Thymic tumours associated with Myasthenia gravis: a long term observation study of operated patients.

Primary tumours of thymus, thymoma and thymic carcinoma, are very rare, they represent less than 1 % of all neoplasms. The most common manifestation of thymoma with appearance of 40 to 50 % of the neuromuscular autoimmune disease is myasthenia gravis (MG). The performance of a complete resection is the most predictive indicator for long-term survival of patients with thymic tumour, also important prognostic factors are the histological type of thymic tumour and its invasiveness. The aim of our study is to study the long-term survival of patients after the resection of the tumour, as well as enhanced efficiency of radical thymectomy in the complex treatment of myasthenia gravis. From 1989 to 2010 we operated on 369 patients with MG. Out of 49 patients (13.7 %) 38 cases (76.6 %) were thymomas and 11 cases (23.4 %) thymic carcinomas. Complete removal of tumours (stage I, II, and III) were performed in 45 (92 %) cases. Of the 41 living patients (83.7 %), three (7.3 %) were diagnosed with metastatic thymic carcinoma or thymoma, and treated with adjuvant therapy. In one case, the patient died due to generalization of the thymic carcinoma. Statistical analysis with Kaplan-Meier method showed better overall survival of patients with thymoma than patients with thymic carcinoma. The difference in survival curves was not significant. (Mantel-Cox p = 0.479, Generalized Wilcoxon p = 0.326). In terms of treatment of Myasthenia gravis associated with thymoma, we achieved 70 % successful clinical and pharmacological remission. On the other hand, paraneoplastic MGAT has the worst prognosis of all the other forms of MG. The difference between MGAT to every other form of MG was statistically significant (Tab. 6, Fig. 1,Ref. 28).

[Relapsing urinary tract infections as a single symptom of a foreign body within the GIT in a diverticulosis patient]. / Recidivujúce infekcie mocových ciest ako jediný príznak cudzieho telesa gatrointestinálneho traktu pri divertikulóze.

Recidiving urinary tract infections and pneumaturia are the cardinal symptoms of colovesical fistula. The authors present a case of rare complication of diverticulosis and gastrointestinal foreign body, that only had urological symptomatology.

Surgical treatment of pulmonary metastases in germ-cell testicular cancer patients--long-term results.

OBJECTIVES: The aim of this prospective clinical study is to evaluate our 20-year experience with surgical treatment of pulmonary metastases in germ-cell testicular cancer and discuss the optimal therapeutical approach. BACKGROUND: Authors presents 63 patients who were surgically treated in the period from 1988 to 2008 for pulmonary metastases in germ cell testicular cancer. All patients were allocated for surgical treatment after undergoing cisplatin-based combination chemotherapy. METHODS: In a group of 63 patients, 57 thoracotomias and 27 sternotomias were performed. In pulmonary procedures small atypical resections prevailed--84%. Postoperative mortality was 1.2%. Decision for follow-up treatment was made on basis of histological investigation of metastases. In some cases when viable tumor tissue was found (16% patients), further chemotherapy was administered. The rest of patients were monitored intensively. RESULTS: In a long-term follow-up, remission was achieved in almost 60% of patients. CONCLUSION: We suggest that lung metastasectomy as the secondary treatment in generalized germ cell testicular cancer should be fully warranted (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

[Long-term results of surgical treatment of pulmonary metastases in germ cell testicular cancer patients]. / Dlhodobé výsledky chirurgickej liecby pl'úcnych metastáz u pacientov s germinatívnymi nádormi testis.

BACKGROUND: Lung metastasectomy as a treatment option in pulmonary metastases has been discussed for a long time.Testicular cancer belongs to a group of tumours primarily treated with chemotherapy because of the high efficacy of anticancer chemotherapy. Surgical treatment plays only a secondary role in the removal of residual pulmonary metastases. Decision-making in the treatment of pulmonary metastases requires histological investigation.The aim of this prospective clinical study is to evaluate 20 years of experience with the surgical treatment of pulmonary metastases in germ-cell testicular cancer. PATIENTS AND METHODS: In the period 1988-2008, 63 patients were surgically treated for residual pulmonary metastases of testicular germ-cell tumours. All of the patients were indicated for surgery--pulmonary metastasectomy after the anticancer chemotherapy had been carried out.The survival rate of patients was evaluated according to the Kaplan-Meier method. RESULTS: In total, 57 thoracotomies and 27 sternotomies were performed. 9 patients underwent repeated thoracotomy due to recurrent metastases. In the case of primary resection of pulmonary metastases, minor procedures dominated--atypical partial resections were performed in 84% of all patients. Postoperative mortality was 1.2%. The histological result of metastasis determined a further procedure. Patients in whom vital tumorous tissue was detected (16% of patients) were subsequently treated by second-line chemotherapy, while the rest of the patients were strictly followed-up. In long-term survival, where the mean duration of follow-up was 8.9 years, an almost 60% remission rate was achieved. CONCLUSION: Based on the long-term results, the authors consider surgical treatment of pulmonary metastases of testicular germ-cell tumours as the treatment fully indicated.

[Scar hernia repairs using a mesh--the sublay technique]. / Operácie hernií v jazve pomocou siet'ky--technikou sublay.

In this work, the authors evaluated a group of patients operated on the III. Surgery Clinic FNsP MB in 2004 to 2006 for incisional hernias using the sublay technique--he mesh is implanted preperitoneally and covered by the fascia. The evaluation was done using a questionnaire, with a return rate of 65.5%. After an average of 24.8 months, 8.3% of patients report recurrence. Based on this data we further use this technique, but put more emphasis on minimalizing postoperative complications. From today's perspective, we consider retromuscular hernia repair using a mesh to be a standard procedure in incisional hernia management with best results in preventing recurrences.

[Ventral hernia associated with morbid obesity--when is surgery indicated?]. / Ventrálna hernia spojená s morbídnou obezitou--kedy operovat'?

The authors refer results of surgical treatment of incarcerated ventral hernias in patients with morbid obesity. In the 3rd Department of Surgery of the Comenius University Medical Faculty in Bratislava, 4 obese patients (BMI over 40) were operated for incarcerated ventral hernias in 2007. Based on a follow up analysis, the authors recommend a proactive approach to elective surgical therapy.

First molecular detection of Neospora caninum in European brown bear (Ursus arctos).

Neospora caninum is an important intracellular protozoan parasite with an affinity to the central nervous system of many animals and a major causative agent of repeated abortions in cattle. In total, 45 muscle, liver, or spleen samples of brown bear sampled in different locations of Central Slovakia were examined by PCR. Genotyping of N. caninum was based on amplification of Nc-5 gene and ITS1 rRNA fragments and subsequent sequencing. Presence of N. caninum DNA was confirmed in 24.4% (11/45) of tested animals. The results obtained in study confirm the first molecular evidence of N. caninum DNA in European brown bear (Ursus arctos) in Slovakia.