Positive family history promotes participation in colorectal cancer screening.

BACKGROUND: Participation rates in colorectal cancer (CRC) screening are rather low. We evaluated the interest of first degree relatives (FDR) of CRC patients to participate in a colonoscopy screening and compared the findings to controls with a negative family history. METHODOLOGY: There were 235 CRC patients diagnosed in our centre in 1984-2001. These were mailed an invitation letter for a preventive examination for their FDR older than 40 years and a questionnaire about occurrence of malignancies in their family. Colonoscopy was performed in 52 FDR and sex/age matched controls. RESULTS: The questionnaire was delivered to 196 patients. Thirty four (17.3%) patients responded. Positive family history for CRC was reported in 12/34 (35.3%) patients, compared to expected 3.4 patients (p = 0.04; OR 4.2; 95% CI = 1.05-17.89). Fifty two of 94 (55.3%) FDR participated in a screening and CRC was diagnosed in 2 and CRA in 18 patients compared to 1 CRC and 9 CRA in control group (p = 0.04; Kaplan-Meier p = 0.04). CONCLUSIONS: Positive family history seems to be a motivation factor for a participation in a CRC screening program. Consistent with previous studies the prevalence of CRA and CRC was significantly higher in the group of FDR compared to controls (Tab. 3, Fig. 1, Ref. 20).

Collagen type IV in epithelial tumours of colon.

Collagen type IV in the lamina propria mucosae is one of the main components of the basement membrane of normal and transitional colon mucosa. The aim of the present study was to assess the use of anti-collagen type IV antibodies in the evaluation of biological activity of epithelial tumours of the colon. Formalin-fixed and paraffin-embedded specimens of polyps and carcinomas of the colon from 14 patients were analyzed. In transitional mucosa around epithelial tumours, only minor deformities of the evenly thick collagen type IV-containing basement membranes were found. This pattern was different in polyps where collagen type IV-positive basement membrane components extended between basolateral membranes of epithelial cells. Local changes of collagen type IV positivity in basement membranes of polyps were observed. Positivity of epithelial basement membranes disappeared in adenocarcinomas but there was an increased positivity in fibrillar components of stroma. Basement membranes of microvessels in lamina propria mucosae were also positive for collagen type IV. Similar observations were made in the stroma of polyps. Our results indicate that loss of collagen type IV in basement membranes of adenocarcinomas is related to loss of differentiation and the malignant potential of epithelial tumours of colon.

Plasma somatostatin levels in ulcerative colitis.

The circadian (24 hour) rhythmicity of somatostatin in healthy subjects and patients with ulcerative colitis (UC) was studied and established. UC patients were found to have a higher 24-hour amplitude, a higher average level and a longer peak level phase of plasma somatostatin. This finding may indicate a defensive role of somatostatin in inflammatory bowel disease.

Uterine necrosis after laparoscopic uterine vessel dissection for symptomatic fibroid--a case report.

Laparoscopic dissection of uterine vessels is a new minimally invasive method to treat symptomatic fibroids. A potential complication of uterine artery dissection is uterine necrosis. A woman with a large intramural fibroid underwent laparoscopic dissection of the uterine vessels using ultrasonic activated shears and three months later developed focal uterine necrosis requiring exploratory laparotomy and supracervical hysterectomy. Although uterine artery coagulation and dissection are procedures with a low reported rate of complications, uterine fibroid or focal uterine necrosis can occur.

[Hepatic injury.]. / Trauma pecene.

Based on a critical review and analysis of results of surgical treatment of blunt liver injuries from 1983 to the present time the authors emphasize the importance of primary treatment of liver injuries. The foremost effort of the surgeon is reliable, aimed haemostasis during temporary short-term ischaemia of the liver by Pringle's manoeuvre or by a block of the suprahepatic cava resp. Pericentesis of the liver is not suitable for hepatic surgery. The second demand is systematic débridement of devitalized parts of the liver even if atypical resections must be made. In the group of patients where these two principles were respected, the number of complications was minimal. Key words: hepatic injury, resection of the liver.

Is there any role for prevention strategies for colorectal cancer other than population-based screening?

Colorectal carcinoma is a growing medical problem. Prevention represents the most effective approach for reducing the incidence and mortality. Population-based screening with subsequent colonoscopic polypectomy is the most common strategy. There are, however, other approaches increasing the portfolio of available measures. These include the special care of groups with an increased risk for CRC based on family or medical history and various chemopreventive strategies. Family history is a simple method to identify a person with increased risk of CRC. There are two groups of familial CRC: monogenetic hereditary syndromes such as FAP and HNPCC and hereditary predispositions with sporadic CRC. Recent advances in genetic tests and tailored surveillance strategies are able to decrease the morbidity and mortality in these groups. Therefore a wider recognition of family history as risk indicator of CRC should be encouraged. Chemoprevention is a very promising concept for both primary and secondary prevention of CRC. Although definite evidence is difficult to provide a number of studies suggest a role for nutritional interventions and/or chemoprevention with plant phytosterols, fiber, selenium, calcium, probiotics or COX2 inhibitors as putative chemopreventive strategies. (Tab. 4, Ref. 70.).

Heterotopic pancreas in gastric antrum with macroscopic appearance of gastric polyp.

Heterotopic pancreas is a relatively rare clinical diagnosis, not commonly involved in differential diagnostic considerations of GI symptoms. The authors report a case of heterotopic pancreas discovered endoscopically in the gastric antrum. A 60-year-old woman presented with epigastric pain. The patient took alendronate for osteoporosis. The endoscopic examination revealed Helicobacter pylori positive antral atrophic gastropathy and a well delineated hemispherical polyp, 8 mm in diameter, in the antrum of the stomach. Histology showed antral gastritis and the presence of heterotopic pancreas. After dietary measures and Helicobacter eradication, the patient was relieved of symptoms. According to the authors' opinion, the finding of heterotopic pancreas did not necessitate intervention, and was an incidental finding. The authors discuss the significance of heterotopic pancreas with the conclusion that the resection of the lesion is indicated only if consistent symptoms are present. Fig. 3, Ref. 28.)

[Families at risk of colon cancer II. Hereditary nonpolyposis colorectal carcinoma]. / Rodiny s rizikom rakoviny hrubého creva II. Hereditárny nepolypózny kolorektálny karcinóm.

Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant inherited disease characterised by almost inevitable development of colorectal carcinoma and/or endometrium and other defined malignancies in affected individuals. HNPCC is caused by a germline mutation in a mismatch repair genes (MMR). The purpose of this review is to summarize current knowledge regarding HNPCC with the focus on recent data on genetic testing, surveillance guidelines and therapy. Available medical databases were searched from 1998 to May 2003 using the keywords "hereditary nonpolyposis colorectal cancer", followed by further search for particular issues. Additional articles were identified through the reference sections of retrieved articles and from personal archive of authors. Approximately 200 papers on HNPCC are published yearly. The major progress in recent research of HNPCC has been made in the area of genetic testing and clinical surveillance. Current guidelines recommend identification of microsatelite instability in a tumour of affected family member followed by germline testing in this person. Once mutation in particular MMR gene is found, screening of all at risk members is recommended. Alternative approach suggests direct germline testing in unaffected family member provided that the testing in affected member is not possible. Annual colonoscopy examinations starting at 20-25 years and gyneacological examination starting at 30-35 years are recommended in all family members at risk. Recent advances in genetic tests and surveillance strategies result in decreased mortality of HNPCC patient.

[Families at risk of colon cancer I. Familial adenomatous polyposis]. / Rodiny s rizikom rakoviny hrubého creva I. Familiárna adenomatózna polypóza.

Familial adenomatous polyposis (FAP) is a well-defined autosomal dominant inherited disease characterised by a diffuse polyposis of the colon and rectum leading to inevitable colorectal cancer by 50 years. The purpose of this review is to summarize the current knowledge regarding this entity with the focus on recent knowledge on genetic testing, surveillance guidelines and therapy of FAP. Available medical databases were searched from 1998 to May 2003 using keywords "familial adenomatous polyposis", followed by further search for particular issues. Additional articles were identified through the reference sections of retrieved articles and from personal archives of authors. Approximately 300 papers on FAP are published yearly. There has been a large progress in our understanding of the genetics of FAP leading to the development of genetic counselling, reliable genetic tests and screening strategies. There is accumulating evidence about genotype-phenotype associations with direct clinical implications. Our knowledge about the extracolonic manifestations is also expanding resulting in new surveillance and treatment strategies for FAP patients after proctocolectomy. Although still representing a serious burden for affected patients and their families, the research of last decades together with national registers improved the life expectancy and the quality of life of FAP patients dramatically. Further research in the area of molecular genetics, genetic testing and emerging gene therapy for FAP patients is to be expected in the near future.

[One day surgery--personal experience]. / One day surgery--vlastné skúsenosti.

The authors present their own experience with surgery carried out in the out-patient department in 1985-1996. It is a modern, effective, reliable and above all economical therapeutic method, because it maintains the standard of surgery while saving the costs of hospitalisation. It is a very attractive method for patients who want to return to work as soon as possible. As many as 87% patients were satisfied with surgical treatment of the anus and rectum.

[Indications for surgical intervention in acute pancreatitis]. / Príspevek k indikacím chirurgické intervence u akutních pankreatitid.

The authors analyze in detail a group of 48 patients treated on account of acute pancreatitis in 1988. As regards the severity and prognosis of the disease, they divide it according to the Mainzer classification into three groups. The first mildest one was not subjected to acute operation. Serious cases in group 2 and 3 called in a total of 22 cases for operation. The authors discuss in detail indications for surgical intervention from four basic aspects: laboratory findings, ultrasonographic and CT examination, the clinical picture and character of the exudate in the abdominal cavity. It is essential to evaluate in a comprehensive way all symptoms and the dynamics of their development, in particular, however, the clinical picture of the disease. The possible lack of of some paraclinical examinations (ultrasonography, CT) must not play a decisive role for the indication.

[Compressive sclerotherapy monitored by ultrasound]. / Kompresívna skleroterapia monitorovaná ultrazvukom.

Echosclerotherapy and sonographic control of aimed sclerotherapy resp. is a major advance in the treatment of chronic venous insufficiency. It facilitates not only aimed administration of highly active substances but ensures above all prevention of serious complications. Functional examination of the venous system helps to locate relatively accurately the sites of pathological reflux which are in the first place responsible for the development of the whole symptomatology and it prevents the administration of excessive amounts of sclerotizing substances into intact portions of the venous system. Similarly as Baccaglini et al. (1995) the authors achieved by compressive sclerotherapy with monitoring by ultrasound occlusion of up to 90% important reflux sites such as the saphenofemoral and saphenopopliteal orifice which are to a great extent responsible for serious clinical symptoms.