[Benefit of PET/CT in the preoperative staging in pancreatic carcinomas]. / Prínos PET/CT v predoperacním stagingu karcinomu pankreatu.

OBJECTIVE: Prognosis of patients with pancreatic cancer is poor. Median survival from diagnosis without determining surgical treatment is 3-11 months, after surgical treatment between 13-20 months according to various studies. 5-year survival rate is below 5%. The only chance of cure remains a radical surgical resection. Early diagnosis and determining resectability of tumour is the most important objective in patients with pancreatic cancer. Aim of this work is to evaluate the benefits and define the role of 18F-FDG PET/CT in preoperative staging. MATERIAL AND METHODS: 195 patients (103 men, 92 women, mean age 66.7 year, range 32-88 years) with suspected pancreatic lesions underwent enhanced 18F-FDG PET/CT in the preoperative staging in addition to standard investigative methods (ultrasonography, contrast enhanced CT, EUS, EUS FNA). All PET/CT findings were compared with standard methods (CT, EUS, EUS FNA), with peroperative findings and definitive histology in surgical patients as the reference standards. Interpretation of the extent of the tumor defined by TNM classification. Limitations of the local resectability was advanced local stage (T4) and presence of distant metastases (M1). RESULTS: In 195 patients with suspected pancreatic lesions was pre-operatively performed PET/CT in the period 1/2007-3/2009. 153 patients with pancreatic cancer, of which 72 was not suitable for radical surgery because of local inoperability or a generalization of the disease. The sensitivity of PET/CT in the capture of primary lesions was 92.2%, specificity 90.5%. False negative findings in 12 patients, false-positive results occurred in 4 cases, positive predictive value (PPV) 97.2%, negative predictive value (NPV) 76.0%. In the assessment of regional lymph nodes sensitivity was 51.9%, specificity 58.3%, PPV 58.3%,NPV 51.9%. In detection of distant metastases PET/CT reached sensitivity 82.8%, specificity 97.8%, PPV 96.9%, NPV 87.0%. PET/CT found distant metastases in 12 patients, which standard methods failed to detect. Surgery was cancelled in 15 patients (15.6%) with potentially resectable tumour based on the performance of PET/CT findings and the management of treatment was changed. CONCLUSION: PET/CT is highly sensitive and specific method suitable for preoperative staging of pancreatic cancer. It improves the selection of patients for surgery, who can benefit from and reduces the number of incorrectly indicated operations.

[Comparative study of detection and evaluation of the size of oesophageal varices with the use of 12 and 20 MHz frequency radial endosonography vs. esophagogastroduodenoscopy]. / Srovnávací studie detekce a vyhodnocování velikosti jícnovýh varixu s vyuzitím radiální endosonografie s frekvencí 12 a 20 MHz vs ezofagogastroduodenoskopie.

INTRODUCTION: Portal hypertension is an important marker in the development of life-threatening complications of hepatic cirrhosis. It is the direct cause ofoesophageal varices (OV), liver encephalopathy, and ofascites. One of the most important locations where the junctions between the portal and systemic circulation become dilated is the region of the oesophagus and the stomach. Bleeding from OV can be the cause of death in as many as 1/3 of cirrhosis patients with portal hypertension. Oesophagogastroduodenoscopy (EGD) is a standard procedure to examine gastro-oesophageal varices, but radial endosonography (EUS) allows for precise quantification of the size of oesophageal and stomach varices including their diagnosis at a stage when they still cannot be distinguished by standard EGD. The objective of the study was to assess the benefit of 12 and 20 MHz EUS and EGD in the detection of oesophageal and stomach varices (including varices which still cannot be diagnosed endoscopically) and in determining their size. Another objective was to find out whether there is a link between hepatic functional impairment measured by the Child-Pugh scale and the size of oesophageal varices. We also assessed the incidence and size of varices with respect to portal blood flow measured by Doppler examination. METHOD: The group contained 31 patients with proven hepatic cirrhosis. RESULTS: The sensitivity rate of EGD with respect to EUS expressing the portion of patients with a positive outcome was 92%. The specificity rate expressing the quantity of healthy individuals with a negative result was 83%.

[Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) leading to the diagnosis of Wilson's disease]. / Trombotická trombocytopenická purpura--hemolyticko-uremický syndrome (TTP-HUS) vedoucí k diagnóze Wilsonovy choroby.

Authors describe the case of a patient suffering from Thrombotic Thrombocytopenic Purpura--Hemolytic-Uremic syndromee. Any cause of the disease was not found, except signs of liver injury. The etiology of indefinite liver disease that had been diagnosed several years before was examined. Wilson's disease was considered as a final eventuality. The finding of 488 micrograms of copper in the dry liver tissue confirmed the diagnosis of Wilson's disease in the end.