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Acute liver failure (ALF) is known for extremely high mortality rate, the result of widespread damage of hepatocytes. Orthotopic liver transplantation is the only effective therapy but its application is limited by the scarcity of donor organs. Given the importance in the liver biology of Wnt/β-catenin signaling pathway, we hypothesized that its stimulation could enhance hepatocyte regeneration and attenuate the course of thioacetamide (TAA)-induced ALF in Lewis rats. Chronic treatment with Wnt agonist was started either immediately after hepatotoxic insult (“early treatment”) or when signs of ALF had developed (“late treatment”). Only 23 % of untreated Lewis rats survived till the end of experiment. They showed marked increases in plasma alanine aminotransferase (ALT) activity and bilirubin and ammonia (NH3) levels; plasma albumin decreased significantly. “Early” and “late” Wnt agonist treatment raised the final survival rate to 69 % and 63 %, respectively, and normalized ALT, NH3, bilirubin and albumin levels. In conclusion, the results show that treatment with Wnt agonist attenuates the course of TAA-induced ALF in Lewis rats, both with treatment initiated immediately after hepatotoxic insult and in the phase when ALF has already developed. Thus, the pharmacological stimulation of Wnt/β-catenin signaling pathway can present a new approach to ALF treatment.

Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair.A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day.Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644).In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.

The article describes the development of oncosurgery in the Czech Republic since the beginning of the century, as well as other perspectives regarding this specialty. The development of surgical treatment of solid malignant tumours in the Czech Republic was evaluated according to the National Cancer Register database and compared to the neighbouring countries, and the educational system of surgeons in oncosurgery was assessed. Although surgery plays a key role in cancer therapy, starting from the beginning of this millennium it has been pushed aside as a service specialty for other disciplines in oncology. In 2002, these changes were supported by the activities of the newly founded Division of Oncosurgery under the Czech Society for Oncology, which became part of the Czech Surgical Society in 2016. An official educational programme of surgeons in oncology was successfully implemented and since 2011, a specialization examination in oncosurgery has been introduced, organized by the subdepartment of oncosurgery of the Institute of Postgraduate Medical Education (IPVZ), Prague. To date, this examination has been completed by 112 physicians and approximately the same number is currently registered in the educational programme. Currently, 34 centres are accredited for education in oncosurgery. The establishment of Complex Oncology Centres based on an initiative of the Czech Society for Oncology of 2006 only addressed pharmaceutical and radiation oncology. Despite progress in oncosurgery, more clearly defined conditions for this specialty are needed. Conclusion: The education of surgeons in oncosurgery should be continued. It is necessary to expand the number of centres with accreditation for oncosurgery and develop a concept for oncosurgery in the Czech Republic which would be associated with rational concentration of this treatment in connection with organization and provision of continuous urgent and acute surgical care in the Czech Republic, including control mechanisms to ensure its quality. This proposal should be discussed by the Czech Surgical Society in order to further enhance the quality of oncosurgery in the Czech Republic.

Acute liver failure (ALF) is a clinical syndrome with high mortality rate, resulting from widespread hepatocyte damage. Its pathophysiological background is still poorly understood and preclinical studies evaluating pathophysiology and new potential therapeutic measures are needed. The model of ALF induced by administration of thioacetamide (TAA) in Lewis rats is recommended as optimal; however, the limitation of previous studies was that they were performed predominantly in male rats. In view of the growing recognition that sex as a biological variable should be taken into consideration in preclinical research, we examined its role in the development of TAA-induced ALF in Lewis rats. We found that, first, intact male Lewis rats showed lower survival rate than their female counterparts, due to augmented liver injury documented by higher plasma ammonia, and bilirubin levels and alanine aminotransferase activity. Second, in female rats castration did not alter the course of TAA-induced ALF whereas in the male gonadectomy improved the survival rate and attenuated liver injury, reducing it to levels observed in their female counterparts. In conclusion, we found that Lewis rats show a remarkable sexual dimorphism with respect to TAA-induced ALF, and male rats display dramatically poorer prognosis as compared with the females. We showed that testosterone is responsible for the deterioration of the course of TAA-induced ALF in male rats. In most general terms, our findings indicate that in the preclinical studies of the pathophysiology and treatment of ALF (at least of the TAA-induced form) the sex-linked differences should be seriously considered.

Colorectal cancer is a major contributor to the overall cancer burden in the Czech population. Anastomotic healing defects are a feared complication which may have a fatal impact on the patient. Fundamental conditions for proper anastomotic healing include sufficient blood supply. Fluorescent angiography using indocyanine green in the spectrum of near-infrared light facilitates the monitoring of tissue perfusion during a surgery. The aim of this article is to present the results of a non-randomized study in which we assessed prospectively obtained data from a perioperative assessment of anastomosis perfusion by fluorescent angiography using indocyanine green during robotic resection of the rectum with a malignant tumor.Thirty patients with rectal cancer who underwent a robotic resection with primary anastomosis were consecutively included in the study between 1 April 2017 and 21 June 2018. The study included patients due to undergo a minimally invasive procedure with guaranteed health insurance coverage. During the operation, we monitored and assessed the quality of perfusion of the resection line of the sigmoid colon and subsequent anastomosis by means of fluorescent angiography using indocyanine green in the spectrum of near-infrared light. The data were obtained prospectively and subsequently analyzed.Between 1 April 2017 and 21 June 2018, we consecutively included 30 rectal cancer patients in the project: 16 men and 14 women. Monitoring of perfusion of the resection line and anastomosis was successful in all cases and perfusion quality was satisfactory across the sample. Perfusion insufficiency requiring a change in the resection line level or anastomosis adjustments was not detected with any patient. In two cases (12.5 %) of TME, we gave up the planned protective ileostomy owing to good perfusion of the anastomosis. One patient (3.3%) suffered from defective anastomotic healing without clinical symptoms (type A). We found no technical complications related to fluorescent angiography or undesirable effects due to the application of indocyanine green.Fluorescent angiography using indocyanine green in the spectrum of near-infrared light is a fast and safe option to monitor the level of blood supply to an anastomosis during surgery, which is a fundamental condition for proper healing. Even though we did not record insufficient perfusion in our sample and hence we did not need to change the resection line level or adjust the anastomosis, we may state that fluorescent angiography performed by an experienced colorectal surgeon may potentially reduce the frequency of complications linked to defective anastomotic healing.

Introduction: Acute abdomen is one of the most important issues in abdominal surgery. Our study aims to describe the differences in clinical presentation of patients, in the course of their hospitalization, and in morbidity and mortality of patients with drug abuse; another aim is to describe our own experience with drug abusers with acute abdomen. Method: Patients with the history of drug abuse and with non-traumatic acute abdomen were included retrospectively to our set. We chose patients hospitalized between 2013 and 2018. We analyzed the demographical data of the patients, types of abused drugs, concordance between the first and final diagnosis, findings of paraclinical examinations, the need of surgical treatment, and the type of surgery. Morbidity, mortality and the length of hospital stay were tracked. All the data was evaluated using descriptive statistics. Results: 8 patients (4.7 per mille of all the patients hospitalized for acute abdomen) fulfilled the criteria of our study. All the patients were men with median age 32 years. Pervitin (methamphetamine) was the most frequently abused drug (in 50%), followed by heroin, benzodiazepines, tetrahydrocannabinol, subutex, hypnotics and tramadol. Peptic ulcer perforation was the most frequent diagnosis in our set (in 50% of all patients). The other diagnoses included: two cases of upper gastrointestinal tract bleeding, one case of Crohn’s disease relapse with peritonitis and one case of colitis of the ascending colon. Surgical treatment was necessary in 75% patients. 30-day mortality was zero; an early complication (wound dehiscence) developed in one operated patient. Mean length of hospital stay was 9.7 days in our set, with the median of 7 days. Conclusion: Drug abusers represent only a marginal part of all patients with acute abdomen. This group is characterized by a significantly lower age, by a considerable predominance of men and by the preference of perforated peptic ulcer.

Although several techniques of laparoscopic left pancreatectomy have already been developed through experiments on animals and human patients, there is still insufficient information about their pathophysiological mechanisms, especially the impact on surgical stress.In a group of 10 pigs, open left pancreatectomy was performed, and the other group of 10 pigs underwent laparoscopic left pancreatectomy. Postoperative stress was compared by determining serum levels of leukocytes, interleukin 1, 6 and CRP from peripheral venous blood collection. The blood was collected prior to incision, 1 and 2 hours after incision, 24 hours after the beginning of the procedure, and on the 7th postoperative day.No statistically significant difference was found between open and laparoscopic left pancreatectomy in the measured values of leukocytes, IL-1 and 6 and CRP.Key words: laparoscopy - left pancreatectomy surgical stress response interleukin 1 interleukin 6.

Acute liver failure (ALF) is a clinical syndrome resulting from widespread damage of hepatocytes, with extremely high mortality rate. Urgent orthotopic liver transplantation was shown to be the most effective therapy for ALF but this treatment option is limited by scarcity of donor organs. Therefore, hepatocyte transplantation (Tx) has emerged as a new therapeutical measure for ALF, however, the first clinical applications proved unsatisfactory. Apparently, extensive preclinical studies are needed. Our aim was to examine if hepatocytes isolated from transgenic “firefly luciferase” Lewis rats into the recipient liver would attenuate the course of thioacetamide (TAA)-induced ALF in Lewis rats. Untreated Lewis rats after TAA administration showed a profound decrease in survival rate; no animal survived 54 h. The rats showed marked increases in plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, in plasma level of bilirubin and ammonia (NH3), and in a significant decrease in plasma albumin. Hepatocyte Tx attenuated the course of TAA-induced ALF Lewis rats which was reflected by improved survival rate and reduced degree of liver injury showing as lowering of elevated plasma ALT, AST, NH3 and bilirubin levels and increasing plasma albumin. In addition, bioluminescence imaging analyses have shown that in the TAA damaged livers the transplanted hepatocyte were fully viable throughout the experiment. In conclusion, the results show that hepatocyte Tx into the liver can attenuate the course of TAA induced ALF in Lewis rats. This information should be considered in attempts to develop new therapeutic approaches to the treatment of ALF.

Colon perforation is a very serious complication of colonoscopy. The correct diagnosis and management of therapy improve the prognosis of patients. The treatment can be conservative, endoscopic and surgical. In this case report we present microperforation as a complication of polypectomy in the caecum during colonoscopy, followed by laparoscopic surgery.Key words: colonoscopy - complication -perforation polypectomy.

Retrospective evaluations of the relevance of primary colorectal cancer (CRC) location consistently indicate that right-sided tumors, arising in the cecum, ascending colon, hepatic bend, transverse colon and splenic flexure, are clinically, biologically and genetically different from left-sided tumors - those located in the descending colon, sigmoid colon or rectum. Location in the right-sided colon represents a negative prognostic indicator, particularly for stage III and IV carcinomas. Irrespective of treatment, the rightward location is associated with a significantly increased risk of death when compared to the left side.Key words: colorectal cancer - location - therapy - prognosis.

Currently, total pancreatectomy (TP) is indicated in approximately one in ten surgical patients with pancreatic cancer. Key role in the decision falls in the competence of the multidisciplinary team, alternatively of the surgeon in the intraoperative period in some cases. Exceptionally, TP is approached in the so-called salvage surgery. Perioperative mortality of TP as an elective procedure does not exceed that of partial resections; however, mortality of up to 50% is associated with salvage surgery in acute postoperative pancreatitis. Postoperatively, patients are afflicted with the so-called brittle diabetes comparable with type 1 diabetes. The aim of our overview is to inform about the current position of TP in the treatment of malignant pancreatic diseases.Key words: pancreatic cancer - total pancreatectomy - multidisciplinary team.

Acute appendicitis is the most common cause of intra-abdominal emergency surgery worldwide. The approach to its treatment keeps changing. The number of acute appendectomies has been decreasing. Many patients are treated conservatively with success. Our study compares conservative and surgical treatment of acute appendicitis, including its complications in our department.We retrospectively analyzed the group of 117 patients hospitalized with the clinical diagnosis of acute appendicitis. We distinguished patients with complicated and uncomplicated appendicitis, and patients operated and treated conservatively. We evaluated complication rates and recurrences of the disease, respectively, in 1-year follow-up. The Student t test and Fishers exact test were used for the statistical analysis.In 2012 we hospitalized 117 patients with acute appendicitis: 83 patients (71%) for uncomplicated and 34 (29%) for complicated appendicitis. 41% of patients with complicated and 13% with uncomplicated appendicitis (p=0.02) were treated conservatively. Conservative treatment or laparoscopic surgery, respectively, were used more often in women ( p0.001). There was no failure of conservative treatment. Perioperative morbidity was 13%. No patient died. 6 patients (24%) of the conservatively treated group were hospitalized in the subsequent year for recurrent problems. 4 (16%) were reoperated. The rate of negative appendectomy (negative pathological findings) was 11%. The hospitalization time was shorter in patients treated conservatively or using laparoscopy, respectively, compared to the group of patients undergoing appendectomy.In the modern era of available complementary examinations and a broad spectrum of antibiotics the conservative approach is favoured as a treatment of complicated appendicitis. Conservative treatment of uncomplicated appendicitis is an option, but not the method of choice. Routine elective appendectomy after successful conservative treatment is groundless. Laparoscopic appendectomy is associated with lower morbidity than open appendectomy. Despite the available tests and scoring systems the negative appendectomy rate remains high.appendicitis - appendectomy - laparoscopy - antibiotic treatment.

In this study we sought to evaluate narlaprevir (NVR) pharmacokinetics (PK) after a single dose with or without ritonavir (RTV) in cirrhotic versus healthy subjects. NVR at 200 mg was administered to 8 healthy and 8 cirrhotic subjects, and NVR at 100 mg with RTV at 100 mg was administered to 8 healthy and 8 cirrhotic subjects. PK analysis was performed. The geometric mean maximum concentration of a drug in serum ( C max ) and the area under the concentration-time curve from 0 to infinity (AUC 0–∞ ) were 563.1 ng/ml and 4,701.8 ng · h/ml in cirrhotic patients versus 364.8 ng/ml and 1,917.1 ng · h/ml in healthy volunteers, respectively. The geometric mean ratios of the PK parameters of cirrhotic subjects to healthy volunteers were 1.54-fold (90% confidence interval [CI] = 1.05 to 2.27) for C max and 2.45-fold (90% CI = 1.56 to 3.85) for AUC 0–∞ . The geometric mean C max and AUC 0–∞ in cirrhotic and healthy subjects were similar: 1,225.7 ng/ml for C max and 15,213.1 ng · h/ml for AUC 0–∞ in cirrhotic subjects and 1,178.9 ng/ml for C max and 14,257.2 ng · h/ml for AUC 0–∞ in healthy volunteers. The corresponding geometric mean ratios were 1.04 (90% CI = 0.67 to 1.62) for C max and 1.07 (90% CI = 0.72 to 1.58) for AUC 0–∞ . Higher exposures in cirrhotic subjects were safe and well tolerated. We found that NVR exposures after a 200-mg single dose were higher in cirrhotic subjects than in healthy subjects and that a 100-mg single dose of NVR boosted with RTV at 100 mg resulted in no significant PK differences between cirrhotic and healthy subjects.

Polytrauma is one of the leading causes of mortality in people at productive age. Prompt activation of the rescue system is most important in the treatment. In cases of severe injuries, primary transport to a specialized hospital - trauma center is crucial. Our report is focused on two cases of polytraumatized patients whose treatment was associated with relatively rare situations. One of the patients suffered a pancreatic injury that required pancreaticoduodenectomy. The other patient had a liver injury, which was treated with right lobectomy with a rare complication. The necessity of a multidisciplinary approach to the management of severely injured patients is also emphasized in our report.

The incidence of colorectal cancer (CRC) in the Czech Republic is reported to be one of the highest on the global scale. Radical tumor removal has been observed to be the most effective part in the context of current multimodal therapy. The authors present their preliminary results of robotic assisted treatment of rectal carcinoma (RC).The observed group includes 61 patients who underwent robotic assisted treatment for rectal cancer. The data were collected prospectively in the last 31 patients. Analyses were conducted on epidemiological data, perioperative outcomes, complications and oncological results.Robotic assisted treatment of RC was performed in 61 patients: 34 men and 27 women, mean age of 62 years (33-80). Neoadjuvant oncological treatment was indicated in 46% of the patients. Average blood loss was 187 ml, transfusions were administered in three cases. Conversion to open procedure was performed 6 times, and 16 patients had postoperative complications. Anastomotic leak was observed in 10% of the patients, and 4 patients undewent surgical treatment. No patient died. Local recurrence of the cancer was diagnosed in 3 (5%) patients. The quality of mesorectal excision (ME) and the circumferential resection margin [(y)pCRM] have been determined in 27 patients since 2013. Positive (y)pCRM was recorded in two cases and incomplete ME was observed in 25.8% of the patients.Surgical treatment for RC is pivotal in multimodal therapy. Our preliminary results are similar to the conclusions in other published studies. The da Vinci robotic system is a safe manipulator in the treatment of RC and provides indisputable benefits to the surgeon when operating in the narrow pelvic space. However, the benefits of robotic treatment in abdominal surgery are yet to be evaluated in patients (with respect to long-term results, sufficient number of patients or a high EBM level of evidence). The high purchase price of the robotic device, individual instruments with equipment and non-systemic compensation constitute a significant hindrance that prevents wider use of the robotic system in the treatment of RC and other abdominal malignancies in the Czech Republic.

No comprehensive knowledge of duodenal tumours exists in the current literature; individual types of malignant tumours may be described within malignancies of the small bowel, sets of case reports, or individual cases. Ampullary carcinomas are the exception and they are detailed in the current WHO histological classification of tumours of digestive system. Neither national nor international literature sources provide a comprehensive review of their therapy. The situation is similar when searching for surgical procedures. Resection procedures on the duodenum should thus be performed in specialized centres with sufficient experience with hepato-pancreato-biliary surgery.

Many previous reports have focused on bile leakage after liver resection. Despite the improvements in surgical techniques and perioperative care the incidence of this complication rather keeps increasing. A number of predictive factors have been analyzed. There is still no consensus regarding their influence on the formation of bile leakage. The objective of our analysis was to evaluate the incidence of bile leakage, its impact on mortality and duration of hospitalization at our department. At the same time, we conducted an analysis of known predictive factors.The authors present a retrospective review of the set of 146 patients who underwent liver resection at the Department of Surgery of the 2nd Faculty of Medicine of the Charles University and Central Military Hospital Prague, performed between 20102013. We used the current ISGLS (International Study Group of Liver Surgery) classification to evaluate the bile leakage. The severity of this complication was determined according to the Clavien-Dindo classification system. Statistical significance of the predictive factors was determined using Fishers exact test and Students t-test.The incidence of bile leakage was 21%. According to ISGLS classification the A, B, and C rates were 6.5%, 61.2%, and 32.3%, respectively. The severity of bile leakage according to the Clavien-Dindo classification system - I-II, IIIa, IIIb, IV and V rates were 19.3%, 42%, 9.7%, 9.7%, and 19.3%, respectively. We determined the following predictive factors as statistically significant: surgery for malignancy (p0.001), major hepatic resection (p=0.001), operative time (p0.001), high intraoperative blood loss (p=0.02), construction of HJA (p=0.005), portal venous embolization/two-stage surgery (p=0.009) and ASA score (p=0.02). Bile leakage significantly prolonged hospitalization time (p0.001). In the group of patients with bile leakage the perioperative mortality was 23 times higher (p0.001) than in the group with no leakage.Bile leakage is one of the most serious complications of liver surgery. Most of the risk factors are not easily controllable and there is no clear consensus on their influence. Intraoperative leak tests could probably reduce the incidence of bile leakage. In the future, further studies will be required to improve the perioperative management and techniques to prevent such serious complications. Multidisciplinary approach is essential in the treatment.

Liver metastases are diagnosed in 60% of patients with colorectal cancer, both at the time of diagnosis or later in the course of their management. Surgical treatment is the sole potentially curable method with 5-year overall survival of approximately 50%. However, only less than 20% of patients underwent liver resection. A joint effort of medical oncologists and surgeons is to increase the numbers of resected patients. The "liver first approach" (LFA) is one of approaches aimed at increasing resecability. The authors present their preliminary results using this method.102 patients were included in the multicentre study supported by the grant IGA NT 13660 Evaluation of quality of multimodal treatment for patients with colorectal cancer liver metastases - conducted at the Central Military Hospital between September 2012 and January 2015. We used LFA in 12 patients (12%). Patients were indicated for liver resection based on good response to neoadjuvant systemic therapy. Multiple bilobar liver involvement (4 metastases) was present in 11 cases and one large solitary metastasis in the right liver lobe in one case. The primary tumor was located in the rectum in 9 patients, in the rectosigmoid in 3 patients; 3 patients had a colostomy. Others showed no signs of bowel obstruction.We have performed R0 resections in 11 cases, and two-stage hepatectomy with portal vein embolisation was indicated 3 times (in one case we did not finish the second stage due to quick progression after PVE). We performed major resections 7 times, along with sever extraanatomic resections, incl. 11 RFA (6 times in combination with major resections). Perioperative mortality was 0%, morbidity 33% (Dindo-Clavien2). Ten patients underwent adjuvant chemotherapy, in 7 cases including radiotherapy of the small pelvis due to a local advanced primary tumor. Resection of the primary tumor was done in 7 patients (58%). Two patients died recently because of disease progression (17%); progression was observed in 6 patients (50%).We deem the LFA suitable especially for patients with metastatic rectal tumors where adjuvant systemic therapy can be combined with radiotherapy. The timing of the resection of the primary tumor still remains a question: it is necessary to rule out potential recurrence of liver metastases, which affected more than 50% of the patients. The benefit of LFA must be confimed by randomised studies.

To evaluate the feasibility of liver blood outflow (LBOF) occlusion and its impact on the effectiveness of radiofrequency ablation (RFA).The experiment was performed on 10 pigs. The animals were divided into groups A and B according to RFA protocol. In group A (n=5) the RFA time was that taken to reach the target temperature of 105 degrees C, whereas group B (n=5) had a constant RFA temperature of 105 degrees C and constant time of 8min. The liver blood flow (LBF) was quantified using Doppler ultrasonography before LBOF occlusion and after that. RFA were performed using an expandable 3cm RF needle. Two liver ablations created in different liver lobes were compared; the first ablation was created before balloon inflation and the second one was created under LBOF occlusion. The time required for RFA procedure, liver ablation volumes, shape and microscopic changes of the thermoablated zones were recorded.The LBF dropped significantly in all liver vessels after balloon inflation. The volume of the ablated area was 8.2+/-2.2cm(3) and increased significantly after LBOF occlusion to 17.4+/-3.8cm(3) (p0.001), in group A. A significant enlargement of the ablated area with occluded LBF was registered in group B, it was 6.7+/-2.8cm(3) versus 19.4+/-1.8cm(3) respectively (p0.01).Temporary LBOF occlusion led to a significant reduction in liver blood flow, enlargement of the thermoablated area volume and homogeneity of the coagulated zones.

To elucidate the chemical factors influencing the structure of radical poly(vinyl chloride) the effect of chain transfer agents was studied. With decreasing degree of polymerization P the association capability of the polymer slowly decreases. From the region of about P = 250 down the aggregation abruptly increases independently of the chain transfer agent used. The influence of copolymerization with a small amount of vinyl acetate under the conditions given was followed. The stereoregularity of the products formed and the content of foreign groups were determined. The results were correlated with kinetic data. The conditions of formation of poly(vinyl chloride) with a regular structure and a strong ability to aggregate are discussed.

The dependence of the structure of poly(vinyl chloride) on precipitation conditions during polymerization was investigated. Properties of polymers prepared in 2,4,6-trichloroheptane, 2,4-dichloropentane, sec-butyl chloride, and isohexane were compared. The character of the polymerization ranged from homogeneous to heterogeneous. The polymers were fractionated in the system tetrahydrofuran–water. Molecular weights of the fractions were determined by osmometry and light scattering in cyclohexanone and tetrahydrofuran. The ratio Mw/Mn of the fractions varied in the range 1.1–1.8. It was found that for all the polymers investigated the same relation between [η] and Mw is valid. Samples prepared by heterogeneous polymerization to a low conversion do not therefore exhibit an appreciable amount of branching with long side chains. These results are compared with the behavior of high-conversion polymers and of branched samples prepared by copolymerization of vinyl chloride with divinyl adipate.

The mechanism of precipitation polymerization of vinyl chloride was studied by gradual transition from homogeneous to heterogeneous polymerization. Diethyl oxalate and 2,4-dichloropentane were used as solvents. In diethyl oxalate the initial course of polymerization is homogeneous up to 7.5 moles/l. The order with respect to monomer is 1.2. At higher concentration of monomers, the order decreases due to aggregation. From about 10 moles/l, the polymerization is heterogeneous. A break is observed in the kinetic curves with a distinct acceleration accompanied by a decrease of the order with respect to monomer and of the degree of polymerization. In the presence of CBr4 the polymerization is heterogeneous in the whole range of monomer concentration studied. In 2,4-dichloropentane the initial rate is lower than in diethyl oxalate and the order with respect to monomer is 1.6. It was shown that in the initial course of precipitation polymerization the propagation rate decreases to such an extent that a termination reaction besides the transfer to monomer bimolecular termination must be taken into consideration.

BACKGROUND: Preservation injury is a phenomenon adversely affecting the quality of transplant grafts. When attempting to identify its degree, suitable parameters are required. In an effort to find a feasible and clinically applicable parameter, we aim to evaluate the usability of IL-2 as a parameter to evaluate quantitatively preservation graft injury. METHODS: IL-2 levels in preservation solutions effluent including Histidin-Tryptophan-Ketoglutarate (HTK) and University of Wisconsin (UW) solutions used in rat (Wistar strain) small bowel graft preservation were determined using ELISA and Quantikine M rat IL-2 R2000. We investigated the effect of UW and HTK solutions on preservation injury of rat jejunal grafts during 0-, 1-, 6-, 9-, and 12-hour cold ischemia time (CIT). RESULTS: In spite of the presence of upwards trend line proportionate with the increase in CIT, these cumulative changes in IL-2 levels are not statistically significant and might not be specific. Although HTK effluent contained higher levels of IL-2 at 0, 6, and 12 hours CIT than UW effluent, these differences are statistically insignificant (p>0.05) CONCLUSIONS: While the outcome of this study is negative, it shows that IL-2 is not a suitable marker to determine the degree of small bowel graft preservation injury in rats.

Acute portal vein thrombosis and septic thrombophlebitis of the portal vein represent serious, although rare cases in the non-cirrhotic population. The authors present a case report, in which nonspecific clinical and CT scan findings led to the difficult diagnosis of pylephlebitis due to perforated rectosigmoid cancer.

Acute postoperative pancreatitis (APP) after proximal pancreatoduodenectomy (PDE) is a major and serious complication. The purpose of the the study is early diagnosis of APP, differentiation from pancreatic stump leak and possibilities of surgical treatment.Of all patients who underwent PDE for ductal adenocarcinoma of the pancreatic head complicated by type C pancreatic leak, who died during primary hospitalization, we used autopsy findings to find patients with histologically confirmed APP. We compared this group to patients with only a pancreatic leak and patients with an uncomplicated clinical course. We retrospectively evaluated the postoperative clinical course, and radiological and laboratory data of all patients. These parameters were statistically compared between the individual groups using Fisher LSD test. We considered p = 0.05 to be statistically significant. Data were analysed using software STATISTICA 10.0 (StatSoft CR s.r.o.).One hundred sixty patients underwent PDE for ductal adenocarcinoma at our institution between 20072011 and were retrospectivaly reviewed. APP with postoperative type C pancreatic leak was observed in 4 (2.5%) patients; none of these patients survived. We found significantly higher levels of serum pancreatic amylase (AMS) on the 1. postoperative day in 3 of these patients compared to the other groups. Significantly increasing levels of CRP during the the first 5 postoperative days were observed in 75% of these patients. Retrospectively analysed contrast CT scans up to the 5th POD did not show APP. Only 1 patient had findings of APP type E according to Balthazar on CT scan performed on the 9th POD.The most significant factor in early diagnosis of APP after PDE is an abrupt change in clinical status. We also observed significantly higher levels of serum concentrations of CRP and AMS. Based on our findings, CT scan is not beneficial in the early diagnosis of APP. In cases of early diagnosed APP after PDE, the question of performing a completion pancreatectomy and its timing remains.

Cystic lesions of the pancreas (CLP) are of different origin and behaviour. Mucinous lesions with the risk of invasive cancer represent an important subgroup. The key point in differential diagnosis of CLP is to distinguish malignant and benign lesions and also correct indication for surgery in order to minimize the impact of serious complications after resection. Different and unsatisfying predictive values of each of the examinations make proper diagnosis challenging. We focused on overall diagnostic accuracy of preoperative imaging and analytic studies. We studied the accuracy of distinguishing between non-neoplastic vs. neoplastic and bening vs. malignant lesions.We retrospectively analyzed all of the patients (N=72) with CLP (median of age 58 years, range 22-79) recommended for surgery. CT, EUS, ERCP, MRCP findings, cytology and aspirate analysis were used to establish preoperative diagnosis. Finally, preoperative diagnoses were compared with postoperative pathological findings to establish overall accuracy of preoperative assessment.During 5 years, 72 patients underwent resection for CLP. We performed 66 (92%) resection and 6 (8%) palliative procedures with 32% morbidity and 7% of one hospital stay mortality. All the patients were examined by CT and EUS. FNA was performed in 44 (61%) patients. Cytology was evaluable in 39 (88%) cases. ERCP was done in 40 (55%) patients. Pathology revealed non-neoplastic CLP in 25 (35%) and neoplastic lesions in 47 (65%) specimens. Mucinous lesions accounted for 25%. Malignant or potentially malignant CLP were found in 37 (51%) patients. Sensitivity, specificity and diagnostic accuracy of preoperative diagnosis for distinguishing between inflammatory and neoplastic, and benign and malignant was 100%, 46%, 85% and 61%, 61%, 44%, respectively.Correct and accurate preoperative assessment of CLP remains challenging. Despite the wide range of diagnostic modalities, the definitive preoperative identification of malignant or high-risk CLP is inaccurate. Because of this, a significant portion of the patients undergo pancreatic resection for benign or inflammatory lesions that are not potentially life-threatening. Possible serious complications after pancreatic surgery are the main reason for precise selection of patients with cystic affections recommended for surgery.

The syndrome of multiple endocrine neoplasia type 1 (MEN 1) is a relatively rare hereditary disease predisposing to a variety of tumours, some of which may be hormonally active. The main organs affected are the parathyroid, the pituitary and the pancreatoduodenal area. Despite the rarity of MEN 1, its occurrence is not negligible in clinical practice and the clinicians ignorance often leads to delayed diagnosis and inadequate treatment.The aim of this review is to present contemporary literature on this issue, including the most controversial topic, i.e. recent modalities of treatment of pancreatoduodenal tumours, and to present a case report. The literature review was based on computer searches in PubMed and DynaMed.Pancreatoduodenal tumours associated with MEN 1 are relatively slow-growing neoplasias. The development of liver metastases is the main factor of long-term survival. The aim of surgical treatment is the stabilisation of the disease and the prevention of liver metastases. Radical surgical methods may lead to better biochemical curability. The extent of surgical intervention should be selected individually. We discuss our case report in the context of these findings.Knowledge of the MEN 1 syndrome has its importance in the clinical practice. Further prospective studies will be needed to evaluate the effectiveness of treatment, especially for pancreatoduodenal tumours.

The robotization of minimally invasive treatment in surgery has been evident since the beginning of the third Millennium. The authors present their current evaluation of the benefits of the da Vinci robotic system in the treatment of abdominal malignancy.The authors summarize published studies in the Medline and Pubmed databases that compare robotic, laparoscopic and open approaches in the treatment of abdominal malignancy. Epidemiological data, intraoperative blood loss, complications and oncological outcomes are monitored in a group of 30 patients with carcinoma of rectum.The results measured in the evaluated parameters (open conversion, perioperative and non - surgery complications, intraoperative blood loss, histological findings, lethality) are similar in the published studies, i.e. without significant differences in both groups subject to the robotic and laparoscopic treatment. The operative time in the group of robotic surgery has been is slightly longer (a non-significant difference) in most of published studies. 30 patients underwent the robotic assisted treatment of the carcinoma of the rectum (14 men and 16 women, average age of 60 years (33-80). Neoadjuvant treatment was indicated in 50% of the patients. Average blood loss was 260 ml, transfusion was administered in one case. Conversion to laparotomic treatment was performed twice, four patients had post-operative complications, no patient has died. We have not found any relapse of oncological disease in the observed set to this date.The Da Vinci robotic system is a safe manipulator in the treatment of abdominal malignancy (including HPB surgery). Randomized clinical trials (RCT) have confirmed (short-term clinical and oncological) results comparable to the laparoscopic or open approach treatment. The benefits of robotic surgery for patients in abdominal surgery (long-term results, sufficient number of patients and high-grade EBM) are yet to be evaluated, however. It is necessary to implement more randomized clinical trials going forward. Our preliminary results are similar to the results reached in other, published studies.

Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings.Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody.In the period of two years (1st January 2009 - 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients' survival data.Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.

Major liver resection involves operations where three or more liver segments are resected. The decrease of perioperative and early lethality enlarged indicator conditions, especially in patients with colorectal cancer liver metastasis. Bile leakage belongs to major postoperative complications.Authors present literary experience and retrospective analysis of patients with emphasis on biliary complications and their treatment.96 patients underwent major hepatic resections between April 2004 and December 2009 at the Surgery Department of the Central Military Hospital in Prague. The average age of patients was 61 (25-84). Patients with an oncology disease dominated the set, representing 78% of all the patients. One half of the patients were formed by patients with colorectal cancer liver metastasis. Fourteen patients (14.6%) suffered from postoperative biliary complications. Non-surgical treatment was successful in nine cases. Surgical treatment was necessary in five cases. Combinations of these methods were essential in half of the patients. Two patients died (2.1%).Bile leakage after major liver resection is a quite common and serious postoperative complication. Conservative treatment (ERCP, CT - navigated drainage) is the method of choice. Surgical treatment is necessary where conservative management fails or where the size of the bile leakage is large. Multidisciplinary approach to treatment of these patients is essential.

In conjunction with adjuvant chemotherapy, radical resections are the only treatment modality, which significantly prolongs survival in pancreatic cancer (CaP) patients. The author aims to define current standards of radical pancreatic resections in CaP patients and to assess benefits of the surgical procedure based on literature data, as well as to evaluate current options for objective assessment of the quality of life in these patients.Employing Pubmed and Ebscohost databases, the author compares radical pancreatic resections depending on the tumor location, performed in conjunction with standard lymphadenectomy in patients with CaP, with the extended version of the resection procedure. The radical procedure is then put into relationship with potential prolongation of survival times, with early mortality incidence rates and with rates of perioperative complications. Based on literature data, the author evaluates current options for objective assessment of the quality of life in these patients.Radical resection with lymphadenectomy in N1-2 diseases followed by adjuvant chemotherapy is currently considered a standard treatment procedure, the only one which significantly prolongs survival in patients with CaP, with the disease stage T1-3, N0-1M0. Angioinvasion into the portomesenteric segment is not a contraindication for the resection procedure. In cases where R0 resection is achieved, the outcomes are similar to those in subjects without vascular segment resections. Views on arterial resections--a. hepatica, truncus coeliacus, a. mesenterica sup. are not uniform and, to date, resections of tumor-infiltrated arteries have not been shown to result in life prolongation. Angioinvasion into arteries is considered a sign of the disease stage and the need for extended procedures is associated with increased complication rates. The quality of life following resection procedures is not commonly assessed and its improvement is usually expected, rather than objectively assessed. At the present time, no questionnaire on the quality of life, which would specifically address CaP patients, is being used on a routine basis.Radical resection R0 and administration of adjuvant chemotherapy is the only current treatment modality in patients with ductal pancreatic adenocarcinoma, which results in significant life prolongation with 7-25% five-year survival rates (median of 15-18.5 months). The tumor's biological characteristics and the fact that the real disease staging is difficult to establish, are the reasons for early relapses after so called R0 resections. Resections of the portomesenteric segment in cases with adherence or penetration of the CaP into the vascular wall is indicated as a part of the radical PDE and do not result in shorter survival times. Extended radical procedures with arterial resections (a. hepatica, truncus coeliacus, a. mesenterica sup.) do not result in prolonged survival times even in cases where the procedures were assessed as R0 procedures, and cannot be thought of as standard procedures. By using invasive resection procedures, the number of resecable patients would increase, however, the prize of this treatment decision may need to paid off by higher complication rates, compared to those in standard procedures, as well as by lower postoperative quality of life of the patients, while achieving comparable survival time outcomes.

The aim of this work was to create a proposal design of the educational programme in surgical oncology (oncosurgery) in the Czech Republic, which would provide a recognized official specialty training for surgeons.The programme was designed based on experience with this specialty in Europe and USA, as well as on the authors' own long-term practical experience in oncosurgery. The material was discussed by the Committee of the Czech Surgical Association and ammended based on the comments.The proposed surgical oncology (oncosurgery) educational programme is designed as a subspecialty of general surgery and its aim is to gain high qualification for the treatment of solid tumors. The course duration is 3 years and is aimed at theoretical and clinical knowledge on tumor disorders. The practical training includes the following modules: Melanomas and sarcomas, Gastrointestinal surgery, Endocrine surgery, Breast surgery and Thoracic surgery. The trained doctor must gain practical experience in at least one module.The surgical oncology (oncosurgery) educational programme proposal was submitted to the Czech Republic Ministry of Health at the end of 2008. The authors applied for the programme to be included in the postgradual training system.

The aim of this work was to point out the role and the significance of surgery in the management of oncology patients in the Czech Republic (CR).Involvement of surgery in the management of patients with solid tumors is documented based on statistical data collected from the National Oncologic Registry.In the Czech Republic, the number of patients operated for newly diagnosed malignant tumors is constantly increasing, e.g. over 44,000 patients in 2005. Considering tumor locations, various surgical specialists are involved in the surgical management of solid tumors. Overall, during the studied period, surgeons were involved in 32,760 surgical procedures, i.e. 73.6 % of all newly diagnosed malignant solid tumors. Oncosurgical procedures are, to a certain extent, performed in all surgical clinics in the Czech Republic (currently, there are 157 surgical clinics in the Czech Republic). The rates of procedures for individual diagnoses do not correspond with the "high volume hospital" principle.Based on the analysis of the current situation in the management of solid tumors in the Czech Republic, the authors recommend rational concentration of oncosurgical procedures to fewer surgical clinics, adequate financing of sophisticated oncosurgical procedures in these clinics and classification of oncosurgery as a recognized official medical specialty.