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Perioperative disorders of haemostasis
Havlůj, Lukáš ; Gürlich, Robert (advisor) ; Ulrych, Jan (referee) ; Procházka, Vladimír (referee)
Introduction: Hemostasis is a part of homeostasis. Its effectiveness is based on the functionality of systems that stop bleeding (primary hemostasis, primary and secondary processes of activation) and fibrinolysis. These processes potentiate and antagonize each other. If external endothelial function and integrity are compromised due to external stimuli, this balance is disturbed and thrombosis or bleeding occurs. Autoregulatory mechanisms are primarily able to normalize these pathophysiological conditions to some extent. However, if the supply of platelets or coagulation factors is depleted, there is a risk of bleeding. Excessive activation of the coagulation cascade with, for example, thrombocytosis can lead to generalized arterial or venous thrombosis. Goal: The main goal of this work is to confirm or refute the hypothesis that the combination of pancreatic mucosal malignancies with discontinuation of chronic antiplatelet therapy is associated with a high risk of thrombosis. Secondary goals were to investigate the effect of long-term antiplatelet therapy on long-term survival and incidence of postoperative complications after pancreatic resections performed for pancreatic malignancies. Methods: This is a retrospective analysis of a prospective registry of patients undergoing surgery for...
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Selected Theoretical and Practical Aspects of the Quality of Nursing Care
Kazatelová, Petra ; Holmerová, Iva (advisor) ; Gürlich, Robert (referee)
The subject of this diploma paper is the quality of The Health Sevice. This is a major issue of interest, not only to medical experts, but patiens and the general public. Due to increasing competititon within The Nursery Health Service, hospitals must now, monitor and evaluate the quality of patient care and instigate changes as necessary . A glossary of words used within this paper, relating to quality in The Helath Service, is found in the Introduction. Systems of quality assurance, accreditation and resource issues are also introduced. The research focuses on patient satisfaction with the nursing care in the Intensive Care Unit within the surgery department of IKEM. The answers are categorised and either presented graphically or compared statistically. The conclusion contains recommmendations for changes that would improve the quality of nursing care.
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Benefit of assesment of cytokines in inflammatory postoperative complications
Chachkhiani, Ivane ; Gürlich, Robert (advisor) ; Vokurka, Martin (referee) ; Adamec, Miloš (referee)
Infection and the resulting sepsis continue to be important causes of morbidity in surgical patients. Cytokine network causes activation of neutrophils and vascular endothelium with increased upregulation of adhesion molecules, setting at a train of pathogenic inflammatory reactions in the host. Increased concentrations of inflammatory cytokines observed in the initial phase of postoperative complications have a great significance in forecasting a potentially fatal outcome of the disease and can be used for an early diagnosis of systemic complications.Prospective, clinical trial. Levels of cytokines, procalcitonin (PCT), leptin and acute phase proteins (APP) were measured before and after the operation (planned resection of colorectal cancer) and compared with levels in sepsis. Cytokine levels were measured by ELISA method. APP were estimated by nephelometric analysis.PCT was measured by immunoluminometric analysisDuring the first 24 h after the planned resection of colorectal cancer there was a significant increase in serum concentration of interleukin (IL)-6 which declined in next 48 to 72 h. Serum concentration of tumor necrosis factor (TNF)was the highest between 18 to 24 h after the operation. IL-1 had a stable serum concentration without significant elevation. Serum concentration of IL-8 rose after 36...
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Relevance of Tumor Infiltrating Lymphocytes as a Prognostic Factors at Patients With Portal Vein Embolisation (PVE) and Patinets With PVE and Administration of Autologous Stem Cells
Brůha, Jan ; Třeška, Vladislav (advisor) ; Gürlich, Robert (referee) ; Šubrt, Zdeněk (referee)
Relevance of tumor infiltrating lymphocytes as a prognostic factors in patients with portal vein embolisation (PVE) and patients with PVE and administration of autologous stem cells Background: low future liver remnant volume (FLRV) is the cause of why 75% of patients with colorectal liver metastases (CLM) are primarily inoperable. Portal vein embolisation (PVE) helps to increase FLRV and so increase the operability. But PVE fails in almost 40 % of patients. Usage of stem cells (SCs) could be the way how to support the effect of PVE. Currently, there are studies of interactions of the immune system and malignancies. We do not know about papers focused on relations of the immune system and CLM in patients treated by PVE. There were not described interactions of ABC transporters and CLM at patients after PVE was performed too. Aims: the aim of this dissertation was to verify the effect of PVE and intraportal administration of SCs on the growth of FLRV and progression of the CLM. Other aims were to evaluate the tumor infiltrating lymphocytes, ABCC10 and ABCC11 transportes in patients treated by surgery for CLM after PVE and their clinical relevances. Methods: intraportal administration of SCs after PVE and their effect was explored in a group of 63 patients (43 patients with PVE alone, 20 in the group PVE with...
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Tumor infiltrating lymphocytes as prognostic factor in colorectal cancer prognosis after radical surgical treatment
Novák, Petr ; Vodička, Josef (advisor) ; Šiller, Jiří (referee) ; Gürlich, Robert (referee)
Novák P.: Tumor infiltrating lymphocytes as prognostic factor of colorectal cancer after radical surgical treatment Background: Colorectal cancer (CRC) belongs among the most frequent malignant diseases and represents worldwide problem. Czech Republic has one of the highest incidence of CRC. The fight against this disease is kept in many lines as preventive, surgical and oncological treatment and very important part is also the estimation of prognosis and suggestion of individual treatment. Aim: The aim of this study was to analyze the relation of contemporary clinical and histopathological factors and tumor infiltrating lymphocytes, dendritic and natural killer cells. The next aim was to differentiate the patients with high risk of shortened overal survival and tendency to early recurrence of CRC after radical surgical treatment. Methods: We analyzed the group of 150 patients (93 men, 57 women) that were operated on at the Department of Surgery of Teaching Hospital in Pilsen between 2004 and 2007. The important condition for inclusion into the study was radical operation. We excluded patients with any disease that could influence immunological reactivity. We examined endovascular, endolymphatic, perineural infiltration by tumor cells (0 - none, 1 positive). Infiltrations of tumor by lymphatic cells...
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Photodynamic Therapy of Xenotransplanted Human Tumours
Sutoris, Karol ; Gürlich, Robert (advisor) ; Mysliveček, Jaromír (referee) ; Šimša, Jaromír (referee)
SUTORIS, Karol. Fotodynamická terapie xenotransplantovaných lidských tumorů. [Photodynamic therapy of xenotransplanted human tumours]. Prague, 2015. 168 pp. Doctoral Thesis. Charles University in Prague, Third Faculty of Medicine, Department of Surgery Faculty Hospital Královské Vinohrady. Lector GÜRLICH, Robert. Language Czech. In todays clinical practice oncological indications of photodynamic therapy (PDT) are limited primarily to palliative treatment and are used as an adjunct to conventional oncosurgical routines with the aim of improving the quality of life and prolonging patient survival. The efficacy of experimental PDT on xenotransplanted human tumours has been proven in our in vivo study on nu/nu mice. One particular cell line of mammary carcinoma (MDA-MB-231) and two biologically different cell lines of prostate carcinoma (LNCaP, PC- 3) were tested. The key aspect of our experiment was the application of newly developed photosensitizer - hydroxy-aluminum phthalocyanine (AlOH-Pc) in the form of liposomal gel designed for locotopical application. Therapy achieved complete remission in 90% of mice with mammary carcinoma xenografts and in 100% of those with prostate carcinoma xenografts. The new photosensitizer, unlike the older ones, has minimal drug-light interval and does not cause...
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Cytokines and adipocytokines in surgically ill patients: the role of fat tissue
Teplan, Vladimír ; Gürlich, Robert (advisor) ; Adamec, Miloš (referee) ; Herget, Jan (referee)
Cytokines and adipocytokines have major effect on post-operative prognosis of patients. In obese patients, we find significantly higher expression of proinflammatory mediators. In first part of our project we focus on cytokine expresion after elective abdominal surgery. Abdominal surgery was choosen as model of stress reaction to organism. Our results show, that proinflammatory cytokine expresion was significantly higher in obese patients and especially early elevation of visfatin could be a new marker in diagnosis of postoperative inflammatory complications. Related publications describe methods, design and results of trials. Second part of our poject is focused on patients after kidney transplanation, considering obesity, type of previous dialysis, early postoperative movement a nutrition. Our results show, that there is higher proinflammatory expresion after kidney transplanation with no effect of previous type of dialysis. On the other side early exercise have positive effect on cytokine expresion and decreases ADMA. Related publicatons describe methods, details and results of trials.
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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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Cholestatic Liver Disease in a Rat Model and the Possibilities for its Control
Kohoutek, Lukáš ; Kaška, Milan (advisor) ; Gürlich, Robert (referee) ; Vokurka, Jan (referee)
Cholestatic liver disease in a rat model and the possibilities for its control Cholestatic liver disease is accompanied with oxidave stress. That it the reason why decreases antioxidative capacity of liver and increases leaky gut. It causes endotoxemia and expansion of production of cytokines and then forming multiorgan failure. Statins can be the way to protect liver cause of their anti-inflammatory efects. Aims: Aims of this study was to verify effect of statines. The questions are if the statin can be medicament which could prevent to increase of liver disease. The reason of this it will be in the oxidative and inflammatory damage, and if may depent on the time of filling statines and dose of statine. Methods: We have defined four groups of rats. We compared between the rats with laparotomy and with or without ligation of choledochus and with taking fluvastatin or not. We rated the tissue of liver and blood sample, or serum. We rated the degree of demage of liver tissue, the degree of cholestasis and proteosyntetic function of the liver. The rating of effects of fluvastatin depends on quantity of the dose (1 and 5 mg/kg of body weight) and the time of dosing of fluvastatin (1 and 2 weeks). Next scale in the studying of processing in cholestatic liver tissues is studium of mechanism of effects...
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