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Biomedical subjects

T Tichý

Publications and source records attributed to T Tichý.

13 recordsLinked to original sources

[Detection of the sentinel lymph nodes in lung carcinoma cases using patent blue and its clinical significance].

INTRODUCTION: Views on significance and the most appropriate approach to lymphadenectomy in the non-small-cell lung carcinoma cases, have not been consistent. The method of the sentinel lymphonode identification and biopsy, which has been verified for other tumor types, may become a promising alternative or, at least, a supplement to currently applied procedures in cases of the lung carcinoma. STUDY GROUP AND RESULTS: This prospective, non-randomized study was conducted in the Faculty Hospital in Olomouc between the years 2000-2003. The sentinel lymphonode identification was conducted in the group of 48 patients suffering from the non-small cell lung carcinoma, using the patent blue lymphatic mapping method. The sentinel lymphonode was identified in 40 patients (83.3%), a false negativity of the sentinel lymphonode was detected in 3 cases (7.5%). CONCLUSION: The study proved the clinical benefit of the sentinel lymphonode identification and biopsy method in cases of the non-small cell lung carcinoma using the patent blue dye. Under the circumstance of certain experience with the technology, the reliability of the detection approaches that of the radionuclide sentinel lymphonode detection method. However, the clinical significance of the above method must be further tested on larger patient groups.

Aged↗

[Extent of lymphadenectomy in lung resection for carcinoma].

Dissemination of the bronchogenic carcinoma into the lung and mediastinal lymphonodes is considered one of the basic prognostic factors. Correct evaluation of the lymphonodes involvement remains the principal pre-requisite for the choice of the most appropriate procedure and makes a forecast of a particular patient's perspective possible. The preoperative diagnostics of malignant lymphadenopathy is based on a CT examination. Once enlarged lymphonodes are detected, invasive exploration is indicated--either via mediastinoscopy, eventually via thoracoscopy. The final picture of the extent of the tumor dissemination via lymphatics is provided by the final histopathological examination of the lymphonodes removed during the surgical procedure. The minimal extent of lymphadenectomy is still being discussed. Some clinics do not conduct it at all. On the other hand, there are some clinics, where the en-bloc mediastinal lymphonodes dissection remains a common procedure during all lung carcinoma surgical procedures. On the group of 226 patients operated between 1996-1999, the authors assess surgical aspects and complications of the lymphadenectomic procedure within the radical lung resection for the non-spinocellular lung carcinoma. In the subgroup of 73 patients with a confirmed malignancy of the lung lymphonodes, the authors have found no statistical difference in the five-year survival rate which would be connected to lymphadenectomy. Mediastinal lymphadenectomy, with respect to its sound diagnostic and prognostic benefits, remains a necessary part of any curative resection. It proved to improve local control of the tumor, however, it has no clear influence on the survival rate. In small peripheral tumors (T1, T2), its extent may be restricted to systematic sampling of the interlobium, lung hilus and medistinum lymphonodes. On the other hand, in case of advanced tumors after the induction therapy, no other than en-block resection procedures are suitable or even possible.

Carcinoma, Bronchogenic↗

[Use of the auditory brainstem neuroprosthesis in the Czech Republic].

BACKGROUND: Auditory brainstem implant (ABI) is an electroprosthetic device enabling sound sensations in deaf persons with a bilateral lesion of auditory nerves. Stimulation of auditory nuclei in the floor of the IVth ventricle is realized by an electrode array introduced during surgery in the lateral recess of the IVth ventricle. METHODS AND RESULTS: The main indication group for ABI is represented by patients with neurofibromatosis 2 (NF2) suffering from bilateral vestibular schwannomas. During surgery aimed at tumour removal, auditory nerve function and integrity are almost always destroyed, therefore, an ABI can be introduced as an one stage procedure. Implantees use the device mainly as the aid in lipreading, only very rarely they can comprehend speech without visual cues. Auditory brainstem implant programme has been introduced in the Czech Republic in the year 1999. It was the very first ABI surgery in the Central Europe. Since that time, 5 patients had received the auditory brainstem implant, from which the first four use the device for a longer time. CONCLUSIONS: The last operated patient has not been activated yet. It may be said, that ABI represents a benefit to all our patients, in one implanted this benefit is significant, since he can understand speech without lipreading, the other implantees use the device as an aid in lipreading. In one female patient, the device benefit is severely limited by a motoric handicap after partial cerebellar resection during surgery. Nevertheless, she uses the implant on a daily basis, but contact with her is limited and difficult.

Adult↗

[Histologic findings in protocol biopsies of transplanted kidneys].

Fourty eight patients with cadaveric kidney allografts treated by cyclosporin A (CSA) or tacrolimus (FK506) underwent protocol graft biopsies at 1, 3 and 12 months after transplantation, and 110 biopsy specimens were obtained. Histologic diagnosis was made according to the Banff scheme. The main cause of the graft instability at 1 and 3 months was acute clinical rejection, these biopsies showed all known histological patterns of tubulointersticial and vascular rejection. Acute tubular nephropathy was found in 13% and borderline changes or nephrotoxicity in 8.7% of instable grafts. Specifically, we focused on the occurRence of subclinical rejection and toxic reactions in stable renal allografts. Of these, 36.1% showed histological patterns of acute tubulointersticial and vascular rejection. The Banff score of subclinical rejection was significantly lower than in clinically apparent rejection. CSA and tacrolimus nephrotoxicity were seen in 14.2%, 19.5% and 27.2% of specimens at 1, 3 and 12 months, respectively. In over one half of the identified cases of nephrotoxicity neither increased level of immunosuppression nor features of allograft dysfunction were found. At 12 months, 45.5% of specimens showed mild chronic transplant nephropathy and 18.1% moderate chronic transplant nephropathy. Normal morphology was found in 36.4% of biopsies. We found a high prevalence of subclinical rejection and nephrotoxicity in the studied cohort. We conclude that protocol biopsy is a reliable method in the diagnosis of clinically silent, as well as clinically apparent, disorders of the transplanted kidney.

Biopsy, Needle↗

[Diagnosis of lymphoproliferative diseases from bone marrow biopsies].

The cytological, histological and immunophenotypical markers of lymphoproliferative diseases are evaluated in the collection of 950 trepanobiopsies, and correlated with types of extramedullary malignant lymphoma. The diagnostic significance of tumor infiltrates topography and basic rules of the differential diagnoses of malignant lymphomas in the bone marrow biopsies are discussed.

Biopsy, Needle↗

[Microsleep from the electro- and psychophysiological point of view].

Impaired wakefulness in machine operators poses a danger not only to themselves but often also to the public at large. While on duty, such persons are expected to be continuously, i.e., without interruption, on the alert. For that purpose, we designed and carried out an experimental model of continuous vigilance monitoring using electroencephalography (EEG) and reaction time measured as the latency of the proband's reaction to sound. If constructed, the set together with other logical elements and an alarm can make for an automatic detection of vigilance and, possibly, also of arousal stimuli in cases of microsleep. We found the following new facts and confirmed the validity of some of the earlier ones: Vigilance is marked by alpha activity in the EEG record (oscillation of 8-13 Hz) and reaction time (RT) of 200-400 ms (milliseconds). Sleep is characterized by theta and delta activities (4-7 and 0.5-3.5 Hz respectively) with no reaction. Between wakefulness and sleep there are at least two stages: relaxation with prolonged RT of 400 to 800 ms and increased EEG alpha, sometimes also beta activities. Then there is the hypnagogic phase with disintegrating alpha and growing theta or even delta activities and an RT of 800 up to 1200 ms. Changes in the EEG and its spectrum and their actual localization on the cranial surface exhibit individual differences; hence, no straightforward categories for the above stages can be established. As for changes in vigilance in the relaxation and hypnagogic phases as well as in the processes of mentation, the most significant are the alpha and delta, less so the theta and beta bands. The most suitable sites for the detection of those changes on the skull surface are temporo-parieto-occipital (TPO) regions, i.e., those over the posterior parts of the skull with the least muscle and oculomotor artifacts and with the most energy for alpha and delta activities. In somnolence, the cortex does not behave as a whole, which means that different areas show different spectra while getting off to sleep, a fact easy to express by means of the alpha/delta ratio, separately for each of the cranial areas. At sleep onset, the alpha/delta ratio undergoes changes; it is greater than one in wakefulness, less than one in sleep, and in the region of one as the person goes to sleep. In the course of sleep with zero reactivity, the cortex already behaves as a whole, i.e., all cranial areas have similar or the same spectrograms, with the alpha/delta coefficient being less than one all over the skull. At times, the spectrogram taken during mentation (e.g., while undergoing psychological tests) resembles that of somnolence, with the alpha/delta coefficient being greater than one. However, there are differences: in somnolence, the delta activity is increased all over its band, i.e., from 0.5 to 3.5 Hz, while during mentation it is increased solely in the slow delta activity band (0.5 to 3.5 Hz). In somnolence, theta is on the increase, but not so in mentation. In the hypnagogic phase, alpha becomes completely extinct--unlike in mentation. As follows from the above listed facts, not everyone applying for an automatic alarm detector of vigilance can be provided with one at random and expect it to go off at the first sign of slumber. Conversely, every applicant ought to be treated as a proband, i.e., tested with simultaneous EEG registration, EEG analysis, determination of the best suitable area on the cranial surface and EEG frequency, separately for vigilance, relaxation, hypnagogic phase and mentation, and--in keeping with the above rules--have individual parameters of the alarm device adjusted accordingly.

Adult↗

[Metanephric adenoma. 11 case reports and detection of collagen spherules in one tumor].

Eleven cases of metanephric adenoma are reported. The tumors were selected out of 6500 tumorous and pseudotumorous lesions of the kidney in our registry. Female to male ratio was 1:1.2. The average age of the patients was 48.3 years, with a range of 13-79 years. The mean size of the tumors was 7.2 cm. The tumors were spherical in shape, whitish to yellowish in colour. Histologically, they were arranged in a mainly tubular pattern with short pseudopapillae. The tumorous cells were deeply eosinophilic to basophilic with predominantly round nuclei. Psammomatous bodies were numerous. Immunohistochemically, they reacted positively with antibodies against cytokeratins, vimentin, and WT1. Ultrastructurally, the cytoplasm contained mitochondria, RER, and ribosomes. A collagenous spherulosis, identical with those in salivary gland and mammary tumors, was revealed in one case. The spherules were located mainly inside tubular structures. Ultrastructurally, they were composed of basement membrane-like material, which was surrounded by epithelial cells. Follow-up all of our patients was negative (if known) for 10 months to 4 years.

Adenoma↗

First auditory brainstem implant in the Czech Republic.

In the Czech Republic, the first implantation of a stimulation electrode into the brainstem was performed on 11 January 1999 in the Department of ORL, Head and Neck Surgery, The First Medical Faculty, Charles University in Prague, University Hospital Motol. The selected patient was a 40-year-old woman with neurofibromatosis type 2 (NF2) who had previously undergone bilateral vestibular schwannoma surgery. Both tumours had been radically removed, the left-sided tumour in 1987, the right-sided one in 1988. She had been completely deaf since the last operation, i.e., for 11 years. The surgery was realized by the international cooperation of three teams. Placement of the electrode pad of the Nucleus CI21 + 1M system on the ventral and dorsal cochlear nuclei was performed. Electrically evoked auditory brainstem responses (EABRs) proved the correct position of the electrode array. The post-operative course was uneventful. Six weeks after the surgery the patient received her speech processor. Since that time, the patient already absolved several sessions of a speech processor tune-up. She uses the device as an aid in lip-reading. No adverse or pathological side effects have been observed. The patient was the 45th person in Europe to receive an ABI and the first in the Czech Republic.

Adult↗

[Pathology of paraneoplastic syndromes. Review].

A review of current opinion on paraneoplastic syndrome pathology is presented. It is supplemented by a reference to the author's own cases (paraneoplastic cerebellar degeneration with Purkinje cell lesion and vacuolar spongiform degeneration of the granuloneuronal layer of the cerebellar cortex).

Humans↗

[Assessment of metastatic potential of pulmonary carcinoma].

The authors evaluated in a group of 25 patients after radical lung resection on account of a non-small cell carcinoma the correlation between tumour grading, invasion into lymphatic and blood vessels, proliferation markers (Ki-67, PCNA), ploidy, cell polymorphism and mitotic cell activity of the lung tumour and the lymphogenic or haematogenic metastatizing proved before or during surgery. From the investigation patients after induction chemotherapy were eliminated. It was of interest that the great majority of investigated parameters was positive or elevated in patients with lymphogenic or haematogenic metastases. Conversely in patients where the majority of these parameters was negative on the day of the operation, no metastases were detected. In the group of patients where the investigated indicators were positive and no metastasis was found, similarly as in both previous sub-groups, the author will continue to follow-up the following: recurrence, median survival and five-year survival. From the assembled parameters a table was prepared stratifying the risk of metastases.

Biomarkers, Tumor↗

[A single-channel cochlear neuroprosthesis made in Czechoslovakia].

The authors explain the principle of cochlear neuroprostheses, an electronic device which makes it possible to mediate acoustic perceptions to completely deaf patients. They describe the Czechoslovak cochlear neuroprosthesis, developed and manufactured in the Laboratory of electronic sensory prostheses. For clinical application preoperative and postoperative examination of the patients is essential. For these examinations in the Laboratory a computer-controlled testing system was developed. The authors describe tests for the selection of candidates for implantation and for evaluation of the assets of the neuroprosthesis.

Cochlear Implants↗

Lung resection in a neoadjuvant protocol.

Neoadjuvant therapy was defined as a cytoreductive therapy administered prior to a definitive locoregional treatment--surgical resection. While surgical resection can be curative in patients diagnosed with localized early-stage non-small cell lung cancer, patients with nodal (N1, N2) disease are generally not candidates for exclusive surgery. Inductive therapy can improve the microscopic metastatic disease, eradicate the primary tumor and thereby improve survival.

Antineoplastic Combined Chemotherapy Protocols↗