Intraoperative enteroscopy: ten years' experience at a single tertiary center.

BACKGROUND AND METHODS: Intraoperative enteroscopy is an invasive technique for small bowel investigation. It enables us to investigate the entire small intestine and to treat pathological findings by endoscopic or surgical means at the same time. The investigation is invasive and that is why the proper indication is mandatory. RESULTS: Forty-one intraoperative enteroscopies were performed at our center within a 10-year period. The procedure was diagnostic in 37/41 patients (90.2%); in 3 patients no pathology was found, and in 1 patient we found only previously diagnosed celiac disease. The investigation was therapeutic in 35/41 (85.4%) patients; 2 patients with small bowel ulcers did not require any intraoperative therapy. The pathological findings were arteriovenous malformations (found in 12 patients), small bowel NSAID-induced or Crohn's ulcers (8 patients)--ulcerations and arteriovenous malformations were simultaneously found in three patients; carcinoid of the small intestine (5 patients); Peutz-Jeghers syndrome (5 patients); bleeding polyps (2 gastrointestinal stromal tumors, 1 paraganglioma, and 1 lipoma--in 4 patients); Rendu-Osler-Weber disease (2 patients); multiple cavernous hemangiomas in blue rubber bleb nevus syndrome (1 patient); Henoch-Schönlein purpura (1 patient); aortoenteral fistula (1 patient); and retrograde intussusception of Meckel's diverticulum (1 patient). In five patients with Peutz-Jeghers syndrome, 6-22 hamartomas (median of 18 per session) were removed by means of endoscopic polypectomy during intraoperative enteroscopy. There were no major procedure-related complications in our series. CONCLUSIONS: Intraoperative enteroscopy is accepted as the ultimate diagnostic procedure for complete investigation of the small bowel. Despite the introduction of double-balloon enteroscopy into clinical practice, intraoperative enteroscopy will be reserved for those cases where double-balloon enteroscopy cannot be performed or fails to investigate the entire small intestine, especially to prevent excessive bowel resection.

[Laser palliative destruction of rectum carcinoma--case reports]. / Laserová paliativní destrukce nádoru rekta--kazuistiky.

The palliative treatment of developed primary or recurrent rectum carcinoma is still an important issue in treatment of this disease. The aim of the surgery is in such case to remove the tumorous obstacle and to prevent the development of ileus, to reduce pain, to limit the volume of tumorous tissue, to prevent bleeding and possible incontinence or mucous secretion. The transanal laser thermodestruction of the tumor represents one of the possible ways of palliative treatment of rectum carcinoma. The method is very considerate even for the high risk patients. On the other hand it requires a short-term hospitalization. The method of transanal laser evaporisation of carcinoma is also important from the ethical point of view: in many cases it may prevent the creation of palliative derivative colostomy. This fact is very important especially in patients with the terminal stage of the malign carcinoma because they live the rest of their lives in acceptable conditions. The important benefits are described in three case histories. The method is presented as an urgent surgery in solution of ileus which is based on tumorous rectum stenosis.

[Unusual cause of the acute appendicitis]. / Neobvyklá prícina akutní apendicitidy.

Exogenous foreign particles in the appendix rarely case appendicitis. Their prevalence is reported to be 0.0005%. This fact makes both lay and medical community underestimate possible complications related to the presence of foreign particles in the appendix lumen. Our case review documents risks related with swallowing a sharp foreign particle. The particle concerned was a tooth root--on prosthesis with an acrylic crown, which caused acute appendicitis with the appendical wall perforation by the above mentioned foreign body.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

Gastric banding: intraoperative and early postoperative complications and their prevention.

BACKGROUND: Intraoperative and early postoperative complications in patients operated for morbid obesity were assessed. METHODS: 114 morbidly obese patients underwnent gastric banding (non-adjustable or adjustable). The influence of body mass index (BMI), age and preoperative morbidity on the occurrence of postoperative ventilatory disturbances was evaluated. RESULTS: Risk of postoperative ventilatory disorders increased with preoperative cardiovascular disease (p < 0.01), diabetes (p < 0.05), and increasing BMI (p < 0.01). Age, hypertension and pulmonary disease did not influence significantly the risk of complication in this series. There have been no deaths. CONCLUSION: In patients undergoing banding for morbid obesity, the potential for ventilatory complications increases with higher BMI, diabetes and cardiovascular disease in the preoperative comorbidities. Principles for postoperative care were developed.

Importance of the anorectal manometry in chronic anal fissure.

This publication presents the results of postoperative manometric investigations of 77 patients with anal fissure treated within the time span 1985-1997 by lateral sphincterotomy (LS). Results of manometric investigations are compared with digital anal examinations and subjective complaints of patients. Digital anal examination correlated with manometry results in 52 cases (68%). The correspondence between these two results was proved in 48 cases when normal finding was present. An increased sphincter tonus was found in 3 patients, all of them having the anal fissure recurrences. A marked sphincters insufficiency, which had been manifested by stool and gas incontinence was found in one case. When searching for the reason of this complication we found out that this operation procedure had been performed by an unexperienced team of surgeons. In 25 cases (32%) the digital anal assessment and manometric measurement were different. Nevertheless, the clinical symptoms in this group of patients were rather poor. To conclude we may state that manometry provides important data for preoperative evaluation of anal sphincter function and should be performed prior to lateral sphincterotomy operation at least in women.

Immunoscintigraphy and intra-operative radioimmunodetection in the treatment of colorectal carcinoma.

PURPOSE: Intra-operative radioimmunodetection of malignant involved lymph nodes follows the pre-operative immunoscintigraphy in the treatment of patients with colorectal carcinoma. The aims of this clinical study were to determine the sensitivity of the method, to compare the results in study when using Oncoscint and CEA-Scan and to evaluate the importance of the method of surgery and postoperative adjuvant therapy. PATIENTS AND METHODS: 121 patients with colorectal tumours (106 primary and 15 recurrent) were operated on using radioimmunoguided surgery (RIGS). The study compared results of pre-operative immunoscintigraphy, intra-operative radioimmunodetection and postoperative histological examination. Histological investigation used classical H&E staining. In histologically negative and RIGS positive cases the immunohistochemical investigation was supplemented. Two radiopharmaceuticals were used Oncoscint CR 103 (MAb B72.3, Satumomab Pendetide), labelled with 111In in 56 patients and CEA-Scan (IMMU 4-Fab' fragments MAb against CEA, Arcitumomab), labelled with 99mTc in 65 patients. RESULTS: The relationship between RIGS positive results and histological examination was statistically assessed after 38 operations and the most acceptable RIGS evaluating index was determined. All subsequent results were evaluated by this index. Immunoscintigraphy of tumour was positive in 112 cases (92.6%). Fifty-five RIGS positive cases of malignant infiltrated lymph nodes were confirmed by 43 histologically positive examinations (78%). In this group 9 cases were discovered only by immunohistochemistry. Sixty-six remaining RIGS negative results were confirmed in 62 (94%) cases by negative histology. CONCLUSIONS: Both immunoscintigraphy and RIGS enable one to make a more accurate diagnosis. While treating the primary disease the use of RIGS may help in assessment of necessary extent of operation performance and in staging of the disease by revealing occult lymph nodes involved. Pre-operative immunoscintigraphy seems to be a useful diagnostic method for detection of tumour recurrence. When comparing two radiopharmaceuticals used, CEA-Scan seems to be more suitable for diagnostic studies, but using the Oncoscint for tumour recurrence detection had some specific benefit, too.

Assessment of sphincterotomy results in patients treated for anal fissure.

OBJECTIVE: This paper summarizes results of a study of 90 patients operated on for chronic anal fissure with lateral sphincterotomy (LS) between 1985 and 1997. METHODS: Preoperative and postoperative complaints, anal examination and continence were evaluated. All patients were asked to rate the results of LS as very good, good, satisfactory or unsatisfactory. RESULTS: Sixty-six patients (73.3%) judged the results of LS to be very good. Only 4 (4.4%) judged the results unsatisfactory and 1 patient (1.1%) considered the results satisfactory. Recurrent anal fissure was found in 4 cases (4.4%). Two patients developed a fistula in connection with the procedure. CONCLUSIONS: Lateral sphincterotomy is a safe and simple operation that yields good results. However, LS should be diagnosed and performed by a surgeon skilled in proctologic surgery.

[Treatment of chronic anal fissure with lateral sphincterotomy]. / Lécení chronické anální fisury laterální sfinkterotomií.

This paper presents a group of 134 patients, who underwent treatment of chronic anal fissure by internal lateral sphincterotomy (ILS) within the period of 12 years (1985-1996). This number of patients where those in whom conservative treatment (anal divulsion) was not successful. From the total number of 134 patients 110 were treated successfully by surgery (82.08%). In 19 patients even after fissure healing slight discomfort persisted. Moderate and more severe complaints were reported in 5 patients. In 4 cases the chronic anal fissure failed to heal, in 1 patient due to ILS perianal fistula developed. No other complications, like incontinency etc., were found within the short time interval of follow-up. ILS is a simple and safe surgical procedure performed under general anaesthesia after precise differentitation of the internal sphincter. The results of surgical treatment are very satisfactory, marked painfulness relieves immediately after operation, the fissure heals rapidly after relaxation of the internal sphincter spasm. Postoperative treatment is simple, the percentage of complications is low. None of the patients operated on in the authors department developed incontinence. (Tab. 3, Ref. 25.)

The chronic anal fissure treatment by internal partial lateral sphincterotomy and following anal manometry.

Anal fissure remains one of the most common proctologic problems. A number of reports have advocated the use of partial internal sphincterotomy as a treatment of chronic anal fissure. Our study shows the results of a retrospective analysis of our patients who underwent lateral internal sphincterotomy for the treatment of chronic anal fissure. To determine long time results we examined random sample of 75 operated patients. Apart from taking careful history and patient's assessment of the operation effect, the patients were investigated "per rectum", and even possibly rectoscopically. To asscertain suitability and also security of properly done internal sphincterotomy, we performed anorectal manometric examinations in 53 patients controlled. To conclude our results, we can state that in 9 (12%) patients controlled some subjective complaints or certain pathologic findings connected with anal fissure or sphincterotomy were found. None of the people from the set of ours suffered from any complaints, which can be taken as stool incontinency. In no patients any change in pressure measured by anorectal manometry indicating incontinency was proved.

[Personal experience in the treatment of perianal fistulas]. / Vlastní zkusenosti s lécením perianálních pístelí.

The authors describe the therapeutic results assembled with perianal fistulae in 130 patients. The best and most reliable method for treatment of the above mentioned lesions is discision or excision of the fistula followed by the so-called "open method" of healing. Since 1988 by this method 74 patients were treated where only two relapses were recorded. Postoperative treatment is simple, dietetic provisions are not necessary. Regular digital control of the wound hastens granulation. After rapid epithelization the wound heals by an almost linear scar. As in particular intersphincteric and low transphincteric fistulae calt for careful sphincterotomy of an appropriate extent it is essential that these operations should be performed by a surgeon adequately experienced in proctosurgery.

An attempt to induce formation of antibodies against endogenous retrovirus BP 6 in syngenic rats.

An attempt was made to induce production of antibodies against C-type endogenous rat retrovirus BP 6. Syngenic Lewis rats were immunized with viable tumor cells, induced with benzo(a)pyrene, continuously producing BP 6 virus. By use of immunoblotting technique, neither short- nor long-term immunization did cause formation of any detectable amounts of antibody against structural proteins of the virus. On the other hand, in immunoblotting, antibodies arised in rats immunized with purified mouse leukemia virus have been found to cross-react with endogenous rat retrovirus.

High prevalence of circulating antibodies to MuLV p30 antigen in human sera. An autoimmune response?

To study the possible involvement of a murine leukemia virus (MuLV) related agent in human cancer, an extensive immunoblotting analysis of human sera (cancer, autoimmune as well as control normal ones) for the presence of antibodies to MuLV structural proteins was performed. Out of 350 sera, 89 reacted with gag precursor Pr65, 72 reacted with major viral core protein p30 and five with the matrix protein p15. Antibody reactivity to the env-encoded glycoprotein gp70 was detected in 7 cases out of 16 sera tested. There were no significant differences between pathological and normal sera concerning the patterns and the frequency of the reactivity. Sera from patients with various malignancies (mainly with breast cancer) generally displayed more intensive signals to MuLV p30 than normal sera. Epitope mapping revealed that MuLV p30-reactive antibodies recognize an antigenic determinant(s) located at the carboxyterminus of the protein.

[Colonoscopy in the diagnosis of hemorrhage in the colorectal area]. / Koloskopie jako príspevek k diagnostice a lécbe krvácení z kolorektální oblasti.

The authors submit a retrospective study based on their own material, pertaining to experience with coloscopies in acute and chronic haemorrhage from the colorectal region. They analyze the causes of haemorrhage, and give a detailed histological classification in particular of polyps as possible precancerous conditions. They also compare the clinical value of coloscopy with other examination methods according to their own experience and data in the literature.

No significant correlation between specific antibodies to mouse mammary tumour virus and human cancer.

To study the possible involvement of mouse mammary tumour virus (MMTV) related agent in human cancer we analysed 300 samples of human sera for the presence of antibodies to MMTV structural proteins. All sera were tested by immunoblotting to achieve high specificity. Out of 300 sera, 22 reacted with transframe protein p30, 16 with the ribonucleoprotein p14, six with the envelope glycoprotein gp52 and three with the major core protein p27. Reactivities to p30 and p14 were observed in sera from cancer patients and healthy controls; reactivities to p27 and gp52 predominated in sera of cancer patients. Sera frequently reacted with a 42 kDa protein which is a cellular contaminant of the virus.

[Personal experience with the treatment of chronic anal fissures using internal lateral sphincterotomy]. / Vlastní zkusenosti s lécením chronické anální fisury vnitrní laterální sfinkterotomií.

The author describes the therapeutic results in 48 patients with chronic anal fissure by means of internal lateral sphincterotomy (ILS). He operated patients where the complaints did not recede after conservative treatment supplemented by divulsion of the anus. In 43 patients (89.58%) in the course of two to three weeks the anal fissure healed. Only four patients (8.33%) experienced after operation a slight discomfort such as itching in the perianal region. A relapse after temporary improvement occurred in one patient (0.49%). ILS is a simple and safe operation performed under general anaesthesia after precise differentiation of the internal sphincter. The results of surgical treatment are very satisfactory the marked painfulness recedes immediately after operation, the fissure heals rapidly after relaxation of the spasm of the internal sphincter. Postoperative treatment is simple, the percentage of complications is small. None of the patients operated in the authors' department developed incontinence.

[Personal experience in the diagnosis and therapy of Boerhaave's syndrome]. / Nase zkusenosti s diagnostikou a terapií Boerhaaveho syndromu.

At the Surgical Clinic of the Faculty Hospital in Hradec Králové during the last 20 years 32 patients with perforation of the oesophagus were treated. Of these five had a spontaneous rupture of the oesophagus--Boerhaave's syndrome. The authors describe their own experience with the diagnosis of this syndrome. They emphasize the importance of early diagnosis which determines the type of surgical treatment, makes a more radical operation possible, reduces the percentage of complications and thus also the high mortality of this syndrome.

Concentration of retroviruses by low-speed centrifugation.

Concentration of retroviruses from volumes of up to 6 liters of medium by low-speed centrifugation is described. In contrast to pelleting, no damage or aggregation of particles was observed. Surface glycoproteins were also fully preserved. This method enables simple handling of relatively large volumes of medium. Highly purified mouse mammary tumor virus (MMTV) was obtained and its transframe protein p30 in SDS-PAGE was recognized as a double band.

Retrovirus like particles produced by human embryonal cells and cell lines derived from human malignancies. II. Protein structure.

Very small amounts of retrovirus-like particles were isolated from tissue culture media of various types of human cell lines derived from malignant as well as normal cells. The aim of the present study is the characterization of protein profiles of these isolates. The comparison of protein profiles of isolated human virus-like particles with the profiles of well characterized animal as well as human exogenous (LAV/HTLV-III) retroviruses revealed a 25k protein (p25) to be a major protein or at least one of the protein components of human retrovirus-like particles.