A study of clinical, histopathological and direct immunofluorescence diagnosis in pemphigus group Utility of direct immunofluorescence.

AIMS: To determine the diagnostic accordance between histopathological and direct immunofluorescence diagnosis of patients with autoimmune vesiculobullous skin diseases. BACKGROUND: The term pemphigus refers to a group of autoimmune blistering diseases mediated by auto-antibodies directed against desmoglein proteins. The differentiation between the various bullous diseases is important for treatment and prognosis. Direct immunofluorescence microscopy is still the gold standard in differentiating these diseases. METHODS: Patients with clinical diagnosis of vesiculobullous dermatitis from pemphigus group were included in the study. We retrospectively analyzed histopathologic and direct immunofluorescence results from skin or mucosal samples over 15-year period. RESULTS: 81 patients were included. The accordance was good in pemphigus vulgaris and pemphigus herpetiformis, but low in pemphigus vegetans, pemphigus foliaceus and pemphigus erythematosus. No accordance was in Hailey-Hailey disease and Grover´s disease. Uncommon result in our analysis included: intraepidermal IgG and IgM depositions at DIF in one Grover´s disease patient. CONCLUSION: Our results confirmed the relevance of direct immunofluorescence assays as a necessary diagnostic method for the definitive diagnosis of autoimmune blistering disease in the case, where the clinical feature and the results of histopathology are not clear (Tab. 4, Fig. 5, Ref. 26).

[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.

[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.

[A different view of acute upper gastrointestinal bleeding in liver cirrhosis patients]. / Jiný pohled na akutní krvácení do horního trávicího traktu u pacientu s jaterní cirhózou.

OBJECTIVES: The study focuses predominantly on non-varicose sources of acute upper gastrointestinal bleeding in liver cirrhosis patients and aims to determine its mortality. METHODS AND SUBJECTS: The prospective examination included 137 liver cirrhosis patients with acute upper GIT bleeding. All the patients underwent an endoscopic examination. In case of multiple findings, defining the bleeding source was based on the specialist's attitude presented as the conclusion of the endoscopic examination. RESULTS: The most frequent causes of acute bleeding included oesophagus varices (57.7%), followed by peptic gastric and duodenal ulcers (18.2%), then portal hypertension gastropathy (9.5%), gastric varices (5.1%), reflux oesophagitis (2.9%), Mallory-Weiss syndrome (2.9%) and erosive gastropathy (1.5%). The endoscopy of the upper digestive tract resulted in a negative diagnosis in not more than 2.2% of patients. The majority of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. Mortality in all bleeding cirrhotic patients reached 14.6%, 18.6% of which were related to the varicose type of bleeding and 7.8% to the non-varicose type. CONCLUSION: Portal hypertension led to bleeding (caused by varices and portal hypertension gastropathy) in 72.3% of patients, 62.8% patients suffered from purely varicose bleeding, 37.2% patients from non-varicose bleeding. Mortality was statistically significantly higher on 0.1 level of significance in cases of varicose bleeding in comparison with non-varicose bleeding. An emphasis should be laid on an early and detailed endoscopic examination leading to an appropriate diagnosis and therapy.

[Changes in lipid metabolism in patients in the active phase of Crohn's disease]. / Zmeny metabolizmu lipidu u pacientu v aktivní fázi Crohnovy choroby.

INTRODUCTION: Crohn's disease (CD) in its active period is accompanied by a decreased food intake and deterioration in water, mineral and metabolic balance. Lipid metabolism is known to be altered in many acute diseases, and hypocholesterolemia is a serious negative prognostic indicator. The causes of decreased serum cholesterol concentration are multiple. Simultaneous affection of both cholesterol synthesis and absorption has been reported in many sources. The changes in both the above processes can be quantified with the use of specific indicators of synthesis (cholesterol level) and absorption (sitosterol and campesterol levels). OBJECTIVE: The objective of the study was to demonstrate changes in lipid metabolism in patients with active Crohn's disease, and to find out to what extent the above phenomenon is influenced by the affection of the process of cholesterol synthesis and/or absorption in the case of detected hypocholesterolemia. MATERIAL AND METHODS: Total serum cholesterol, LDL- and HDL-cholesterol and triglyceride levels were measured on the 3rd, 14th and 28th day from admission in addition to admission analyses in 24 patients with acute manifestation of CD (CDAI - Cohn's disease activity index - over 150). Also measured were the concentrations ofsqualene, lathosterol, sitosterol and campesterol. The results were compared with a control sample of 100 voluntary blood donors. The obtained data was processed using the Sigma-stat 3.1 statistical software. RESULTS: Decreased levels of all basic lipid metabolism parameters were detected. At the same time, a statistically significant decrease in the levels of lathosterol and camposterol was recorded. The decrease in sitosterol levels was insignificant and the level of squalene was higher than in the controls. CONCLUSION: Significant changes in lipid metabolism were demonstrated in the study in patients in active phase of Crohn's disease. Also detected was statistically significant hypocholesterolemia, with altered process of cholesterol synthesis and absorption.

[Endoscopic findings in upper gastrointestinal tract in patients with liver cirrhosis]. / Endoskopické nálezy v horním trávicím traktu u pacientu s jaterní cirhózou.

151 patients suffering from the cirrhosis of the liver underwent a prospective endoscopic examination of the upper digestive tract. The most frequent diagnoses in the group with the cirrhosis of the liver included oesophagus varices (64.9%), portal hypertension gastropathy (45.7%) and the peptic ulcer of the gastroduodenum (25.8%). A normal diagnosis in the endoscopy of the upper digestive tract was found only in 8.6%. Other diagnoses comprised reflux oesophagitis (13.2%), diaphragm hiatus hernia (12.6 %), duodenogastric reflux (8.6 %), gastric antrum erosion (4.6 %), aphthic gastropathy (3.3 %), rhagades of the cardium (2%), gastric polyp (1.3%), mycotic oesophagitis, gastric carcinoma, oesophagus carcinoma and oesophagus achalasy (0.7% each). Further on the study discusses possible causes of the high incidence of peptic ulcers in the patients with the cirrhosis of the liver. All findings are correlated with literary data.

[The etiology of upper gastrointestinal bleeding in patients with liver cirrhosis]. / Príciny akutního krvácení do horního trávicího traktu u pacientu s jaterní cirhózou.

108 patients suffering from the cirrhosis of the liver and acute bleeding into the upper digestive tract underwent a prospective endoscopic examination with diagnostic and therapeutic objectives. The most frequent causes of acute bleeding included oesophagus varices (57.4%) followed by peptic gastric ulcer (13.9%) and peptic ulcer of duodenum (11.1%), then portal hypertension gastropathy (5.6%), gastric varices (4.6%), reflux oesophagitis (2.8%), Mallory-Weiss syndrom (2.8%) and erosive gastropathy (0.9%). The endoscopy of the upper digestive tract in one patient resulted in negative diagnosis. 69% of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. To determine the source of bleeding the specialist's attitude presented at the end of the endoscopic examination was taken into consideration. In 67.6% of patients the bleeding was a direct consequence of portal hypertension, in 62% it was caused by varices. The emphasis is put on early and thorough endoscopic examinations aimed at proper diagnosis and therapy.

[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.