[Analgesic effect of videothoracoscopic splanchnicectomy]. / Analgetický efekt videotorakoskopické splanchnikektomie.

The authors demonstrate analgetic effect on a group of 32 patients operated for pancreatic cancer pain after videothoracoscopic splanchnikectomy. The authors define adequate criteria for selection of splanchnikectomy.

[Cardiovascular stress in laparoscopic surgery]. / Kardiovaskulární zátez pri laparoskopických chirurgických výkonech.

AIM: To evaluate response of cardiovascular system in laparoscopic surgery. The main aim was: 1--comparison of healthy subjects and morbid obese population, 2--comparison of healthy subjects and cohort of patients with organic cardiopathy. Secondly we compared the influence of the operation position. PATIENTS AND METHODS: Patients (n = 17) were divided into 3 subgroups:--Control group of "normal" subjects: mean age 36.8 +/- 11.2 years; BMI 25.33 +/- 3.62; BSA 1.84 +/- 0.21 m2; two men and four women; op. diagnosis: 3x cholecystectomy, 1x appendectomy, 1x inguinal herniotomy, 1x hiatal hernia operation. --Group of patients with morbid obesity: mean age 38 +/- 8.1 years; BMI 45.82 +/- 7.54!; BSA 2.66 +/- 0.32 m2; one man and five women; all of them were operated for obesity (laparoscopic gastric banding).--Group of patients with severe cardiopathy: mean age 64.0 +/- 11.55; BMI 26.4 +/- 4.09; BSA 1.89 +/- 0.23; three men and two women; card. diagnosis: 2x aortic stenosis, 1x combined aortic valvulopathy, 1x aortic stenosis with secondary mitral regurgitation, 1x secondary mitral regurgitation (both caused by coronary artery disease); op. diagnosis: 4x cholecystectomy; 1x extraction of catheter for peritoneal dialysis. The method of our examination was transesophageal echocardiography with use of omni planar sond with continual monitoring of each patient. Our data are based on repeated measurements (3x minimal for each state and each patient) before and after peritoneal cavity insufflation and third after positioning of patient (in Trendelenburg or Fowler position). Examinations were recorded and data analysed off-line. Following parameters were analysed: mean age, BMI, BSA, heart rate, mean arterial pressure (MAP), ejection fraction of left ventricle (EF), E/A ratio of transmitral flow, cardiac output (CO), cardiac index (CI), systemic (peripheral) vascular resistance (SVR) and pressure-rate-product (PRP). For statistical analysis were used: ANOVA tests, t-tests with Benforroni correction and Friedman's tests. RESULTS AND DISCUSSION: In comparison of normal and obese patients statistically significant differences were found (after exclusion of BMI and BSA) in cardiac output values, after recalculation on body surface (cardiac index) remained only non-significant trend to fall. Differences between control group and group of cardiacs were also non significant with exclusion of E/A ratio of transmitral flow. This result we explain by pseudonormalization. All 17 operations were successfully done without any complication. CONCLUSIONS: Our data were obtained on relatively small cohort of patients but the number of patients was respected by statistics and results might be borderline but significant. Laparoscopic gastric band (operation is done in semi-sitting position) in morbid obese patients is well tolerated without any differences in comparison to healthy population. The population of patients with severe organic cardiopathy needs careful approach. Our data are favourable but significant change in the left ventricle filling together with non-significant hemodynamic disadvantageous trends in EF, CI and MAP requires care. Further investigations are needed and with intraoperative monitoring (transesophageal echocardiography is preferred) can be considered as safe.

[Disseminated intravascular coagulation syndrome and protein C]. / Syndrom diseminované intravaskulární koagulace a protein C.

Disseminated intravascular coagulation (DIC) is characterized by systemic activation of the haemostasis. In many instances the release of inflammatory cytokines and tissue factor trigger the system in septic or traumatic conditions. Initially, the increased activation of haemostasis can be compensated by natural inhibitor systems. As release of the triggers persists, inhibitors (e.g. antithrombin and protein C) will be consumed leading to intravascular clotting. In this process many coagulation factors, most notably fibrinogen and platelets are consumed too, resulting in a failure of haemostasis system and in a diffuse bleeding (decompensated DIC). Fresh frozen plasma, blood transfusion, and fibrinogen concentrate correct the bleeding, if needed, in the case of traumatic (obstetric) DIC. Arrest of the activated haemostasis by heparin and natural anticoagulants (antithrombin or/and protein C) is recommended, mainly in septic conditions with systemic inflammatory reactions. A case of stercoral sepsis usefully treated by recombinant human activated protein C is reported.

[The acute phase reaction in laparoscopic and open surgery of inguinal hernias]. / Reakce akutní fáze pri laparoskopické ci otevrené chirurgii tríselné kýly.

The acute phase response to tissue injury is art of the wound healing process after surgery. The aim of study was to determine levels of acute phase proteins and levels of thrombocytes in patients with laparoscopic surgery (intraabdominal preperitoneal repair) and in patients with open surgery (tension free repair). Exclusion criteria in both groups of patients: malignity, diabetes mellitus, obesity (BMI > 30), infection, hypoproteinemia, hepatic or renal insufficiency and hypertension. Type of anaesthesia: general. Perioperative preventive antithrombotic medication: LMWH 5 days after surgery. The observed parameters were estimated before, one hour, 2nd and 7th days after surgery. Statistical test: ANOVA, statistical by significant difference p < 0.05. The results of the study demonstrate an increase of acute phase proteins CRP, OROSO and Fb in both groups of patients in comparison to their levels before surgery. In this respect we did not find a difference between the two types of operation. In patients with laparoscopic surgery the observed peak of FBG increase (+69%) was on the 2nd day after surgery followed by a slight drop of values in comparison to the results of open surgery patients with a FBG increase on the 2nd day (+42%) and with continuation on the 7th (%) postoperative day. The peak of CRP values was on the 2nd day in both groups. OROSO values increased even on the 7th day. The same situation occurred with Plt levels (p < 0.05). We suggested, that laparoscopic and open surgery of inguinal hernia repair are both followed by an acute phase response related to the tissue injury and this response perists even 1 week after surgery. But the recovery time of some parameters of the acute phase response (e.g. orosomucoid and fibrinogen levels) to the basical preoperative state is longer in patients with open type of surgery. We do not confirm differences in the degree of risk of postoperative thrombophilia in both types of surgery and suggest, that the prevention of thromboembolic complications is indicated in both types of surgery.

Antitumor action of bovine seminal ribonuclease.

Unlike the bovine pancreatic ribonuclease (RNAase A), bovine seminal ribonuclease (BS RNAase) displays various biological activities including antitumor cytotoxicity. To learn more about its antitumor activity, we investigated BS RNAase effect on athymic nude mice bearing various tumors. BS RNAase (250 micrograms per mouse per day) was administered to the mice with prostate carcinoma for three weeks by three different routes (intraperitoneally--i.p., subcutaneously--s.c., and intratumorally-i.t.). Administration i.p. was ineffective, while s.c. administration reduced significantly size of tumors and i.t. administration abolished half of the tumors in treated mice. The i.t. administration of BS RNase to nude mice bearing melanoma showed even better results. Eighty % of mice were without tumors and in the other mice the tumors were significantly diminished. The best antitumor effect was obtained in case of seminoma. All mice bearing this tumor were cured after ten doses of BS RNAase.

Antitumor action of bovine seminal ribonuclease. Cytostatic effect on human melanoma and mouse seminoma.

This paper reports on the antitumor activity of BS RNase on human melanoma and mouse seminoma. Human melanoma cells established in culture were extremely susceptible to BS RNase, administered in concentrations ranging from 1-100 microg/ml. Concentrations of BS RNase over 10 microg/ml caused complete inhibition of cell growth. Bovine pancreatic ribonuclease (RNase A), a prototype of the ribonuclease superfamily, did not exert any effect under these conditions. Based on our previous results, athymic mice bearing human melanoma or mouse seminoma were treated with intratumoral administration of BS RNase (12.5 mg/kg b.w.). This dose was injected for five consecutive days excluding weekends. The intratumoral administration of BS RNase to nude mice bearing human melanoma showed a significant antitumor effect. There were no tumors seen in eighty percent of mice treated for three weeks, and tumors in the other mice diminished significantly. After some delay the tumors started to regrow. Prolonging of the treatment to five weeks had a similar effect. The effect of BS RNase on mouse seminoma was well pronounced. Five to seven doses of BS RNase were sufficient to eliminate tumors in all treated mice. However, as in the previous experiment, the growth of tumor tissue later reappeared.

Determination of sodium-to-calcium ratio in mouse femora by INAA.

Within the scope of the study of the heteroionic exchange in the bone mineral, the sodium-to-calcium ratio was established in femora of 55 male ICR mice. The purpose of the work was to establish the precision of the method as well as biological variations, since the authors intend to investigate the sodium-to-calcium ratio on pathophysiological models in the future with a special regard to osteoporosis. The resulting mean value was of 0.02515 +/- 0.00053. The small standard deviation indicates that the ratio is not subject to considerable individual variations. The accuracy of the method was checked by analyzing the reference bone sample IAEA H-5. The results obtained exerted a good agreement with the certified sodium and calcium concentrations.

A comparison of haemocoagulation tests in the experimental endotoxin model DIC and in rats whole-body irradiated by 250 Gy.

Based on comparing results of tests followed in the present work between the endotoxin model of the disseminated intravascular coagulation (DIC) and irradiated groups of rats we consider that after the whole-body irradiation by a high dose of 250 Gy, the DIC occurs, in spite of the fact that the first stage--hypercoagulation condition, can be hardly observed. In the experimental endotoxin model, an increase of activated partial thromboplastin test (APTT) values and prolongation of the thrombin time was observed up to 24 hours in both endotoxin doses. After both endotoxin doses, the fibrinogen level was transiently decreased with its subsequent increase. The fibrin monomers correspond to decreasing the fibrinogen level. After the first dose, they were positive between the 3rd and 12th hours and after the second dose, the positivity was observed 6 hours after the application. The antithrombin III level was decreased after 12 hours in both endotoxin doses. The thrombocyte count was considerably reduced already from the 6th hour after administering endotoxin to the end of the experiment. Considerable changes of the thrombocyte aggregation were observed only 3 hours after administering the second dose. When comparing the resulting values of these tests with values observed in irradiated animals, then we can see a certain agreement in the nature of the changes after the exposure to 250 Gy. The fibrinogen level was transiently decreased 3 hours after irradiation, when considerable changes in the thrombocyte aggregation also occurred.

Changes of certain biochemical values during whole-body exposures of rats to doses of 50, 100 and 250 Gy.

In the course of the postirradiation syndrome, changes of concentrations of certain components and of activities of certain enzymes occur in the blood serum. The data available in the literature concern doses lower than 10 Gy. In the present work, changes were studied of concentrations of mineral components, total proteins, glucose, creatinine and bilirubin and activities of liver transaminases, acid prostatic and alkaline phosphatases up to 24 hours after the whole body exposures of rats to doses of 50, 100 and 250 Gy of ionizing radiation. The changes observed--enhanced kalemia and activity of aspartate aminotransferase, particularly after the highest radiation dose used, and changes of the glycaemia (early increase with a subsequent considerable decrease)--support the assumptions based on the former results known from the literature.

[Relation between lipid-bound sialic acid in blood serum and plasma andin human tumors]. / Vztah lipidicky vázané kyseliny sialové v krevním séru a plazme k lidským nádorum.

Athymic mice with transplanted osteosarcoma and carcinoma of the rectum were found to have increased blood plasma levels of lipid-bound sialic acid (LSA). To verify the applicability of the method of LSA determination, patients with cancer of the mammary gland, rectum, and colon were examined for their LSA level. The serum LSA level was significantly increased in patients with cancer of the mammary gland and rectum, compared to levels determined in the serum of healthy volunteers. The serum LSA level elevation was even more pronounced in patients with carcinoma of the colon. In patients with carcinoma of the colon who were in remission at the time of blood collection the serum LSA level was found to be reduced to control values.

Utilization of determining lipid-bound sialic acid for the diagnosis and further prognosis of cancer.

In three types of tumors, rectal carcinoma, large intestine carcinoma and bronchogenic carcinoma, the level of lipid-bound sialic acid (LSA) was determined in blood serum before and after surgical operation. In all the cases, there was a significant increase of LSA content in comparison with healthy controls. Considerable increase in LSA values was observed in patients in relapse after surgical intervention. In contrast to this, in patients with regression the LSA levels were lower as compared with LSA levels prior to the surgical intervention. We believe that the method of determining LSA level could be used not only for the diagnosis of cancer, but also for the prognosis.

[Changes in platelet aggregation and cAMP levels in isolated blood platelets in rats after 5.0 Gy and 10.0 Gy whole-body irradiation doses]. / Zmeny agregace krevních desticek a hladiny cAMP v izolovaných krevních destickách u celotelove ozárených potkanu dávkami 5.0 Gy a 10.0 Gy.

Rats were subjected to whole-body irradiation with doses of 5.0 Gy and 10.0 Gy. After intervals of 1.5 hours, 3, 6, 12 and 24 hours following irradiation the authors tested the aggregation capacity of thrombocytes after induction with adenosine--5--diphosphate and the cAMP level in isolated thrombocytes. Statistically significant differences between experimental and control groups were found particularly at some time intervals in rats irradiated with 10.0 Gy. The authors found a significant acceleration of the time of maximal aggregation at time intervals of 3.6 and 24 hours following irradiation with 10.0 Gy. Only at the time interval of 3 hours after irradiation with 10 Gy a statistically significant reduction of the maximum aggregation, as compared with the control group, occurred, and similarly the tang alpha value indicates that also the initial rate of aggregation was lower. The cAMP level in isolated thrombocytes was markedly reduced in particular after 5.0 Gy already during the early intervals after irradiation. A temporary increase of the cAMP levels was recorded 3 hours after irradiation with 10.0 Gy which may explain the reduced aggregation capacity of thrombocytes found during the same time interval. The results of both tests are not sufficient evidence of a hypercoagulation state after irradiation with the mentioned doses within 24 hours after irradiation.

Changes of lipid-bound sialic acid in the plasma of mice bearing benzpyrene-induced tumors.

The level of lipid-bound sialic acid (LSA) was followed in inbred C57Bl/6 mice bearing tumors induced by benzpyrene at a dose of 20 mg per kg of body weight. In the plasma of mice with macroscopically ascertained tumors, the level of LSA was increased significantly. The LSA level was also significantly increased in the plasma of suspect mice i.e., in a period when the tumor was not yet macroscopically ascertained, however, when a change was observed in the motion of the hind limb of mice to which benzpyrene was administered.

The effect of total body irradiation on the occurrence of chemically induced tumors in mice of inbred strains with different activabilities of the AHH system.

On four strains of inbred mice (C57B1/6, C57B1/10, C3H and DBA2), which were chosen according to their genetically conditioned activability of the arylhydrocarbonhydroxylase system (AHH) the effect was checked of repeated whole body exposure to 60Co gamma rays on the occurrence and origination of the formation of tumors induced by methylcholanthrene. Mice of the strains C57B1/6, C57B1/10 and C3H have a high activability of the AHH system, those of the strain DBA2 exert a low activability. The experiment was supposed to check, how much is the damage of the immunological reactivity induced by radiation able to affect carcinogenic effects of methylcholanthrene. The repeated whole body irradiation of mice neither increased the rate of occurrence of tumors nor affected the time of origination of growth of tumors induced with methylcholanthrene. These results indicate that in the formation of tumors induced with methylcholanthrene, there is a prevalent role of genetically conditioned metabolism of the precarcinogen and not of an intervention into immunologic processes in the organism resulting from the whole body irradiation.