[Treatment of an asymptomatic splenic cyst using percutaneous drainage]. / Lécba asymptomatické slezinné cysty perkutánní drenází

Asymptomatic voluminous splenic cysts can be detected as an accidental finding whereas those with surrounding organs compression might be sought after. After succesful diagnosis a reasonable therapy proceeds. There are two treatment options, either a commonly used surgical management including resection or unroofing of the cyst (a better option), or splenectomy. The authors present two case reports of not revolutionary but yet rarely used splenic cyst drainage and sclerotisation procedure with very good outcomes.

Levels of circulating biomarkers at rest and after exercise in coronary artery disease patients.

As traditional risk factors are unable to fully explain the pathogenesis of coronary artery disease (CAD), novel mechanisms became a target of many investigations. Our aim was to study the response of selected markers to physical exercise. High-sensitive C-reactive protein (hs-CRP), matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), advanced oxidation protein products (AOPP), soluble receptor for advanced glycation end-products (sRAGE), pregnancy-associated plasma protein A (PAPP-A), E-selectin, vascular endothelial growth factor (VEGF) and B-type natriuretic peptide (BNP) levels were measured in serum of 21 CAD patients and in 22 healthy controls at rest and after exercise bicycle stress test performed up to the maximal tolerated effort. At rest, hs-CRP, AOPP, MMP-9 and BNP were significantly elevated in the CAD patients as compared with controls. In contrast, P-selectin was significantly lower in CAD patients and a tendency to lower levels of sRAGE was noted. After exercise MMP-9 and BNP, increased significantly in both groups. In conclusions, CAD patients have elevated hs-CRP, AOPP, MMP-9 and BNP--novel markers related to cardiovascular risk or left ventricular overload. MMP-9 and BNP increase significantly with exercise in both healthy individuals and CAD patients.

[Abdominal tuberculosis in CT imaging]. / Abdominální tuberkulóza v CT obrazu.

According to WHO declaration, tuberculosis is considered the world health danger. Almost 1% of world population is infected by tuberculosis every year and up to 3 millions of new cases are registered in the south-east Asia only. Prevalence of extra-pulmonary tuberculosis is rising, which is probably caused by the rising prevalence of AIDS. Fifty eight years old man, the immigrant from south-east Asia was accepted in a subileous state at the department of Internal medicine. He had suffered for longer period from the torpidness, tabescence and other non-specific symptoms. Among results of laboratory tests, the higher erythrocyte sedimentation and elevation of liver tests were conspicuous. After the colonoscopy, suspicion on the Crohn's disease was expressed. CT examination revealed several segments of the infected intestine. Both the small and large intestine were affected with skip-lesions; short afflicted segments had not the passage impaired with no ring-like dilatations. Mesenterial, periportal and retroperitoneal lymph nodes were enlarged. In the small pelvis, between the intestine and at the dorsal margin of the liver, some free fluid was visible. Abdominal parenchymatose organs had no obvious focal afflictions. In the differential diagnose, the Crohn's disease and the malignant lymphoma were considered. The probatory laparoscopy gave the correct diagnosis of the abdominal tuberculosis. Prevalence of tuberculosis is rising in the whole world, and in western countries rare cases of extrapulmonary tuberculosis can be found. A higher attention is necessary in cases of immuno-suppressed patients, who earlier lived in countries with endemic tuberculosis, or in cases of patients originating in those countries.

[Our first experience with CT enteroclysis]. / Nase první zkusenosti s CT enteroklyzou.

BACKGROUND: Small intestine belongs to abdominal organs which are difficult to imagine. Methods of examination have therefore continuously improved in order to get better picture of the intestine. METHODS AND RESULTS: CT enteroclysis represents a modern method of the small intestine imagining which combines classical enteroclysis with spiral abdominal CT. Small intestine is filled with negative contrast material applied by an enteric tube. The negative contrast material optimises visualisation of the intestinal wall, namely after the enhancement using iodine intravenous contrast. Within 23 months we examined 33 patients with gastroenterological indication using CT enteroclysis. In 31 cases results were technically satisfactory, small intestine was well filled by the negative contrast material and sufficiently distended. According to clinical indications patients were classified into four groups. Group A: 10 patients with problematic indications. No pathological changes were found in this group. Group B: 8 patients suspected of Crohn's disease. Only two cases were negative in this group. In 6 cases signs of inflammation in the small or large intestine were found. Group C: 6 patients after the surgical treatment of Crohn's disease, suspected of the recurrence. All patients had signs of the recurrence. Group D: 7 patients with various clinical diagnoses. Examination was in 2 cases negative, in other 5 cases some pathological changes of the intestine were found: Icase of malabsorption, 3 cases of adhesion and hernia, 1 case of intestinal inflammation with covered perforation and inter-intestinal abscess. CONCLUSIONS: CT enteroclysis was confirmed to be effective method for high quality imaging of the small intestine with associated tissues and the whole abdominal cavity. However, it is a method with represent irradiation, stress of intravenous administration of the contrast material and the discomfort related to enteric tube. Examination should not be indicated in cases of the problematic diagnosis only. However, in cases of correct indication signs of pathology were frequently confirmed.

Pregnancy-associated plasma protein A during hemodialysis with polyamide and diacetate cellulosic membranes.

Pregnancy-associated plasma protein A (PAPP-A) is a new prognostic factor of acute coronary syndrome in the general population. It is elevated in hemodialysis (HD) patients and at baseline, it was shown to be related to inflammation and oxidative stress. The aim of the study was to examine the relationship of PAPP-A and oxidative stress and inflammatory markers to HD treatment. Studied parameters were determined in 10 chronic HD patients treated with low flux polyamide (1st session) and diacetate cellulosic membranes (2nd session) at the beginning, after 15 minutes and at the end of the dialysis session. TRACE method (Time Resolved Amplified Cryptate Emission) was used for PAPP-A assessment. Results were evaluated with ANOVA. PAPP-A levels did not depend on the type of HD membrane but changed significantly with the time of the HD session. They increased significantly from the beginning of HD to 15 min and then decreased to the end of the HD session - p<0.05 15 min of HD vs start, p<0.01 end vs start, p<0.0001 end vs 15 min of HD for polyamide membrane and p=0.05 15 min of HD vs start, p<0.01 end vs start, p<0.0001 end vs 15 min of HD for diacetate cellulosic membrane. Changes in other parameters and differences between membranes were only minimal. We can conclude that PAPP-A as a marker of cardiovascular damage shows significant changes during the HD session. Its initial increase might be ascribed to its release from complexes or storage. During dialysis, it might be destroyed or cleaved and removed as free fragments. Its levels both before and after the HD session are higher than in healthy subjects.

Y-chromosome transfer induces changes in blood pressure and blood lipids in SHR.

Previous studies with chromosome-Y consomic strains of spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats suggest that a quantitative trait locus for blood pressure regulation exists on chromosome Y. To test this hypothesis in the SHR-Brown Norway (BN) model and to study the effects of chromosome Y on lipid and carbohydrate metabolism, we produced a new consomic strain of SHR carrying the Y chromosome transferred from the BN rat. We found that replacing the SHR Y chromosome with the BN Y chromosome resulted in significant decreases in systolic and diastolic blood pressures in the SHR.BN-Y consomic strain (P<0.05). To elicit possible dietary-induced variation in lipid and glucose metabolism between the SHR progenitor and chromosome-Y consomic strains, we fed rats a high-fructose diet for 15 days in addition to the normal diet. On the high-fructose diet, the SHR.BN-Y consomic rats exhibited significantly increased levels of serum triglycerides and decreased levels of serum HDL cholesterol versus the SHR progenitor rats. Glucose tolerance and insulin/glucose ratios, however, were similar in both strains on both normal and high-fructose diets. These findings provide direct evidence that a gene or genes on chromosome Y contribute to the pathogenesis of spontaneous hypertension in the SHR-BN model. These results also indicate that transfer of the Y chromosome from the BN rat onto the SHR background exacerbates dietary-induced dyslipidemia in SHR. Thus, genetic variation in genes on the Y chromosome may contribute to variation in blood pressure and lipid levels and may influence the risk for cardiovascular disease.

Genetics of Cd36 and the clustering of multiple cardiovascular risk factors in spontaneous hypertension.

Disorders of carbohydrate and lipid metabolism have been reported to cluster in patients with essential hypertension and in spontaneously hypertensive rats (SHRs). A deletion in the Cd36 gene on chromosome 4 has recently been implicated in defective carbohydrate and lipid metabolism in isolated adipocytes from SHRs. However, the role of Cd36 and chromosome 4 in the control of blood pressure and systemic cardiovascular risk factors in SHRs is unknown. In the SHR. BN-Il6/Npy congenic strain, we have found that transfer of a segment of chromosome 4 (including Cd36) from the Brown Norway (BN) rat onto the SHR background induces reductions in blood pressure and ameliorates dietary-induced glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. These results demonstrate that a single chromosome region can influence a broad spectrum of cardiovascular risk factors involved in the hypertension metabolic syndrome. However, analysis of Cd36 genotypes in the SHR and stroke-prone SHR strains indicates that the deletion variant of Cd36 was not critical to the initial selection for hypertension in the SHR model. Thus, the ability of chromosome 4 to influence multiple cardiovascular risk factors, including hypertension, may depend on linkage of Cd36 to other genes trapped within the differential segment of the SHR. BN-Il6/Npy strain.