[Neuroendocrine tumours of the upper gastrointestinal tract, characteristics and comparison of localization diagnostics]. / Neuroendokrinné nádory horného tráviaceho traktu, charakteristika a porovnanie efektivity lokalizacnej diagnostiky.

In daily clinical practice it's important to think of neuroendocrine tumors, since their prevalence for the past 5 years exceeded even the common occurrences of stomach, esophageal and pancreatic cancers. Patients diagnosed early and accurately with NET, have a greater chance for complete cure. The diagnostic tools over the past century were significantly inefficient in diagnosing NET i.e. (40% of tumors were not localized after USG, CT, MRI, AG investigations). Until the past 2 decades that major turnover in diagnostic methods has been achieved. In particular, the introduction of the somatostatine receptor scintigrafy (SRS) and endoscopic ultrasonography (EUS) have increased sensitivity of localization diagnostics up to 90%. Our work is to test the success of the localization diagnostics in 22 patients with surgically and histologically confirmed NET ofthe pancreas and duodenum. These patients fulfilled jointly SRS, CT and/or MRI, but also classic USG and EUS. From our comparison, clearly endoscopic USG is the most efficient tool with 90% sensitivity.

[Diagnosis of the Zollinger-Ellison syndrome. I: Significance of anamnestic, clinical and laboratory examinations]. / Diagnostika Zollingerovho-Ellisonovho syndrómu I.: význam anamnestických, klinických a laboratórnych vysetrení.

The authors describe the diagnostic algorithm of Zollinger-Ellison's syndrome which proved useful in the diagnosis of 73 patients with a confirmed diagnosis. They evaluate the diagnostic validity of anamnestic and clinical data, of different examination methods and compare them with experience assembled abroad. For the diagnosis of sporadic gastrinomas the onset of the disease after the age of 40 years is important, the development of serious peptic complications (haemorrhage F-70%, M-59%, perforation M-54%, F-47%) and the presence of watery diarrhoea (41%). As to laboratory parameters they rely on high BAO values (96% > 15 mmol H+/hour and 100% > 5 mmol H+ after gastric resection. Less important is the examination of basal serum gastrin (almost 30% patients have normal or liminal values of BSG--empirically set at 100-150 pg. ml-1). The authors draw attention to the fact that patients with ZES after gastric resections may have BSG values lower than 100 pg/ml (12%). A positive secretin test has a higher validity (rise of SG by 150-200 pg. ml-1 above basal values) positive in 82.2% patients, liminally positive in 11% and negative in 6.3% patients. An even higher diagnostic value was possessed by a BAO/MAO index higher than 0.6 which was positive in 93.4% patients. At present it is not used as pentagastrin is not available. Every year they diagnose 4-6 new cases of ZES which with regard to the number of inhabitants (5 million) places Slovakia along with Denmark and Sweden among the countries with the highest detection rate (0.8-1.2 ZES cases/1 million per year).

[Single-photon emission-computed tomography in the diagnosis of cerebrovascular diseases]. / Príspevok jednofotónovej emisnej pocítacovej tomografie k diagnostike cievnych ochorení mozgu.

BACKGROUND: SPECT-HM-PAO allows to detect the regional cerebral blood flow and total diminution of the brain perfusion still before morphological substrate evolution in CT scan, without invasive technologies. SEARCH GOAL: The authors have analyzed data obtained by SPECT-99mTc HM-PAO in the group of 46 patients suffering from cerebrovascular disorders and they have compared them with results aimed by CT scans. Both, the SPECT-99mTc HM-PAO and CT scan were performed within 48 hours or later after the onset of the stroke; some of CT scans were repeatedly performed. RESULTS: They discovered 40 positive and 6 negative SPECT-HM-PAO findings, 26 positive and 20 negative CT scans. SPECT investigation more frequently discovers circulatory failures in the clinically altered hemisphere than the CT scan does in a substrate; SPECT discloses hypoperfusion of the clinically unaltered hemisphere if silent hypoperfusion is present. The ipsilateral foci of CT substrates were significantly less frequently observed (p < 0.001) than some ipsilateral regional hypoperfusions. Not only the number, but also size and extent of hypoperfusional foci searched by SPECT are significantly higher and wider than the numbers and dimensions of substrates observed by CT (p < 0.001). CONCLUSION: CT scan diagnostic possibilities are restricted by the time factor (CT examinations performed within 48 hours since the onset of the stroke are significantly less frequently positive than those performed later-p < 0.001). SPECT examination has not such a limiting time factor (p > 0.05). MEANING: Hence SPECT-HM-PAO renders early, long lasting and wide information on the restriction of the overall and regional perfusion, independently of the fact as to whether the reduction of cerebral perfusion is, or is not going to result in ischemic necrosis and/or ischemic sclerosis. SPECT renders correlation of the perfusion disorder earlier, wider in space, and more frequently than the CT scan, and therefore it is a prerequisite to the disclosure of the mentioned silent focal blood flow reductions. (Graph 12, Fig. 3, Ref. 4.)

Contribution to occupational angiopathy diagnosis using special examination method.

The authors presented 1642 cases of professional diseases caused by vibrations (VD) and 435 cases of extremity overload disease (EOD) diagnosed in the years 1974-1993. In addition to the standard rheoplethysmography there were evaluated the results of digital laser Doppler flowmetry (Moor instruments, UK) in 104 workers exposed to vibration (EV) and 25 controls with the age and smoking habit standardisation. In the selected subgroup were used continual measurements of digital blood pressure (Finapress, Ohmeda), digital LD flux and speed and the measuring of digital skin and central body temperature simultaneously. The records before and after 10 min of local cooling test (Rejsek method) and postocclusive hyperemic tests were summarized (computer evaluation, program STATGRAPHICS, T-test). Vasoconstriction to local cooling persisted in EV for longer time. The records of digital skin flux and speed, digital blood pressure reactions of EV were significantly different (EV/controls) also in the 10th min after cooling. Postocclusion hyperemic tests revealed good functional capacity also in EV. Advantages and disadvantages of methods were discussed. The results found by non-invasive methods in VD were in good relation to images obtained by means of radionuclides (clearance and cumulative tests). Cumulative tests (after 99m--pertechnetate i.v.) can be used in the selected differential diagnostic cases of angiopathies to help to distinguish degree of angiospastic and angioparalytic changes in the hands of VD, and also in special cases at angiopathies connected with EOD.

[Contribution of Three-phase Scintigraphy to Indication of Revision Arthroplasty of the Hip Joint.]. / Prínos trojfázovej scintigrafie pre indikáciu k revíznej artroplastike bedrového klbu.

In the introduction of the paper the authors abalyze the problem of stable and long-term fixation of endoprostheses of the hip joint. They present statistics on the ratio of surgical revisions of endoprostheses of the hip joint in 1993-1996 which has a rising trend. In the subsequent part of the paper they deal with the problem of early diagnosis of loosening in the stage when only subjective data reported by the patient are available and the X-ray finding does not yet show signs of osteolysis and loosening of the TEP. Therefore they started to use in 1993 as a diagnostic aid three-phase all-skeletal scintigraphy. So far they used it in 18 patients with 100% reliability, as confirmed on operation. The authors describe in detail the method of three-phase scintigraphy with special emphasis on phase III. The results of scintigraphy are demonstrated on two patients. Key words: revision of endoprosthesis of the hip joint, radiopharmaceutical preparations, 99mTc-MDP, all-skeletal three-phase scintigraphy.

[Use of radiocolloids in orthopaedic practice.]. / Moznosti pouzitia rádiokoloidov v ortopedickej praxi.

The authors submit in their paper the results of treatment with radiocolloids 198Au and Y90 in patients with chronic synovialitis associated with rheumatoid arthritis, degenerative diseases, haemophilia, posttraumatic conditions, arthropathy and gout. During the period between 1970 and 1995 they administered radiocolloid 1259 times to 865 patients. Up to 1986 they administered radiocolloid of gold 198, since 1986 to the present time only radiocolloid of yttrium 90. The authors compare the results obtained with the two preparations, the results being greatly in favour for yttrium. The evaluation was made 6 months before administration and 6 months following administration of radiocolloid. Following administration of gold 198 they recorded substantial improvement in one third of the patients and improvement in half the patients. After administration of yttrium 90 44% patients improved substantially and 49% of the patients improved. A long-term effect of treatment with radiocolloids after more than six months of treatment was found after gold 198 administration in 27% patients and after yttrium 90 in 78% patients. No therapeutic response was recorded after administration of gold 198 in 29% and after administration of yttrium 90 in 22% patients. Key words: chronic synovialitis, radiosynoviorthesis, radiocolloid 198Au and 90Y.

[Madelung's disease]. / Morbus Madelung.

The paper reports on symmetric benign lipomatosis of the head and neck--Madelung's syndrome. Over a period of 5 years, 6 men were treated for this disease at the ENT Department of the School of Medicine, Comenius University in Martin. Four of these patients had hepatopathy, two diabetes mellitus, and in two gynecomasty was observed. Surgical treatment yielded satisfactory functional and cosmetic results.

[Magistral preparation of methylene diphosphonate and its clinical evaluation in radionuclide diagnosis of the skeleton]. / Magistraliter pripravený metyléndifosfonát (MDP) a jeho klinické hodnotenie v rádionuklidovej diagnostike skeletu.

The present authors report on their own method of preparation of a frozen kit of methylenediphosphonate (MDP) which has been hitherto imported from the foreign currency area. The preparation after labelling with 99mTc serves for scintigraphy of the skeleton. The rate of MDP and the reducing reagent (SnCl2.2H2O)-5:1 proved to be the most advantageous. The preparation was compared with two more radiopharmaceuticals: hydroxyethylidenedisphosphanate (HEDP) and pyrophosphate (PYP). The results of a subjective evaluation of readability of scintigrams with grades 1-5 are unequivocally more favourable for MDP and HEDP (2.3 and 2.4) against PYP (3.1). MDP possessed the best rate of the number of impulses from the bone and the surrounding tissue--the background of the radiopharmaceuticals under study. The authors also examined the rapidity of uptake of MDP in the bone, kidney and its elimination from the plasma. The obtained results were in good agreement with commercial preparations tested at different laboratories. The use of MDP prepared in this manner is a contribution both to economy and clinical practice.

[Radionuclide evaluation of the relation between the upper and lower respiratory organs]. / Moznost rádionuklidového hodnotenia vztahov medzi hornými a dolnými dýchacími orgánmi.

Functional examination of the lungs provides information on global pulmonary parameters. Radionuclide examination of pulmonary ventilation and gas distribution in the latter makes it possible to evaluate the functional regional finding in the lungs. In six subjects, using the bolus method with 133Xe, the respiratory system as a whole was examined and relations between upper and lower airways were evaluated. It did not prove possible to demonstrate by the radionuclide examination that there exists a homolateral relationship between the respective side of the nose and lungs and that experimental short-term irritation and obstruction of one of the nasal cavity influences the regional ventilation and distribution of gas in the lungs. It can be assumed that a change on the tracheobronchial tree induced by nasal reflexes does not cause an apparent change in the pulmonary ventilation, but changes in a negative way the respiratory mechanics and the air flow in the lower airways.

[Blood gases and acid-base balance in patients before and after treatment of obstruction of the nose]. / Blutgase und azidobasisches Gleichgewicht bei Patienten vor und nach der Behandlung einer behinderten Durchgänigigkeit der Nase.

Poor patency of the nasal passage has a negative impact on respiration. In 52 patients with increased nasal resistance blood gases and acid-base balance were measured according to the method of Astrup before and after surgical treatment of the upper respiratory organs. We found a significant increase of paO2 (on the average by 0.656 kpa; p less than 0.05) and of the buffer bases. The other parameters did not change to a statistically significant extent. The lower paO2 value in increased nasal resistance is most likely not due to hypoventilation. Altered nasopulmonary and nasothoracis reflexes exercise a negative influence on pulmonary mechanics and the laryngotracheobronchial tonus with subsequent alteration of the intrapulmonary distribution of the inspired air, and on ventilation-perfusion conditions of the lungs.