[Complications arising out of insufficient reporting of clinical data to the pathologist investigating placentas]. / Komplikace vyplývající z neposkytnutí relevantních klinických údaju patologovi vysetrujícímu placenty.

OBJECTIVE: To inform gynecologists-obstetricians about the problems associated with pathological examination of placentas, with special regard to the possibility of crucial role of complete and relevant clinical data in establishing the correct pathological diagnosis. DESIGN: Case report and overview of the problems associated with examination of placentas by pathologist. SETTING: Sikl´s Institute of Pathology, Faculty Hospital and Medical Faculty Pilzen of the Charles University in Prague; Biopticka laborator, s.r.o., Pilzen. METHODS: Own observation in the setting of routine pathological examination. RESULTS: Case report representing a typical complication resulting from insufficient interdisciplinary communication describes a case of unsatisfactory result of pathological investigation of placenta due to the missing clinical information about complications of the late phase of pregnancy which eventually led to intrauterine death of the fetus. Due to the absence of the clinical information of paramount importance, the initial investigation of placenta was untargeted and thus imperfect. Therefore, the primary investigation of the placenta did not reveal pathological changes responsible for the complications of pregnancy. It was only the revision of material necessitated by the information additionally conveyed by gynecologist-obstetrician leading to the final correct pathological diagnosis, which even averted the possibility of serious forensic consequences. CONCLUSION: The basic prerequisite for proper pathological examination of placenta is sharing the available clinical data with the pathologist performing the morphological investigation, mainly focusing on complications of pregnancy. Lack of such information causes examination of placenta more difficult and sometimes even unable to interpret, as the interpretation of morphological changes of placenta have to interpreted in the context of clinical data on the course of pregnancy. Regarding the extreme emotional and possibly even legal consequences of lethal complications of pregnancy or delivery, the correct pathological diagnosis may be of crucial importance.

Protein expression of ATP-binding cassette transporters ABCC10 and ABCC11 associates with survival of colorectal cancer patients.

PURPOSE: This study investigated the prognostic importance of protein expression of ATP-binding cassette (ABC) transporters ABCC10 and ABCC11 in colorectal cancer. METHODS: Protein content of ABCC10 and ABCC11 was assessed in tumor tissue blocks of 140 colorectal cancer patients and associated with survival of patients with regard to 5-fluorouracil-based therapy. RESULTS: Low ABCC10 protein content in tumors increased hazard ratio of patient's death more than three times in comparison with high ABCC10-expressing tumors (P = 0.004). In contrast, the low ABCC11 content increased the hazard ratio of cancer recurrence in patients almost four times (P = 0.016). Analysis of patients treated with regimens based on 5-fluorouracil revealed that patients with low ABCC11 content in their tumors had shorter disease-free interval than those with higher content (P = 0.024). CONCLUSIONS: The present study shows for the first time that the protein expression of ABCC10 significantly associates with overall survival and the expression of ABCC11 with disease-free interval of colorectal cancer patients and provides strong impulse for further validation of their prognostic value in colorectal cancer.

[Lynch Syndrome -  the Pathologist's Diagnosis]. / Diagnóza Lynchova syndromu od patologa.

Lynch syndrome (formerly known as hereditary non-polyposis colorectal cancer) is the most com-mon hereditary colorectal cancer syndrome. The syndrome is caused by a germline mutation of one of the mismatch repair (MMR) genes responsible for DNA replication error repair. Impaired function of the proteins encoded by these genes leads to microsatellite instability (MSI), which is associated with increased incidence of neoplasms: mainly colorectal cancer. According to recent estimates, up to 5% of all colorectal cancers are associated with Lynch syndrome. Due to this relatively high frequency, familial occurence, absence of premorbid phenotype, and development of malignant tumors at a reproductive age, a correct diagnosis is important not only from an ethical but also from an economical point of view. Unfortunately, clinical means of diagnosis, namely, the revised Bethesda guidelines designed to detect patients suitable for genetic testing for Lynch syndrome, lack sufficient sensitivity. The methods associated with modern pathology are more sensitive than the clinical criteria used to detect patients suspected of having Lynch syndrome. Pathological diagnostics are based on direct or indirect detection of MSI. Indirect methods include analysis of morphological signs associated with MSI in histological samples from colorectal carcinoma patients and immunohistochemical investigation of MMR protein expression. To rule out sporadic cases caused by epigenetic inactivation of an MMR gene, molecular genetic investigation of the BRAF gene and methylation analysis of the MLH1 promoter are performed during diagnostic workup. A suspicion of Lynch syndrome based on the results of the methods mentioned above should be proven by detection of a germline mutation in an MMR gene in peripheral blood leukocytes.

Utility of immunohistochemical investigation of SDHB and molecular genetic analysis of SDH genes in the differential diagnosis of mesenchymal tumors of GIT.

Loss of expression of beta subunit of succinate dehydrogenase (SDHB) was proved to be present in a subgroup of KIT/PDGFRA wt gastrointestinal stromal tumors (GISTs). To evaluate possible diagnostic utility of SDHB immunohistochemistry in the differential diagnostics of mesenchymal tumors of gastrointestinal tract (GIT), 11 cases of KIT/PDGFRA wt GISTs, 12 gastric schwannomas (GSs), 20 solitary fibrous tumors (SFTs), 4 leiomyomas (LMs), 16 leiomyosarcomas (LMSs), 5 synovial sarcomas (SSs), 3 endometrioid stromal sarcomas (ESSs), and 1 ileal inflammatory myofibroblastic tumor (IMT) were investigated for SDHB immunoexpression together with molecular genetic analysis of genes encoding succinate dehydrogenase (SDH). Three recent cases of KIT/PDGFRA mutant GISTs were used as controls. Among the 11 KIT/PDGFRA wt GISTs, 6 expressed SDHB, 1 of them harboring a sequence change of SDHD. All SDHB-negative cases were SDHB-D wt. In 1 of the control GIST cases molecular genetic analysis revealed an SDHD sequence change in addition to a mutation in KIT exon 11. No SFT was truly SDHB-negative, but in 2 of them the staining was impossible to analyze. Furthermore, 1 SFT carried an SDHB and another 1 SDHD sequence change. All GSs, LMs, LMSs, SSs, ESSs, and IMT were SDHB-positive or non-analyzable, and SDHB-D wt. Additional factors may play a role in regulating expression of SDHB. Furthermore, SDHB immunohistochemistry alone may be misleading in excluding tumors other than GIST (especially SFT) in the differential diagnosis of KIT/PDGFRA wt mesenchymal tumors of GIT.

[Changes of hemodynamics during the treatment of patients with neurologic pain syndromes by the method of dynamic electrical neurostimulation].

The Doppler ultrasound technique was used to study blood flow characteristics for the evaluation of the efficacy of the treatment of painful neurological syndromes with the help of a DiaDENS apparatus allowing for dynamic changes of electrostimulation parameters. A significant improvement of the extracranial cerebral blood flow was achieved as early as the mid-course of 10 treatment sessions when the most pronounced stabilization of the clinical characteristics was apparent. Marked heterogeneity of responses of extracranial vessels to the therapeutic effect of dynamic electrostimulation (DENS) was documented, possibly due to the redistribution of the blood flow in certain vascular areas during the treatment. DENS applied to the lumbar region was shown to induce positive dynamics of the initially impaired blood flow in the tibial artery. It is concluded that positive hemodynamic changes in the cerebral blood flow constitute an important component of the anesthetic and general sanogenetic actions of DENS.

[Genetically determined organ-specific changes of some tissue morphometric characteristics under the various exogenous influences].

Organ-specific alterations of ultrastructure and morphofunctional condition in different organism's tissues, which could evidence of the genetic factors inclusion under the development of different hypoxic condition in organism, were investigated. The dates obtained indicated the marked organ-specific "structure" reaction of tissues, cells and organelles under various exogenous influences. Such reactions confirm the presence of different genes expression which account for ultrastructure alterations; its activity is determined by a type, intensity, duration of influence as well as organ belonging. Ultrastructural alterations are mainly determined by tissue and cell factors but not by genetically determined system reactions; it is confirmed by various reactions on external factors in animal tissues with different genetically determined oxygen consumption level or genetically determined adaptation to middle-altitude conditions.

[Correlation between the thickness of air-blood barrier of the lung and main indices of respiration during changes in oxygen concentration]. / Vzaiemozv'iazok tovshchyny aerohematychnoho bar'iera lehen' ta osnovnykh pokaznykiv dykhannia pry zmini kontsentratsiï kysniu.

In experiments on adult white laboratory rats the correlation among external respiration, gas exchange and blood O2 transport under breathing by air and gas mixtures with 40%, 14.5%, 11% and 7% O2 in N2 was investigated. It was demonstrated the narrow structural-functional interrelation in oxygen transport system. The thickness of air-blood barrier (ABB) correlates not only with the external respiration and diffusion capacity of lung, but with parameters, which are not directly connected with the state of lung tissue, such as oxygen content in venous blood, VaO2/VO2 and even with circulation volume. The existence of narrow correlation of ABB thickness and the most of investigated parameters permits to prognosticate the availability of structural disturbances in the presence of external respiration, gas exchange and blood O2 transport changes.

[Clinico-pharmacologic aspects of the use of ofloxacin]. / Kliniko-farmakologicheskie aspekty primeneniia ofloksatsina.

Ofloxacin was used in the treatment of 124 patients with bronchopulmonary diseases, the diseases of the biliary system and other infectious inflammatory diseases of the internal organs. The microbiological and pharmacokinetic indices as well as the immune status were investigated. The drug proved to be efficient in the treatment of 78.9 per cent of the cases. The pharmacokinetic indices were evident of the fact that the treatment of severe cases should be started with the drug intravenous administration. Ofloxacin had no negative effects on the immune status.

[Role of electrolytes in the pathogenesis of arterial spasm and muscle cramps in varicose veins of the lower limbs]. / Rol' élektrolitov v patogeneze arterial'nogo spazma i myshechnyk sudorog pri varikoznoi bolezni nizhnikh konechnostei.

The blood magnesium and calcium content and the blood flow in the limbs was studied in 68 patients suffering from varicosity, 42 of whom had trophic ulcers of the legs. It was established that diminished content of magnesium in blood serum contributes to the development of hypercalcemia, spasm of arterioles, and the occurrence of muscular convulsions and trophic disorders and thus plays an essential role in the pathogenesis of changes of the blood flow and trophic disorders. Administration of magnesium preparations in the preoperative period improved circulation in the limb and relieved muscular convulsions completely.

[Possibility of predicting and preventing postoperative complications leading to relaparotomy]. / Vozmozhnosti prognozirovaniia i profilaktiki posleoperatsionnykh oslozhnenii, privodiashchikh k relaparotomii.

The occurrence of relaparotomies is known to be 1,2% of operations on the abdomen organs. Pyo-inflammatory complications are responsible for more than half cases resulting in relaparotomies. Relaparotomies are divided into emergent and urgent, radical and palliative. A system for prognosis of complications and differential diagnosis of postoperative paresis of the gastro-intestinal tract and postoperative peritonitis is presented. Prophylactics of postoperative complications reduced lethality after relaparotomies from 79% to 56%.