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L Holubec

Publications and source records attributed to L Holubec.

At least 19 recordsLinked to original sources
PubMed2006

[A partial relaps of a colorectal carcinoma metastatic process following liver surgery--a multifactorical study].

In the period of November 1999 - June 2003 78 patients with colorectal liver metastases (CLM) were operated at Department of Surgery, University Hospital in Pilsen. In multifactorial analysis there were evaluated these clinical parametres: age of patient, sex, localisation of primary tumor, Dukes classification, grading, staging and histology of primary tumor, histologicaly free resection margin, chemotherapy or actinotherapy after colorectal operation, type of liver resection, complications after liver surgery, radicality of liver surgery, lateralisation of liver metastatic process, number of metastases, blood transfusions, repeated liver surgery, volume of metastases. Kaplan-Meier method was used for evaluation of survival rate and disease free interval (DFI). Statistical analysis of studied clinical parametres was performed by Log-rank test and Wilcoxon test. The medium DFI after liver surgery was 16 months for all the patients (range 0-55 months), the medium DFI for patients after radical surgery was 18 months. The medium survival time after liver surgery for all the patients was 30 months (range 1-57 months), for patients after radical surgery it was 32 months, and for patients after palliative surgery the medium disease free interval was 29 months (range 5-30 months). The 4-year survival rate after the liver surgery was for all the patients 37%. The factors statistically significant for a disease free interval after liver surgery were bilaterality of metastatic process, the microscopically free resection line, radical surgical treatment versus RFA and unilaterality of metastatic process. The authors proved followed factors as statistically significant for survival rate: grading of colorectal cancer and age of patients. The prediction of early recurrence enables us to choose adequate surgical therapy or its extension by oncological therapy. More thorough follow up of patients with tendency to early recurrence of CLM helps to early diagnosis of relaps and it increases the posssibility of repeated liver surgery.

Carcinoma↗
PubMed2006

[Prognostic factors of early recurrence of colorectal liver metastases and their usage in clinical praxis].

Liver surgery for colorectal liver metastases (CLM) is very often followed by recurrence. The prediction of early relapse of CLM is important for successful treatment, long disease free period and for long survival of patients, because it could help us to choose adequate surgical and oncological treatment. The authors present contemporary overview of the prognostic factors of early CLM recurrence and their possible use in prognostic scoring systems. These could be very helpful in clinical practice.

Colorectal Neoplasms↗
PubMed2005

Folate co-administration improves the effectiveness of fenofibrate to decrease the lipoprotein oxidation and endothelial dysfunction surrogates.

Fibrate therapy results in elevation of plasma total homocysteine (tHcy), which is known to induce oxidative stress and endothelial dysfunction. We aimed to establish whether fibrate-induced elevation of tHcy has also similar consequences and whether they may be prevented by folate co-administration. Eighteen subjects with hypercholesterolemia were included in an open, prospective, cross-over study. We compared intra-individually the effect of fenofibrate on tHcy, oxidative stress and endothelial dysfunction surrogates, in monotherapy and when combined with 10 mg of folate. These effects were also compared with fluvastatin monotherapy. Fenofibrate in monotherapy significantly decreased LDL cholesterol, increased the tHcy by 39.5 %, while oxidized LDL (oxLDL), malondialdehyde (MDA), von Willebrand factors (vWf) and thrombomodulin (TMD) remained unchanged. When fibrate was co-administered with folate, the tHcy remained on the initial post-diet level, while both the total and oxLDL as well as MDA, vWf and TMD decreased. In contrast to fenofibrate monotherapy, fluvastatin (80 mg) had a similar effect as combined therapy with fenofibrate and folate, while tHcy remained uninfluenced. In conclusion, fenofibrate decreases the LDL cholesterol, but in contrast to fluvastatin, has no significant antioxidative and endothelium-protective potential, probably due to a concomitant increase of tHcy. These effects may be improved by co-administration of folate.

Adult↗
PubMed2005

[Serum tumor markers at exocrine adenocarcinoma of pancreas].

Pancreatic cancer represents a group of cancers with the worst prognosis. There exists only one method of successful therapy--radical surgery, i.e. the complete resection of the tumor. However, only 5% of cases are diagnosed in the early stage. More than 60% are recognised in the period of advanced disease. For those patients only palliative treatment can be used. Only early diagnosis can ensure better therapy results. Possibility of early diagnosis based on imaging and endoscope methods is at present very limited due to the anatomical location of pancreas. Serum tumor markers assessment might represent one of the possibilities of early detection of the pancreatic cancer. Review summarizes current knowledge on the use of tumor markers for diagnosis, prognosis and therapy monitoring of pancreatic exocrine adenocarcinomas with respect to the clinical use at the daily routine practice.

Adenocarcinoma↗
PubMed2005

Comparative analysis of thymidylate synthase, thymidine phosphorylase and dihydropyrimidine dehydrogenase expression in colorectal cancer and surrounding normal tissue.

Thymidylate synthase [TS], thymidine phosphorylase [TP] and dihydropyrimidine dehydrogenase [DPD] play the essential role in the activation and catabolism of the fluoropyrimidines used in cancer therapy. Its expression may influence the antitumor activity or toxicity of these drugs. We studied the expression levels of selected enzymes in colorectal tumors and adjacent normal mucosa. The analysis of TS, TP and DPD gene expression was performed using quantitative Real time PCR technique (Roche) in 15 (TS), 64 (TP) and 12 (DPD) of 64 colorectal cancer patients. The mean gene expression of TS, TP and DPD was found to be 3.29; 3.79 and 8.24 in tumors and 1.88; 3.80 and 19.69 in normal mucosa. The corresponding median gene expression was 1.87; 2.32 and 4.50 for tumors and 2.14; 2.63 and 11.64 for normal tissue. We did not find any significant differences in TS, TP and DPD gene expression between colorectal tumor and surrounding mucosa.

Colorectal Neoplasms↗
PubMed2004

[Clinical importance of determination of tumor markers during follow-up in breast carcinoma].

BACKGROUND: Paper deals with detection of the early disease progression in breast cancer patients during follow up using tumor markers. METHODS AND RESULTS: The basic group of 1184 patients with breast carcinoma in follow up after primary therapy were examined from 1996 to 2002. Sera were tested using commercial kits CA 15-3 (MEIA, Abbot), CEA (IRMA, Immunotech), TPA (IRMA, Byk Sangtec), TPS (IRMA, Beki). Results were compared with the retrospectively confirmed clinical status of individual patients. The authors calculated optimal cut offs and sensitivities and their combinations for particular tumor markers at 95% level of specificity. Best sensitivities for the detection of distant metastases into bone, liver, lung and brain was achieved by CA 15-3 (53-68%). As an optimal combination of tumor markers seems to be the tricombination CA 15-3, CEA and TPA. All the tumor markers have insufficient sensitivity for the metastatic process into the lymphnodes. CONCLUSIONS: As optimal combination of tumor markers during the follow up seem to be tricombination CA 15-3, CEA and TPA, but also the clinical relevance and cost effectiveness of these assessments have to be considered. For the tumor disease follow up only CA 15-3 has sufficient sensitivities (at 95% specificities) for the early diagnosis of the metastatic process.

Aged↗
PubMed2004

[Clinical relevance of tumor markers in epithelial ovarian cancer].

AIM OF STUDY: The authors present the view of possible usage of tumour markers in epithelial ovarian cancer, and they aim at their use in routine clinic practice. TYPE OF STUDY: Review article. SETTING: Oncology and Radio-Therapeutic Department, Faculty Hospital, Pilsen. SUBJECT AND METHODS OF THE STUDY: Summary of data published in Czech and foreign professional literature. CONCLUSION: In case of epithelium tumours of ovaries, CA 125 is the tumour marker of the first choice. For the reason of low sensitivity, it is not possible to use the tumor markers for screening and primary diagnostics. Regarding prognoses, high pre-operational levels of CA 125 are considered unfavourable. At the same time the study demonstrates that CA 125 levels monitoring in the course of chemotherapy appears to be one of the most significant indicators of chemotherapy effects and, therefore, also of prognoses. Regular CA 125 monitoring in the course of follow up can contribute to early detection of tumour disease relapses. The optimal time interval for monitoring seems to be three months for the period of the first two years, and then six-month interval. Other tumour markers used in routine clinic practice are mainly CA 19-9 and CA 72-4, particularly in case of mucinoid epithelium tumours. However, these markers are of subsidiary importance only.

Biomarkers, Tumor↗
PubMed2004

[The role of procalcitonin in the patient assessment after surgical procedures].

In the group of 450 patients operated in the Cardiosurgical Department of the Faculty Hospital in Plzen during the period from III/2003 till XI/2003, 1451 samples were collected to examine the following-procalcitonin levels (PCT), white blood cell counts (Leu) and C-reactive protein levels (CRP). The findings were assessed with respect to the respective patient's clinical status, and any correlation between procedures with extracorporeal circulation (MO), signs of inflammation, septic and non-septic serious complications and between the above mentioned markers levels, was searched. It was detected, that the PCT levels correlated well with the clinical signs of inflammation and sepsis, as well as with the non-inflammatory complications. The CRP and Leu changes were not statistically significant and their levels are commonly increased by the surgical procedure itself.

Biomarkers↗
PubMed2004

[Metabolic syndrome and latent depression in the population sample].

BACKGROUND: The aim of study was to reveal the relationship between metabolic syndrome and depression in a population sample, based on clinical and metabolic parameters. METHODS AND RESULTS: We tried to estimate depression (or other psychopathologies) prevalence in a randomly chosen population sample of the Pilsen city, using special questionnaires. Further, we estimated metabolic syndrome of insulin resistance risk factors and we looked for the relationship between these two disorders. Mental state of object was classified according to the questionnaires results, currently evaluated by the psychiatrist. Metabolic syndrome of insulin resistance was diagnosed as a presence of 3 of the 5 following factors: Triglycerides > or = 1.7 mmol/l, HDL cholesterol < 1.0 mmol/l in males or < 1.3 mmol/l in females, blood pressure > or = 130/85 mmHg (and/or antihypertensive medication), fasting plasma glucose > or = 6.1 mmol/l, waist circumference >102 cm in males or > 88 cm in females. Depressive syndrome diagnosed by Zungs scale is present in 31% of the Pilsen population, in 38% females and 31% males (n = 340). In the group of depressive objects, characteristics of metabolic syndrome of insulin resistance were two times higher than in the control group. Differences in resting heart rate, triglycerides level and fasting C-peptid were significantly higher in the depressive subjects. After the corrections considering age, sex and treatment adjustment, the waist to hip ratio was in the depressive subjects statistically higher as well as the 24 hour excretion of urine cortisone. In persons with metabolic syndrome of insulin resistance the prevalence of depression and anxiety was significantly higher. CONCLUSIONS: Our results show a possible relationship between depressive disorder and risk factors of the syndrome of insulin resistance. The question remains if the depression treatment can correct some of the metabolic syndrome risk factors.

Depression↗
PubMed2002

[Biological activity in colorectal carcinoma].

The trend of current research is not only to obtain a complete characterisation of the cause of inception of tumor proliferation, but in particular to characterize in detail multi-degree cascades of the metastatic process. Precise description of the effector genes and their protein products which influence individual processes of the metastatic cascade, is of great significance not only for the early diagnosis of the possible tumor invasion into its immediate environment and the creation of distant metastases, but particularly for the development of new therapeutic procedures which will help to change from empirical to causal treatment. In practice this means a shift from those therapeutic procedures which lead only to simple blocking of cell division or cell growth, to addressing the individual stages of tumor development (correction of genetic defects in tumor cells, inhibition of the metastatic cascade, inhibition of angiogenesis and apoptosis, etc.). The article characterizes the biological activity of tumors in connection with the metastatic process in colorectal carcinoma.

Carcinoma↗
PubMed2002

[Treatment of diabetic neuropathic defect at the surgery department and at the center for diabetic foot care].

UNLABELLED: The aim of the study was to evaluate the treatment of neuropathic diabetic ulcer at the surgery department and the treatment at the diabetic foot centre at dismissal time and 3 months after the dismissal. METHODS: For assessment of treatment success parameters of glucose control were used (average of daily blood glucose values, glycosylated haemoglobin--HbA1C and glycosylated protein), healing of ulcers (Wagner classification), hospitalisation time and number of amputations. 22 diabetic patients at the centre and 17 patients at the surgical department were observed in this investigation. There was no difference between the groups as for the age, glucose control (HbA1C), and severity of diabetic ulcers (Wagner 3-4). Local and antibiotic therapies were the same ones. Results as median and difference 75th and 25th percentile were evaluated by Wilcoxon test for paired data within the groups and by Man-Whitney test between both of the groups. RESULTS: In the both group the diabetic control and ulcer healing were significantly improved during hospitalisation period, 3 months after discharge deteriorate diabetic control and ulcer healing stagnated, however, only in the group treated at the surgical department. The hospitalisation time was significantly longer in the surgical group in comparison with the centre group [median 52 days (35)] vs. [median 31 days (38)], p < 0.01. Amount of transmetatarsal and higher amputations was lower at the foot centre in comparison with the surgical group (1 vs. 7). Statistical evaluation was not used for low amount of amputations. CONCLUSION: Team approach at the centre of diabetic foot is effective in the treatment of diabetic foot ulcers, significantly shortened the hospital stay, probably decrease amount of amputations. Three months after discharge the diabetic control and ulcer healing were significantly better in patients treated at the diabetic foot centre.

Aged↗
PubMed2002

[Prevalence of thyroid gland disorders in pregnant women in the West Bohemia Region during their 2nd trimester of pregnancy in the year 2000--pilot study].

The diagnostics and the treatment of the disorders of the thyroid gland in pregnancy belong to the most important topics for most endocrinologists in the whole world. Untreated or mistreated thyroid gland disorders may influence the course of pregnancy and development of the foetus and child. Autoimmune thyroiditis, hyperthyroidism and hypothyroidism represent the most common thyreopaties in pregnancy and that is why the aim of the study was to establish their prevalence in population of pregnant women of the West Bohemia region. In our study we assessed serum levels of thyrotropin (TSH), free tyroxin (fT4) and antithyroid peroxidase antibodies (antiTPO) in 650 pregnant women. Sera were acquired during routine blood sampling for Down syndrome screening in the 2nd trimester of pregnancy. In our group we found the prevalence of 1.5% of hypothyroidism and 9.4% of autoimmune thyroiditis and we revealed no case of thyrotoxicosis, only subnormal TSH in 2.3%.

Adult↗
PubMed2002

[Thyroid disease in pregnant women and its development after childbirth].

OBJECTIVE: To assess the incidence of post-partum thyropathies in women with positive antibodies against thyroid peroxidase in the second trimester of pregnancy. MATERIAL AND METHODS: Based on a cross-sectional study of the prevalence of abnormal laboratory parameters of thyroid function in a group of 650 pregnant women in the second trimester of pregnancy the authors invited for subsequent clinical examination and repeated controls women with elevated antibodies against thyroid peroxidase (antiTPO) above 60 mU/l (1). The group comprised 75 pregnant women, incl. 44 (58.7%) who attended the examination. After delivery the authors examined the serum levels of TSH, fT4, antiTPO, if necessary fT3 and TRAK. RESULTS: 18, i.e. 58.1% women developed post-partum thyroiditis, incl. 10, i.e. 55.6% who developed hypothyroidism and 8, i.e. 44.4% who developed hyperthyroidism. CONCLUSION: Based on the presented study the authors recommend in pregnant women in the first trimester of pregnancy to introduce assessment of thyrotropin (TSH) and free thyroxin (fT$) and antibodies against thyroid peroxidase (antiTPO)[to detect neuropsychic sequelae on the infant after delivery. The investigation of serum levels of antiTPO antibodies will make it possible to select a group of women in risk of by the development of post-partum thyropathies which must be followed up.

Adult↗
PubMed2001

[Erectile dysfunction after surgery for rectosigmoid tumors--diagnosis and therapy].

OBJECTIVE: To assess the standard diagnostic and therapeutic algorithm of erectile dysfunction (ED) after radical operations on account of rectosigmoid tumours. MATERIAL AND METHODS: At the Faculty Hospital in Plzen from Jan. 1995 till Oct. 1999 the mentioned operation was implemented in 167 men, incl. 98 who were sent a questionnaire concerning postoperative sexual complaints. 39 replied. Those interested were examined further and treatment of ED was started. RESULTS: Four men, mean age 75.3 +/- 1.0 years were before surgery sexually inactive. In the remaining 35 ED developed in 68.6% (24/35)--mean age 58.2 +/- 9.8 years (in men without ED it was 61.7 +/- 11.1 years), in 37.1% (13/35) ED was complete, in 31.4% (11/35) partial. A postoperative decline of libido was in recorded in 37.1% (13/35) and impaired ejaculation in 65.7% (23/35). In men with postoperative ED 66.7% (16/24) suffered also from another disease causing ED, in men without ED this ratio was only 18.1%. In the group of men with ED, on account of ED 40% were examined and treated (14/35) incl. 10 who were examined for the first time in conjunction with the questionnaire project. Sildenafil was administered to 10 men, an effect sufficient for intercourse was described by two (both with partial ED), a partial effect however inadequate for intercourse was described by four and four recorded no response. Only four men tried intracavernous PGE1 injections and in all instances with a favourable effect. CONCLUSION: ED which affects about two thirds of patients is not treated as a rule. For examination a rule anamnestic data and physical examination are sufficient. Oral sildenafil treatment is effective only in a small percentage of patients. Intracavernous injections are more effective but are usually refused.

Aged↗
PubMed1993

[Reoperation in Crohn's disease].

In 1967-1992 at the surgical clinic in Plzen 101 patients were operated with histologically confirmed Crohn's disease. A total of 32 urgent operations were performed. Due to the possibility to provide complete parenteral nutrition from this number during the past 6 years only three patients were operated. During the next and subsequent period 70 patients were reoperated. Relapses occurred most frequently four years after the first operation. As to the extent of resection, the authors agree with the view that 20 cm from the macroscopic borderline of the affection are sufficient without special regard to lymph nodes. Nevertheless it is important to keep in mind that Crohn's disease is a systemic disease and even by radical removal of the affected part this disease cannot be cured by surgery.

Adult↗