Tomas Skricka’s research while affiliated with Masaryk University and other places

BACKGROUND. The most challenging task in treating the Clostridium difficile colitis (CDC) is to deal with its fulminant form. It is often non-responding to antibiotics and, upon recurrence, necessitates surgical treatment. The primary aim of our prospective research was to evaluate surgical treatment results in patients with severe CDC in the period of 2008-2014, determining risk factors leading to serious postoperative morbidity and mortality.Our secondary objective was to assess the success of faecal microbiota transplant (FMT) treatment of the recurrent colitis caused by Clostridium difficile in the period of 2010-2014. METHODS. During 2008-2014, Clostridial toxins were detected in 1956 patients at the University Hospital Brno. From them, 37 patients underwent surgery for a severe form of colitis. The Fisher exact test and Mann-Whitney test were used to evaluate factors affecting increased mortality and incidence of serious postoperative complications. Factors affecting overall survival were assessed using the Log-rank test.From 2010 to 2014, there were 80 patients with CDC recurrence enrolled and treated with FMT at the Department of Infectious TRANSPLANTDiseases, University Hospital Brno. RESULTS. Factors that were proven statistically significant to increase the mortality and incidence of serious postoperative complications included: Mental status changes before the surgery (p=0,008), the albumin level on the day of surgery ≤20 g/l (p=0,005) and the total serum proteins level on the day of surgery ≤45 g/l (p=0,037). Statistically significant factors negatively affecting overall survival were found to be these: circulatory instability before surgery (p-value=0,035), mental status changes or artificial lung ventilation with pharmacological attenuation of consciousness before surgery (p=0,025), CRP value on the day of surgery >75 mg/l (p=0,034), the albumin level on the day of surgery ≤18,5 g/l (p=0,007), blood urea on the day of surgery >10 mmol/l (p=0,019) and the serum creatinine on the day of surgery >120 μmol/l (p-value=0,004). Thirty-day mortality reached nearly 35%, morbidity climbed up to 89%, and the 90-day mortality was 54%.A total of 80 patients were treated for recurrent CDC with FMT and the success rate of the method was 83,1%. CONCLUSION. Early and accurate surgical intervention in the fulminant form of CDC improves significantly prognosis of patients. FMT is an effective and safe method for treatment of the recurrent form of Clostridium colitis.

Clostridium difficile infection (CDI) is the most frequent cause of nococomial diarrhoea. Most cases are succesfully treated by antibiotic therapy, but nearly 10% may progress to the fulminant form. The aim of this work is a retrospective evaluation of the results of surgical treatment of patients with the severe Costridium colitis, in the period 2008-2014. Clostridium toxins were detected in patients in Bohunice University Hospital in 1956. Thirty seven of them underwent surgery due to toxic colitis. There were 6 total colectomies with terminal ileostomy, 29 subtotal colectomies with terminal ileostomy, 1 coecostomy and 1 axial ileostomy. The 30-day mortality was nearly 35 %, 90- day mortality 54% and morbidity 89%. Early and precise indication for surgery could save about 65% of patients with fulminant course of Clostridium difficile colitis.

Since the "War on Cancer" was declared in 1971, the United States alone has expended some $300 billion on research, with a heavy focus on the role of genomics in anticancer therapy. Voluminous data have been collected and analyzed. However, in hindsight, any achievements made have not been realized in clinical practice in terms of overall survival or quality of life extended. This might be justified because cancer is not one disease but a conglomeration of multiple diseases, with widespread heterogeneity even within a single tumor type. Only a few types of cancer have been described that are associated with one major signaling pathway. This enabled the initial successful deployment of targeted therapy for such cancers. However, soon after this targeted approach was initiated, it was subverted as cancer cells learned and reacted to the initial treatments, oftentimes rendering the treatment less effective or even completely ineffective. During the past 30 plus years, the cancer classification used had, as its primary aim, the facilitation of communication and the exchange of information amongst those caring for cancer patients with the end goal of establishing a standardized approach for the diagnosis and treatment of cancers. This approach should be modified based on the recent research to affect a change from a service-based to an outcome-based approach. The vision of achieving long-term control and/or eradicating or curing cancer is far from being realized, but not impossible. In order to meet the challenges in getting there, any newly proposed anticancer strategy must integrate a personalized treatment outcome approach. This concept is predicated on tumor- and patient-associated variables, combined with an individualized response assessment strategy for therapy modification as suggested by the patient's own results. As combined strategies may be outcome-orientated and integrate tumor-, patient- as well as cancer-preventive variables, this approach is likely to result in an optimized anticancer strategy. Herein, we introduce such an anticancer strategy for all cancer patients, experts, and organizations: Imagine a World without Cancer.

Background Since the “War on Cancer” was declared in 1971, the United States alone has expended some $300 billion on research, with a heavy focus on the role of genomics in anticancer therapy. Voluminous data have been collected and analyzed. However, in hindsight, any achievements made have not been realized in clinical practice in terms of overall survival or quality of life extended. This might be justified because cancer is not one disease but a conglomeration of multiple diseases, with widespread heterogeneity even within a single tumor type. Discussion Only a few types of cancer have been described that are associated with one major signaling pathway. This enabled the initial successful deployment of targeted therapy for such cancers. However, soon after this targeted approach was initiated, it was subverted as cancer cells learned and reacted to the initial treatments, oftentimes rendering the treatment less effective or even completely ineffective. During the past 30 plus years, the cancer classification used had, as its primary aim, the facilitation of communication and the exchange of information amongst those caring for cancer patients with the end goal of establishing a standardized approach for the diagnosis and treatment of cancers. This approach should be modified based on the recent research to affect a change from a service-based to an outcome-based approach. The vision of achieving long-term control and/or eradicating or curing cancer is far from being realized, but not impossible. In order to meet the challenges in getting there, any newly proposed anticancer strategy must integrate a personalized treatment outcome approach. This concept is predicated on tumor- and patient-associated variables, combined with an individualized response assessment strategy for therapy modification as suggested by the patient’s own results. As combined strategies may be outcome-orientated and integrate tumor-, patient- as well as cancer-preventive variables, this approach is likely to result in an optimized anticancer strategy. Summary Herein, we introduce such an anticancer strategy for all cancer patients, experts, and organizations: Imagine a World without Cancer.

Background: Video-assisted anal fistula treatment is a new method used for treatment of complex perianal fistula with maximal sparing of sphincter muscles and prevention of false route. Authors inform about their experience and operative results. Aims: Our aim was to verify feasibility of the method, help in internal opening identification and define its position in our management of perianal fistulas. Methods: Patients with chronic fistula-in-ano of IBD and non-IBD benign etiology were enrolled. Anoscopy with fistuloscopy was attempted in all patients followed by loose seton drainage or other procedure. Results: Fistuloscopy was attempted in 30 patients, finished in 93% and internal opening was found in 67%. No procedure-related morbidity was observed. Conclusion: Fistuloscopy alone is feasible for diagnosing type of IBD and non-IBD fistulas. VAAFT technique and instruments were helpful for identification of an internal opening in most cases. As such it has established role in our management of fistula-in-ano.

Infection with Clostridium difficile (CDI) is the most frequent cause of nosocomial diarrhoeas. Most cases are successfully treated by antibiotic therapy, but nearly 10% may progress to the fulminative form of this condition. The objective of the work is retrospective evaluation of the results of surgical treatment in patients with the fulminative form of Clostridium colitis with revealing of risk factors leading to serious post-operative morbidity and mortality. Retrospective evaluation of the results of surgical treatment in patients with the fulminative form of Clostridium colitis between 2008 and 4/2012. Between 2008 and 4/2012 Clostridium toxins were positively detected in 1,088 patients in total, 21 of whom underwent operations due to the fulminative form of Clostridium colitis. The operations included 4 total colectomies with terminal ileostomy, 15 subtotal colectomies with terminal ileostomy, 1 caecostomy and 1 axial ileostomy. The 30-day mortality was 23.8%, and morbidity reached 66.6%. High leukocytosis is a statistically significant predictor of post-operative mortality and morbidity (p = 0.008). Early indication for a colectomy operation with terminal ileostomy in patients with the fulminative form of Clostridium colitis leads to lower morbidity and mortality.