[Reminiscences on the occasion of the Whipple's disease centenary: a summary paper]. / Reminiscence k stoletému výrocí objevu Whippleovy nemoci: souborný referát.

The disease referred to eponymically as Whipple's disease (WD) in medical literature was thoroughly described by the American physician and pathologist George Hoyot Whipple (1878-1976) in 1907 and given a temporary denomination of "intestinal lipodystrophy". According to literature, WD is rare, but its precise incidence has not yet been established. Familial incidence of the disease is acknowledged, and its immunogenetic pathogenesis is assumed. The incidence ofWD is prevailingly observed in middle-aged men (mean age 55), exceptionally at child age - the ratio being 3 to 6 for men and women, respectively. 1. Clinical diagnosis is based on symptoms in the GIT region and, in rare cases, on extraintestinal symptoms. Clinical symptomatology includes: abdominal pain with persistent diarrhoea (steatorrhoea), symptoms typical of malabsorption connected with weight loss, fevers, polyarthritic symptoms, swollen lymph nodes and, in part of patients, skin hyperpigmentation. Anaemia and hypoalbuminaemia (reduced IgA) are typically detected in laboratory tests. Rarer extraintestinal symptoms of the disease are of a diverse nature: cardiac lesions, cerebral lesions, ocular symptoms, conspicuous or even tumour-like enlargement of lymph nodes, lesions of the hemopoietic system. The clinical course ofWD is of progressive or remittent nature and the disease is fatal without treatment. Long-term therapy with antibiotics, especially a combination oftetracyclines (doxycyclin) and corticoids (dexametazone), or chloramphenicol in case of cerebral lesion, have a significantly positive effect on the course and prognosis of WD. From the point of view of pathology, WD is a multisystem infectious disease (Tropheryma whipplei) primarily affecting the GIT (39, 47, 52, 103) or different extraintestinal locations. Due to the known diversity of clinical symptoms, no clinical-diagnostic standard has been established for WD. Differential diagnosis includes different multisystem diseases, primarily malignant lymphomas (especially Hodgkin's disease). From the pathogenetic point of view, we can either assume the effect of a particular cytokine (or TNFalpha) activating macrophage phagocytosis or, if its production is normal, a disorder or defect of the respective receptor in the macrophage cellular membrane. The identification of "Whipple's bacteria" - Tropheryma whipplei - gen. nov. et sp. nov. was made possible by modern molecular biology research methodologies. Its cultivation allows both for the acquisition of the specific antibody and of detailed knowledge of its genoma (PCR, 16S rRNA sequencing).

[Adrenal incidentalomas. Clinical experience]. / Incidentalomy nadledvin. Klinické zkusenosti.

In the course of two years the authors treated 27 patients with incidentally detected adrenal tumours. Detailed morphological and laboratory examination revealed four cases of non-classical late type adrenogenital syndrome (AGS) and two pheochromocytomas. From the submitted paper ensues that it is essential to provide interdisciplinary comprehensive treatment in departments which have sufficient experience with this problem.

[Radical surgery of stage II primary nonresectable colonic tumors]. / Radikální operace primárne neresekabilního tumoru kolon provedená v druhé dobe.

The authors present an account on six patients with a primarily non-resectable tumour of the colon where radical resections were made in the second stage. Based on their experience they recommend an active approach to patients with primarily non-resectable tumours of the colon who have no signs of dissemination of the tumour. In these patients they recommend not only dispensarisation but also adjuvant chemotherapy and radiotherapy. In case of regressing tumourous infiltration they recommend resection of the tumour in the second or if necessary third stage.

Increased serum beta-2-microglobulin level in patients with inflammatory bowel disease.

Beta-2-microglobulin (B2m) serum levels were measured by newly developed electroimmunoassay in a group of patients with inflammatory bowel disease. Increased serum B2m concentrations were found in 66.7% out of 93 subjects with Crohn's disease and in 56.0% out of 25 subjects with idiopathic proctocolitis. According to the author's view, serum B2m can be regarded as a useful adjunct to other immunological markers in diagnostic evaluation and monitoring of Crohn's disease. The high B2m level may reflect elevated biosynthesis and release from immunologically activated lymphocytes in areas of inflammation.

Malignant lymphomas primarily involving the gastrointestinal tract.

Primary gastrointestinal lymphoma (PGIL) develops mostly on the basis of lymphoplasmocellular infiltration following an alteration of gastric or intestinal mucosa; its evolution is enhanced by a simultaneous defect of cell-mediated immunity. The paper deals with clinical, biochemical and immunological findings observed in 22 patients with PGIL during a course of 10 years. Some illustrative patient summaries are reported in a more detailed description. In histological terms, the cases were classified according to the Kiel classification. There seems to be an unfavourable prognosis of the disease, the average survival being about 10 months and cytostatic treatment is not tolerated well. The particular features of PGIL important for the diagnosis and treatment are pointed out.

Crohn's disease, serum immunodepressive factors and circulating immune complexes.

The presence of serum immunodepressive factors (SIDF), able to inhibit E-rosette formation of normal donor lymphocytes and the presence of circulating immune complexes (CIC) was studied in sera from 45 patients with Crohn's disease. Significantly elevated levels of both SIDF and CIC were detected in the majority of the examined cases. The parameters seem to correlate well with the disease activity. The effect of SIDF on E-rosette formation could be at least partially neutralized by simultaneous incubation with levamisole.

Inhibition of leucocyte migration by antigens from human colon and E. coli O 14 in patients with ulcerative colitis.

In 55 patients with ulcerative colitis and in 25 controls the leucocyte migration inhibition test was performed. As antigens the extract from human fetal colon and the lipopolysaccharide antigen from E. coli O 14 were used. The leucocyte migration in patients with ulcerative colitis was significantly inhibited in the presence of the antigens mentioned. In patients with an active form of ulcerative colitis the leucocyte migration was significantly inhibited as compared to the leucocyte migration in patients with a nonactive form of the disease.