J Klein

University Hospital Olomouc, Olmütz, Olomoucký, Czech Republic

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Publications (61)36.27 Total impact

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    ABSTRACT: An actin-binding protein filamin A connects the actin filament network to cell membrane receptors, and acts as a scaffold for various signaling pathways related to cancer growth and progression. Recently, it has been reported that filamin A is required for efficient regulation of early stages of DNA repair process. Moreover, some in vitro studies showed that the overexpression of filamin A determines resistance to various cytotoxic drugs, including cisplatin. We aimed to analyse the expression of filamin A protein in resected NSCLC (Non Small Cell Lung Cancer) specimens, to investigate the association of the level of filamin A protein expression and other clinicopathological features, and possible relationship between the expression of filamin A and survival outcome in NSCLC patients, treated with platinum-based combination chemotherapy. We performed filamin A protein immunohistochemistry on formalin-fixed and paraffin-embedded (FFPE) tissue sections from 135 NSCLC patients, using EP2405Y antibody against C-terminus of filamin A. Cytoplasmic, membranous and nuclear positivity of filamin A was evaluated semi-quantitatively and correlated with available clinicopathological data. Patients were divided into two groups for survival analysis (I group - patients treated with adjuvant platinum-based chemotherapy, II group - patients with surgical treatment only). We found significant positive correlation between filamin A protein expression and NSCLC stage (r.332; p Keywords: filamin A, non-small-cell lung cancer, prognosis, cisplatin, chemoresistance.
    No preview · Article · Jan 2016 · Neoplasma
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    ABSTRACT: Introduction: The only curative treatment of tumors of the chest wall (primary or secondary),despite all the progress in oncological therapy, is a surgical radical resection. The goal of the paper is the identification of a complication occurring after chest wall resections for a tumor (evaluation of morbidity and mortality). Furthermore, the tumor type and employed reconstruction method were analyzed.Methods: A group of patients who underwent resection of the chest wall for primary or secondary tumors at the 1st Dept. Of Surgery, University Hospital Olomouc, was retrospectively analyzed. Age, diagnosis, procedure, histopathology of the tumor, preoperative and postoperative oncological treatment, preoperative co-morbidities, postoperative complications, the use of artificial lung ventilation and recurrences were recorded for all patients.Results: 57 patients aged 16 to 86 years underwent a chest wall resection, 51% for a primary tumor and 49% for a secondary tumor. Resection of at least one rib or partial resections of the sternum were performed in every patient. Reconstruction with a mesh was employed in 22 patients; in 10 patients the mesh was covered with a muscle flap. Postoperative complications occurred in 10 patients (17.5%).Conclusion: It is necessary to follow the basic principles of treatment of chest wall tumors; therefore surgery of these tumors should be concentrated to specialized centers. Always before surgery, diagnosis should be established by means of a biopsy and generalization of the disease should be excluded, ideally using PET/CT. Most important for successful treatment is experience and interdisciplinary cooperation of the team. This results in a low mortality and morbidity rate, which was confirmed by our results.Keywords: chest wall tumors chest reconstruction sternum resection - treatment of chest wall tumors chondroma.
    No preview · Article · Jan 2015 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti

  • No preview · Article · Jul 2012 · European Journal of Cancer
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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.
    No preview · Article · Apr 2012 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti

  • No preview · Article · Sep 2011 · European Journal of Cancer
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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.
    Full-text · Article · Aug 2011 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
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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.
    Full-text · Article · Dec 2010 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
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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.
    Full-text · Article · Mar 2010 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
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    ABSTRACT: Patients and methods: A retrospective assessment was made of the numbers of patients newly diagnosed with bronchogenic carcinoma at the Department of Respiratory Medicine, University Hospital Olomouc in 1993-2008 and those referred for resection due to this condition. For the latter 10 years (1999-2008), a detailed analysis was performed of the diagnosed diseases, including histological types of cancer and stages of the disease. Results: There is an apparent marked increase in the number of patients newly diagnosed with bronchogenic carcinoma (153 patients in 1993 vs. 203 patients in 2008). Small cell carcinoma accounts for up to 20% of all newly diagnosed cases. In non-small cell carcinoma, there is a gradual increase in the incidence of adenocarcinoma, the most frequent histological type of cancer in 2007 and 2008 (34.9%). At the same time, a negative trend has been noticed of a significant increase in the number of patients diagnosed in the advanced stages of the disease (more than 75% in 2007 and 2008). Conclusions: The number of patients newly diagnosed with bronchogenic carcinoma at our department continues to increase. With the absolute number of surgeries remaining unchanged, the relative operability has slightly decreased in the last two years. This may be due to the increase of patients diagnosed in inoperable stages HIB and IV of the disease or more thoracic surgeries performed in the neighboring centers. The patients' operability and length of survival might improve if carcinoma was diagnosed earlier.
    No preview · Article · Jan 2010
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    ABSTRACT: A group of 278 patients with various types of tracheal stenosis diagnosed in 1995-2006 is evaluated. Their survival was assessed with respect to the cause of stenosis, used therapy and gender. The median survival (MS) was 63.8 months for 127 patients with benign stenosis and 7 months for 151 patients with malignant stenosis. In 182 males, the MS was 11 months; in 96 females, it was 53 months. Separately, the application of 186 stents in 134 patients was evaluated. After stent insertion, the MS rates were 66 and 6.5 months in patients with benign or malignant stenosis, respectively. A comprehensive approach to treatment is stressed, dependent on the type and site of tracheal stenosis as well as the patients' overall condition.
    No preview · Article · Jan 2008 · Studia Pneumologica et Phthiseologica
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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.
    No preview · Article · May 2007 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
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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.
    Full-text · Article · Feb 2007 · Acta chirurgica Belgica
  • P Drác · J Klein · T Tichý · V Kolek · J Skarda
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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.
    No preview · Article · Feb 2007 · Casopís lékar̆ů c̆eských
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    ABSTRACT: Drug resistance is an important problem in the treatment of patients with cancer. Tumors become resistant not only to the drugs used initially, but also to those to which they have not yet been exposed. Data obtained from various sources indicate that multiple mechanisms contribute to drug resistance. Many of them are mutually related to each other. Resistance-related proteins such as P-glycoprotein, multidrug resistance related protein, lung resistance related protein, glutathione-dependent enzymes, topoisomerases, metallothioneins, thymidylate synthase and O6-alkylguanine-DNA alkyltransferase have been found in different human lung tumors, but these alone cannot explain the drug-resistant phenotype. Cell-cycle-related proteins, angiogenic-factors, protooncogenes, and tumor suppressor genes can also contribute to the manifestation of drug resistance phenotypes. In future, a key challenge will be to determine the relative quantitative contributions of each of these mechanisms to overall resistance. The use of DNA microarray technology will yield insight into the mechanisms of drug resistance and facilitate the rational design of more effective strategies to circumvent resistance.
    No preview · Article · Jan 2007 · Pharmacologyonline
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    ABSTRACT: Background: The method of detection and removal of the sentinel lymph node (SLN) is a current challenge in many kinds of solid malignancies. This paper discusses experience in identification and obtaining of SLN in tumors of the distal esophagus and the gastric cardia. Design and Subjects: A prospective nonrandomized study was performed in 38 patients with esophageal cancer before neoadjuvant therapy. Methods and Results: SLN was detected in 22 cases employing patent blue. In 2 cases only a radionuclide was used and in 14 patients a combination of both methods was applied. SLN was found, after endoscopic application of the detection substance, via laparoscopic trans-hiatal approach. SLN were examined histopathologically and also immunohistochemically. SLN was successfully detected in 19 patients. Metastatic involvement was found in 10 patients, micrometastatic involvement in 2 patients. Remaining patients showed no involvement of SLN. Results of examination of SLN were compared to results of standard lymphadenectomy, performed during subsequent routine D2 lymphadenectomy. False negativity of SLN was revealed in one case. Conclusions: The study proved a clinical usability of the method in esophageal cancer. Its clinical significance is especially in a possible less-invasive treatment, mainly in initial stages of the disease.
    No preview · Article · Jan 2006

  • No preview · Article · Jan 2006 · Ceska Radiologie
  • C Neoral · R Aujeský · V Král · J Klein · T Bohanes · R Vrba · P Koranda
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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.
    No preview · Article · Jul 2005 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
  • J. Klein · P. Nemec · T. Bohanes · M. Szkorupa · D. Horak

    No preview · Article · Jul 2005 · Lung Cancer
  • J. Klein · P. Drac · T. Bohanes · T. Tichy

    No preview · Article · Jul 2005 · Lung Cancer
  • J. Klein · V. Kral · T. Bohanes · M. Szkorupa · M. Herman

    No preview · Article · Jul 2005 · Lung Cancer