[Diagnosis of lymphoproliferative diseases from bone marrow biopsies]. / Zkusenosti s diagnostikou lymfoproliferativních onemocnení v biopsii kostní drene.

The cytological, histological and immunophenotypical markers of lymphoproliferative diseases are evaluated in the collection of 950 trepanobiopsies, and correlated with types of extramedullary malignant lymphoma. The diagnostic significance of tumor infiltrates topography and basic rules of the differential diagnoses of malignant lymphomas in the bone marrow biopsies are discussed.

[Large volume tumors with uncertain biological activity located in the pleural cavity]. / Objemné tumory s nejistou biologickou aktivitou lokalizované v pohrudnicní dutine.

The authors discuss specific problems of an exact diagnosis and indication for surgical treatment in patients with large tumours in the pleural space. Our series includes even some rare tumours of varied histogenesis. The biological activity of those tumours is frequently uncertain and causes an unpredictable prognosis. The prognostic conclusion is based on a bioptic diagnosis, established by histological examination. Complete extirpation is essential.

[The hepatic form of Wilson's disease in young patients]. / Jaterní forma Wilsonovy nemoci u mladých pacientu.

UNLABELLED: Wilson's disease (WD) is a hereditary disorder of the copper metabolism with very varied clinical and biochemical symptoms. Hepatic and neurological forms are the most frequent manifestations of this rare disease. In schoolchildren and adolescents symptoms of liver damage predominate. In a retrospective study 19 patients were evaluated with biochemical signs of hepatopathy manifested before the age of 18 years. The diagnosis of WD was established at the age of 7 to 27 years. One female patient was admitted with fulminant hepatic failure which was treated by acute transplantation of the liver in the Institute of Clinical and Experimental Medicine in Prague. Only 9 of 18 patients with chronic hepatic affection at the time of diagnosis met the Sternlieb diagnostic criteria. These patients had reduced ceruloplasmin levels (0.08-0.18 g/l) and a high copper content in the hepatic dry matter (783 ug/g +/- 323 [SD]). In the remaining 9 patients the ceruloplasmin level was normal, however, in 8 a high copper content of the hepatic dry matter was found (696 ug/g (+)- 352[SD]. The last patient from this group had Kayser-Fleischer's (K-F) ring. It was possible to confirm the high copper content in the hepatic dry matter only after one year's penicillinamine treatment because at the time of the diagnosis poor coagulation did not permit to perform a liver biopsy. There was a statistically significant difference in the copper content of the hepatic dry matter in patients meeting and not meeting Sternlieb's criteria. Statistically significant differences between both groups were found in the plasma copper levels and in the 24-hour urinary copper excretion. Histological examination of the liver under a light microscope revealed findings from minimal changes associated with the presence of glycogen nuclei in hepatocytes to the picture of active chronic hepatitis. In all 19 patients the gene mutation H1069Q was examined and the results were positive in 39.8%. In 3 asymptomatic patients it was present in the homozygous form. CONCLUSION: Early detection of the atypical form of WD remains very difficult. The gold standard is still in all cases assessment of copper in the dry liver tissue. In the near future an important place will be held also by direct DNA analysis although its use is limited not only by the large number of known mutations but also by the financial costs of the method.

[Classic carcinoids of the appendix]. / Klasické karcinoidy apendixu.

Nine classic carcinoids smaller than 2 cm, situated elsewhere than at the base of the appendix have been diagnosed in the Department of Pathology of the University Hospital in Olomouc during the period from 1994 to 1999. Appendectomy including removal of the mesenteriolum was performed in all cases. The literature mentions favourable prognosis of patients with small appendiceal carcinoids--100 per cent 5-year survival rate. Tumours greater than 2 cm recur and metastasise. These tumours require oncological therapy in cases with unresectable metastases. This worsens the 5-year survival rate to 21-42%.

Apoptosis-related proteins, BCL-2, BAX, FAS, FAS-L and PCNA in liver biopsies of patients with chronic hepatitis B virus infection.

While the elimination of hepatitis B virus (HBV) is a common phenomenon at the end of the acute phase of disease, the persistence of HBV is characteristic for chronic hepatitis (CHB). Recent evidence indicates that the elimination of HBV is achieved by FAS/FAS-L induced apoptosis of infected hepatocytes. The aim of this study was to test the hypothesis that HBV persistence in the hepatocytes of CHB patients is due to the delayed onset of apoptosis caused by altered FAS/FAS-L interactions between lymphocytes and hepatocytes. The expression of FAS, FAS-L, BAX, BCL-2, ICE and PCNA in the liver biopsies of 55 patients (14 HBsAg positive, 20 patients with alcoholic hepatopathy, 21 patients with other hepatopathies) was tested by immunohistochemistry. Apoptosis of hepatocytes was evaluated by morphological as well as by TUNEL method. The results were correlated with a grading/staging score and analysed statistically using a one way analysis of variance and the Duncan test. Significantly highernumbers of BAX positive hepatocytes were observed in HBsAg positive patients when compared to control groups. Similarly, both BAX and FAS positive lymphocytes were more frequent in HBsAg positive patients. FAS-L positive lymphocytes and hepatocytes were numerous in all patient groups. Increased numbers of BAX positive hepatocytes in CHB may reflect the increased readiness of these cells to undergo apoptosis. However, the increased numbers of both BAX and FAS positive lymphocytes in CHB suggest that these cells may be particularly sensitive to FAS-L mediated apoptosis potentially resulting in lowered viability of these lymphocytes. This may explain, at least in part, the defective removal of virus-infected cells in chronic hepatitis. However, we cannot rule out the possibility that survival of hepatocytes during CHB may be due to other mechanisms such as defects in apoptosis activation triggered by CD40, defects involving DNase and/or other caspases downstream in the apoptotic cascade within these cells, or to defects in CTL function.

[Sarcoidosis of the liver, a granulomatous process with an unclear prognosis]. / Sarkoidóza jater, granulomatózní proces s nejasnou prognózou.

The authors demonstrate on two patients the pitfalls of the diagnosis and prognostic uncertainty of systemic sarcoidosis. The typical pulmonary finding was in the background due to the very extensive and serious affection of the liver.

[Reoperation after Heller's myotomy]. / Reoperace po Hellerove myotomii.

Advanced achalasia with serious additional complications is quite rare. It should be seen mostly in individuals who were already unsuccessfully operated. The way definitively solving both dysphagia and the complications of advanced achalasia is the resection of oesophagus. Authors are showing their experience and according to the clinical appearance of the disease and histological examination of the whole extirpated thoracic oesophagus they are discussing acceptability of the extirpation of the whole thoracic oesophagus using regardful technique without thoracotomy. (Tab. 2, Fig. 3, Ref. 8.)

Fulminant hepatitis caused by a hepatitis B virus infection in the patients with haematologic malignancies. Report of 5 cases.

We describe 5 cases of fulminant hepatitis caused by the HBV infection in patients with haematological diseases, mostly malignancies (ALL, lymphoma, aplastic anemia, AML) following intensive chemotherapy. Infection was confirmed by serological examination (HBsAg positivity) and by electron microscopy (viral particles). After termination of chemotherapy fulminant hepatitis developed with hepatic failure and very high levels of AST and ALT. Autopsy revealed massive necrosis without signs of regeneration. We suggest that immunosuppressive therapy increases the risk of severe infection of hepatocytes with HBV and subsequent withdrawal of chemotherapy causes "immunological rebound" leading to massive necrosis.

Immunohistochemical study of the expression of BCL-2, PCNA and P53 proteins in the patients with hepatitis B. The pilot study.

In HBV related hepatitis it is generally accepted that the liver injury is mediated by an immune response to the virus, since HBV is not directly cytopathic. The first step in cytotoxic T lymphocyte mediated immune reaction in HBV infected mice is the induction of apoptosis. The role of BCL-2, p53 and PCNA (as the main regulators of cell cycle homeostasis) in this process has not been studied. The aim of this pilot study is to estimate immunohistochemically the expression of the BCL-2, p53 and PCNA in a group of HBV infected patients at various stages of the disease. Formalin fixed, paraffin embedded liver biopsies from 5 patients with HBsAG positivity in their serum were used for immunohistochemical study of the expression of BCL-2, PCNA (PC10) and P53 (DO1clone). As the chromogen we used both the DAB and AEC. The results were co-related with the 3 liver biopsies as controls. In the hepatocytes of the all cases (including controls) we did not found any positivity of BCL-2, p53 and PCNA. However the majority of the lymphocytes present in the liver of some cases of HBV infected patients were strongly BCL-2 positive. This preliminary results of very small group of patients could indicate that hepatocytes in the HBV infection are in the quiescent stage as in the controls and that the cell cycle regulation during infection could be controlled by other genes such as bax, bcl-Xs, FAS etc., but further studies are required.

[Mixed carcinoid-carcinoma of the stomach]. / Smísený karcinoid-karcinom zaludku.

Bioptical observation of a mixed carcinoid-carcinoma in a 75-year-old man's stomach was described. The subcardial tumour was 10-7 cm in diameter with secondaries in perigastric lymph nodes. A well differentiated adenocarcinoma with mucus production formed a minor marginal part of the carcinoid which expressed immunohistochemical markers common in gut cancers: carcinoembryonic antigen, epithelial membrane antigen and some cytokeratins. The well differentiated adenocarcinoma expressed different cytokeratins detected by AE1-AE3 antibody. The carcinoid was positive with Grimelius impregnation and strongly positive with chromogranin A and synaptophysin bound antibodies. Transition of both the tumour types was continuous.

[An instrument for hepatic artery compression in palliative treatment of liver metastases using repeated ischemia. A model and experimental study]. / Kompresní zarízení na jaterní tepnu pro paliativní lécbu jaterních metastáz prerusovanou ischemizací. Modelová a experimentální studie.

Method of interrupted ischaemization of the liver afflicted with metastases from colorectal cancer is not definitively evaluated yet. Using the literary reports the authors proposed (in cooperation with MEDIN) a instrument for compression of the liver artery, economically easy available. The reability of this instrument was tested in model conditions and his safety to the tested artery was proved on the experimental animal.

[Solitary liver metastasis of malignant schwannoma of the stomach treated with hemihepatectomy]. / Solitární jaterní metastáza maligního schwannomu zaludku, lécená hemihepatektomií.

The cause of large solitary hepatic metastasis is mostly the colorectal cancer, rarely also the cancer of breast, kidney, gynecologic organs, the melanoblastoma and the nonepithelial tumors of the stomach. These metastases, when they are proved as solitary, especially with long interval after removing the primary tumor, are well indicated for liver resection till hemihepatectomy. The authors treated successfully a large metastasis of malignant schwannoma, eight years after resection of the stomach with the primary tumor. Morphologic characteristics and biologic activity of primary tumors of this kind are discussed.

Some biochemical characteristics of the early phase of immunomodulation.

The study estimates some biochemical changes of chosen immunological and biochemical parameters after intraperitoneal application of a) immunomodulators of microbial origin--Propionibacterium acnes and Geotrichum candidum, b) chemical substances--indomethacin and phenobarbital. The estimation was concentrated above all to the changes of chemiluminiscence, phagocytic activities, the amount of cAMP in peritoneal macrophages, the amount of liver cytochrome P-450 and cAMP in the liver, spleen and thymus. The experiments also included histological examination of the spleen, thymus, lungs and diaphragm. The effect of Propionibacterium acnes was evident as soon as 24 hrs after application. In the frame of studied parameters, there was manifested the nonspecific activation of the immune system by the mechanisms independent to oxygen. The early changes were accompanied by the increase of cAMP in macrophages. In contrary, the intraperitoneal application of Geotrichum candidum activated the release of oxygen radicals from peritoneal macrophages. The amount of the cytochrome P-450 correlated to the intensity of immunomodulation. On the other hand, the induction of cytochrome P-450 by phenobarbital decreased the value of several immunity indices.

[Experimental verification of the hepatic perfusion index for monitoring direct liver perfusion by portal blood]. / Experimentální overení hepatoperfúzního indexu (HPI) pro sledování prímé perfúze jater portální krví.

The reliability of HPI measurement was studied in animal experiment. The portal vein of experimental dogs was narrowed by application of a metallic coil. The induced portal hypertension with important hepatofugal collaterals appeared to be a suitable model for the study of changes in HPI. A decrease in the index was statistically significant and corresponded to the hemodynamical efficiency of collateral circulation. The original experiment verified the reliability of HPI for an assessment of direct perfusion of the liver by portal blood.

Biochemical aspects of immunomodulation by Propionibacterium acnes.

The present paper deals with the effect of indomethacin and/or Propionibacterium acnes (Pa) on the cytochrome P-450 content in liver microsomal fraction, free fatty acids and lipase concentration in serum with respect to the phagocytic activities of monocytomacrophage system, changes in weight of the spleen and liver, survival after LD100 of Klebsiella pneumoniae, and histology of the spleen and liver. The results obtained indicate that INDO acts as an inhibitor of cytochrome P-450 and at the same time stimulates functions of the monocytomacrophage system in all the parameters studied. Pa, a classical immunomodulator, inhibits cytochrome P-450. After the initial suppression phase (3rd day after administration), it stimulates significantly the activity of monocytomacrophage system and increases the amount of FFA in the serum. The combination of both preparations also inhibits the cytochrome P-450 concentration in the liver and stimulates functions of the monocytomacrophage system in all the studied parameters. However, no temporary suppression of phagocytic activities was observed on the 3rd day of the experiment, in contrast to the animals administered Pa alone. Serum FFA concentration increased significantly. The application of both preparations accelerated markedly the onset of proliferation and differentiation processes in lymphatic follicles of the spleen.

[Liver resection using a suction knife in an experiment and in clinical practice]. / Resekce jater s pouzitím sacího noze v experimentu a v praxi.

The authors describe their experience with liver resection by means of an suction knife. In animal experiments, the optimal value of under-pressure for an effective and non-destructive function the knife was tested and the healing process in the vicinity of the cut surface was followed. This simple device was developed that allows evaluation of the results of liver resection (segmentectomy to hemihepatectomy) in clinical practice. The method was applied in ten out of twenty patients in which liver resection was performed in the last fourteen months. The inexpensive device functioned to the authors full satisfaction.