[OSTEOPOROSIS IN MEN: CURRENT ISSUES].

Analysis of outpatients male patients aimed at Bone Density Measurement (Dual-Energy X-Ray Absorptiometry) during 2013. The study shows that men are sent to the examination for osteoporosis nearly 20 times less than women, while in men older than 60 years the decrease in bone mineral density was observed in more than 85% of cases. The identified violations of mineralization of bone tissue in men in different age periods and the main reason for referral for examination were analyzed.

[Prognostic value of leptin level detection in industrial workers suffering from osteoarthrosis in Volgograd].

Study of 130 osteoarthrosis patients revealed high serum level of leptin in 42 (32.3 %) patients including 9 males and 33 females. Osteoarthrosis patients with high serum leptin level are characterized by more severe course of the disease.

[Detecting adiponectin in industrial workers having inflammatory diseases of joints].

Examination of 55 patients with rheumatoid arthritis revealed low serum level of adiponektin in 25.4 % of the patients. Patients with low serum level of adiponektin demonstrate such symptoms set as: increased activity degree on DAS28 (II-III activity grade), high level of antibodies to citrullinated vimentin, advanced and late stages of the disease, severe X-ray changes.

[Efficiency of unsaponifiable compounds of soya beans and avocado in health care personnel with osteoarthrosis in Volgograd].

The authors used immunoenzyme method to assess level of oxydated low density lipoproteins (o-LDL) in 130 patients with osteoarthrosis. High serum level of o-LDL was seen in 60% of the patients with osteoarthrosis. 40 patients with osteoarthrosis were treated by unsaponifiable compounds of soya beans and avocado (Piaskledin, Expanscience, France)--dose of 300 mg daily, over 3 months. The treatment resulted in good effect in the patients with high level of o-LDL (over 168 ng/ml).

Emulsive polymerization as a method of enzyme modification preserving biological properties of nanostructures.

The proposed method of emulsive polymerization provides the possibility of modifying and obtaining insoluble forms of superoxide dismutase (SOD), glutathione reductase, and streptolysin-O preserving nanoobjects (conformationally active centers and antigenic determinants) in their native states. Apart from enzymatic and immunological properties, the samples acquired some new features: resistance to high temperature, resistance to 3 M KCNS solution and buffer solutions with high concentration of hydrogen ions, and resistance to preserving solutions. Magnetic properties provide the possibility of simplifying enzyme-linked immunosorbent and immunofluorescence assays. In addition, sensitivity of these assays was by an order of magnitude higher and the specificity fully preserved. Taking all the facts into account, we prepared agents for long-term and repeated use. Due to preserved enzymatic properties, insoluble forms of SOD and glutathione reductase can be considered as a tool for correction of peroxide-antioxidant balance and associated immunological abnormalities.

Recurrent mucinous carcinoma of skin mimicking primary mucinous carcinoma of parotid gland: a diagnostic pitfall.

A case of a 63-year-old man with a swelling lasting 2 years in the left infraauricular area is reported. Examination by fine needle aspiration cytology raised suspicion of mucoepidermoid or adenoid cystic carcinoma of the parotid gland and an excision was recommended. The lateral parotidectomy specimen showed a poorly circumscribed gelatinous tumor measuring 15 mm in diameter within the parotid gland tissue. Microscopically, the lesion featured large pools of mucin containing clusters of tumor cells with little atypia and low mitotic activity. Immunohistochemically, the tumor cells showed expression of epithelial markers and of both estrogen and progesterone receptors. Left lateral neck dissection revealed massive lymphogenous dissemination of the tumor. Retrospective analysis of a skin biopsy from the same anatomic area performed 8 years prior to parotid neoplasm displayed a tumor with identical microscopic appearance and immunohistochemical profile (additionally performed) which was, however, misdiagnosed as a benign lesion. The diagnosis of recurrent primary mucinous carcinoma of the skin infiltrating the parotid gland was established. The patient underwent radiotherapy and has been 3 years free of disease. The differential diagnostics of this rare tumor is discussed.

[Extrapleural solitary fibrous tumor mimicking lateral neck cyst--a case report]. / Extrapleurální solitární fibrózní tumor napodobující laterální krcní cystu--kazuistika.

A 62-year-old man was referred to the Department of Dentistry because of ultrasonographic finding of "cystoid lesion with relationship to right parotid gland". During operation, a tumor mass without any relationship to parotid gland but attached to the right internal carotid artery was found. Grossly, the tumor was well circumscribed, spheric, measuring 40 mm in diameter; it was of solid, firm appearance and tan-to-white color on cross section. Microscopically, the tumor cells were round to spindle-shaped with vesicular nuclei and eosinophilic cytoplasm, arranged in fascicular pattern. Immunohistochemically, the cells expressed vimentin, CD 34, smooth muscle actin, and bcl-2 protein. On the basis of microscopical appearance and results of immunohistochemistry, the diagnosis of solitary fibrous tumor (cellular variant) was established. One year after resection, the patient is free of disease. A new concept of this uncommon mesenchymal tumor is discussed.

[Prenatal detection of congenital mezoblastic nephroma]. / Prenatální záchyt kongenitálního mezoblastického nefromu.

TYPE OF STUDY: Case report. SETTING: Department of Gynecology and Obstetrics, Department of Radiology, Department of Pathology, Department of Medical Genetics, Charles University Hospital, Hradec Králové. METHODS: The autors report a case of renal tumor in a fetus at 33 weeks of gestation detected by means of ultrasonography and magnetic resonance imaging. The pregnancy course was complicated by polyhydramnios. The female infant was born vaginally at 37 weeks of gestation. Postnatal nephrectomy confirmed prenatal diagnostic presumption - congenital mezoblastic nephroma. At follow-up at 12 months of age, the infant had no evidence of the disease. CONCLUSION: Detection of renal tumor in a fetus is rare. Congenital mezoblastic nephroma with the favourable prognosis is most probable diagnosis. Prenatal detection enables the prevention of complications (prematurity prevention, detection of the developing cardial decompensation and fetal hydrops) with the planning of labour and postnatal management.

Low grade myofibroblastic sarcoma of tongue: a case report.

A case of a 24-year-old woman with a 6 weeks lasting nodule of the right margin of the tongue is described. The nodule was 20 mm in diameter and showed surface ulceration. The diagnosis of low grade myofibroblastic sarcoma was supported by histological, immunohistochemical and electronmicroscopic examination. Although the tumor resection was not complete, the patient is free of disease 1 year after operation. The differential diagnostics of low grade myofibroblastic sarcoma is discussed.

[Apoptosis of urothelial carcinoma cells]. / Apoptóza u bunek uroteliálního karcinomu.

BACKGROUND: Programmed cells death, apoptosis, is a physiological, genetically controlled mechanism. It represents the fate of the majority of cells formed during the somatic development and during the next life of most of the creatures. In the article, data from the study of urothelial carcinoma cells are presented and compared with histochemical analysis. METHODS AND RESULTS: During 1999 to 2002 native urine samples of 36 of patients with the verified urothelial carcinoma were studied. Nine patients had tumors of grade II, 27 patients had tumors of grade III. Urine samples were analysed by flow cytometry and the data obtained were compared with tumor gradients. In our cohort the zero apoptotic activity was found in 32 patients (88.9%). In four patients with preserved apoptosis the tumors were of grade III. CONCLUSIONS: Lack of apoptosis of the tumor cells was the dominant sign in our sample. The premise of existing apoptosis in tumors of the lower grade contrary to the higher one was not confirmed when apoptosis was found in four tumors of the grade III. When the tumor grading was compared, apoptosis was less active in the group of tumors with the highest histopathologic grading. Values expressing the direct relation between apoptosis and the histopathologic grading were obtained.

[Experimental modeling of nucleoprotein disposal disorders in systemic lupus erythematosus].

The objective of this research was to adapt the experimental model simulating the nucleoprotein disposal disorders in systemic lupus erythematosus (SLE) for further study of its extracorporeal correction, as well as to assess validity of the model by short-term experiment. Twenty to female Wistar rats were intraperitoneally injected with the chromatin-containing extract from bovine liver followed by intravenous administration of anti-DNA antibodies derived from SLE patients. After these procedures plasma concentrations of anti-dsDNA, circulating immune complexes and DNA became sharply increased, together with distinct elevation of leukocytes. On the contrary, changes in erythrocytes, platelets, total protein concentration, creatinine, asparagine and alanine aminotransferase activities, as well as blood coagulation time were changed insignificantly. Using direct immunofluorescence of cryosections, we detected human IgG deposition in rat kidneys treated in accordance with the simulation protocol. Thus, our model reproduces essential DNA disposal disorders in SLE without any animal death or the life-threatening changes in examined markers during short-term experiment.

[Extracorporeal treatment of nucleoprotein disposal disorders using the systemic lupus erythematosus model: evaluation of efficacy and safety in a short-term simulated experiment].

Efficacy and safety of the extracorporeal blood perfusion through DNase I- and C1q-containing magnetic beads have been evaluated using the experimental model simulating the nucleoprotein disposal disorders in systemic lupus erythematosus (SLE). The study was performed using 20 rats in which the essential impairments of nucleoprotein catabolism typical for SLE were modeled. The animals were randomized into the experimental group and the placebo perfusion control group. Rats of the experimental group were characterized by the statistically significant reduction of increased levels of circulating immune complexes and plasma DNA as well as diminished levels of plasma creatinine and kidney IgG deposition as compared with placebo controls. During short-term experiment there were neither animal deaths nor substantial blood cell destruction and hepatotoxicity signs.

Apoptosis and regression of embryonic mesenchyme in the development of the middle ear spaces.

Apoptosis was studied using temporal bones from three fetuses representing different times of gestation and from three neonates. Paraffin-embedded sections 20-microm thick were studied using the terminal deoxynucleotide transferase-mediated dUTP nick-end labeling method based on 3'-end-labeling of fragmented DNA. Phenotyping of the immune cells was performed using regular monoclonal antibodies. In the bone marrow the granulocyte series dominated and the number of cells in the macrophage series was noticeably fewer, with apoptotic cells occurring in both. In the embryonic mesenchyme, solitary apoptotic cells occurred in all locations in both the fetuses and neonates. Apoptosis is a basic factor in the regression of embryonal mesenchyme, but may not be preprogrammed. Basic scientific data obtained from modified tissue cultures show that mechanical forces cause cells to switch between different genetic programs. It is suggested that the act of swallowing causes periodic changes in the amniotic fluid pressure and provides the necessary force for regression of the mesenchyme by apoptosis.

Acute purulent thyroiditis with retropharyngeal and retrotracheal abscesses.

An unusual case of acute purulent thyroiditis in a 45-year-old man forming a large abscess in the left lobe of the thyroid gland is described. It perforated the capsule at the posterior wall of the thyroid, causing extensive retropharyngeal and retrotracheal abscesses. The patient was treated with broad-spectrum antibiotics and surgical excision of the infected tissues. He has remained well one year after the operation.

[An unusual complication of myxoma of the left atrium]. / Neobvyklá komplikace myxomu levé srdecní predsíne.

The authors give an account of a 59-year-old female patient with a myxoma of the left atrium which was complicated by repeated multiple embolizations into the systemic circulation. The cause of death after a successful operation was haemorrhage into the abdominal cavity from a ruptured spleen, as a result of a new lienal infarction after embolization of a portion of the myxoma into the lienal artery, 24 before the operation. The authors emphasize the necessity of immediate removal of an intracardiac formation as soon as it is detected.

[Synovial metaplasia around breast implants]. / Synoviální metaplazie kolem mamárních implantátu.

Three cases of the periprosthetic breast capsules showing typical features of synovial metaplasia are presented. The histological picture is characterized by the presence of cellular layer mimicking synovial membrane. These elements are devoid of basement membrane, otherwise, nevertheless, they strongly resemble single- or multilayered epithelium. Focally, the differentiation towards giant multinucleated cells is noted. Immunohistochemical profile, as well as the ultrastructure of the cells, confirms their histiocytic origin with advanced differentiation towards elements of the synovial membrane. These histological features are referred to as synovial or synovial-like metaplasia. They are found in considerable fraction of textured breast implant capsules. The pathogenesis remains uncertain; however, similar picture was observed in other locations in association with prolonged or repeated action of mechanical forces. Thus, movement of the implant in situ is the most probable trigger of synovial metaplasia.

[Lymph node enlargement in hairy cell leukemia and problems with significant abdominal lymphadenopathy]. / Zvetsení uzlin u leukemie s vlasatými bunkami a problematika výrazné abdominální lymfadenopatie.

Enlargement of nodes in leukaemia with hairy cells (LVB) during the initial examination is rarely encountered. In the final stage of the disease it was found in six of our ten patients. A special situation is marked enlargement of retroperitoneal nodes observed in two patients. In one of them the nodes diminished after irradiation, in the second patient irradiation was not possible because of severe pancytopenia. Treatment with alpha-interferon failed previously in this patient. The question remains whether marked enlargement of the abdominal nodes is part of the picture of the disease or whether it is the manifestation of transformation of the disease into a more acute type. The authors recommend examination of the abdominal nodes by means of computed tomography (CT) already during the initial examination and during the subsequent course of the disease, in particular when there are signs of relapse.

[Cardiac tamponade as a complication of acute myocardial infarct. (Clinical and pathologico-anatomic analysis of patients with acute myocardial infarct and cardiac tamponade)]. / Srdecní tamponáda jako komplikace akutního srdecního infarktu. (Klinický a patologicko-anatomický rozbor nemocných s akutním srdecním infarktem a srdecni tamponádou.)

Cardiac tamponade is a frequent cause of death in acute myocardial infarction--in as many 23%. It is encountered in particular in the 7th and 8th decade, in patients with a first infarction which is frequently situated in the anterior wall of the left ventricle. 93% of the patients have obvious ECG manifestations of Q infarction. The diagnosis of cardiac tamponade is easy when during an acute terminal attack slow activity on the ECG tracing is found without a haemodynamic response and the pulse on the great arteries is not palpable even after external cardiac massage. In 80% the onset of cardiac tamponade is very sudden. The presence of shock or cardiac failure makes the diagnosis of cardiac tamponade more difficult. As to investigated indicators, in the development of cardiac tamponade the systemic pressure--systolic as well as diastolic--on admission or during hospitalization, may play a part. The patients have a less marked coronary sclerosis, fibrosis of the cardiac muscle is less frequently present. Previous necroses of the heart muscle may have probably a certain protective effect on the development of cardiac tamponade. Anticoagulants obviously do not influence the development of cardiac tamponade.

[Subacute thrombosis of the abdominal aorta with suprarenal involvement and successful treatment with pharmacomechanical fibrinolysis]. / Subakutní trombóza brisní aorty suprarenálne zasahující, úspesne lécená farmakomechanickou fibrinolýzou.

In a 43-year-old patient with Ebstein's anomaly and a history of acute myocardial infarction by means of duplex ultrasonography and aortography the diagnosis of thrombotic occlusion of the a aorta was established, starting above the insertion of the renal arteries and reaching as far as the bifurcation of the aorta and the common iliac arteries. In the clinical picture dominated complete anuria with uraemia and marked hyperkaliaemia as a result of ischaemic affection of the extremities due to thrombosis of the aorta; at the onset of hospitalization also left ventricular failure with hyperhydration and later also signs of the hyperviscous syndrome. The latter developed after repeated haemofiltrations which led to a rise of the originally high haemoglobin and haemotocrit values a result of a righ-left shunt in Ebstein's anomaly. After improvement of the clinical condition local fibrinolytic treatment of the aortal thrombosis with urokinase (total dose 2,160,000 u. administered within 24 hours) was provided. The thrombus with a total length of 13.5 cm was dissolved except for a residual portion of 10 mm located in the area of insertion of the right renal artery. After dissolution of the thrombus it proved possible to restore the blood flow into the left kidney a and lower extremities, but not into the right kidney because of the residual thrombus. Seventy-two hours after terminated fibrinolysis - and after 31 days of anuria - the diuresis was restored and after a polyuric stage normalization of mineral, urea levels was restored and the creatinine value was slightly above the upper normal range. Concurrently with fibrinolytic therapy angioplasty of the aorta was carried out and a stent was placed on the left iliac artery. The clinical condition of the patient was improving, the patient started to mount stairs. Death occurred suddenly and the cause was cardiac failure due to very serious congenital heart disease.

[Pneumatosis cystoides intestinalis as a cause of obstructive ileus]. / Pneumatosis cystoides intestinalis jako prícina obstrukcního ileu.

The authors present the case-history of a 83-year-old patient hospitalized and operated on account of ileus caused by pneumatosis cystoides intestinalis. In the discussion the authors pay attention to the etiology, pathogenesis, clinical picture and possible treatment of this disease.