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Impact of Different Fluid Volume on Distal Rectum Anastomosis Microcirculation
Örhalmi, Julius ; Čečka, Filip (advisor) ; Kala, Zdeněk (referee) ; Klos, Dušan (referee)
SOUHRN Dehiscence anastomózy je závažná pooperační komplikace po resekci rekta vyskytující se v 2-12 % případů. Cílem teoretické části této práce bylo shrnout současné poznatky týkající se resekce rekta. Cílem experimentální části práce bylo posoudit vliv kumulativní bilance tekutin na mikrocirkulační změny v oblasti anastomózy tlustého střeva. Studie byla provedena na 14 jedincích prasete domácího. U všech byla provedena resekce rekta. Experimentální zvířata byla rozdělena do tří skupin dle objemu podávaných krystaloidů. V průběhu operace a po operaci byly experimentálním zvířatům podávány infuze krystaloidů konstantní rychlostí 5, 10 a 15 ml/h. Mikroperfuze tlustého střeva byla sledována v přesně daných časových intervalech pomocí Laser Doppler Flowmetrie (LDF). Každé experimentální zvíře bylo observováno po dobu šesti hodin po operaci. Naměřené hodnoty LDF pro každou skupinu byly statisticky analyzovány pomocí Leveneho testu a Welchovy ANOVA. Primární zjištění této studie ukázala, že průměrné hodnoty naměřené perfuze v oblasti stěny tlustého střeva se ve všech třech skupinách shodovaly na začátku, tj. před intervencí, stejně jako na konci studie (p>0,05). Stejný výsledek byl také potvrzen pro druhé měření perfuze v oblasti kolorektální anastomózy a pro poslední měření (p>0,05). Naopak, rozdíly ve...
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The Importance of Measuring Intraabdominal Pressure in Cases of Severe Acute Pancreatitis
Kural, Tomáš ; Třeška, Vladislav (advisor) ; Chytra, Ivan (referee) ; Kala, Zdeněk (referee) ; Leffler, Jan (referee)
Treatment of severe acute pancreatitis is considered to be conservative. The only generally accepted indication for surgery in severe acute pancreatitis patients is an established infection of the necrotic tissue and persisting or progressing symptoms of multiorgan failure despite the maximal intensive treatment. For surgical treatment are also indicated patients with complications of severe acute pancreatitis (erosive hemorrhage, perforation of GIT etc.). In the proposed work, attention is drawn to those cases, where the general condition of the patient deteriorates combined with a progression of ACS and where a decompressive laparotomy can improve the prognosis of the disease. In our group of 214 patients with severe acute pancreatitis, who were treated over the last six years, 70 patients were indicated for surgery. Out of this count, in 17 cases the indication for decompressive laparotomy was a raise of intraabdominal pressure up to the values of ACS together with the symptoms of organ dysfunction, 6 patients died and 11 younger patients survived.
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Predictive and prognostic factors of gastric cancer
Šmíd, David ; Skalický, Tomáš (advisor) ; Kala, Zdeněk (referee) ; Šimša, Jaromír (referee)
Predictive and prognostic factors in gastric cancer Šmíd D. Surgical clinic of University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague. Introduction: Gastric cancer is one of malignant diseases which have the worst prognosis. Unfortunately, there are most patients with advanced-stage disease who have to be treated in a palliative way. Patients suffered from the same type of tumor, being at the same stage of disease and treated with the same chemotherapy have various rates of survival, which can be caused by diverse expression of selected genes impacting on the mechanism of cytostatic effects. The determination of these genes or microRNAs which regulate these genes could be used as a predictive factor for prediction of effects of administered chemotherapy. The determination of some microRNAs, or in the combination with suitable plasmatic factors, could be used as a prognostic factor for patients with gastric cancer. It is also possible to use this combination for early diagnosis of cancerogenesis Object: The aim is to verify the possibility to use expression of selected genes and some microRNAs in tumor tissue as a prognostic factor or a predictor for therapeutic effects of chemotherapy in patients with gastric cancer. Methodology: We retrospectively evaluated the group...
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Intestinal transplantation on an experimental model.
Oliverius, Martin ; Adamec, Miloš (advisor) ; Gürlich, Robert (referee) ; Kala, Zdeněk (referee)
Intestinal transplantation represents a life-saving procedure for patients with an intestinal failure. An experiment on pigs was carried out during the preparation part of a clinical project in the Czech Republic. The main aim of the experiment was to successfully master the transplant surgery technique (i.e. small bowel harvesting, its preservation, followed by the transplantation). Another goal was to decide on the optimal immunosuppressive regime. Immunosuppression was based on tacrolimus monotherapy or its combination with sirolimus. A graft biopsy still remains the most reliable method for the diagnosis of an acute cellular rejection. In an attempt to find a suitable noninvasive humoral marker of the acute cellular rejection, we examined the correlation between plasma citrulin level and the acute rejection. The plasmatic level of proinflamatory and antiinflamatory cytokines was investigated as another potential marker of the rejection. We succeeded in standardizing the technique of intestinal transplantation. Connecting the graft to aorta and inferior vena cava is simpler and safer than connecting it to the portomesenteric vessel bed due to fewer subsequent complications. Both immunosuppressive regimes seem to be equally effective in preventing the acute cellular rejection. Histopathological...
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Sensitivity analysis of stability problems of steel structures
Valeš, Jan ; Vičan,, Josef (referee) ; Kučerová,, Anna (referee) ; Melcher, Jindřich (referee) ; Kala, Zdeněk (advisor)
The doctoral thesis is focused on evaluation of global sensitivity analysis of load-carrying capacity of steel hot-rolled beams. These beams are subjected to lateral-torsional buckling, weak axis buckling and strong axis buckling. Very comprehensive computational models which were both geometrically and materially nonlinear were created in Ansys software using solid finite elements to calculate the load-carrying capacity. The computational models allowed modelling of random initial imperfections such as initial curvature, deviations of cross-section dimensions and steel properties. Sensitivity analysis quantified their influence on the load-carrying capacity. Simulation runs of random imperfections were generated using the Latin Hypercube Sampling method. Since the evaluation of sensitivity analysis of load-carrying capacity of all finite element models would cost an extreme amount of computer time, the thesis aimed at developing a meta-model (also known as surrogate model) based on approximation of FEM model. The approximation polynomial then facilitated the evaluation of sensitivity indices using a high number of simulation runs. At the end, the relationships between the slenderness and the first and second-order sensitivity indices are plotted in graphs. Those random input imperfections that influence the variability of load-carrying capacity the most are pointed out.
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Effect of rivet holes on calibration curves for edge cracks under various loading types in steel bridge structure
Seitl, Stanislav ; Miarka, Petr ; Kala, Z. ; Klusák, Jan
Attention has been paid to fatigue cracks in steel structures and bridges for a long time. In spite of efforts to eliminate the creation and propagation of fatigue cracks throughout the designed service life, cracks are still revealed during inspections. There is some limitation of crack sizes which are detectable on structure (from 2 up to 10 mm). Note that depending on the location of the initial crack, the crack may dominantly propagate from the edge or from the surface. The theoretical model of fatigue crack progress is based on linear elastic fracture mechanics. Steel specimens are subjected to various load types (tension, three- and four-point bending, pure bending etc.). The calibration functions for short edge cracks that are near the hole for a rivet or bolt are compared for various loads and the discrepancies are discussed.
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Predictive and prognostic factors of gastric cancer
Šmíd, David ; Skalický, Tomáš (advisor) ; Kala, Zdeněk (referee) ; Šimša, Jaromír (referee)
Predictive and prognostic factors in gastric cancer Šmíd D. Surgical clinic of University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague. Introduction: Gastric cancer is one of malignant diseases which have the worst prognosis. Unfortunately, there are most patients with advanced-stage disease who have to be treated in a palliative way. Patients suffered from the same type of tumor, being at the same stage of disease and treated with the same chemotherapy have various rates of survival, which can be caused by diverse expression of selected genes impacting on the mechanism of cytostatic effects. The determination of these genes or microRNAs which regulate these genes could be used as a predictive factor for prediction of effects of administered chemotherapy. The determination of some microRNAs, or in the combination with suitable plasmatic factors, could be used as a prognostic factor for patients with gastric cancer. It is also possible to use this combination for early diagnosis of cancerogenesis Object: The aim is to verify the possibility to use expression of selected genes and some microRNAs in tumor tissue as a prognostic factor or a predictor for therapeutic effects of chemotherapy in patients with gastric cancer. Methodology: We retrospectively evaluated the group...
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