[Adenocarcinoma of the small intestine: a rare diagnosis--4 case reports]. / Adenokarcinom tenkého streva: vzácná diagnóza--kazuistika 4 prípadu.

The authors submit four case-histories of rare primary adenocarcinoma of the small intestine. The poor symptomatology and equivocal results of examinations caused a long delay of the final solution. As compared with data in the literature the submitted cases can be considered typical.

In vitro autoreactivity against skin and synovial cells in patients with juvenile idiopathic and rheumatoid arthritis.

In the present study we compared specific lysis of various autologous target cells in patients with juvenile idiopathic arthritis JIA; n = 8) or rheumatoid arthritis RA; n = 17) with those of healthy controls (n = 15). (51)Cr-release cytotoxic assay with autologous peripheral blood mononuclear cells as effector cells was used. When compared with controls, effector cells of patients with JIA or RA were found to lyse significantly autologous synovial cells (p < 0.0005) and epidermal keratinocytes (p < 0.0005), however, no difference was found for autologous dermal fibroblasts.

[Primary adenocarcinoma of the duodenum]. / Primární adenokarcinom dvanáctníku.

The authors describe a case of 60-year-old man with primary adenocarcinoma of the distal duodenum. The first, ex post assumed symptom, was haemorrhage into the gastrointestinal tract almost two years before the final diagnostic conclusion. The diagnosis was not correctly established even during subsequent examinations during progression of the disease and not even during the first surgical revision. The reason is, no doubt, the rareness of the diagnosis and the adverse site of the tumour. An asset was was enteroscopy, although its conclusion was not accurate as regards the site. The tumour was radically removed only during the second operation by segmental resection of the distal duodenum with a duodenojejunal anastomosis in the region of D2. The patient was then referred to the care of an oncologist. The case shows the diagnostic difficulties and the unique operation that was performed. Possible success of treatment is always conditioned by coordinated gastroenterological, surgical and oncological care.

[Mini-invasive procedures in the treatment of complicated retroperitoneal hemorrhage in a patient with multiple injuries]. / Vyuzití miniinvazivních postupu v lécbe komplikovaného retroperitoneálního krvácení u polytraumatizovaného pacienta.

The authors present the case-history of a patient with multiple injuries where the dominating injury was haemorrhage into the retroperitoneum and subsequently into the abdominal cavity. The solution after CT and sonographic diagnosis was laparoscopy and subsequent arteriography with embolization. The authors consider the described procedures as the most suitable one in the given case.

[Our experience with a conservative treatment of the blunt injuries of the liver and the spleen.]. / Nase zkusenosti s konzervativní lécbou tupých poranení jater a sleziny.

Indication for conservative treatment in the blunt injuries of the liver and the spleen have been recently significantly extended. On the example of the case histories and discussion in the literature the authors specify the necessary conditions, difficulties and results of this procedure. Key words: conservative treatment, injury of the liver, injury of the spleen.

[Blunt injury of abdomen as a part of polytrauma.]. / Tupá poranení bricha v rámci polytraumatu.

In the period from 1 July till 31 August 1998 Central Military Hospital Praha treated 28 multiply injured patients (with polytrauma including blunt injury of abdomen, of which 27 were operated on and 1 patient was treated conservatively. The mean injury severity score was 39.3. CT was used for diagnosis in 21 patients and its total accuracy in the group of patients was 83%. Liver and spleen were injured in 70 % of cases. Of other regions it was the chest (89% of cases) and head (75% of cases) which were most frequently injured. The most imortant for the prognosis of a patient in our group is the injury of head. A successful initial procedure in multiply injured patients (with polytrauma) with a blunt injury of abdomen has to include an intensive antishock treatment, a quick diagnosis and urgent operation, if need be.