Novel Striatal GABAergic Interneuron Populations Labeled in the 5HT3a(EGFP) Mouse.

Histological and morphological studies indicate that approximately 5% of striatal neurons are cholinergic or γ-aminobutyric acidergic (GABAergic) interneurons (gINs). However, the number of striatal neurons expressing known interneuron markers is too small to account for the entire interneuron population. We therefore studied the serotonin (5HT) receptor 3a-enhanced green fluorescent protein (5HT3a(EGFP)) mouse, in which we found that a large number of striatal gINs are labeled. Roughly 20% of 5HT3a(EGFP)-positive cells co-express parvalbumin and exhibit fast-spiking (FS) electrophysiological properties. However, the majority of labeled neurons do not overlap with known molecular interneuron markers. Intrinsic electrical properties reveal at least 2 distinct novel subtypes: a late-spiking (LS) neuropeptide-Y (NPY)-negative neurogliaform (NGF) interneuron, and a large heterogeneous population with several features resembling low-threshold-spiking (LTS) interneurons that do not express somatostatin, NPY, or neuronal nitric oxide synthase. Although the 5HT3a(EGFP) NGF and LTS-like interneurons have electrophysiological properties similar to previously described populations, they are pharmacologically distinct. In direct contrast to previously described NPY(+) LTS and NGF cells, LTS-like 5HT3a(EGFP) cells show robust responses to nicotine administration, while the 5HT3a(EGFP) NGF cell type shows little or no response. By constructing a molecular map of the overlap between these novel populations and existing interneuron populations, we are able to reconcile the morphological and molecular estimates of striatal interneuron numbers.

[Delayed gastric emptying after partial duodenopancreatectomy]. / Porucha evakuace zaludku po parciální duodenopankreatektomii.

INTRODUCTION: Delayed gastric emptying (DGE) is a relatively common complication in patients after partial duodenopancreatectomy (PDPE) and significantly contributes to their postoperative morbidity. There has only been a small amount of interest attributed to DGE in Czech literature. The aim of this article is to present and analyze our own experience with the occurrence of DGE after PDPE. MATERIALS AND METHODS: Retrospective analysis of prospectively collected data from 106 patients who underwent a PDPE at the Department of Surgery, University Hospital Motol and 2nd Medical Faculty, between 2001 and 2011. The data were statistically analyzed using the Chi-square test with statistical significance set at 5% of probability value (p < 0.05). RESULTS: During the reporting period, PDPE was performed in 106 patients with a pathological process in the pancreatic head. 4 patients died in the postoperative period (30-day mortality 3.8%). Major postoperative complications occurred in 31 patients (morbidity 29%), with clinically significant DGE (grade B and C) in almost half of them (16 patients). Along with the DGE, 4 patients suffered from other major complications (2 pancreatic anastomotic insufficiency, 1 bile fistula and 1 external pancreatic fistula). We did not prove a statistically significant difference in the incidence of DGE depending either on the type of resection or pancreatic anastomosis type. CONCLUSION: DGE contributes significantly to postoperative morbidity in patients after PDPE and is associated with other serious postoperative complications in a considerable number of cases.

[Minimal node affection in gastric carcinoma--pilote multicentric study results]. / Minimální uzlinové postizení u karcinomu zaludku--pilotní výsledky multicentrické studie.

INTRODUCTION: Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings. MATERIAL AND METHODS: Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody. RESULTS: In the period of two years (1st January 2009 - 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients' survival data. CONCLUSION: Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.

Ghrelin suppresses insulin secretion in human islets and type 2 diabetes patients have diminished islet ghrelin cell number and lower plasma ghrelin levels.

It is not known how ghrelin affects insulin secretion in human islets from patients with type 2 diabetes (T2D) or whether islet ghrelin expression or circulating ghrelin levels are altered in T2D. Here we sought out to identify the effect of ghrelin on insulin secretion in human islets and the impact of T2D on circulating ghrelin levels and on islet ghrelin cells. The effect of ghrelin on insulin secretion was assessed in human T2D and non-T2D islets. Ghrelin expression was assessed with RNA-sequencing (n = 191) and immunohistochemistry (n = 21). Plasma ghrelin was measured with ELISA in 40 T2D and 40 non-T2D subjects. Ghrelin exerted a glucose-dependent insulin-suppressing effect in islets from both T2D and non-T2D donors. Compared with non-T2D donors, T2D donors had reduced ghrelin mRNA expression and 75% less islet ghrelin cells, and ghrelin mRNA expression correlated negatively with HbA1c. T2D subjects had 25% lower fasting plasma ghrelin levels than matched controls. Thus, ghrelin has direct insulin-suppressing effects in human islets and T2D patients have lower fasting ghrelin levels, likely as a result of reduced number of islet ghrelin cells. These findings support inhibition of ghrelin signaling as a potential therapeutic avenue for stimulation of insulin secretion in T2D patients.

[Cystic neoplasms of the pancreas]. / Cystické neoplazie slinivky brisní.

INTRODUCTION: Neoplastic changes represent an important part of cystic deposits in pancreas. It is morphologically non-homogenous group of neoplasms with different occurrence depending on sex and age, different localization and different biologic properties. The aim of the paper is to remind current knowledge of this topic and confront it with our own experience. MATERIAL AND METHODS: Together 13 patients with histologically proved cystic neoplasm of pancreas underwent surgery during the period of ten years from 1997 to 2007. They represent 6% of all patients operated for pancreatic tumor (213 patients). Women (9 patients) represented more than two thirds of all operated patients and deposits were more often localized in the head of pancreas (8). RESULTS: The most frequent operation was partial duodenopancreatectomy (7) and most frequently cystadenocarcinoma was identified histologically (5 times). Median survival of these patients is 54 months. Left sided resection, done in 5 cases, identified benign tumor in all patients; no recurrence was found in 2 years follow-up. CONCLUSION: Cystic neoplasms localized in the pancreatic head are more frequent in men than in women and predominantly malignant, on the contrary localization in the tail of pancreas is particularly in younger women linked with benign tumor. Prognosis after resection is markedly better in malignant processes even in comparison with ductal carcinoma.

Maternal thyroid hormone is required for parvalbumin neurone development in the anterior hypothalamic area.

Thyroid hormone (TH) is crucial for brain development and function. This becomes most evident in untreated congenital hypothyroidism, leading to irreversible mental retardation. Likewise, maternal hypothyroxinaemia, a lack of TH during pregnancy, is associated with neurological dysfunction in the offspring, such as autism and reduced intellectual capacity. In the brain, TH acts mainly through TH receptor α1 (TRα1). Consequently, mice heterozygous for a dominant-negative mutation in TRα1 display profound neuroanatomical abnormalities including deranged development of parvalbumin neurones. However, the exact timing and orchestration of TH signalling during parvalbumin neurone development remains elusive. In the present study, we dissect the development of parvalbumin neurones in the anterior hypothalamic area (AHA) in male mice using different mouse models with impaired pre- and postnatal TH signalling in combination with bromodeoxyuridine birth dating and immunohistochemistry. Our data reveal that hypothalamic parvalbumin neurones are born at embryonic day 12 and are first detected in the AHA at postnatal day 8, reaching their full population number at P13. Interestingly, they do not require TH postnatally because their development is not impaired in mice with impaired TH signalling after birth. By contrast, however, these neurones crucially depend on TH through TRα1 signalling in the second half of pregnancy, when the hormone is almost exclusively provided by the mother. For the first time, our findings directly link a maternal hormone to a neuroanatomical substrate in the foetal brain, and underline the importance of proper TH signalling during pregnancy for offspring mental health. Given the role of hypothalamic parvalbumin neurones in the central control of blood pressure, the present study advocates the inclusion of cardiovascular parameters in the current discussion on possible TH substitution in maternal hypothyroxinaemia.

[Surgical treatment of bleeding gastroduodenal ulcer]. / Chirurgické lécení krvácení z gastroduodenálního vredu.

THE AIM OF THE STUDY: Based on the evaluation of results we prove authorization of our elected approach to the treatment of bleeding gastroduodenal ulcer with the restrained and careful choice of patients for surgeries. MATERIAL AND METHODS: The authors analyse in a retrospective study a group of 45 patients operated on for bleeding gastroduodenal ulcer in the period from 2001 to 2005 year. Only patients with actual conservatively or endoscopically ensolvable bleeding were consistenly indicated for surgery. We prefered the local surgical hemostasis procedure. RESULTS: In the period from 2001 to 2005 year 45 patients were operated on. Altogether 9 patients died (20.0%). It was needed reoperated 8 patients (17.8%) for bleeding recurrence. In most cases (39 i.g. 86.7%) local surgical procedures were done. CONCLUSION: Our reached results give clear warrant to the conservative surgical treatment, when only patients with actual endoscopically ensolvable bleeding from gastroduodenal ulcer are indicated for surgery and the aim of local surgical procedure is safe hemostasis. Our results are comparable with data in literature.

[Long-term results after radical resections for pancreatic ductal adenocarcinoma--10 years experience]. / Dlouhodobé výsledky po radikálních resekcích pro duktální adenokarcinom pankreatu--desetileté zkusenosti.

INTRODUCTION: Pancreatic ductal adenocarcinoma is the most often and the most malignant type of pancreatic tumor. Effective systemic anticancer treatment is still missing and only radical resection can potentially lead to the life prolongation. TARGET: Long-term therapeutic outcomes evaluation in patients after radical resections due to the pancreatic ductal adenocarcinoma during the 10 years period. MATERIAL AND METHODS: Population included 42 patients after resection of pancreas due to ductal adenocarcinoma realized during the period from 1995 to 2005. Therapeutic outcomes including long-term survival in different stages of the disease were compared with data collected from patients with another histological type of periampullar tumor by statistical analysis. RESULTS: 48 radical resections of pancreas due to ductal adenocarcinoma were realized during the 10 years period. Six patients were excluded from the follow up. Median of survival with the minimum 6 months of follow up has reached 14 months and the maximal survival time was 35 months. None of the patients has survived 5 years. Five patients were alive after the end of follow up period. There were no statistical difference in survival when particular disease stages were compared (p = 0.3226). Survival of female patients in this population was statistically lower in comparison to male patients (p = 0.0222). Significantly lower survival of patients with ductal adenocarcinoma in comparison to the patients with other types of carcinoma in periampullar localization was demonstrated (p = 0.0234). CONCLUSION: Achieved results proved that pancreatic carcinoma is solid tumor with the worst long-term prognosis. Long-term survival in this population did not exceed 35 months and was independent on per-operative staging. Long-term prognosis of ductale adenocarcinoma is significantly worse in comparison to other types of carcinoma in periampullar localization.

Protection against maternal infection-associated fetal growth restriction: proof-of-concept with a microbial-derived immunomodulator.

Infection-associated inflammatory stress during pregnancy is the most common cause of fetal growth restriction and/or miscarriage. Treatment strategies for protection of at-risk mothers are limited to a narrow range of vaccines, which do not cover the bulk of the common pathogens most frequently encountered. Using mouse models, we demonstrate that oral treatment during pregnancy with a microbial-derived immunomodulator (OM85), currently used clinically for attenuation of infection-associated airway inflammatory symptoms in infants-adults, markedly reduces risk for fetal loss/growth restriction resulting from maternal challenge with bacterial lipopolysaccharide or influenza. Focusing on LPS exposure, we demonstrate that the key molecular indices of maternal inflammatory stress, notably high levels of RANTES, MIP-1α, CCL2, KC, and G-CSF (granulocyte colony-stimulating factor) in gestational tissues/serum, are abrogated by OM85 pretreatment. Systems-level analyses conducted in parallel using RNASeq revealed that OM85 pretreatment selectively tunes LPS-induced activation in maternal gestational tissues for attenuated expression of TNF, IL1, and IFNG-driven proinflammatory networks, without constraining Type1-IFN-associated networks central to first-line antimicrobial defense. This study suggests that broad-spectrum protection-of-pregnancy against infection-associated inflammatory stress, without compromising capacity for efficient pathogen eradication, represents an achievable therapeutic goal.

Factor H uptake regulates intracellular C3 activation during apoptosis and decreases the inflammatory potential of nucleosomes.

Factor H (FH) binds apoptotic cells to limit the inflammatory potential of complement. Here we report that FH is actively internalized by apoptotic cells to enhance cathepsin L-mediated cleavage of endogenously expressed C3, which results in increased surface opsonization with iC3b. In addition, internalized FH forms complexes with nucleosomes, facilitates their phagocytosis by monocytes and induces an anti-inflammatory biased cytokine profile. A similar cytokine response was noted for apoptotic cells coated with FH, confirming that FH diminishes the immunogenic and inflammatory potential of autoantigens. These findings were supported by in vivo observations from CFH(-/-) MRL-lpr mice, which exhibited higher levels of circulating nucleosomes and necrotic cells than their CFH(+/+) littermates. This unconventional function of FH broadens the established view of apoptotic cell clearance and appears particularly important considering the strong associations with genetic FH alterations and diseases such as systemic lupus erythematosus and age-related macular degeneration.

Strictures of the terminal bile duct--who profits from the surgery?

BACKGROUND: Elucidation of the etiology of terminal bile duct strictures is oftentimes challenging. In choosing the optimal treatment method, a multidisciplinary approach is necessary. AIMS AND METHODS: To demonstrate the advantages and indications of surgical management, 153 patients with terminal bile duct strictures were retrospectively analysed. All patients had been treated during a period of eight years (1st January 1995 - 31st December 2002) in same department. The principal datas studied were surgical morbidity, thirty-days' mortality rates and recurrence of jaundice. RESULTS: During a period of eight years, 153 patients (100%) underwent laparotomy. Radical surgery (duodenopancreatectomy) was performed in 79 patients (51.6%), while 74 others (48.4%) benefited from bypass procedures. Postoperative morbidity reached 13.1%; nine patients (5.9%) died within the thirty days of surgery. Recurrence of jaundice was observed in three patients (1.9%). CONCLUSION: Surgical management of terminal bile duct strictures is indicated in most patients with benign strictures, strictures of unknown origin and with malignant strictures, where the patients are in a reasonably satisfactory clinical condition. The surgical approach provides the potential advantage to obtain a definite histological diagnosiscare and to remove the tumour in many patients. Patients with non resectable tumours could benefit from bypass procedures ensuring long-term and effective drainage of the bile.

[Carcinoma of the pancreatic head and periampular carcinomas. 10-year results of their resection management]. / Karcinom hlavy pankreatu a periampulární karcinomy. Výsledky resekcní lécby za 10 let.

INTRODUCTION: Parcial duodenopancreatectomy (DPE) remains the principal treatment method of carcinomas located in the region of the pancreatic head. Although several surgical clinics use this method, assessment of, mainly the long-term, treatment results is virtually absent in our literature. AIM: Presentation of early and late results of the procedure collected in a clinic, managing the procedures with "medium frequency". The study is aimed at patients with histologically confirmed carcinomas of the pancreatic head. MATERIAL AND METHODS: Prospective data from a group of patients who had undergone the DPE during the 10-year study in the Surgical Clinic of the IInd Medical Faculty of the Charles University in Prague-Motol, have been collected. RESULTS: From January 1995 to the end of 2004, 121 DPEs were completed, the 30-day mortality rate was 4.9% and the morbidity rate reached 17.5%. The long-term results were assessed in 71 cancer patients - the median survival rate was 18 months following the procedure (1-121 months), depending on the tumor type. CONCLUSIONS: The collected results are similar to those presented by foreign clinics (but conducted with lower frequencies here) and fall within a European better average.

Early treatment of congenital unilateral cataract minimizes unequal competition.

PURPOSE: Dense congenital unilateral cataracts may compromise visual development through visual deprivation and biased interocular competition, whereas dense congenital bilateral cataracts compromise visual development primarily through visual deprivation alone. Differences in sensory deficits between the two patient groups with these disorders may reflect the specific effects of unequal competition. To determine whether early treatment (at <8 weeks of age) minimizes the adverse effects of unequal competition, grating acuity deficits during the immediate posttreatment period and contrast sensitivity deficits at 6 to 8 years of age were assessed in 29 children with histories of dense congenital unilateral or bilateral cataracts who had had treatment between 1 and 8 weeks or 12 and 30 weeks. All children maintained good to excellent compliance with optical correction and occlusion therapy. METHODS: Grating acuity was measured using a two-alternative forced-choice preferential-looking staircase protocol. Contrast thresholds at three spatial frequencies (0.38, 1.5, and 6 cyc/deg) were measured at each of two temporal frequencies (2- and 8-Hz sinusoidal counterphase modulation) using D6 grating patches. RESULTS: Grating acuity deficits in the immediate posttreatment period were similar in patients with a history of unilateral cataract (n=10) and those with a history of bilateral cataracts (n=6) when treatment was provided during the first 8 weeks of life. With later treatment, patients with a history of unilateral cataract (n=7) had significantly larger grating acuity deficits than patients with a history of bilateral cataracts (n=6). Children with a history of dense congenital unilateral cataract had similar deficits in contrast sensitivity to children with a history of bilateral cataracts when treatment was initiated during the first 8 weeks of life. When treatment was initiated later (i.e., at 12-30 weeks), patients with a history of unilateral cataract showed greater deficits in contrast sensitivity and a dependence of the amount of spatial contrast sensitivity deficit on temporal frequency than did patients with a history of bilateral cataracts. CONCLUSIONS: These findings support the hypothesis that only visual deprivation is active as an amblyogenic factor during the first weeks of life, but when unilateral deprivation is prolonged to 12 to 30 weeks, unequal competition also plays a role in amblyogenesis.

Factors influencing stereoacuity in accommodative esotropia.

PURPOSE: Despite successful optical realignment, many children with accommodative esotropia (ET) have abnormal stereoacuity. In a prospective study, we examined the influence of age of onset, age at alignment, duration of constant misalignment, and accommodative convergence/accommodation ratio on random dot stereoacuity outcomes in accommodative ET. METHODS: Participants were 111 consecutive children with accommodative ET. Random dot stereoacuity was measured using the Randot preschool stereoacuity test, the Randot stereoacuity test, the infant random dot stereoacuity cards, and the Lang 1. RESULTS: Age of onset has only a minor influence on stereoacuity (P <.02); children with onset >/=age 25 months have better stereoacuity compared with children with an onset between ages 7 and 17 months. Age at alignment has a minor influence on stereoacuity (P <.001); children with intermittent ET who have been treated have better stereoacuity than children with a constant ET aligned between ages 6 and 24 months and after age 24 months. Duration of constant misalignment has the strongest influence on stereoacuity (P <.001); children who had intermittent misalignment or who had a constant misalignment of less than 4 months' duration have better stereoacuity than patients who had a constant misalignment greater than 4 months' duration. The accommodative convergence/accommodation ratio does not influence stereoacuity outcomes (P >.10). CONCLUSIONS: Fine random dot stereoacuity is associated with a constant misalignment of less than 4 months' duration. These findings promote prompt and aggressive treatment of accommodative ET at the onset of intermittent or constant misalignment.

Gastric cancer in young patients--is there any hope for them?

Gastric cancer usually affects people older than sixty years. This type of cancer is very rare in adults under thirty years of age. In addition, the prognosis in this part of population is grave due to the high incidence of undifferentiated tumours and advanced stage at time of diagnosis. Radical surgery affords the only chance for long term survival, but even this option is often limited upon finding locally advanced disease or peritoneal seeding. The following are case studies of three young adults from a group of 45 patients, who were treated between January 1st, 2000 and December 31st, 2003.

Sentinel node biopsy in gastric cancer: preliminary results.

BACKGROUND: Extent of lymphadenectomy in gastric cancer is one of the still unresolved and ongoing questions. Whether extensive procedures lead to better survival remains controversial. The detection of sentinel node could become a helpful method to define the desirable extent of lymph node dissection for each particular patient. MATERIAL AND METHODS: Prospective, single-centre, clinical trial. Sentinel node is identified using vital blue dye. After performance of D2 lymphadenectomy, the pathologist minutely investigates all lymphatic nodes by histological and immunohistochemistry techniques. RESULTS: During a period of 36 months, an attempt to localise the sentinel node for biopsy was made in 22 patients. The successful rate of sentinel node detection with a good relation between metastatic involvement of the sentinel node and other nodes was 56% (13 out of 22 patients). All these patients suffered from small tumours and early stage of the disease. In large tumours and advanced stages, blue dye stained the tissue around the tumour diffusely rendering the identification of true sentinel node impossible. Fresh frozen section of the sentinel node resulted in two patients in a false negative outcome because of micrometastatic involvement. CONCLUSIONS: Sentinel node biopsy in gastric cancer using vital staining is a feasible method. Reliable results were seen in early stage of the disease. Fresh frozen section of sentinel node has probably a low sensitivity for detection of micrometastases.

[Bleeding gastroduodenal ulcers from the viewpoint of the surgeon]. / Krvácení z gastroduodenálního vredu z pohledu chirurga.

The article has discoursed of a diagnosis and a therapy of bleeding peptic ulcer. There has been used the group of the patients admitted at The Surgical Unit of The Faculty Hospital Motol in Prague during two and half years. Urgent endoscopy and endoscopic treatment of indicated findings have been performed as a common procedures. The surgical therapy has been necessary for the part of this patients. Operation's indications, types of the operations and their timing have been discussed.

[History of the anatomy and surgery of the thyroid gland]. / Historie anatomie a chirurgie stítné zlázy.

The submitted historically oriented paper reviews anatomical and surgical prerequisites for the development of thyroid surgery. Operations which up to the middle of the last century were associated with an extremely high lethality and were considered heroic and unjustified, changed due to new findings and procedures into standard operations performed in some thyroid diseases. Despite this, indications for operation and views on some surgical procedures are even in contemporary medicine highly controversial.

[Pancreatic tumors--pessimism, optimism or realism?]. / Nádory pankreatu--pesimismus, optimismus nebo realismus?

Among 35 patients with the preoperative diagnosis of a tumour of the head of the pancreas who had a radical operation at the Surgical Clinic of the Second Medical Faculty Charles University in Prague-Motol between January 1995 and March 1998 a malignant tumour was confirmed in 24 instances. Another nine patients had a histological finding of chronic pancreatitis and the remaining two patients a benign cystadenoma of the pancreas. The 30-day mortality in the whole group is 5.7% (2/35). Both deaths within 30 days after surgery were due to massive haemorrhage into the upper GIT in patients with pancreatic cancer. The haemorrhage developed within 21 and 30 days after surgery. The source of haemorrhage was not proved unequivocally, neither clinically nor post mortem. Obviously late haemorrhage from some gastrointestinal anastomosis was involved. From a total of 24 patients after Whipple's operation on account of a malignant tumour of the head of the pancreas nine died. The mean survival period was seven months after surgery. Fifteen patients survive and after a mean follow-up period of 14 months the median of survival calculated to the date of March 31 1998 is 17 months for stage UICC I and five months for stage UICC III. Because of the short follow-up period the results cannot be compared properly with data in the contemporary literature but they are promising for further work in this sphere of surgery and evidence that it is correct to refute the nihilist view held in the past. Hitherto achieved therapeutic results in this country and abroad certainly do not justify yet an optimistic view as regards the perspective of patients with carcinoma of the pancreas.

[Pancreatic head tumors--preoperative examination and reality]. / Tumory hlavy pankreatu--predoperacní vysetrení a skutecnost.

The authors evaluated in a retrospective study the asset and accuracy of methods of preoperative diagnosis (ultrasonography, endoscopy, computed tomography and endoscopic sonography) in 47 patients with a preoperative finding of a tumour in the region of the head of the pancreas, where during the last three years a radical resection was performed. As compared with objective morphological findings of the resected tissues, endoscopic sonography proved the most sensitive and most reliable method for detection of focal changes in this area. The other compared methods also belong to the indispensible standard of preoperative diagnosis and in clear cases are sufficient for indication of surgery. Evaluation of nodal affection based on the finding of enlarged nodes during preoperative examination is very unreliable and should not influence decisions on indications for surgery.