[Extragastrointestinal stromal tumor (EGIST)--a case review]. / Extragastrointestinální stromální tumor (EGIST)--kazuistika.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Due to the presence of thyrosine kinase receptors within the tumor tissue, GIST is thought to originate from gastrointestinal pacemaker cells, the intersticial cells of Cajal. Tumors with the same morphological and imunohistochemical characteristics detected outside the gastrointestinal tract, are called extragastrointestinal stromal tumors (EGIST). Biological characteristics of these tumors is uncertain and the malignancy rates are difficult to predict. Surgical R0 resection in resecable tumors is the only option with the potential for complete cure. Nevertheless, the recurrence rates are high. Adjuvant biological treatment with imatinib, a thyrosine kinase inhibitor, reduces the risk of relapses. Imatinib administration is also the principal treatment method in metastatic GIST disorders. The article offers a short and complex overview of gastrointestinal stromal tumor (GIST) problematics and presents a case report of a patient suffering from EGIST of mesocolon transversum treated by R0 resection which was performed under multidisciplinary cooperation, with a specialist follow up.

[An example of the liver metastases downstaging following chemoport implantation]. / Príklad downstagingu jaterních metastáz po implantaci chemoportu.

The case review describes a case of a patient, hospitalized with T3N0M1 carcinoma of the splenic flexure, with multiple metastases in the both liver lobes. The patient underwent left-sided hemicolectomy with cholecystectomy. Having considered the inoperable liver findings, a chemoport was implanted. The patient underwent 10 chemotherapy cycles with no major complications recorded. The chemotherapy cycle included Campto, Leucovorin, 5FU and, concomittantly, 5FU as a continual 22-hour infusion into the port. After completion of the Cycle 10, the ultrasound and CT findings showed marked regression of the metastases, by half to two thirds. Following consultation at the onco-surgical seminar, extended left-sided hemihepatectomy was performed. The procedure lasted 6 hours, the blood loss was 3.500 ml, the period of warm ischemia was 8 minutes. Based on the oncologists' recommendation, the chemoport was preserved. The latest abdominal ultrasound detected no focal liver changes, a hypechogenic to unechogenic septed formation, v.s. a postoperative hematoma, was detected near the medial liver margin. Based on the conclusion of the oncological assessment, the patient was indicated for adjuvant chemotherapy, containing the same agents, for a period of 2-3 months. The aim of this report is to present a case of downstaging of the originally inoperable finding of the liver metastases.

[Liver metastasis in colorectal carcinoma]. / Jaterní metastázy kolorektálního karcinomu.

The authors describe the method and therapeutic results of liver metastases of colorectal carcinoma in a group of 14 patients followed up for 2 to 33 months. In these patients in five instances (35.7%) resection with subsequent intraarterial chemotherapy (HAI) was possible. In nine instances (64.3%) a chemoport was introduced, as resection was impossible due to the size of the lesion. For checking of the site and patency of the arterial chemoport, the authors recommend the use of port scintigraphy, a method which is accurate, accessible and simple.

Carpal tunnel syndrome. Revision of the thenar motor branch?

This paper presents the authors' views and experience with operations of carpal tunnel syndrome. Because of the multifactorial etiology of the disease they cannot recommend a schematic solution using a single surgical procedure for the treatment of all patients. During an operation much depends on the local findings as well as on the neurological ones. Individual steps during an operation are analyzed and discussed with regard to their risks and the authors deal also with the asset from the aspect of causality of the approach. The authors recommend revision of the thenar branch of the median nerve. Between January 1994 and October 1996 the authors investigated 212 patients. EMG examinations were performed prior to surgery in all cases. General evaluations showed favourable postoperative results in 94% of individuals.

[Laparostomy--technical remarks]. / Laparostomie--technické poznámky.

The authors discuss the technique of laparostomies. They reflect on the advantages and disadvantages of different methods. They submit a locally modified feasible technique of temporary closure of the surgical wound.

[Treatment of peripheral nerves in a district hospital]. / Osetrení periferního nervu v podmínkách "okresní" nemocnice.

The authors submit the results of 23 operations performed on peripheral nerves of the upper extremity in a district hospital. They emphasize the good cooperation of the surgeon with the neurologist, the importance of clinical and EMG examinations for diagnosis as well as during evaluation of the accomplished operation. In cooperation with the Physical Institute of the Czech Academy of Sciences it proved possible to reconstruct for surgical purposes a common colposcope so that it can be used for microsurgical operations. A brief description of the apparatus is given in the paper. From a total of 23 performed operations a satisfactory result was recorded in 87% of the operated patients.

[Ultrasonography as an aid in the detection of intestinal invagination]. / Ultrasonografie jako pomocná metoda pri odhalení invaginace strevní.

The authors demonstrate on two case-histories of intestinal invagination in children the effectiveness and aptness of ultrasonographic examination which contributes towards early diagnosis and therapy. They recommend this method therefore in case of obscure findings of the child abdomen as a routine examination.

[Peritoneal form of adiaspiromycosis (author's transl)]. / Peritoneale Form der Adiasporose.

A female patient, aged 30 years was subjected in 1977 to an appendectomy because of a perforated gangrenous appendix associated with purulent peritonitis. Postoperatively she developed an intractable constipation persisting for more than one year. Because of suspected intestinal stenosis an exploratory laparotomy was performed which failed to disclose the presence of stenosis. Histological studies of excised peritoneal specimens were suggestive of tuberculous peritonitis. Since cultivation failed to provide evidence of mycobacteria and the clinical symptoms were not characteristic of a tuberculous involvement of the peritoneum it was decided to carry out a re-evaluation of the original histological slides. This revealed that the patient was infected with adiaspores of the fungus Emmonsia crescens which were disseminated over the entire peritoneum from the perforated appendix. The difficulties associated with the diagnosis which are due to the striking morphologic similarity between the minute nodules in adiasporosis and those in productive miliary tuberculosis, as well as because of the acid-fast adiaspore capsules, are stressed. Since Emmonsia crescens is spread in some regions of Czechoslovakia it may be expected that humans will come into contact with its spores either by inhalation or by alimentary ingestion.

Factors influencing the effects of the initial phase of tuberculosis chemotherapy.

Two groups of patients suffering from extensive pulmonary tuberculosis treated with daily or twice-weekly regimens of isoniazid (INH) plus rifampicin (RMP) plus ethambutol (EMB) were formed by random selection. The effectiveness of treatment was expressed by the slope of regression line calculated for each patient in terms of quantitative time dependent decrease of mycobacteria isolated by culture per 1 ml of sputum. Chemically serum concentrations of drugs in five time intervals following simultaneous administration were established. It was shown that the rate of decrease of mycobacteria did not significantly vary in the compared groups. Negativity was reached in 48 day on the average. The mean regression line with double standard deviation allocated patients with rapid, normal or slow sputum conversion. Rapid convertors were the youngest, excreted largest amounts of mycobacteria before the start of treatment, and their x-ray showed predominantly changes of exudative character. Slow convertors excreted least amounts of mycobacteria. In the group of slow convetors with daily regimen was significantly higher number of rapid INH inactivators compared with groups of rapid and normal convertors. Analysis of multiple correlation and variance of the ratio of mycobacterial decrease rate and of the parameters of the biological availability of drugs as expressed by the area under the curve of drug serum levels reveal the rate of mycobacterial decrease to be dependent always on the drug out of the combination. In daily regimen the decrease rate was controlled by INH, in the intermittent regimen by RMP. The speed of negativization could therefore be increased in daily regimen by increased doses of INH, chiefly in rapid INH inactivators. The most important share of RMP in the mycobacterial decrease rate during intermittent administration can be judged from dependence of biological availability on the dose of RMP. Under the experimental circumstances of this study the pharmacological means for speeding up negativization were best utilized. Further shortening of time necessary for obtaining negativity would be practicable only when residual factors are involved presumably existing beyond the region of pathogen and drug relationship.

Epidemiological and clinical study of tuberculosis in the district of Kolín, Czechoslovakia. Second report (1965-1972).

An epidemiological and clinical study of tuberculosis in a district with a population of 100 000 has been in operation in Czechoslovakia since 1960. Its objective is to ascertain the epidemiological situation and long-term trend in respect of tuberculosis in a country with well-established tuberculosis control facilities. This second report presents the results achieved in the period 1965-72 and the epidemiological trend of tuberculosis observed during the 12-year study period. The fundamental control measures adopted during the study included systematic BCG vaccination of the newborn and revaccination of persons aged 14 and 19 years; mass surveys of the population over 14 years of age by photofluorography; case-finding among persons with symptoms and in risk groups; systematic treatment of all persons with active tuberculosis-i.e., supervised inpatient treatment followed by outpatient self-administered regimens; and radiological and bacteriological follow-up of cases.The results confirmed that the systematic application of effective treatment throughout the study population was followed by a rapid decline in the prevalence of bacillary tuberculosis, particularly in its chronic form. The incidence of bacillary tuberculosis declined more slowly, because the risk of contracting the disease continued to be high for middle-aged and elderly persons. Indiscriminate photofluorographic surveys of the study population at 3-yearly intervals produced a decreasing yield.An increasing proportion of noninfected persons among the population is the basic condition for a further decline of tuberculosis. The cost of tuberculosis control can be reduced by strict adherence to rational and economical working methods. Most of the economic indicators analysed fell to less than one-fifth between 1961 and 1972.

Epidemiological and clinical study of tuberculosis in the district of Kolin, Czechoslovakia. Report for the first 4 years of the study (1961-64).

Many developed countries are faced with the problem of reorganizing their tuberculosis-control programme to bring it into line with modern conditions. The study reported was undertaken to provide guidelines for this reorganization. It was begun in the district of Kolín, Czechoslovakia, with a population of some 100 000, in 1961 and is still in progress. The paper covers the first 4 years of the study.In 1961 a thorough check-up was made on all persons registered as having active or inactive tuberculosis, or fibrotic lung lesions. In 1961 and 1963 a mass X-ray and tuberculin-testing campaign, with 95% coverage, was carried out for all persons over 14 years of age. All persons with active tuberculosis received adequate treatment. Persons registered as having tuberculosis or suspected tuberculosis were subjected to regular photofluorographic and bacteriological investigations. Newborn infants were given BCG vaccination, and persons aged 14 years and 19 years with negative tuberculin reactions were vaccinated.The prevalence of bacillary tuberculosis fell from 150 cases in 1960 to 91 in 1964, mainly owing to a decrease in the number of chronic cases. The incidence of bacillary tuberculosis detectable by direct smear microscopy, however, remained at about 25 cases throughout the period 1961-64. The risk of developing tuberculosis was found to be highest in persons with fibrotic lung lesions or inactive tuberculosis, and in men above 45 years of age and women above 65 with previously normal photofluorograms.It is concluded from the study that in developed countries priority should be given to adequate treatment of all persons with active tuberculosis, and to early diagnosis in persons consulting physicians and in the high-risk population groups.