Vloga endoluminalnih opornic med neoadjuvantnim zdravljenjem karcinomov požiralnika

The first goals of treatment of symptomatic malignomas of the oesophagus include maintenance of the nutritional path and prevention of haemorrhage and pain. All patients require a multidisciplinary assessment in order to get the appropriate regular multi-modal therapy. Definition of the most appropriate nutritional support for the oesophageal cancer patient must be individual. Treatment depends on the disease stage, symptoms, the available technology and experience of the attending doctor. We present our method for treating dysphagia with the help of intraluminal oesophageal stents. In our practice, the intraluminal oesophageal stent has proven to be a very effective and the most patient-friendly method for optimal delivery of nutrients before and during neoadjuvant therapy. There are few complications, and insertions do not have a negative impact on the perioperative outcomes.Prvi cilji zdravljenja simptomatskih malignomov požiralnika vključujejo vzdrževanje prehranske poti, preprečevanje krvavitev in bolečin. Vsi bolniki potrebujejo multidisciplinarno oceno, da jim zagotovimo primerno, običajno več-modalno terapijo. Opredelitev najbolj ustreznega načina prehranske podpore bolnika z rakom požiralnika mora biti individualna. Zdravljenje je odvisno od stadija bolezni, simptomov, razpoložljive tehnologije in izkušenj lečečega zdravnika. Predstavljamo naš način reševanja disfagije s pomočjo znotraj- -lumenskih opornic požiralnika. V naši praksi se je znotraj- -lumenska opornica požiralnika pokazala za zelo učinkovit in bolniku najprijaznejši način zagotavljanja optimalnega vnosa hranil pred ter med neoadjuvantno terapijo. Zapletov je malo, vstavitve pa nimajo negativnega vpliva na perioperativne izide

[The role of endoluminal stenting during neoadjuvant treatment of esophageal carcinomas]

Prvi cilji zdravljenja simptomatskih malignomov požiralnika vključujejo vzdrževanje prehranske poti, preprečevanje krvavitev in bolečin. Vsi bolniki potrebujejo multidisciplinarno oceno, da jim zagotovimo primerno, običajno več-modalno terapijo. Opredelitev najbolj ustreznega načina prehranske podpore bolnika z rakom požiralnika mora biti individualna. Zdravljenje je odvisno od stadija bolezni, simptomov, razpoložljive tehnologije in izkušenj lečečega zdravnika. Predstavljamo naš način reševanja disfagije s pomočjo znotraj- -lumenskih opornic požiralnika. V naši praksi se je znotraj- -lumenska opornica požiralnika pokazala za zelo učinkovit in bolniku najprijaznejši način zagotavljanja optimalnega vnosa hranil pred ter med neoadjuvantno terapijo. Zapletov je malo, vstavitve pa nimajo negativnega vpliva na perioperativne izide.The first goals of treatment of symptomatic malignomas of the oesophagus include maintenance of the nutritional path and prevention of haemorrhage and pain. All patients require a multidisciplinary assessment in order to get the appropriate regular multi-modal therapy. Definition of the most appropriate nutritional support for the oesophageal cancer patient must be individual. Treatment depends on the disease stage, symptoms, the available technology and experience of the attending doctor. We present our method for treating dysphagia with the help of intraluminal oesophageal stents. In our practice, the intraluminal oesophageal stent has proven to be a very effective and the most patient-friendly method for optimal delivery of nutrients before and during neoadjuvant therapy. There are few complications, and insertions do not have a negative impact on the perioperative outcomes

Toxicity of Magnetic Chitosan Micro and Nanoparticles as Carriers for Biologically Active Substances

Abstract Nanoparticles of inorganic magnetic core surrounded by layers of functional coatings are potential representatives of nanostructures for immobilization of bio-substances. Magnetic nanoparticles (MNPs) are often bound in aggregates due to a strong magnetic dipole, which has a lot of advantages, such as large surface area for binding biologically active substances. Chitosan is a polysaccharide polymer that is non-toxic, hydrophilic, biocompatible and has hydroxy and amino groups in its structure. Because of these chemical and biological properties it is a desirable bio-product for immobilization of enzymes and for binding of other biologically active substances. Magnetic micro and nanoparticles were synthesized with chitosan by three different methods; microemulsion process, suspension cross-linking technique and covalent binding of chitosan. Toxic effect of the prepared magnetic particles was determined as well and was examined on five different bacterial cultures; Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis and Klebsiella pneumoniae. At concentrations of 10-30 mg of magnetic particles per 0.5 McFarland Standard solution of E. coli and per 400 CFU of S. aureus, P. aeruginosa, E. faecalis in K. pneumonia, no inhibition on the chosen bacterial cultures was detected

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Release of growth factors after mechanical and chemical pleurodesis for treatment of malignant pleural effusion

Background: Growth factors are key inducers of fibrosis but can also mediate inflammatory responses resulting in increasing pleural effusion and acute respiratory distress syndrome. The primary aim of the study was to analyse growth factors release after performing chemical and mechanical pleurodesis in the first 48 hours at the patients with malignant pleural effusion. The secondary endpoints were to evaluate the effectiveness of the both pleurodeses, symptoms release and the quality of life of patients after the treatment. Patients and methods: A prospective randomized study included 36 consecutive female patients with breast carcinoma and malignant pleural effusion in an intention-to-treat analysis. We treated 18 patients by means of thoracoscopic mechanical pleurodesis and 18 patients by chemical pleurodesis with talcum applied over a chest tube. We gathered the pleural fluid and serum samples in the following 48 hours under a dedicated protocol and tested them for growth factors levels. A quality of life and visual analogue pain score surveys were also performed. Results: Median measured serum vascular endothelial growth factor (VEGF) level after chemical pleurodesis was 930.68 pg/ml (95% CI: 388.22-4656.65) and after mechanical pleurodesis 808.54 pg/ml. (95% CI: 463.20-1235.13) (p = 0.103). Median pleural levels of transforming growth factor (TGF) ß1 were higher after performing mechanical pleurodesis (4814.00 pg/ml [95% CI: 2726.51-7292.94]) when compared to those after performing chemical pleurodesis (1976.50 pg/ml [95% CI: 1659.82-5136.26]) (p = 0.078). We observed similar results for fibroblast growth factor (FGF) ßthe serum level was higher after mechanical pleurodesis (30.45 pg/ml [95% CI: 20.40-59.42]), compared to those after chemical pleurodesis (13.39 pg/ml [95% CI: 5.04-74.60]) (p = 0.076). Mechanical pleurodesis was equally effective as chemical pleurodesis in terms of hospital stay, pleural effusion re-accumulation, requiring of additional thoracentesis, median overall survival, but, it shortened the mean thoracic drainage duration (p = 0.030) and resulted in a higher symptoms release and in a better quality of life (p = 0.047). Conclusions: We recorded an increase in serum VEGF levels after chemical pleurodesis, however on the contrary, an increase in the pleural fluid level of TGF%1 and FGF%] after mechanical pleurodesis with respect to compared group. Although the differences did not reach statistical significance, VEGF, TGFß1 and FGFß remain the most interesting parameters for future research. Considering the mechanisms of growth factors action, we conclude that in our study group mechanical pleurodesis might be more efficient in terms of growth factors release, thoracic drainage duration and resulted in a higher symptoms release and in a better quality of life than chemical pleurodesis

Thyrotoxic struma ovarii after thyroid ablation: a case report of laparoscopic management

Struma ovarii is a rare type of germ cell tumor and a rare cause of ectopic thyroidal hormonal production. We report a case of laparsocopic management of a thyrotoxic struma ovarii. In a 49-year-old patient, previously treated by ablative surgery and radioactive iodine for Graves\u27 disease, a new onset of hyperthyroidism occurred unexpectedly. A whole-body scan with 131I detected increased pelvic uptake, suggesting struma ovarii. The patient was subsequently treated with laparoscopic bilateral salpingo-oophorectomy. The postoperative course was uneventful. Histopathologic examination revealed the presence of a benign struma ovarii. Three years after treatment the patient is disease free and is receiving thyroid replacement therapy with levothyroxine. In this case the thyrotoxic struma ovarii was diagnosed preoperatively and laparoscopic surgery proved to be a useful and reliable method for ovarian ablation.Struma jajčnika je redka oblika tumorja zarodnih celic, ki predstavlja redek vzrok ektopičnega izločanja ščitničnih hormonov. Poročamo o primeru laparoskopskega zdravljenja strume jajčnika. Pri 49-letni bolnici, ki je bila zaradi Gravesove bolezni predhodno zdravljena z ablativno operacijo in radioaktivnim jodom, se je nepričakovano pojavil hipertiroidizem. Scintigrafija telesa z 131J je pokazala povečano aktivnost v medenici in s tem nakazavala na strumo jajčnika. Bolnico smo zdravili z laparoskopsko običajno adneksektomijo. V pooperativnem poteku ni bilo posebnosti. Histopatološka preiskava je pokazala prisotnost benigne strume jajčnika. Trenutno je bolnica brez znakov bolezni in prejema ščitnično nadomestno zdravljenje z levotiroksinom. V obravnavanem primeru amo še pred operacijo ugotovili diagnozo tirotoksične strume jajčnika, laparoskopska operacija pa se je izkazala za koristno in zanesljivo metodo za odstranitev jajčnika