The surgical anatomy of the nervus laryngeus recurrens.

In this study, the authors remind the readers the problem traditionally discussed in the thyroid gland surgery--protection of the nervus laryngeus recurrens (NLR) from iatrogenic damage. The aim of this study is to point out some anatomical details on the course of the recurrent nerve (Ref 4).

[Giant bilateral adrenal myelolipoma associated with congenital adrenal hyperplasia]. / Ein bilaterales Riesenmyelolipom der Nebennieren in Kombination mit kongenitaler adrenaler Hyperplasie.

BACKGROUND: Myelolipoma is a rare benign tumor formed by mature fat tissue with strata of haematopoiesis. It is mainly asymptomatic, only large myelolipomas manifest themselves by abdominal discomfort, bleeding or by symptoms of oppressing adjacent organs. It is usually localized in the region of the adrenal gland. Myelolipomas are mostly clinically inert, only a small number of them are associated with Cushing's type of endocrine disorders, Conn's syndrome, Addison's disease, etc. PATIENT AND METHODS: The authors present a rare case of a giant bilateral myelolipoma emerging out of the adrenal gland cortex in a congenital adrenal hyperplasia, with steroid 21-hydroxylase deficiency, in a woman with pronounced virilism. The principal diagnostic methods include sonography and computer tomography. The therapy available is either a surgical extirpation in the case of large or growing myelolipomas or observation in the case of small ones (< 5 cm). RESULTS: The condition was resolved by bilateral adrenalectomy with extirpation of both myelolipomas and subsequent hormonal substitution treatment during which there was a gradual regression of virilising symptoms. CONCLUSIONS: The coincidence of myelolipoma and congenital disorder with subsequent overproduction of the adrenocorticotropin hormone and androgens, might be explained by the incipient of myelolipoma through chronic hormonal stimulation of the adrenal gland cortex. However, the etiopathogenesis of myelolipoma is still unclear.

[Splenic peliosis associated with adrenal adenoma]. / Pelióza sleziny v kombinaci s adenomem nadledviny.

PURPOSE: Peliosis of the spleen is very rare disease diagnosed mainly histologically. The ethiopathogenesis is still unknown and various factors can play the important role (steroids, chemotherapy, chronic infection, hematology disease etc.). Authors present the case of peliosis of the spleen which was combined with suprarenal adenoma. METHOD: The splenectomy for the large spleen with suspicion from lymphoma was done in hypertonic patient with normocytic normochromic anaemia. During operation the left suprarenal adenoma was revealed and epinephrectomy was performed. The diagnosis of peliosis of spleen was done by histological examination. The hypothesis of the connection between hormonal activity of the suprarenal adenoma and development of the peliosis was expressed. Unfortunately the suprarenal adenoma was not diagnosed before operation and so plasma hormone levels were not evaluated. RESULTS: The postoperative course of patient was without complications and patient was discharged 8th postoperative day. One year after operation the patient is in the good health condition. The hypertension is corrigated on the lower dosage of antihypertensive medicaments. CONCLUSIONS: It is probable, that the suprarenal adenoma could play the important role in the ethiopathogenesis of peliosis of the spleen in our case.

The significance of CEA, CA19-9 and CA72-4 in the detection of colorectal carcinoma recurrence.

UNLABELLED: The significance of CEA, CA19-9 and CA72-4 was evaluated the for early detection of disease recurrence, on the basis of retrospective evaluation of routine data in patients with colorectal carcinoma. They also considered the dependence of the results of these data analyses on the definition of groups of patients, both with no evidence of disease (NED) and with recurrence of disease (RD). PATIENTS AND METHODS: From January 1994 to March 1999 serum levels of CEA, CA19-9 and CA72-4 were determined in the follow-up of 517 patients with colorectal cancer and compared with the retrospectively confirmed clinical status of the patients. RESULTS: CEA and CA19-9 showed comparable sensitivities in the detection of locoregional recurrence of colorectal carcinoma, whilst the sensitivity of CA72-4 was considerably lower. CEA is an optimal marker for detecting distant metastases, in particular liver metastases, since its sensitivity considerably exceeds the sensitivities of the other two monitored markers. CONCLUSION: Using routine data required detailed analysis and clear definitions of groups of patients with NED and RD. The following conclusions for the evaluation of data were drawn from this analysis: a) Tumor marker cut-off values and sensitivities related to 95% specificity of remission values depended strongly on the given definition of the groups of patients with NED and RD. b) The patient group with NED is best characterized as the group of patients who never developed progression and where all the values which were assessed within a period shorter than six months from the end of therapy and follow-up, or less than six months before progression, death, or before the last marker assessment in the patient, were excluded. c) For the optimal characterisation of the group of patients with RD it is recommended only to consider values obtained during the first progression, after the period of complete post-operative or post-therapeutic remission. d) These conclusions refer not only to routine data, where this correction represents a condition for reliable evaluation, but also to any research done, since they ensure complete homogeneity of the group and mutual comparability of the results.