[Importance of ERCP in laparoscopic cholecystectomy in comparison with classical cholecystectomy]. / Význam ERCP u laparoskopické cholecystektomie ve srovnání s klasickou cholecystektomií.

The authors compare the value of ERCP in laparoscopic and classical cholecystectomy. They analyze groups of 1356 classical and 527 laparoscopic cholecystectomies. The number of ERCP indicated before surgery rose in laparoscopic cholecystectomies 17x, as compared with classical surgery. In ERCP indicated after surgery the number increased 2.3x. In choledocholithiasis ERCP proved to be a reliable diagnostic and therapeutic method. The number of laparotomies in residual choledocholithiasis in laparoscopic cholecystectomies should not exceed 10-12%.

New alternatives for the treatment of fistulas in Crohn's disease.

The authors refer on the combination of the administration of artificial nutrition with enterohormone Somatostatin in a group of 16 patients with Crohn's disease (CD), complicated by the occurrence of fistulas. The sole administration of total parenteral or enteral nutrition led in each case to a significant reduction of secretion from the fistulas, and in two cases to their complete closing. Apart from this, the nutritional status of the patients improved. The administration of Somatostatin i.v. in the form of the preparation Stilamin led to a further reduction of secretion from the fistulae. Complete closing of the fistulae due to a combination of total parenteral nutrition (TPN) or total enteral nutrition (TEN) and Stilamin, was achieved in only 2 patients, but the combination use of tissue sealant Histoacryle with the treatment resulted in a closure of the fistulas in a further 2 patients. Altogether the application of this treatment resulted in closing 6 fistulas (37.5%). The authors consider that the above mentioned methods can open new prospectives, but this requires further experience.

[Prevalence of bone decalcification in the treatment of Crohn's disease]. / Prevalence odvápnení kostí pri lécbe Crohnovy nemoci.

In clinically active Crohn's disease the bone mineralization is impaired due to calcium malabsorption by the inflamed intestinal wall which is potentiated by diarrhoea and the thus accelerated transit time. To this we must add the shortening of the gut after operations, the inadequate dietary calcium supply or possibly calcium elimination in case of concurrent lactose intolerance. Corticoid treatment leads also to deterioration of bone mineralization. This is the reason why the authors assessed in 98 patients with Crohn's disease the bone mineralization, using the method of clavicular bone index (NIBA). Then treatment was started: a high protein diet, calcium forte, Ossin (sodium fluoride), vitamin D forte, anabolics and regular physical exercise. Check-up examinations after one year revealed that the index was restored in the majority of patients (60.84%) to normal. The above treatment is thus effective. It must be, however, regular and of a long-term character, in some patients it must extend over many years. We had, however, also patients who although subjected to an extensive resection of the gut and treated for prolonged periods with corticoids, had permanently an index between 100 and 120% without treatment.

Immunohistochemical determination of some tumour markers (blood group antigens A, B, H, T-antigen, CEA) in colonic and rectal tissue after endoscopic polypectomy.

The expression of blood group antigens A, B, H, T-antigen and CEA was determined in tissue samples of polyps of the rectosigmoideum removed by endoscopic polypectomy. On average 39 months later, during colonoscopic examination bioptic samples were removed at the site of previous polypectomy and the expression of the same tumour markers as previously was determined. In contrast to literary data, the cellular expression of blood group antigens was demonstrated only in one case out of seven adenomas of the rectosigmoideum. On the other hand, cellular expression of blood group antigen B was found in 6 cases at the site of previous polypectomy and in 6 cases, this antigen was incompatible. Interpretation of these results is difficult at this time.

[Long-term follow-up of patients with diffuse colonic polyps]. / Langzeitige Beobachtung der Kranken mit diffuser Dickdarmpolypose.

During the years from 1968 to 1984, at the First Department of Surgery in Olomouc, 10 patients with diffuse polyposis of the colon were treated. In 5 of them, a familial occurrence of polyposis was dealt with. In three of them, malignity developed. In five unfamilial polyposes, malignity occurred only once. In one patient, the occurrence of malignity was found present immediately with the first manifestation of the disease. In the other patients, it was after an interval of 3 to 17 years after the onset of the disease. Three patients died from generalization of the malignant process. In two of them, carcinoma developed in the remaining part of the colon, once after previous hemicolectomy and once after colectomy. One patient with an advanced disease died one year after proctocolectomy. Two other operated on patients survive after proctocolectomy 12 and 13 years. The other patients who had been operated on before the development of malignity are healthy. The choice of an adequate radicalintervention is of importance. Optimal is the performance of colectomy with ileorectal anastomosis and the regular endoscopic and bioptic follow-up of the stump of the intestine. When proctocolectomy is necessary, it is of advantage to apply Kock's continent ileostomy.

Prevalence of Helicobacter pylori in some patients undergoing upper endoscopy.

The group of 156 patients undergoing upper endoscopy at the Department of Central Endoscopy, University Hospital in Olomouc was followed up for determination of HP status by means of the methods of culture, microscopic examination and determination of specific IgG antibodies by ELISA method. Prevalence of HP was determined in individual groups of the series under study (peptic gastroduodenal lesion, antral gastritis of type B, duodenitis) and in subjects with normal endoscopic finding. The most frequent HP positivity was established by the method of specific antibodies determination by ELISA, then microscopic evidence of HP and finally culture. In the whole series under study HP positivity was found in 59.6% (bacteriology) and 79.8% (ELISA method). The highest HP bacteriological positivity was recorded in antral gastritis of type B (87.1%), or 100% (ELISA method). Individuals with normal endoscopic finding were HP positive in 24.2%, by serology in 38.8%. The group of 25 dialyzed patients with chronic renal insufficiency was HP positive in 28%, by serology in 53.3%.

[Posttraumatic biliary pseudocyst of the liver in a child]. / Poúrazová biliární pseudocysta jater u dítete.

The authors describe a rare complication of a severe liver injury--the development of a post-traumatic biliary pseudocyst--in a 5-year-old child with a multiple injury. The pseudocyst was detected by ultrasound and computed tomography when searching for the cause of the persisting septic condition following prolonged resuscitation during the postoperative period. Percutaneous puncture drainage by means of a pigtail made under sonographic control, although because of limited experience it was repeated, led to recovery of the child. Thus it proved possible to resolve a post-traumatic infected biliary hepatic pseudocyst without a major invasion into the child's organism which was severely affected by the multiple injury as well as septic condition.