[Primary gastrointestinal lymphoma]. / Primární lymfomy zazívacího traktu z pohledu chirurga.

This article deals with a surgical approach to primary gastrointestinal lymphoma - a rare finding when compared to primary gastric carcinoma. The clinical findings, diagnosis and staging of the disease as well as various treatment methods and prognosis of the condition are discussed. As it is evident from the paper, the opinions of individual authors regarding this diagnosis may often differ considerably. Furthermore, this paper presents two separate case studies of surgical treatment for gastric lymphomas performed at our department in 2016. Case study 1 describes a surgical intervention for acute abdomen, where lymphoma was already diagnosed peroperatively. Case study 2 presents the case of a patient indicated for elective laparoscopic cholecystectomy with an unexpected finding of primary gallbladder lymphoma.Key words: primary gastrointestinal lymphoma - chemotherapy - surgical intervention - primary intestinal lymphoma - primary lymphoma of the gallbladder.

[Diverticular disease of the large bowel - imaging methods]. / Divertikulární choroba tracníku - zobrazovací metody.

INTRODUCTION: Imaging methods are fundamental for diagnosis in patients suffering from diverticular disease of the large bowel. In case of complications, radiological intervention can be helpful for treatment. AIM: The authors aim to summarize current possibilities of imaging methods, both in diagnosis and treatment of diverticular disease. METHODS: Review of the literature and recent findings in the diagnosis of diverticular disease. CONCLUSION: The article presents the importance of imaging methods in the diagnosis and treatment of patients with diverticular disease.

Diagnostics of "non-acute" vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses.

INTRODUCTION: Vascular prosthesis infection (VPI) is a life-threatening complication that occurs in 0.5-5% of prostheses. Low-grade infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work was to define the accuracy of (18)F-FDG PET/CT in these settings and to identify essential parameters of the evaluation. MATERIAL AND METHODS: PET/CT was performed prospectively in 76 consecutive patients with a total of 96 vascular prosthetic grafts in which infection was suspected. PET/CT scans were analysed in terms of the presence and intensity of focal and diffuse FDG uptake, the presence of an anastomotic pseudoaneurysm, the presence of an irregular boundary of infiltration, a combination of these, and the uptake ratio between the graft and blood background. The gold standard was based on operative/histopathological finding or a clinical follow up of >6 months. RESULTS: Among the various assessed parameters only focal FDG uptake and an irregular graft boundary were significant predictors of VPI. Focal intense FDG uptake together with an irregular boundary of the lesion on CT scan predicted VPI with 97% probability, while smooth lesion boundaries and no focal FDG uptake predicted a probability of VPI of less than 5%. Even in lesions with nondiagnostic inhomogeneous focal FDG uptake (18/96) an irregular boundary effectively helped in decision-making with a probability of 28% (smooth) or 77% (irregular) for VPI. CONCLUSION: PET/CT gave reliable results with an accuracy >95% in 75% of prostheses. PET/CT can identify those prostheses (25% of prosthesis) for which its diagnostic accuracy is diminished to 70-75%. In our series PET/CT was an excellent diagnostic modality for suspected VPI.

[Idiopathic retroperitoneal fibrosis--Ormond's disease]. / Idiopatická retroperitoneální fibróza--Ormondova choroba: kazuistika.

Ormond disease - idiopathic retroperitoneal fibrosis - is a rare condition characterized in situ by the development of fibrous plaques in the retroperitoneal space and anatomicaly dependent structures. The associated encasement of both ureters and progress to hydronefrosis of the kidney are typical clinical manifestations. Less typical manifestations are possible (for example chronic periaortitis), where clinical diagnosis is more difficult. The laboratory findings are not specific for this disease and a biopsy is not always possible for anatomical reasons. In these cases, the use of positron emission tomography/computed tomography - has been found to be the solution, specifically for patients with periaortitis. Ormond disease is generally idiopathic, and secondary - to the use of certain drugs, malignant diseases, infections. Idiopathic retroperitoneal disease is thought to result from the clinical manifestation of a systemic autoimmune disease. The purpose of this article is to present two casuistics, one of a less than usual clinical manifestation. Both positron emission tomography/computed tomography were used in the diagnostics. The treatment ofOrmond disease involves the combination of surgical and immunosuppressive treatment.

[The use of PET/CT in the diagnostics of lung cancer]. / Vyuzití PET/CT v diagnostice nádoru plic.

More than 6000 new cases of lung cancer are diagnosed annually in the Czech Republic. While incidence in men remains stagnant in recent years, incidence in women steadily grows. Combined imaging modality positron-emission tomography (PET) and computed tomography (CT) becomes the imaging method of choice for an increasing number of oncology indications, including lung cancer. With this integrated PET/CT device, accurately registered anatomic and functional images can be acquired in a single examination. Having such aligned image sets available has been shown to increase the accuracy of the interpretation of pulmonary nodules and pulmonary masses.

[Jejunal perforation by a plastic biliary stent after injury]. / Perforace jejuna plastovým biliárním stentem po úrazu.

The authors present case of patient with biliary stent dislocation after chest injury and fracture of VIII. rib. Polymorbid patient with cirrhosis, chronic pancreatitis, portal hypertension (Child Plugh B) and biliary stent insertion came with acute abdominal pain and inflammatory signs. Progressive signs of acute abdomen have led to laparotomy. Perforation of duodeno-jejunal-loop due to dislocated biliary stent, small loop adhesions and thickened intestine wall were found. Postsurgical period was complicated with obstructive ileus, cholecystitis and cholangiolitis and the second biliary stent was inserted. Present-day status of the patient is satisfactory.

[Organ torsion and abdominal symptoms--diagnosis]. / Torze orgánu a brisní symptomatologie--diagnostika.

The authors reflect on the etiology of torsions of intraabdominal organs and the testes. They mention anamnestic data, which may lead to suspicion of possible organ torsion. They analyze the clinical picture of a patient who suffered such an attack. The authors submit a list of diagnostic possibilities using modern imaging methods: sonography, computed tomography, angiography, scintigraphy and magnetic resonance. They discuss laparoscopy as a diagnostic and therapeutic method.

[Organ torsion and abdominal symptoms--case reports]. / Torze orgánu a brisní symptomatologie--kazuistiky.

Torsions are rare acute abdominal conditions and are mistaken for other more frequent diseases. The present work draws attention to the most frequent diagnostic errors. The authors present three cases of torsions of intraabdominal organs and two cases of testicular torsion. All patients attended their doctor because of abdominal pain. In four of five cases the patients were first treated for an erroneous diagnosis of acute abdomen. In the first case the torsion of the omentum was mistaken for diverticulitis of the sigmoid, later for an intraperitoneal lipoma, in he second case for cholecystitis, in the third case a patient with torsion of a myoma was indicated for surgery on account of acute appendicitis. In the fourth case incomplete torsion of the testis was mistaken for irritation of the appendix. In the fifth case where abdominal symptomatology dominated the correct diagnosis of testicular torsion was made and atypically spontaneous detorsion of the testis occurred.

[Local staging of rectal carcinoma--comparison of endorectal ultrasonography and CT]. / Lokální staging karcinomu rekta--srovnání endorektální ultrasonografie a CT.

Correct staging of adenocarcinoma of the rectum is mandatory before any therapeutic choice is made. Important features are infiltration of the perirectal fatty tissue (T3 and T4) and the presence of locoregional lymphatic spread. Computed tomography with rectal air insufflation (CT) was compared with transrectal ultrasonography (TRUS) in 212 patients. Results of the preoperative examinations were compared with histological findings. The CT examination in evaluation of perirectal spread had an accuracy rate of 76%, sensitivity of 86% and specificity of 62%, the corresponding figures for TRUS were 83%, 91% and 66%. The accuracy, sensitivity and specificity of CT for nodal involvement were 51%, 57% and 50% and of TRUS 60%, 68% and 59%. These findings confirm that TRUS is more accurate than CT in local tumour staging (T) and in detecting nodal spread (A).

[Fixation of a non-adjustable gastric band using an anterior gastric wall cuff (randomized study)]. / Fixace neadjustabilní gastrické bandáze manzetou z prední steny zaludku (randomizovaná studie).

We have been concerned with bariatric surgery at the First Surgical Clinic of th General Faculty Hospital, First Medical Faculty, Charles University Prague since 1983. In 1983-1986 vertical gastroplasties were made, between 1986 and 1993 non-adjustable gastric bands were provided by the laparotomic approach. Since 1993 when we were the first to implement a gastric band operation (GB) by the laparoscopic route, this method is used as the standard method. In 1993-1998 we made at the First Surgical Clinic 517 laparoscopic GB operation on account of morbid obesity in patients with a body mass index of 34-49 kg/m2. The group comprised 449 women and 59 men. The most frequent late complication in our group of morbidly obese patients who had a laparoscopically administered GB was in 5.1% enlargement of the proximal pouch above the GB by dilatation of its wall or slippage of the anterior wall proximally under the GB with a subsequent disorder of gastric evacuation and vomiting. We tried to reduce the incidence of this complication by fixing the GB by a cuff made from the anterior gastric wall. To test the effectiveness of the suggested fixation of the non-adjustable GB by a cuff we implemented in 1998-1999 a prospective randomized study in a group of 80 morbidly obese patients divided into experimental group n1-GB + C with the cuff and a control group n2-GB - C without a cuff. We investigated the incidence of the mentioned complication and the changed volume of the pouch above the GB after one year. Endoscopic assessment of the size of the pouch above the GB after surgery and after one year revealed that in group n1-GB + C the mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size, while in group n2-GB - C the mean increase of the volume was 33.6 ml, i.e. 154.1% of the original size (p < 0.001). Based on the assembled results and aware of the fact that small groups were involved, we should like to express the assumption that the suggested modification, i.e. fixation of a non-adjustable GB by a cuff made from the anterior gastric wall can reduce the incidence of the complication of slippage of the anterior gastric wall proximally above the bandage.