, (p < 0,05), diabetes mellitus (p < 0.05) and septic conditions (p < 0.001). The need for re-hospitalization due to a relaps of the pyogenic abscess of the liver correlated significantly with the following: a number (> 2) of abscesses (p < 0.04), C-reactive protein levels (p < 0.005) - cut off> 100 mg/l and septic conditions (p < 0.007). Furthermore, significat correlation was detected between the mortality rates and sepsis (p < 0.05).
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Affiliation(s)
- V Treska
- Chirurgická klinika FN a LF UK v Plzni
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Liska V, Treska V, Mírka H, Novák M, Slauf F, Skalický T, Sutnar A, Kormunda S. [Portal vein embolization--increased chance for liver resecability for malignancies]. Rozhl Chir 2007; 86:97-101; discussion 102. [PMID: 17436675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Liver surgery for liver malignancy is recently limited not by technical possibilities but by physiological reserves of liver parenchyma. Portal vein embolization (PVE) is performed to increase future liver remnant volume (FLRV) to extend the possibilities of liver resections. The authors evaluate the cohort of patients, that underwent PVE and confront them with the cohort of patients that underwent liver resection without PVE. METHODOLOGY At the Department of Surgery and Departement of Radiology, University Hospital Pilsen there were performed successfully PVE at 24 patients between January 2001 and August 2006. The increase of FLRV was sufficient at 17 patients. The mean period between PVE and computed tomography volumetry was 29 days. The mean period between PVE and surgical procedure was 54 days. 8 patients underwent radical liver surgery (right hepatectomy, extended right hepatectomy, combination of right hepatectomy with RFA in left lobe), 3 patients underwent radiofrequency ablation, the rest of patients was explored. For comparison we used cohort of 107 patients that underwent one step radical surgery for malignancy. RESULTS 1 year survival rate after liver operation was 85.7%, 3 years survival rate 42.9%. Disease free interval (DFI) was counted only for group of radicaly operated patients. One year DFI was 40%, two year DFI was 20%. The number of leasions was not proved as statistically significant for DFI or survival rate. In non PVE group 1 year survival rate was 78.9%, 3 years survival rate was 34.0%, one year DFI was 60.2%, two years DFI was 36.6%. DISCUSSION The survival rate was higher in PVE group, the DFI was shortened in PVE group. In our cohort we could conclude, the PVE increase survival rate instead of shortened DFI. PVE spreads possibilities for liver resections at patients with small FLVR and enables radical surgical therapy for patients, that will be leaved a palliative surgery or oncological therapy.
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Affiliation(s)
- V Liska
- Chirurgická klinika, FN Plzen-Lochotín, LF UK v Plzni.
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Safránek J, Spidlen V, Vodicka J, Certík B, Mírka H. [Chylothorax. A case review and literature overview]. Rozhl Chir 2006; 85:604-8. [PMID: 17407948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Chylothorax is a rare disorder, predominantly of traumatic (iatrogenic) or tumorous aetiology. Its symptomatology complies with other types of fluidothorax. Long-term chylous depletion may result in malnutrition and other metabolic and immunological symptoms. Infectious complications are rare. The authors present a literature overview and their own case-review of chylothorax resulting from the suprarenal aortic aneurysm surgery. The conservative management failed and the complication in the 75-year old patient was managed using pleuroabrasion and talk pleurodesis.
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