Úvod: Existuje mnoho studií věnujících se problematice biliárních komplikací po jaterních resekcích. Přes zlepšení operační techniky a perioperační péče má incidence této komplikace spíše vzrůstající charakter. Byly analyzovány četné prediktivní faktory. Na jejich vliv na vznik biliárního leaku doposud nepanuje shoda. Za cíl analýzy jsme si stanovili zhodnotit incidenci biliárního leaku, jeho vliv na mortalitu a na dobu hospitalizace na našem pracovišti. Současně jsme provedli rozbor známých prediktivních faktorů. Metoda: Autoři retrospektivně analyzují soubor 146 nemocných, u kterých byla na Chirurgické klinice 2. LF Univerzity Karlovy a ÚVN, Praha v období 2010–2013 provedena jaterní resekce. K vyhodnocení biliárního leaku jsme užili současnou uznávanou klasifikaci ISGLS (International Study Group of Liver Surgery). Závažnost komplikace byla stanovena dle Clavien-Dindo. Statistickou významnost prediktivních faktorů jsme určili pomocí Fisherova exaktního testu a Studentova t-testu. Výsledky: Incidence biliárního leaku byla 21 %. Dle ISGLS bylo 6,5 % pacientů zařazeno do skupiny typu A, v 61,2 % se jednalo o leak B a v 32,3 % o leak typu C. Stupeň závažnosti dle Clavien-Dindo I-II, IIIa, IIIb, IV a V byl v poměru 19,3 %, 42 %, 9,7 %, 9,7 %, resp. 19,3 %. Jako statisticky významné jsme stanovili tyto faktory: operaci pro malignitu (p<0,001), velkou jaterní resekci (p=0,001), dobu operace (p<0,001), vyšší peroperační krevní ztrátu (p=0,02), konstrukci HJA (p=0,005), portální venózní embolizaci/two-stage chirurgii (p=0,009) a ASA skóre (p=0,02). Biliární leak významně prodloužil dobu hospitalizace (p<0,001). V souboru pacientů s biliárním leakem byla 23krát vyšší perioperační mortalita (p<0,001) než v souboru bez leaku. Závěr: Biliární leak je jednou z nejzávažnějších komplikací jaterních resekcí. Většina rizikových faktorů je těžko ovlivnitelných a na jejich vliv nepanuje jednoznačná shoda. Incidenci by mohly redukovat diskutované peroperační leak testy. V budoucnu bude třeba dále pracovat na zlepšení perioperačního managementu a techniky k prevenci vzniku této závažné komplikace. V léčbě se uplatňuje multidisciplinární přístup., Introduction: Many previous reports have focused on bile leakage after liver resection. Despite the improvements in surgical techniques and perioperative care the incidence of this complication rather keeps increasing. A number of predictive factors have been analyzed. There is still no consensus regarding their influence on the formation of bile leakage. The objective of our analysis was to evaluate the incidence of bile leakage, its impact on mortality and duration of hospitalization at our department. At the same time, we conducted an analysis of known predictive factors. Method: The authors present a retrospective review of the set of 146 patients who underwent liver resection at the Department of Surgery of the 2nd Faculty of Medicine of the Charles University and Central Military Hospital Prague, performed between 2010−2013. We used the current ISGLS (International Study Group of Liver Surgery) classification to evaluate the bile leakage. The severity of this complication was determined according to the Clavien-Dindo classification system. Statistical significance of the predictive factors was determined using Fisher‘s exact test and Student‘s t-test. Results: The incidence of bile leakage was 21%. According to ISGLS classification the A, B, and C rates were 6.5%, 61.2%, and 32.3%, respectively. The severity of bile leakage according to the Clavien-Dindo classification system – I-II, IIIa, IIIb, IV and V rates were 19.3%, 42%, 9.7%, 9.7%, and 19.3%, respectively. We determined the following predictive factors as statistically significant: surgery for malignancy (p<0.001), major hepatic resection (p=0.001), operative time (p<0.001), high intraoperative blood loss (p=0.02), construction of HJA (p=0.005), portal venous embolization/two-stage surgery (p=0.009) and ASA score (p=0.02). Bile leakage significantly prolonged hospitalization time (p<0.001). In the group of patients with bile leakage the perioperative mortality was 23 times higher (p<0.001) than in the group with no leakage. Conclusion: Bile leakage is one of the most serious complications of liver surgery. Most of the risk factors are not easily controllable and there is no clear consensus on their influence. Intraoperative leak tests could probably reduce the incidence of bile leakage. In the future, further studies will be required to improve the perioperative management and techniques to prevent such serious complications. Multidisciplinary approach is essential in the treatment., and K. Menclová, F. Bělina, J. Pudil, D. Langer, M. Ryska
The complex architecture of the liv er biliary network represents a structural prerequisite for the formation and secretion of bile as well as excretion of toxic substances through bile ducts. Disorders of the biliary tract affect a significant portion of the worldwide population, often leading to cholestatic liver diseases. Cholestatic liver disease is a condition that results from an impairment of bile formation or bile flow to the gallbladder and duodenum. Cholestasis leads to dramatic changes in biliary tree architecture, worsening liver disease and systemic illness. Recent studies show that the preva lence of cholestatic liver diseases is increasing. The availability of well characterized animal models, as well as development of visualization approaches constitutes a critical asset to develop novel pathogenetic concepts and new treatment strategies., L. Sarnova, M. Gregor., and Obsahuje bibliografii
From the bioarchaeological and morphofunctional point of view, a skeletal deformity is described from an individual buried in a settlement pit at an archaeological site Třebčín in Moravia dating from the period of the Great Moravian (AD 800-950). Macroscopic and radiological examinations are employed to diagnose pathological leasions on the skeleton of an adult female. Female was probably affected by a haematogenous form of acute osteomyelitis from early neonatal age., Anna Pankowská., and Obsahuje bibliografii
The BIOCEV project was launched October 31 at an official ceremony at the headquarters of the ASCR, with the inauguration of the first research program, Functional Genomics. BIOCEV is one of six major approved projects that are to become centers of scientific excellence in the Czech Republic and Europe. BIOCEV's research program is focused on two current and rapidly changing scientific fields - biomedicine and biotechnologies - and combines primary and applied research. The results of the scientific research are expected to be used to develop new medicaments and diagnostic processes. The new center is funded by the European Commission's Operational Program Research and Development for Innovation through a grant won by the Czech Academy of Sciences and Charles University Prague. and Luděk Svoboda.
Unikátní vakcína pro léčbu infekčních onemocnění, historicky první zdokumentování vývoje zubu, které může pomoci v boji proti rakovině, revoluční objev organismu bez mitochondrií neboli „buněčných elektráren“ -i takové jsou aktuální výsledky vědeckých týmů z centra BIOCEV, které za účasti významných hostů zahájilo 16. června 2016 plný provoz., A unique vaccine to treat infectious diseases, tooth development documented the first time in history that might help fight cancer and the revolutionary discovery of an organism without mitochondria, referred to as “cell power plants”. These are some of the current results from the BIOCEV research teams. The centre’s full operation was officially launched on June 16, 2016 in the presence of Czech and foreign guests from different areas of science and politics. The Biotechnology and Biomedicine Centre of the Academy of Sciences and Charles University in Vestec (BIOCEV) was established with substantial financial aid from the European Union. By 2020, 400 researchers and 200 master’s degree as well as postgraduate students are expected to work there. As of today, 56 research groups under five synergic research programmes are focused on obtaining more detailed understanding of organisms at the molecular level. Their results are oriented towards applied research and the development of new medical procedures to combat severe health problems., Isd., and Autor je podepsaný šifrou Isd.
Representatives of the Academy of Science of Czech Republic and Charles University have subscribed to the Founding Contract of the Biotechnological and Biomedical Center (BIOCEV) that will be situated in the vicinity of Vestec. and Luděk Svoboda.
Jaroslav Dvořák, Prof. Dr. O. Laxa, Z laktologického ústavu c.k. čes. vys. školy techn. v Praze, and Converted from MODS to DC version 1.8 (EE patch 2018/05/24)