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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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Pathogenesis of the Lymphocele following the Kidney Transplantation
Pacovský, Jaroslav ; Navrátil, Pavel (advisor) ; Třeška, Vladislav (referee) ; Adamec, Miloš (referee)
The lymphocele is a surgical transplant complication resulting from lymphatic vessels injury. This injury is background of the lymphocele pathogenesis, no lymphocele cannot become into existence without this step. On the other hand, the all organ procurement and transplantation procedures are associated with any rate of this injury at all time. Our results present proteins as a very important factor influencing interstitial fluids transport. The colloid osmotic pressure of the proteins controls interstitial fluids flow even across the vessel walls. Lymph fluid flow is also under the osmotic pressure control. The proteins play serious role in the second phase post-transplant lymphocele pathogenesis. At first, proteins control return of the leaked lymph back into the lymphatic vessels. Finally, inflammatory proteins participate on development of the fibrous lymphocele capsule. Postoperative care for protein metabolism seems to be very important in the protection against the post-transplant lymphocele formation. Carefully metabolic care for patient after renal transplantation should help to decline risk of lymphocele. The knowledge of the pre-transplant protein level and its fractions is very useful for relevant estimation of the risk of the post-transplant lymphocele formation. Calculation of the...
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Cryopreserved semilunar heart allografts: Leaflet surfase damage in scanning electron microscopy
Burkert, Jan ; Špatenka, Jaroslav (advisor) ; Černý, Štěpán (referee) ; Černý, Jan (referee) ; Třeška, Vladislav (referee)
7. Anglický souhrn: Cryopreserved semilunar heart valve allografts: leaflet surface damage in scanning elect.-on microscopy. Objective: Allograft heart va1ves (AHV), biologica1 va1ves ofhuman origin, offer potential advantages over conventiona1 xenografts in terms of superior hemodynamics and, perhaps, better durability. The most important factors for long-term AHV c1inical peďormance are the processing and cryopreservation methods. The aim ofthis study was to eva1uate the impact of current processing protocol on va1ve tissue morphology, maínly to address the effect of successive processing steps on the leaflet suďace structure. For the detection offine changes in endothelia1 covering and underlying layers, our own modification ofthe scanning electron microscopy (SEM) technique was utilized. Material and methods: The study was based on an investigation of20 AHV (40 specimens). Fourteen valves came from heart-beating donors (multiorgan harvesting) when the heart could not be transplanted for any reason (donor criteria, availability of recipient and/or logistics). Six were obtained at the time of routine postmortems - non heart-beating donors (NHBD). AU specimens were initially flxed in Bakeťs solution. Tissue samples were dissected, dried with hexamethyldisilazane (HMDS), gold-coated, studied and...
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Gemcitabine in anti-rejection treatment in experimental liver transplantation
Mergental, Hynek ; Ryska, Miroslav (advisor) ; Bělina, František (referee) ; Třeška, Vladislav (referee)
The first part of thesis is focused on the technical aspects of experimental model of liver transplantation on rats. The second part describes the research project that tested a novel immunosuppressive drug gemcitabine compared to low dose of cyclosporine A on the acute liver rejection model. To use a cytostatic drug in a low dose with a minimal toxicity as an immunosuppressant would be attractive for clinical use. Particularly because liver transplantation for hepatocellular carcinoma represent a frequent indication nowadays and also due to risk of development of a new post transplant malignancies as an side effect of standard immunosuppressant. Our results showed lower nephrotoxicity compared to cyclosporine, however, did not confirm the previous optimistic reports in terms of rejection treatment as it only mildly decreased the rejection severity. Our data suggests that gemcitabine cannot be used as a main immunosuppressant alone.
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The importance of tumor markers and markers of angiogenesis for colorectal cancer prognosis
Levý, Miroslav ; Lipská, Ludmila (advisor) ; Třeška, Vladislav (referee) ; Šafarčík, Kristian (referee) ; Keil, Radan (referee)
Despite extensive progress in understanding of the molecular pattern of the tumor, growing possibilities of chemotherapy and surgical treatment, colorectal cancer remains the significant cause of death worldwide. Surgical treatment alone has already reached in oncologic radicality its limits, and therefore the surgeons turned to the molecular base of tumor growth in an effort to find markers that allow to operate patients at lower stages of the disease and thus improve the results and prognosis of the disease. And also to find markers, which, after currative operation will find a possible relapse in early stage to enable the surgeon to perform second curative intervention. Tumor markers are substances that often arise in connection with the changed metabolism transformed tumor cells, and therefore their levels increased in the presence of malignancy. Serum tumor markers are important parameters that may facilitate the prediction of the disease, its progression or regression (remission). Tumor markers are clinically used for screening, primary diagnosis, staging, prognosis, but particularly for predicting recurrence of disease, monitoring therapy. This work aims to summarize the current knowledge about the colorectal cancer markers, outline the possible development and present results of relationship...
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Cytomegalovirus infection after kidney transplantation
Reischig, Tomáš ; Třeška, Vladislav (advisor) ; Viklický, Ondřej (referee) ; Zadražil, Josef (referee) ; Pazdiora, Petr (referee)
1 SUMMARY Cytomegalovirus (CMV) disease is a common infectious complication in patients after solid organ transplantation. The last decade witnessed major advances in CMV disease prevention. Use of universal prophylaxis or preemptive therapy resulted in a decrease in the incidence of CMV disease from 20-60% to 5-20%. However, the efficacy of preventive approaches in terms of indirect effects of CMV occurrence is problematic. Association with allograft rejection belongs to well documented and clinically extremely important indirect effects of CMV with a prolonged adverse impact on graft survival. Potential mechanisms include overexpression of major histocompatibility complex molecules, growth factors and cytokines, and upregulation of adhesion molecules. A number of questions remain to be answered in evaluating CMV as a risk factor for acute rejection. While CMV disease is associated with an increased incidence of acute rejection, data regarding the role of asymptomatic CMV viremia are controversial. In our research we evaluated the role of CMV in pathogenesis of allograft rejection in the era of modern immunosuppression and CMV prophylaxis as well as optimal preventive strategy to minimize impact of CMV. In the first trial, renal transplant (RTx) recipients were followed prospectively for 12 months to...
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Implantation of cryopreserved mitral allograft into tricuspidal position in an experiment with sheep: Technical aspects of implantation and immediate results evaluated with the aid of epicardial echocardiography
Vojáček, Jan ; Špatenka, Jaroslav (advisor) ; Dominik, Jan (referee) ; Třeška, Vladislav (referee) ; Černý, Štěpán (referee)
Aortic, mitral and pulmonary valve replacement is routinely performed with reasonable clinical results. But the optimal substitute for the tricuspid valve remains controversial. Contemporary prostheses either mechanical or bioprosthetic are associated with a high risk of thrombosis and/or structural failure. Mitral allografts could have advantages over existing prostheses, especially in patients with infectious endocarditis. We describe our first experience with cryopreserved mitral allograft processing and implantation into the tricuspid position in a sheep experimental model. Material and Methods: We subjected 20 sheep (age 1 year, weight 23 - 36 kilograms) to general anesthesia and a left thoracotomy. An epicardial echocardiographic study was performed and the mitral valve was harvested. Donor animals were put to death by intravenous anesthetics injection. Allografts were immersed into cultivation medium E 199 with an antibiotic cocktail. After 24 hours storage at the temperature of 37.0oC the valves were kept at + 5 to + 7 oC over a period of 3-5 days. Then they were transferred into the cryoprotective solution (E 199 with 10% dimethylsulfoxide) and sealed into plastic bags using a double-layer technique. Finally, they were programmed cooled and stored in the liquid stage of liquid nitrogen (- 196 oC)...
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název v anglickém jazyce není uveden
Böhmová, Radka ; Matl, Ivo (advisor) ; Třeška, Vladislav (referee) ; Vaněčková, Ivana (referee)
Background. TGF- is a key profibrogenic cytokine associated with chronic allograft nephropathy (CAN) pathogenesis. Renal ischemia/reperfusion (I/R) injury and hypertension represent important factors contributing to the development of CAN. The aim of the first, experimental part of the present study was to investigate the effect of immunosuppressant sirolimus in a model of accelerated renal injury in hypertensive transgenic rats (TGRs). The aim of the second, clinical part was to correlate the degree of CAN in the protocol biopsy of transplanted patiens with TGF-1 plasma levels and plasma levels of fibronectin. Another aim was to evaluate TGF-1 and fibronectin plasma levels in patients treated with different immunosuppressive (IS) regimes. Methods. Experiments were performed in TGR(mREN-2)-27 rats and their normotensive controls. We used a model of accelerated renal I/R injury. In clinical part of the present study, protocol biopsy has been suggested to be a beneficial method for early CAN detection. Protocol core biopsy was carried out in 105 kidney transplant recipients treated with different IS regimes 12 months after renal transplantation. Conclusions. Hypertension induced by high levels of renin in transgenic rats aggravated the renal injury induced by I/R injury. Sirolimus treatment was shown...
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