[Giant myelolipoma of the adrenal gland]. / Obrovský myelolipom nadledviny.

INTRODUCTION: Myelolipoma is a rare benign tumor of adrenal gland, composed from a fatty tissue and hematogenous elements. It may be associated with endocrine disorders such as androgyneity, Cushing's disease, Addison's disease and other causes including obesity. It may also occur as a soft-tissue mass in various regions, especially in the area of small pelvis. Giant myelolipomas of adrenal gland have rarely been described in the world literature and it was considered useful to describe this case. CASE REPORT: A 54-year woman was examined in an internal ward for arterial hypertension and an ultrasound abdominal examination was therefore indicated. The finding was later confirmed by CT examination, which demonstrated a sizable expansion with fatty densities and a stroma, which was slightly more visible after the administration of a contrast compound, projecting in the region of the right adrenal gland. CONCLUSION: The formation is most probably a myelolipoma. No disease-related symptoms were detected. A surgical extirpation of three tumors of the same character was made. The diameter of the largest tumor was at least 140 mm. The diagnosis of myelolipoma was confirmed by histological examination. The patient was cured up and released from the hospital on day 12 after the operation. CONCLUSIONS: The tumor is without symptoms in most cases, but bleeding or rupture may occur. It is rarely associated with endocrine disorders. Etiology is so far not clear. The diagnosis can be established by US, CT or MR examination. The operation is indicated in patients with symptoms, tumor of large size, in case of bleeding etc. Small tumors may be followed subsequently. The surgical intervention, extirpation of the tumor, may also be done by laparoscopy. This paper appears to be the first published information about myelolipoma of adrenal grand, especially of such considerable size, in the Czech medical literature.

[Cholestatic icterus during parenteral nutrition and the therapeutic effect of enteral feeding--case report]. / Cholestatický ikterus na parenterální výzive a lécebný vliv enterální aplikace--kazuistika.

An acute operation was made on a 56-year woman for inflammatory perforation of colon. A series of repeated operations followed due to relapsing iatrogenic intestinal fistula and peritonitis. From the day 70 the patient was treated at the Intensive Metabolic Care Unit of the Gerontological and Metabolic Clinic of Faculty Hospital in Hradec Králové. Having cured the septic shock the authors prepared the patient to a reconstruction operation on alimentary tract by administering parenteral nutrition, treating the wounds and by motion rehabilitation. From day 150 on the patient was treated with low doses of enteral nutrition into the segment of intestine between the fistulas, in connection with the subsequent decrease of two-month lasting hyperbilirubinemia of 200-260 mumol/l. A successful reconstruction of the alimentary tract was performed on the day 205 of the treatment with the time lapse of 146 days after the last surgical intervention. A three-fold anastomosis on small intestine and a resection of the fistula on the transversal colon was made. The post-operation fistula was healed-up conservatively, while the parenteral nutrition continued, as verified on day 246 by enteroclysis. The paper draws attention to the importance of conservative metabolic care in the therapy of dishiscences of intestinal anastomoses not treated by acute surgery in time. A favourable additive effect of enteral nutrition on the persisting cholestasis during parenteral nutrition is discussed.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

[Pigmented hepatocellular adenoma of the liver caused by long-term use of phenobarbital]. / Pigmentované hepatocelulární adenomy jater vzniklé na podklade dlouhodobého uzívání fenobarbitalu?

A 28-year-old female patient was operated on account of symptomatic hepatocellular adenomas of the liver. Tumours with a diameter of 10 x 11 cm in the left lobe and 9 x 7 cm in the right lober were extirpated. In the adenomas non-ferric pigment resembling the pigment in Dubin-Johnson's syndrome was detected. The patient did not use contraceptives and was treated for more than 10 years for epilepsy. The size, pigmentation, frequency of adenomas and absence of contraceptives in the case-history made the authors consider another aetiology of these adenomas. The authors discuss the possible development of adenomas of the liver as a result of long-term use of phenobarbital. As a basis they use experimental observations where this drug acts as a strong promotor of DNA synthesis and leads to the development of multiple adenomas and carcinomas in the liver of rats and mice.

Proliferative activity in primary ovarian carcinoid tumors.

The proliferative potential of six primary ovarian carcinoids with different clinical outcome and histogenetic origin was examined immunohistochemically. The results showed that two cases with extremely high level of proliferative activity were associated with metastatic spread. In the remaining tumors, the examined factor was found to be at low level comparable with excellent prognosis of typical carcinoids in other locations. The preliminary results showed a possibility of a prognosis prediction according to typing of the ovarian carcinoids into two categories, i.e., tumors of low and intermediate malignancy. Topoisomerase II-alpha and Ki-67 are suitable markers giving valuable information about this phenomenon.

Immunoscintigraphy and intra-operative radioimmunodetection in the treatment of colorectal carcinoma.

PURPOSE: Intra-operative radioimmunodetection of malignant involved lymph nodes follows the pre-operative immunoscintigraphy in the treatment of patients with colorectal carcinoma. The aims of this clinical study were to determine the sensitivity of the method, to compare the results in study when using Oncoscint and CEA-Scan and to evaluate the importance of the method of surgery and postoperative adjuvant therapy. PATIENTS AND METHODS: 121 patients with colorectal tumours (106 primary and 15 recurrent) were operated on using radioimmunoguided surgery (RIGS). The study compared results of pre-operative immunoscintigraphy, intra-operative radioimmunodetection and postoperative histological examination. Histological investigation used classical H&E staining. In histologically negative and RIGS positive cases the immunohistochemical investigation was supplemented. Two radiopharmaceuticals were used Oncoscint CR 103 (MAb B72.3, Satumomab Pendetide), labelled with 111In in 56 patients and CEA-Scan (IMMU 4-Fab' fragments MAb against CEA, Arcitumomab), labelled with 99mTc in 65 patients. RESULTS: The relationship between RIGS positive results and histological examination was statistically assessed after 38 operations and the most acceptable RIGS evaluating index was determined. All subsequent results were evaluated by this index. Immunoscintigraphy of tumour was positive in 112 cases (92.6%). Fifty-five RIGS positive cases of malignant infiltrated lymph nodes were confirmed by 43 histologically positive examinations (78%). In this group 9 cases were discovered only by immunohistochemistry. Sixty-six remaining RIGS negative results were confirmed in 62 (94%) cases by negative histology. CONCLUSIONS: Both immunoscintigraphy and RIGS enable one to make a more accurate diagnosis. While treating the primary disease the use of RIGS may help in assessment of necessary extent of operation performance and in staging of the disease by revealing occult lymph nodes involved. Pre-operative immunoscintigraphy seems to be a useful diagnostic method for detection of tumour recurrence. When comparing two radiopharmaceuticals used, CEA-Scan seems to be more suitable for diagnostic studies, but using the Oncoscint for tumour recurrence detection had some specific benefit, too.

[Gastrointestinal stromal tumor--GIST--case report]. / Gastrointestinální stromální tumor--GIST--kazuistika.

Authors describe a newly introduced oncological entity that represents different views on some already well known mesenchymal and neuroectodermal tumours of gastrointestinal tract. These submucosal GIT tumours, showing only few differences in both the clinical and histological pictures, are generally called gastrointestinal stromal tumours. This paper presents a case of 37 year old patient with this disease.

[Solitary rectal ulcer]. / Solitární rektální vred.

The solitary rectal ulcer syndrome describes a condition in which a symptom complex consists of rectal bleeding, mucous discharge, tenesmus, perineal or abdominal pain, a feeling of obstructed defecation and incomplete evacuation and developing of rectal stenosis. The etiology of this disease is not known yet. The histological diagnosis is very important, because of excluding the diagnosis of malignancy. According to diagnostic results, the type of therapeutic method is used. The initial conservative methods are suggested in every time. In the case of failure of this method, the surgical procedure is chosen. An operative specimen must be histologically investigated in every case.

[Ultrasonography in the diagnosis of acute appendicitis]. / Cena UZ vysetrení v diagnostice akutní appendicitis.

By analysis of as group of 147 patients operated in 1996 at the Surgical Clinic of the Faculty Hospital in Hradec Králové on account of acute appendicitis the author evaluates the importance of ultrasonographic examination for the diagnosis. Its sensitivity was, consistent with data in the literature, 64.1%. US examination is valuable in particular in doubtful clinical diagnosis, the clinical examination remains however the basis in the diagnosis of acute appendicitis.

[Reoperations in Crohn's disease]. / Reoperace u Crohnovy choroby.

In the span of 23 years (1973-1995) 242 patients with Crohn's disease were operated on at the Department of Surgery in Hradec Králové. From this total number there were 146 (60.3%) men and 96 (39.7%) women. Eight patients (3.3%) died, in 4 cases (1.6%) carcinoma in Crohn's disease was found. Reoperations for recurrences were performed in 76 patients (31.4%), in 46 (60.5%) of them only 1 operation, in 18 (23.7%) 2 reoperations and in 12 patients (15.8%) 3 or more surgical treatments were necessary. Within the time interval mentioned above 124 different operations were done. Authors point out some factors that may affect the Crohn's disease recurrences, their influence was assessed even in the clinical set. A higher risk of recurrences and reoperations were found in women, patients younger than than 20 years, people with a short history prior to primary operation, in distal parts of intestine (ileum, rectum) localizations, in multiple gut involvement, after improper surgical performance, in cases of aggressive forms of disease and from other reasons (medicamentous post-operative treatment, immunological factors etc.). (Tab. 11, Fig. 1, Ref. 22.)

[Conclusions from the clinical trials of TachoComb, a hemostatic]. / Závery z klinických zkousek hemostyptika TachoComb.

The authors present a report on their very favourable experience assembled during clinical tests of a new haemostatic TachoComb of the company HAFSLUND NYCOMED PHARMA AG Linz Austria which were made at their department before the preparation was introduced in the Czech Republic. Despite the high price the authors recommend that the preparation should be available in every operation theatre in particular for haemostasis of injured parenchymatous organs.

[Recurrent Crohn's disease]. / Príspevek k problematice recidivující Crohnovy choroby.

In 1973-1990, i.e. in the course of 18 years, at the Surgical Clinic in Hradec Králové 148 patients with Crohn's disease were operated. The author gives an account of the localization of the disease and surgical interventions performed. Thirty-four patients were operated on account of relapses, i.e. 23%. One re-operation was performed in 22 patients (64%), two re-operations in 6 patients (17.6%) and three and more re-operations also in 6 patients (17.6%). The authors mention the types and total number of re-operations which amounted to 56 operations. They evaluate some causes such as the patients age, sex, site of relapse, duration of disease before the primary operation and some other factors which could have an impact on relapses and re-operations of Crohn's disease.

Contribution to the technique and tactics of the surgical treatment of Crohn's disease.

On the basis of their own long time experience with the surgical treatment of the Crohn's disease the authors refer to the correct course and ways in surgical treatment, whose influence on the frequency of recurrences and thus on the destiny of patients are evaluated. They especially stress the effort to prolong the symptom-free interval between the remissions of this grave general disease.

[Personal experience with the treatment of Crohn's disease]. / Nase zkusenosti s lécbou Crohnovy choroby.

The authors present a statistical review of 101 patients treated on account of Crohn's disease in Hradec Králové from 1973 to 1987, i. e. 15 years. Based on experience with 119 operations made in these patients with a relatively low percentage of postoperative complications and a low rate of relapses, the authors recommend the surgical tactics and technique in the therapy of this serious disease, i. e. the preoperative preparation as well as the operation proper. Finally they recommend follow-up by specialists during the whole subsequent life of the patients.

[Acalculous gangrenous cholecystitis in a toddler]. / Akalkulózní gangrenózní cholecystitida u batolete.

The authors describe a case of acute gangrenous cholecystitis in a 17-month-old boy manifested by symptoms of an inflammatory acute abdomen after several days of a febrile condition associated with diarrhoea. Cholecystectomy was performed and after antibiotic and infusion therapy a noncomplicated postoperative development followed. Five years after operation the boy has no subjective complaints. In the discussion the authors analyze the incidence, aetiopathogenesis, clinical, laboratory and X-ray findings of this rare disease. For the therapy of advanced cholecystitis the authors recommend cholecystectomy.