Portal vein ligation with alcohol injection - our first experiences.

INTRODUCTION: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. PATIENTS AND METHODS: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. RESULTS: The mean FLRV increase was 206.6 cm3 46 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. CONCLUSION: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

[Diagnosis of early pancreatic cancer and precursor lesions]. / Diagnostika casného karcinomu pankreatu a prekurzorových lézí.

Pancreatic cancer is a malignancy, which usually carries a poor prognosis; the 5-year survival is less than 6%. Therefore, its early detection in a stage when curable resection can be performed is essential to give the patients the best possible chance for a long-term survival. Despite the use of the most up-to-date diagnostic procedures, an early diagnosis of pancreatic carcinoma is rather unsuccessful. Furthermore, long-term survival rates for pancreatic cancer patients are still unsatisfactory, even when diagnosed early. Nevertheless, alterations occur in biomolecules as early as during the onset of oncogenesis, which can be detected by structure-sensitive spectroscopic methods. These methods provide a potential for detecting a sufficiently specific biomarker of early pancreatic carcinoma. A pilot study using molecular spectroscopy was conducted at the 1st Department of Internal Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital in Prague, Czech Republic, in cooperation with the Department of Analytical Chemistry, University of Chemistry and Technology in Prague, Czech Republic. In the study, we compared the spectral response of blood plasma of patients with pancreatic carcinoma and healthy controls. Molecular spectroscopy provided evidence of significant differences between the two groups as illustrated by the study results. This approach thus might be suitable for detecting a specific biomarker of early pancreatic carcinoma. The findings have forced us to rethink the practical benefits of all potential biomarkers. In the future, we might face a situation where although any given marker is positive in a patient, no convincing morphological correlation can be found using available imaging methods. An important question is thus raised - whether or not to indicate surgical resection only on the basis of the biomarker positivity, and what type of resection to opt for.Key words: pancreatic cancer - early detection - spectroscopy - pancreatectomy.

[Current possibilities to influence surgical site infection]. / Soucasné moznosti ovlivnení infekce v míste operacního výkonu.

Infections associated with surgical procedures, also referred to as surgical site infections (SSIs), are the most common nosocomial infections (HAIs - Health Care-Associated Infections) in surgery departments. Although effectively preventable in most cases, they are still associated with significant morbidity and mortality, prolonged or repeated hospitalizations and increased treatment costs. Therefore, compliance with applicable procedures and guidelines is essential for SSI prevention, which was also shown in numerous EBM studies. Relevant procedures and clinical guidelines involve all phases of perioperative care, covering preoperative patient preparation, the course of the surgical procedure itself, as well as post-operative care. In order to effectively reduce the risk of postoperative infectious complications, these proven principles and procedures need to be implemented into daily practice with every single surgical patient. Continuous monitoring of compliance with these procedures, staff education, recording the incidence of SSI in individual departments with regular evaluation and presentation of results should form an integral part of these measures.Key words: surgical site infection - incidence - risk factors - prevention - guidelines.

[Bile leakage after liver resection: A retrospective cohort study]. / Biliární leak po jaterních resekcích: retrospektivní analýza vlastního souboru.

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 20102013. 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 Fishers exact test and Students 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.

[Rare situations in treatment of polytraumatised patients - case reports]. / Raritní situace pri osetrování polytraumatizovaných pacientu - kazuistická sdelení.

Polytrauma is one of the leading causes of mortality in people at productive age. Prompt activation of the rescue system is most important in the treatment. In cases of severe injuries, primary transport to a specialized hospital - trauma center is crucial. Our report is focused on two cases of polytraumatized patients whose treatment was associated with relatively rare situations. One of the patients suffered a pancreatic injury that required pancreaticoduodenectomy. The other patient had a liver injury, which was treated with right lobectomy with a rare complication. The necessity of a multidisciplinary approach to the management of severely injured patients is also emphasized in our report.

Feedback is the best way to see.

A 60-year-old man with past history of acute mild pancreatitis (AP) in 1997 and 2005, recently with repeated attacks of AP 5 times in last 2 years. Repeated endoscopic ultrasonography (EUS) showed 20 mm cyst in pancreatic body with 5 mm nodule, main pancreatic duct (MPD) 4-6 mm, fine-needle aspiration malignant cell negative, mucin positive. Computed tomography and magnetic resonance imaging of branch duct intraductal papillary mucosal neoplasms with 10 mm branch duct. From 2011 to 2013, the cyst was without progression in size or character. Due to clinical course of repeated AP, endoscopic retrograde cholangiopancreatography was recommended. It revealed dilated MPD 5-7 mm and 15 mm × 13 mm cyst in pancreatic body. Distal pancreatectomy was indicated because of clinical course and "worrisome EUS features" - MPD size and intramural nodule. In terms of having feedback, endosonographer use to examine every resected specimen of pancreas in our hospital just after surgery. The resected body with "sand glass" appearance of the cyst of size 3 cm was totally different from what we saw previously. We rewinded the previous EUS documentation and made a new evaluation. EUS is unique method for pancreatic tumors, but only in combination with real image of specimen makes endosonographer to bow up.

[Hilar cholangiocarcinoma (Klatskin tumor) - current treatment options]. / Hilový cholangiokarcinom (Klatskinuv tumor) - soucasné moznosti lécby.

Hilar cholangiocarcinoma is a rare tumor with a rather poor prognosis, and thus remains a challenge for diagnosis and treatment. The sole potentionally curative treatment is the complete resection of the tumor. A negative surgical margin is one of the most important factors in achieving prolonged survival. A preoperative evaluation of the tumor is important for the evaluation of resectability and the extent of surgery. Unfortunately, only a small number of patients with hilar cholangiocarcinoma is indicated for the radical procedure. Liver transplantation is not a standard method in the treatment of the Klatskin tumor and it is reserved only for carefully selected patients in a few transplant centres. The main aim of the palliative treatment is biliary drainage, reduction of the pain and pruritus and overall improvement of the quality of life. Adjuvant chemotherapy and radiotherapy are the important parts of the complex therapy, however, no definite regimen has been established to date. Further evidence is needed to define the role of liver transplantation and (neo)adjuvant new therapeutic modalities. Key words: hilar cholangiocarcinoma - radical surgery - palliative treatment - liver transplantation - (neo) adjuvant chemotherapy - radiotherapy.

[Is accurate preoperative assessment of pancreatic cystic lesions possible?]. / Je presná predoperacní diagnostika cystických lézí pankreatu mozná?

INTRODUCTION: Cystic lesions of the pancreas (CLP) are of different origin and behaviour. Mucinous lesions with the risk of invasive cancer represent an important subgroup. The key point in differential diagnosis of CLP is to distinguish malignant and benign lesions and also correct indication for surgery in order to minimize the impact of serious complications after resection. Different and unsatisfying predictive values of each of the examinations make proper diagnosis challenging. We focused on overall diagnostic accuracy of preoperative imaging and analytic studies. We studied the accuracy of distinguishing between non-neoplastic vs. neoplastic and bening vs. malignant lesions. MATERIAL AND METHODS: We retrospectively analyzed all of the patients (N=72) with CLP (median of age 58 years, range 22-79) recommended for surgery. CT, EUS, ERCP, MRCP findings, cytology and aspirate analysis were used to establish preoperative diagnosis. Finally, preoperative diagnoses were compared with postoperative pathological findings to establish overall accuracy of preoperative assessment. RESULTS: During 5 years, 72 patients underwent resection for CLP. We performed 66 (92%) resection and 6 (8%) palliative procedures with 32% morbidity and 7% of one hospital stay mortality. All the patients were examined by CT and EUS. FNA was performed in 44 (61%) patients. Cytology was evaluable in 39 (88%) cases. ERCP was done in 40 (55%) patients. Pathology revealed non-neoplastic CLP in 25 (35%) and neoplastic lesions in 47 (65%) specimens. Mucinous lesions accounted for 25%. Malignant or potentially malignant CLP were found in 37 (51%) patients. Sensitivity, specificity and diagnostic accuracy of preoperative diagnosis for distinguishing between inflammatory and neoplastic, and benign and malignant was 100%, 46%, 85% and 61%, 61%, 44%, respectively. CONCLUSION: Correct and accurate preoperative assessment of CLP remains challenging. Despite the wide range of diagnostic modalities, the definitive preoperative identification of malignant or high-risk CLP is inaccurate. Because of this, a significant portion of the patients undergo pancreatic resection for benign or inflammatory lesions that are not potentially life-threatening. Possible serious complications after pancreatic surgery are the main reason for precise selection of patients with cystic affections recommended for surgery.

[Minimal node affection in gastric carcinoma--pilote multicentric study results]. / Minimální uzlinové postizení u karcinomu zaludku--pilotní výsledky multicentrické studie.

INTRODUCTION: Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings. MATERIAL AND METHODS: Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody. RESULTS: In the period of two years (1st January 2009 - 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients' survival data. CONCLUSION: Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.

[Biliary complications after major liver resection]. / Biliární komplikace po velkých resekcích jater.

INTRODUCTION: Major liver resection involves operations where three or more liver segments are resected. The decrease of perioperative and early lethality enlarged indicator conditions, especially in patients with colorectal cancer liver metastasis. Bile leakage belongs to major postoperative complications. AIM: Authors present literary experience and retrospective analysis of patients with emphasis on biliary complications and their treatment. RESULTS: 96 patients underwent major hepatic resections between April 2004 and December 2009 at the Surgery Department of the Central Military Hospital in Prague. The average age of patients was 61 (25-84). Patients with an oncology disease dominated the set, representing 78% of all the patients. One half of the patients were formed by patients with colorectal cancer liver metastasis. Fourteen patients (14.6%) suffered from postoperative biliary complications. Non-surgical treatment was successful in nine cases. Surgical treatment was necessary in five cases. Combinations of these methods were essential in half of the patients. Two patients died (2.1%). CONCLUSION: Bile leakage after major liver resection is a quite common and serious postoperative complication. Conservative treatment (ERCP, CT - navigated drainage) is the method of choice. Surgical treatment is necessary where conservative management fails or where the size of the bile leakage is large. Multidisciplinary approach to treatment of these patients is essential.

[Liver transplantations in children using reduced grafts]. / Transplantace jater u detí redukovaným stepem.

AIM: Liver transplantation is a life-saving procedure in patients with end stage liver disease. Five-year survival in patients indicated for transplantation based on standard indication criteria, has reached a rate over 80%. Shortage of suitable grafts remains the main problem in these procedures. While the situation in adult patients is relatively satisfactory, liver transplantations in children, mainly in the low-weight categories, remain a worldwide problem because of the absolute lack of suitable donors. In order to reduce mortality in the youngest patients on the waiting list, a concept of reduction of the adult graft for pediatric use was introduced in the early 1990s. Recent introduction of novel methods, such as split transplantations or transplantations between relatives, has resulted in lower mortality rates in the youngest recipients on the waiting lists. The author assesses a group of patients below 18 years of age, who underwent reduced liver graft transplantations in the Czech Republic. MATERIAL AND METHODS: From 1995 to 2009, a total of 43 patients below 18 years of age underwent transplantations, using 48 liver grafts. Further 17 children were sent abroad for transplantations, where a total of 23 liver grafts were used. Only patients who underwent transplantations using the liver grafts adjusted in IKEM were assessed in the patient group, i.e. 14 patients, resp. 16 liver grafts. Reduction was performed in 13 subjects. One subjects underwent transplantation between relatives and a liver split was used in two subjects. In the lowest weight category up to 10 kgs, 5 liver reductions were performed. OUTCOMES: Out of the total (n = 16), 4 grafts failed (2 were early postoperative failures, ie. within 2 postoperative days and 2 grafts failed in Month 5). The mean graft survival was 65 months. Within the youngest recipient age group (n = 5), no graft failure was recorded. The mean survival time is 26 months. CONCLUSION: Since 2007, the Czech Republic has been providing a program for all patients, including the lowest weight-category pediatric patients. To date data are satisfactory. No graft failure has been recorded in the category of the smallest (up to 10 kgs) pediatric patients.

[Metastasis of melanoma malignum in distal ileum like rare causation of ileocoecal invagination--case report]. / Metastáza maligního melanomu distálního ilea jako vzácná prícina ileocekální invaginace--kazuistika.

Authors are presenting the case of a patient, whom developed acute ileocoecal invagination, as a result of the stem tumor of distal ileum. The patient underwent ileocoecal resection with the primary anastomosis end to end. Another clinical and histopatological examinations showed and established diagnosis of metastasis of melanoma malignum in distal ileum with metastasis to liver. This was the first patient's clinical manifestation of the tumor.

[Multidisciplinary cooperation in the management of serious bleedings complicating necrotizing pancreatitis--a case review]. / Multioborová spolupráce pri osetrení závazného krvácení komplikující prubeh nekrotizující pankreatitidy--kazuistika.

Acute necrotising pancreatitis is connected with a high complication rate. The most serious ones are hemorrhagic complications with bleeding from vascular structures erosions. Authors report a case of endovascular treatment of surgically untreatable lesion of portal vein. In this case stentgraft was successfully implanted to cover the erosion and stop the bleeding. Percutaneous transhepatic route was used.

[Radical resection in patients with pancreatic head carcinomas. A retrospective survival analysis in a group of 307 subjects]. / Radikální resekce u nemocných s karcinomem hlavy pankreatu. Retrospektivní analýza prezívání u souboru 307 nemocných.

INTRODUCTION: The Czech Republic has the world's highest rates of pancreatic carcinomas. The pancreatic carcinoma is the fourth commonest cause of deaths due to malignancies, in our republic. Resection procedure is currently the only current treatment method, which has a curative potential and significantly prolongs a patient's life. AIM: To assess morbidity, mortality and survival of patients following radical and paliative procedures in the pancreatic head carcinoma patients. METHODS AND PATIENT GROUP: Only patients, who, based on the preoperative staging, were expected to require the following procedures, were indicated for surgery: I radical resection, i.e. stage I, II patients, 2 - palliative resection - i.e. stage III or IV patients, where no angioinvasion was detected preoperatively. Patients with peroperative detection of angioinvasion into the portomesenteric venous drainage area who required partial vein resection, were also included in the above subgroup. 3 - palliative bypass, where longer survival was expected. Radical resection included proximal pancreatoduodenectomy (PDE) with preservation of the pylorus according to Traverso-Longmire, with N1-2 lymphadenectomy and with reconstruction to an excluded jejunal loop. The same procedure was followed in cases of palliative resections. The collected data were statistically assessed using the Logrank test. From 05/1998 to 12/2006, a total of 307 patients with carcinomas of the pancreas and the Vater papila were treated. In 242 patients, the carcinoma was located within the pancreatic head, in 65 subjects, the pancreatic body and cauda were affected. Resection for the pancreatic head carcinoma was performed in 78 patients: 46 males, 32 females, the mean age was 63.5 y.o.a, with the median of 64 years. Bypass procedures were performed in 109 subjects and explorations in 55 subjects. RESULTS: Surgical procedures, with exception of 55 subjects who underwent exploration only, were performed in 187 subjects. Out of the total 78 PDEs, resections in stage I and II were performed in 22 subjects, in stage III in 41 subjects. In the group of 63 radical resection subjects, 2 subjects exited: the first one due to multiorgan failure, the second one for necrotizing postoperative pancreatitis. In the group of 15 palliative resections, 3 subjects exited. 10 patients died during the early postoperative period after palliative bypass procedures. A total of 15 subjects, i.e. 8%, exited during the early postoperative period. 5 subjects exited after resection procedures, i.e. 6.4%, 3% after radical resections. 3 subjects exited after palliative resections. Early complications were recorded in 44 subjects: pancreato-jejuno anastomosis insufficiency in 6 patients, insufficiency of hepaticojejunoanastomosis in 5 subjects, postoperative pancreatitis in 5 subjects, intraabdominal absces in 10 subjects, wounds infections with secondary healing in 19 subjects and cardiopulmonary complications in 33 subjects. In 19 subjects (43% of all complications), surgical revision was performed. Three-year survival rates were recorded in 60, resp. 29.5 and 39.5% of the patients in stage I, resp. II and III, while they were recorded in 15.6.% of the stage IVa subjects and only in 10.5% of the stage IVb subjects. There is a significant difference between survival rates of the stage I, II and III patients, compared to the stage IV patients (p < 0.005). There is no significant difference in the over- 3-years survival rates between the patients undergoing radical or palliative resections, however, the radical resection patients have significantly higher survival rates 3 months to 2 years postoperatively (p < 0.05). The radical resection subjects have significantly higher survival rates during the first 36 postoperative months, compared to the palliative resection and BDA subjects (p < 0.05). Comparison of sur vival rates in patients with radical or palliative resections is affected by a small number of the palliative resection subjects (n = 15), where no differences in survival rates were detected from the end of 9th postoperative month to the end of 3rd postoperative year. There is a significant difference in the survival rates between the resection and exploration subjects (p < 0.05). The survival rates differences between the subjects with palliative resections and BDAs cannot be evaluated in our study, due to nonhomogenity of the subjects. CONCLUSION: Radical PDEs for the pancreatic head carcinoma results in significantly longer survival of the subjects, compared to palliative bypasses. Stage I, II or III patients survive significantly longer, compared to those operated in stage IV.

[Treatment of hepatocellular carcinoma and current situation in the Czech Republic]. / Lécba hepatocelulárního karcinomu a soucasný stav v Ceské republice.

Hepatocelullar carcinoma (HCC) is the commonest primary liver malignacy. Its incidence is increasing worldwide. In the Czech Republic, about 250 new cases are reported per year. The patient's prognosis depends on early diagnosis and initiation of a correct therapeutical procedure. During the decision making process, tumor staging, as well as the chronic liver disease stage, must be considered. Surgery, i.e. liver resection or transplantation, is the only potentially curable method. Other treatment options include chemoembolization, radiofrequency ablation, alcoholization and, currently poorly effective systemic chemotherapy. Current monitoring of the radical procedures in the Czech Republic is unsatisfactory. Although surgical treatment has been performed by many clinics, based on the available data, none of the following could be assessed: the number of surgically managed HCC patients in the Czech Republic per year, disease staging in these patients and their short-term and long-term treatment outcomes. In the Czech Republic, 45 liver transplantations have been performed, data on resection procedures are not available. The aim of the authors is to support the Central HCC Patient Registry, presented at the following website: www.koc.cz.

[Prediction of treatment outcome after adjuvant loco-regional chemotherapy following liver resection for colorectal metastases--preliminary results]. / Predikce lécebné odpovedi na adjuvantní lokoregionální chemoterapii po resekci jater pro metastázy kolorektálního karcinomu--predbezné vysledky.

INTRODUCTION AND AIM OF STUDY: Czech Republic leads the worldwide league in colorectal cancer's occurrence. Colorectal liver metastases are detected in about a half of patients with colorectal cancer. Liver resection of colorectal metastases is currently the only potentially curative treatment with a chance for a long-term survival rate. Until now there has remained a question of whether adjuvant HAIC can improve the treatment results of radical resection. The aim of our study is to verify predictive efficiency of thymidylátsyntasis (TS), dihydropyrimidindehydrogenasis (DPD) and thymidinfosforylasis (TP) in patients undergoing adjuvant hepatic artery infusion chemotherapy (HAIC) following radical liver resection for colorectal metastases. METHODS: From 1990 to 2005 80 patients underwent 84 liver resections for colorectal metastases. R0 resection was achieved in 60 events. Ten patients who underwent R0 resection both for primary cancer and for colorectal liver metastases and who were given portcatheter for HAIC were included in this study. Adjuvant chemotherapy contained 5-fluorourycil (1200 mg/m2) combined with oxyliplatinum and leukovorin. Whole dose was administered via hepatic artery. The samples were procured both from healthy liver tissue and from metastases for imunohistochemical and molecular biological analysis. RESULTS: The recurrence of disease was verified in 2 of 10 included patients (20%). We detected neither occurrence of death nor serious complication in early postoperative course in none of ten patients. Low expression of TS was found in both events and very high expression of DPD in one event was detected. DISCUSSION: High expression of DPD in one of these patients could contribute to lower outcome of adjuvant chemotherapy. Low expression of TS in both patients responds to the written statement regarding contribution of adjuvant chemotherapy only in patients with high TS level. CONCLUSION: The expression of TS and DPD responds to expected outcome of HAIC. Low number of patient does not permit statistic evaluation.

[Living relative donor for liver transplantation in paediatric recipient]. / Transplantace jater dítete od zivého príbuzenského dárce.

Paper refers the first in Czech Republic liver transplantation in a child with the donor being the close living relative - the father. Indication was the chronic liver failure caused by biliary atresia after the Kasai procedures, which enabled the child to survive two years. Liver segments II. -III were transplanted with favourable postoperative development. Within the following twenty months the nutrition status and the psychomotor development of the child significantly improved. Authors discuss present situation and results of the paediatric liver transplantation in the world.

[Long-term follow up of renal function after orthotopic liver transplantation]. / Dlouhodobé sledování funkce ledvin po ortotopické transplantaci jater.

BACKGROUND: Renal dysfunction in patients after the orthotopic liver transplantation (OLT) is frequent and it significantly contributes to the morbidity and mortality. The aim of our work was to assess the level of glomerular function (GFR) within the first to fifth year after OLT. METHODS AND RESULTS: Serum creatinine concentration (Skr), creatinine clearance (Ckr) and predicted value of creatinine clearance using the Cockcrofta a Gaulta formula (CG) were assessed in 75 patients. Normal values of the given parameters (Skr <110 umol/l, Ckr > or = 1.3 ml/s/1.73 m2) were found only in 16% of all patients. Significant decrease of GFR (Ckr < 0.5 ml/s/1.73 m2) was found in 24% of cases, acute renal failure, which required transitory haemodialysis developed in 4% of patients. In 60% of patients various degree of GFR decrease was found without the necessity of haemodialysis. CONCLUSIONS: Level of renal functions was not significantly related to the blood pressure or serum lipids concentration. An important factor appeared to be the level of renal function before OLT. Because the level of renal function after OLT can significantly influence the post transplantation development, regular follow up of GFR is recommended.

[Surgical treatment of liver metastases of non-colorectal tumors]. / Chirurgická lécba jaterních metastáz nekolorektálních tumoru.

INTRODUCTION: Surgical resection is the only potentially curative treatment for metastatic cancer to the liver. Therapeutic guidelines for treatment of colorectal liver metastases are well defined, but it remains difficult to establish therapeutic guidelines for heterogeneous group of noncolorectal liver metastases. METHODS: 20 patients with liver metastases of different origin were preoperatively indicated for multimodal therapy and were operated between 1998-2002 at our department. All patients could be divided in 4 homogenous groups according to origin of primary tumour. Group of metastatic Grawitz tumour, breast carcinoma, digestive tumours and a group of different tumours. Preoperative assessing of metastatic extent allowed application of multimodal strategy to each patient. RESULTS: 26 multimodal procedures (6 hemihepatectomies, 6 nonanatomical resections, 4 segmentectomies and bisegmentectomies, 5 implantation of port catheter, 5 cytodestructive procedures) were performed at 20 patients. There were no perioperative death. Postoperative complication was seen in 20% of patients. Actuarial survival rates were 65%, 35% and 15% at 1, 2 and 3 years with median survival 15.6 month. CONCLUSION: Low morbidity and satisfactory survival rates justify a multimodal approach to the surgical management of noncolorectal liver metastases.