The tubercle of Zuckerkandl, the ligament of Berry - importance for thyroid surgery.

The anatomical structures of the tubercle of Zuckerkandl (TZ) and the ligament of Berry (LB) have been known since the turn of the 20th century. The importance of the relationship between these structures and the thyroid gland was pointed out in the first half of the last century; nevertheless, it was neglected by most of the then surgeons. An increased interest of surgeons in detailed knowledge of these structures could only be observed from the 80´s of the last century in connection with guidelines for radical surgical treatments of the gland (both for benign and malignant diseases) and with the need to enhance the safety of these treatments. The knowledge of these two important structures and the skill of an exact surgical technique are necessary for the protection of the recurrent laryngeal nerve and the parathyroid glands, and also for the actual removal of the entire thyroid gland. Thyroid surgeons must keep in mind the existence of many anatomical and pathological variations in these regions, which makes the preparation of the gland so delicate.

Hashimotos thyroiditis.

Hashimotova tyreoiditida je chronické orgánově specifické autoimunitní onemocnění. Je charakterizována tvorbou autoprotilátek proti antigenům štítné žlázy s její lymfocytární infiltrací, vede k postupné destrukci funkčního parenchymu žlázy. Onemocnění je nejčastější příčinou vzniku hypotyreózy v oblastech, kde není dostatek jódu. Jeho etiologie není dosud přesně objasněna, často se u pacientů vyskytuje současně s dalšími autoimunitními poruchami, byl pozorován i jeho familiární výskyt. Bývá spojeno se zvýšeným rizikem rozvoje nádorového onemocnění štítné žlázy. Léčba je většinou konzervativní, chirurgický výkon bývá indikován při podezření na malignitu, nebo pokud se u pacientů vytvoří objemná struma působící mechanický útlak.

[Duplication of the gallbladder and cystic duct as a rare finding during cholecystectomy - a case report]. / Zdvojení zlucníku a duktus cystikus jako raritní nález pri cholecystektomii - kazuistika.

Congenital anomalies of the gallbladder, the biliary tract and their vasculature are relatively common. They usually represent only anatomical variations that may not manifest clinically, but in some cases they are of fundamental importance for the surgeon as they can cause diagnostic confusion or lead to problems during surgery. Their ignorance may result in many errors, injury during surgery and subsequent serious consequences. Genuine duplication of the gallbladder with the cystic duct and its artery is extremely rare and is therefore still only a subject of case reports. Gallbladder duplication itself is not an indication for surgery. If it contains stones or if inflammation occurs, however, both gallbladders may not be affected equally and if this variety is not recognized, only one of them may be removed and the other one can escape attention. The case report describes the rare case of gallbladder duplication including the cystic duct during elective cholecystectomy in a middle-aged man who was operated on after birth for omphalocele. Preoperative diagnostic examination described malrotation of the intestine and a cystic lesion next to the gallbladder, considered to be rather a liver cyst. Although it was indeed possible to assume various other abnormalities in the anatomical arrangement of the organs with regard to the patients history, the finding of double gallbladder including cystic duct was still surprising.

T-cell regulation of immunoglobulin synthesis and proliferation in pokeweed (Pa-1)-stimulated human lymphocyte cultures.

In pokeweed (Pa-1)-stimulated human lymphocyte cultures, T cells are essential for the survival, proliferation, plasma-cell development, and high-rate Ig secretion of B cells. Their effects are T-cell-specific in the sense that B-cell stimulation does not take place in the absence of T cells even when fibroblasts or monocytes are provided. The experimental system is the most effective model for activation of human B lymphocytes so far described. Plasmablast development requires approximately 7 days in culture. In T + B-cell cultures established at 1 X 10(6)/ml (1 X 10(4)/mm2) initial cell density, plasma cells can secrete, on the average, as much as 40-70 pg IgM or IgG per cell per day. When the initial T-cell density is increased well above 1.0 X 10(6)/ml, a T-cell-mediated depression of Ig synthesis becomes predominant. Thus, in the pokeweed model T-cell effects represent a balance of helper and suppressor influences. The study also shows that B cells are heterogeneous. A non-adherent IgG-committed (smIg-?) TONSIL B-cell population seems to be less susceptible to T suppressor effects than normal tonsil B cells. This subset proliferates particularly well and synthesizes large quantities of IgG in the presence of large initial proportions of T cells.