[Enzalutamide and Abiraterone in the Treatment of Metastatic Castration-resistant Prostate Cancer after Chemotherapy]. / Enzalutamid a abirateron v lécbe metastatického kastracne refrakterního karcinomu prostaty po predchozí chemoterapii.

AIM: Enzalutamide and abiraterone represent new therapeutical options in the treatment of metastatic castration-resistant prostate cancer (mCRPC). The aim of the presented study was retrospective analysis of clinical experience and efficacy of enzalutamide or abiraterone in the postchemo indication in patients with mCRPC. PATIENTS AND METHODS: A total of 32 mCRPC patients were evaluated. All patients received one or more lines of chemotherapy. Twenty-three patients were treated by enzalutamide, nine patients were treated by abiraterone. We defined two parameters: over all survival and progression-free survival. RESULTS: The median follow-up was 6.5 months. A total of 10 patients treated by enzalutamide progressed (43.47%) and eight patients died (34.78%). A total of five patients treated by abiraterone progressed (55.56%) and one patient died (11.11%). We did not observe any statistical difference in over all survival (HR 0.2362, 95% CI 0.0295- 1.8942; p = 0.102) and in progression-free survival (HR 0.9853, 95% CI 0.2934- 3.308; p = 0.939) between enzalutamide and abirateron. CONCLUSION: Our retrospective study demonstrated similar efficacy of enzalutamide and abiraterone in mCRPC patients previously treated by chemotherapy.

[Which first-degree relatives of patients with colorectal neoplasias are at the highest risk]. / Kterí príbuzní prvního stupne nemocných s kolorektálními neoplaziemi jsou nejvíce ohrozeni.

BACKGROUND AND AIMS: The first-degree relatives of patients with colorectal neoplasias have higher risk of colorectal cancer than general population. The aim of our study was to identify first- degree relatives at the highest risk of colorectal neoplasia considering both their hereditary and nonhereditary risks. METHODS: We have analysed the results of colonoscopic examinations of the first- degree relatives done within the project and we have compared them with the epidemiologic data relevant to colorectal cancer that we obtained from first-degree relatives. RESULTS: 160 first- degree relatives (66 men, 94 women, mean age 48.2, SD ± 10.9 years) have undergone colonoscopic examination within the project, 105 (66 %) of them had no or nonneoplastic polyps, 55 (34 %) had neoplastic lesions. In the univariate analysis the risk factors for the occurrence of neoplastic lesions were: male sex (OR 2.30, 95% CI 1.18- 4.48, p = 0.014), age over 50 years (OR 2.78, 95% CI 1.42- 5.45, p = 0.003), sibship (OR 2.71, 95% CI 1.25- 5.87, p = 0.012), smoking (OR 2.37, 95% CI 1.21- 4.63, p = 0.012) and higher fat intake (OR 2.07, 95% CI 1.07- 4.04, p = 0.032). In the multivariate analysis only the age over 50 years proved significant (OR 2.84, 95% CI 1.32- 6.09, p = 0.007). The most of the neoplastic lesions in first- degree relatives were located in the right colon. CONCLUSIONS: We can confirm high prevalence of neoplastic lesions among first- degree relatives. First-degree relatives at the highest risk are men over 50 years of age, siblings, smokers, who do not reduce dietary fat intake. This group of patients share both genetic and environmental risks and thus should be screened with the highest priority.

[Inadequate screening and low awareness about risk factors among first-degree relatives of colorectal cancer patients]. / Nedostatecný screening a malá informovanost o rizikových faktorech a príbuzných I. stupne nemocných s kolorektálním karcinomem.

INTRODUCTION: First-degree relatives ofcolorectal cancer patients have higher risk of disease, thus colonoscopic screening should be started at the age of 40 in this group. Goal of the study was to assess their awareness of the colorectal cancer risk factors and their compliance with colorectal cancer screening programme. METHODS: 62 patients after colorectal cancer resection and their 67 first-degree relatives (42% out of 160 addressed) answered structured questionnaire and counselling focused on colorectal cancer risk factors, and screening participation. RESULTS: Before diagnosis of colorectal cancer only 18% of colorectal cancer patients (11/62) were aware of its risk factors, after diagnosis their awareness increased to 65% (40/62, p < 0.001). Before questionnaire 46% of first-degree relatives (31/67) were aware of colorectal cancer risk factors, after counselling awareness increased to 66% (44/67, p = 0.024). 79% (53/67) offirst-degree relatives were aware of their increased familial risk. 28% (19/67) of first-degree relatives enrolled for colorectal cancer screening. Most frequent screening method was fecal occult blood test (FOBT) in 21% (14/67) of first-degree relatives, colonoscopy was performed only in 7% (8/67) of first-degree relatives. Average age of screening participation was 53 years. 22% (15/67) of first-degree relatives refused any screening in the future. CONCLUSIONS: We have found low awareness of colorectal cancer risk factors in colorectal cancer patients and their relatives before their diagnosis of disease respectively before their counselling. First-degree relatives are aware of their increased risk, however their screening participation is unsatisfactory. Screening is performed only in minority of first-degree relatives, often late and with inappropriate modality (FOBT). 22% of first-degree relatives refused any screening in spite of their increased colorectal cancer risk.

[Surgery tracheostomies and percutaneous dilatation tracheostomies--retrospective study]. / Chirurgická a punkcní dilatacní tracheostomie--retrospektivni studie.

BACKGROUND: Surgical tracheostomy (ST) is replaced by percutaneous dilatation tracheostomy (PDT), namely because the second one requires less equipment and it consumes less time. PDT is indicated and performed mostly in intensive-care units. We focused on the type of technique of both methods and on the frequency of their complications. METHODS AND RESULTS: Retrospective study of patients, who underwent tracheostomy in Hospital Pardubice and Hospital Frydek-Mistek from 1998 to 2002, was conducted. Total number of 667 tracheostomies was performed, including 561 (84%) surgical tracheostomies and 106 (16%) percutaneous dilatational tracheostomies. During the previous five years an increase of PDT was observed. For the surgical tracheostomy a horizontal incision of the skin at the throat (49%) and the division of the thyroid isthmus (60%) were performed most frequently. The skin at the throat was sutured to the tracheal mucosa to create a mucocutaneous anastomosis in 122 cases (22%). PDT was performed using Griggs' guide wire dilating forceps in all cases. Early postoperative complications were observed in 27 cases (5%) in ST group and 12 cases (11%) in PDT group. There were 50 cases (9%) of late postoperative complications in ST group and 11 cases (10%) of late complications in PDT group. Statistically significant difference was found only in early complications, which were more frequent in PDT group (p < 0.05). CONCLUSIONS: During the last five years an increase of PDT performed to secure airways was observed. When performing ST, horizontal incision of the skin and division of the thyroid gland isthmus were used most frequently. Griggs' technique was used to perform PDT. PDT was associated with the higher rate of early complications and there was no significant difference in late complications in both groups.

[Treatment of chronic postirradiation proctitis with argon plasma coagulation ]. / Lécba chronické postradiacní proktitidy argonovou plazmakoagulací.

Chronic radiation proctitis calls for a disease of the rectum due to irradiation of pelvic malignancies. The results of treatment of 8 patients with hematochezia from chronic radiation proctitis are presented here. They were treated with argon plazmakoagulation during 1-4 sessions. Hematochezia has disappeared in all cases. Rectal pain was the reason for hospitalization in one case. After the treatment, improved quality of live was claimed by all patients.

[Clostridium difficile infection associated with pseudomembranous colitis in district hospitals]. / Asociace infekce Clostridium difficile a pseudomembranózní kolitidy v nemocnici okresního typu.

At a regional hospital serving 150,000 inhabitants, the authors were tracking the occurrence of antibiotic-associated diarrhea caused by a nosocomial infection of the Clostridium difficile, especially its most serious form--pseudomembranous colitis. Six cases of the disease were found in a retrospective study in 2001, another 20 cases were diagnosed while actively searching for the disease from January till September of 2002. The patients suffered from many complications, were of an average age of 69.24 years, their hospitalization averaged 34 days and 15 (52%) of them underwent surgery during their hospitalization. It could be demonstrably proved that 25 cases of nosocomial infection occurred during hospitalization and 3 patients were admitted to hospital with the disease. However, 2 of them had been released from hospital less than 20 days before being admitted again. Twenty-five patients (96%) had been treated with antibiotics, often in combined therapy. Most often this involved penicillin with betalactamas activity (50%), clindamycin (42%) and cefalosporins (42%). We used methods for detecting enterotoxin A in the stool, rectoscopy and anaerobic cultivation of the stool in the diagnostic process. Rectoscopy discovered pseudomembranous colitis in 14 of 17 patients examined this way. The sensitivity for proving enterotoxin A in the stool using EIA, for patients with proven pseudomembranous colitis via rectoscopy, was 75%. Anaerobic cultivation of the stool was done in 12 patients and all the results were negative. The mortality rate of 38% for our group of patients testifies to the seriousness of this disease, which we consider to be the results of antibiotic therapy. In conclusion, nosocomial infection caused by Clostridium difficile is quite often a nosocomial disease, a prognosis that especially worsens for seriously ill patients.

[Spinocellular carcinoma in a patient with Fanconi's anemia]. / Spinocelulární karcinom u nemocné s Fanconiho anémií.

The authors describe the case of a 24-year-old female patient with Fanconi's anaemia where they diagnosed spinocellular carcinoma of the oesophagus. At the same time they found skeletal abnormalities, caked kidney with pelvic dystopia and uterus unicornis. In patients with Fanconi's anaemia frequently acute leukaemia, liver tumours and spinocellular carcinoma are described. The knowledge of these facts makes early diagnosis of these associated diseases possible.

A research-based guideline for appropriate use of transdermal fentanyl to treat chronic pain.

PURPOSE/OBJECTIVES: To describe a research utilization project intended to develop, implement, and evaluate a research-based guideline for the use of transdermal fentanyl. DATA SOURCES: The guideline was based on existing literature, clinical expert knowledge, manufacturer recommendations, and cost considerations. Principles of guideline development and evaluation were based on recommendations from the Agency for Health Care Policy and Research. DATA SYNTHESIS: A comparison of data from baseline to six months after guideline implementation revealed improvements in all criteria. Most of the improvements were maintained at 18 months postguideline implementation. CONCLUSIONS: The guideline improved the appropriate use of transdermal fentanyl. Ongoing education and monitoring is necessary to maintain change in practice. IMPLICATIONS FOR NURSING PRACTICE: The cost-effective use of expensive technology is a concern in the area of health care. Nurses need to promote the appropriate use of pain-management techniques to provide quality care for patients with chronic pain. Guidelines will help nurses to support the use of higher-cost medications in this subpopulation of patients.

[Choledochal cyst]. / Cysta choledochu.

Cysts of the choledochus are the most frequent type of cystic dilatation of the biliary pathways. The authors describe the case of a 24-year-old patient with a history of biliary complaints. A cyst of the choledochus was suspected after sonographic examination. The diagnosis was confirmed by infusion cholangiography and endoscopic retrograde cholangiography. The patient was indicated for surgery, i.e. resection of the cyst with hepaticojejunoanastomosis Roux-en-Y.