[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.

BRAFV600E mutation in the pathogenesis of a large series of papillary thyroid carcinoma in Czech Republic.

BACKGROUND: Activating point mutation of the BRAF gene, the most common genetic alteration reported in papillary thyroid carcinomas (PTC), has been associated with poor prognostic characteristics. AIM: Our objective was to determine the frequency of BRAFV600E mutation in PTC tumor tissues from the period 1960-2007 and to correlate it with clinicopathological parameters. SUBJECTS AND METHODS: DNAs were extracted from 242 PTCs, 23 sporadic medullary carcinomas, one anaplastic carcinoma and 6 poorly differentiated carcinomas. The presence of BRAFV600E mutation was determined using single strand conformation polymorphism method and verified by direct sequencing. RESULTS: BRAFV600E mutation was detected in 81 of 242 PTCs (33.5%), in one of 6 poorly differentiated carcinomas (16.7%) and in anaplastic carcinoma. BRAFV600E mutation was much less frequent in the follicular variant compared to classical variant and mixed follicular- classical variant of PTCs (p=0.001). BRAFV600E mutation was significantly associated with presence of nodal metastasis (p=0.029), more advanced TNM stage (p=0.014) and recurrence of disease (p=0.008). The mutation correlated with a higher age at diagnosis (p=0.049) and with a greater tumor size (p=0.041). Multivariate analysis confirmed these findings. The prevalence of BRAFV600E mutation before 1986 was significantly lower than after it (p=0.008). CONCLUSIONS: Our data suggest that BRAFV600E mutation is associated with high-risk clinicopathological characteristics of PTC and worse prognosis of patients. The frequency of the mutation significantly varied during the observed period but rather because of the different age distribution of patients in particular periods than as a consequence of Chernobyl accident.

[Occlusion of a post-pneumonectomy bronchopleural fistula using the Dumon stent]. / Okluze bronchopleurální pístele po pneumonektomii s vyuzitím DUMON stentu.

A postoperative bronchiopleural fistula associated with empyema of the chest is a serious complication in thoracic surgery, in particular when it develops after pneumonectomy. Some patients are in a condition which threatens their life and rules out extensive surgical interventions. Immediate thoracic drainage, thoracoscopic revision and sanation of the empyema cavity and endoscopic closure of the fistula are in indicated cases a therapeutic alternative of open surgical procedures. The justification of these miniinvasive procedures is confirmed by the submitted case-record of a successfully cured fistula associated with empyema of the chest after pneumonectomy. At the same time, based on assembled experience, the authors draw attention to the possible use of a stent.

[Surgical treatment of benign tumors of the thyroid gland]. / Chirurgické resení benigních nádoru stítné zlázy.

Based on 22-year experience with surgery of 2107 benign thyroid tumours and data in the literature the authors evaluate some controversial problems from this sphere of thyrology pertaining to the definition and classification of benign tumours, their diagnosis, treatment and subsequent follow-up. Modern diagnostic procedures indicate that the actual number of true benign tumours is smaller than reported in some statistics and the assumption of monoclonal development of tumours is one of the most fundamental characteristics. The authors consider total lobectomy as minimal surgery, in case of uncertainty as regards possible malignancy further procedures depend on final histological examination. If the final finding alters the diagnosis from an originally benign tumour to a malignant one, the authors recommend a two-stage procedure to implement total thyroidectomy. In the authors' opinion total lobectomy is sufficient also in some variants of follicular adenoma--Hürtle's adenoma or atypical adenoma. Then however subsequent dispensarization is essential. After a partial operation (lobectomy) it is important to ensure substitution with thyroid hormones to suppress the function of TSH.

[Malignant lymphomas of the thyroid gland]. / Maligní lymfomy stítné zlázy.

The authors evaluate their experience with malignant lymphomas of the thyroid gland, recorded in 22 patients from a total of 4501 operated on account of thyroid diseases in the course of 22 years. Although thyroid lymphomas are rare, their number is increasing. In localized findings curative procedures can be used, possibly supplemented by operations of the lymph nodes. The method of choice is still radiotherapy and surgery, in particular in lesions restricted to the thyroid gland. The role of chemotherapy is still controversial.

[Experience with the use of criteria for evaluating the need for hospitalization in a surgery department]. / Zkusenosti s uplatnením kritérií k hodnocení nutnosti hospitalizace na chirurgickém oddelení.

Acute hospital care is the most expensive form of medical care. Some of patients hospitalized in acute hospitals could be cared for in alternative settings without compromising quality of care. The Appropriateness Evaluation Protocol (AEP) is the most widely used tool for evaluation of appropriateness of hospitalisation in acute care hospitals. We applied AEP to 189 patients admitted within 20 days to department of surgery of a teaching hospital. We have evaluated appropriateness of admission and each following day of stay up till discharge or 15th day of hospitalization. Reasons of inappropriate admissions and delayed discharges were classified and analyzed. Results of the evaluation of selected patients were subject to control by a committee of fully specialized hospital physicians. 16 (8%) of 189 admissions and 306 (27.5%) of 1114 evaluated days of stay failed the AEP criteria. These patients could be well served by lower treatment intensity in outpatient clinics, nursery homes or their own homes. Such a shift in pattern of provided care requires profound organizational changes many of which are out of reach of individual acute hospitals. Despite some limitations we find AEP a useful tool for internal utilization review. External application of AEP in a representative sample of acute care hospitals could provide important data for future development of the Czech health care system.

[The effect of the primary operation on reoperations on the thyroid gland]. / Jak ovlivní primární výkon reoperaci na stítné zláze.

The authors analyze the possibility to reduce the number of reoperations of the thyroid gland, based on a group of thyroid operations performed at the Surgical Clinic of the Second Medical Faculty Charles University and Faculty Hospital Motol during the 22-year period from 1975-1997. 507 reoperations from a total number of 4501 thyroid operations amount to 11.3%. In the authors opinion correct indication of the operation is most important as well as the correct extent and technique of the primary operation. The achieved results are except for unilateral temporary lesions of the NLR comparable with primary operations.

[Contemporary views on thyroid gland surgery]. / Nekteré soucasné pohledy na chirurgii stítné zlázy.

The authors reflect on changes in the approach of surgeons to patients and operations of the thyroid gland in recent years and emphasize those elements which they had favourable experience in recent years.

[The significance of the ultrasound examination in surgery of the thyroid gland]. / Význam ultrazvukového vysetrení pri operacích na stítné zláze.

The authors emphasize the importance of ultrasonographic examination of the thyroid gland for the diagnosis of disease as well as for planning and implementation of the operation. They evaluate the importance of 154 sonographic examinations which were made during the last three years in 545 operations of the thyroid. For the surgeon anatomical parameters of the pathological tissue are important with special emphasis on the relation with surrounding tissues and affection of the lymphatic system. The examination is irreplaceable, in particular in reoperations of the thyroid gland and nodular syndrome.

[Gallbladder carcinoma]. / Karcinom zlucníku.

The authors analyze a group of 34 operated patients with carcinoma of the gallbladder operated in 1984-1990. Before operation the diagnosis was established only in 6% of the patients. The authors draw attention to certain symptoms which could lead to the diagnosis of the disease on the basis of clinical and paraclinical examination. Even in recent years the incidence of this disease is not declining, difficulties with early diagnosis persist, in the majority the finding before operation cannot be resolved and only 1-5% patients survive for 5 years (due to several incidentally detected cases of carcinomas during operations performed on account of concrements). The necessity of early treatment of all biliary diseases is still urgent.

[A case of anaerobic emphysematous cholecystitis with a subhepatic abscess]. / Prípad anaerobní emfyzematózní cholecystitidy s podjaterním abscesem.

The authors describe their own observation of a complicated course of emphysematous cholecystitis caused by anaerobic microorganisms. An extensive subhepatic abscess was involved which developed as a results of emphysematous cholecystitis diagnosed by sonographic and CT examination. After two operations on account of the abscess and a phlegmon of the abdominal wall the patient recovered. The authors emphasize that early diagnosis and adequate treatment calls for collaboration of clinicians, microbiologists and roentgenologists.