[Laparoscopic management of an infected oesophageal cyst]. / Laparoskopické resení infikované ezofageální cysty.

Oesophageal cysts are rare congenital anomalies. Most commonly, they are located in the posterior mediastinum, approximately at the level of the distal third of the oesophagus. In most cases, they are diagnosed during childhood as an accidental finding of a symptomatic mediastinal lesion. A CT or MRI, oesophagoscopy and endosonography of the oesophagus are the essential diagnostic methods. In the adulthood, most of the cysts cause problems pushing against the surrounding organs and, therefore, surgical removal is recommended. In this report, a case of a potential complication is described: infection of the oesophageal cyst of the distal part of the oesophagus following a transoesophageal punction. The case resulted in sepsis, which was managed laparoscopically. Entering through the diaphragmatic hiatus,a cyst in the posterior mediastinum was revealed. The cyst was partially resected and its content evacuated. No complications followed. The laparoscopic method is feasible and safe even if the oesophageal cysts are infected. A complete resection of the cyst would be complicated due to a possibility of injuring the oesophagus. A significance of the peroperative oesophagoscopy to verify the oesophagus position in an unclear anatomic situation due to inflammatory infiltration, is highlighted. The above decreases the risk of the oesophageal wall lesion.

[Large-droplet liver steatosis in celiac disease]. / Velkokapénková steatóza jater pri celiakii.

Authors monitored a case of a 25 years old woman who was admitted for swelling of lower limbs. Laboratory results showed hypoproteinemia, elevation of liver enzymes, and prolonged prothrombin time. Ultrasound examination proved hepatomegalia with diffusely hyperechogenic liver without central lesion. Computer tomography confirmed hepatomegalia with diffusely hyperechogenic liver and a suspicion of liver steatosis was expressed. Liver biopsy confirmed serious diffuse large droplet steatosis of unclear genesis. Carried out examinations excluded infectious and autoimmune liver diseases, metabolic diseases, and congenital liver diseases (Wilson's disease, porphyria, haemochromatosis etc.). Laboratory results showed gliadin, endomysin, and reticulin antibodies. An enteroscopy picture showed villi decrease. Histology examination of a biopsy specimen confirmed total villi atrophy with non-differentiated enterocytes and round-cell cellulisation of epithelium and proprium. Histology and histochemical findings were distinct proves of coeliac disease. A patient was prescribed a gluten free diet. Her metabolic parameters (normalisation of albumine levels, prothrombine time, and trace elements) and anino transferase levels gradually improved. This case documents development of a serious liver disorder as a result of malnutrition which developed in a young woman as a result of unrecognised coeliac disease.

The changes of biological markers and treatment efficacy in schizophrenia.

1. In a group of schizophrenic patients, the effect and selected parameters of biological markers were evaluated during the index hospitalisation in the acute phase of schizophrenia (n = 30) and then after one year of ambulatory treatment. 2. During the acute treatment, a significant drop in symptomatology was recorded in average; an analogical tendency was observed further on, too. Apart from that, a significant change was observed in 5/41 parameters being monitored (the pair t-test): I) decrease in the total NES score, II) decrease in the sensorial integration subscale NES score, III) increase in psychomotor speed, IV) decrease in auditory reaction time, V) increase in basal cortisol. 3. In the comparison of the successfully (severity of illness after one year = 1, 2) and unsuccessfully (severity of illness after one year > or =3) treated patients in the beginning of treatment in the acute phase, the unsuccessful group had a significantly higher score of negative symptomatology, and by the end of the acute treatment, again, a significantly higher score of negative symptomatology, a higher total PANSS score and a greater severity of illness. 4. In the acute phase, the successful group had a significantly better score in individual items of the Contemporary Memory Scale and a significantly worse performance and goal-aimed concentration in the Bourdon test than the unsuccessfully treated one; apart from that, it had a significantly higher cortisol level after dexamethasone, which was also reflected in the lower percentage rate of dexamethasone nonsupression. 5. In the course of the year, a drop in the total NES score for the individual subscales occurred; a significant drop was observed in the sensory integration subscale. The worse concentration items improved significantly in the successful group in contrast to the unsuccessful group, where they showed a downgrade tendency. Changes in Contemporary Memory Scale were negligible and mostly below statistical significance. Apart from that, a drop in basal cortisolemia occurred in the successful group and an increase in cortisolemia after administering dexamethasone was registered in the unsuccessful group. 6. The more successful group had a significantly lower NES score, a significantly better visual reaction time and a smaller forgetting item (in percentiles) after the one-year period.

[Complications of esophageal stents used in benign esophageal stenoses]. / Komplikace jícnových stentu uzitých u benigních stenóz jícnu.

Oesophageal stents are used in the treatment of stenosis of the oesophagus in the last 10 years. The application of the stent in benign stenosis should be exceptional because it is associated with high morbidity and mortality. Two cases with severe complications treated by operation are demonstrated. Types of stents for the treatment of the oesophageal stenosis are presented.

[Metal stents in patients with malignant and benign esophageal stenoses]. / Kovové stenty u nemocných s maligní a benigní stenózou jícnu.

The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

[A rare cause of ileus and its laparoscopic treatment]. / Raritní prícina ileózního stavu a její laparoskopické resení.

Stenting is a modern method making possible to open malignant oesophageal stenosis. The technique is associated with various complications. The authors describe the management of a rare stent migration to the aboral part of the GI tract, causing an acute abdomen. Based on their own experience with dislocated stents they recommend, contrary to the literature, an active approach when migration to the aboral of the GI tract occurs. Early stent extraction even when the course is uneventful is advantageous.

[Present possibilities and the role of imaging methods in the diagnosis of acute abdomen, particularly ileus]. / Soucasné moznosti a postavení zobrazovacích metod v diagnostice náhlých príhod brisních se zamerením na ileus.

The authors compare the importance of modern imaging methods and simple X-rays of the abdomen for the accurate diagnosis of ileus conditions. They discuss the possibilities of different methods and emphasize the importance of series of simple X-rays of the abdomen in different positions. The objective of the recommended procedures is to examine as well as possible a group of patients with an obstruction in the small or large intestine, to localize the obstruction, assess its etiology and not merely state that on the simple X-ray the horizontal beam reveals levels.