[Hemipelvectomy for a desmoidal tumor]. / Hemipelvektomie pro desmoidální tumor.

A case- review describing a desmoid in a young female. The tumor originated at the tendinuous attachment of the m. rectus abdominis on the pubic bone, which had had two relapses. During the third--so far the latest--procedure it required left-sided hemipelvectomy with resection of the rectum and a part of the vagina. The patient was instructed about the serious character of the disease, the requirement for the radical resection and about the requirement for a careful long-term follow-up of the patient after the procedure.

Squamous intraepithelial lesion-microinvasive carcinoma of the cervix during pregnancy.

OBJECTIVE: The objective of this work was to assess proper management of squamous intraepithelial lesion (SIL) and microinvasive carcinoma during and after pregnancy, to assess risks of punch biopsy and conization in pregnancy and to assess regression, persistence and risk of progression with low-grade (L) and high-grade (H) SIL. METHODS: We carried out a prospective study of 167 pregnant women from our colposcopic unit who were referred to us for abnormal cytological findings between 1997 and 2002. The diagnosis of precancerosis was verified in all of the women by punch biopsy, suspect microinvasive carcinoma needle or LETZ conization up to the 20th week of pregnancy. All women were followed-up during the pregnancy and 24 months after their deliveries. RESULTS: In 23 women with suspect early invasion we performed conization during the pregnancy (weeks 13-23). There were six cases (26.1%) of microinvasive carcinoma and 17 cases (73.9%) of HSIL. One pregnancy aborted two days after the conization. No other obstetrical complications were recorded and there were no premature deliveries. Sixty-two women with HSIL were only followed-up during their pregnancy. We observed complete regression of HSIL during the study in 14 patients (22.6%), regression to LSIL in 17 patients (27.4%), persistence in 25 patients (40.3%) and progression to microcarcinoma in six cases (9.7%). Eighty-two patients were followed up for LSIL. Complete regression of LSIL was observed during the study in 40 cases (48.8%), persistence in 24 cases (29.2%) and progression to HSIL in 18 cases (22.0%). CONCLUSION: For LSIL and HSIL during pregnancy the above follow-up is a sufficient and safe protocol. Suspect microinvasive carcinoma should be treated by conization, which is a safe procedure until the 24th week of pregnancy.

[Sentinel lymph node mapping in early-stage cervical cancer]. / Identifikace sentinelových lymfatických uzlin u casných stadií cervikálních karcinomu.

OBJECTIVE: The aim of this study was to determine the utilization and usefulness of intraoperative lymphatic mapping and sentinel node identification with Patent blau in early stage cervical cancer. DESIGN: Prospective case observational study. SETTING: Department of Obstetrics and Gynecology, Charles University, 2nd Medical Faculty, Faculty Hospital Motol, Prague. METHODS: From February 2000 to July 2002, 100 patients undergoing surgery for early cervical cancer were included, 21 patients undergoing SNI (sentat laparoscopy and 79 patients undergoing SNI at the time of radical abdominal hysterectomy after installation of blue dye (PatentBlau V 2.5%). We carefully inspected the lymphatic channels and sentinel nodes and performed a preoperative frozen section of sentinel nodes. Finally, complete lymphadenectomy was done. RESULTS: There was one false-negative result in the group of 100 women. In the group of tumors less than 20 mm the detection rate was 90.5% when laparoscopic detection was performed and 91.7% in laparotomic detection. In tumors more than 20 mm the detection rate was 80% and in the group of 25 women with "bulky" tumors IB2 after neoadjuvant chemotherapy the detection was 60% only. We analysed locoregional distribution of 176 sentinel lymph nodes in 75 women not undergoing neoadjuvant chemotherapy and distribution of 20 positive sentinel nodes. CONCLUSION: Detection of sentinel nodes in early stages of cervical carcinomas using patent blue dye is a easy-to-perform, feasible and cheap method. Additional studies are necessary using radioisotope to improve detection rate. Another prospective studies should evaluate the role of SNI in reduction in surgical radicality.

[Benign clear cell tumors of the lung--sugar tumors]. / Benigní nádory plic z jasných bunek--sugar tumors.

The authors present the case reports of rare benign clear cells tumors of the lung (CCLT) and drawn attention, that examination from frozen sections can be misleading and definitive histological verification can be done on basis of immunohistochemical analysis and can be different from frozen sections examination.

[Regression of hCG in various types of molar pregnancies--clinical course and prognosis]. / Regrese hCG u ruzných typu molárních tehotenství--klinický prubeh a prognóza.

OBJECTIVE: To evaluate spontaneous regression curves of hCG serum positivity in patients with surgically treated molar pregnancies. Comparison of complete, partial and invasive mole. The study should result in optimalisation of follow up criteria of molar pregnancies in respect to their potential malignant change. DESIGN: Retrospective comparative clinical study. SETTING: Obst. Gyn. Dpt., Oncogynecology div., 2nd Medical Faculty, FNM, Charles University Prague, Pathology Dpt., 2nd Medical Faculty, Institute of Biology and Medical Genetics. METHODS: Evaluation of spontaneous regression curves of serum hCG levels in 104 molar pregnancies. 46 patients with partial hydatiform mole, 48 patients with complete hydatiform mole, 10 patients with invasive mole. Serum hCG levels were detected by radioimunoassay (RIA) in the first period and imunochemoluminisent assay (LIA) in the second period. Regression curves of hCG positivity in particular moles were statistically evaluated by Fischer test and t-test. RESULTS: There is statistically significant difference in spontaneous regression of hCG positivity in different types of molar pregnancies. Recommended criteria for gestational trofoblastic disease (GTD) diagnosis and follow up are fully applicable in clinical practice. There is exception in partial hydatiform moles, where plateau in hCG regression does not necessarily implicate chemotherapy in patient with good compliance. CONCLUSION: Early diagnosis of GTD predominantly due to the widespread use of ultrasonography changes classical clinical features of molar pregnancies. Spontaneous regression in hCG positivity in serum is more rapid in patients with partial hydatiform mole, slower in complete hydatiform mole and invasive mole. There is no significant change in malignant potential regarding early detection and treatment.

[Therapeutic embolization of the venous bed using Vilan 500 in animal experiments]. / Terapeutická embolizace zilního reciste Vilanem 500 pri pokusech na zvíreti.

The experiment in four dogs verified a suitability of the Czechoslovak preparation Vilan 500, a copolymer of polyvinyl acetate - polyvinyl alcohol in 93% ethanol, for the embolism of venous vascular bed in the percutaneous, transfemoral catheterization way. In all four cases there was a complete occlusion of embolized spermatic or pararenal veins, verified by a control angiography after one hour and after three months. The prepared venous samples were also examined by histology and changes indicating intraluminar thrombotization and subsequent fibrous reconstruction were observed. In view of the results reached it may be concluded that the catheterization technique and the use of Vilan 500 is suitable as an alternative of non-surgical solution of varicocele.

Genetic analysis of anti-TBM disease in the Norway rat.

The anti-tubular basement membrane (TBM) disease was found in own kidneys of BN, but not BN.1B rats, after immunization with BP.1N (or BP) allogeneic kidney homogenate in CFA. Both humoral [anti-TBM reaction assessed by direct immunofluorescence (IF)] and cellular response to TBM antigen (tubulointerstitial nephritis and giant cell infiltration) appeared to be controlled by an MHC-linked Ir gene(s). In the present experiments all of the 54 RT1b/RT1n heterozygous Bc rats (BN.1B x BN) x BN.1B were found to be anti-TBM positive by direct IF following the immunization mentioned above, as were all (BN.1B x BN)F1 hybrids. Among 51 RT1b/RT1b Bc homozygotes, 5 animals formed linear anti-TBM deposition in their own kidneys. The direct IF staining was somewhat weaker than in the preceding groups but continuous. However, circulating anti-TBM antibodies were not proven by indirect IF in these rats. BN animals failed to develop anti-TBM disease not only after syngeneic immunization but also after BN.1B inoculum differing in RT1 antigens alone. Only donor-recipient strain combinations involving non-RT1 differences (BP or BP.1N to BN, BN.1B or BN to BP.1N) were susceptible to the anti-TBM response. Thus the previously revealed adjuvant effect of non-RT1 alloantigenic differences was confirmed, whereas RT1 difference had no such effect nor was involved in it. In conclusion, the main anti-TBM Ir gene seems to be closely linked with, or even included in, the RT1n haplotype in our system of congenic strains. An alternative hypothesis is that there may be two separately functioning Ir genes, one within the RT1n allele and the other in linkage with RT1.

Experimental infection with Mycobacterium kansasii in athymic nude mice.

Subcutaneous infection with Mycobacterium kansasii did not cause mortality in athymic nu/nu and control nu/+ mice. It had a stimulatory activity comparable to obligatory mycobacterial pathogens: thymus-dependent lymphatic tissues areas were populated during the infection by lymphocytes also in nu/nu mice in which a low degree of migration inhibition factor production could be seen. In both models of chief site of mycobacterial trapping and phagocytosis was the hyperplastic interdigitating cell mesh in the thymus-dependent areas of lymph nodes. A detailed morphological description of the organ changes is given.

MHC control of autoimmune anti-TBM reaction in the Norway rat.

The RT1 control of anti-TBM reaction presupposed in rat kidney transplantations has been revealed in immunization experiments performed in similar strain combinations. The anti-TBM reaction proven by immunofluorescence and in some cases even tubulointerstitial nephritis with giant cell infiltration developed in kidneys of BN rats immunized with BP.1N (or BP) kidney homogenate in CFA. On the contrary, BN.1B recipients of BP (or BP.1N) kidney homogenate in CFA displayed no anti-TBM reaction. This is in perfect correlation with the absence of TIN and anti-TBM reaction in chronically rejected BP kidneys grafted to BN.1B (RT1b-identical) recipients. In accord with the literature data, LEW.1N animals carrying no TBM antigen(s) did not develop anti-TBM reaction detectable on their own kidneys following BP.1N immunization. In our experiments the adjuvant effect of alloantigenic difference was necessary for the immunization with syngeneic BN kidney and CFA did not induce any anti-TBM signs in BN recipients' own kidneys. The existence of some anti-TBM antigen Ir genes linked to the rat MHC can thus be assumed. However, there was no clear-cut association of glomerular changes with MHC in immunization experiments. On the basis of the data presented here the contribution of an anti-TBM component and TIN to the subacute rejection of RT1n-matched rat kidney grafts seems to be confirmed in the special (BP.1N to BN) strain combination previously described.

[Epithelial tumors of the liver in childhood]. / Epitelové nádory jater v detském veku.

A group of five epithelial hepatic tumours in children includes one adenoma, one embryonic and two mixed hepatoblastomas, and one hepatocarcinoma. The specific features of the histological structure of the above tumours are discussed.

An unusual case of phospholipidosis.

We present the results of a structural, histochemical and lipid-chromatographic study of tissues obtained at postmortem from an unusual case of phospholipidosis. A previous biopsy of the appendix and liver (Elleder et al., 1975a) had revealed a predominance of phosphoglyceride storage, principally of lysobisphosphatidic acid (LBPA) postmortem material showed that this lipid was stored exclusively in central neurons. In the spleen and the lymph node, however, sphingomyelin (SP) was shown, histochemically and chromatographically, to be the main lipid stored. Total sphingomyelinase (SPase) activity in the appendix was reduced to about 50% of normal. Neuroaxonal dystrophy (NAD) and a conspicuous discrepancy between the degree of distension of some neurons and their lipid content deserve special mention. The case is contrasted with classical sphingomyelinosis; the complexity of the Niemann-Pick group of diseases is discussed as an indication of the difficulties of classification of any atypical case.