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PubMed2002

[Screening programs for sporadic colorectal carcinoma].

In developed countries colorectal cancer (CRC) is the second most frequent organ malignancy of both genders. According to the world statistics Czech Republic occupies the top position in incidence of this disease. Approximately 75% of all CRC are the sporadic CRC in subjects with negative family or personal history of the disease. The low (average) risk factor in these subjects is age over 50 years, from which the incidence of CRC nearly doubles in each decade. The following options of screening are available for these subjects: 1. faecal occult blood test (FOBT), 2. flexible sigmoidoscopy, 3. combination of both previous procedures, 4. colonoscopy, 5. virtual colonography. FOBT is the mostly used programme in asymptomatic subjects over age 50 at one-year or at least two-years intervals. In FOBT-positive persons colonoscopy is considered the optimal diagnostic and in the case of polyps also therapeutic method. Prospective randomized studies proving a decrease of CRC-mortality in the range of 15-33% are available only for this type of programme. Screening of sporadic CRC was introduced on national basis in Federal Republic Germany in 1977 and in Czech Republic since the second half of the year 2000. With so many people dying of the disease, we cannot afford not to do its screening.

Colonoscopy↗
PubMed2002

[Injuries of extremity blood vessels, personal experience and results].

The authors evaluated the results achieved in 47 patients with injuries of the acral vesels where they performed a total of 50 vascular operations during the five-year period from 1998-2001. 21.3% injuries were part of multiple injuries. The mean period of hospitalization was 14.7 days. The 30-day mortality was 6.4% and the morbidity 12.8%. The upper extremity was saved in all instances (100%), the lower extremity in 77.3% of the injured. The reason for high amputations of the lower extremity were most frequently injuries of the popliteal artery associated with skeletal injury and extensive contusion of the soft tissues of the extremity. The authors discuss the optimal diagnostic and therapeutic procedures in injuries of the acral vessels. They emphasize a multidisciplinary approach without delay with early, frequently during the primary operation indicated fasciotomy, to prevent the development of compartment syndrome. The order of operations in concurrent injuries of the acral skeleton depends on the stage of ischaemia, type of injury and solution of the skeletal fractures. This type of injury frequently calls for repeated redressing in the operation theatre with repeated necrectomies of soft tissues to prevent infection which may prove fatal for the extremity. Injuries of the acral vessels should be nowadays treated in specialized departments with a 24-hour diagnostic and therapeutic traumatological service which comprises a highly specialized team of vascular surgeons.

Adolescent↗
PubMed2002

[Current diagnosis of pulmonary embolism].

In this article the current imaging techniques that may be helpful in diagnosing pulmonary embolism are reviewed. The controversy concerning the optimal diagnostic algorithm of the disease is also covered.

Algorithms↗
PubMed2003

Urachal anomalies in children: experience at one institution.

BACKGROUND: The embryological and anatomical features of urachal anomalies have been well defined. Because of the variable clinical presentations, uniform guidelines for evaluation and treatment are lacking. In an attempt to establish an optimal diagnostic and treatment modality, we report our experience with urachal anomalies at a single institution over a 10-year period. METHODS: The records of 20 patients with urachal abnormalities were reviewed. These included 12 males and 8 females with ages from 1 day to 12 years (average, 3 years). The evaluation included symptoms and signs, and results of fistulography, sonography, and voiding cystography. Postoperative conditions were also reviewed. RESULTS: The presenting complaint was umbilical discharge in 14 patients, umbilical discharge with marked umbilical granulation tissue in 2, periumbilical erythema in 3, and abdominal pain in 1. Diagnostic evaluation included fistulography in 5 cases, sonography in 13, and voiding cystourethrography in 3. The 3 variants of urachal anomalies included a patent urachus in 4 patients (20%), urachal sinus in 13 (65%), and an infected urachal cyst in 3 (15%). Treatment consisted of primary excision with a cuff of the bladder in 3, excision with ligation in 1, excision of the sinus in 13, incision and drainage in 3, and secondary excision in 1. There was 1 postoperative wound infection. CONCLUSION: Diagnosis and treatment of urachal anomalies can be made with certainty if a good physical examination and proper imaging study are performed. Voiding urethrocystography might not be required in view of the fact that none of the patients studied had an associated urinary tract anomaly.

Child↗
PubMed1992

Comparison of counterimmunoelectrophoresis, latex agglutination and bacterial culture for the diagnosis of bacterial meningitis using urine, serum and cerebrospinal fluid samples.

1. Urine, serum and cerebrospinal fluid (CSF) samples from 98 children with clinical and laboratory diagnosis of bacterial meningitis were evaluated by counterimmunoelectrophoresis (CIE) and latex agglutination (LA) methods and the results compared to those obtained with bacterial cultures of the CSF samples. Antigens of Neisseria meningitidis groups A, B and C, Haemophilus influenzae type b and Streptococcus pneumoniae were determined by both immunological methods. Serum was diluted (1:4) with 0.1 M sodium EDTA, pH 7.5, and held at 80 degrees C for 10 min before assay. Polysaccharide of the urine samples was precipitated overnight using an equal volume of 1:1 ethanol-acetone followed by a heat-treatment with 0.1 M sodium EDTA, pH 7.5, at 80 degrees C for 10 min.. 2. Sensitivity indices were 0.772 (CSF), 0.595 (urine) and 0.317 (serum) for CIE, and 0.914 (CSF), 0.930 (urine) and 0.683 (serum) for LA in relation to the 42 positive bacterial cultures. 3. The optimal diagnostic efficacy reached 52% for CIE and 72% for LA when urine was concentrated 20- to 30-fold. 4. These data show that immunological tests of urine samples were more effective than bacterial culture for diagnosing bacterial meningitis and may be indicated when negative results are obtained for CSF tested by bacterial culture and immunoassay methods.

Bacteriological Techniques↗
PubMed2004

Sarcoid heart disease.

BACKGROUND: Sarcoidosis is a multisystem inflammatory disease of unknown cause. Due to its protean and nonspecific clinical manifestations, the optimal diagnostic and therapeutic strategies, as well as prognosis, are not well defined. OBJECTIVE: To review the literature on sarcoid heart disease and present an approach to its diagnosis, prognosis and therapy. METHODS: MEDLINE and PreMEDLINE searches of all available English-language articles and case reports from 1966 to 2002 were performed. Search terms included 'sarcoidosis' and 'heart diseases', with a variety of medical subject subheadings. RESULTS: Clinical disease often includes heart block, dilated cardiomyopathy and ventricular arrhythmias. Patients with sarcoidosis are at increased risk of sudden death. Because the yield of endomyocardial biopsy for definitive diagnosis is low, the diagnosis is often made with a combination of electrocardiography, Holter monitoring, echocardiography, myocardial perfusion imaging and, most recently, magnetic resonance imaging. For symptomatic patients, medical therapy may include a trial of steroids and immunosuppressive therapy. Monoclonal antibodies against tumour necrosis factor may be employed in refractory cases. Heart block warrants a permanent pacemaker, while ventricular tachyarrhythmias are typically amiodarone-unresponsive, requiring implantation of an implantable cardioverter defibrillator. CONCLUSIONS: Although there are no large, randomized trial data on cardiac sarcoidosis, the literature suggests that making the diagnosis is clinically important. Unlike the situation in isolated pulmonary disease, cardiac involvement implies a poor prognosis. The diagnosis often requires high clinical suspicion with a combination of radiological and nuclear imaging. Therapy with steroids may halt progression of left ventricular dysfunction, while arrhythmias warrant device therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Basedow's disease associated with benign and malignant nodular disease of the thyroid: diagnosis and treatment].

Nowadays the prevalence of thyroid nodules in Graves' disease (GD) is estimated as ranging from 15 to 33% and several studies support a high risk of thyroid cancer in this condition. The present study presents a retrospective analysis of 41 cases of GD submitted to total thyroidectomy from 1995 to 2003, aimed at discovering the most useful elements for an optimal diagnostic and therapeutic strategy. We identified 23 patients with coexisting nodular goitre (nodular variants of GD) and among these we carried out a comparative study of 12 cases with only benign nodules and 7 with thyroid carcinoma detected prior to the operation. Four cases were not considered because of incidental microcarcinomas. We found no significant differences in the number, average size and radionuclide imaging of nodules in the two groups. In contrast, analysis of ultrasonographic findings showed that hypoechogenicity correlated closely with malignancy, particularly if associated with ill-defined margins, microcalcifications and intranodular vascular patterns, whereas hyperechogenicity was a typical appearance of benign lesions. Our study suggests that routine thyroid US scans should be considered for complete evaluation of GD, since this pathology frequently implies the development of thyroid nodules which are not always detectable at clinical or radionuclide examination. Surgery is mandatory when nodules with suspicious ultrasonographic features are found and if malignancy cannot be excluded at fine needle aspiration cytology.

Adult↗
PubMed2004

Determination of anti-cyclic citrullinated peptide antibodies in the sera of patients with juvenile idiopathic arthritis.

OBJECTIVE: Anti-cyclic citrullinated peptide (anti-CCP) antibodies have been found in sera of 76% of patients with rheumatoid arthritis (RA), mainly in rheumatoid factor (RF) positive patients, with a specificity of 96%. We evaluated the presence of anti-CCP antibodies in patients with juvenile idiopathic arthritis (JIA) and assessed the possibility of synthetic citrullinated peptides as antigenic determinants in JIA. METHODS: The presence of anti-CCP antibodies was determined using 3 synthetic citrullinated peptide variants and 2 commercial kits (Inova Diagnostics and Axis-Shield Diagnostics) optimized for detecting JIA-specific antibodies in serum by an ELISA based assay. We evaluated 66 patients with JIA (16 RF positive polyarthritis, 18 RF negative polyarthritis, 19 oligoarthritis, and 13 systemic arthritis). We also tested 9 adult RA patients, 34 patients with systemic lupus erythematosus (SLE), and 25 healthy persons as controls. RESULTS: Significant concentrations of anti-CCP antibodies were detected in the majority of RF positive JIA patients with polyarthritis. Using the 2 synthetic linear peptides, 12/16 (75%) were positive; 9/12 (75%) were positive with the Inova kit and 9/10 (90%) were positive with the Axis-Shield kit. However, utilizing the synthetic linear peptides, significant concentrations of anti-CCP antibodies were detected in 51/66 (77%) JIA patients, including 15/18 (83%) RF negative polyarthritis, 16/19 (84%) oligoarthritis, and 8/13 (62%) systemic arthritis patients. No healthy control showed elevated antibody levels. In contrast, 4/9 (44%) patients with adult RA and 2/6 (33%) with SLE had elevated anti-CCP levels. The synthetic cyclic variant cfc-1-cyc yielded significant anti-CCP levels for 13/14 (93%) patients with RF negative polyarthritis, 6/10 (60%) with oligoarthritis, and 3/7 (43%) with systemic arthritis, and 8/9 (88%) RF positive patients. No healthy control had increased anti-CCP levels. However, 4/9 (44%) adult RA and 9/34 (26%) SLE patients were found to have elevated anti-CCP levels. Using the Inova and Axis-Shield kits, much smaller percentages were found in the RF negative patients, with only 4/16 (25%) in the oligoarthritis and RF negative polyarthritis patients with the Inova kits and 0/25 (0%) by the Axis-Shield kits. The Inova kit revealed elevated anti-CCP antibodies in 5/9 (56%) adult RA patients and in 8/34 (24%) SLE patients. No healthy control had elevated anti-CCP antibodies. However, the Axis-Shield kits did not detect anti-CCP antibodies in adult RA (0/9) or SLE (0/34) patients. Moreover, 0/25 (0%) healthy individuals exhibited anti-CCP levels. The presence of anti-CCP antibodies correlated more frequently with the presence of RF. CONCLUSION: This study confirms the presence of anti-CCP antibodies in patients with JIA, especially those with RF positive polyarthritis, by all ELISA based methods. Use of synthetic peptides also revealed anti-CCP antibodies in a percentage of RF negative patients with polyarthritis, oligoarthritis, and systemic arthritis; there was a loss in specificity, but an increase in sensitivity. These results suggest that antibodies to these antigenic peptides may be markers for JIA, and indicate a possible role of citrulline-containing epitopes in the pathogenesis of JIA.

Adolescent↗
PubMedDate not supplied

Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging.

BACKGROUND: Diagnosing TIA can be difficult, since evidence of brain ischemia is habitually lacking on CT and conventional MR imaging. It has been suggested that patients with acute brain infarction on neuroimaging should be considered stroke cases instead of TIA, regardless of duration of symptoms, implying that optimal diagnostic methods need to be utilized. We therefore postulated that perfusion-weighted MR imaging (PW imaging) would be useful in the diagnosis of TIA. METHODS: Retrospective analysis of 22 patients with reversible neurologic symptoms lasting less than 24 hours, assessed with DW and PW imaging. RESULTS: MR imaging was abnormal in 15 patients (68%): 12 had abnormal DW imaging, four had both DW and PW imaging defects (all with a mismatch) and three had an isolated PW imaging abnormality. There were no differences in symptom duration, stroke etiology or cardiovascular risk factors between patients with abnormal MR imaging and those with unremarkable scan. Patients with mismatch were more likely to need conventional angiography or other cerebrovascular procedures. CONCLUSION: The combined use of DW imaging and PW imaging provided evidence of brain ischemia in most patients with clinical diagnosis of TIA. Prospective studies using follow-up MR imaging are required to determine the outcome of affected tissue, as well as the clinical implications of DW-PW imaging abnormalities.

Aged↗
PubMed2005

The emerging use of 16- and 64-slice computed tomography coronary angiography in clinical cardiovascular practice.

Multi-slice computed tomography (MSCT) coronary angiography is an imaging modality that can identify patients with both soft and hard plaque, supplementing the information gleaned from an ordinary coronary calcium scan and classic risk-factor assessment. Clinicians now have the tools to identify the presence of coronary artery disease (CAD) in the presymptomatic phase, as well as those needed to help identify the etiology of pain syndromes in patients presenting with atypical or obscure symptoms and who may be suffering from obstructive CAD, aortic dissection, pulmonary emboli, or other pathologic processes. There is considerable training and practice involved in developing the skills necessary to convert raw information from a CT scanner to optimal diagnostic images; however, MSCT provides important diagnostic information in a faster, less expensive, more patient-friendly, and safer manner than conventional coronary angiography. The following 2 cases describe the use of MSCT coronary angiography in patients with atypical symptoms and exemplify the use of this technology in a clinical setting.

Clinical Competence↗
PubMed1992

[Cardiovascular abnormalities in Marfan syndrome].

During the period February to December 1990, 52 adult patients were referred to our clinic for evaluation of the presence of the Marfan syndrome. In 24 out of 52 patients the Marfan syndrome was diagnosed. Cardiac abnormalities were found in all patients: mitral insufficiency because of mitral valve prolapse (83%), aortic dilatation (67%), aortic insufficiency (38%), tricuspid valve insufficiency with or without tricuspid valve prolapse (17%) and atrial septal defect (4%). In 3 patients an aneurysm of the ascending aorta was found. Early recognition of the Marfan syndrome is relevant for prevention of the life threatening complication of aortic dissection. In patients with valve abnormalities endocarditis prophylaxis is advised. A Marfan outpatient clinic offers optimal diagnostic possibilities.

Abnormalities, Multiple↗
PubMed2006

Local recurrence of primary non-ampullary adenocarcinoma of duodenum after surgical treatment--a case report and a literature review.

Worldwide there is no general attitude on optimal surgical procedure in treatment of primary non-ampullary adenocarcinoma of duodenum, especially for early stage of duodenal cancer. Some authors prefer local excision and segmental resection while others rather perform duodenopancreatic resection, even in the case of early stage of duodenal cancer with aim to avoid tumor recurrence. In this paper we present a rare clinical course of a 60-year-old male patient with an endoscopically and pathohistologically proven early stage duodenal cancer that was treated by wide local excision. Three years after operation, control endoscopy showed "flat" polyp in the duodenum and radical duodenopancreatic resection was performed. Pathohistological examination of resected specimen showed cancer that had spread throughout the duodenal wall with metastases in the regional lymph nodes. According to our findings and literature review we gave some direction concerning the optimal diagnostic and surgical procedure for this rare tumor.

Duodenal Neoplasms↗
PubMed2006

Development and utilization of a quantitative polymerase chain reaction assay to evaluate human polyomavirus JC DNA load.

AIM: Quantitative polymerase chain reaction (PCR) analysis to evaluate virus load in comparison with the patient's base-line virus levels would be an optimal diagnostic approach to monitoring human polyomavirus infections and to investigate their possible involvement in the onset of nephropathy in this patient group. Studies on the correlation between viral burden and renal disease have pointed to the incidence of JC virus (JCV) related progressive multifocal leukoencephalopathy (PML) occurring in renal and haematopoietic stem cell transplant recipients. METHODS: We developed a reliable internally-controlled quantitative PCR assay to measure JCV-DNA in fluid samples of urine, serum and cerebrospinal fluid (CSF) by densitometric analysis of the amplification products. The assay was also used to evaluate the JCV load in CFS samples from patients with suspected demyelinating syndrome and in urine and serum samples from healthy subjects and renal transplant recipients. RESULTS: All CSF samples from the 51 patients with suspected demyelinating syndrome tested JCV-DNA negative: none of them had a diagnosed PML. Analysis of the prevalence of JCV-viruria and JCV-viraemia confirmed our previous data. JCV-viruria was detected in 17% of renal transplant recipients and 26.6% of healthy controls; JCV-viraemia was found in 3.4% of transplant patients and 0% in controls. Noteworthy was a lower prevalence of JCV-viraemia in the 116 (3.4%) renal transplant patients than the prevalence previously reported for the 51 (11.8%) patients with suspected demyelinating syndrome. The mean viral load of viruria was much higher in the healthy controls than in the transplant recipients [104020 DNA copies/mL (DS+/-62284) vs 4136 DNA copies/mL (DS+/-77371)]. CONCLUSIONS: The quantitative PCR assay developed in our lab offers in 2 h time a reliable true quantification of viral DNA by densitometric analysis of the amplification product. To check for the possible presence of potential Taq polymerase inhibitors an internal control (the homemade pJCV-C plasmid) is used. The relation between polyomavirus infections and their possible involvement in post-transplant pathologies need further investigation. It would be useful to monitor the JCV-DNA load in urine and serum from more renal transplant recipients, including patients with nephropathy or active graft rejection over a longer period of time.

Base Sequence↗
PubMed2000

The inability of the clinical picture to characterize pain from facet joints.

Facet joints, as a source of low back pain, have attracted considerable attention and been a source of controversy in recent years. Significant progress has been made in precision diagnosis of chronic low back pain with neural blockade. In the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies, and in the face of mounting evidence showing lack of correlation between clinical features, physical findings, and diagnosis of facet joint mediated pain, controversial features have been described to validate the assumption of facet joint mediated pain by set criteria. The prevalence of lumbar facet joint mediated pain in patients with chronic low back pain has been established in this study as 42% using controlled comparative local anesthetic diagnostic blocks, with a false positive rate of 37%. The evaluation of role of various clinical features described in the literature, six features showed negative correlation with facet joint mediated pain. However, these six feature involved only a small number of patients. In conclusion, facet joint mediated pain is a common entity in patients suffering with chronic low back pain nonresponsive to conservative care, who present to a nonuniversity pain management practice. However, the history, clinical features, and radiological features are of no significance or assistance in making the diagnosis of facet joint mediated pain with certainty.

Journal Article↗
PubMed2006

State of the art management of adrenal masses--"how to do it?".

By the frequent use of computed tomography or ultrasound the detection of incidentally found adrenal tumours has become a common problem. This is also reflected in the worldwide proliferation of literature over the past decades. Most incidentally-found adrenal tumours are benign non-functioning cortical adenomas. But benign functioning tumours producing aldosterone, cortisol or catecholamines, adrenocortical carcinoma or adrenal gland metastasis can also be found. Surgical therapy is always indicated in case of hormonal overproduction or in case of suspected adrenocortical carcinoma; in all other cases the correct and adequate therapeutic approach is still under debate and a controversial topic of discussion. This review deals with the different forms of adrenal tumours regarding the optimal diagnostic and therapeutic approach to give physicians an easy-to-follow guideline.

Adrenal Gland Neoplasms↗
PubMed1991

[MR tomographic diagnosis of internal derangement of the temporomandibular joint].

On the basis of MR imaging studies in 150 temporomandibular joints (TMJ) a classification system for internal derangement of the TMJ was defined. Clinically, internal derangement is characterized by disc displacement and disorders of the mandibular condyle. MR imaging enables a differentiation of early stages (I,II) with disc displacement, the intermediate stage (III), and the later stages (IV,V) with osseous destruction. Optimal diagnostic results (n = 140) allowed the use of proton-density sequences in both open and closed joint positions (TR/TE = 1000/28). Dynamic imaging of the TMJ was performed using fast-gradient echo sequences and a self-developed hydraulic opening device (n = 20). MR imaging has proved to be the method of choice for the pre- and post-therapeutic evaluation of internal derangement of the TMJ.

Adult↗
PubMed1990

Role of surgery in the management of pituitary tumors.

Growth characteristics and size, irrespective of endocrine activity, predict the nonendocrine clinical presentation of a pituitary adenoma. Anatomic classification by degree of sellar destruction (grade) and extrasellar extension (stage) has value in determining prognosis and in designing therapy, and magnetic resonance imaging provides optimal diagnostic information. The transsphenoidal approach is the preferred surgical technique for most pituitary adenomas and the treatment of choice for those secreting growth hormone (acromegaly) or adrenocorticotropic hormone (Cushing's disease, Nelson's syndrome) and certain nonsecreting tumors. Opinions differ on the initial treatment for prolactin-secreting adenomas; whether most patients should be treated medically or surgically and whether bromocriptine or irradiation should be reserved for surgical failures are still being debated. From experience in a series of 1813 pituitary adenomas, the author surveys tumors of the pituitary region and the role surgery plays in their management.

Adenoma↗