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Pancreatic Cancer Diagnosis
Bunganič, Bohuš ; Zavoral, Miroslav (advisor) ; Rejchrt, Stanislav (referee) ; Urban, Ondřej (referee)
Pancreatic cancer is a malignant disease with an unfavorable prognosis. Currently, the diagnosis of pancreatic cancer is based mainly on CT, MR and EUS imaging methods, because a reliable biomarker of pancreatic cancer is not available. It is considered a success in the current clinical practice if patients suitable for surgical resection can be selected, because in this group the overall survival is slightly better than in the group where surgery is not technically possible. In the first part, the presented dissertation focuses on testing of already established imaging diagnostic methods used in common practice, i.e. EUS and EUS FNA, as well as modern examination possibilities, such as contrast endosonography, and the comparison of the accuracy of the methods used. The dominant role of the EUS FNA was confirmed. In the next phase of the work, the methodological procedure of EUS FNA collection and the preprocessing of pancreatic tissue samples was tested with regard to the quantity and quality for epigenetic examination and further testing using the prognostic role of KRAS and miR-21. It has been suggested that cytological smears are the most suitable source of biological material for DNA and miRNA analysis, where non-tumor tissue contamination is low. Although the prognostic role of KRAS is...
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The role of preventive colonoscopy in the detection of colorectal neoplasia.
Vojtěchová, Gabriela ; Zavoral, Miroslav (advisor) ; Rejchrt, Stanislav (referee) ; Falt, Přemysl (referee)
Colonoscopy is used in colorectal cancer (CRC) screening either as an independent screening method (screening colonoscopy) or following a positive result of a primary screening test (eg. fecal occult blood test, FOBT). Preventive colonoscopy is the collective name for screening and FOBT+ colonoscopy. Due to the considerable variability in the detection of colorectal neoplasia between individual endoscopists, colonoscopy quality indicators were introduced. Adenoma detection rate (ADR) and polyp detection rate (PDR) are defined as the proportion of colonoscopies in which at least one adenoma (for ADR) or polyp (for PDR) was detected to the total number of colonoscopies performed. ADR is considered a key indicator of the quality of colonoscopy. Adenoma per colonoscopy (APC), defined as the total number of adenomas detected relative to the total number of colonoscopies performed, is the most accurate indicator currently available. However, APC limit values have not yet been set. Both ADR and APC are validated indicators, but their evaluation is time-consuming and personnel-intensive, which limits their use in clinical practice. The main purpose of the presented work is to simplify the monitoring of colonoscopy quality by introducing a more user-friendly indicator, which does not require histological...
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S100 Proteins in Inflammatory Bowel Disease and Colorectal Neoplasia
Morávková, Paula ; Kohoutová, Darina (advisor) ; Ehrmann, Jiří (referee) ; Zavoral, Miroslav (referee)
S100 proteins in inflammatory bowel disease and colorectal neoplasia Inflammatory bowel disease and colorectal cancer represent a serious medical and socio- economic problem worldwide. Despite the progress in diagnostic of both diseases, there is no specific serum maker, which would allow to detect risk group of patients. Our paper focused on importance of serum S100 proteins in inflammatory bowel disease and colorectal neoplasia: (1) association of serum S100A4 with inflammatory bowel disease, ulcerative colitis and Crohn's disease, (2) association of serum S100A6, S100A8, S100A9 and S100A11 with colorectal neoplasia and (3) association of serum S100P with colorectal cancer. A total of 253 subject were enrolled: 40 healthy controls, 16 patients with ulcerative colitis, 93 patients with Crohn's disease, 20 patients with non-advanced colorectal adenoma, 20 patients with advanced colorectal adenoma and 62 patients with colorectal cancer. We confirmed significantly higher serum concentrations of S100A4 protein in patients with ulcerative colitis and Crohn's disease. In Crohn's disease, serum S100A4 was significantly higher in patients with colonic and ileocolonic involvement. We did not confirm association of serum S100A4 with fibrostenosing phenotype of Crohn's diseases and with perianal involvement. We...
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The identification of the risk factors and optimization of the follow-up of colorectal cancer patients and their families
Vítek, Petr ; Bureš, Jan (advisor) ; Dítě, Petr (referee) ; Zavoral, Miroslav (referee)
The identification of the risk factors and optimization of the follow-up of colorectal cancer patients and their families Introduction: Patients after colorectal cancer resection are at risk of a recurrence of neoplasia at the site of anastomosis as well as metachronic neoplasias. First-degree relatives of colorectal cancer patients also have a higher risk of the disease that is caused both by hereditary and non-hereditary common factors. Objective: The main goal of the endoscopic part of the project was to evaluate the benefit of chromocolonoscopy with a solution of methylene blue for detection of neoplastic lesions in patients after colorectal cancer resection. The epidemiological part of project was focused on the evaluation of risk factors and current follow-up of patients with colorectal cancer and their families. Methods and results:In the endoscopic part of the work we performed regular white-light colonoscopy followed by chromocolonoscopy in 62 patients after colorectal cancer resection. We used 0.1% solution of methylene blue; total chromocolonoscopy was possible in 94% (58/62) of the patients. Endoscopic and histopathological characteristics of detected lesions were assessed for both methods. Chromocolonoscopy resulted in a statistically highly significant (p < 0.001) higher detection of...
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Wireless Capsule Endoscopy in Experimental and Clinical Diagnostics of Enteropathy Induced by Nonsteroidal Anti-inflammatory Drugs
Tachecí, Ilja ; Kopáčová, Marcela (advisor) ; Lata, Jan (referee) ; Zavoral, Miroslav (referee)
Introduction Non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy represents an important complication related to one of the most commonly used drugs worldwide. The prevalence has been underestimated for a long time due to previous diagnostic difficulties. Objective The main goal of our project was to evaluate the basic characteristics of NSAID- induced enteropathy as well as the benefit of capsule endoscopy in its diagnostics. Methods and results In the first, experimental, part of the dissertation, we elaborated methodology of capsule endoscopy in an experimental animal and checked it on 7 healthy pigs. Although normal enteroscopy pictures were found in all the animals, some limitations were identified. The markedly worse visibility of the small bowel mucosa, and incomplete evaluation were the main ones. A model of NSAID-induced enteropathy (using a 10-day per oral indomethacin administration - 400 mg/day) was projected and verified in 8 healthy pigs consecutively. The endoscopy findings were confirmed by means of autopsy. We revealed the presence of small intestinal mucosal lesions on capsule endoscopy in the majority of the experimental pigs (87.5%). The most frequent findings were mild mucosal injury (red spots and erosions) in 6/8 animals. These findings were confirmed in 50.0% at...
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Carcinogenesis of colorectal cancer and cancer associated with inflammatory bowel diseases: theoretical basis and its implications for clinical practice
Bortlík, Martin ; Lukáš, Milan (advisor) ; Zavoral, Miroslav (referee) ; Dítě, Petr (referee)
Colorectal cancer originates as a consequence of accumulating genetic changes and sequential conversion from normal epithelium through dysplastic, intraepithelial neoplasia. It is called an adenoma in subjects with sporadic cancer and dysplasia in those with ulcerative colitis. An inactivation of the APC gene in former and p53 gene in the later group was found to be an initial genetic event in most cases. However, in case of sporadic adenoma, some data indicate the possibility that mutation of only one APC allele occurs early at the stage of adenoma, while the loss of the second allele may occur later, at the time of adenoma to carcinoma progression. Epigenetic changes, namely hypermethylation of the gene promoter, play an important role during carcinogenesis of both sporadic and UC related types of neoplasia. Recent epidemiologic studies suggest the relative risk for UC associated colorectal cancer varies between 2-3. Besides risk factors already recognized, i.e. disease extension and duration, and coincidental primary sclerosing cholangitis, the severity of inflammation and presence of structural changes in the bowel substantially affect the risk for neoplastic conversion. Using the current technique, most dysplastic lesions in IBD patients are nowadays detectable endoscopically. Also, their endoscopic...
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