Úvod a cíl: U mladých pacientů bývá velmi často příčina ischemické cévní mozkové příhody (iCMP) kryptogenní. Ve starší populaci jsou za možnou příčinu považovány nedetekované poruchy srdečního rytmu. Cílem této prospektivní studie bylo stanovit výskyt srdečních arytmií u mladých pacientů s kryptogenním iktem pomocí dlouhodobého EKG‑Holter monitoringu a podkožně implantovaného srdečního monitoru. Soubor a metodika: Soubor tvoří konsekutivní pacienti s akutní iCMP do 50 let zařazení do prospektivní studie HISTORY (Heart and Ischemic STrOke Relationship studY). Kryptogenní iCMP byla definována dle TOAST kritérií. U všech pacientů byla mozková ischemie potvrzena na CT/MR, provedeno vstupní EKG, vyšetření sérových kardiomarkerů, trombofilní skríning vč. genetického vyšetření, neurosonologie, jícnová echokardiografie (TEE), 24hod EKG‑Holter a třítýdenní holterovský EKG monitoring. Vybraným pacientům s negativním třítýdenním EKG‑Holterem byl následně implantován podkožní srdeční monitor. Výsledky: Z 838 pacientů zařazených do studie HISTORY mělo 123 pacientů méně než 50 let. Z nich bylo 102 (83 %) identifikováno jako kryptogenní iCMP (56 mužů, průměrný věk 39 ? 8,5 let). Srdeční arytmie byla zachycena celkem u 12 (12 %) pacientů (devět mužů, průměrný věk 43 ? 4,2 let). V devíti (75 %) případech se jednalo o fibrilaci síní. U tří pacientů byla arytmie zaznamenána během 24hod EKG‑Holteru a u zbývajících devíti pak během třítýdenního monitoringu. Podkožní monitor byl implantován 12 pacientům, u žádného ale nedošlo k záchytu arytmie během sledovaného období (medián 122 dní). Závěr: Arytmie byla detekována u 12 % mladých pacientů s kryptogenní iCMP. Prodloužení holterovského EKG monitoringu významně zvýšilo jejich záchyt. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT01541163., Background and aim: The cause of ischemic stroke (IS) in young patients remains often cryptogenic. In elderly population, undetected heart arrhythmias with a risk of embolization are considered the cause of cryptogenic IS (CIS). The aim of this prospective study was to assess the presence of heart arrhythmias in young CIS patients using a long-term ECG-Holter monitoring and implantable subcutaneous heart monitor. Patients and methods: Study set consisted of acute IS patients < 50 years enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study. CIS was defined according to the TOAST criteria. In all patients, brain ischemia was confirmed on CT/MRI. Admission ECG, serum levels of cardio-markers, markers of thrombophilia including genetic screening, neurosonology, transoesophageal echocardiography, 24-hour and 3-week ECG-Holter monitoring were performed in all patients. In selected patients with negative 3-week Holter, subcutaneous heart monitor was implanted. Results: Out of 838 patients enrolled in the HISTORY study, 123 patients were < 50 years and 102 (83%) of them were identified as cryptogenic (56 males, mean age 39 ? 8.5 years). Cardiac arrhythmia was detected in 12 (12%) patients (nine males, mean age 43 ? 4.2 years). In nine (75%) patients, atrial fibrillation was presented. In three patients, the arrhythmia was detected during 24-h ECG-Holter and during 3-week monitoring in the remaining nine patients. The subcutaneous monitor was implanted in 12 patients, but no arrhythmia was detected during study period (median 122 days). Conclusion: Heart arrhythmia was detected in 12% of young CIS patients. Prolongation of ECG-Holter monitoring increased the detection rate significantly. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT01541163. Key words: cryptogenic ischemic stroke – cardiac arrhythmias – atrial fibrillation – ECG-Holter monitoring The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers., and D. Šaňák, M. Hutyra, M. Král
Introduction: Routine surveillance of colorectal cancer includes serial measurements of CEA levels. Although not routinely indicated Ca 19-9 is also a tool for recurrence. When any of these serum markers is elevated during follow up, this could represent a recurrence. The management of elevated tumor marker levels include clinical exams, endoscopy and conventional imaging–ultrasound, CT, MRI. Objective: To evaluate the positive predictive value of CEA and Ca19-9 as tumor markers for recurrent colorectal cancer in cases where conventional imaging and endoscopic studies fail to localize disease. Materials and methods: A total of 75 patients with elevated CEA and/or Ca19-9 serum levels and negative endoscopic exam as well as negative abdominal CT and Chest X-ray were included in the study. CEA levels were tested in 50 patients. Ca 19-9 was tested in 65 patients. 34 of the patients had both markers tested. All patients underwent whole body 18F-FDG PET/CT. Patients with negative of equivocal PET scan were further followed up (10 to 24 months). Results: Based on the reference standard – the results from PET/CT, if positive and the results from follow-up in cases of negative or equivocal scans, the positive predictive value of Ca 19-9 was 84% and that of CEA -83%. There was no significant difference in the PPV of Ca19-9 and CEA. Conclusion: Elevated CEA and Ca 19-9 levels in patients under active surveillance after operation for colorectal cancer have high positive predictive value for recurrence, even in cases where conventional work-up – endoscopy and CT don’t localize disease., Yana Bocheva, Pavel Bochev, and Literatura