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The Use of Stem Cells in Liver Surgery
Skalický, Adam ; Skalický, Tomáš (advisor) ; Šimša, Jaromír (referee) ; Klos, Dušan (referee)
Aim of the study: Verification of safety and efficacy of mesenchymal stem cell therapy after extensive liver resection in a pig model. Type of study: Experimental study Name and location of study site: Department of Surgery, Faculty of Medicine, Charles University in Pilsen Set and methodology: A total of 18 experimental animals underwent liver resection in the extent of hemihepatectomy. Mesenchymal stem cells were administered perioperatively in 10 pigs, the remaining 8 pigs were included in the control group. Blood samples were taken at regular intervals for biochemical and immunohistochemical examination. Control sonographic examination was performed at weekly intervals. Experimental animals were sacrificed on the 28th postoperative day and liver tissue samples were subjected to histological examination. Results: There were no statistically significant differences in any of the monitored parameters. Sonographic examinations, however being performed by one experienced radiologist, did not provide valid data from which liver hypertrophy could be assessed. Conclusion: Mesenchymal stem cell therapy appears to be a safe method. However, the results of our study did not show a positive effect of this treatment on liver regeneration after surgical resection. We find sonographic volumetric examination...
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New methods of in vivo monitoring and management of colonic anastomoses leak in experimental study
Kalvach, Jaroslav ; Pohnán, Radek (advisor) ; Kala, Zdeněk (referee) ; Klos, Dušan (referee)
The primary aim of the project was to assess two different minimally invasive techniques (Transanal minimally invasive surgical approach - TAMIS and endoscopic closure) in the treatment of colorectal anastomosis dehiscence on an experimental model. The secondary aim was to evaluate microdialysis (MD), and confocal laser endomicroscopy (CLE) as novel methods potentially suitable for postoperative monitoring of colo-rectal anastomosis. In the first step, large animal model of dehiscent colo-rectal anastomosis was developed. Two novel techniques of dehiscence closure were then compared with conventional surgical repair and laparotomy with anastomotic diversion. Thus 4 intervention groups and one untreated control group were included. Transanal repair using TAMIS and endoscopic closure were technically feasible with high healing rate. Both techniques reduced the incidence of intra- abdominal septic complications compared to control. With regards to secondary aim, colorectal anastomosis was monitored using MD and CLE before and after the induction of ischaemia. Moreover, intramural and serosal positioning of MD sensors were compared. Both methods revealed hypoperfusion of anastomosis promptly and were proven as suitable for early detection of impaired healing. Based on the results of this project, a...
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Clinico-pathological characteristics of mucin-producing colorectal carcinoma
Sojka, Ladislav ; Levý, Miroslav (advisor) ; Boublíková, Ludmila (referee) ; Klos, Dušan (referee)
Colorectal carcinoma (CRC) is one of the most common malignancies worldwide with persistently high mortality. As a consequence, high demands are placed on research into this disease. The aim of this study was to evaluate the epidemiology of colorectal carcinoma in the Czech Republic in comparison with worldwide data. We focused on the evaluation of the latest findings in screening and diagnosis, investigated prognostic factors, and also focused on the therapeutic options of CRC. Furthermore, mucin-producing carcinomas are described in detail and mucin itself was confirmed as a risk factor for the prognosis of CRC patients. The experimental part of the study focused on gene mucin MUC13 and the MUC13 - miR-4647 axis, which is associated with adverse prognosis in CRC patients. Samples of CRC and samples of adjacent non-malignant mucosa tissue were used. The samples were collected from patients who underwent surgery at the General University Hospital in Prague, at the Thomayer University Hospital in Prague and at the University Hospital in Pilsen (Czech Republic). The collection of samples took place between 2011 and 2015. The total of 187 samples were collected from patients with sporadic colorectal cancer. The subjects of the study all provided information on their lifestyle habits, body mass index...
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Criminal act of fraud with focus on fraud in the health care system
Klos, Dušan ; Jelínek, Jiří (advisor) ; Vokoun, Rudolf (referee)
This rigorous thesis deals with the crime of fraud as regulated by the Czech criminal law with focus on fraudulent practices within the system of healthcare services provision. The crime of fraud represents generally one of the most frequent wrongful practices. The Czech legislation distinguishes between the general form of fraud and special form of fraud, within the framework of which specific subtypes of fraud are defined. Fraudulent practices not only occur in the healthcare system, but are also supported by the system. The reasons are numerous. The first reason is that there is a large number of participants in this system with multiple complex links between them, which are part of the healthcare system as such, the second reason is the rather unclear and non-transparent situation of financing and cash flows in this area, and finally, there is a considerable amount of money going into the healthcare sector annually. Financial losses within the system, which are caused by such wrongful practices, are estimated to amount to about 3% of the contributed amount, i.e. 3% of the CZK 290 billion flowing into the healthcare system of the Czech Republic. This sum is alarming and calls for increased attention from the professional public and for the creation of a rational and functional model for fighting the...
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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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Criminal act of fraud with focus on fraud in the health care system
Klos, Dušan ; Jelínek, Jiří (advisor) ; Vokoun, Rudolf (referee)
This rigorous thesis deals with the crime of fraud as regulated by the Czech criminal law with focus on fraudulent practices within the system of healthcare services provision. The crime of fraud represents generally one of the most frequent wrongful practices. The Czech legislation distinguishes between the general form of fraud and special form of fraud, within the framework of which specific subtypes of fraud are defined. Fraudulent practices not only occur in the healthcare system, but are also supported by the system. The reasons are numerous. The first reason is that there is a large number of participants in this system with multiple complex links between them, which are part of the healthcare system as such, the second reason is the rather unclear and non-transparent situation of financing and cash flows in this area, and finally, there is a considerable amount of money going into the healthcare sector annually. Financial losses within the system, which are caused by such wrongful practices, are estimated to amount to about 3% of the contributed amount, i.e. 3% of the CZK 290 billion flowing into the healthcare system of the Czech Republic. This sum is alarming and calls for increased attention from the professional public and for the creation of a rational and functional model for fighting the...
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