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Lawrie K, O'Neill S, Waldauf P, Balaz P. Validation of Arterio Venous Access Stage Classification (VAVASC): Study Protocol and Preliminary Results. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.020] [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] [Indexed: 04/08/2023] Open
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Lawrie K, Bafrnec J, O'Neill S, Corr M, Waldauf P, Balaz P. Identifying classification systems regarding vascular access for haemodialysis: protocol for a scoping review. BMJ Open 2022; 12:e064842. [PMID: 36581414 PMCID: PMC9806000 DOI: 10.1136/bmjopen-2022-064842] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Classifications are important clinical tools that enable data arrangement, patient categorisation and comparative research. The care of patients with end-stage renal disease who have vascular access requires collaboration of several specialists. In such a field, where several different specialties overlap, strong evidence and well-grounded recommendations for good practice are essential. In this protocol, we aim to search the literature to identify classification systems regarding vascular access for haemodialysis. This protocol serves as a pragmatic tool for setting a systematic approach using scoping review methodology. It also aims to make the study transparent and avoid potential duplication. METHODS AND ANALYSIS We will follow the Joanna Briggs Institute methodology for the conduct of scoping reviews during the course of the proposed review. Scopus, Web of Science, PubMed, Google Scholar and the ClinicalTrials.gov registry will be searched by two researchers. Titles and abstracts will be screened and articles featuring classifications regarding vascular access for haemodialysis will be eligible for full-text analysis. There will be no age, sex or race limitation for the study populations. The title and abstract (if abstract available) must be in English but there will be no language restrictions for full-text review. Databases will be searched from inception to the date of search. All patients indicated for creation or placement of vascular access will be eligible, as well as patients with already existing vascular access. Classifications regarding preprocedural assessment, vascular access insertion or creation, complications and their management will be included in the study. Classifications regarding peritoneal dialysis will not be eligible. A comprehensive summary of the available evidence will be presented. ETHICS AND DISSEMINATION The protocol and the review are exempt from ethical approval as there is no direct patient involvement and the review will summarise data from already published literature. The final article will be submitted to a peer-reviewed scientific journal.
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Affiliation(s)
- Katerina Lawrie
- Division of Vascular Surgery, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Bafrnec
- Division of Vascular Surgery, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Stephen O'Neill
- Department of Transplant Surgery and Regional Nephrology Unit, Belfast City Hospital, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michael Corr
- Department of Transplant Surgery and Regional Nephrology Unit, Belfast City Hospital, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Petr Waldauf
- Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Balaz
- Division of Vascular Surgery, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Whitley A, Bafrnec J, Rokosny S, Lawrie K, Balaz P. Pancreaticoduodenal artery aneurysm associated with coeliac trunk occlusion treated with aorto-hepatic bypass and aneurysm resection. Vascular 2022; 31:598-602. [PMID: 35230917 DOI: 10.1177/17085381211070353] [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] [Indexed: 11/16/2022]
Abstract
Pancreaticoduodenal artery aneurysms are rare visceral artery aneurysms that may be associated with stenosis of the coeliac trunk. We present a case of a 48-year-old woman with a symptomatic aneurysm of the inferior pancreaticoduodenal artery caused by occlusion of the coeliac trunk due to median arcuate ligament syndrome. The patient was treated with an aorto-hepatic bypass and excision of the aneurysm. We discuss the case and the complexities and controversies in the treatment of this disease.
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Affiliation(s)
- Adam Whitley
- Department of Surgery, 385317University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague Czech Republic
| | - Jan Bafrnec
- Division of Vascular Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Slavomir Rokosny
- Division of Vascular Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Lawrie
- Division of Vascular Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Balaz
- Division of Vascular Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovak Republic
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Balaz P, Rokosny S, Herman J, Pirkl M, Vlachovsky R, Whitley A. Experience with VariClose® vein sealing system in the Czech Republic. Phlebology 2021; 37:105-111. [PMID: 34644196 DOI: 10.1177/02683555211051500] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to assess occlusion rates of saphenous veins treated with the VariClose vein sealing system. METHODS A retrospective analysis including a total of 64 patients from four centres from the Czech Republic. Occlusion was defined as a non-compressible vein with absence of flow with exception to the first 3 cm from the saphenofemoral or saphenopopliteal junction on duplex ultrasound. RESULTS In 64 patients a total of 79 veins were treated. Technical success of the procedure was achieved in 74 (94%) of cases. The mean follow-up was 5.5 months. The closure rates calculated by the Kaplan-Meier method at 1, 3, 6 and 12 months were 94%, 85%, 69% and 36%, respectively, and there were no significant differences between centers. The average difference in VCSS score before and after the procedure was 1.8. CONCLUSIONS The present study demonstrated surprisingly worse occlusion rates than the current literature.
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Affiliation(s)
- Peter Balaz
- Division of Vascular Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovak Republic
| | - Slavomir Rokosny
- Division of Vascular Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Herman
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miloslav Pirkl
- Department of Vascular Surgery, Pardubice Hospital, Pardubice, Czech Republic
| | - Robert Vlachovsky
- Second Department of Surgery, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adam Whitley
- Division of Vascular Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Abstract
OBJECTIVES The treatment of concomitant abdominal aortic aneurysms and renal tumours is controversial. The aim of this study was to ascertain which of the following three strategies, one-stage open aneurysm repair and nephrectomy, two-stage open aneurysm repair and nephrectomy or two-stage endovascular aneurysm repair and nephrectomy, is the best approach. METHODS systematic review and meta-analysis of articles published between January 1992 and April 2021 describing the treatment of concomitant abdominal aortic aneurysms and renal tumours. RESULTS A total of 1168 records were identified. After the selection process, 12 studies with data on 89 patients were included. Sixty-two patients underwent one-stage open procedures, 18 patients underwent two-stage open procedures and nine underwent two-stage endovascular procedures. The overall postoperative mortality was 0.82% (95% CI, 0.00-4.61). The postoperative mortality for one-stage open procedures was 3.09% (95% CI, 0.00-10.11). No deaths occurred in the postoperative period open two-stage procedures or two-stage endovascular procedures. The weighted postoperative morbidity for all procedures was 23.86% (95% CI, 12.64-35.08) and for open one-stage procedures was 37.40% (95% CI, 14.33-60.47). Data concerning postoperative complications of two-stage open procedures were extractable from only one patient in whom no complications were reported. Two postoperative complications were reported after two-stage endovascular procedures from a total of six patients with extractable postoperative data. We were unable to perform meta-analysis on long-term outcomes as the data were reported non-uniformly. CONCLUSION There is currently no evidence to suggest that any procedure is associated with better outcomes. However, a one-stage open approach was the most commonly used option, favoured as it avoids delaying treatment of either of the conditions. Two-stage open procedures were preferred in cases where the surgical risk of a one-stage procedure was higher than the potential benefit. For such cases, two-stage endovascular repair is becoming more popular as a less invasive approach.
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Affiliation(s)
- Katerina Lawrie
- Department of Surgery, 48370University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, 48370University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Balaz
- Department of Surgery, 48370University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovakia
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Abstract
BACKGROUND One of the three commercially available cyanoacrylate venous glues used for the treatment of saphenous vein insufficiency is the VariClose® vein sealing system. Previous studies have documented a high rate of occlusion and minimal postoperative complications. The aim of this study was to compare occlusion rates and clinical outcomes of endovenous laser treatment with the VariClose® vein sealing system in the treatment of truncal vein insufficiency. PATIENTS AND METHODS Retrospective non-randomized single center study with prospectively collected data comparing endovenous laser treatment and VariClose® procedures between April 2018 and November 2019. RESULTS VariClose® was used in 27 patients (30 veins) and endovenous laser treatment in 42 patients (51 veins). The occlusion rate at one, three, and six months were 96%, 85%, and 65% for VariClose® procedures and 100%, 100%, and 97% for endovenous laser treatment procedures (p = 0.01), respectively. Reduction of VCSS scores before treatment and at the last postoperative follow-up visit in the VariClose® group dropped by an average of 1.8 ± 1.6 and in the endovenous laser treatment by an average of 3.3 ± 2.9 (p = 0.01). CONCLUSION VariClose® vein sealing system is inferior to endovenous laser treatment as a treatment option for varicose veins as it has a higher recanalization rate.
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Affiliation(s)
- Peter Balaz
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovak Republic
| | - Slavomir Rokosny
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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7
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Balaz P. The "Hybrid Era" of Vascular Access Surgery. Eur J Vasc Endovasc Surg 2020; 60:145. [PMID: 32402808 DOI: 10.1016/j.ejvs.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Peter Balaz
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovakia.
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Balaz P, O'Neill S. Liposuction Is Not Just an Aesthetic Surgery Procedure. Eur J Vasc Endovasc Surg 2019; 58:761. [PMID: 31378657 DOI: 10.1016/j.ejvs.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Peter Balaz
- Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovak Republic.
| | - Stephen O'Neill
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
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Abstract
The life-saving procedures for patients in chronic renal failure (CRF) are hemodialysis (HD) or successful kidney transplantation. HD requires a properly placed and functioning vascular access, most often obtained by creating an arteriovenous fistula (AVF). The long-term patency of AVFs is limited, in addition to other factors, by the development of intimal hyperplasia and the process results in venous wall thickening and progressive fistula occlusion. Another problem is limited patency, due to the development of pseudoaneurysm, which is associated with an increased risk of thrombosis, infection and bleeding, difficult cannulation for dialysis, pain and cosmetic defects. Treatment is focused on rapidly progressing pseudoaneurysms, which can predispose to rupture, technical problems during cannulation because of pseudoaneurysm size or a growing intraluminal thrombus. Most of these patients are scheduled for pseudoaneurysm removal and new fistula construction or, occasionally, an endovascular procedure involving stent graft implantation. This paper describes a simple and inexpensive technique of managing an AVF pseudoaneurysm, i.e. aneurysmorrhaphy. To offset the weakening of the venous wall by suture following aneurysmorrhaphy, an external polyethylene terephthalate (PET) prosthesis was implanted in the vein to prevent the development of intimal hyperplasia in the de novo created AVF.
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Affiliation(s)
- P. Balaz
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine (IKEM) Prague - Czech Republic
| | - S. Rokosny
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine (IKEM) Prague - Czech Republic
| | - D. Klein
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine (IKEM) Prague - Czech Republic
| | - M. Adamec
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine (IKEM) Prague - Czech Republic
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Cholujova D, Bujnakova Z, Dutkova E, Hideshima T, Groen RW, Mitsiades CS, Richardson PG, Dorfman DM, Balaz P, Anderson KC, Jakubikova J. Realgar nanoparticles versus ATO arsenic compounds induce in vitro and in vivo activity against multiple myeloma. Br J Haematol 2017; 179:756-771. [PMID: 29048129 DOI: 10.1111/bjh.14974] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/29/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
Multiple myeloma (MM), a B cell malignancy characterized by clonal proliferation of plasma cells in the bone marrow, remains incurable despite the use of novel and conventional therapies. In this study, we demonstrated MM cell cytotoxicity triggered by realgar (REA; As4 S4 ) nanoparticles (NREA) versus Arsenic trioxide (ATO) against MM cell lines and patient cells. Both NREA and ATO showed in vivo anti-MM activity, resulting in significantly decreased tumour burden. The anti-MM activity of NREA and ATO is associated with apoptosis, evidenced by DNA fragmentation, depletion of mitochondrial membrane potential, cleavage of caspases and anti-apoptotic proteins. NREA induced G2 /M cell cycle arrest and modulation of cyclin B1, p53 (TP53), p21 (CDKN1A), Puma (BBC3) and Wee-1 (WEE1). Moreover, NREA induced modulation of key regulatory molecules in MM pathogenesis including JNK activation, c-Myc (MYC), BRD4, and histones. Importantly, NREA, but not ATO, significantly depleted the proportion and clonogenicity of the MM stem-like side population, even in the context of the bone marrow stromal cells. Finally, our study showed that both NREA and ATO triggered synergistic anti-MM activity when combined with lenalidomide or melphalan. Taken together, the anti-MM activity of NREA was more potent compared to ATO, providing the preclinical framework for clinical trials to improve patient outcome in MM.
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Affiliation(s)
- Danka Cholujova
- Cancer Research Institute, Biomedical Research Center SAS, Bratislava, Slovakia
| | | | | | - Teru Hideshima
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Richard W Groen
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Constantine S Mitsiades
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Paul G Richardson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David M Dorfman
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Balaz
- Institute of Geotechnics SAS, Košice, Slovakia
| | - Kenneth C Anderson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jana Jakubikova
- Cancer Research Institute, Biomedical Research Center SAS, Bratislava, Slovakia.,Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Wohlfahrt P, Rokosny S, Melenovsky V, Borlaug BA, Pecenkova V, Balaz P. Reply to 'Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease: methodological issues'. Hypertens Res 2016; 40:411. [PMID: 27904157 DOI: 10.1038/hr.2016.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Peter Wohlfahrt
- Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.,Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Slavomir Rokosny
- Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Vera Pecenkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Peter Balaz
- Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,Department of Transplantation Renal Unit, Guy's Hospital, London, UK.,Department of Surgery, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
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12
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Balaz P, Rokosny S. Infected Aortic Stentgraft Treated with Fresh Cold Stored Arterial Allograft. Eur J Vasc Endovasc Surg 2016; 52:123. [PMID: 27167059 DOI: 10.1016/j.ejvs.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- P Balaz
- Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - S Rokosny
- Vascular and Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Pastorek M, Gronesova P, Cholujova D, Hunakova L, Bujnakova Z, Balaz P, Duraj J, Lee TC, Sedlak J. Realgar (As4S4) nanoparticles and arsenic trioxide (As2O3) induced autophagy and apoptosis in human melanoma cells in vitro. Neoplasma 2015; 61:700-9. [PMID: 25150315 DOI: 10.4149/neo_2014_085] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of the present study was to compare the effect of realgar nanoparticles and arsenic trioxide (ATO) on viability, DNA damage, proliferation, autophagy and apoptosis in the human melanoma cell lines BOWES and A375. The application of various flow cytometric methods for measurements cell viability, DNA cell cycle, mitochondrial potential, lysosomal activity, and intracellular content of glutathione was used. In addition, quantitative PCR, western blotting and multiplex bead array analyses were applied for evaluation of redox stress, autophagic flux, and cell signaling alterations.The results showed that realgar treatment of studied cells caused modulation of cell proliferation, induced a block in G2/M phase of the cell cycle and altered phosphorylation of IκB, Akt, ERK1/2, p38, and JNK kinases, as well as decreased mitochondrial membrane potential. Additionally, it appeared that induction of cell death by both realgar and ATO was dose-dependent, when lower (0.3 µM) dosage increased lysosomal activity and induced autophagy and higher (1.25 µM) concentration resulted in the appearance of apoptosis, while pan-caspase inhibitor attenuated more efficiently realgar- than ATO-induced cell death. Furthermore, low concentrations of ATO and realgar nanoparticles increased the content of intracellular glutathione and elevated γ-H2AX expression confirmed DNA damage preferentially at higher concentrations of both drugs used. Further analysis revealed slight differences in time-dependent phosphorylation pattern due to both realgar and ATO treatments, while significant differences were noticed between cell lines. In conclusion, realgar nanoparticles and ATO treatment induced dose-dependent activation of autophagy and apoptosis in both melanoma cell lines, when autophagy flux was determined at lower drug concentrations and the switch to apoptosis occurred at higher concentrations of both arsenic forms.
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Balaz P, Rokosny S, Wohlfahrt P, Wohlfahrtova M, Adamec M, Janousek L, Fronek J, Viklicky O, Pokorna E. Dual kidney transplant: a single-center experience and review of the literature. EXP CLIN TRANSPLANT 2014; 11:388-95. [PMID: 24128132 DOI: 10.6002/ect.2013.0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Adult dual kidney transplant is a strategy to overcome the imbalance between limited nephron mass supplied from an older donor and a recipient with a metabolic request. MATERIALS AND METHODS In our report, we review the literature and present our single-center experience. From June 2007 until July 2012, nine hundred twenty-eight single and seventeen dual kidney transplants from deceased donors were performed. RESULTS The average donor was 71.5 ± 3.6 years of age with an average serum creatinine, creatinine clearance, and an average number of sclerotic glomeruli, 106.1 ± 44.2 μmol/L, 0.97 ± 0.37 mL/s, and 22.4 ± 14.2. Immediate graft function and acute rejection episodes were observed in 75% and 6% of patients. The overall patient survival rates at 1 and 2 years after transplant were 93%. The overall graft survival rates at 1 and 2 years were 88%. CONCLUSIONS Previous studies and our single-center experience suggest that the dual transplant procedure may help improve results of kidney transplants from expanded criteria donors and extend the donor pool by using kidneys that would be discarded otherwise.
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Affiliation(s)
- Peter Balaz
- Department of Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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15
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Balaz P, Rokosny S, Wohlfahrt P, Adamec M, Janousek L, Björck M. Early and late outcomes of hybrid endovascular and open repair procedures in patients with peripheral arterial disease. VASA 2013; 42:292-300. [DOI: 10.1024/0301-1526/a000290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Hybrid endovascular and open reconstructions are used increasingly often for multilevel revascularization for lower limb ischaemia. The aim was to evaluate outcomes after such procedures in a single-center non-randomized retrospective study. Patients and methods: Consecutive patients with multilevel arterial disease who underwent single session hybrid procedures were analyzed depending on the type of ischaemia and the type of revascularization. Results: 164 patients were included with a median follow up time of 14 months (range: 0 - 70). Indication was claudication (group 1, 47 %), critical limb ischaemia (group 2, 33 %) and acute limb ischaemia (group 3, 20 %). Technical success rate was 99.3 %, perioperative mortality 2 %. Primary, assisted-primary and secondary patency rates at one year were 60 %, 61 % and 64 %, respectively. Primary, primary assisted and secondary patency were lower in group 2 and 3 compared to group 1 (all p < 0.05). Results were better when endovascular repairs were performed above compared to below the open repair site (all p < 0.05). Limb salvage at 1 year in groups 1 - 3 were 98 %, 92 % and 90 %, respectively. The risk of major amputation was highest in group 3 compared to group 1 (p = 0.001) or group 2 (p < 0.04). Conclusions: The results depend on the type of ischaemia and the localization of endovascular procedures.
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Affiliation(s)
- Peter Balaz
- Department of Transplant and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Slavomir Rokosny
- Department of Transplant and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic, and Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, and International Clinical Research Center, St. Annes University Hospital Brno, Brno, Czech Republic
| | - Milos Adamec
- Department of Transplant and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Libor Janousek
- Department of Transplant and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martin Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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Yildirim T, Yilmaz R, Altindal M, Turkmen E, Arici M, Altun B, Erdem Y, Guliyev O, Erkmen Uyar M, Tutal E, Bal Z, Sezer S, Erkmen Uyar M, Bal U, Bal Z, Tutal E, Say n B, Guliyev O, Erdemir B, Sezer S, O'Rourke-Potowki A, Gauge N, Penny H, Cronin A, Frame S, Goldsmith DJ, Yagan JA, Chandraker A, Velickovic Radovanovic RM, Catic Djordjevic A, Mitic B, Stefanovic N, Cvetkovic T, Serpieri N, Grosjean F, Sileno G, Torreggiani M, Esposito V, Mangione F, Abelli M, Castoldi F, Catucci D, Esposito C, Dal Canton A, Vatazin AV, Zulkarnaev AB, Borst C, Liu Y, Thoning J, Tepel M, Libetta C, Margiotta E, Borettaz I, Canevari M, Martinelli C, Lainu E, Abelli M, Meloni F, Sepe V, Dal Canton A, Miguel Costa R, Vasquez Martul E, Reboredo J, Rivera C, Simonato F, Tognarelli G, Daidola G, Gallo E, Burdese M, Cantaluppi V, Biancone L, Segoloni GP, Burdese M, Priora M, Messina M, Tamagnone M, Daidola G, Linsalata A, Lavacca A, Biancone L, Segoloni G, Zuidema W, Erdman R, van de Wetering J, Dor F, Roodnat J, Massey E, Timmerman L, IJzermans J, Weimar W, Goldsmith DJ, Sibley-Allen C, Hilton R, Moghul M, Burnapp L, Blake G, Koo TY, Park JS, Park HC, Kim GH, Lee CH, Oh IH, Kang CM, Hwang JK, Park SC, Choi BS, Chun HJ, Kim JI, Yang CW, Moon IS, Van Laecke S, Van Biesen W, Nagler EV, Taes Y, Peeters P, Vanholder R, Pruthi R, Ravanan R, Casula A, Harber M, Roderick P, Fogarty D, Cho A, Shin JH, Jang HR, Lee JE, Huh W, Kim DJK, Oh HY, Kim YG, Sancho Calabuig A, Gavela Martinez E, Kanter Berga J, Beltran Catalan S, Avila Bernabeu AI, Pallardo Mateu LM, Gonzalez E, Polanco N, Molina M, Gutierrez E, Garcia Puente L, Sevillano A, Morales E, Praga M, Andres A, Banasik M, Boratynska M, Koscielska-Kasprzak K, Bartoszek D, Myszka M, Zmonarski S, Nowakowska B, Wawrzyniak E, Halon A, Chudoba P, Klinger M, Rojas-Rivera J, Gonzalez E, Polanco N, Morales E, Andres A, Morales JM, Egido J, Praga M, Kopecky CM, Haidinger M, Kaltenecker C, Antlanger M, Marsche G, Holzer M, Kovarik J, Werzowa J, Hecking M, Saemann MD, Hwang JK, Kim JM, Koh ES, Chung BH, Park SC, Choi BS, Kim JI, Yang CW, Kim YS, Moon IS, Banasik M, Boratynska M, Koscielska-Kasprzak K, Krajewska M, Mazanowska O, Kaminska D, Bartoszek D, Zabinska M, Halon A, Malkiewicz B, Patrzalek D, Klinger M, Sulowicz J, Szostek S, Wojas-Pelc A, Ignacak E, Sulowicz W, Bellizzi V, Calella P, Cupisti A, Capitanini A, D'Alessandro C, Giannese D, Camocardi A, Conte G, Barsotti M, Bilancio G, Luciani R, Locsey L, Seres I, Kovacs D, Asztalos L, Paragh G, Wohlfahrtova M, Balaz P, Rokosny S, Wohlfahrt P, Bartonova A, Viklicky O, Kers J, Geskus RB, Meijer LJ, Bemelman F, ten Berge IJM, Florquin S, Hwang JC, Jiang MY, Lu YH, Weng SF, Testa A, Porto G, Sanguedolce M, Spoto B, Parlongo R, Pisano A, Enia G, Tripepi G, Zoccali C, Zuidema W, Mamode N, Lennerling A, Citterio F, Massey E, Van Assche K, Sterckx S, Frunza M, Jung H, Pascalev A, Johnson R, Loven C, Weimar W, Dor F, Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR, Meys KME, Groothoff JW, Jager K, Schaefer F, Tonshoff B, Mota C, Cransberg K, van Stralen K, Gurluler E, Gures N, Alim A, Gurkan A, Cakir U, Berber I, Van Laecke S, Caluwe R, Nagler E, Van Biesen W, Peeters P, Van Vlem B, Vanholder R, Sulowicz J, Wojas-Pelc A, Ignacak E, Betkowska-Prokop A, Kuzniewski M, Krzanowski M, Sulowicz W, Masson I, Flamant M, Maillard N, Cavalier E, Moranne O, Alamartine E, Mariat C, Delanaye P, Canas Sole LL, Iglesias Alvarez E, Pastor MCMC, Moreno Flores FF, Abujder VV, Graterol FF, Bonet Sol JJ, Lauzurica Valdemoros RR, Yoshikawa M, Kitamura K, Nakai K, Goto S, Fujii H, Ishimura T, Takeda M, Fujisawa M, Nishi S, Prasad N, Gurjer D, Bhadauria D, Gupta A, Sharma R, Kaul A, Cybulla M, West M, Nicholls K, Torras J, Sunder-Plassmann G, Feriozzi S, Lo S, Wong PYH, Ip D, Wong CK, Chow VCC, Mo SKL, Molnar M, Ujszaszi A, Czira ME, Novak M, Mucsi I, Cruzado JM, Coelho S, Porta N, Bestard O, Melilli E, Taco O, Rivas I, Grinyo J, Pouteau LM, N'Guyen JM, Hami A, Hourmant M, Ghahramani N, Karparvar Z, Shadrou S, Ghahramani M, Fauvel JP, Hadj-Aissa A, Buron F, Morelon E, Ducher M, Heine C, Glander P, Neumayer HH, Budde K, Liefeldt L, Montero N, Webster AC, Royuela A, Zamora J, Crespo M, Pascual J, Adema AY, van Dorp WTH, Mallat MJK, de Fijter HW, Kim YS, Hong YA, Chung BH, Park CW, Yang CW, Kim YS, Choi BS, Suleymanlar G, Uzundurukan Z, Kapuagas A, Sencan I, Akdag R, Pascual J, Torio A, Mas V, Perez-Saez MJ, Mir M, Faura A, Montes-Ares O, Checa MD, Crespo M, Sawinski D, Trofe-Clark J, Sparkes T, Patel P, Goral S, Bloom R, Kim HJ, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Abdel Halim M, Gheith O, Al-Otaibi T, Mosaad A, Awadeen W, Said T, Nair P, Nampoory MRN. Transplantation: clinical studies - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft123] [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] [Indexed: 11/14/2022] Open
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Balaz P, Rokosny S, Bafrnec J. Mesenteric ischemia, new trends, diagnostic methods and algorithms to significantly reduce mortality and morbidity. ACTA ACUST UNITED AC 2013; 114:158-65. [PMID: 23406185 DOI: 10.4149/bll_2013_035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review article summarizes the most recently available data covering the modern trends and methods in the diagnosis and treatment of mesenteric artery disease. Its aim is to point out the critical moments in the whole spectrum of matters such as early diagnosis and treatment of the chronic form of bowel ischemia, role of MDCT in prompt diagnosis, and urgent therapeutic modalities of treating its acute forms. To achieve the best possible results, we must minimize the time of diagnosis while the treatment has to be tailored individually to each patient according to occlusion type, age and co-morbidities (Fig. 2, Ref. 66).
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Affiliation(s)
- P Balaz
- Institute of Clinical and Expertimental Medicine, Praha, Czech Republic
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Abstract
This paper provides a summary of up-to-date information and experience with the combined treatment of patients suffering from peripheral arterial disease (PAD) with endovascular and open surgery, performed simultaneously and in a single operating room. Hybrid intervention is reported to have good results in well-indicated groups of patients with acute and chronic limb ischemia, even with older, high-risk patients. The indications for the use of this technique remain unclear with inconsistent opinions among vascular surgeons. The indications for treatment were divided into three main groups: 1) Patients with chronic limb ischemia, 2) acute limb ischemia, and 3) occlusion of a previous vascular reconstruction. The operating techniques for the most commonly used combinations are described. In conclusion, hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. Modern vascular surgeons need to master both open and endovascular techniques, and to combine them in a creative fashion to the benefit of our patients.
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Affiliation(s)
- P. Balaz
- Vascular and Transplant Surgery Department, IKEM Prague, Czech Republic
| | - S. Rokosny
- Vascular and Transplant Surgery Department, IKEM Prague, Czech Republic
| | - J. Bafrnec
- Vascular and Transplant Surgery Department, IKEM Prague, Czech Republic
| | - M. Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
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Adamczak M, Koleganova N, Nyengaard JR, Ritz E, Wiecek A, Slabiak Blaz N, Yi Chun DX, Alexandre H, Sandrine GS, Olivier T, Isabelle E, Christophe L, Guy T, Pierre Francois W, Jean-Philippe R, Yvon L, Eric R, Muller-Krebs S, Muller-Krebs S, Weber L, Tsobaneli J, Reiser J, Zeier M, Schwenger V, Tinel C, Samson M, Bonnotte B, Mousson C, Machcinska M, Machcinska M, Bocian K, Wyzgal M, Korczak-Kowalska G, Ju MK, Huh KH, Park KT, Kim SJ, Cho BH, Kim CD, So BJ, Leee S, Kang CM, Joo DJ, Kim YS, Bocian K, Zarzycki M, Sobich A, Korczak-Kowalska G, Matsuyama M, Hase T, Yoshimura R, Koshino K, Sakai K, Suzuki T, Nobori S, Ushigome H, Brikci-Nigassa L, Chargui J, Touraine JL, Yoshimura N, Cantaluppi V, Medica D, Figliolini F, Migliori M, Mannari C, Dellepiane S, Quercia AD, Randone O, Tamagnone M, Messina M, Manzione AM, Ranghino A, Biancone L, Segoloni GP, Camussi G, Turk TR, Zou X, Rauen U, De Groot H, Amann K, Kribben A, Eckardt KU, Bernhardt WM, Witzke O, Lidia G, Wouter C, Yvon L, Eric A, Yann LM, Guy T, Christian N, Marie E, Pierre M, Zineb A, Miriana D, Annick M, Marc A, Daniel A, Wornle M, Ribeiro A, Motamedi N, Grone HJ, Cohen CD, Schlondorff D, Schmid H, Teplan V, Banas M, Banas B, Steege A, Bergler T, Kruger B, Schnulle P, Yard B, Kramer BK, Hoger S, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Zaza G, Rascio F, Pontrelli P, Granata S, Rugiu C, Grandaliano G, Lupo A, Wohlfahrtova M, Wohlfahrtova M, Brabcova I, Balaz P, Janousek L, Lodererova A, Honsova E, Wohlfahrt P, Viklicky O, Grabner A, Grabner A, Kentrup D, Edemir B, Sirin Y, Pavenstadt H, Schober O, Schlatter E, Schafers M, Schnockel U, Reuter S, Rascio F, Pontrelli P, Accetturo M, Gigante M, Gigante M, Tataranni T, Zito A, Schena A, Schena FP, Stallone G, Gesualdo L, Grandaliano G, Maillard N, Masson I, Lena A, Manolie M, Eric A, Christophe M, Lassen CK, Keller AK, Moldrup U, Bibby BM, Jespersen B, Cvetkovic T, Velickovic Radovanovic R, Pavlovic R, Djordjevic V, Vlahovic P, Stefanovic N, Sladojevic N, Ignjatovic A, Rong S, Menne J, Haller H, Suszdak P, Tomczuk P, Gueler F, Nelli S, Sara D, Salma EK, Naoufal M, Tarik M, Mohamed Z, Guislaine M, Mohamed Gharbi B, Benyounes R, Lu X, Rong S, Shushakova N, Menne J, Kirsch T, Haller H, Gueler F, Bockmeyer CL, Bockmeyer CL, Ramackers W, Wittig J, Agustian PA, Klose J, Dammrich ME, Kreipe H, Brocker V, Winkler M, Becker JU, Agustian PA, Bockmeyer CL, Wittig J, Becker JU, Bockmeyer CL. Transplantation - basic. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs247] [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] [Indexed: 11/15/2022] Open
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Balaz P, Plaschke J, Krüger S, Görgens H, Schackert HK. TCF-3, 4 protein expression correlates with beta-catenin expression in MSS and MSI-H colorectal cancer from HNPCC patients but not in sporadic colorectal cancers. Int J Colorectal Dis 2010; 25:931-9. [PMID: 20532534 DOI: 10.1007/s00384-010-0959-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE The beta-catenin-T-cell factor-4 (TCF-4) complex is the main control switch of cell proliferation and differentiation of normal and malignant intestinal cells. The aim of our study was to analyze the protein expression of components of the Wnt pathway in microsatellite stable (MSS) and highly unstable (MSI-H) sporadic and hereditary nonpolyposis colorectal cancer (HNPCC) in human colorectal cancers. METHODS Sixty seven colorectal tumors comprising of 15 sporadic MSS, 12 sporadic microsatellite instability colorectal tumors and 40 tumors from HNPCC patients, of which 20 were MSS and 20 MSI-H, were analyzed for the expression of APC, beta-catenin, and TCF-3, 4 proteins by immunohistochemistry. RESULTS We found a significant difference in cytoplasmic APC expression frequency between sporadic MSS (52%) and HNPCC tumors (78%), whereas no difference was detected between MSI-H and MSS or HNPCC tumors. All tumor groups showed a similar pattern of decreased membranous staining and increased cytoplasmic and nuclear staining for beta-catenin compared to normal cells. Moreover, the TCF-3, 4 protein expression was higher (43%) in HNPCC-associated MSS tumors compared to sporadic tumors (14%; analysis of variance (ANOVA) p < 0.05). For HNPCC tumors, the subcellular beta-catenin expression (membranous, cytoplasmic, and nuclear) correlated with the nuclear TCF-3, 4 signal in MSS tumors (Spearman correlation p < 0.0007) and MSI-H tumors (Spearman correlation p < 0.0001). CONCLUSION We have shown a previously unknown difference in TCF-3, 4 protein expression between sporadic and HNPCC MSS tumors. In addition, we found no difference in nuclear beta-catenin signal intensity, which may be caused by an alteration in Wnt pathway in MSS sporadic tumors by unknown mechanisms leading to lower TCF-3, 4 protein expression. This hypothesis has to be tested in future investigations.
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Affiliation(s)
- Peter Balaz
- Department of Surgical Research, Technische Universität Dresden, Dresden, Germany
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Honsova E, Lodererova A, Balaz P, Oliverius M. NUMBER OF SEROTONIN POSITIVE CELLS AND ACUTE CELLULAR REJECTION IN THE EARLY PERIOD AFTER SMALL BOWEL TRANSPLANTATION IN PIGS. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154:25-9. [DOI: 10.5507/bp.2010.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Balaz P, Rokosny S, Koznar B, Adamec M. Combined infrainguinal reconstruction and infrapopliteal intraluminal angioplasty for limb salvage in critical limb ischemia. Interact Cardiovasc Thorac Surg 2009; 9:191-4. [DOI: 10.1510/icvts.2009.204867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Oliverius M, Balaz P, Kudla M, Valsamis A, Cap J, Adamec M. Small bowel graft revascularization in experiment. BRATISL MED J 2009; 110:65-68. [PMID: 19408835] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The technical aspects of a procedure are most important for the outcome of the experiment. This study was designed to compare two techniques suitable for graft revascularization. METHODS The first technique, where the animal is both donor and the recipient, consists of connecting the grafts' vascular anastomoses to the mesenteric vessel bed. In the second technique, one animal is the graft donor and the other is the recipient, with revascularization to the central vessel bed (subrenal inferior vena cava and aorta). Techniques of restoring digestive tract continuity and creation of diagnostic "chimney ileostomy" were identical in both groups. All experimental animals were monitored clinically regularly basis as per protocol (weight, temperature, stoma appearance, output and nature of stools). Blood and biopsy samples were obtained on days 0, 3, 5, 7, 10, 20, and 30. RESULTS Overall, 43 transplant procedures were performed. The first group included 18 transplants and 66.7% animals had vascular complications. While in the second group (25 transplant procedures), vascular complication rate was only 12% (3 out of 25) perhaps due to technique modifications. CONCLUSION Our experiment showed that both types of vascular anastomosis could be used in small bowel transplantation. Connecting the graft vessels to the aorta and inferior vena cava is technically simpler and safer because of fewer subsequent complications (Tab. 1, Fig. 4, Ref. 6). Full Text (Free, PDF) www.bmj.sk.
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Affiliation(s)
- M Oliverius
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Balaz P, Rokosny S, Klein D, Adamec M. Aneurysmorrhaphy is an easy technique for arteriovenous fistula salvage. J Vasc Access 2008; 9:81-84. [PMID: 18609522] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The life-saving procedures for patients in chronic renal failure (CRF) are hemodialysis (HD) or successful kidney transplantation. HD requires a properly placed and functioning vascular access, most often obtained by creating an arteriovenous fistula (AVF). The long-term patency of AVFs is limited, in addition to other factors, by the development of intimal hyperplasia and the process results in venous wall thickening and progressive fistula occlusion. Another problem is limited patency, due to the development of pseudoaneurysm, which is associated with an increased risk of thrombosis, infection and bleeding, difficult cannulation for dialysis, pain and cosmetic defects. Treatment is focused on rapidly progressing pseudoaneurysms, which can predispose to rupture, technical problems during cannulation because of pseudoaneurysm size or a growing intraluminal thrombus. Most of these patients are scheduled for pseudoaneurysm removal and new fistula construction or, occasionally, an endovascular procedure involving stent graft implantation. This paper describes a simple and inexpensive technique of managing an AVF pseudoaneurysm, i.e. aneurysmorrhaphy. To offset the weakening of the venous wall by suture following aneurysmorrhaphy, an external polyethylene terephthalate (PET) prosthesis was implanted in the vein to prevent the development of intimal hyperplasia in the de novo created AVF.
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Affiliation(s)
- P Balaz
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine, Prague - Czech Republic.
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Gbelcová H, Lenícek M, Zelenka J, Knejzlík Z, Dvoráková G, Zadinová M, Poucková P, Kudla M, Balaz P, Ruml T, Vítek L. Differences in antitumor effects of various statins on human pancreatic cancer. Int J Cancer 2008; 122:1214-21. [PMID: 18027870 DOI: 10.1002/ijc.23242] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Statins are widely used for the treatment of hypercholesterolemia. However, their inhibitory action on HMG-CoA reductase also results in the depletion of intermediate biosynthetic products, which importantly contribute to cell proliferation. The aim of the present study was to compare the effects of the individual commercially available statins on experimental pancreatic cancer. The in vitro effects of individual statins (pravastatin, atorvastatin, simvastatin, lovastatin, cerivastatin, rosuvastatin and fluvastatin) on the viability of human pancreatic cancer were evaluated in CAPAN-2, BxPc-3 and MiaPaCa-2 cell lines. The in vivo experiments were performed on nude mice xenotransplanted with CAPAN-2 cells. The mice received oral treatments either with a placebo, or with the statins mentioned earlier in a daily dose corresponding to a hypocholesterolemic dose in humans. The effect of these statins on the intracellular Ras protein, trafficking in MiaPaCa-2 transfected cells, was also investigated. Substantial differences in the tumor-suppressive effects of all statins were detected in both in vitro and in vivo experiments. While simvastatin exerted the highest tumor-suppressive effects in vitro, rosuvastatin (p = 0.002), cerivastatin (p = 0.002) and fluvastatin (p = 0.009) were the most potent compounds in an animal model. All statins (except pravastatin) inhibited intracellular Ras protein translocation. In summary, substantial tumor-suppressive effects of various statins on the progression of experimental pancreatic adenocarcinoma were demonstrated, with marked differences among individual statins. These results support greatly the potential of statins for the chemoadjuvant treatment of pancreatic cancer.
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Affiliation(s)
- Helena Gbelcová
- Department of Biochemistry and Microbiology and Center for Applied Genomics, Institute of Chemical Technology, Prague, Czech Republic
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Zelenka J, Lenícek M, Muchová L, Jirsa M, Kudla M, Balaz P, Zadinová M, Ostrow JD, Wong RJ, Vítek L. Highly sensitive method for quantitative determination of bilirubin in biological fluids and tissues. J Chromatogr B Analyt Technol Biomed Life Sci 2008; 867:37-42. [PMID: 18373963 DOI: 10.1016/j.jchromb.2008.03.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 02/11/2008] [Accepted: 03/05/2008] [Indexed: 11/24/2022]
Abstract
Unconjugated bilirubin (UCB) exhibits potent antioxidant and cytoprotective properties, but causes apoptosis and cytotoxicity at pathologically elevated concentrations. Accurate measurement of UCB concentrations in cells, fluids and tissues is needed to evaluate its role in redox regulation, prevention of atherosclerotic and malignant diseases, and bilirubin encephalopathy. In the present study, we developed and validated a highly sensitive method for tissue UCB determinations. UCB was extracted from rat organs with chloroform/methanol/hexane at pH 6.2 and then partitioned into a minute volume of alkaline buffer that was subjected to HPLC using an octyl reverse phase (RP) column. Addition of mesobilirubin as an internal standard corrected for losses of UCB during extraction. Recoveries averaged 75+/-5%. The detection limit was 10pmol UCB/g wet tissue. Variance was +/-2.5%. When used to measure UCB concentrations in tissues of jaundiced Gunn rats, this procedure yielded UCB levels directly comparable to published methods, and accurately determined very low tissue bilirubin concentrations (</=40pmol UCB/g tissue) in non-jaundiced rats.
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Affiliation(s)
- Jaroslav Zelenka
- Institute of Clinical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University in Prague, Czech Republic
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Balaz P, Kudla M, Lodererova A, Oliverius M, Adamec M. Preservation injury of the small bowel graft in clinical small bowel transplantation. BRATISL MED J 2007; 108:516-518. [PMID: 18309642] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Clinical success of small bowel transplantation depends on quality of the preservation small bowel graft which is notoriously sensitive to ischemia. There is still no general agreement as to which segment of the small bowel is preferred (jejunum or ileum) for clinical use. In our study, using a light microscopy and concentrations of tissue serotonin-positive cells, we tried to identify a part of the human intestine, which is more resistant to preservation injury sustained by HTK preservation solution with 1-24 hr of cold ischemia. Statistical analysis of both parameters did not reveal any significant differences between the jejunum and ileum. According to our data, there is no difference between jejunal and ileal grafts in susceptibility to ischemic injury due to cold ischemia within 24 hours when using HTK preservation solution. A significant difference was observed in histological pictures only after 12-hour of cold ischemia in both groups (jejunum and ileum) (Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.
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Affiliation(s)
- P Balaz
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
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Balaz P, Kudla M, Lodererova A, Oliverius M, Adamec M. Preservation injury to the human small bowel graft: jejunum vs. ileum. Ann Transplant 2007; 12:15-18. [PMID: 17953138] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Early postoperative complications after small bowel transplantation (SBT) including endotoxemia, bacterial translocations, and stimulation of the recipient's immune response have been attributed to preservation injury. Small intestine is notoriously sensitive to ischemia and there is still no general agreement as to which segment of the small bowel is preferred (jejunum or ileum) for clinical use. AIM OF STUDY In our study, using light microscopy and concentrations of tissue serotonin-positive cells we sought to identify the part of the human intestine, which is more resistant to preservation injury sustained by HTK preservation solution with 1-24 hr cold ischemia time. RESULTS Statistical analysis of both parameters did not reveal any significant differences between the jejunum and ileum. CONCLUSIONS Judging by our data, there is no difference between jejunal and ileal grafts in susceptibility to ischemic injury due to cold ischemia within 24 hours when using HTK preservation solution. Significant difference was observed in histological pictures only after 12-hour of cold ischemia time in both experimental groups (jejunum and ileum).
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Affiliation(s)
- Peter Balaz
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
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Antos F, Balaz P, Matejovska J, Chovanec E, Lunackova I. Spontane Milzruptur nach Milzinfarkt unter Langzeit- Antikoagulationstherapie. Visc Med 2005. [DOI: 10.1159/000086350] [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] [Indexed: 11/19/2022] Open
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Köninger J, Balaz P, Wagner M, Shi X, Cima I, Zimmermann A, di Sebastiano P, Büchler MW, Friess H. Phosphatidylserine receptor in chronic pancreatitis: evidence for a macrophage independent role. Ann Surg 2005; 241:144-51. [PMID: 15622002 PMCID: PMC1356857 DOI: 10.1097/01.sla.0000149304.89456.5a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study analyzes the role of phosphatidylserine receptor (PSR) in chronic pancreatitis. SUMMARY BACKGROUND DATA In chronic pancreatitis, destruction of parenchyma comes along with infiltration of lymphocytes and macrophages. The phosphatidylserine receptor is expressed on the surface of macrophages and is crucial for the recognition and engulfment of apoptotic cells. In the present study, we investigated the role of this receptor and its relation to apoptosis in chronic pancreatitis. METHODS The expression and localization of PSR were analyzed by Northern blot analysis, RT-PCR, Western blot analysis and immunohistochemistry. Apoptosis was detected by the TUNEL method, and the RNA protection assay (RPA) was used to compare activation of apoptosis with PSR mRNA expression levels. In addition, the molecular data were related to clinicopathological parameters. RESULTS PSR mRNA expression was low to absent in normal pancreatic tissue samples. In human chronic pancreatitis, increased expression of PSR mRNA was present in 12 of 29 samples (41%). Up-regulation of PSR could be confirmed by Western blot analysis. In chronic pancreatitis tissue, PSR immunoreactivity was present in all islets, in some ductal cells and in macrophages. The RNA protection assay revealed high mRNA levels of the antiapoptotic genes bcl-2 and bfl-1 (P < 0.05) in chronic pancreatitis tissues with high PSR mRNA expression. The TUNEL apoptosis in situ detection method showed positive signals in some redifferentiating acinar cells and focally in acinar cells adjacent to stromal fibroblasts in chronic pancreatitis tissue samples. The distribution pattern of PSR on pancreatic cells in chronic pancreatitis corresponded to a great extent with regions of high apoptotic activity. CONCLUSIONS We show for the first time the presence of PSR in chronic pancreatitis on pancreatic cells other than macrophages in regions with high apoptotic activity. The coexpression and colocalization of this gene with other apoptosis mediators suggest its involvement in apoptotic processes. However, in chronic pancreatitis PSR is not only involved in phagocytosis of apoptotic cells by macrophages.
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Affiliation(s)
- Jörg Köninger
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
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Balaz P, Kudla M, Adamec M. Small bowel transplantation in experimental and clinical medicine. BRATISL MED J 2005; 106:193-5. [PMID: 16201733] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Small bowel transplantation (SBT) has recently the attention of clinicians as an alternative to management of patients with irreversible bowel failure. In this paper, the authors provide an overview of basic facts regarding SBT in experimental and clinical medicine. The paper describes the evolution of bowel transplantation in experiment before it was introduced into clinical practice. In the part discussing clinical SBT, the author's report the currently available international data on SBT. In its conclusion, the paper presents the authors own experience with experimental SBT in animals and humans (Ref. 15).
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Affiliation(s)
- P Balaz
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
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Balaz P, Becker M, Polanski C. Wiederholte Omentumstrangulation als eine seltene Ursache des akuten Abdomens. Visc Med 2004. [DOI: 10.1159/000078072] [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] [Indexed: 11/19/2022] Open
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Balaz P, Matia I, Jackanin S, Pomfy M, Fronek J, Ryska M. Morphological changes of small bowel graft in Wistar rats after preservation injury. BRATISL MED J 2004; 105:62-4. [PMID: 15253537] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE In our study we decided to define the harvesting and preservation injury of the graft using Park's scheme for the quantification of morphological changes. METHODS ANIMALS Male Wistar rats (n=25) weighting 322+/-18 g. Harvesting preservation technique: Proximal jejunum (5-7 cm) was flushed with 5 ml of HTK solution and preserved for 0, 1, 6, 9 and 12 hours at 4 degrees C in the same solution. Biopsies for light microscopic evaluations were obtained after the preservation period. Park's scheme was used for the quantitative assessment of histological changes. t-test for two independent samples was used to evaluate statistical significance. RESULTS HISTOLOGY The extent of the preservation injury in the samples obtained at 0 hours was of grade 0 and increased to 1.84 after 12 hours of preservation time. At 0 hours of preservation a degree of 0 (s=0: no changes) was observed, after 1 hour, a degree of 0.50 (s=0.47: slight changes, similar to 0 time), after 6 hours a degree of 1 (0.97, s=0.41: discrete subepitelial oedemas in villi apexes), after 9 hours a degree of 2 (1.74, s=0.64: extension of subeppitelial spaces in villi apexes), and after 12 hours a degree of 2 (1.83, s=0.64: more extension of subepitelial spaces) was observed, except for these findings, there were also changes of grade 3 (massive subepitelial edema and sequestration of the mucosa from lamina propria) in the 12-hour group. A statistically significant (p=0.05) difference was found between all groups except for 9 and 12-hour groups. CONCLUSIONS HISTOLOGY revealed increasing preservation injury with a increasing duration of preservation and its dynamic. (Tab. 1, Fig. 2, Ref: 6.)
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Affiliation(s)
- P Balaz
- Transplant Surgery Department, Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
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Abstract
In this article the role of different growth factors and their receptors in the pathogenesis of chronic pancreatitis and pancreatic cancer is discussed. The expression of members of the epidermal growth factor family, the fibroblast growth factor family, the transforming growth factor-beta family, the platelet-derived growth factor family, the nerve growth factor family, the insulin-like growth factor family and their signaling receptors is presented, and a correlation of the molecular data with clinical and pathological changes is performed. A number of these growth factors and their receptors are markedly overexpressed in chronic pancreatitis and pancreatic cancer. In chronic pancreatitis, overexpression of growth factors and their receptors contributes to tissue remodeling and fibrogenesis. In contrast to chronic pancreatitis, pancreatic cancer is associated with a variety of genetic alterations, including mutations in tumor suppressor genes and cell cycle regulators. In the presence of these genetic disturbances, enhanced expression of growth factors and their receptors contributes to cell proliferation and enhances the aggressiveness of pancreatic cancer cells. In summary, growth factors and their receptors are often altered in chronic pancreatitis and pancreatic cancer and contribute to various pathogenetic aspects in these disorders.
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Affiliation(s)
- P Balaz
- Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland
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Abstract
OBJECTIVE To evaluate the role of human macrophage metalloelastase (HME) in pancreatic cancer. SUMMARY BACKGROUND DATA HME, a member of the human matrix metalloproteinase family, possesses elastolytic activity and is critical for the degradation of extracellular matrix proteins. Inasmuch as tumor invasion and metastasis formation require lysis of extracellular matrix, HME plays a critical role in both processes. METHODS HME expression was analyzed by Northern blot analysis, reverse transcriptase-polymerase chain reaction, Western blot analysis, and immunohistochemistry in 39 pancreatic cancer tissues and 13 normal controls. The molecular data were related to clinicopathologic parameters and patient survival. RESULTS In human pancreatic cancer, overexpression of HME mRNA was present in 25 of 39 pancreatic cancer tissues (64%) and in five pancreatic cancer cell lines. In contrast, low levels of HME mRNA expression were present in 13 normal pancreatic tissues samples. By Western blot analysis, high levels of HME were found in pancreatic cancer tissues and in the pancreatic cancer cell lines compared with the normal controls. Fifty-six percent of the cancer samples exhibited HME immunoreactivity in the cancer cells, and 63% in the stromal cells. Analysis of the survival data revealed that patients whose tumors exhibited HME mRNA overexpression lived significantly shorter compared with patients whose tumors did not overexpress HME. No relationship between HME expression and tumor stage, tumor grading, or presence of lymph node metastases was found. CONCLUSIONS These findings indicate that HME participates in pancreatic cancer progression and that its presence worsens the prognosis. These data suggest a benefit of its inhibition in the treatment of pancreatic cancer.
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Affiliation(s)
- Peter Balaz
- Department of General Surgery, University of Heidelberg, Germany
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Hutan M, Bandzak J, Balaz P, Hostyn L. [Aortoesophageal fistulae as a cause of fatal hemorrhage]. BRATISL MED J 1999; 100:330-3. [PMID: 10573651] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding, ranging from 0 to 2.3% in literature. The authors studied a group of 266 patients with upper gastrointestinal bleeding during the period of three years (1996-1998). According to two patient cases and the data from literature diagnostic methods, causes of aortoesophageal fistulas are analysed and the necessity of urgent closure of the fistulas is stressed. (Tab. 2, Fig. 2, Ref. 15.)
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Affiliation(s)
- M Hutan
- Dpt of Surgery, Hospital Ruzinov, Bratislava, Slovakia
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