[An inflammatory pseudotumor of the liver surrounding a foreign object]. / Zánetlivý pseudotumor jater kolem cizího telesa.

The authors present a rare case of the fish bone migration from the upper GIT into the liver parenchyma. Furthermore, a possibility of the diagnostics and management of its rare complication- an inflammatory pseudotumor of the liver is presented. Based on the literature data, other possible complications of foreign objects in the liver parenchyma are listed, including their diagnostic and treatment options.

Epidermoid tumor of the pons.

Epidermoid tumors originating from the brainstem are extremely rare. The authors report a patient with an intraaxial epidermoid tumor of the pons. The tumor involved most of the pons and had a small exophytic component.

Dermoid tumor with involvement of the frontal lobes.

Intraparenchymal location of a dermoid tumor is extremely rare, and there are only four reports in the literature. This article presents a patient with a dermoid tumor with trilobulated components; an extra-axial component in the basal frontal/ethmoidal region, and two intra-axial components located in each frontal lobe. In addition, two small fat-density lesions anterior to the component in the left frontal lobe were present, probably due to partial intraparenchymal rupture of the tumor. The pathogenesis of intra-axial locations is still controversial, and this article proposes that in at least some cases intraparenchymal rupture of dermoids can cause intra-axial dermoids.

[Percutaneous treatment of malignant stenoses of the biliary tract]. / Perkutánní resení maligní stenózy zlucových cest.

Experience with treatment of more than 800 patients with malignant stenosis of the biliary tract is reviewed. The significance of complex treatment using simple internal or external drainage, stent introduction, brachytherapy, percutaneous actinotherapy and locoregional chemotherapy is presented. Advantages of individual percutaneous methods are compared and indications for using metallic stent in patients with malignant stenosis of the biliary tract are evaluated. Significance and indications for the percutaneous treatment is discussed and its advantages are compared with the endoscopic approach.

[Interventional methods in the treatment of malignant conditions of the liver]. / Intervencní metody v lécbe maligních procesu jater.

The article overviews vascular and percutaneous interventional methods used in the locoregional chemotherapy of liver tumors. It is based on experience from the treatment of 248 patients on the Radiodiagnostic clinic of the Teaching hospital in Brno (Bohunice department). Chemoembolization includes precisely aimed administration of cytostatics and a total ischaemization of the malignant tissue. Another method of locoregional chemotherapy is the administration of high doses of cytostatics into the afferent artery. Positive effect can be achieved only when the cytostatic perfuses all liver segments. Preoperative embolization of the portal vein represents an effective preliminary treatment of patients before the liver ablation. Percutaneous thermal ablation and the use of percutaneous ethanol injections are limited by the costs of treatment, by the number, size and location of tumors. Percutaneous ethanol injections are indicated in the treatment of hepatocellular carcinoma in the cirrhotic tissue. Percutaneous thermal ablation can effectively destroy foci in the liver up to the size of 5 cm without impairment of the surrounding tissue. Locoregional and percutaneous therapy of malignant liver processes represent alternative methods and individual approaches should be combined. Indication has to be carefully thought about by an interdisciplinary committee. It is necessary to realise that the aim is not to perform "technically precise operation" gut the lengths and quality of the patient's life.

[Intervention radiology in the diagnosis and treatment of hepatic tumours]. / Intervencni radiologie v diagnostice a terapii nádoru jater.

Although intervention radiology has affected all spheres of oncology, in particular in diagnostics and therapy of malignant liver processes, its importance is fundamental. The authors summarize their long-term experience with invasive diagnosis of focal processes in the liver and with a minimally invasive therapy in more than 250 patients with malignant focal processes in the liver. Intervention radiology extends common diagnostic methods by the possibility of aimed administration of contrast substance before examination (CT after administration of Lipiodol) or during examination (CT angiography). Biopsy from a focus only 10 mm in size or less under CT control, ultrasound or MR lead rapidly to histological assessment of the nature of the process. In preoperative staging in particular in patients with colorectal carcinoma and secondaries in the liver peroperative ultrasound and CT arterial portography is of great importance. These methods are highly sensitive (CTAP) and also specific (peroperative ultrasound). Angiography combined with therapeutic procedures, similarly as percutaneous thermoablation methods have become an integral part of intervention radiology. An advantage of this approach to treatment of malignant focal hepatic processes is short hospitalization, the procedure is done under local anaesthesia and treatment can be repeated. However careful indication of the procedure is essential, best by an indication commission (surgeon, oncologist, gastroenterologist, radiologist).

[Metal stents in the treatment of benign tracheal stenoses]. / Kovový stent pri resení benigní stenózy trachey.

OBJECTIVE: To demonstrate in a group of 26 patients with benign stenosis of the trachea the possibility to use a Palmaz stent as the method of choice. MATERIAL AND METHODS: The authors introduced since 1995 to patients with benign stenosis of the trachea 36 stents (1 Wallstent, 2 Z stents and 33 Palmaz stents). The operation was performed under general anaesthesia in an operating theatre under skiascopic and optic control. The stent was inserted along a guide. Before insertion of the stent they dilated the stenosis by means of a balloon dilatation catheter. RESULTS: Respiration improved in all patients within 6 days after introduction of the stent. Within 30 days after insertion of the stent none of the patients died. Two patients (7.7%) died four weeks (Palmaz stent) and 11 months (Wallstent) after insertion of the stent. Restenosis was observed in 9 patients (34.6%) 2-16 weeks after introduction of the stent. In 5 patients restenosis developed repeatedly. At present 19 patients (73%) are free from complaints for 1 month to 4 years after insertion of the stent (average 28 months). 5 patients (19%) had a tracheostomy and insertion of the stent in these patients did not produce so far the anticipated result. CONCLUSION: The authors assume that the use of Palmaz stent is in patients with benign stenosis of the trachea in indicated cases the method of choice.

[Use of metal stents in treatment of benign stenoses of the biliary tract]. / Vyuzití kovových stentu pri resení benigní stenózy zlucových cest.

OBJECTIVE: The authors submit for discussion a group of patients where they resolved a relapsing benign stenosis of the biliary pathways by insertion of a metal stent. MATERIAL AND METHODS: Since 1995 the authors introduced a metal stent in 29 patients with benign stenosis of the biliary pathways. In the majority they used a Palmaz stent. RESULTS: The 30-day mortality in the group of patients was 3.4% (1 patient, myocardial infarction). Two patients (6.9%) died 3 and 18 months resp. after insertion of the stent (pneumonia complicated by a pulmonary abscess, hepatorenal failure). Signs of obstruction of the stent (raised levels of bilirubin and liver enzymes) were observed in 5 patients (17%). In 8 cases (27%) migration of the stent occurred. The follow-up period in 26 patients with benign stenosis with a stent is two months--4 years (mean 19 months). Sixteen patients are followed up for more than 12 months. CONCLUSION: In the treatment, in particular of relapsing benign stenosis of the biliary pathways, specially when located in the area of the anastomosis, insertion of a metal stent is effective alternate treatment.