Evaluation of Dietary Habits in the Study of Pancreatic Cancer.

BACKGROUND: Pancreatic cancer is serious and rapidly progressing condition. Little is known about the role of diet in etiology of pancreatic cancer. The study focused on the role of selected dietary factors related to pancreatic cancer. MATERIAL AND METHODS: The case-control study was performed in the Czech Republic in 2006- 2009, involving three centers in Olomouc, Ostrava and Ceske Budejovice. It comprised a total of 530 persons, of whom 310 had pancreatic cancer and 220 were controls. Data were obtained directly from each participant in an interview with a trained interviewer and entered into a standardized questionnaire. The data were analyzed using a crude odds ratio (OR) and multivariate logistic regression with an adjusted OR and 95% CI. The statistical analysis was performed with the STATA v. 10 software. RESULTS: A very strong protective effect was found in pickled cabbage (OR 0.32; 95% CI 0.19- 0.55), broccoli (OR 0.37; 95% CI 0.25- 0.53), cooked onion (OR 0.14; 95% CI 0.08- 0.27), tomatoes (OR 0.28; 95% CI 0.13- 0.60), raw carrot (OR 0.33; 95% CI 0.20- 0.56), cooked carrot (OR 0.35; 95% CI 0.19- 0.62). In logistic regression model, statistically significant protective associations were found in consumption of more than three portions of cooked vegetables per week (OR 0.16; 95% CI 0.05- 0.55) and high consumption of citrus fruit (OR 0.46; 95% CI 0.23- 0.90). CONCLUSION: The study found statistically significant protective effect of consumption of more than three portions of cooked vegetables per week and high consumption of citrus fruit.

[A multifactor epidemiological analysis of risk factors for pancreatic cancer in women]. / Multifaktorová epidemiologická analýza rizikových faktoru karcinomu pankreatu u zen.

STUDY OBJECTIVE: A multifactor analysis of risk factors for pancreas cancer in women. MATERIAL AND METHODS: A case-control study was conducted in three centres in the Czech Republic (Olomouc, Ostrava, and Ceské Budejovice) in 2006-2009. In total, 226 women (129 pancreas cancer cases, 97 controls) were included in the study. Statistical analysis was performed, the crude odds ratio (OR) was calculated, and logistic regression analysis was used at a 5% level of statistical significance. RESULTS: A statistically significant inverse association was found between pancreatic cancer and oral contraceptives (OR 0.21; 95% CI: 0.07-0.69). Pregnancy and number of pregnancies or gynecological surgical procedures did not show any association with pancreatic cancer. No significant difference in the first menstrual period was found between pancreatic cancer patients and controls. CONCLUSIONS: The study results showed inverse association between pancreatic cancer and oral contraceptives (OR 0.21; 95% CI: 0.07-0.69), controlled alcohol consumption (OR 0.26; 95% CI: 0.12-0.55), and anti-inflamatory drug use (OR 0.10; 95% CI: 0.02-0.41).

Differentiating autoimmune pancreatitis from pancreatic cancer.

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer can be very difficult. The main clinical symptoms in patients with autoimmune pancreatitis are jaundice, weight loss, abdominal pain and new onset of diabetes mellitus. Unfortunately, the same symptoms could be observed in patients with pancreatic carcinoma too. Imaging methods as computed tomography (CT) scan, magnetic resonance imaging (MRI) and endosonography (EUS); together with serological examination (IgG4 and Ca 19-9) play the important role in differentiation autoimmune pancreatitis from pancreatic cancer. Extrapancreatic findings are distinctive in patients with autoimmune pancreatitis. In some cases the pancreatic biopsy is indicated, mainly in patients with focal or multifocal form of autoimmune pancreatitis. Response to steroids (decreased pancreatic or extrapancreatic lesion or damage) is distinctive to AIP. In clinical practice, CT scan seems to be the most reasonable tool for examining the patients with obstructive jaundice with or without present pancreatic mass. Stratification the patients with possible AIP versus pancreatic cancer is important. In patients with AIP it may avoid pancreatic resection, as well as incorrect steroid treatment in patients with pancreatic carcinoma.

Is physical activity a protective factor against pancreatic cancer?

OBJECTIVES: The objective of the study was to analyze an association between selected factors and pancreatic cancer, assuming that knowing the etiology would help influence the incidence of this severe type of cancer through primary prevention. In addition to age, gender, BMI and education, the analysis aimed at assessing occupational and leisure-time physical activities with respect to pancreatic cancer. BACKGROUND: In numerous studies, physical activity is reported to be a protective factor against pancreatic cancer. METHODS: A case-control study was carried out in three centers in the Czech Republic in 2006-2009. RESULTS: The study comprised a total of 529 individuals, of which 309 were patients with pancreatic cancer and 220 were controls. Leisure-time physical activity showed a statistically significant inverse association with a crude odds ratio of 0.65 (95% CI 0.45-0.93), even after adjustment for other studied factors (OR =0.63, 95% CI 0.43-0.92). Conversely, for occupational physical activity, a positive association was only suggested. CONCLUSIONS: Leisure-time physical activity is a protective factor against the development of pancreatic cancer. Occupational physical activity was not confirmed as a protective factor against pancreatic cancer (Tab. 4, Fig. 1, Ref. 22).

[Pancreatic cancer and lifestyle factors]. / Karcinom pankreatu a faktory zivotního stylu.

BACKGROUND: Pancreatic cancer is a serious cancer with unfavorable prognosis. Due to differences in the incidence of pancreatic cancer in different regions, it is clear that factors associated with lifestyle play an important role in the etiology. The aim of this study was to evaluate the impact of selected lifestyle factors in relation to pancreatic cancer. MATERIALS AND METHODS: The study included a total of 529 subjects, including 309 cases and 220 control subjects. Cases of newly diagnosed patients with pancreatic cancer who lived in the region were selected in hospitals in three centers (University Hospital Olomouc, University Hospital Ostrava, Hospital Ceske Budejovice). The control group was obtained in cooperation with selected general practitioners for adults, and it is a population control group. RESULTS: Analyses compared persons who reported consuming alcohol with those who do not consume alcohol. Results showed a statistically significant inverse association, even after adjustment for the other studied factors (OR = 0.57, 95% CI 0.36 to 0.89). When assessing leisure time physical activity, results showed statistically significant inverse association and 35% decrease in the risk (crude OR = 0.65, 95% CI 0.45 to 0.93), and this inverse association was confirmed after adjustment for other studied factors although the result is on the border of statistical significance (adjusted OR = 0.68, 95% CI 0.44 to 1.04). Drinking coffee and tea has only a marginal impact on the occurrence of pancreatic cancer, although the medium and high consumption of black tea was found increased risk by 90 or 44%, respectively. Smoking is considered a causal risk factor for pancreatic cancer, but in this study, a positive association was not found. The study found no statistically significant association between overweight and obesity. CONCLUSION: Physical activity, dietary measures that will lead to weight loss and education to non-smoking can have a significant impact on the primary prevention of cancer.

[An effect of continuous and intermittent renal replacement therapy on antibiotic treatment in critically ill patients with sepsis - a practice-based perspective of vancomycin and gentamycin therapies]. / Vliv kontinuální a intermitentní náhrady renálních funkcí na antibiotickou lécbu u kriticky nemocných v sepsi - praktický pohled na lécbu vankomycinem a gentamicinem.

Sepsis and septic shock are common cause of hospitalisation in intensive care unit. Acute kidney injury is an accompanying manifestation of sepsis/septic shock leading to worsening of morbidity and also mortality and requiring use of intermittent or continual renal replacement therapy. Life saving effect is attributed to early and effective antibiotic therapy. Therapeutic drug monitoring and do-sage adjustment is important for successful treatment. Despite therapeutic drug monitoring of both antibiotic agents vankomycin and gentamicin the treatment still rises many questions about the convenient use in septic patients due to their nephrotoxicity.

[The benefits of centralization of care for patients with acute upper gastrointestinal bleeding]. / Prínos centralizace péce o pacienty s akutním krvácením do horního trávicího traktu.

INTRODUCTION: Acute upper gastrointestinal bleeding still remains one of the serious conditions that require a rapid diagnostic and therapeutic intervention. Such procedure is highly dependent on good interdisciplinary cooperation, which, when centralized, may positively influence mortality and economic costs. OBJECTIVE: To determine the benefits of centralization of care provided to patients with acute bleeding in the upper gastrointestinal tract. PATIENTS AND METHODS: A total of 632 patients with acute bleeding were enrolled in the study at two different health-care establishments of the same type, however with a different organisation of care. We have evaluated the influence of the organisation of care on the length of hospitalization stay, mortality and economic costs. RESULTS: Centralized treatment significantly shortens the interval from hospital admission to endoscopic examination and leads to a reduction in mortality, although not statistically significant. On the other hand, it does not affect the length of hospitalization, the distribution of patients between internal and surgical departments, and provides no guarantee of lower economic costs. Many other factors play an important role in that respect. It seems, that the importance of centralization plays the main role especially in the pre-hospital and early hospital period, when it accelerates and simplifies the diagnostic and therapeutic procedure.

[Bone mineral density in patients with chronic renal failure at the start of haemodialysis therapy]. / Kostní minerální denzita u nemocných s chronickým selháním ledvin pri zahájení hemodialyzacní lécby.

AIM: To determine bone mineral density (BMD) in nephrology patients at the start of haemodialysis therapy and its dependence on some laboratory and clinical characteristics of the study set. METHODS: There were 73 newly haemodialyzed patients accepted in the 3 months period from the beginning of the chronic haemodialysis program. Each patient underwent measurements BMD with DXA method in the area of lumbar spine and the left hip. Ca, P and parathormone values were measured once per month during 3 months before BMD determination. 25-OH vitamin D, estradiol and blood pH were determined only once before the densitometry examination. RESULTS: BMD in the osteoporosis zone was measured most often in the area of femoral neck in the whole group (prevalence 35 %) and also in the single groups of patients (men, women, non-diabetics, diabetics). In women, BMD findings corresponding to osteoporosis values in the total hip were significantly more often (p < 0.01). In the area of femoral neck and lumbar spine the percentage of women and men in single groups (osteoporosis, osteopenia and normal values) was without any statistical differentiation. Diabetics and non-diabetics did not distinguish in the number of findings osteoporosis and osteopenia in any followed areas of skeleton. As the significant factors predicating BMD there were found: calcium level and sex for the area of the total hip, calcium level, blood pH and height for the femoral neck, and sex for the lumbar spine only. The certain degree of vitamin D deficiency was measured in nearly all patients (mean 11.5 ± 7.4 µg/l), and hypocalcaemia was demonstrated in one fifth of patients. CONCLUSION: Bone mineral density values and some laboratory parameters affecting bone metabolism are often abnormal in the patients entering the chronic haemodialysis program and must be taken into consideration.

[Diagnostic algorithm of syncope: integrative approach]. / Diagnostický algoritmus synkop: integrativní prístup.

Syncope is a symptom, defined as transient loss of consciousness and postural tone with spontaneous and mostly prompt recovery. At first it is necessary to differentiate other non-syncopal transient loss of consciousness and simple falls, where thorough history taking is pivotal. EGSYS and OESIL risk scores seem to be contributional in initial risk stratification, however they are neither widely accepted nor a part of national guidelines. They are part of the European society of cardiology guidelines, though. Next it is essential expert ECG evaluation, thorough physical status examination, supine and standing blood pressure measurement and carotid sinus massage, if not contraindicated. Successively one has to decide if hospitalization or outpatient management is more suitable. Recently it has been shown, that so-called syncope management units (aimed for short-term hospitalization or fast outpatient examination, including vital function monitoring, echocardiography and facile cathlab access) are effective in fast syncope evaluation. Echocardiography, ECG monitoring and head-up tilt test should be a part of complex diagnostic evaluation. If syncope is not clarified by upon stated methods moreover syncope is recurrent, electrophysiological study, ILR implantation or both are justified. Despite of entire health practitioner's effort, more than 1/3 of syncopes remain unexplained.

[Primary hepatic carcinoid]. / Primární jaterní karcinoid.

Primary hepatic carcinoid (PHC) is considered to be particularly sporadic diagnosis; in current world literature about 60 cases have been reported. Most of the patients present with abdominal pain, diarrhea, icterus, flush, weight loss or respiratory disease; even though the course of the disease might stay asymptomatic for a long time. An illuminating case of at presentation oligosymptomatic 72-year-old patient, which was after extensive examination based on OctreoScan and histological verification diagnosed to have generalized PHC, is reported. Paliative therapy with somatostatine analogues followed. At autopsy 8 months later the clinical diagnosis of PHC was confirmed. PHC is difficult to diagnose both due to radiological similarity to other hepatic lesions and demanding exclusion of other primary foci. The diagnosis of PHC is based on negative imaging techniques result in other possible localizations. Minimal symptomatology in stage of generalization, atypical primary localization and rapid progression is of interest in current case.

[Pancreas cancer epidemiology]. / Epidemiologie karcinomu pankreatu.

Pancreas cancer is characterized by a rapid and fatal outcome. It is a non-communicable disease showing increasing incidence mainly in Europe, North America and Japan. In the Czech Republic, the incidence of pancreas cancer has more than tripled over the last 50 years. The pancreas cancer incidence and mortality rates are practically identical in this country. The standardized incidence rates (world standard) are 10.4 in men and 7.1 in women, with the Czech Republic ranking the sixth and fourth in the world, respectively. The standardized mortality rates are 10.4 and 7.2, respectively, with the Czech Republic ranking the fourth and sixth to seventh in the world, respectively. Very rapid fatality is also indicative of the seriousness of the disease whose median survival ranges from three to six months.

[Long-term monitoring of patients with clinical symptoms of upper gastrointestinal tract bleeding with a negative endoscopy result]. / Dlouhodobé sledování pacientu s klinickými známkami krvácení do horní cásti trávicího traktu a negativním endoskopickým nálezem.

The authors present the results of a long-term monitoring of patients who presented with clinical signs of bleeding from the upper gastrointestinal tract (GIT) but totally negative endoscopy results on admission. Retrospective-prospective analysis of acute endoscopies in patients with clinical signs of bleeding from the upper gastrointestinal tract performed in the Endoscopy Centre of the OstravaTeaching Hospital from 2002 to 2005, long term monitoring of the sample with negative results on admission. A total of 133 patients, i.e. 16.3 % of all acute procedures, with no source of bleeding detected in the first endoscopy. 26.4% of wrong indications. In the rest of the sample, a source of bleeding was detected by endoscopy in 17 patients (15 in an early examination and 2 within one month from the event), i.e. 17.3%. The rate of bleeding recurrence was 15%. The risk of recurrence was higher in patients with haematemesis and a decrease in the blood count (BC) at the time of the first event. In 19 patients, i.e. 14.3%, the source was not detected. In the remaining 33 patients, the findings were as follows: 1) in 4 patients, the source of bleeding was detected in the small intestine (push enteroscopy or enteroclysis); 2) in 3 patients, the source of bleeding was detected in the colon; 3) in 6 patients, IBD was detected; 4) in 5 patients, cirrhosis of the liver was diagnosed within months or years from the event.

Prospective, multicenter, randomized trial to compare incidence of new-onset diabetes mellitus and glucose metabolism in patients receiving cyclosporine microemulsion versus tacrolimus after de novo kidney transplantation.

New-onset diabetes mellitus (NODM) is associated with increased risk of graft failure and death in renal transplant recipients. Some clinical studies have indicated that NODM risk is higher with tacrolimus than cyclosporine, but no comparative trial has used American Diabetic Association (ADA)/World Health Organization (WHO) criteria for diagnosis of diabetes mellitus. The Diabetes Incidence After Renal Transplantation, Neoral C2 Monitoring Versus Tacrolimus (DIRECT) study is a 6-month open-label, multicenter trial comparing the impact of tacrolimus and Neoral (cyclosporine microemulsion) on glucose metabolism in 700 de novo kidney transplant recipients, based on ADA/WHO criteria. Patients are randomized to tacrolimus (C0 monitoring) or Neoral (C2 monitoring), stratified by baseline diabetic status and ethnicity. All patients receive basiliximab, corticosteroids, and mycophenolate mofetil or enteric-coated mycophenolate acid (myfortic). Pooled interim 3-month results from a subset of 115 patients receiving either tacrolimus or Neoral showed that the primary efficacy end-point (biopsy-proven acute rejection [BPAR], graft loss or death) occurred in 11 patients (10%). There were four graft losses and only one death, which occurred after graft loss. Eight patients experienced BPAR (7.3%). Among 99 patients who were nondiabetic at baseline, 14 developed NODM by month 3, 17 developed impaired fasting glucose or impaired glucose tolerance, and another 5 patients received hypoglycemic treatment for at least 14 consecutive days or at the month 3 visit, resulting in a 36% incidence of impaired glucose metabolism. At 3 months, median GFR (Nankivell) was 63.7 mL/min; median serum creatinine was 137 micromol/L. Full complete results are expected in December 2005.

A contribution to examination of propidium iodide and annexin V plasma cells indices in multiple myeloma.

The aim of this study was a contemporaneous measurement and a mutual comparison of plasma cells proliferative activity and grade of apoptosis in patients with monoclonal gammopathy of undetermined significance (MGUS) and various phases of MM i.e. smoldering (SMM), stable/plateau and active (progression/relapse) forms of this disease. The analyzed group of 197 patients consisted of 30 MGUS, 21 SMM, 82 patients examined at the time of MM diagnosis and 64 patients analyzed during various phases of the disease after previous chemotherapy. Plasma cell proliferative activity was measured by means of a propidium iodide index (PC-PI) examined by flow cytometry using a DNA/CD138 double staining technique. For detection of plasma cells entering apoptosis (PC-AI) flow cytometry method with annexin V FITC and MoAb CD138 was used. The individuals with MGUS, SMM and stable/plateau form of MM had overall low levels of PC-PI (M-1.8, 1.7% and 2.1%) and relatively high levels of PC-AI (M-9.1, 10.8 and 9.0%). The correlation between PC-PI and PC-AI was in all the groups mutually highly statistically significant (p=0.000). Analysis of plasma cells proliferative activity (PC-PI) was statistically significant in comparison of MGUS or SMM and versus: patients examined at the time of MM diagnosis (p=0.018 or 0.016); patients evaluated during various phases of MM after previous chemotherapy (p=0.021 or 0.019); stable/plateau MM phase in the cohort of all patients (p=0.017 or 0.040); in the plateau phase after chemotherapy (p=0.008 or 0.024) but insignificant in comparison of MGUS and SMM and with the stable group examined at the time of MM diagnosis. Analysis of the apoptotic process revealed significant differences when comparing PC-AI of SMM but not MGUS group versus all cohort of stable/plateau MM patients (p=0.045); there were also insignificant differences in comparison of MGUS and SMM groupsand versus the stable form of MM measured at the time of MM diagnosis or plateau phase after chemotherapy. There was observed a statistically significant difference in the PC-AI in comparison of SMM group versus group of all patients examined at the time of MM diagnosis (p=0.001) or in various phases of this disease (p=0.015) and the group of MGUS patients compared with patients evaluated at the time of MM diagnosis (p=0.03). Very significant statistical differences of plasma cell proliferative (PC-PI) and apoptotic (PC-AI) activity were found when comparing the levels of both the indices of MGUS, SMM and stable/plateau MM group versus the active (progression/relapse) form of MM marked by a higher level of PC-PI (3.2%, p=0.000) and PC-AI (4.8%, p=0.000) in the whole cohort of MM patients, but also in comparison with both the active forms at the time of MM diagnosis or active forms evaluated during various phases of the disease after chemotherapy. Highly significant inverse relationship between PC-PI versus PC-AI was also revealed in the group of patients in the active (progression/relapse) phase of MM (p=0.000). These results revealed importance of measurement not only of proliferative but also of apoptotic plasma cells indices for a complex evaluation of the cells kinetics of plasma cells compartments in patients with MGUS or MM. This study confirmed the initial hypothesis of a common 'inverse relationship between the proliferative (PC-PI) and the apoptosis activity (PC-AI) in plasma cells compartments in patients with MGUS, smoldering, stable/plateau and active (progression/ relapse) forms of MM'.

Importance of guided fine needle aspiration cytology (FNAC) for the diagnostics of thyroid nodules - own experience.

UNLABELLED: The aim of our study was to assess the accuracy and limitations of ultrasound guided fine-needle aspiration cytology (FNAC) of thyroid nodules. METHODS: The usg-FNAC results of 245 patients with thyroid nodules, who afterwards underwent thyroid surgery or who died, and autopsies were carried out, and compared retrospectively with cytologic results. Patients with malignant cytologic conclusion without histological confirmation after surgery or autopsy were excluded from the study (9 persons). The usg-FNAC results were divided as follows: group 1: diagnosis of malignancy (n = 30), group 2: suspicion of malignancy (n = 28), group 3: benign (n = 126), group 4: inconclusive (n = 29). RESULTS: Assuming the cytologic results of group 1 and group 2 were interpreted as being malignant and those of group 3 as being benign, the sensitivity, specificity and accuracy of usg-FNAC were 90 %, 85 % and 86 % respectively. Comparing the cytologic conclusions between a group of patients with follicular lesions and a subgroup of other lesions a statistically significant difference (p < 0,01) between both subgroups using Fisher's test was found. Sensitivity, specificity and diagnostic accuracy in subgroup of follicular lesions were low (71 %, 63 %, 67 %), while in the subgroup of other lesions were high (94 %, 86 %, 88 %). FNAC can specify the nature of focal lesion with high sensitivity, specificity and diagnostic accuracy in the cases of non-follicular lesions. Histological evaluation is required to specification of the nature in cases in which cytology is indicative of follicular proliferation.

[Malignant stenosis of the superior vena cava]. / Maligní stenóza horní duté zíly.

Superior vena cava syndrome is a distressing manifestation of a benign or malignant disease that obstructs the blood flow in the superior vena cava. Radiation and chemotherapy are often used to treat malignant forms of the disease. However, this therapy brings slow and sometimes incomplete regression of symptoms. Percutaneous administration of the metallic intravascular stents appears to be effective therapy. It offers immediate resolution and long-term relief of symptoms. Paper describes two patients with superior vena cava syndrome of a malignant aetiology where the incomplete but hemodynamicaly significant stenosis was successfully treated by percutaneous stenting.

[Testing the effectiveness of drug therapy in supraventricular dysrhythmias using diagnostic esophageal cardiac stimulation]. / Testování úcinnosti medikamentózní lécby supraventrikulárních dysrytmií pomocí diagnostické jícnové kardiostimulace.

The authors examined 33 patients aged 59.9 years with a new atrial fibrillation and 18 patients aged 45.6 years with attacks of supraventricular tachycardia. After medicamentous change to a sinus rhythm (in fibrillation after digoxin and verapamil i.v. and in supraventricular tachycardia after verapamil i.v.) the patients were changed to oral antiarrhythmic drugs. The method of diagnostic oesophageal stimulation was used after saturation with the oral form to test the effectiveness of long-term treatment. In the author's opinion the basic drug in atrial fibrillation is digoxin, possibly combined with verapamil or quinidine. In supraventricular tachycardia the basic drug is verapamil, in particular in case of a double AV node pathway. In the majority of patients combined treatment is indicated, selected individually by means of diagnostic oesophageal stimulation. The authors consider the described method due to its innocuous and repeatable character as the method of choice for optimization of antiarrhythmic treatment of supraventricular dysrhythmias.

[Long-term effect of drug therapy in supraventricular dysrhythmia evaluated by diagnostic esophageal cardiac pacing]. / Dlouhodobý efekt medikamentózní lécby supraventrikulárních dysrytmií stanovený pomocí diagnostické jícnové kardiostimulace.

The authors investigated the long-term therapeutic effect in 33 patients after a medicamentous reversal of recent atrial fibrillation and 18 patients after reversal of an attack of supraventricular tachycardia (SVT). None of the patients had signs of cardiac failure. A change to sinus rhythm was achieved in the group with atrial fibrillation by digoxin with verapamil, in the group with SVT by verapamil. Treatment was then adjusted, based on testing by means of diagnostic oesophageal pacing. The basic drug for long-term use in atrial fibrillation was digoxin either as monotherapy or in combination; the majority of patients with SVT had verapamil treatment. At the end of the period 24.5 +/- 8.4 (12-36) months after the reversal in the group with atrial fibrillation 8 (25.8%) had permanent atrial fibrillation or different therapy on account of atrial fibrillation; short-term attacks of palpitation were recorded during the investigation period in 16 (51.6%), and the remaining 7 patients (22.6%) had no complaints. In the group with SVT none of the patients was hospitalized on account of persisting dysrhythmia and it was not necessary to alter treatment. Testing treatment of supraventricular dysrhythmias by means of diagnostic oesophageal pacing is of prognostic importance and the authors consider it the method of choice.

[Puncture aspiration using ultrasound guidance in the treatment of abscesses and other purulent foci in the liver, pancreas and kidneys]. / Vyuzití aspiracní punkce pod kontrolou ultrazvuku v lécbe abscesu a jiných hnisavých lozisek jater, pankreatu a ledvin.

The authors deal with the problem of application of a therapeutic fine needle aspiration puncture in abscesses and other purulent foci in organs of abdominal cavity and retroperitoneum. The treatment using this method under continuing antibiotic therapy has been used in 60 patients (40 men, 20 women), 25 of them suffering from liver abscesses, 28 other from purulent foci of pancreas and seven patients from purulent foci of the kidney. In most patients there were solitary foci (43 persons). The total volume of the evacuated pus was higher than 20 ml in most patients (52), being even more than 100 ml in 2 patients. No relation ship was found among the number of foci, their volume and efficiency of the treatment. The average number of punctures until the abscesses and other purulent foci were healed up was 2.76 in the liver, 2.5 in pancreas and 1.1 in the kidney. The efficiency of therapy was higher in liver abscesses (96%), in purulent foci of pancreas (82%) and lower in the kidney abscesses (57%). The higher efficiency in the purulent foci of pancreas was probably influenced by predominant representation by infected pseudocysts in this group. The lower average number of punctures until the abscesses were healed up and the lower success in the kidney were influenced by a more radical approach of urologists who, having made the first evacuation puncture, performed a radical operation intervention. The complications were encountered in 9.5% of all punctures, being always insignificant. The results obtained demonstrated the contribution of aimed therapeutic aspiration puncture in the therapy of purulent foci of parenchymal organs of abdominal cavity and retroperitoneum as compared with surgical treatment. The advantage of the applied method in the therapy of purulent foci of the liver and pancreas may be seen in the higher success rate, low invasiveness and a low risk of complications together with a low financial cost and wide availability.

[Are ultrasonic images in diabetics different?]. / Je sonografický nález u diabetiku odlisný?

The authors evaluated the results assembled in 5397 patients where between Jan. 1 1999 and Oct. 31 2000 sonographic examinations of the abdominal cavity and retroperitoneum were made with the objective to assess whether there are any statistically significant differences of results in diabetic patients, as compared with a group without this disease. The group of patients was divided into a sub-group of 4287 patients without diabetes and a sub-group of 1100 diabetics. For statistical evaluation of the significance of differences in the incidence of the investigated parameters Fisher's exact test was used. The image of "light liver" was significantly more frequent in diabetics type 1 and 2, as compared with non-diabetics (p < 0.001). The sonographic picture, consistent with the diagnosis of cirrhosis of the liver, was at the same level of significance more frequent in non-diabetics, similarly as the incidence of haemangioma. The finding of cholecystolithiasis and the number of patients with a history of CHCE on account of cholecysolithiasis was significantly higher (p < 0.05) only in type 1 diabetics as compared with non-diabetics. The incidence of sonographic changes consistent with acalculous cholecystitis was statistically higher in both groups of diabetics (p < 0.001), as compared with non-diabetics. On examination of the pancreas only the incidence of changes consistent with acute or chronic pancreatitis was significantly higher (p < 0.05) in the group of type 2 diabetics as compared with non-diabetics. Evaluation of sonographic findings of the kidneys revealed statistically significant differences only in the higher incidence of cysts in the group of type 2 diabetics as compared with type 1 diabetics and as compared with non-diabetics (p < 0.01). The impact of the presented findings and their comparison with data reported in the literature is discussed.