What should a surgeon known about genetic background of thyroid cancer.

Thyroid cancer is the most common endocrine malignancy, the treatment is multidisciplinary and multimodal. Thyroid tumors are heterogeneous in origin, morphology, biological behavior and therapeutic options. Substantial advances in diagnostic methods for  thyroid cancer have led to detection of earlier stages of the disease that have the possibility of targeted therapeutic treatment and improved patient prognosis. In addition to surgical treatment, hormonal suppression and radioiodine therapy, targeted molecular therapy, which requires genetic testing, has come to the fore in recent decades. In the summary, we present an overview of current knowledge on the genetic background of individual types of thyroid carcinomas and the possibilities of therapeuticintervention.

Critical complications of intestinal tuberculosis--a case report.

Intestinal tuberculosis is a rare disease in developed countries, affecting mainly immigrants and immunocompromised patients. Clinical presentation may mimic many other abdominal diseases such as intra-abdominal infections, tumors, and Crohn´s disease. Differential diagnosis of Crohn´s disease and intestinal tuberculosis poses a dilemma to clinicians and pathologists as both are chronic granulomatous disorders with similar clinical features. We report the case of a 53 year-old man presenting with perforated intestinal tuberculosis in which the initial diagnostic work-up suggested Crohn´s disease. The severity of the findings resulted in critical complications during the course of treatment. This case points out the need for awareness of intestinal tuberculosis in the differential diagnosis of chronic intestinal disease.

[Dissection and coagulation technique in thyroid surgery - is it the key to a successful outcome?]. / Disekcní a koagulacní technika - má vliv na výsledky totální tyreoidektomie?

INTRODUCTION: This study analyzes the impact of coagulation instrument devices used during thyroid gland removal in which careful dissection and perfect haemostasis represent very important aspects. Standard electrocautery is compared to the use of bipolar forceps. The aim is to determine whether the use of different modes of coagulation is the key to the frequency and severity of postoperative complications following total thyroidectomy. MATERIAL AND METHODS: This study included 82 patients undergoing total thyroidectomy with haemostasis by conventional suture ligation technique combined with monopolar electrocauterization and 36 patients undergoing total thyroidectomy with complete haemostasis by bipolar forceps. The main outcomes measured were postoperative bleeding, recurrent laryngeal nerve palsy and post-thyroidectomy hypocalcaemia and hypoparathyroidism. Patients were followed up for 6 months. RESULTS: The results of our study showed that the use of bipolar forceps for vessel ligation in thyroid surgery is as safe and effective as the use of monopolar electrocautery and ligatures. Statistical analysis showed no significant differences in the rate of the individual postoperative complications between the two cohorts. Complication rates in the entire cohort were comparable with data reported in the literature. CONCLUSION: Both approaches are safe and reliable and both represent valid options. The choice might depend on the surgeons preferences and experience, the nature of the thyroid condition and the nature and extent of the surgical procedure.

[Anaplastic carcinoma of the thyroid gland]. / Anaplastický karcinom stítné zlázy.

INTRODUCTION: The characteristics of anaplastic carcinoma, its biological properties, incidence and possibilities of therapeutic influence are described in the article. MATERIAL AND METHODS: The authors present a cohort of patients with anaplastic carcinoma of the thyroid gland (ATC) who were operated on at the Department of Surgery during the last 5 years. RESULTS: The destiny of all the patients with histologically confirmed anaplastic carcinoma is followed, the survival period is evaluated. With regard to the small patient cohort there was no further statistical processing. CONCLUSION: The role of the surgeon in the treatment of anaplastic carcinoma as well as the necessity of the multimodal way of treatment is evaluated.

[News in parathyroid surgery]. / Novinky v paratyreoidální chirurgii.

BACKGROUND: Primary Hyperparathyroidism is a generalized impairment of the calcium, phosphate and bone metabolism resulting from the prolonged hypersecretion of parathormone. METHODS AND RESULTS: Surgical treatment offers safe and definitive solution. Key moment of the disease is the correct diagnose and localization of the hyperfunctional gland. Wide spectrum of methods for the diagnosis has been available. The method of choice is the combination of MIBI scintigraphy and ultrasonography which can achieve up to 98% of sensitivity. A cohort of 95 patients treated during the last 4 years is presented. CONCLUSIONS: The aim of the paper is to give an overview on the individual pre- and peroperative methods and to analyse their significance for our patients.

[Gastric carcinoma and D2 lymphadenectomy--technique and possible complications]. / Karcinom zaludku a D2 lymfadenektomie--technika, mozné komplikace.

Lymphadenectomy in gastric cancer became vital and obligatory part of staging procedure. Therapeutic effect of lymphadenectomy with patient's prognosis improvement still remains uncertain. In subgroups, extensive lymphadenectomy enhance radicality of the procedure, enables to reach R0 resection in the area of tumour bed and hopefully improves survival. D2 lymphadenectomy is now becoming as a standard also in our country. Technique and possible complications of D2 lymphadenectomy are the matter of this article.

[Lymphadenectomy in gastric carcinoma--present status, new trends and personal experience]. / Lymfadenektomie u karcinomu zaludku--soucasný stav, nové trendy, vlastní zkusenosti.

The only hope for long time survival in gastric cancer is radical surgery with complete tumour removal. Lymphadenectomy as a part of surgical procedure helps to remove tumour completely. The value of lymphadenectomy for staging is clear and surgeons have no doubt about it. Therapeutic effect of lymphadenectomy with improvement of the prognosis remains uncertain. In this work we would like to discuss current trends in lymphadenectomy in gastric cancer, especially evaluating the value and extent of the procedure.

[Ultrasonography as an auxiliary method in diagnosis of acute appendicitis]. / Ultrasonografie jako pomocná metoda v diagnostice akutní apendicitidy.

The diagnosis of acute appendicitis remains a difficult task for even the experienced surgeon. For this reason every supplementary examination affords help for the surgeon its diagnosis. The goal of our study was to evaluate the significance of ultrasonography (USG) in diagnosing right lower quadrant abdominal pain. 204 patients admitted for suspect acute appendicitis were evaluated retrospectively. The accuracy of USG was studied by comparing this finding with preoperative, histopathological findings respectively. In comparison leucocytosis was also studied. In our studied cohort, USG examination had a sensitivity of 88.4% and specificity of 93.0%. Leucocytosis for diagnosis gave a sensitivity of 88.6% and specificity of 60.0%.