Cíl. Pseudomyxom peritonea je velmi vzácné semimaligní onemocnění. Záměrem našeho sdělení je pojednání o typickém nálezu, možnostech léčby a komplikacích. Metoda. Nedávné případy z našeho pracoviště ilustrují patognomické znaky nemoci v CT obrazu, obvyklý klinický nález, průběh onemocnění i svízelnost jeho léčby. Ve dvou našich kazuistikách je příčinou pseudomyxomu peritonea mucinózní cystadenom appendixu, v jednom appendikální low grade cystadenokarcinom, v posledním případě mucinózní cystadenokarcinom neznámého původu. U prvního pacienta se navíc objevila raritní komplikace - metastatická ložiska intrathorakálně. Závěr. Pseudomyxom peritonea je klinický syndrom, který je způsoben excesivní produkcí gelatinózního ascitu buňkami mucinózního cystadenomu či cystadenokarcinomu různého původu, nejčastěji se však jedná o tumory appendixu. Typický morfologický nález v zobrazovacích metodách určuje jejich významné místo v diagnostice, stagingu a monitorování výsledků léčby pseudomyxomu., Aim. Pseudomyxoma peritonei is an uncommon semimalignous disease. The aim of our statement is the discussion about the typical finding, the possibilities of treatment and complications. Method. The recent findings from our workplace illustrate pathological signs of the disease on CT-scan, usual clinical finding, the progression of the disease and the arduous of its treatment. In two of our cases is the cause of pseudomyxoma peritonei mucinous cystadenoma of the appendix, in one low grade mucinous cystadenocarcinoma and in the last case the mucinuos cystadenoma of unknown origin. There has appeared by the first patient a rare complication - intrathoracic implants lesions. Conclusion. Pseudomyxoma peritonei is a clinical syndrome that is caused by the excessive production of gelatinous ascites cells mucinous cystadenoma or cystadeno-karcinoma of different origin, but mostly these are the cases of appendix tumors. The typical morphological found in the imaginig methods determines their important place in the diagnostics, staging and the monitoring of the results of the treatment of pseudomyxoma., Žáčik M, Kacvinská T, Pernická B, Pospíšková M, Palíšek J., and Literatura 12
Pacienti s metastatickým kolorektálním karcinomem (mKRK) by měli v průběhu své léčby obdržet všech pět látek účinných u tohoto onemocnění. Tyto látky se skládají ze tří chemoterapeutik: 5-fluorouracil/leucovorin (5-FU/LV), irinotecan, oxaliplatina a dvou monoklonálních protilátek: bevacizumab namířený proti vaskulárnímu endoteliálnímu růstovému faktoru a inhibitor epidermálního růstového faktoru cetuximab nebo panitumumab. Léčebné možnosti třetí linie závisí na tom, jaké látky byly použity v předchozí terapii. U pacientů předléčených 5-FU, oxaliplatinou a irinotecanem představuje léčba kombinací cetuximab a irinotecan atraktivní možnost., Patients with metastatic colorectal cancer (mCRC) should receive all five drugs active in this disease during the overall course of their treatment. These drugs consist of three chemotherapeutic agents: 5-fluorouracil/leucovorin (5-FU/LV), irinotecan and oxaliplatin and two monoclonal antibody: bevacizumab directed against the vascular endothelial growth factor and the epidermal growth factor receptor inhibitor cetuximab or panitumumab. Treatment options for third-line therapy depend on what agents have been used in previous therapy. In patients with prior treatment with 5-FU, oxaliplatin, and irinotecan, treatment with the combination of cetuximab and irinotecan is an attractive option., Ilona Kocáková, and Lit.: 6
V klinické kazuistice je prezentována role cetuximabu ve 2. linii terapie metastatického kolorektálního karcinomu s následnou udržovací monoterapií, kdy byla u pacienta dosažena kompletní remise nádorového onemocnění. Uvedený případ potvrzuje účinnost léčby cetuximabem u předléčených pacientů s metastazujícím kolorektálním karcinomem za předpokladu nemutovaného genu K-RAS. Jedná se tak o cílenou biologickou léčbu, která se stává standardem personalizované medicíny nemocných s pokročilým nádorovým onemocněním., The clinical case report presents the role of cetuximab in the second-line treatment for metastatic colorectal cancer with subsequent maintenance monotherapy in which the patient achieved a complete remission of a cancerous disease. The present case confirms the efficacy of treatment with cetuximab in pretreated patients with metastatic colorectal cancer in the presence of the unmutated K-RAS gene. This is a case of targeted biological therapy which is becoming a standard of personalized medicine for patients with advanced cancerous disease., Luboš Holubec, Vít Martin Matějka, and Lit.: 20
Spontaneous rupture is a rare and dramatic complication of hepatocellular carcinoma (HCC), burdened by a high mortality. Here we describe a case of a 73-year-old man, who arrived at the ER because of syncope, and acute epigastric and right upper quadrant abdominal pain. He had a history of hepatitis C-related liver cirrhosis and HCC in treatment with sorafenib. The physical examination showed a state of hemorrhagic anemia with the presence of blood in the peritoneal cavity. The patient underwent an urgent liver resection. Thirty days after surgery, he was in good general condition. Sorafenib is a multikinase inhibitor recently introduced in the therapy of patients with advanced HCC. Among the various side effects reported in patients treated with sorafenib, there is a higher risk of bleeding. In conclusion, sorafenib may increase the risk of bleeding and rupture of HCC in susceptible individuals., Ferdinando Rombolà, Angelo Caravetta, Francesco Mollo, Antonio Spinoso, Lenino Peluso, Raffaele Guarino, and Literatura 15
Stiff-person syndrome (SPS) is a rare disorder characterized by muscle stiffness and painful spasms. Misdiagnosis may occur due to the fact that the clinical picture of SPS is often atypical. The main pathophysiologic mechanism underlying the development of SPS is insufficient inhibition at the cortical and spinal levels. There is good evidence for a primary autoimmune etiology. A 61-year-old man was admitted to a neurological department due to muscle hypertonia with episodic attacks of painful spasms predominantly affecting axial muscles. The symptoms developed shortly after tickborne meningoencephalitis. Electromyography (EMG) revealed signs of continuous motor unit activity. Antibodies against glutamate decarboxylase (anti-GAD) were highly elevated. We present a case of a man who developed clinically severe anti-GAD positive SPS, provoked by tick-borne encephalitis. After therapeutic plasma exchange (TPE) a rapid, temporary improvement of the clinical and neurophysiological findings was noted. Only after being placed on long-term immunosuppression did the patient achieve stable recovery. This case supports the importance of EMG findings and demonstrates the effect of TPE as well as the need for chronic immunosuppression in severe cases of SPS., Edvard Ehler, Jan Latta, Petra Mandysová, Jana Havlasová, Milan Mrklovský, and Literatura 22
Few studies concerning the importance of wheat allergy affecting the course of atopic eczema in adolescents and adult patients exist. Aim: The evaluation if wheat allergy can deteriorate the course of atopic eczema. Follow-up of patients with confirmed food allergy to wheat. Method: Altogether 179 persons suffering from atopic eczema were included in the study: 51 men and 128 women entered the study with an average age of 26.2 (s.d. 9.5 years) Dermatological and allergological examinations were performed, including skin prick tests, atopy patch tests, and specific serum IgE for wheat, open exposure test and double-blind, placebo-controlled food challenge test with wheat flour. Results: Wheat allergy affecting the coures of atopic eczema was confirmed in eight patients (4.5%) out of 179 patients enrolled in this study by double-blind, placebo controlled food challenge test. The course of atopic eczema showed a positive trend in patients with confirmed food allergy at 3, 6, 9, 12 month follow-up (statistical evaluation with paired t-test) after the elimination of wheat flour. Conclusion: Wheat allergy may play an important role in the worsening of atopic eczema (acting as a triggering exacerbating factor) only in a minority of adolescents and adult patients (4.5% in our study). The diagnostic methods (skin prick test, specific IgE, atopy patch test, history) cannot be used as separated tests for the determination of food allergy to wheat in patients with atopic eczema.Open exposure tests and double-blind, placebo-controlled food challenge should be used for the confirmation of wheat allergy affecting the course of atopic eczema., Jarmila Čelakovská, Květuše Ettlerová, Karel Ettler, Jaroslava Vaněčková, Josef Bukač, and Literatura 34
Rubber dam is considered an ideal device for tooth isolation. Nevertheless, its usage is quite rare in the Czech Republic. The aim of this study was: firstly, to gather and evaluate information regarding the use of rubber dam by dentists in the Czech Republic and to compare it with other countries; secondly to find out whether there are any influencing factors as to rubber dam usage; and finally to find out frequency of rubber dam use separately in endodontic treatment and in placing fillings of different materials. A questionnaire-based survey was conducted. Dentists filled in the questionnaires during dental conventions, educational events, conferences and congresses. Rubber dam was routinely used by less than eight per cent of the respondents (n = 35); less than twenty-two per cent of the respondents (n = 97) used rubber dam occasionally, and more than seventy per cent of the respondents (n = 317) has never use it. The results showed that rubber dam is not used frequently in the Czech Republic. If rubber dam is used, then it is typically for endodontic treatment or composite fillings. There were several factors with a statistically significant influence on the usage of rubber dam, such as gender, length of professional career, percentage of direct payments, previous experience in using rubber dam, and undergraduate training in rubber dam use., Martin Kapitán, Zdeňka Šustová, and Literatura 22
Variant branching pattern of the cords of brachial plexus coupled with erroneous communications has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. The present case description reports a unilateral variant branching pattern of the posterior cord coexistent with a neural communication between lateral and medial cords in an adult male cadaver. This intercordal neural communication between lateral and medial cords was oriented obliquely and measured 2.2 cm in length. Furthermore, the posterior cord revealed a variant branching pattern. It branched into three upper subscapular nerves and a common trunk for the thoracodorsal and lower subscapular nerves. The lowest of the three upper subscapular nerves gave a communicating twig to the thoracodorsal nerve. Inspite of uncountable reports on variations of brachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists., Renu Baliyan, Vandana Mehta, Jyoti Arora, Ashish Kr. Nayyar, R. K. Suri, Gaytri Rath, and Literatura 18
Bio-degradable stents are be made of different synthetic polymers (like polylactide or polyglycolide) or their co-polymers (polydioxanone). They can be used for treating benign stenoses of the small and large intestine, particularly in Crohn’s disease. Endoscopic introduction of bio-degradable stents into small and large intestinal stenoses is feasible and relatively simple. Initial results are encouraging and the complication rate is low. However, there are still some difficulties that need to be overcome. The rate of early stent migration is still rather high (up to one third of patients). This might be solved by changes in the shape or rigidity of the stents as well as by further improvement in the design. Proof of long-term efficacy and safety requires further studies., Stanislav Rejchrt, Jan Bureš, Jan Brožík, Marcela Kopáčová, and Literatura 52
Hodnocení mezipohlavních rozdílů v utváření dolní čelisti je jednou z mála možností, jak lze u nedospělých skeletů morfo-- logicky odhadovat pohlaví. V této průřezové studii jsme se pokusili morfometricky prostudovat věkové rozdíly a ověřit existenci pohlavního dimorfismu ve velikosti a tvaru zubního oblouku dolní čelisti u nedospělých jedinců recentní české populace. Vzorek tvořilo 163 sádrových modelů dolních čelistí ortodontických pacientů, vybraných z Brněnské sbírky sádrových ortodontických modelů chrupu na základě stupně prořezání a nepřítomnosti zjevných patologií v rozsahu I(i)1–M1. Mladší kategorie od 7,5 let včetně do 9,5 let sestávala ze 77 případů (35 mužů a 42 žen), starší kategorie od 14 let včetně do 20 let z 86 případů (36 mužů a 50 žen). Velikost a tvar zubního oblouku jsme na standar dizovaných fotografiích okluzní roviny hodnotili morfometricky pomocí jedenácti rozměrů, definovaných význačnými body na předních řezácích, špičácích a prvních trvalých stoličkách. Tvar jsme hodnotili pomocí šesti indexů. Ženy měly celkově menší rozměry zubního oblouku než muži stejné věkové kategorie, ve vyšší věkové kategorii byl velikostní dimorfismus mírně vyšší, ve většině rozměrů však nepřesahoval 5%. Rozdíly mezi věkovými kategoriemi nejsou jen odrazem prostého zvětšování čelisti v průběhu postnatálního růstu. Délka distální části zubního oblouku (C(c)–M1) je ve vyšším věku u obou pohlaví menší. To může být způsobeno stěsnáváním mesiálnějších zubů s tím, jak se postupně prořezávají zuby distálnější. Ve většině hodnocených indexů se pohlaví výrazně nelišila, výjimkou byl Index vystupování špičáku v mladší věkové kategorii. Špičák vystupoval z oblouku bukálním směrem výrazněji ženám než mužům. Diskuse je věnována srovnání zjištěného dimorfismu s předchozími studiemi a vlivům, jejichž prostřednictvím mohl klinický charakter sbírky a způsob výběru vzorku ov- livnit zjištěné mezipohlavní rozdíly., The evaluation of sex differences in mandibular development of subadult skeletons is one of the few possible methods of determining sex using morphological characteristics. In this cross-sectional study, we attempted to morphometrically investigate age differences and to confirm the existence of sexual dimorphism using the size and shape of mandibular dental arch in subadults from a recent Czech population. The sample consisted of 163 plaster casts of mandibles from orthodontic patients in the Brno Collection of Orthodontic Den - tal Plaster Casts , selected on the basis of the degree of tooth eruption and the absence of visible pathological conditions in the I(i)1–M1 range. The younger age category ranging from 7,5 years to 9,5 years accounted for 77 cases (35 males and 42 females) and the older age category rang- ing from 14 to 20 years accounted for 86 cases (36 males and 50 females). The size and shape of the dental arch was evaluated using standar- dized photographs of the occlusal plane by employing eleven dimensions, with landmarks on central incisors, canines and first permanent molars. Shape was evaluated using six indices. The mean size of the dental arch was smaller in females than in males in the same age category. In the older age category the sexual dimorphism was slightly greater, but did not exceed 5% in most measurements. Differences between age categories cannot be explained as a simple reflection of increasing size of the mandible with postnatal growth. The length of the distal segment of the dental arch (C(c)–M1 range) is shorter in the older category in both sexes. This could be caused by crowding of mesial teeth, with gradual eruption of distal teeth. Sex differences were not recorded in most shape indices, except for the Canine Protrusion Index in the younger age category. Canine protrusion from the arch in the buccal direction was greater in females than in males. The discussion is focused on comparison of the observed dimorphism with results found in previous studies and also on possible ways in which the clinical character of the collection and method of sample selection could have affected the detected inter-sex differences., Vlasta Dadejová, Miroslav Králík, Petra Urbanová, and Literatura