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Innovatice Methods in the Diagnosis of Sleep Apnea
Kostlivý, Tomáš ; Slouka, David (advisor) ; Kučera, Radek (referee) ; Šlapák, Ivo (referee)
With the development of diagnostics and the whole field of somnology in the 1970s, the diagnosis of sleep apnea was defined among sleep disorders. Obstructive sleep apnea is its most common type with the highest prevalence, affecting up to 1/3 of the adult population. The disease is characterized by obstruction of the upper airways during sleep, leading to apneic pauses. The final consequence is the development of a number of comorbidities mainly of the cardiovascular system. Not yet fully clarified pathophysiological mechanisms include oxidative stress, inflammatory processes, endothelial dysfunction and others. Diagnosis is multidisciplinary, involving otorhinolaryngological examination of the upper respiratory tract and sleep monitoring, which is demanding in terms of technical equipment, time and experience. Therapy is predominantly conservative, involving lifestyle measures, weight reduction and continuous positive airway pressure therapy. Surgical therapy consists of anatomical widening or removal of the obstruction at various levels of the upper airway. The difficulty of diagnosis has encouraged the search for alternative diagnostic methods that could be used for screening the disease or monitoring the effect of treatment. One possibility is to find a sufficiently sensitive and specific...
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The development of new dilational stents for resolving chronic benign stenosis and strictures of the respiratory airways and esophagus in children
Janoušek, Petr ; Kabelka, Zdeněk (advisor) ; Betka, Jan (referee) ; Šlapák, Ivo (referee) ; Přádný, Martin (referee)
Stenosis of the larynx and trachea accounts for a small but adverse spectrum of diagnoses in patients treated in ENT and Head and Neck Surgical departments. In treating chronic stenosis and strictures, an unequivocal, generally -accepted approach has not been established. The predominant method of treatment is surgical. Other methods applied include endoscopic (laservaporation, aryteooidectomy) and extemal (expansive, resection) procedures. 10 the pediatric population, the desired method is one which has a minimal1y harmful impact to the growing child. For these reasons, indications to exteosive surgical treatments are limited. Dilatation of stenosis and stricture, and temporary maintaining of lumen patency using stents individual1y measured "to size" seem to afford greater advantages for use in the pediatric population. In cooperation with the Institute of Macromolecular Chemistry (Academy of Sciences, Czech Republic), we have worked on the development of stents suitable for clinical use that exhibit a combination of useful properties (rigidity, absorbability, biocompatibility, microbial inactivity). The steots were developed by polymerisatioo of 2 hydroxyethy1methacrylate onto a template made from polyethylenenterphtalate type silk (Dacron). The Poly-HEMA material is registered by the national Drug...
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NO Synthases, TGF-beta 1 and EGF Expression in Patients with Proven Oropharyngeal Helicobacter Pylori Infection and its Role in Oropharyngeal Pathogenesis
Lukeš, Petr ; Astl, Jaromír (advisor) ; Šlapák, Ivo (referee) ; Fučíková, Terezie (referee)
The thesis focuses on detection of Helicobacter pylori (HP) in the oropharyngeal lymphatic tissue and changes of selected cytokines expression according to the inflammatory response to the HP infection. HP is well known gastric pathogen, which leads to the development of chronic gastritis, gastric ulcers and malignancies such as gastric carcinoma or MALT lymphoma. According to the supposed way of transmission of this bacterium, oral cavity was investigated for HP presence recently. Data about possible colonisation of oropharyngeal tissue are insufficient. Several papers were published with inconsistent results. This inconsistency is due to different investigation methods used. The pathogenetic effect of HP in the oropharyngeal tissue was not investigated. It is supposed, that HP could lead to inflammation or carcinogenesis of oropharyngeal tissue in the same way as in gastric mucosa. The presence of HP in oropharyngeal tissue samples of patients suffering from tonsillar carcinoma, chronic tonsillitis or obstructive sleep apnea syndrome (OSAS) was investigated in this study. Real-time PCR was used. Part of the patients was investigated for gastric HP presence using UBT and PCR. Specific anti-HP antibodies and levels of EGF and TGF-beta 1 were detected in sera. Differences in iNOS, eNOS and caspase-3 were...
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Factors affecting vestibular compensation in patients after vestibular schwannoma surgery.
Balatková, Zuzana ; Čada, Zdeněk (advisor) ; Salzman, Richard (referee) ; Šlapák, Ivo (referee)
Vestibular schwannoma surgery causes in majority of patients the unilateral peripheral or combined vestibular lesion due to surgical interruption of both branches of vestibular nerve. It manifests postoperatively with postural instability, vertigo, oscilopsia and even with vegetative symptoms. Central compensation, in which cerebellum plays dominant role, influences duration of the symptoms. Factors affecting compensation may be divided into several groups (general health status of a patient, the tumor itself, actual state of function of vestibular system, external factors induced by a therapeutist). Therapeutic aim is to induce compensatory mechanisms as soon as possible and to reduce overall duration of the compensation. The aim of this study is to consider predictive factors influencing central vestibular compensation and to influence the vestibular compensation itself. Early operated vestibular rehabilitation is a basic procedure. It leads to faster recovery in majority of patients. Even with maximal effort the full compensation is not always achieved. It results in permanent deficit of vestibular function manifested with postural instability. However in some patients it is difficult to achieve full compensation despite maximum effort of a physiotherapeutist and that results in permanent...
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Immuno-biological Aspects of Head and Neck Squamous Cell Carcinoma
Bouček, Jan ; Říhová, Blanka (advisor) ; Fučíková, Terezie (referee) ; Šlapák, Ivo (referee)
The process of tumorigenesis is conditioned by change or the series of changes at a gene level. The development of cancer is largely pre-ordained by this change, but very important role is played by other factors. In case of solid tumors it is mainly a tumor microenvironment, where the tumor cells are in contact with stromal cells, especially fibroblasts, and immune cells. Tumor microenvironment can also critically modify the nature and intensity of anti- tumor immune response. Squamous cell carcinomas of the head and neck are the sixth most common cancer, which affect each year more than half a million patients worldwide. Despite advances and improvements in all treatment modalities, achieved therapeutic results even in Western countries are not satisfactory and remain at approximately the same values for several decades. At prezent, the 5 years survival rate, regardless of the location and stage of disease, is approximately only 40%. In the prezented work the immunological and biological aspects of squamous cell carcinoma of the head and neck are discussed. It summarizes the recent findings on the molecular basis of the behavior of tumor cells and the influence and significance of regulation of the immune system for the clinical course of disease and the modern therapeutic approaches.
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Immunoprofiling in patients with HPV-associated and non-associated head and neck squamous cell carcinoma
Lukešová, Eva ; Klozar, Jan (advisor) ; Šlapák, Ivo (referee) ; Laco, Jan (referee)
Head and neck squamous cell carcinomas (HNSCC) remain a significant cause of morbidity worldwide, with approximately 550,000 new cases diagnosed each year. The main etiological factors include smoking and alcohol consumption. The incidence of non-oropharyngeal HNSCC is gradually decreasing while the incidence of squamous cell oropharyngeal carcinoma (OPSCC) is still on the rise. This increasing incidence can be most likely attributed to an increasing prevalence of human papillomavirus (HPV) infection. From the clinical point of view the most significant fact is that patients with HPV positive OPSCC have better prognosis. HNSCC is linked to an alteration in the immune system. Only a limited number of studies have correlated both the immunological parameters and HPV status with patient prognosis. Therefore, we focused on the research of the immunological profile of patients with HNSCC of viral and non-viral etiology. In our study, 110 patients with HNSCC were enrolled. They were divided into HPV-positive and HPV-negative groups based on the expression of HPV 16 E6 mRNA detected in the tumor tissue. Basic lymphocyte subpopulations (CD3+, CD4+ CD25+ Treg, CD4+ CD25+ FoxP3 Treg, CD4+, CD8+, CD19, and CD3- CD16+ CD56+ cells) were determined by flow cytometry in the peripheral blood (PB). We observed...
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The role of human papillomavirus in the etiology and prognosis of squamous cell carcinoma of the oropharynx
Rotnáglová, Eliška ; Klozar, Jan (advisor) ; Šlapák, Ivo (referee) ; Zámečník, Josef (referee)
Tonsillar cancer (TC) presents an important part of head and neck cancers and its incidence is rising in the Czech Republic. Cigarette smoking and alcohol abuse are risk factors responsible for approximately two thirds of all head and neck cancers. Furthermore, a role of human papillomavirus (HPV) as an independent risk factor has been demonstrated recently. The aims of the present study were to find demographical differences between the group of HPV-positive and negative patients, to determine the prevalence of HPV in TC of Czech patients and also to find out whether the virus in HPV DNA positive tumors is transcriptionally active. Another aim was to test different markers of HPV infection for a precise selection of patients with HPV associated disease and to determine the prognostic role of these markers. A set of 109 patients with primary TC was examined for HPV DNA presence in tumor tissue and for the presence of HPV specific antibodies in serum. Data regarding risk factors were obtained by questionnaires. Forty-five samples were available for E6 and E2 mRNA analysis and for immunohistochemical analysis of p16 and p53 expression. The overall prevalence of HPV DNA in TC was 65%. In 93% of HPV16 DNA positive samples the virus was transcriptionally active. The E2 expression status has shown that in...
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Application of special methods in diagnostics of benign and malignant mucosal lesions of upper aerodigestive tract.
Zábrodský, Michal ; Bouček, Jan (advisor) ; Čelakovský, Petr (referee) ; Šlapák, Ivo (referee)
Optical imaging methods incorporating observation of the mucosal surface of organs with narrowband filtered light are diagnostic tools with a significant development in recent years and have become an integral and inseparable part of the diagnostic process of benign and malignant pathologies of the mucosal surface of various anatomical systems of the human body. Malignant and premalignant lesions of the upper aero-digestive tract (UADT) are no exception. The present work demonstrates the benefits of evaluation of changes in microvascular architecture by narrowband imaging. Its major advantage is a more accurate diagnosis of premalignant and malignant mucosal pathologies in the head and neck region based on the identification of significant changes in superficial vascularity. There is a very strong correlation of these vascular changes with the final histopathological analysis. The present data have shown that videoendoscopic examination with narrowband imaging significantly improves the distinction between benign and malignant mucosal lesions even in the UADT pathologies with a similar tendency to neoangiogenesis (squamous cell papilloma vs. squamous cell carcinoma). It also refines the determination of surface extension of tumoral changes and helps to localize and accurately diagnose tumors of...
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Factors affecting vestibular compensation in patients after vestibular schwannoma surgery.
Balatková, Zuzana ; Čada, Zdeněk (advisor) ; Salzman, Richard (referee) ; Šlapák, Ivo (referee)
Vestibular schwannoma surgery causes in majority of patients the unilateral peripheral or combined vestibular lesion due to surgical interruption of both branches of vestibular nerve. It manifests postoperatively with postural instability, vertigo, oscilopsia and even with vegetative symptoms. Central compensation, in which cerebellum plays dominant role, influences duration of the symptoms. Factors affecting compensation may be divided into several groups (general health status of a patient, the tumor itself, actual state of function of vestibular system, external factors induced by a therapeutist). Therapeutic aim is to induce compensatory mechanisms as soon as possible and to reduce overall duration of the compensation. The aim of this study is to consider predictive factors influencing central vestibular compensation and to influence the vestibular compensation itself. Early operated vestibular rehabilitation is a basic procedure. It leads to faster recovery in majority of patients. Even with maximal effort the full compensation is not always achieved. It results in permanent deficit of vestibular function manifested with postural instability. However in some patients it is difficult to achieve full compensation despite maximum effort of a physiotherapeutist and that results in permanent...
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Examination of Exhaled Nitrous Oxide as an Inflammatory Bioindicator of Atopy and Allergy in Children with Adenoid Hypertrophy
Rybnikár, Tomáš ; Hybášek, Ivan (advisor) ; Petrů, Vít (referee) ; Šlapák, Ivo (referee)
Introduction: Adenoids are common disease in childhood, especially at preschool age. The main symptoms of adenoids are nose obstruction, chronic rhinitis, cough, relapsing otitis media, sinusitis, sleeping disorders and otitis media with effusion. The nasal patency influences the nasal nitric oxid (nNO) concentration. However, there are only a few published data about concentration of nNO in patients with adenoids. Aims: The prospective study explores the influence of adenoids on nNO in children. The investigated parameters in probands are the age, atopic diseases, allergic rhinitis and bronchial asthma. The results of nNO are compared with epipharyngoscopy, rhinomanometry and effect of adenoidectomy. Methods: The study was carried out on children with adenoids (n=105) at the age from 5 to 18 years old. The control group consists of 38 healthy children. All children underwent epipharyngoscopy, allergology examination including prick test and measurement of nNO and fractional exhaled nitric oxide (FENO) by the chemoluminescence analyzer. Results: The concentration of nNO is lower in children with adenoids in comparison with healthy children. The nNO depression depends on size of adenoids. In 10 patients (9,5%) with adenoids the depression of nNO was under the screening limit for primary ciliary...
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