[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).

[Surgery of the low extremity varices as a part of a same-day surgery programme]. / Operace varixu dolních koncetin v rámci jednodenní chirurgie na klinickém pracovisti.

INTRODUCTION: One-day surgical methods lower the procedures costs as well the need for urgent beds in surgical clinics. The varix operation seem to be the optimal diagnosis suitable for the one-day surgical procedure. AIM: The aim of this work is to assess a feasibility of the one-day surgery for the low extremities varix operations. METHODOLOGY: During the period starting in January until December 2003, 98 extremities were operated for varices. The surgical procedure was the same for the hospitalized as well as for the patients assigned to the one-day surgery programme. Each patient was examined with the duplex ultrasound prior to the surgery, after the surgery a compressive bandage was indicated. RESULTS: We operated 98 extremities in 96 patients suffering from varices during the period from January 2003 to December 2003. The trial group consisted of 67 females and 29 males aged 21-79 years of age (the average of 45.3 years). According to the CEAP classification, 57 extremities (58.2%) were assigned to the C2 category, 30 extremities (30.6%) to the C3 category, 6 extremities (6%) to the C4 category, 4 extremities (4%) to the C5 category and one extremity (1%) to the C6 category. 14 extremities in the group were operated due to the disease relapse. 62 patients (i.e. 65%) were released for the home-care on the day of the operation, 27 patients (28%) were released the following day. One patient was hospitalized for two days, three patients for three days, one patient for four days and two patients for five days. 91 out of the total 98 extremities (i.e. 93%) underwent the one-day surgery. CONCLUSION: Although some patients require hospitalization, the varix surgery is safe and suitable for the one-day surgery. A thorough preoperative examination as well each patient's cooperation are both very important.

[Blunt injuries of the iliac artery--case reports]. / Tupé poranení ilické arterie--kazuistické sdelení.

The authors describe three patients with blunt injuries of the iliac artery. They mention the causes and mechanism of their development, symptomatology, diagnosis and treatment. They draw attention to early diagnosis and an active approach; they discuss the type of vascular prosthesis and mention alternative therapeutic procedures. In all patients surgical treatment (resection and prosthesis of the affected part) led to favourable long-term results.

[Treatment of esophageal achalasia]. / Soucasné moznosti lécby achalázie jícnu.

During the past years the authors performed at the First Surgical Clinic, Faculty Hospital Olomouc laparoscopic cardiomyotomy with Dor's plastic operation in 17 patients with achalasia of the oesophagus. From the above number 15 patients were relieved of their complaints, two patients were reoperated. The cause of failure of the operation was in one case previous treatment with botulotoxin, in the other case achalasia grade IV, refractory to this type of treatment. The authors consider laparoscopic oesophago-cardiomyotomy a safe procedure, effective in particular in the earlier stages of the disease. They warn against excessive protraction of surgical treatment, frequently caused by selection of ineffective non-surgical therapy.

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.

[Ultrasonic diagnosis of gastrointestinal diseases]. / Ultraschalldiagnostik bei Erkrankungen des Verdauungstraktes.

The authors describe their experiences with the ultrasound tomography (compound scan and real-time scan) on the basis of 2,360 own examinations. This examination method was particularly suitable in cholelithiases, in concrements of the choledochus, in diseases of the pancreas above all in different forms of pancreatitis and pancreatic tumours and in abdominal lymphomas. The authors emphasize the advantages of the non-invasive method, however, they recommend to valuate the ultrasonographic findings always taking into consideration all other results of clinical examinations.

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.