J Klein

University Hospital Olomouc, Olmütz, Olomoucký, Czech Republic

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Publications (43)3.22 Total impact

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    ABSTRACT: Minimal systemic disease (MSD) means the presence of circulating or disseminated tumour cells in mesenchymal compartments of a patientts' body (lymphatic nodes, blood or bone marrow). The aim of our pilot study was to identify sensitive and specific markers for MSD detection in 50 lung cancer patients, who underwent curative surgery in the I. Department of Surgery, Faculty of Medicine and Dentistry, Palacky University and Faculty Hospital Olomouc in 2009 and 2010. Absolute gene expression of carcinoembryonic antigen (CEA), epidermal growth factor receptor (EGFR1), lung-specific X protein (LUNX) and hepatocyte growth factor receptor (c-met) was determined in peripheral blood, bone marrow and pulmonary blood of 50 lung cancer patients using real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR). (1) The LUNX marker is specific and sensitive for MSD detection in lung cancer patients. (2) The CEA positivity for MSD in the bone marrow correlated significantly with histopathological grading (GI-GIII). (3) Higher expression of CEA and c-met was found in pulmonary blood of patients with hilar or mediastinal lymphadenopathy. (4) Higher expression of MSD markers (CEA in bone marrow, c-met in peripheral blood and LUNX in pulmonary blood) correlated with higher pTNM classification. Minimal systemic disease detection in lung cancer patients is technically feasible using sufficiently sensitive and specific markers for RT-PCR. Minimal systemic disease detection can be used to guide further systemic treatment. This theory must be validated in a larger group of patients and correlated with clinical data, especially with survival data.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 04/2012; 91(4):209-15.
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    ABSTRACT: Lung cancer takes first place in both incidence and mortality in the Czech Republic. This is associated with the disease being diagnosed in late stages, which limits the possibility of radical therapy. Five-year survival of patients operated on with stage IIIA is low and doesn't even reach 20%. These poor results and the development of systemic chemotherapy in the 1990's led to an effort to treat locally advanced disease by administering chemotherapy before the surgical procedure- induction chemotherapy. Its benefit, however, unlike that of adjuvant chemotherapy, remains unclear. To analyze and compare the results between a set of patients with non-small cell lung cancer (NSCLC) with stage III A-B, operated on at the I. Department of Surgery at the University Hospital and Palacky Medical Faculty in Olomouc between the years 2000-2008, who underwent preoperative chemotherapy with the results of patients with stage III A-B diagnosed after the operation based on histological findings. Three- and five-year survivals, as well as survival median, were evaluated in both groups. A statistically significant difference in survival between the two groups was not observed. Neoadjuvant chemotherapy remains controversial in the treatment of NSCLC. The initially promising results have not been unequivocally confirmed in later studies and its role remains a question to be answered in future extensive randomized studies.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 08/2011; 90(8):433-9.
  • European Journal of Cancer - EUR J CANCER. 01/2011; 47.
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    ABSTRACT: Solitary fibrous pleural tumor (SFT) is, in most cases, a benign tumor arising from mesenchymal cells. A malignant version of the tumor is rare and its histopathological evaluation is quite difficult. Usually, SFT affects visceral, as well as parietal pleura, most commonly in a form of a pedunculated tumor. The treatment is primarily surgical, with the aim to perform radical resection even in case of infiltrative growth. Adjuvant therapy is indicated in malignant varieties of the tumor, however, its outcome is uncertain. SFTs have fairly high relaps rates and their prognosis and the risk of relaps can be estimated based on morphological indicators and assessment of their biological characteristics. Retrospective analysis of SFT group of patients, who were operated from 2006 to 2009. The authors present a group of 11 patients with solitary fibrous pleural tumors, who were operated at the Ist Faculty Hospital Surgical Clinic of the LF UP (Medical Faculty of the Palacky University) in Olomouc from 2006 to 2009. The authors assessed the patient's age, size of the tumors, types of the procedures, biological characteristics of the tumors, duration of hospitalization and complication rates. Solitary pleural tumors are fairly rare tumors arising from fibroblastic cells, Its biological characteristics is uncertain and, in some cases, is difficult to assess based on immunohistochemical, as well as morphological indicators. The treatment is surgical--removal of the tumor as far as the healthy tissue. Adjuvant therapy is indicated in malignant varieties of the tumor. SFT relaps rate is fairly high, depending on the tumor biological characteristics and its morphological features.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 12/2010; 89(12):750-3.
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    ABSTRACT: To evaluate therapeutic options and outcomes of repair of iatrogenic bile duct injuries during cholecystectomy, which were solved in our institution over the past five years. The incidence of this injury is stated in the range of 0-0.4% for open cholecystectomy and 0-0.7% for laparoscopic cholecystectomy. Authors present a group of ten patients who were operated on for iatrogenic bile duct injury incurred during cholecystectomy in 2005-2009. All patiens were refered from other hospitals. Three men and seven women aged 20-71 years. The bile duct injury occured twice during open procedure and during laparoscopic procedure in eight. Incomplete lesion was idenified in one case, complete lesions with tissue loss were found in nine patients. Right hepatic artery injuries were found in four patients with tissue loss injury. Nine patients required reconstruction of the biliary tract using hepaticojejunoanastomosis with Roux-Y loop. The bile leak occurred in two patients after reconstruction. In one patient was required early percutaneous transhepatic drainage. The early death occurred in a patient with a complicated course, where our reconstruction of the biliary tract was already in the field of advanced biliary peritonitis as a third operation during 7 days. All other patients are monitored postoperatively at regular intervals in our clinic. They carried out clinical examinations and monitoring of liver enzymes. In the long interval from reconstruction (6-12 months) anastomotic stenosis occurred in three patients. Postoperative radiological intervention in the form of dilation of anastomosis and prolonged transient transanastomotic drainage was necessary (the duration of drainage was 6-7 months). Iatrogenic bile duct injury is a serious condition threatening the patient's life from the progressive failure of liver function on the basis of secondary biliary cirrhosis. Due to the nature of lesions arising from laparoscopic cholecystectomy (loss tissue injuries, thermal damage to surrounding structures, the hepatic artery injuries) reconstructions are extremely difficult. For most patients reconstructive operations are the last possible surgical procedures in this area, except for liver transplantation. Hilar reconstructions have a higher probability of stenosis of the anastomosis. If they occur, there are repeated cholangitis, which pass into the secondary sclerosing cholangitis and cause secondary biliary cirrhosis, with all the consequences of disease (portal hypertension, bleeding esophageal varices). For these reasons, it is necessary for careful long-term postoperative monitoring of liver function and good interdisciplinary cooperation, especially with the intervention radiologist in management postoperatively evolving stenosis of anastomoses. It is necessary for the early identification and indication of radiological interventions in order to prevent damage to the liver parenchyma.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 03/2010; 89(3):183-7.
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    ABSTRACT: Prognosis of higher stages of non-small cell lung cancer (NSCLC) is very poor. Only 13% of patients in stage IIIA survive 5 years after the diagnosis determination. The purpose of neoadjuvant (inductive) therapy is to eliminate haematogenous and lymphogenous metastases and to cause a cytoreduction in the primary tumor before the resection. Especially detection of lymphogenous metastases is the main factor in the indication of the pre-operative chemotherapy, but this therapy is frequently indicated according to CT without any bioptic verification. The authors suppose such a discrepancy in radiological and histo-pathological staging to influence in a positive sense rather optimistic results of therapeutic protocols, which include the pre-operative chemotherapy. A biopsy of the lymph nodes was performed as a part of the staging. If the metastasis was proved, the lymph node was labeled and the patient was treated by 3 cycles of the pre-operative chemotherapy. The 57 labeled lymph nodes were removed during the subsequent lung resection and lymphadenectomy. An analysis of regressive alterations in the lymphatic metastases of lung cancer after an inductive chemotherapy and comparison with the pre-operative bioptic findings have quantificated the chance of the inductive therapy to eliminate lymphatic metastases. The clinical down-staging was stated in 21 cases (36.8%), but the viable malignant cells rested in the majority 50 (87.7%) of the taken labeled lymph nodes 57 (100%) even after the neoadjuvant therapy. On the other hand, the satisfactory tumor regression changes was proven in 49 (86%) lymphatic metastases. CONCLUSIN: The results of the study may modify an indicating judgment in the therapy of locally advanced stages of lung cancer because it has brought a new view to the results of neoadjuvant therapy.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 05/2007; 86(4):206-11.
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    ABSTRACT: Matrix metalloproteinases (MMPs) belong to proteolytic enzymes. Degradation of the cell basement membrane and the extracellular matrix is one of their functions. In malignant tumors they can hypothetically contribute to the invasion and metastasis formation. They are mostly produced by stromal cells (fibroblasts and endothelial cells) as a response to the presence of tumor cells. MMP-2 (gelatinase A), MMP-9 (gelatinase B) and MMP-11 (stromelysin 3) are often mentioned in regard to Non-small Cell Lung Cancer (NSCLC). The relation between the expression of the above-mentioned matrix metal-loproteinases in stromal cells and the cancer-related survival in 80 patients after curative resection of NSCLC in stage I according to TNM was studied. The expression of MMP-2 was associated with cancer-related survival but without significant correlation. No correlation was found in MMP-9. There was a statistically near-significant relation between the expression of MMP-11 and cancer-related survival. The expression of MMP-11 in stromal cells in surgically treated NSCLC patients in stage I appears useful for evaluation of their prognosis.
    Casopís lékar̆ů c̆eských 02/2007; 146(1):45-7.
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    J Klein, V Kral, P Nemec, T Bohanes
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    ABSTRACT: Involvement of the aortic arch, or the descending aorta, is not uncommon in left-sided lung tumours. The direct invasion of the aortic wall is generally considered a contraindication in lung resection. However, there are a limited number of reports of full thickness resections of the aorta during lung cancer surgery. They may be accomplished as a partial resection using a patch, or as a local tubular resection with reconstruction by a graft. In order to prevent ischaemia of the spinal cord, a cardiopulmonary bypass is usually recommended. The authors present a case report of a full thickness tubular resection of the descending aorta during pneumonectomy for centrally located lung carcinoma. The direct invasion to the descending aorta was only confirmed intraoperatively. After tumour dissection, two aortal cannulas were inserted into the aorta: the first one into the aortic arch over the left subclavian artery, the other one into the descending aorta over the diaphragm. They were then bypassed without a pump. The descending aorta was cross-clamped and replaced by a Dacron graft. There were no early complications : the patient has already survived two years after surgery with no recurrence.
    Acta chirurgica Belgica 01/2007; 107(1):81-3. · 0.36 Impact Factor
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    ABSTRACT: The authors discuss the technique of identification and biopsy of sentinel lymph nodes in tumors of the upper gastrointestinal tract. They describe difficulties and problems of the technique, in which the identified sentinel lymph node is obtained mainly employing endoscopical and minimally invasive techniques.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 07/2005; 84(6):307-9.
  • Lung Cancer. 01/2005; 49.
  • Lung Cancer. 01/2005; 49.
  • Lung Cancer. 01/2005; 49.
  • Lung Cancer. 01/2005; 49.
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    ABSTRACT: 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.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 12/2004; 83(11):539-44.
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    ABSTRACT: During an eight-year-period, 623 laparoscopic fundoplications were conducted in the Surgical Clinic in Olomouc. Out of the total number, 14 of them were reoperations and 4 reoperations were conducted on patients, primarily operated in other clinics. 9 patients were reoperated for dislocations of the rim transhiatally into the mediastinum, respectively aborally to the gastric fundus. 4 patients were operated for oesophageal constricions in the hiatus region and 2 patients for haemoperitoneum caused by haemorrhaging from a wound after the port removal. The remaining 3 patients had the reoperation indicated for a biliary reflux in the oesophageus, the rim loosening or for a non-standard primary procedure, conducted to treat the oesophageal reflux disorder in another clinic. This study discusses causes of individual complications and their treatment alternatives. The authors point-out prevention of complications based on following certain principles during the laparoscopic fundoplication procedures.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 11/2004; 83(10):503-5.
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    ABSTRACT: The aim of this study was to assess the neoadjuvant therapy of the oesophageal carcinoma firstly from the perspective of the immediate effect on the resection procedure itself and, secondly, from the perspective of the long-term results. Prior to the resection of the oesophagus, the patients were administered the neoadjuvant therapy. The patients were allocated to three groups with the following branches of the cytostatic treatment: CDDP+FU, TAX+FU a CDDP. A smaller group with a less advanced disorder was treated only surgically, with the oesophageal resection. Furthermore, the study aimed at assessing chemoresistance of the tumors according to the MTT test and at correcting the individual branches appropriately. The total of 70 patients were operated from 2001 to V/2004. Out of this number, 15 oesophgeal resections without the neoadjuvant therapy were conducted. None of the patients exited, and fistules were the commonest complications. No differences in postoperative complications were reported between the groups with or without the neodjuvant therapy. Therefore, this therapy has no positive effect on the resection results themselves. The MTT test proved to be of low significance in the neodjuvant therapy assessment. Chemoresistance can be assessed only retrospectively and, furthermore, the results are likely to be affected by a relatively high sensitivity to the neodjuvant therapy itself. The pCR rate reaches 20%. Long-term results had not been assessed due to a short follow-up period.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 11/2004; 83(10):488-92.
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    ABSTRACT: Local tumor expansion in the sense of the tumor invasion into the extrapulmonary structures, which must be removed in one step, preferably en-bloc, together with the primary tumor, is the reason for extending the lung resection procedure. Although verified lymphogenic metastasing into either unilateral, eventually into contralateral mediastinal lymphonodes (stage N2 resp. N3, according to the TNM), remains the commonest indication for the induction therapy in cases of the lung carcinoma, application of the neoadjuvant therapy in cases when extended resections may be expected, is indicated in case the tumor expands into the surrounding structures, which signifies opening of new, unnatural routes of possible lymphogenic and haematogenic dissemination, and thus, a significantly higher risk of the surgical therapy failure. During the period 1995-2002, our team conducted 15 extended lung resection procedures following the preceding induction therapy in patients suffering from the IIB-IIIB stage of the non-small cellular lung carcinoma (NSCLC). The 30-day lethality rate equalled zero. We recorded two rare complications and the postoperative morbidity was acceptable. Conclusion: Exhausting staging, the best possible prediction of the tumor behaviour following the surgical procedure and minimal surgical complications remain the prerequisite for good long-term results following the extended lung resections for the lung carcinoma. Application of the neoadjuvant therapy prior to the resection procedure need not increase the risk of surgical complications and, furthermore, may positively affect the disease prognosis.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 07/2004; 83(6):236-9.
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    ABSTRACT: 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.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 07/2004; 83(6):210-6.
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    ABSTRACT: The success of endoscopy in treating esophageal varices and the later introduction of liver transplantation into the algorithm of therapy for liver failure shifted surgery of portal hypertension out of sight of hepatologists and surgeons. This decline from surgical treatment was further confirmed by introduction of TIPS into clinical practice. It is completely out of question that only liver transplantation is the causal solution of decompensated liver disease and a series of reliable and less invasive methods may be selected for acute treatment of bleeding from varices. However, even at the present time the portal-systemic shunt may be used in its own indication in repeatedly bleeding patients with a good liver capacity, where it can play a role by bridging the time to liver transplantation in a way similar to TIPS or even to provide a final solution, which makes it possible to live the life expectancy in adequate comfort without the risk of bleeding complications. However, it is not always possible to place a surgical shunt on some of the main branches of the portal vein. In such cases, devascularization is often successfully applied. Atypical shunts represent an exceptional alternative, because side feeder veins of the portal vein are rarely of sufficient caliber for placing a hemodynamically significant shunt. The authors describe two cases, in which stubborn anemia-causing bleeding events in portal hypertension were treated with left-side epiploic-renal shunt or anastomosis between the mesenteric and left-side iliac vein.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 02/2004; 83(1):20-3.
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    ABSTRACT: The basic task of induction (neo-adjuvant) therapy is elimination of occult micrometastatic dissemination found in some cases already in localized stages of non-small cell pulmonary cancer (stage I-IIIA NSCLC). An equally important effect is also cytoreduction in primary tumours which have before the local intervention an intact vascular supply. A difficult problem remains the correct selection of patients who from the long-term aspect may profit from such a procedure. The authors evaluated perspectively aspects of oncological treatment and circumstances of surgical intervention after induction chemotherapy in 81 and 87 patients resp. in stage IIIA NSCLC evaluated before initiated neo-adjuvant chemotherapy. Complete remission was recorded in 4.9%, partial remission in 50.6%, stabilized disease in 23.5% and progression in 21% patients. Down-staging was recorded in 26%, 70.3% patients were indicated for surgery. In the group of 87 patients operated after induction therapy pneumonectomies predominated--41 (46%), only one operated patient died within 30 days after surgery (1.1%), complications were neither frequent nor serious. The median of survival after radical resection is 26 months. Neo-adjuvant chemotherapy by modern cytostatics is usually well tolerated and creates satisfactory conditions for successful complete resection. The operation proper may be more difficult but need not be associated with serious complications. By this treatment it is probably possible to influence long-term results not only in stage IIIA but to reduce also the risk of a later more remote metastatic dissemination in some patients operated in lower stages of lung cancer. Our present aim is to test parameters which will be able to predict possible failure of induction therapy, and seek factors predicting risk behaviour of the tumour also in lower stages (stage I and II TNM classification).
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 04/2003; 82(3):152-6.