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Neoadjuvant chemotherapy is being increasingly used in the treatment of breast carcinoma. We performed a single-center retrospective analysis of the results of neoadjuvant therapy in 376 breast carcinoma patients treated with three different regimens combining doxorubicin and paclitaxel (AT), dose-dense doxorubicin and cyclophosphamide with sequential weekly paclitaxel (DD AC-P), or the combination of trastuzumab with chemotherapy (DD AC-PT). The expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (HER)-2 was determined immunohistochemically. Pathological response was determined in 318 patients. Pathological complete response (pCR) was observed in 18% of patients. The pCR rate was significantly higher in patients treated with DD regimen (22 vs. 13%) and younger than 55 years (23 vs. 13%). The pCR rate was higher in patients with triple negative (TN) tumors (43%) and tumors over-expressing HER-2 (HER-2+; 28%) compared to patients with ER- or PR-positive tumors not expressing HER-2 (ER/PR+HER-2-; 6%). In patients with TN tumors pCR rate was significantly higher after treatment with DD AC-P compared to AT (61 vs. 22%, p=0.005). pCR was associated with significantly improved relapse-free survival (RFS) and overall survival (OS), but when analysis was performed based on tumor phenotype, the difference was significant only in patients with TN tumors. In multivariate analysis, pCR, stage, and ER expression were significant predictors of RFS, while pCR, stage, ER and DD regimen were significant predictors of OS. In conclusion, present data indicate superiority of a DD regimen in obtaining pCR in patients with breast carcinoma treated with neoadjuvant chemotherapy. The difference in efficacy is due mostly to markedly higher pCR rate in patients with TN tumors.

Background: The aim of the study was to assess positivity nonsentinel lymph nodes in patients with macro, micro and submicrometastases in sentinel lymph nodes and find predictive factors of positivity nonsentinel lymph nodes. Study was conducted at the Department of Surgery in Pardubice, Pilsen, Ostrava and Zlín., Material and Methods: Sentinel lymph nodes were assessed based on standards of Czech Pathological Society. Detection of sentinel lymph nodes was performed based on radionavigation or combination of radionavigation and blue dye method., Results: In group N1 (macrometastases) there was found positivity of nonsentinel lymph nodes in 50% (45 from 90 patients). In group N1 Mi (micrometastases) there was found positivity of nonsentinel lymph nodes in 26.7% (16 from 60 patients). In group NO I+ (sub-micrometastases) there was found positivity of nonsentinel lymph nodes in 6.7% (1 from 15 patients). Predictive factors were size of metastasis, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor of positivity nonsentinel lymph nodes., Discussion: High positivity of nonsentinel lymph nodes in pacients with macro and micrometastases in sentinel lymph nodes advocates to perform axillary lymph nodes dissection. Due to small number of patients with submicrometastases it is not possible to assess if axillary dissection is necessary or not. Predictive factors of positivity of nonsentinel lymph nodes are size of metastasis in sentinel lymph nodes, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor due to small tumors in the study. In spite of this it is necessary to consider it like a predictive factor of positivity nonsentinel lymph nodes., Conclusion: In patients with macro and micrometastases it is necessary to perform axillary dissection. In patients with submicrometastases in sentinel lymph nodes it is necessary to consider predictive factors.

Background: The breast carcinoma is the most frequent malignancy in the women in the Czech Republic. The incidence of the breast carcinoma is still increasing. But the diagnostics and treatment of this disease was also changed. MATERIAL AND A METHODS: Retrospective study on the Department of Surgery Pardubice General Hospital. There are compared two periods--the years 1991 and 2006. Particularly there are followed numbers of procedures, diagnostics methods, types of procedures, size of the tumor, lymph node and systemic metastases, preoperative time and age of the patients., Results and Conclusion: The number of procedures doubled, the size of the tumor decreased from 3.05 to 2.01 cm, detection of lymph node metastases and lung metastases improved, there is trend to breast conservative treatment, preoperative time shortened.

The incidence of Candida afflictions in critically ill patients is still growing in the Czech Republic. We looked for a method that not only decreases Candida afflictions but also decreases treatment expenses. This method is preemptive therapy. Critically ill patients were determined by a risk score system. This system was based on summarizing all the risk factors in one patient. Patients who reach the risk score were randomized into groups A and B. Patients in group A were administered itraconazole; patients in group B were not administered any antimycotics. Results of the study show that preemptive treatment decreases Candida infection and Candidemia. A decrease of treatment expenses was reached by identifying the specific group of patients at risk using the risk score system and administering antimycotics.

Aim of the Work: Bleeding into GIT is still serious problem with not low lethality. Especially, acute bleeding needs fast diagnostics and treatment. The aim of our work is to present the rare case of bleeding into GIT--haemobilia., Group of the Patients: There is presented casuistics of the patient who was successfully treated on our department for bleeding from erosion of cystic artery as a consequence of acute cholecystitis., Conclusion: Nowadays there is dominantly preferred endoscopic approach in diagnostics and treatment of the bleeding into GIT. But surgical approach is in some cases the only one method in treatment of these complications.

Background: Carcinoma of the breast is the most commonly diagnosed women cancer. Less than 1% of the patients diagnosed with breast cancer initially present with axillary metastases as their only clinical manifestation. CASUISTIC: We report case of 58 years old woman with occult breast carcinoma in which extensive axillary node metastasis was the first manifestation., Discussion: Breast cancer presenting with axillary metastases and no clinical apparent primary tumour in the breast is an uncommon form of stage II or IV of this disease. Ultrasonography, mammography, MRI and excisional biopsy are indicated for detecting occult primary tumours. The appropriate treatment of the breast after an axillary presentation of occult breast carcinoma continues to be a controversial issue. Complete axillary lymph node dissection is indicated in all patients. As a local treatment of the breast is indicated irradiation of the breast or total mastectomy or subcutaneus mastectomy with application of the breast prothesis., Conclusion: Axillary metastasis is rare first sign of breast cancer. Diagnostics of the occult breast carcinoma is difficult. The treatment of occult breast carcinoma is still controversial.

Purpose: There has been an ongoing increase in the frequency and severity of blunt chest injuries. Their rather high lethality is caused by the injury alone as well as by the following systemic inflammatory response. The aim of the study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries, and to identify whether the administration of indomethacin as a cyclooxygenase inhibitor could prevent a multiorgan dysfunction (MODS) and a multiorgan failure (MOF)., Methods: Patients were divided into 4 Groups according to trauma severity--injury severity score (ISS) and into two subgroups--an indomethacin subgroup where patients received indomethacin together with standard therapy, and a non-indomethacin subgroup., Results: Eighty-four patients were included in the study and 33 patients were given indomethacin. In Groups III and IV there was a later increase in inflammatory markers in patients treated with indomethacin. The elevation of inflammatory markers and the period of mechanical ventilation support in patients treated with indomethacin were shorter in Groups II and III. Seven (8.3%) patients died. Six of the seven dead patients were from the non-indomethacin subgroup. MOF was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup., Conclusion: The results obtained during the first 20 months of the study imply that a certain number of patients with serious blunt chest trauma could benefit from indomethacin administration.

Background: Axillary lymph node staging is the most powerful predictor of survival in breast cancer women. Sentinel lymph node biopsy (SLNB) is more accurate method in evaluation of axillary lymph node staging than complete axillary lymph node dissection (CALND) because of more precious histological and imunohistochemical assessment of the first draining lymph nodes. Furthermore, SLNB eliminates complications resulting from CALND., Material and Methods: SLNB is either performed using blue dye technique or using of combination of blue dye and radioguided technique. We prefer two days protocol in application of Tc 99 radiocolloid. There were used both techniques for detection sentinel lymph nodes and results were compared., Results: There were performed 21 SLNBs using blue dye technique, Group A, and 20 SLNBs using combination of blue dye and radioguided technique, Group B, from October 2001 to November 2003. Sentinel lymph nodes were not detected in Group A in two cases, false negativity occurred two times in this group. Sentinel lymph nodes were detected in all cases in Group B and there was no false negativity present in this group., Conclusion: Combination of blue dye and radioguided technique is more precious in detection of sentinel lymph node than blue dye technique itself. Two days protocol of application of Tc 99 radiocolloid enables performing this method even in hospitals, where the Department of Nuclear Medicine is not available.

Authors in their theoretical report discuss problems of traumatic haemoperitoneum resulting from blunt abdominal injury including diagnostics and therapy. They put the stress on diagnostic-therapeutic algorithm. It is emphasized the necessity of immediate US of the abdomen and at the haemodynamically stable patients helical CT scan. Classification of injured certain abdominal cavity organs is mention and suggested unification of these classifications. It is highlighted conservative treatment of traumatic haemoperitoneum with regular monitoring including monitoring of intralpha abdominal pressure and abdominal compartment syndrome. Damage Control Surgery System, as a new strategy, is discussed in a part regarding operative management.

The authors are presenting a review of the current state of diagnosis and surgical treatment of the early breast cancer, an algorithm of the diagnosis and the treatment. The authors are showing the impact of the breast preserving surgery and from their point of view present experience with 362 patients operated at the General Surgery Pardubice assembled in years 1998 and 1999.