[Chronic pancreatitis in 2011]. / Chronická pankreatitida v roce 2011.

The incidence of chronic pancreatitis grows slowly but steadily. At present, alcohol is the most frequent risk factor, although the new forms of so called non-alcoholic chronic pancreatitis, such as genetically induced pancreatitis and its autoimmune variety, are carefully watched. Alcohol consumption continues to be most closely associated with the disease, though it is no more than a risk factor and other aspects, e.g., genetic predisposition, are prerequisite to the disease development. Imaging methods play a fundamental role in diagnosing the disease; non-invasive magnetic resonance and CT, invasive but safe endosonography, and diagnostically rarely used ECRP that, because of its invasive nature, is currently predominantly used for therapeutic purposes. Genetic markers are also exploited, including CFTR mutation, SPINK 1 and PRRS 1 gene, immunoglobulin G4 in the autoimmune form of the disease as well as, alternatively, pancreatic biopsy. Disease symptoms, i.e., pancreatic malabsorption (enzymes with high lipase content) and pancreatic pain are treated conservatively, with paracetamol as the first line therapy for pain followed, if necessary, by so called synaptic analgesics. Alternatively, endoscopic techniques (drainage) or surgery (drainage and resection) are applied. Hereditary and non-hereditary chronic pancreatitis is among the risk factors for pancreatic cancer and thus patients with these diseases should be closely followed up.

[Autoimmune pancreatitis and IgG-positive sclerosing cholangitis]. / Autoimunitní pankreatitida a IgG pozitivní sklerotizující cholangitida.

Sclerosing cholangitis is a heterogenous disease. Sclerosing cholangitis with an unknown cause is abbreviated PSC. PSC affects extra- as well as intra-hepatic bile ducts and since this is a permanently progressing fibrous condition, it leads to liver cirrhosis. The disease is often associated with a development of cholangocarcinoma and idiopathic intestinal inflammation. Causal therapy does not exist; liver transplantation is indicated. IgG4 cholangitis differs from PSC in a number of features. This form is, unlike PSC, linked to autoimmune pancreatitis (AIP) as well as other IgG4 sclerosing diseases. Anatomically, distal region of ductus choledochus is most frequently involved. Icterus is, unlike in PSC, a frequent symptom of AIP. There also is a distinctive histological picture--significant lymphoplasmatic infiltration of the bile duct wall with abundance of IgG4 has been described, lymphoplasmatic infiltration with fibrosis in the periportal area and the presence of obliterating phlebitis is also typical. However, intact biliary epithelium is a typical feature. IgG4 can be diagnosed even without concurrent presence of AIP. IgG4 sclerosing cholangitis is a condition sensitive to steroid therapy. At present, there is no doubt that IgG4 sclerosing cholangitis is a completely different condition to primary sclerosing cholangitis. From the clinical perspective, these diseases should be differentiated in every clinician's mind as (a) AIP is treated with corticosteroids and not with an unnecessary surgery, (b) IgG4 sclerosing cholangitis is mostly successfully treated with corticosteroids and the disease is not, unlike PSC, a risk factor for the development of cholangiocarcinoma.

[Pancreatic cancer--association with diabetes mellitus and smoking]. / Pankreatický karcinom--vztah k diabetes mellitus a kourení.

INTRODUCTION: Pancreatic cancer is a disease with rather poor prognosis. This can be explained, among other reasons, by unusually aggressive course of the tumour growth and, in the majority of cases, late, and thus further treatment limiting, diagnosis. In addition, no effective screening programme for pancreatic cancer is available and thus identification of risk factors associated with the development of pancreatic cancer represents a possible approach to diagnosing early stages of the disease. Smoking represents a general and diabetes mellitus a specific risk factor for pancreatic cancer. The aim of our prospective study in pancreatic cancer patients was to identify patients with diabetes mellitus and divide these into smokers and non-smokers--in association with the diagnosis of pancreatic carcinoma. MATERIALS AND METHODS: We included 83 patients, 50 men and 33 women, with pancreatic cancer who were divided into 3 groups--non-smokers with diabetes mellitus, smokers and smokers with diabetes mellitus; the mean age was 64.2 years in male and 59.8 years in female patients. Pancreatic cancer was confirmed histomorphologically from pancreatic biopsies or a histology of pancreatic tissue obtained during a surgery. RESULTS: Pancreatic cancer was diagnosed after 3 or more years in patients with diabetes mellitus, the majority of diagnoses in smokers were made within the first year from the first dyspeptic symptoms. We found that the proportion of patients with subsequent diagnosis of pancreatic cancer increased with the number of cigarettes smoked per day (33.3% up to 10 cigarettes per day and 66.5% over 10 cigarettes per day). The highest incidence of pancreatic cancer, in 42 persons (50.6%), was associated with concurrent diabetes and smoking. CONCLUSION: Pancreatic cancer was identified in 24% of patients with diabetes mellitus, 25.3% of smokers with no diabetes and in more than 50% of smokers with diabetes mellitus. We assume that smoking is an independent risk factor for pancreatic cancer induction and it importantly increases the risk of pancreatic cancer in patients with diabetes mellitus.

[The expected worldwide burden of oesophagus, stomach and colorectal cancers]. / Ocekávaná zátez nádory jícnu, zaludku a kolorekta ve svete.

According database of Globocan 2008 of total 482 thousand worldwide new esophagel cancers are reported 16.9% cases in more developed and 83.1% in less developed regions, 6.9% in EU, 2.7% in the Eastern Europe; of total 989 thousand new stomach cancers are reported 27.8% in more developed and 72.2% in less developed regions, 8.4% in EU, 7.4% in the Eastern Europe; of total 1.235 milion new colorectal cancers are reported 59% cases in more developed and 41% in less developed regions, 27% in EU, 10.5% in the Eastern Europe. Of total 59,052 all neoplasms (without skin cancers) were reported 10,439 new cases of these three diagnoses in recent Czech Cancer Registry survey, higher by 595 cases than numbers based in Globocan 2008. However, according to these data the Czech males reached the 3rd order and females the 14th order by their cumulative risk of colorectal cancer in the world. The alarming worldwide numbers of new 4.771 milion of these three diagnoses and 3,137 thousands deaths from them, expected in 2030 with a higher risk in population of less developed regions require greater international cooperation and personal responsibility for improving the life-style, which would be failed the expected statistics.

[Cryopreservation of sperm before neoplasm therapy--7 years' experience]. / Kryokonzervace spermatu pred onkologickou lécbou--7 let zkuseností.

OBJECTIVE: To compare sperm count of cancer patients with health men, to analyze possible relation of sperm pathology and diagnosis of malignant disease and present experience of our cryopreservation programme for cancer patients. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, Brno, Czech Republic. METHODS: 215 patients (age 25.4 +/- 5.6 years) were referred to our unit by oncology specialists for semen cryopreservation before cancer treatment during 1995-2001. Sperm samples were analysed according to guidelines of WHO. Richardson's medium and Planer Kryo 10 were used for standard cryopreservation. Sperm count results were compared to control group of 84 men (23.1 +/- 3.6 year) examined as possible sperm donors. Program SPSS version 9 was used for statistical analysis. Standard intracytoplasmic sperm injection (ICSI) using frozen spermatozoa was used for infertility treatment following malignant disease recovery. RESULTS: Testicular cancer was diagnosed in 115 (53.5%) patients, malignant disease of lymphatic and haemopoetic tissue in 75 (34.9%) cases--out of them 35 (16.3%) Hodgkin's lymphoma. Twelve men (5.6%) were treated for osteosarcoma and 13 for other malignant disease. Only 2.8% patients had normospermia. Severe oligospermia < 5 mil/ml was found in 73 men (33.9%) including 22 cases of azoospermia (10.2%) and 12 cases (5.6%) of cryptozoospermia. 138 (64.2%) patients had asthenospermia < 10% of progressive motility, 49 (22.8%) had terratozoospermia < 10% spermatozoa with standard WHO morphology. Sperm concentration, progressive motility and morphology were in cancer patients significantly lower (P < 0.001) than in control group. Men with testicular cancer had significantly higher frequency of severe sperm pathology. Only 4 patients have returned for assisted reproduction treatment. In all cases ICSI was used, 1 pregnancy and delivery was achieved. During more than 4 years after cryopreservation died 16.6% of patients. CONCLUSION: Cancer patients has significantly higher frequency of severe sperm pathologies than healthy men. The most severe sperm pathologies are among men with testicular cancer. Only minority of patients return for fertility treatment. Cryopreserved spermatozoa of cancer patients are able to initiate pregnancy by assisted reproduction techniques.

[Support for cancer research and therapy with regard to its incidence]. / Moznost podpory výzkumu a lécby nádoru vzhledem k jejich výskytu.

With the current annual incidence of about 63,000 new cancers in the Czech Republic and with 320,000 treated diseases it is necessary to make use of all experience to warn the population against cancer. The treatment of more than 8 million oncological patients in the U.S.A. demands more than 100 billions dollars per a year. In order to support it, a postage stamp with an extra charge of 8 cents was issued in 1998. The 200 mil. pieces will bring given an expected profit of 16 mil. dollars which will be to the research of breast cancer. That is why a proposal has been submitted to issue the first Czech postage stamp with the topic of cancer prevention. The aim is to draw the people's attention to the risk of cancer and to support the healthy way of life. The issuing of the stamp will not include any extra charge for the support cancer treatment.

[Trends in cancer incidence in the Czech Republic]. / Trendy výskytu zhoubných nádoru v Ceské republice.

In general, the cancer incidence becomes stabilized in the Czech Republic during last years. However, the incidence of colorectal and renal cancers remains increasing and dominates also in European comparisons. A program of cancer prevention and early detection needs to be established at least for six so called preventable cancers as breast, lung, colorectal, cervical and prostatic carcinomas and malignant melanoma, which represent together 40 % of all oncological cases. The aim is reduction of cancer mortality as well as improved effectivity of cancer treatment and cost reduction. More efficient utilisation of the National Cancer Registry data for monitoring of the cancer management is suggested with an application of the project SVOD - the software system of visualisation of oncological data.

[Smoking in the United States and Europe]. / K tematice kourení ve Spojených státech a v Evrope.

Article reports on new findings in smoking prevalence, incidence of cancer and preventive actions against smoking in the United States and some countries in Europe. Situation in the Czech Republic is described and data from the National Cancer Registry are included.

Childhood leukaemia in Europe after Chernobyl: 5 year follow-up.

The European Childhood Leukaemia - Lymphoma Incidence Study (ECLIS) is designed to address concerns about a possible increase in the risk of cancer in Europe following the nuclear accident in Chernobyle in 1986. This paper reports results of surveillance of childhood leukaemia in cancer registry populations from 1980 up to the end of 1991. There was a slight increase in the incidence of childhood leukaemia in Europe during this period, but the overall geographical pattern of change bears no relation to estimated exposure to radiation resulting from the accident. We conclude that at this stage of follow-up any changes in incidence consequent upon the Chernobyl accident remain undetectable against the usual background rates. Our results are consistent with current estimates of the leukaemogenic risk of radiation exposure, which, outside the immediate vicinity of the accident, was small.