EUS-guided jejunoduodenostomy: another option for the management of stenosis in hepaticojejunoanastomosis.

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically.  EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.

[Primary retroperitoneal tumor--extraadrenal paraganglioma--a case review]. / Primární retroperitoneální tumor--extraadrenální paragangliom--kazuistika.

Primary retroperitoneal tumors are extremely rare tumors of this location. The authors present a case review of a 53-year-old patient operated for unexplained retroperitoneal neoplasm. No complications were recorded during the postoperative course and histology demonstrated extraadrenal paraganglioma structures, ranked among the above neoplasms. Preoperative hypertension subsided postoperatively, following the active neuroendocrinne tumor removal. The aim of this work is to present clinical and histopathological characteristics of this rare retroperitoenal neoplasm.

[Initial experience with magnetic resonance cholangiopancreatography]. / Nase první zkusenosti s magneticko-rezonancní cholangiopankreatikografií.

BACKGROUND: Magnetic resonance cholangiopancreaticography (MRCP) is based on heavily weighted T2 sequences (ETSE--echo-train spin echo) with suppression of fat, giving visualisation of slowly flowing or stagnating fluid. MRCP are short sequences in coronary plane with thickness of 8 cm or 4 mm. Retrospective analysis of all MRCP examinations performed during last 12 months is presented. METHODS AND RESULTS: Eighty-eight examinations were done, of which 67 ones with both adequate technical quality and clinical indication were included into the study (20 males aged 25-83 years, 47 women aged 19-82 years). Patients were divided into 4 groups regarding to the indications (group I.--temporary cholestasis, normal abdominal ultrasound, II.--definite cholestasis, III.--pathologic findings on pancreas, IV.--other). Vast majority of patients were included into group I (35 subjects). In 7 (20%) of them choledocholithiasis and/or stenoses (including multiple stenoses in primary sclerotizing cholangoitis) were found. MRCP brought diagnostic information in subjects with cholestasis (group II.) and answered questions given by clinicians. However, in 1 of 4 subjects with primary sclerotizing cholangoitis, MRCP did not reveal intra-hepatic stenoses, which were later visualised by classical ERCP. Only the extrahepatic stenoses were diagnosed by MRCP in the latter subject. CONCLUSIONS: MRCP should become a standard examination in the diagnostic algorithm in patients with cholangiopathies. MRCP has its value not only in subjects with unsuccessful or contraindicated ERCP, but also in subjects with temporary cholestasis with negative ultrasound finding.

[Comparison of immunochemical and biochemical tests for occult hemorrhage in feces]. / Srovnání imunochemického a biochemického testu okultního krvácení ve stolici.

The authors compared in a group of 104 patients assessment of occult haemorrhage in faeces made by the immunochemical test HemeSelect (HS-SmithKline Diagnostics) and the biochemical Haemoccult test (HT-Röhm Pharma). In all patients subsequently total coloscopy was performed. In the whole group the sensitivity of HS was 49.3% and of HT 16.0% (p << 0.001) and the specificity 72.4% and 100% (p << 0.01). The predictive value in polyps, 10 mm in size or larger, was 65.2% (positive) and 60.0% (negative). The assessed sensitivity and predictive values of HS do not permit to recommend immunochemical tests of this type as an alternative procedure to repeated colonoscopic checks in the dispensarization of high risk groups of colorectal cancer.

Preparing high school students for a career in the health sciences.

The Summer Scholars Programs at the University of Missouri-Kansas City School of Medicine are designed to identify talented minority or economically disadvantaged high school students and to encourage these students toward careers in the health sciences. In the summer of 1984, 31 students participated in a one-month educational program during which they observed and participated in selected patient care procedures. They developed interpersonal and interviewing skills needed for successful application to health education programs. Students were provided information about numerous health careers to help them clarify their perceptions of health roles.To assess the programs' impact, the 18 scholar participants, who were high school seniors, responded to a questionnaire that sought information about their academic program during the senior year and their plans for higher education. Responses indicated that all had pursued rigorous academic programs, had achieved at a superior level in these courses, and were enrolling in college in the fall of 1985. Fourteen of the 18 students were planning careers in medicine. Responses indicated that the students felt that the programs had been effective in helping them learn about, prepare for, and make appropriate choices regarding careers in the health sciences.