Background Renal cell carcinoma (RCC) with tumor thrombus extension into the right atrium (level IV) is a rare life-threatening clinical condition that can only be managed by means of a combined urological and cardiac surgical approach. The early and late outcomes of this radical treatment were analyzed in a large single-institution series over a period of 30 years. Methods In 37 patients with RCC and intracardiac tumor thrombus extension, nephrectomy was performed followed by the extraction of the intracaval and intracardiac tumor thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Recently, in 13 patients, selective aortic arch perfusion (SAAP) was instituted during DHCA. Results In all patients, precise removal of the tumor thrombus was accomplished in a bloodless field. The mean duration of isolated DHCA was 15 ± 6 min, and 31.5 ± 10.2 min in the case of DHCA + SAAP, at a mean hypothermia of 22.7 ± 4°C. In-hospital mortality was 7.9% (3 patients). In Kaplan–Meier analysis, the estimated median survival was 26.4 months whereas the 5-year cancer-related survival rate was 51%. Conclusions Despite its complexity, this extensive procedure can be performed safely with a generally uneventful postoperative course. The use of cardiopulmonary bypass with DHCA, with the advantage of SAAP, allows for a safe, precise, and complete extirpation of intracaval and intracardiac tumor mass. Late outcomes after radical surgical treatment in patients with RCC and tumor thrombus reaching up in the right atrium in our series justify this extensive procedure.

Moravek P, Broďak M, Kosina J, Hafuda A, Prosvic P, Safranek H, Moravek P jr. Komplikace po radikalni prostatektomii otevřeným a laparoskopickým přistupem, srovnani výsledků podle Clavienova systemu klasifikace. Cil: Srovnani cetnosti a zavažnosti komplikaci po radikalni prostatektomii provedene otevřeným přistupem (RP) v letech 1993-2012 a laparoskopickým přistupem (LRP) od roku 2008 do konce roku 2012. Metoda: Pro porovnani cetnosti a zavažnosti komplikaci jsme vyhledali 100 po sobě jdoucich otevřených operaci v letech 2004-2005 a 100 po sobě jdoucich laparoskopických operaci v letech 2011-2012. Hodnotili jsme intraoperacni, casne a pozdni pooperacni komplikace dle Clavienova systemu klasifikace (CS) ve skale I-V. Výsledky: Při porovnani casných komplikaci ve skupině A (RP) a skupině B (LRP) dle CS klasifikace II bylo meně komplikaci ve skupině LRP. Při hodnoceni komplikaci dle CS klasifikace III nebyly mezi skupinami RP a LRP rozdily. Komplikace dle CS klasifikace IV a V se nevyskytly. Při porovnani pozdnich komplikaci nebyly zaznamenany rozdily. Zavěry: Otevřený i laparoskopický přistup k radikalni prostatektomii se ukazal jako bezpecný a srovnatelný při hodnoceni podle Clavienova systemu hodnoceni komplikaci. Laparoskopický přistup měl nižsi výskyt mirných (stupeň II) casných komplikaci. Stupeň III a pozdni komplikace byly srovnatelne.

UNLABELLED:What's known on the subject? and What does the study add? Surgical treatment of renal cell carcinoma (RCC) with tumour thrombus extending into the right atrium remains, despite its complexity and specific technical aspects, the only radical therapeutic option. This single-centre study, unique in size for this rare condition, reports early and late results over a period of 18 years. All patients were operated on using a standardised protocol with use of cardiopulmonary bypass and deep hypothermic circulatory arrest. Overall and cancer-specific cumulative survival was better than in other reports.OBJECTIVE:To evaluate the long-term results of radical surgical management of renal cell carcinoma (RCC) with tumour thrombus extension (TTE) level IV into the right atrium (RCC/TTE IV) in a large single-institution series.PATIENTS AND METHODS:Radical complex urological and cardio-surgical procedure was performed over a period of 18 years (1993-2010) on 21 patients with RCC/TTE IV. A radical nephrectomy was performed followed by sternotomy, institution of cardiopulmonary bypass and extraction of the intracardiac tumour thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Perioperative and postoperative variables, and long-term overall and cancer-specific survival using the Kaplan-Meier method were analysed.RESULTS:In all patients, precise removal of tumour thrombus was accomplished in a bloodless field during DHCA. The mean (sd) duration of circulatory arrest was 16 (6) min at a mean hypothermia of 20 (3) °C. In-hospital mortality was 9.5% (two patients). The median survival (including in-hospital mortality) was 25 months. In Kaplan-Meier analysis, 2- and 5-year overall cumulative survival rate was 57 (95% confidence interval, CI 36-78)% and 37 (95% CI 15-58)%, respectively. Cancer-specific cumulative survival was 68 (95% CI 49-89)% at 2 years and 51 (95% CI 28-74)% at 5 years.CONCLUSIONS:Late outcome after radical surgical treatment in patients with RCC and TTE reaching up to the right atrium justifies this extensive procedure. Cardiopulmonary bypass with DHCA allows safe and precise extirpation of all intracaval and intracardiac tumour mass.

We study a simple higher-dimensional toy mode l of electroweak symmetry breaking, in particular a pure gauge 5D theory on flat background with one extra finite space dimension. The principle of least action and the requirement of gauge independence of scattering amplitudes are used to determine the possible choices of boundary conditions. We demonstrate that for any of these choices the scattering amplitudes of vector bosons do not exhibit power-like growth in the high energy limit. Our analysis is an extension and generalization of the results obtained previously by other authors.

To compare acute and late toxicity after three-dimensional conformal radiotherapy to the prostate to 74 Gy (3D-CRT) with intensity-modulated radioterapy to 78 Gy (IMRT 78) and IMRT using simultaneous integrated boost to 82 Gy (IMRT/SIB 82).

Aims and background The prognosis of patients with metastatic colorectal carcinoma (CRC) has improved substantially over the last two decades. Longer patient survival comes at a price of more complications, including second primary neoplasms and metastases at unusual sites. Method Retrospective chart review. Results We present 4 patients with metastatic CRC who developed kidney tumors. In 2 cases, partial nephrectomy or nephrectomy was performed for second primary renal cell carcinoma. The patients survived 2.5 and more than 6 years after kidney surgery. In the other 2 patients the kidney tumors were diagnosed as CRC metastases, histologically verified in one case; these two patients died within two years of diagnosis of kidney involvement. Conclusion The diagnostic approach to kidney tumors in CRC patients should include a biopsy because only patients with primary renal cell carcinoma and selected patients with metastatic CRC benefit from nephrectomy.

Cil:Ověřit mikrobialni nalezy v moci pacientů po cystektomii s rekonstrukci mocových cest s využitim střevniho segmentu ilea, se zjistěnim citlivosti mikrobů na antibakterialni leky a přicin infekce. Ve spolupraci s Ustavem klinicke mikrobiologie vytipovat zajistěni operacniho výkonu vzhledem k primarnimu osidleni střeva bakterialni florou a vhodnost nasledne antibioticke lecby v pooperacnim obdobi.Material a metoda:V souboru 31 nemocných po cystektomii s kontinentni derivaci v modifikaci V.I.P. (Vesica ileale padovana) operovaných na Urologicke klinice v Hradci Kralove v letech 1998-2007 jsme v intervalech po 1, 3 a 6 měsicich vysetřili kvantitativni bakteriurii (KBU), citlivost na antibiotika a ucinnost podane antimikrobni lecby.Výsledky:Bakteriurie se v pooperacnim obdobi vyskytla u 35,5% nemocných. Nejcastěji slo o Escherichia coli citlivou na běžna antibiotika. Z ostatnich uropatogenů byly prokazany zejmena Pseudomonas aeruginosa, Enterococcus faecalis a Klebsiella pneumoniae s citlivosti jen na vazana antibiotika. I přes cilenou lecbu byla bakteriurie opakovaně pozitivni, ale klinicky v 77,4 % asymptomaticka.Zavěr:Dle zkusenosti lze k zajistěni operace využit chinolony, trimetoprim se sulfamethoxazolem nebo ampicilin s inhibitorem beta-laktamaz v kombinaci s metronidazolem (i.v.) podane jednu hodinu předoperacně a nasledně po operaci 7-10 dni. Přetrvavajici asymptomatickou bakteriurii neni třeba v souladu s literarnimi citacemi lecit, v připadě aktivace infekce s klinickými znamkami sepse nebo pyelonefritidy je třeba ihned nasadit antibiotika dle citlivosti.

Fas ligand (FasL) causes apoptosis of epidermal keratinocytes and triggers the appearance of spongiosis in eczematous dermatitis. We demonstrate here that FasL also aggravates inflammation by triggering the expression of proinflammatory cytokines, chemokines, and adhesion molecules in keratinocytes. In HaCaT cells and in reconstructed human epidermis (RHE), FasL triggered a NF-κB-dependent mRNA accumulation of inflammatory cytokines (tumor necrosis factor-α, IL-6, and IL-1β), chemokines (CCL2/MCP-1, CXCL1/GROα, CXCL3/GROγ, and CXCL8/IL-8), and the adhesion molecule ICAM-1. Oligomerization of Fas was required both for apoptosis and for gene expression. Inhibition of caspase activity abolished FasL-dependent apoptosis; however, it failed to suppress the expression of FasL-induced genes. Additionally, in the presence of caspase inhibitors, but not in their absence, FasL triggered the accumulation of CCL5/RANTES (regulated on activation normal T cell expressed and secreted) mRNA. Our findings identify a novel proinflammatory role of FasL in keratinocytes that is independent of caspase activity and is separable from apoptosis. Thus, in addition to causing spongiosis, FasL may play a direct role in triggering and/or sustaining inflammation in eczemas.

Antibiotic prophylaxis is an important measure aimed at reduction of infectious complications after urologic procedures. The goal of this prospective study is assessment of the efficacy, safety and cost of short-time antibiotic prophylaxis before planned urologic surgery. Uncomplicated cystoscopy, urodynamic examination and ESWL were performed without antibiotic prophylaxis. Oral quinolones were effective in prostate biopsy. In open, laparoscopic or endoscopic surgery intravenous prophylaxis by cephalosporins had excellent efficacy. All types of prophylaxes were very safe and without adverse effects, and could be applied at low economic cost.

[1] Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007;356:115 24. [2] Figlin RA, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Negrier S, et al. Overall survival with sunitinib versus interferon (IFN)-alfa as first-line treatment of metastatic renal cell carcinoma (mRCC). Oral (abstract 5024). Presented at the 44th American Society of Clinical Oncology Annual meeting, Chicago, USA, May 30 June 3, 2008. [3] Demetri GD, van Oosterom AT, Garrett CR, Blackstein ME, Shah MH, Verweij J, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: A randomized controlled trial. Lancet 2006;368:1329 38. [4] Schmidinger M, Zielinski CC, Vogl UM, Bojic A, Bojic M, Schukro C, et al. Cardiac toxicity of sunitinib and sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 2008;26:5204 12. [5] Force T, Krause DS, Van Etten RA. Molecular mechanisms of cardiotoxicity of tyrosine kinase inhibition. Nat Rev Cancer 2007;7:332 44. [6] Chu TF, Rupnick MA, Kerkela R, Dallabrida SM, Zurakowski D, Nguyen L, et al. Cardiotoxicity associated with tyrosine kinase inhibitor sunitinib. Lancet 2007;370 (9604):2011 19. [7] Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation 2006;114:2474 81. [8] Pfizer Inc. SUTENT, Summary of Product Characteristics. January 2008. Accessed 23/04/2008. http://emc.medicines. org.uk/emc/industry/default.asp?page displaydoc.aspd3:682 92. [11] Joensuu H. Cardiotoxicity of sunitinib. Lancet 2007;370: 1978 9.

Using the protein array method we determined the serum levels of a number of angiogenic factors. We identified serum levels of angiogenin, PDGF and MCP-1 (CCL2 chemokine) in serum of 32 patients with RCC, and 14 healthy volunteers by means of antibody array analysis. The patients were divided into three groups according to their disease stages (I+II, III, and IV). We found significant differences between the controls and patients with RCC both pre-operatively and post-operatively in angiogenin, PDGF and MCP-1 serum levels. The increase in angiogenin, PDGF and MCP-1 lasted in patients with RCC stages I-III even without metastases eight weeks post-operatively. The patients with stage IV RCC showed disturbed production of PDGF and MCP-1. Protein array analysis is a powerful tool for the identification of large numbers of trace proteins. Multiplex antibody array is able to provide data more precisely reflecting the nature of pathological processes.

INTRODUCTION When checking tumour growth, a number of observations indicate that the immune system plays a significant role in patients with renal cell carcinoma (,,RCC"). Infiltration by lymphocytes (tumour infiltrating lymphocytes, "TILs") is more prevalent in RCC than any other tumours. T lymphocytes are the dominant population of TIL cells. Views concerning the role ofT lymphocytic subpopulations, B lymphocytes and NK cells in an anti-tumour response are not established. AIM The aim is to determine the phenotype and activation of lymphocytic cells and to compare their representation in tumour stroma (TIL), peripheral blood (PBL) and renal vein blood in patients with RCC. PATIENTS AND METHODS The samples of peripheral blood taken from the cubital and renal veins and tumour stroma cells were obtained from 60 patients in the course of their surgeries carried out due to primary RCC. TILs were isolated from mechanically disintegrated tumour tissue. Immunophenotype multiparametric analysis of PBL and TILs was carried out. Their surface and activation characteristics were determined by means of flow cytometer. RESULTS CD3+ T lymphocytes (70.4%) were the main population of TILs. The number of CD3+/CD8+ T lymphocytes was significantly higher in TILs, 39.7% (p < 0.01), while CD4+ T lymphocytes were the majority population in peripheral blood, 41.35% (p < 0.001). The representation of CD3+/69+ T lymphocytes was significantly higher in TILs, 32.05%, compared to PBL (p < 0.001). On the contrary, the numbers of CD3+/CD25+, CD8+/57+ and CD4+/RA+ (naive CD4+ T lymphocytes) were higher in PBL (p < 0.001). The differences in representation of (CD3+/16+ 56+) NK cells and CD3+/DR+ T cells in TILs and PBL were not significant. CONCLUSION The above-mentioned results prove that the characteristics and intensity of anti-tumour responses are different in compared compartments (tumour/PBL). CD3+/CD8+ T lymphocytes are the dominant lymphocytic population of TILs. The knowledge of phenotype and functions ofeffector cells, which are responsible for anti-tumour response, are the basic precondition for understanding the anti-tumour immune response and the cause of its failure.

Tumour progression requires the presence of a rich vascular supply. A number of cytokines, chemokines and proteases participate in the process of tumour angiogenesis. We evaluated serum levels of angiogenin, panGRO (Growth Related Oncogene) (CXCL 1,2,3) and ENA-78 (Epithelial Neutrophil Activating) (CXCL5) in the serum of 32 patients with RCC (renal cell carcinoma) and 14 healthy blood donors by means of a protein array analysis. The patients were divided into three groups according to their disease stages (I+II, III, IV). We discovered significant differences between the blood donors and patients with RCC both in pre-operative and post-operative angiogenin, panGRO and ENA-78 levels. The increase in angiogenic factors lasted in patients even without metastases 2 months after surgery. We found no correlation between the levels of angiogenin and stages I+II, III and IV RCC. Patients with advanced carcinoma (stage III) had pre-operatively higher serum levels of ENA-78 than patients with stages I+II (p = 0,009) and IV (p< 0.001). Eight weeks after surgery the patients with stages I+II had significantly higher levels of panGRO than patients with stage IV.