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Metabolic aspects of the hormone replacement therapy in menopause
Fait, Tomáš ; Cibula, David (advisor) ; Češka, Richard (referee) ; Hořejší, Jan (referee)
The aim of project was to evaluate which of aplication forms of estrogen replacement therapy (in daily doses 2 mg estradiol orally or 0,05 mg estradiol transderma) is better for postmenopausal women from the view of cardiovascular risk. Oral aplication was conected with favourable elevation of HDL-cholesterol level and lowering of prothrombin activator inhibitor (PAI-1). On the other side there were elevation of tigylcerides and high selective C-reactive protein (hs CRP) and lowering of tissue factor pathway inhibitor (TFPI). Transdermal therapy was conjoined with elevation of HDL-cholesterol. Other markers were not influenced by this aplication form. Transdermal estrogen replacement therapy is more favourable than oral estrogen replacement therapy from the view of cardiovascular risks. The choice of hormone replacement therapy must be strongly individual. The knowledge of level lipids and other factors of cardivascular risk, could be helpfull during choice of aplication form, dose and contents of hormone replacement therapy.
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The role of sentinel lymph node biopsy in the management of patients with early-stage cervical cancer
Kocián, Roman ; Cibula, David (advisor) ; Roztočil, Aleš (referee) ; Špaček, Jiří (referee)
The sentinel lymph node biopsy is part of recommended surgical staging guidelines in patients with early stages of cervical cancer. High success rates of bilateral detection of SLN are achieved in sites with adequate experience with this procedure. The sentinel lymph node biopsy without systematic pelvic lymph node dissection is currently considered inadequate procedure for stages IB to IIA of the disease. One of the benefits of sentinel lymph node detection is extensive histopathological examination using the ultrastaging protocol enabling detection of small metastases (i.e. micrometastases). At the moment, there is lack of evidence about oncological safety of sentinel lymph node biopsy which might replace systematic lymph node dissection in the future. Prognostic significance of micrometastases is also controversial due to the lack of data about their potential presence in non-sentinel lymph nodes in cases with negative sentinel lymph nodes. This dissertation deals with the concept of sentinel lymph node biopsy in the cervical cancer and focuses on several topics. We have shown that the presence of micrometastasis is associated with significant negative impact on patients' prognosis on the largest retrospective cohort of patients ever published. Only 67% of patients with micrometastasis have...
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název v anglickém jazyce není uveden
Fischerová, Daniela ; Cibula, David (advisor) ; Rešlová, Taťána (referee) ; Seidl, Zdeněk (referee)
Ultrazvukem navigovaná biopsie silnou jehlou je bezpečná, rychlá a spolehlivá metoda k histologické verifikaci pokročilého nebo recidivujícího abdominopelvického nádoru. Výkon lze provést ambulantně, bez nutnosti celkové anestézie, při minimálním dyskomfortu pro pacienta ve srovnání s laparoskopií nebo laparotomií. Riziko komplikací je nízké a hlavní výhodou je získání adekvátního histologického vzorku s možností následného imunohistochemického vyšetření, které je nezbytným předpokladem pro volbu optimální onkologické léčby.
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Metabolic aspects of the hormone replacement therapy in menopause
Fait, Tomáš ; Cibula, David (advisor) ; Češka, Richard (referee) ; Hořejší, Jan (referee)
The aim of project was to evaluate which of aplication forms of estrogen replacement therapy (in daily doses 2 mg estradiol orally or 0,05 mg estradiol transderma) is better for postmenopausal women from the view of cardiovascular risk. Oral aplication was conected with favourable elevation of HDL-cholesterol level and lowering of prothrombin activator inhibitor (PAI-1). On the other side there were elevation of tigylcerides and high selective C-reactive protein (hs CRP) and lowering of tissue factor pathway inhibitor (TFPI). Transdermal therapy was conjoined with elevation of HDL-cholesterol. Other markers were not influenced by this aplication form. Transdermal estrogen replacement therapy is more favourable than oral estrogen replacement therapy from the view of cardiovascular risks. The choice of hormone replacement therapy must be strongly individual. The knowledge of level lipids and other factors of cardivascular risk, could be helpfull during choice of aplication form, dose and contents of hormone replacement therapy.
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Prediction of chemosensitivity to 5-fluorouracil and its derivates in patients treated with chemotherapy for colorectal cancer
Zimovjanová, Martina ; Nečas, Emanuel (advisor) ; Cibula, David (referee) ; Vízek, Martin (referee)
Aim: 5-Fluorouracil (5-FU) is the most commonly used anticancer drug for colorectal cancer (CRC). Initially, we aimed to compare expression of 5-FU metabolic enzymes genes: thymidylate synthase (TS), thymidin phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) in colorectal cancer and normal colon mucosa. We have tried to prove the correlation of the mRNA levels in fresh frozen tissues and protein expression using immunohistochemistry in paraffin-embedded colorectal cancer and adjacent normal tissues. Finally, we aimed to clarify the prognostic and predictive value of the expression of the 5-FU metabolic enzyme genes in patients with early colorectal cancer. (...) Results: We have found significantly higher DPD mRNA levels in normal colon tissue than in tumor tissue (p=0,03), but no significant differences in TS mRNA (p=0,34) and TP mRNA (p=1,0) levels in tumor and normal tissue. Immunohistochemically we have determined significantly higher TS expresion in tumor than in normal tissue (p=0,02) and significantly higher TP expression in stroma 9 cancer tissue than in normal tissue (p<0,001). No linear relationships were found between mRNA expression and protein TS and TP expression (p=0,28 resp. p=0,87). High TP mRNA expression associated with worse prognosis (p=0,05 HR 4,1), also high protein...
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Peroperative and postoperation sentinel lymph node detection evaluation in treatment strategy in cervical and vulvar cancer patients
Pluta, Marek ; Rob, Lukáš (advisor) ; Rokyta, Richard (referee) ; Cibula, David (referee) ; Feyereisl, Jaroslav (referee)
Vulvar cancer is not frequent disease regarding individualized treatment approach. Complete inguinofemoral lymphadenectomy is still standard treatment modality with relatively high short and long term morbidity. Anatomical correlation between vulva and regional lymphatic system represented by inguinofemoral region is basic for actual strategy for less radical operations including sentinel lymph node identification and detection. Application technique, timing and identification technique were presented in Czech and foreign publication as well [46] (see attachment no.: 9). Sydney consensus made by expert board in 2008 is based on 10 publications including our one. Consensus recommends in squamous cancer patients up to 4 cm stage I and II only sentinel lymph node identification procedure like an alternative to standard inguinofemoral lymphadenectomy. This procedure is recommended only for oncogynecologic centers with sentinel nodes identification experiences. Most important original information arises from study about in vivo lymphatic drainage and sentinel lymph nodes localization and topography. If we separate superficial groin in thirds, there were no sentinel nodes in outer third. On the other hand, 15% sentinel nodes were localized in deep femoral region. It explains that extirpation only superficial...
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