Malignant schwannoma of the obturator nerve.

Lesions of obturator nerve are rare. Tumours and mainly malignant schwannoma of this nerve are extremely rare. The authors describe an unusual case of a gigantic schwannoma of the obturator nerve in 69 year old woman. Due to tumour expansion in the proximal part of the thigh MRI was performed and demonstrated extensive tumour originating most probably from the obturator nerve. The patient had no neurological symptoms. Biopsy from the lesion was taken at the Department of Orthopaedics with the following conclusion: malignant schwannoma. The patient received neoadjuvant chemotherapy due to diffuse metastatic spread on the chest X ray, after which metastatic spread subsided. The main lesion reduced its size by 1 cm. In 4 months after biopsy the patient was referred for operation to neurosurgery. The tumour was removed along its borders and except of minimal weakness of adduction of the right thigh there was no neurological deterioration. She was subsequently referred for further care to oncology and radiotherapy.The goal of this work is to emphasize the extremely rare occurrence of tumours of this nerve and suggest therapeutic options (Fig. 4, Ref. 11).

Hereditary C7 deficiency. Diagnosis and HLA studies in a French-Canadian family.

The serum of a 44-yr-old woman of French-Canadian descent having a B-27 positive ankylosing spondylitis was deficient in the seventh component of complement (C7) as determined by hemolytic and immunochemical methods. No inhibitor against C7 was detected, and the levels of all other complement components were normal. No deficiency in the opsonic activity of the serum was found, and the results of basic coagulation studies of the plasma were normal. On investigation of the patient's family, two sisters were found to have the same deficiency but were otherwise in good health. The seven other siblings were heterozygous for C7 deficiency, while the paternal aunt had a normal C7 level. In the third generation, six children of the three homozygous sisters and five children of heterozygotes were available for testing. Studies of the HLA antigens in all the 22 subjects and in three spouses indicated no close linkage between the CM deficienty and the HLA system. In addition, the simultaneous occurrence of two hereditary complement deficiencies (C2 and C7) was discovered in one family of this remarkable kindred.

Perioperative fractionated high-dose rate brachytherapy in the treatment of soft tissue sarcomas.

The purpose of the study was to investigate the viability of perioperative fractionated high dose rate brachytherapy (HDR BT) for primary and reccurent soft tissue sarcomas (STS). From February 1998 through June 2002, 21 adult patients, 11 females and 10 males with either low grade or high grade soft tissue sarcomas were treated by perioperative HDR BT. Surgical margin was negative in 10 cases, close in 4 and positive in 4 in cases. In 3 cases it was not described. BT was used as a part of primary treatment in 10 cases and for the treatment of reccurent tumor in 11 cases. The localisation of the tumor was the extremity in 16 patients and the trunk in 5 patients. Ten patients were treated with HDR BT alone (total mean dose 40 Gy) and 11 were treated with combination of external beam radiotherapy (EBRT) (40-50 Gy) and brachytherapy (total mean dose 24 Gy). Hyperfractionation 2.4-3 Gy twice daily at 10 mm from the source was used for BT. Follow-up periods were between 7--48 months (median: 20 months). Local control in patients treated pro primary STS was 100%.The pulmonal metastases were a cause of death in one case, one patient was alive with dissemination and one patient was disease free after salvage surgery and chemotherapy for lung metastases. Local control was achieved only in 3 of 11 patients treated for reccurent tumor (27%). Six patients were disease free after salvage surgery, 2 patients died of disease progression, one patient died of toxicity of chemotherapy without evidence of disease and 2 patients are alive with distant metastases. Local control was achieved in 5 of 11 (45%) patients with positive, close or not stated surgical margin and in 5 of 10 (50%) patients with negative margin. Local control was 100% in patients treated by EBRT + BT, but only 20% in patients treated by BT alone. No infection or delayed wound healing has occurred after BT. Soft tissue necrosis was seen in 4 cases, subcutanous fistula in one case and peripheral nerve palsy in one case. Despite small number of patients and short follow up our study suggest that perioperative HDR BT is easy and promissing when used as a part of primary treatment for STS. The treatment results for recurrence are poor and in a lot of cases radical surgical approach should have been considered for the salvage.

[Use of lasers in orthopaedics.]. / Pouzití laseru v ortopedii.

In the introduction the authors draw attention to the physical properties of laser radiation and its effect on living tissue. They deal also with characteristics and properties of different types of lasers. In the second part they discuss possibilities of the use of lasers in orthopaedic practice. Key words: laser arthroscopy, extraction of bone cement, biostimulation therapy.

A possible solution to the cost explosion of the emergency department.

Once considered a source of care for major injuries and life-threatening medical conditions, the emergency department has become part primary care physician and part social worker to many Americans. This article looks at the problem of emergency room overutilization and poses some solutions to stem the rising cost of urgent care.

Information technology in the health care industry.

The health care information systems market has grown to a multibillion dollar industry, with a predicted average annual growth rate of 12% through the year 2000. This paper provides an overview of information and management technology applications in health care for (a) medical diagnosis and treatment; (b) health care administrative functions; and (c) special applications of information technology to health care problems.

[Valve replacement in congenital aortic stenosis]. / Náhrady chlopní pro vrozené stenózy aortálního ústí.

BACKGROUND: Hemodynamically significant congenital aortic stenosis is usually surgically solved by valvotomy, infrequently aortic valve replacement is necessary. The aim of this retrospective study (period 1979-1995) is to find reasons for valve replacement, frequency of these procedures and early and long term results after aortic valve replacement for congenital aortic stenosis. METHODS AND RESULTS: Congenital aortic stenosis was solved by aortic valvotomy in 82 patients and by aortic valve replacement in 18 patients. Aortic valve replacement was performed 6x for congenital valvar aortic stenosis with mean aortic gradient 53.7 +/- 13.9 mm Hg and aortic valve area 0.42 +/- 0.04 cm2/m2 and 4x for valvar and subvalvar stenosis with mean aortic gradient 87.0 +/- 31.3 mm Hg, valve area 0.45 +/- 0.03 cm2/m2 and associated regurgitation 44.7 +/- 25.6%. In the remaining 8 patients aortic valve replacement was performed as reoperation after aortic valvotomy (after 20 +/- 8.4 years). In this group mean aortic gradient was only 32.2 +/- 13.8 mm Hg but regurgitation was 54.0 +/- 15.8%. Infective endocarditis occurred in 8 patients (44.5%) preoperatively. There were two hospital deaths (sudden death and multiorgan failure) and one death 3 years after operation (prosthetic endocarditis). Remaining 15 patients are in very good condition (NYHA I.-II.) 1-13 years after aortic valve replacement. CONCLUSIONS: Severely calcified aortic valve, endocarditis and associated incompetence are indications for valve replacement in patients with congenital aortic valve disease. Prevention of infective endocarditis is necessary pre and postoperatively, too. Long-term results after valve replacement for aortic valve stenosis are very good.

[Surgical treatment of renal carcinoma with tumor thrombus extending into the right heart atrium]. / Chirurgická lécba karcinomu ledviny s nádorovou trombózou zasahující do pravé síne srdecní.

Tumours thrombosis affecting the kidney or vena cava inferior in renal carcinoma is encountered in 4%-19% of the operated patients. Thrombosis reaching as far as the right atrium is rare. It is a very serious complication for the surgeon, but its does not imply a poorer prognosis of the disease nor shorter survival than tumours thrombosis of the inferior vena cava. Five-year survival is reported in 35-60% of the patients. Therefore radical surgery is fully indicated provided team collaboration of the urologist and cardiosurgeon is ensured. It involves removal of the tumours kidney with the tumours thrombus in an open heart and inferior vena cava, using extracorporeal circulation and arrested circulation with hypothermia. The authors present a successfully performed operation performed in a 63-year-old male [correction of female] patient.

[Results of open valvotomy in congenital stenosis of the aortic valve]. / Výsledky otevrené valvotomie pro kongenitální stenózu aortální chlopne.

Between 1977 and 1992 at the Cardiosurgical Clinic of the Faculty Hospital in Hradec Králové on account of congenital valvular aortic stenosis 142 patients were subjected to catheterization. Valvotomy of a stenotic aortic valve was performed in 69 patients. The submitted paper evaluates the progression of aortic stenosis based on investigations of the aortic gradient and the area of the aortic orifice in repeatedly catheterized patients before and after valvotomy and evaluates also the results of surgery after a 1-15-year interval after surgery.

[Results of pericardiectomy in the treatment of constrictive pericarditis]. / Výsledky perikardektomie v lécbe konstriktivní perikarditidy.

Between 1981 and 1990 at the Cardiosurgical Clinic in Hradec Králové pericardectomy on account of chronic constrictive pericarditis was performed in 20 patients. The authors evaluated the duration of complaints, preoperative symptomatology, surgical procedure and results of the operation. Symptoms of right-sided cardiac congestion were recorded in 80% of the patients. Calcifications of the pericardium were found in 70% of the patients. During the postoperative period one patient died (5%). The long-term results evaluated at least three years after operation were very good in 65% of the operated patients. Treatment of chronic constrictive pericarditis is surgical and involves subtotal pericardectomy from medial sternotomy.

[Injuries of the diaphragm]. / Urazová poranení bránice.

The authors submit a group of 11 patients treated in 1977-1988 on account of traumatic injury of the diaphragm. The group comprised 9 adults and two children. The authors analyzed the causes of injury, the condition of the patients on admission to hospital, the interval between admission and surgical treatment of the diaphragm, the diagnostic approach, the surgical approach and its results.

[Pleural mesothelioma in data from the Surgical Clinic in Hradec Králové 1971-1987]. / Mezoteliomy pleury v materiálu chirurgické kliniky v Hradci Králové v období 1971-1987.

The authors describe a group of 12 patients operated at the Surgical Clinic in Hradec Králové in 1971-1987 with the diagnosis of a pleural mesothelioma. This tumour was found most frequently in the 6th decade. A slight predominance of women was found. Risk factors which might be associated with the development of a mesothelioma were found only in one patient. This disease is often recorded in a too advanced stage as it is manifested by a late, poor and non-specific symptomatology. In the authors' group of patients operated on account of mesothelioma the tumour was removed in six patients. Only those survive where the mesothelioma had a benign localization 2 patients). The fate of one patient could not be traced. All patients with the histological classification of malignancy in the diffuse or localized form died (9 patients), even when the tumour was surgically removed (3 patients). This fact indicates the great aggressivity of malignant mesotheliomas.

[Changes in stomach and duodenal mucosa caused by acetylsalicylic acid therapy]. / Veränderungen der Magen- und Duodenalschleimhaut unter Azetylsalizylsäuretherapie.

The ulcerogenic effect of acetylsalicylic acid on the gastric and duodenal mucosa is well known. In a retrospective survey we analysed 1203 gastroscopic investigations from 1980 to 1986. Of these patients 47 were under therapy with acetylsalicylic acid for at least 4 weeks and 39 of them (82.9%) showed pathologic changes of the gastric and duodenal mucosa. The residual 1156 patients received no therapy; among these only 426 patients (36.8%) showed pathologic changes of the gastric and duodenal mucosa. The significant difference in the incidence of peptic lesions of the gastroduodenal mucosa between the two patient groups confirms the existence of an ulcerogenic side effect of acetylsalicylic acid.

[The significance of mediastinoscopy in the diagnosis and treatment of diseases of the lungs and mediastinum]. / Význam mediastinoskopie v diagnostice a lécbe onemocnení plic a mediastina.

A total of 299 patients is presented in them the mediastinoscopy has been performed from 1970 up to 1987. The indications and examination technique are also reported. Its significance is evaluated in recognizing the individual groups of diseases of lung and mediastinum. Comparing this method with other techniques, its advantages are referred to as for its precision a good tolerance by patients. The relatively small rate of complications is stated which represented 1.33 per cent in total proposed.

Identification of the platelet glycoprotein IIb/IIIa complex as a target antigen in primary biliary cirrhosis-associated autoimmune thrombocytopenia. Evidence that platelet-reactive autoantibodies can also bind to the mitochondrial antigen M2.

A 67-year-old woman with a 4-year history of primary biliary cirrhosis (PBC) unexpectedly developed autoimmune thrombocytopenia. The platelet-bound IgG antibody was eluted from the patient's platelets to determine the platelet target antigen. The autoantibodies were found to precipitate the platelet glycoprotein complex IIb/IIIa of autologous and allogeneic platelets. A further precipitate of 70 kDa was detectable under reducing conditions. In addition, platelet-reactive antibodies bound to the 70 kDa mitochondrial antigen M2. No cross-absorption studies were performed to confirm that a single antibody reacted with both antigens. Computer analysis of published peptide sequences of the mitochondrial protein and the platelet GPIIb/IIIa complex showed partial amino acid sequence homology suggesting the possibility of a common antibody binding site. These findings suggest a relationship between the development of autoimmune thrombocytopenia in PBC and the underlying liver disease.

Simultaneous occurrence of hereditary C6 and C2 deficiency in a French-Canadian family.

The sera of four sisters were found to lack the sixth component of complement (C6) and the serum of one was also partially deficient in the second component (C2). Two other blood relatives were found to be heterozygous for both deficiencies, while only one sibling had normal values. The father of these eight siblings was heterozygous for C2D and C6D and in the third generation, six children were heterozygous for C6 deficiency was treated for chronic active brucel-transmitted; the C6 deficiency was not linked to the HLA system, while the C2-deficiency segregated with the haplotype A10,B18. The proband, homozygous for C6 deficiency was treated for chronic active Brucellosis and in another sibling with C6 deficiency, toxoplasmosis was diagnosed. Neither bleeding disorders nor a tendency to collagen diseases have been observed and the opsonic activity was normal in the sera of all family members.