Miloslav Rocek

Transarterial chemoembolisation (TACE) using irinotecan-loaded beads for the treatment of unresectable metastases to the liver in patients with colorectal cancer: an interim report

BackgroundFollowing failure of standard systemic chemotherapy, the role of hepatic transarterial therapy for colorectal hepatic metastasis continues to evolve as the experience with this technique matures. The aim of this study to gain a better understanding of the value of drug eluting bead therapy when administered to patients with unresectable colorectal hepatic metastasis.MethodsThis was an open-label, multi-center, single arm study, of unresectable colorectal hepatic metastasis patients who had failed standard therapy from 10/2006-10/2008. Patients received repeat embolizations with Irinotecan loaded beads(max 100 mg per embolization) per treating physicians discretion.ResultsFifty-five patients underwent 99 treatments using Irinotecan drug eluting beads. The median number of total treatments per patient was 2(range of 1-5). Median length of hospital stay was 23 hours(range 23 hours - 10 days). There were 30(30%) sessions associated with adverse reactions during or after the treatment. The median disease free and overall survival from the time of first treatment was 247 days and 343 days. Six patients(10%) were downstaged from their original disease status. Of these, four were treated with surgery and two with RFA.Neither number of liver lesions, size of liver lesions or extent of liver replacement(<= 25% vs >25%) were predictors of overall survival. Only the presence of extrahepatic disease(p = 0,001), extent of prior chemotherapy (failed 1st and 2nd line vs > 2 line failure)(p = 0,007) were predictors of overall survival in multivariate analysis.ConclusionChemoembolization using Irinotecan loaded beads was safe and effective in the treatment of patients as demonstrated by a minimal complication rate and acceptable tumor response.

Cortical and subcortical atrophy in alzheimer disease: Parallel atrophy of thalamus and hippocampus

Brain atrophy is a key imaging hallmark of Alzheimer disease (AD). In this study, we carried out an integrative evaluation of AD-related atrophy. Twelve patients with AD and 13 healthy controls were enrolled. We conducted a cross-sectional analysis of total brain tissue volumes with SIENAX. Localized gray matter atrophy was identified with optimized voxel-wise morphometry (FSL-VBM), and subcortical atrophy was evaluated by active shape model implemented in FMRIB’s Integrated Registration Segmentation Toolkit. SIENAX analysis demonstrated total brain atrophy in AD patients; voxel-based morphometry analysis showed atrophy in the bilateral mediotemporal regions and in the posterior brain regions. In addition, regarding the diminished volumes of thalami and hippocampi in AD patients, subsequent vertex analysis of the segmented structures indicated shrinkage of the bilateral anterior thalami and the left medial hippocampus. Interestingly, the volume of the thalami and hippocampi were highly correlated with the volume of the thalami and amygdalae on both sides in AD patients, but not in healthy controls. This complex structural information proved useful in the detailed interpretation of AD-related neurodegenerative process, as the multilevel approach showed both global and local atrophy on cortical and subcortical levels. Most importantly, our results raise the possibility that subcortical structure atrophy is not independent in AD patients.

Mechanical thrombectomy performs similarly in real world practice: a 2016 nationwide study from the Czech Republic

Background Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis. Methods Available nationwide data for the CR from 2016 from the Safe Implementation of Treatments in Stroke–Thrombectomy (SITS-TBY) registry for patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusions were compared with data from HERMES. CR and HERMES patients were comparable in age, sex, and baseline National Institutes of Health Stroke Scale scores. Results From a total of 1053 MTs performed in the CR, 845 (80%) were reported in the SITS-TBY. From these, 604 (72%) were included in this study. Occlusion locations were as follows (CR vs HERMES): ICA 22% versus 21% (P=0.16), M1 MCA 62% versus 69% (P=0.004), and M2 MCA 16% versus 8% (P<0.0001). Intravenous thrombolysis was given to 76% versus 83% of patients, respectively (P=0.003). Median onset to reperfusion times were comparable: 232 versus 285 min, respectively (P=0.66). A modified Thrombolysis in Cerebral Infarction score of 2b/3 was achieved in 74% (433/584) versus 71% (390/549) of patients, respectively (OR 1.17, 95% CI 0.90–1.5, P=0.24). There was no statistically significant difference in the percentage of parenchymalhematoma type 2 (OR 1.12, 95% CI 0.66–1.90, P=0.68). A modified Rankin Scale score of 0–2 at 3 months was achieved in 48% (184/268) versus 46% (291/633) of patients, respectively (OR 0.92, 95% CI 0.71–1.18, P=0.48). Conclusions Data on efficacy, safety, and logistics of MT from the CR were similar to data from the HERMES collaboration.

Thoracic Outlet Syndrome: A Significant Family Genetic Phenotypic Presentation

We report on a very rare case of diagnosis and successful surgical treatment of three young family members with a four-fold presentation of thoracic outlet syndrome. In the relevant family case, we are considering and discussing the population incidence, a possible HOX genes disorder, and a significant phenotypic presentation.

Evaluation of white matter alterations in Alzheimer's disease and normal pressure hydrocephalus as measured by diffusion weighted MRI

IN ALZHEIMER’S DISEASE AND NORMAL PRESSURE HYDROCEPHALUS AS MEASURED BY DIFFUSION WEIGHTED MRI Daniel Horinek, Irena Buksakowska, Nikoletta Szab o, Eszter T oth, Vlastimil Sulc, Luka s Martinkovi c, Ji r ı Vr ana, Martin Vyhnalek, Franti sek Charv at, Miloslav Ro cek, L aszl o V ecsei, Jakub Hort, Tam as Kinsces, Charles Universit, 1st Medical Faculty, and University Central Military Hospital, Prague, Czech Republic; Charles University in Prague and University Hospital Motol, Prague, Czech Republic; Albert Szent-Gy€orgyi Clinical Center, University of Szeged, Szeged, Hungary; International Research Center, St. Anne’s University Hospital, Brno, Czech Republic; Charles University, 2nd Medical Faculty and University Hospital Motol,, Czech Republic; 6 University Central Military Hospital, Prague, Czech Republic; 7 Department of Neurology, Motol University Hospital, Prague, Czech Republic; International Research Center, Brno, Czech Republic.

Integrative assessment of brain atrophy in Alzheimer's disease: Parallel hippocampal and thalamic atrophy

try(VBM) using statistical parametric mapping (SPM). Results: AD showed poorer performance of CDP, such as swaying distances, velocities and numbers of falling in unilateral stance, and medio-lateral swaying distance and velocity in sensory organization test than controls. Motor latency and antero-posterior swayingwere not different between groups. Therewere significant correlations of the performance in the unilateral stancewith frontal function tests, verbal memory and BNT. Although the cognitive status between AI+ and AIwas not different, there were gray matter atrophy in the bilateral SMA, right inferior frontal and right rectus gyrus when AI+ were compared to controls, and in left inferior frontal area when to AI(P<0.001). Conclusions: Postural instability was more prominent in AD and it was associated with gray matter atrophy in frontal and prefrontal regions responsible for attention and motor controls. We can speculate that postural instability might be an epiphenomenon of AD or be affected by the atrophy of the localized frontal areas.