Magnetic resonance spectroscopy - its added value in brain glioma multiparametric assessment.

OBJECTIVE: In this study, we analysed the results of magnetic resonance spectroscopy (MRS) in the patients with gliomas, including the error rate, MRS parameters variability, correlations with gene mutations and overall usefulness for clinical practice. MATERIAL AND METHODS: Eighty patients with glial tumours were examined by multiparametric MRI completed with single voxel MRS, as one group, then as two separate groups according to progression of the disease after the initial surgery. The error rate between the groups, MRS parameters variability, hazard ratios and correlations between metabolites, genetic markers and tumour grade were all analysed. RESULTS: Variability in Cho/Cr(h) was significantly higher in the group with a disease progression (p = 0.044). In the patients with a stable disease, strong significant negative correlations between Cho/Cr and Cho/NAA with p53 mutation (-0.945 and -0.812 respectively, p < 0.05) and between Cho/Cr and IDH1, 2 mutation (-0.796, p < 0.05) were found. In the patients with tumour progression, a significant positive correlation of NAA/Cr with 1p19q codeletion (0.486, p < 0.05) and of Cho/Cr and Cho/NAA values with p53 mutation (0.477 and 0.416, p < 0.05) were identified. Tumour grade positively correlated with Cho/Cr values (0.304, p = 0.02) in the whole patient group. CONCLUSION: MRS brings an added value to multiparametric MRI evaluation of brain tumours in the patient follow-up after an initial surgery, especially in ambiguous findings (Tab. 5, Fig. 2, Ref. 29).

Occurrence of two histopathologically different malignancies.

BACKGROUND: Synchronous primary malignancies are defined as two or more malignancies without finding a subordinate relationship in different organs of the patient. Reports of patients with primary malignancies with hepatocellular carcinoma are rare. CASE: We describe the course of the disease in a 71-year-old patient with a synchronous occurrence of two histopathologically different malignancies. CONCLUSION: Consistent screening can detect individual tumors early. Understanding the clinicopathological properties and prognostic factors in synchronous malignancies is important to facilitate the treatment.

Environmental estrogen bisphenol A and autoimmunity.

Over the past few years, there has been evidence of the increasing prevalence of autoimmune diseases. Autoimmune diseases consist of many complex disorders of unknown etiology resulting in immune responses to self-antigens. The immune system, and its function, is under complex and integrated control and its disruption can be triggered by multiple factors. Autoimmunity development is influenced by multiple factors and is thought to be a result of interactions between genetic and environmental factors. Here, we review the role of a specific environmental factor, bisphenol A (BPA), in the pathogenesis of autoimmune diseases. BPA belongs to the group of environmental estrogens that have been identified as risk factors involved in the development of autoimmune diseases.

[Prevalence of hyponatremia in patients on department of internal medicine]. / Prevalencia hyponatriémie u hospitalizovaných na internej klinike.

INTRODUCTION: Hyponatremia is the most common electrolyte disorder detected by bio-chemical laboratories in the present time and interest about it increases because of new informations about its consequences. AIM: Objective of our work was to determine the prevalence of hyponatremia in patients hospitalized at clinic of internal medicine and to analyze its most common causes. PATIENTS AND RESULTS: The total number of hospitalized patients for a period of 6 months was 1,203. Severe hyponatremia, i.e. S Na < 130 mmol/ l was detected in 83 cases, i.e. 6.9% of all patients. 14 patients, i.e. 1.15% have more severe hyponatremia with S Na < 120 mmol/ l. The most common type of hyponatremia was hypervolemic hyponatremia (n = 41; 49.4%) associated with liver cirrhosis and hearth failure, less common was euvolemic hyponatremia (n = 28; 33.7%) and least common was hypovolemic hyponatremia (n = 14; 16.9%). The most common cause of euvolemic hyponatremia was syndrome of inappropriate antidiuretic hormone secretion (SIADH) and thiazide diure-tics therapy. Next to thiazide diuretics, other common cause of euvolemic hyponatremia, and so SIADH, was therapy by selective serotonin reuptake inhibitors (SSRI). CONCLUSION: The authors point out, that it is necessary to control serum sodium concentration on regular base in case of longterm therapy by thiazide diuretics or SSRI, especially in elderly patients.

[Hyponatraemia associated with the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) - options for treatment]. / Hyponatriémia pri syndróme neprimeranej sekrécie vazopresínu (SIADH) - moznosti liecby.

Hyponatremia is the most common electrolyte imbalance in outpatients and hospital inpatients and the syndrom of inappropriate secretion of antidiuretic hormone (SIADH) is one of the common causes of euvolemic hyponatremia. Recent studies showed significantly higher mortality and morbidity of hyponatriemic patients compared to normonatriemic controls. Moreover the morbidity and mortality of hyponatremic patients significantly increases in nontreated in comparison to those with the therapy. Clinical consequences of hyponatremia in SIADH could be devided according to stage of the disorder. The cerebral oedema with its symptoms (letargy, weakness, nausea, coma) is the most dangerous clinical feature. Clinical symptoms of hyponatremia also depend on how rapid the change of natremia is. Therefore the early diagnosis of disturbance and treatment are necessary. Not only acute but also chronic hyponatriemia must be treated. In the correction the restriction of water intake, loop diuretics (together with hypertonic solution of NaCl), demeclocyclin, urea and litium can be used. The blockers of vasopresin receptors - vaptans are perspective in treatment of patients with hyponatremia.