University Hospital Ostrava Research Articles

Overexpression of the miR-143/145 and reduced expression of the let-7 and miR-126 for early lung cancer diagnosis.

Lung cancer is the leading cause of cancer-related deaths worldwide. For this reason, huge efforts are being invested in discovering suitable blood biomarkers that would allow early diagnosis and treatment. One of the possible promising candidates for this role are microRNA molecules (miRNAs). The aim of the study was to identify individual blood miRNAs that could be used as potential biomarkers for early diagnosis of lung cancer. This prospective study analyzed blood samples of 60 patients with early-stage lung cancer, and blood samples of 60 healthy individuals. All study patients with lung cancer had undergone radical pulmonary resection at the University Hospital Ostrava within the study period (2015-2017). Definitive diagnosis of lung cancer was confirmed by histopathology examination of the resected pulmonary specimen. We investigated relative expressions in selected 13 blood miRNAs; the examined miRNAs were miR-126, miR-155, miR-221, miR-21, miR-143, miR-145, miR-133a, let-7a, miR-146a, miR-31, miR-182, let-7g and miR-19b. The outcome of this study showed that the levels of the majority of the tested circulating miRNA in lung cancer patients are significantly altered. The most significant serum miRNA biomarkers for the early detection of lung cancer are as follows: miR-143, let-7g, miR-126, let-7a, and miR-145 (miR-143 and miR-145 have oncogene functions, while miR-126, let-7g and let-7a have suppressor functions). We have demonstrated the excellent diagnostic value of several miRNAs (miR-126, miR-143, miR-145, let-7a and let7g). These have an estimated sensitivity and specificity of 75-85% and 0.90-0.93 AUC. However, these individual miRNA biomarkers require further validation in larger prospective cohorts.

THE NETWORKING OF MAINTENANCE ENTITIES FOR PRODUCTION AND OTHER PROCESSES

The high share of maintenance costs in manufacturing processes and their continuing low efficiency lead to a search for solutions to this problem not only in the organization and management of internal maintenance, but also in outsourcing and interconnecting the maintenance entities into separate but cooperating partner units. The creation of business networking, recently applied in manufacturing processes, offers significant potential for efficiency in specific fields of manufacturing and other equipment maintenance. Applying such a system can increase flexibility, professionalism, operability and the quality of maintenance through new digital, virtual, organizational and working forms. This article deals with the assessment of the possibility of creating business networks for maintenance processes within production and non-production operations, which use machinery and other equipment for their activities, and it also deals with a demonstration of the significant economic and non-economic benefits. It is based on process analysis of the company Vitkovice Heavy Machinery (VHM), University Hospital Ostrava and on research in other industrial companies.

Endovascular Repair of Thoracic Aorta Injury: 17 Years of Single-Center Experience.

BackgroundTraumatic thoracic aortic transection is one of the most severe complications of high-energy injuries, but patients rarely receive treatment, and it is fatal in the vast majority of cases. Due to the complexity of surgical revision for transection, endovascular repair with stent graft implantation is the preferred approach.Material/MethodsWe retrospectively analyzed the short-term and long-term treatment results for 31 patients (29 men, 2 women) treated at the Interventional Radiology Department, University Hospital Ostrava, for the isthmus part of a descending thoracic aorta injury between 2004 and 2020.ResultsThe median patient age was 48 years (interquartile range [IQR]: 28–63 years). The most common causes of injury were traffic accidents and falls or jumps, with the trauma location at the Ishimaru zones 2 to 4 of the aortic isthmus. Aortic stent grafts were successfully implanted in all patients; 13% of patients had complications and 10% died due to the trauma severity. The median procedure duration was 30 min (IQR: 25–43 min) and the median hospital stay was 29 days (IQR: 28–63 days).ConclusionsAortic stent graft implantation appears to be a safe and effective method for dealing with thoracic aorta injury, with a low complication rate and high patient survival. The endovascular approach is the method of choice for treating this severe disease, and a multidisciplinary approach for emergency medical treatment with a comprehensive trauma protocol is essential.

Laparoscopic versus open hernia repair in patients with incarcerated inguinal hernia.

Laparoscopic approach is employed very rarely in the treatment of patients with incarcerated inguinal hernia. The aim of the present study was to evaluate the safety and benefits of laparoscopic hernioplasty (TAPP) in the treatment of incarcerated inguinal hernia. It was a retrospective clinical study focused on comparison of perioperative and postoperative outcomes of laparoscopic and open hernia repair of incarcerated inguinal hernia. All adult patients undergoing surgery for incarcerated inguinal hernia at the University Hospital Ostrava between 2014 and 2018 were included in the study. In total, 31 patients were enrolled into the study (20 patients with open hernia repair and 11 patients with laparoscopic transabdominal preperitoneal hernioplasty [TAPP]). Operative time was shorter in the laparoscopic group (69.5 vs 82.2 min, p=0.444); length of hospital stay was significantly shorter in the TAPP group (3.45 vs 8.5 days, p=0.010). Postoperative complications were more frequent in the open hernia repair group (40% vs 0.0%, p=0.134); the difference was not statistically significant. Laparoscopic hernioplasty provides a safe and effective operating technique for patients with incarcerated inguinal hernia.

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis

BackgroundClosure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure.MethodsThis was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler).ResultsIn total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was—104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072).ConclusionsThe present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 (http://www.clinicaltrials.gov).

Laparoskopická nebo klasická splenektomie?

Introduction: With current development of mini-invasive techniques, laparoscopic splenectomy also gained its place under the sun. The goal of this study is to compare the results of open and laparoscopic splenectomy performed at Clinic of Surgery of University Hospital Ostrava in the period 2010–2019. Materials and Methods: A retrospective cohort study during the period 2010–2019 were counted: an operation time, a need of blood transfusions, weight, complications and duration of hospital stay. A group of patients with laparoscopic operation was compared to a group with an open operation, using the t-test. Results: During the period 2010–2019, we performed 23 laparoscopic splenectomies and 15 classic operations. Unfortunately, the comparison of both groups is difficult. The splenic weight differs in both groups statistically significantly (P = 0.0001). The patients in the classic laparotomy group had much bigger spleens and in four cases, the splenectomy was performed together with metastasectomy of the liver, diaphragmatic resection and resection of the tale of pancreas. Even then the operative time was significantly shorter than the operative time of laparoscopic operation – the operative times differ in both groups statistically significantly (P = 0.0001). The need of blood transfusion and operative complications appear to be comparable in both techniques. The duration of hospital stay was shorter in the patients with laparoscopic operation. Conclusion: Laparoscopic splenectomy off ers all the general benefi ts of mini-invasive operative techniques and is suitable method for patients undergoing elective splenectomy especially for spleens smaller than 20 cm in diameter. We consider portal hypertension and severe comorbidities of the patient to be a contraindication. It seems to us that the main problem of this method lies in a very small number of operated patients and thus in a limited possibility to obtain sufficient surgical erudition, which is probably the case of some complications and insufficient use of this method in practice. It is highly desirable to concentrate these services in the centers.

Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)-A Comprehensive Review.

The electrophysiology-guided noninvasive cardiac radioablation, also known as STAR (stereotactic arrhythmia radioablation) is an emerging treatment method for persistent ventricular tachycardia. Since its first application in 2012 in Stanford Cancer Institute, and a year later in University Hospital Ostrava, Czech Republic, the authors from all around the world have published case reports and case series, and several prospective trials were established. In this article, we would like to discuss the available clinical evidence, analyze the potentially clinically relevant differences in methodology, and address some of the unique challenges that come with this treatment method.

Osteolytická ložiska, hyperkalcemie a paraprotein, ale myelom to není

In June 2018, 77-year-old man was referred to The Department of Haematooncology, University Hospital Ostrava, for suspicion of multiple myeloma. This was supported by laboratory findings of hypercalcemia, paraprotein IgA κ in serum and by the presence of multiple osteolytic skeletal lesions. Low number of plasma cells in bone marrow sample - cytologically (3.6 %) as well as in flow cytometry (less than 95 % clonal plasma cells out of total bone marrow plasma cells) - pointed at the direction of monoclonal gammopathy of undetermined significance (MGUS). In the course of differential diagnosis of hypercalcemia, elevated level of parathormone had been found which led to the performance of 99mTc-MIBI scintigraphy where parathyroid adenoma was discovered and later histologically verified. The final diagnosis was determined as a coincidence of MGUS and primary hyperparathyroidism. This case report also contains brief differential diagnosis of hypercalcemia and osteolytic skeletal lesions and suggestions for their diagnostic algorithms.

Determination of chitinase 3-like 1 in cerebrospinal fluid in multiple sclerosis and other neurological diseases

ObjectivesChitinase 3-like 1 (CHI3L1) is an extracellular monomeric single-chain glycoprotein expressed by many types of cells. Its elevated levels were found in cerebrospinal fluid in central nervous system (CNS) inflammatory diseases patients. The aim of the study was 1) to validate the reference interval of cerebrospinal fluid (CSF) CHI3L1 in a control group; 2) to measure the CHI3L1 concentration in different diagnosis groups .including multiple sclerosis (MS); and 3) to correlate those values with other biomarkers of axonal damage or neuroinflammation in different grous.MethodsThe study included 132 CSF samples sent to the Department of Clinical Biochemistry, Institute of Laboratory Diagnostics, University Hospital Ostrava. Concentrations of CHI3L1, CXCL13 chemokine, neurofilament light chains, and phosphorylated neurofilament heavy chains were determined by enzyme-linked immunosorbent assays. IgG oligoclonal bands were detected by isoelectric focusing in agarose gels followed by immunofixation. IgM and FLC oligoclonal bands were analyzed by IEF followed by affinity immunoblotting. The group consisted of 42 patients with multiple sclerosis, 14 with clinically isolated syndrome, 11 with other central nervous system inflammatory diseases, 46 with non-inflammatory diseases of the central nervous system, 4 with inflammatory diseases of the peripheral nervous system, and 15 controls.ResultsThe estimated reference values of CHI3L1 were 28.6–182.5 μg.L-1. Statistically significant differences of CSF CHI3L1 concentrations were found among diagnosis groups (p < 0.0001), after age adjustment (p = 0.002). There was a statistically significant relationship between CHI3L1 and NFL in the MS group (rs = 0.460; P = 0.002), and between CHI3L1 and pNFH in the MS group (rs = 0.691; P < 0.001). No statistically significant difference was found in the categorical comparison of CHI3L1 in the MS group and other diagnostic groups as well as when using the Mann-Whitney U test for CHI3L1 with additional parameters with and without oligoclonal bands present.ConclusionsCSF CHI3L1 values differ depending on diagnosis and correlate significantly with concentrations of the axonal damage markers CSF neurofilament light chains, and CSF phosphorylated neurofilament heavy chains, but not with CSF concentrations of the inflammatory marker CXCL13. Thus, CSF CHI3L1 could be another promising prognostic, albeit probably etiologically nonspecific, biomarker of MS.

Genetic Causes of Rare Pediatric Ovarian Tumors.

Ovarian tumors in childhood and adolescence are distinguished from those that arise in adulthood by their histological subtype. These tumors may arise as the first manifestation of a cancer predisposition syndrome. Correct diagnosis of the syndrome may offer the possibility of surveillance for other members of the patients family. To summarize current knowledge about paediatric ovarian tumors that may be associated with genetically defined cancer syndromes. Juvenile granulosa cell tumors occur in those with Ollier disease and Maffucci syndrome; they are caused by postzygotic IDH1 and IDH2 gene mutations. Sertoli-Leydig cell tumors usually arise in association with DICER1 syndrome, which is caused by germline DICER1 gene mutations. Sex cord tumors with annular tubules and Sertoli cell tumors may arise in patients with Peutz-Jeghers syndrome; this syndrome is caused by germline STK11 gene mutations. The majority of germ cell tumors develop in the context of gonadal dysgenesis. In XY gonadal dysgenesis, the presence of a Y chromosome material renders the patient at increased risk for developing gonadal malignancy. Characteristically, these patients develop gonadoblastoma, which has the potential to evolve into dysgerminoma and exhibit malignant behavior. Sex-chromosome aneuploidy syndromes or mutations in genes involved in gonadal development and differentiation may cause gonadal dysgenesis. Small cell carcinoma of the ovary of a hypercalcaemic type is usually caused by loss-of-function mutations in the SMARCA4 gene. Ovarian tumors are uncommon during childhood and adolescence. It is always necessary to consider gonadal dysgenesis or any of the inherited cancer syndromes. These patients require interdisciplinary care, careful noting of personal and family history, precise clinical examination, laboratory testing, and differential diagnosis by a clinician with a good knowledge of genetic syndromes. Expert pathological review may be required for correct diagnoses. This is necessary for appropriate management and to establish an association with hereditary cancer syndromes. The work was supported by the Ministry of Health of the Czech Republic - Conceptual Development of Research Organization, Faculty Hospital of Ostrava /2015. We thank to Lenka Foretová, M.D., Ph.D., (MMCI, Brno) and Radoslava Tomanová, M.D., (Institute of Pathology, University Hospital Ostrava) for rewarding advice, Mrs. Jana N&#283;mcová (Department of Medical Genetics, University Hospital Ostrava), Bc. Ludmila Stuchlá and Mrs. Lenka Ziv&#269;áková (Medical Library, University Hospital Ostrava) for help during manuscript preparation. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 10. 3. 2019 Accepted: 16. 4. 2019.

Effect of antibiotic therapy on proton MR spectroscopy findings in human pyogenic brain abscesses.

This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment for pyogenic brain abscess. This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012-2017. Preoperative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in 23 patients who had undergone antibiotic therapy for less than 72 hours beforehand (median 7 hours; IQR 30 hours). The 20 patients who underwent antibiotic therapy for longer than this (the median time was 336 hours with an IQR of 284 hours) showed no abscess-specific metabolites, only nonspecific lactate and/or lipid resonance (P<0.0005). These results were further compared with culture findings of pus samples taken intraoperatively: a significantly higher rate of positive culture (78.2%) was determined in cases where antibiotics were administered less than 72 hours before MRS (P<0.0005). Prolonged antibiotic therapy can influence MRS findings in pyogenic brain abscesses - a fact which is certainly necessary to take into account in its differential diagnosis. The disappearance of the characteristic metabolites can be indirectly interpreted as an indicator of successful antibiotic therapy in cases where surgical intervention is not possible. Further study in this field is required to confirm the results of this study.

Brain abscess and pyocephalus: our experience with treatment.

Pyocephalus always presents serious complications in the treatment of brain abscesses, and is associated with high rates of mortality and morbidity. This study aimed to comprehensively evaluate this understandably feared complication from a purely medical perspective by using an evidence-based approach and drawing comparisons from the available literature, which mostly comprises case reports. This was a prospective monocentric study of all patients treated for brain abscesses at the Neurosurgery Clinic of the University Hospital Ostrava between 2012 and 2017. The cohort was divided into two groups for statistical comparison; one group comprised those in which pyocephalus occurred before or during treatment, while the other group comprised patients without this complication. Particular consideration was given to the effect of pyocephalus on morbidity and mortality rates and C-reactive protein levels, as well as to the identification of risk factors, and to its possible therapeutic influence. Patients were followed up for six months. A total of 43 patients were treated for a brain abscess. An unequivocal diagnosis of pyocephalus was established via CT and MRI brain scans in five cases (11.6%). In the cohort as a whole, mortality and morbidity rates were 23.3% and 48.8% respectively. Among patients with pyocephalus the incidence of mortality and morbidity was 40% and 66.6% respectively. The presence of pyocephalus is not a significant predictor of either morbidity (p 0.575) or mortality (p 0.664). In patients with pyocephalus, we determined elevated CRP levels on the day of surgery (p 0.038). The occurrence of epileptic seizures in the acute phase of the disease is associated with a poor outcome (p 0.039). Pyocephalus will continue to be a serious complication in the treatment of brain abscesses, although we were unable to determine its utility as a prognostic factor. Patients with this complication have elevated CRP levels on the day of operation.

Ocular Manifestations in Patients with HIV infection.

To evaluate the characteristics and incidence of ophthalmic manifestations in patients with HIV (Human Immunodeficiency Virus) infection. Aretrospective evaluation of medical records of 147 patients with HIV infection (22 female, 125 male), the average age of 41 (range 22-79 years) examined by an ophthalmologist at the Clinic of Ophthalmology at the University Hospital Ostrava in years 1987 - 2015. Ophthalmic manifestations of HIV were observed in 16 patients (11.9 %). There was not observed ocular involvement in patients in asymptomatic stage of HIV infection. Ophthalmic complications were observed in 1 patients (0.7 %) in early symptomatic stage and 15 patients (10.2 %) with stage AIDS (Acquired Immune Deficiency Syndrome). The most frequent ocular symptoms were caused by the virus (HIV retinopathy, mikroangiopathy) - total of 13 infected (76.5 %). Three patients had opportunity infections (17.6 %). As aresult of the underlying AIDS disease 5 patients died. Ocular findings were observed at 2 of those (40.0 %). Ocular manifestation are common finding in late stages of HIV infection. Ophthalmic examination is an integral part of the diagnostic algorithm of patients with HIV infection. Most frequently, ocular symptoms have been found within the group of patients with advanced part of disease, which is in relation with the body´simmune defense decrease thus death itself.

Meckel's Diverticulum in Children-Parameters Predicting the Presence of Gastric Heterotopia.

The presence of gastric ectopic mucosa in Meckel's diverticulum is associated with a higher risk of development of complications. The aim of the present study was to investigate which demographic/clinical parameters predict the presence of gastric heterotopia in Meckel's diverticulum. This was a retrospective cohort study conducted in a single institution (University Hospital Ostrava, Czech republic). All children who underwent laparoscopic/open resection of Meckel's diverticulum within a 20-year study period were included in the study. In total, 88 pediatric patients underwent analysis. The mean age of the children was 4.6 ± 4.73years; the male-female ratio was approximately 2:1. There were 50 (56.8%) patients with asymptomatic Meckel's diverticulum in our study group. Laparoscopic resection was performed in 24 (27.3%) patients; segmental bowel resection through laparotomy was performed in 13 (14.8%) patients. Gastric heterotopia was found in 39 (44.3%) patients; resection margins of all patients were clear of gastric heterotopia. No correlation was found between the presence of gastric heterotopia and the following parameters: age, gender, maternal age, prematurity, low birth weight, perinatal asphyxia, distance from Bauhin's valve and length of Meckel's diverticulum. The width of the diverticulum base was significantly higher in patients with gastric heterotopia (2.1 ± 0.57 vs. 1.2 ± 0.41cm; p < 0.001). According to the study outcomes, the width of the diverticulum base seems to be a significant predictive factor associated with the presence of gastric heterotopia in Meckel's diverticulum. The laparoscopic/open resection of asymptomatic MD with a wide base should therefore be recommended.

Critical Analysis of ALPPS Procedure: A Single Centre Experience

The ALPPS (Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy) method was presented to the expert public with the intention of providing a chance to patients with metastatic or primary liver cancer and a lack of residual parenchyma excluding resection therapy which is considered to be the only curative treatment. This method has been regarded as controversial due to its high mortality and morbidity on the one hand and high resection success rate on the second hand. The article presents the initial experience from one workplace. Materials and Methods: From August 2013 to June 2014 eight patients were selected for ALPPS method of hepatic resection at the Surgery of the University Hospital Ostrava Czech republic. For all patients the initial FLR (future liver remnant) volume was less than 25% and they have exhausted other treatment options for the disease. Results: The group consisted of two men and six women, aged 40 to 70. Four patients had CRC (colorectal cancer) liver metastases and two patients were diagnosed with gallbladder cancer metastatic to the liver. The first female patient suffered from hilar cholangiocarcinoma and the last female patient had leiomyosarcoma. Altogether six patients were subject to both phases of the therapy (75% of cases). From the entire patient group one female patient died after the first phase due to haemorrhagic shock, and one was assessed by the multidisciplinary team as unsustainable for the second phase. Remaining all six patients who underwent both phases of surgery had R0 resection but three of them had severe liver failure and they ended fatally. Conclusion: ALPPS is a new method for inducing rapid hypertrophy of the liver parenchyma based on the ligation the portal vein branch and in-situ splitting. However this therapy is still burdened by a relatively high rate of morbidity and mortality which are directly related to the tumour’s histological character to the age of the patient and to the functional state of their hepatic parenchyma

Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery

BackgroundThe aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery.MethodsThe observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, 35 of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with discision and ablation of the ligament of Marshall (Group GP). A control group was consisted of 65 patients without ganglionated plexi intervention (Group LA). The main primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up.ResultsEvaluation of the number of patients with a normal sinus rhythm in per cent has shown comparable values in both groups (Group GP - 93.75%, Group LA – 86.67%, p = 0.485); comparable results were also observed in patients with normal sinus rhythm without anti-arrhythmic treatment in the 12th month (Group GP – 50%, Group LA – 47%, p = 0.306). We have not observed any relation between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, or between the presence of a mitral and tricuspid valves surgery and between the left atrial diameter > 50 mm.ConclusionsEnhancement of left atrial cryoablation by gangionated plexi ablation did not influence the outcomes of surgical ablation due to atrial fibrillation in our population in the course of 12-month follow-up.Trial registrationThe study was approved retrospectively by the Ethics Committee of the University Hospital Ostrava (reference number 867/2016).

Incidence and risk factors for delirium development in ICU patients - a prospective observational study.

Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

Assessing needs of family members of inpatients with advanced cancer.

To provide high-quality and effective cancer care, problems and unmet needs of family members during their relatives' hospitalisation have to be identified as well. The aims were to determine how needs of family members of patients with terminal cancer are met and to analyse factors that influence them. The needs were assessed with the Family Inventory of Needs. Each item (n=20) represents one need of family members, for which the importance and satisfaction are rated. The study comprised 270 family members of hospitalised advanced cancer patients staying in the University Hospital Ostrava who were receiving palliative care. The family members preferred sufficient basic information and patient comfort. The unmet needs were support of hope (73%) and provision of information (65%). The unmet needs were more frequently identified by women, individuals with lower education, younger persons, unemployed, patients' children and family members of patients with generally unfavourable health status (P<0.05). There was a correlation between lower quality of life and higher numbers of unmet needs. Targeted interventions aimed at meeting important needs of the family members may improve their quality of life.

Fenofibrate-induced Anemia and Neutropenia – a case report

August 2015 e103 FenoFibrAte-induced AnemiA And neutroPeniA – A cAse rePort I. Kacirova; and M. Grundmann Faculty of Medicine, University of Ostrava, Czech Republic; and University Hospital Ostrava, Czech Republic Introduction: Fenofibrate is used in the treatment of hyperlipidemia. Adverse effects affect the skeletal muscle, kidneys and liver, laboratory tests could be mildly abnormal for leukocytes and hemoglobin. We report the first documented case of the significant fenofibrateinduced anemia and neutropenia. Methods: A 42-year-old male (BMI 48) with compensated hypertension suffered from hyperuricemia, diabetes mellitus type 2 and pulmonary thromboembolism in anamnesis. He was treated by perindopril, indapamide, metoprolol, amlodipine, allopurinol, metformin, liraglutide, flavonoids and rivaroxaban. At May 2014, fenofibrate 200mg daily was added due to hypertriglyceridemia (6.45 mmol/L). Laboratory tests including lipid profile were analysed two and three months later. Results: At July 2014, triglyceride level decreased to 3.78 mmol/L. However, significant changes occurred in white and red blood cell count: leucocytes decreased from 7.8 to 4.3 × 10, absolute neutrophil count from 4.58 to 1.26, lymphocytes increased from 27.5% to 51.2% and monocytes increased from 6.8% to 13.10%; hemoglobin decreased from 149.0 to 122.0 g/L and hematocrit from 0.45 to 0.37, without any changes in clinical features. Fenofibrate was immediately discontinued. Three weeks after fenofibrate withdrawal the haematological findings improved to previous normal values. Conclusions: We present the first case report of the significant fenofibrate-induced anemia and neutropenia. The pathogenesis of this adverse drug reaction remains unclear, however, allergic reaction following a fenofibrate prescription could be explanation. Although fenofibrate-induced anemia and neutropenia appears to be uncommon, patients receiving fenofibrate should be monitored for this adverse drug reaction.

Quality of Life after Laparoscopic and Open Resection of Colorectal Cancer

Background: The aim of the study was to evaluate quality of life (QOL) outcomes after colorectal surgery for cancer from a 6-month perspective at a single institution. Methods: Cohort study to prospectively assess postoperative QOL in patients who underwent elective colorectal resection at the University Hospital Ostrava. QOL was assessed using the validated Short Form 36 (SF-36v2™) questionnaire at fixed time points. Results: A total of 148 patients were enrolled in the study (83 and 65 patients underwent laparoscopic and open colorectal resection, respectively). Operative time was significantly longer (161 vs. 133 min; p = 0.0073) and length of hospital stay was significantly shorter (10.7 vs. 13.1 days; p = 0.0451) in the laparoscopic group. Overall 30-day morbidity rates were lower in the laparoscopic group, but the difference was not significant (27.7 vs. 33.8%; p = 0.2116). QOL scores were comparable in both study groups before surgery (p ≥ 0.05). QOL was statistically significantly lower 2 days and 1 week after open colorectal surgery compared with laparoscopic surgery. One month and 6 months after surgery, there were no statistically significant differences between groups. Conclusion: The present study suggests a higher postoperative QOL during the first month after laparoscopic colorectal resection could be one of the benefits of laparoscopy.