Artificial intelligence for predictive biomarker discovery in immuno-oncology: a systematic review.

BACKGROUND: The widespread use of immune checkpoint inhibitors (ICIs) has revolutionised treatment of multiple cancer types. However, selecting patients who may benefit from ICI remains challenging. Artificial intelligence (AI) approaches allow exploitation of high-dimension oncological data in research and development of precision immuno-oncology. MATERIALS AND METHODS: We conducted a systematic literature review of peer-reviewed original articles studying the ICI efficacy prediction in cancer patients across five data modalities: genomics (including genomics, transcriptomics, and epigenomics), radiomics, digital pathology (pathomics), and real-world and multimodality data. RESULTS: A total of 90 studies were included in this systematic review, with 80% published in 2021-2022. Among them, 37 studies included genomic, 20 radiomic, 8 pathomic, 20 real-world, and 5 multimodal data. Standard machine learning (ML) methods were used in 72% of studies, deep learning (DL) methods in 22%, and both in 6%. The most frequently studied cancer type was non-small-cell lung cancer (36%), followed by melanoma (16%), while 25% included pan-cancer studies. No prospective study design incorporated AI-based methodologies from the outset; rather, all implemented AI as a post hoc analysis. Novel biomarkers for ICI in radiomics and pathomics were identified using AI approaches, and molecular biomarkers have expanded past genomics into transcriptomics and epigenomics. Finally, complex algorithms and new types of AI-based markers, such as meta-biomarkers, are emerging by integrating multimodal/multi-omics data. CONCLUSION: AI-based methods have expanded the horizon for biomarker discovery, demonstrating the power of integrating multimodal data from existing datasets to discover new meta-biomarkers. While most of the included studies showed promise for AI-based prediction of benefit from immunotherapy, none provided high-level evidence for immediate practice change. A priori planned prospective trial designs are needed to cover all lifecycle steps of these software biomarkers, from development and validation to integration into clinical practice.

Is high age a contraindication to pulmonary resection?

INTRODUCTION: As the population ages, there are increasing numbers of elderly patients diagnosed with operable primary pulmonary malignancy or other lesions requiring pulmonary resection. The objective of the study was to evaluate post-operative outcomes in the elderly group and compare them with younger patients undergoing the same surgery. METHODS: Retrospectively, we evaluated our own set of 424 patients undergoing anatomical pulmonary resection for primary lung cancers and other resectable lesions in 20112020. 328 patients underwent open procedures, and VATS lobectomy was performed 96 times. We evaluated the set of patients in terms of 30-day morbidity and mortality using Clavien-Dindo classification modified for pulmonary resections. We compared the patient subgroups by age (under 55, 5564 years old, 6574 years and over 75 years). RESULTS: A non-biometric Kruskal-Wallis test was used to compare the groups. We have not shown a statistically significant difference in the number of complications (p=0.220). CONCLUSION: Standard surgical treatment for non-small cell lung carcinoma, lobectomy with systematic mediastinal lymphadenectomy, is safe also for a well-indicated group of seniors. With careful preoperative assessments and consideration of the extent of resection, we can expect a comparable rate of complications in the elderly compared to younger patients. Sublobar resection or radiotherapy should be considered in case of patients at risk. For seniors over 70 years of age, comparable outcomes of oncological treatment can be reached, taking into account their shorter life expectancy.

Splenectomy in patients older than 65 years - a single-center experience.

INTRODUCTION: Despite current efforts at the most conservative approach possible to splenic injury, splenectomy remains a relatively common surgical procedure. Indications for splenectomy, however, are not limited to spleen injury. In senior patients in particular, non-traumatic reasons for splenectomy becomemore frequent. In addition, previous studies have indicated a relatively wide range of complications and lethality in splenectomized patients without taking into account the age aspect. Within the scope of geriatric surgery, this study deals with splenectomy in elderly patients and is based on retrospectively evaluated experience of our clinic. METHOD: We studied a group of patients older than 65 years having undergone splenectomy at our institutionover the past 11 years. For each patient, the demographics, the reason for splenectomy, the mechanism of injury (if any), the degree of spleen damage, co-morbidities, the length of hospital stay, complications and lethality were evaluated. A group of patients operated on due tospleen trauma and the other group operated on for other reasons were analysed separately. Attention was paid to the reasons leading to splenectomy in the non-traumatic patients. Complications and lethality rate were evaluated in relation to the individual patient groups. RESULTS: 269 splenectomies were performed in our clinic between 2006 and 2016. Of these, only 57 (21.2%) were carried out in patients older than 65 years (32 men and 25 women aged 6590, mean age 73.6). Splenectomy was even rarer in association with splenic trauma:it was performed in only 13 senior patients. Other causes leading to splenectomy in elderly patients were: perioperative spleen injury (17 patients), gangrene, septic activation or spontaneous rupture of the spleen (10 patients), splenectomy during an operation on another organ (8 patients), splenomegaly (5 patients) and splenic artery aneurysm (4 patients). Lethality in the entire group was 29.8%, the percentage of complications was 57.9%; however, circumstances leading to splenectomy and also potential co-morbidities played a significant role. The average length of hospitalization in the entire group was 20.3 days. CONCLUSIONS: Splenectomy in patients over 65 years of age is associated with a high risk of complications and very high lethality. However, senior patients after splenectomy for monotrauma and those after elective splenectomy have a very good prognosis. Key words: geriatric surgery splenic rupture - splenectomy.

Pleural empyema - single center experience.

INTRODUCTION: Retrospective analysis of a group of patients treated for pleural empyema in the Department of Surgery, University Hospital Pilsen, over the last ten years. METHOD: We evaluated a group of patients treated for pleural empyema in the Department of Surgery, University Hospital in Pilsen, during the period 2007-2016. We focused on the demographic data of this group, the causes of empyema in these patients, surgical procedures performed in connection with empyema, the microbial species found in empyema, and, last but not least, on morbidity and lethality. RESULTS: We treated 103 patients with pleural empyema during the above period - 80 men (77.7%) and 23 women (22.3%) aged 23-83 years (average age 59.4 years). 64 patients had a history of surgical or invasive procedure (62.1%). The length of history was traceable in 55 patients (53.4%) and was 23.1 days on average, remaining unclear in the rest of the group. 1/3 of cases were metapneumonic empyemas, 1/3 postoperative empyemas and 1/3 of the cases were due to other reasons. The most commonly cultivated bacterial genus was Streptococcus, species Staphylococcus aureus. The most common surgery was chest drainage (51%). 13 patients died (lethality 12.6%) after surgery, the most common cause of death being sepsis; postoperative morbidity was 34%. CONCLUSION: Pleural empyema is a serious condition with very high morbidity and lethality. Surgical procedures done to manage empyema are associated with a very high risk of necessary reoperation. Positive mycological culture from empyema seems to be associated with a higher risk of complications and death. Key words: empyema - thoracic drainage - thoracotomy - lung decortication - videothoracoscopy.

[Traumatic pneumothorax - diagnosis and treatment of 322 cases over a five-year period]. / Traumatický pneumotorax - diagnostika a lécba 322 prípadu v petiletém období.

INTRODUCTION: Retrospective analysis of a set of patients treated for traumatic pneumothorax in the Trauma Centre of Teaching Hospital in Pilsen over a period of five years. METHOD: In total, 322 patients with traumatic pneumothorax were treated in the study period 20122016. The set included subjects whose injury fell within the definition of traumatic pneumothorax and who underwent either primary treatment or secondary transport to the Trauma Centre following basic treatment in another health facility on the day that the trauma occurred. The exclusion criterion was a pneumothorax <1 cm; in addition, patients with inconclusive findings from imaging screening were not included in the set. Basic demographic information, the mechanism, type and laterality of the traumatic pneumothorax, the Injury Severity Score, associated injuries, diagnostic procedures, timing, method and outcome of the treatment, as well as any complications and reoperations, were identified in the set. Other assessed information included deaths of patients with traumatic pneumothorax, including the cause and time of death in relation to the time of admission to the Trauma Centre. RESULTS: The vast majority of traumatic pneumothoraces (94.1%) occurred as a result of blunt chest trauma, car accidents being the most common mechanism (about 28%). Closed pneumothoraces dominated (91.3%). Traumatic pneumothorax was part of a polytrauma in about one half of the injured. The average Injury Severity Score within the set was 20 points. Traumatic pneumothorax was diagnosed in more than three quarters of the patients based on clinical examination and computed tomography. The most common therapeutic procedure was drainage of the relevant pleural cavity (259 patients - 80.5%). Almost two thirds of surgical procedures were carried out within 1 hour of admission to the Trauma Centre. Complications associated with traumatic pneumothorax treatment were reported in 10.2% of the cases, and 33 reoperations were carried out. 15 patients (4.7%) in the set died, out of which 12 on the day of the trauma, all of them as a result of decompensated traumatic shock. CONCLUSION: Traumatic pneumothorax is a relatively frequent type of chest trauma found in up to half of the patients with chest trauma as part of a polytrauma. It usually occurs as closed pneumothorax as a result of blunt chest trauma. The diagnostic process is based on clinical examination and chest radiogram. However, ultrasound examination could be an alternative to chest radiogram in emergency situations. Computed tomography is the method of first choice for more serious traumas and inconclusive findings. To manage this condition, proper drainage of the relevant pleural cavity is sufficient in the vast majority of the patients. With timely diagnosis and adequate therapeutic intervention, the prognosis for patients with traumatic pneumothorax is favourable.Key words: traumatic pneumothorax - diagnosis - chest drainage.

[Penetrating chest trauma - experience of the Pilsen University Hospital Trauma Centre]. / Penetrující poranení hrudníku - zkusenosti Traumacentra Fakultní nemocnice Plzen.

INTRODUCTION: Retrospective analysis of a set of patients treated for penetrating chest trauma in the Trauma Centre at University Hospital Pilsen over seventeen years. METHOD: Overall, 96 injured with penetrating chest trauma were treated in the study period 2000-2016. Basic demographics, the mechanism, type, location and extent of the penetrating chest trauma, Injury Severity Score, existence of associated injuries, diagnostic procedures, timing and method of the chest trauma treatment as well as any complications and reoperations were identified in the set. Other collected information included deaths of the injured, and the cause and time of death in relation to the time of admission to the Trauma Centre. RESULTS: The most common mechanism of injury was attack by a stabbing weapon (54%) and the most common type of injury was pulmonary laceration (33%). The average Injury Severity Score within the set was 24 points. The most common therapeutic procedure was pleural cavity drainage (47 patients), and less than 40% of the cases required revision surgery by means of thoracotomy or sternotomy. One patient died immediately after being admitted to the Trauma Centre without a chance to apply any therapy; three other patients died during resuscitative thoracotomy or laparotomy. Post-operative complications occurred in 13 patients (13.5%) and required 14 reoperations. CONCLUSIONS: The diagnostic and therapeutic algorithm of penetrating chest trauma is primarily determined by the condition of the injured. Adequate drainage of the relevant pleural cavity is sufficient to treat one half of the patients; on the other hand, 40% of traumas, injuries of the heart, large vessels and gunshot wounds in particular, require urgent revision surgery by means of thoracotomy or sternotomy. If the injured patient is transported to a specialized centre for timely treatment, the prognosis of penetrating chest traumas is quite favourable.Key words: penetrating chest trauma - diagnosis - chest drainage - thoracotomy - sternotomy.

[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience]. / Poranení hrudníku a jeho operacní lécba u polytraumatizovaných nemocných v petiletém období.

UNLABELLED: PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma patients died within 24 hours of injury (61.5%). CONCLUSIONS Chest injury, almost always blunt, is often diagnosed in polytrauma patients. A prevalent cause of multiple trauma is a traffic accident. Chest injury most frequently involves pulmonary contusion. Nearly half of chest injuries require surgery, of which 2/3 are urgent procedures. The procedure most frequently performed in polytrauma patients with chest injury is chest drainage and this is also a sufficient procedure in 75% of surgically treated patients. KEY WORDS: polytrauma, chest injury, pulmonary contusion, surgical treatment, chest drainage.

[The Influence of Palliative Chemotherapy on the Quality of Life of Patients with Gastric Cancer]. / Vliv paliativní chemoterapie na kvalitu zivota nemocných s karcinomem zaludku.

BACKGROUND: Gastric cancer is a malignant disease with a poor prognosis. The incidence of gastric cancer in the Czech Republic in 2013 was 14.34 cases per 100,000 citizens. Unfortunately, most patients are dia-gnosed with advanced stage disease and therefore undergo palliative treatment. Some patients undergo surgery and a very small percentage undergo palliative chemotherapy. The five year survival rate for those with advanced gastric cancer ranges from 5-15%. METHODS: This is a prospective study of patients undergoing chemotherapy for advanced gastric cancer. The aim was to assess the quality of life of those undergoing chemotherapy. RESULTS: The results showed that chemotherapy reduced the quality of life for these patients. DISCUSSION: Although palliative chemotherapy prolonged time to progression, it had little impact on overall survival. Conversely, chemotherapy reduced quality of life. Thus, clinicians and patients must decide whether to begin palliative chemotherapy. The final decision should be made by the patient after discussion with the treating clinician. CONCLUSION: Treatment of patients with gastric cancer must be undertaken on an individual basis. Those undergoing palliative treatment must play an active role in the decision process regarding chemotherapy and assess the potential benefits and drawbacks. Because chemotherapy treatment has a detrimental effect on quality of life, the decision should be based on factors that predict the likely therapeutic effect of chemotherapy. A definitive decision can then be made as to whether chemotherapy is indicated. KEY WORDS: gastric cancer - palliative chemotherapy - chemotherapy - quality of life - WHOQOL-BREFThis study was supported by grant of Internal Grant Agency of the Czech Ministry of Health No. NS14227-3.The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 10. 1. 2016Accepted: 8. 6. 2016.

[Thyroid carcinoma, ten-years file]. / Karcinom stítné zlázy, desetiletý soubor.

INTRODUCTION: Even though thyroid carcinoma has, in general, a good prognosis and low mortality rate, its incidence, especially the incidence of early forms of the disease has been growing. METHOD: Retrospective analysis of the file of surgeries of documented thyroid carcinoma within the years of 2006-2015. RESULTS: Thyroid carcinoma was recorded in 145 of 1820 patients operated for thyreopathy (8%); microcarcinoma (<10mm) was recorded in 64 cases (44.1%). The carcinoma was mostly detected accidentally during total thyroidectomy, which was in 70 cases (48.3%). The carcinoma was expected in 35 cases (24.1%) on the basis of prior puncture and total thyroidectomy was carried out straight away. Perioperative histology after hemithyroidectomy was requested in 31 cases (21.4%), and it was found positive only in 13 cases; thyroidectomy was finished in the second period in the other cases. Due to advanced carcinoma, tumour exploration/debulking was performed in 3 cases (2.1%) - for anaplastic carcinoma in all these cases. A permanent unilateral lesion - n. laryngeus recurrens - occurred in 3 cases (2.1%); a permanent bilateral lesion was recorded twice (1.4%).The most frequently manifested carcinoma was the papillary carcinoma in 114 patients (78.6%; 83 women/31 men; age of 1284 years; mean age of 50.6), the second most frequent carcinoma was the follicular carcinoma in 16 patients (11.0%; 15/1; 1969; 55.3), followed by the medullary carcinoma in 10 patients (6.9%; 6/4; 2576; 58.1). Anaplastic carcinoma was detected only in 4 cases (2.8%; 2/2; 6487; 75.5), and lymphoma of the thyroid gland occurred twice as well as Hürtle cell carcinoma. CONCLUSION: Thyroid carcinoma is mostly found accidentally during surgery in the early phase of the disease. This proves the high quality of endocrinology care and the correctness of the tendency to indicate early surgical treatment of thyroidal pathology.Key words: thyroid carcinoma - thyroidectomy complications.

[Predictive and prognostic factors of gastric cancer]. / Prediktivní a prognostické faktory karcinomu zaludku.

INTRODUCTION: Gastric cancer is a frequent malignant disease with poor prognosis. Most patients undergo only palliative treatment. Chemotherapy is another alternative but its effect differs in individual patients. METHOD: This is retrospective study. We enrolled 54 patients (N=54) according to the inclusion criteria. We performed quantification of gene expression of selected genes and some microRNA from tumour tissue, which was used for the diagnosis. Statistical analysis of the data was performed. RESULTS: We demonstrated a predictive value of gene expression of thynidylate synthase in tumour tissue for a therapeutic effect of chemotherapy based on 5-Fluorouracil or Capecitabine. At the same time, we demonstrated a predictive value of miR181, miR150, mir192 and miR342 microRNA levels from the tumour tissue. In addition, we succeeded to demonstrate a predictive value of miR221, miR224, miR520 and miR375 microRNA levels for a therapeutic effect of chemotherapy based on platinum derivates. CONCLUSION: Thanks to the use of efficient therapy predictors, we can distinguish those patients who will profit from chemotherapy from patients where an effect cannot be expected. Thanks to personified oncology therapy the quality of life of some patients can be improved while reducing the costs of the therapy by avoiding inefficient chemotherapy. Only an early diagnosis of gastric cancer can reverse the adverse prognosis of patients with this disease. KEY WORDS: gastric cancer - microRNA - prognostic markers - predictive markers.

Surgical treatment of gastric cancer.

UNLABELLED: Gastric cancer is a malignant disease which has generally a very bad prognosis. The frequency of occurence of this disease in the population is dependent on the age and localisation. Most frequently, this disease has occured in Japan, China, countries of South Africa and Eastern Europe for a long time but men are more likely to suffer from this disease than women witha ratio of 2 : 1. METHODS: We retrospectively evaluated the group of patients who had been treated in our complex oncology center in the course of five years RESULTS: We treated 572 patients with gastric cancer in five years period. 218 patients of the total number were admitted, 185 patients of all hospitalized patients were operated (85 %). 53 patients of our group of hospitalized patients underwent adjuvant oncology therapy (24 %). Overall, five-year survival was 18.4 % in our group, the median survival time was 12.9 months. CONCLUSION: Radical surgery is considered to be the only treatment modality which can lead to patient´s cure under optimal conditions. Complex care for patients with gastric carcinoma should be centralized in big centers. Personalized oncological treatment should be a way how to get better results (Tab. 2, Fig. 5, Ref. 14).

[Vesicouterine tiny fistula 8 years after a cesarean section - case report]. / Vezikouterinní vlasová pístel osm let po císarském rezu - kazuistika.

OBJECTIVE: To describe a case of uterovesical fistula after cesarean section with symptoms of vulvovaginal discomfort. DESIGN: Case report. SETTING: Department of Urology, Department of Obstetrics and Gynecology, University Hospital and Medical Faculty in Hradec Kralove, Charles University Prague. CONCLUSION: Uterovesical fistula is a rare and unusual complication of cesarean section. Uterovesical fistula is tough to diagnose because of unspecific symptoms. A multidisciplinary approach is necessary for its successful diagnosis and treatment.

[Vascular reconstructions infections in the aortofemoral region]. / Infekce cévních rekonstrukcí v aortofemorální oblasti.

INTRODUCTION: The incidence of prosthetic vascular graft infections in the aortofemoral region is reported at 0.6-3%. These complications are burdened with a high mortality of up to 50% and an amputation rate of up to 20%. The aim of our study was to give a complex view on the diagnostic and treatment possibilities of these serious complications of reconstructive vascular surgery. MATERIAL AND METHODS: Prosthetic bypass grafts were performed in 1088 patients in the aortofemoral region between 2001-2011 at the Department of Surgery, Teaching Hospital and the Faculty of Medicine, Charles University, in Pilsen. 24 (2.2%) patients suffered from graft infection at various time intervals after primary vascular reconstruction. Clinical examination, computed tomography and positron emission tomography were the main diagnostic methods of vascular graft infection. "In situ" reconstructions dominated over extra-anatomic reconstructions. When the infection involved only the peripheral part of the prosthetic graft, a more conservative approach - local debridement and drainage - was used. RESULTS: The mortality of the patients was 20.8%, high amputation rate 12.5%, and morbidity rate 58.3%, respectively. The average time of hospitalization in surviving patients was 46.5 days. Primary 30-day patency rate in "in situ" and extra-anatomic reconstructions was 100 and 60%, respectively. CONCLUSION: Prosthetic vascular graft infections in the aortofemoral region require tailored multidisciplinary treatment approach in vascular centres. "In situ" reconstructions are the method of first choice. A more conservative approach in infections involving only the peripheral part of the vascular reconstruction has a positive treatment effect.

Radiation exposure of the staff at the therapeutic and diagnostic nuclear medicine department. A single centre six years' retrospective study.

AIM: To assess a radiation exposure and the quality of radiation protection concerning a nuclear medicine staff at our department as a six-year retrospective study. Therapeutic radionuclides such as (131)I, (153)Sm, (186)Re, (32)P, (90)Y and diagnostic ones as a (99m)Tc, (201)Tl, (67)Ga, (111)In were used. MATERIAL, METHOD: The effective dose was evaluated in the period of 2001-2006 for nuclear medicine physicians (n = 5), technologists (n = 9) and radiopharmacists (n = 2). A personnel film dosimeter and thermoluminescent ring dosimeter for measuring (1-month periods) the personal dose equivalent Hp(10) and Hp(0,07) were used by nuclear medicine workers. The wearing of dosimeters was obligatory within the framework of a nationwide service for personal dosimetry. The total administered activity of all radionuclides during these six years at our department was 17,779 GBq ((99m)Tc 14 708 GBq, (131)I 2490 GBq, others 581 GBq). The administered activity of (99m)Tc was similar, but the administered activity of (131)I in 2006 increased by 200%, as compared with the year 2001. RESULTS: The mean and one standard deviation (SD) of the personal annual effective dose (mSv) for nuclear medicine physicians was 1.9 +/- 0.6, 1.8 +/- 0.8, 1.2 +/- 0.8, 1.4 +/- 0.8, 1.3 +/- 0.6, 0.8 +/- 0.4 and for nuclear medicine technologists was 1.9 +/- 0.8, 1.7 +/- 1.4, 1.0 +/- 1.0, 1.1 +/- 1.2, 0.9 +/- 0.4 and 0.7 +/- 0.2 in 2001, 2002, 2003, 2004, 2005 and 2006, respectively. The mean (n = 2, estimate of SD makes little sense) of the personal annual effective dose (mSv) for radiopharmacists was 3.2, 1.8, 0.6, 1.3, 0.6 and 0.3. Although the administered activity of (131)I increased, the mean personal effective dose per year decreased during the six years. CONCLUSION: In all three professional groups of nuclear medicine workers a decreasing radiation exposure was found, although the administered activity of (131)I increased during this six-year period. Our observations suggest successful radiation protection measures at our department.

A case-control study of lifestyle and lung cancer associations by histological types.

The objective of the study was to investigate the contribution of dietary factors and physical exercise to the variation in the risk of lung cancer and its major histological types among men and women in the Czech Republic, and reveal interactions between smoking and diet/physical exercise, if any. In a hospital based case-control study, data collected by in-person interviews from 1096 microscopically confirmed lung cancer cases (587 women, 509 men) and 2966 controls were analyzed using unconditional logistic regression stratified by appropriate factors. Among all nonsmoking women protective effects were observed for black tea (OR=0.69), among all smoking women for wine (OR=0.71), physical exercise (OR=0.64) and vitamin supplements (OR=0.71). Among all men, inverse associations were found in smokers between lung cancer risk and frequent intake of fruits (OR=0.69) or moderate intake of spirits (OR=0.64), and a direct association for fat foods (OR=1.68). Comparing the effects of diet/physical activity on lung cancer risk among nonsmokers versus smokers, interactions with smoking appeared for the intake of black tea and milk/dairy products among women, and for moderate intake of spirits in men. When the effects of diet/physical exercise on risk were analyzed by major cell types in women, the intake of wine and physical exercise were inversely associated with the risk of both adenocarcinoma and small cell cancer, the intakes of fruits and vitamin supplements were inversely associated with the risk of squamous cell cancer. In men, the intake of fat foods was directly associated with the risk of squamous cell cancer, while the frequent intake of apples was inversely associated with the risk of both squamous- and small cell cancers. In men an inverse association with the risk of squamous cell cancer was found for the intake of other fruits. These data suggest that diet/physical exercise may affect the risk of lung cancer and major cell types, and that interactions between some dietary items and smoking may occur. Lung cancer is a multifactorial disease, since smoking, its main determinant, and other environmental and lifestyle factors interact with one another and with genetic factors to cause the disease.

Experiences with detection of the ectopic gastric mucosa by means of Tc-99m pertechnetate disodium scintigraphy in children with lower gastrointestinal bleeding.

AIM AND BACKGROUND: We report our experience of the detection of ectopic gastric mucosa by means of perfusion Tc-99m pertechnetate disodium scintigraphy in patients with lower gastrointestinal bleeding. Gastric mucosa may be present in Meckel's diverticulum and is associated with peptic ulcer disease and lower gastrointestinal (GI) bleeding; Tc-99m pertechnetate scintigraphy can help to make the diagnosis of ectopic gastric mucosa. PATIENTS AND METHOD: Seventy-nine children (40 boys, 39 girls, aged 1 - 17, mean age 8 years) underwent Tc-99m pertechnetate scintigraphy in the last thirteen years. All patients had melena or hematochezia. Morphology imaging and endoscopy were negative in all patients. Dynamic scintigraphy of the abdomen was started immediately after i. v. administration of Tc-99m pertechnetate. The static image of the abdomen was performed subsequently. Where necessary, SPECT was additionally performed to improve the sensitivity, specificity and spatial specification. RESULTS: Three patients (two boys: two and ten years old; one girl: four years old) had positive scintigraphy results. All 3 patients underwent surgery and Meckel's diverticulum with ectopic gastric mucosa found (histology). GI bleeding stopped spontaneously in patients with a negative scintigraphy. These patients did not undergo intraoperative enteroscopy or surgery. CONCLUSION: Tc-99m pertechnetate scintigraphy can help to detect ectopic gastric mucosa in the abdomen and improve the management of patients with lower gastrointestinal bleeding.

[The scintigraphic 99mTc-MAA imaging quantification of the right-to-left shunt in a patients with multiple pulmonary arteriovenous malformation and familial teleangiectasis]. / Kvantifikate pravo-levého zkratu u pacientky s mnohocetnými plicními arteriovenózními malformacemi v rámci hemoragické hereditární teleangiektázie pomocí celotelové scintigrafie s 99mTc-makroagregátem humánního sérového albuminu.

AIM: To present a case report about 57-years-old woman with hypoxemia, multiple pulmonary arteriovenous (AV) malformations and lips teleangiectasis where the right-to-left shunt quantification was assessed by means of whole body scintigraphy with 9mTc-labelled human macro-aggregated albumin (MAA). MATERIAL AND METHOD: A 57-years-old woman underwent X-ray and bolus enhanced lung CT for dyspnoea, hypoxemia and cyanosis. A multiple intrapulmonary arteriovenous malformations were detected. The whole-body 99mTc-MAA scintigraphy for the right-to-left shunt quantification was performed. The whole-body scintigraphy in anterior and posterior view was started after intravenous application of 185 MBq 99mTc-MAA. The double-head gamma camera Infinia (General Electric Medical Systems--GE MS) with infrared body countouring and the large field of view was used. The Gamma camera was fitted with low-energy, high resolution, parallel-hole collimator. Images were evaluated by processing system Xeleris (GE MS). RESULTS: The whole-body 99mTc-MAA scintigraphy revealed significant R-L shunt and uptake of radiotracer in extrapulmonary organs (brain, kidney, spleen). The right-to-left shunt ratio was 36%. The woman underwent successful percutaneous transcatheter microembolization treatment. After treatment the woman underwent the next 99mTc-MAA whole-body scintigraphy and the R-L shunt ratio decreased to 17%. CONCLUSION: The 99mTc-MAA whole-body scintigraphy assessed the right-to-left shunt ratio and improved the management of patients with multiple intrapulmonary A-V malformations. The next 99mTc-MAA scintigraphy after the percutaneous transcatheter microembolization of multiple intrapulmonary A-V malformations confirmed success of treatment.

[67Ga-citrate SPECT imaging of the isolated right ventricle heart metastatic malignant melanoma in a patient with chest pain]. / Zobrazení izolované metastázy maligního melanomu v pravé srdecní komore pomocí scintigrafie s 67galium-citrátem.

AIM: To present a rare case report about a woman with a right heart ventricle malignant melanoma metastasis who presented with chest pain and that was successfully detected by 67Ga-citrate single photon emission computer tomography (SPECT). MATERIAL AND METHOD: A 73-years-old woman with a past history of excision of a malignant melanoma from the right calf, 6 years later, was admitted to hospital with chest pain. The examination excluded myocardial ischemia. The chest CT and MR imaging detected a large tumour mass in the right heart ventricle. The CT and MR finding was evaluated as a suspect benign, mesenchymal intracardiac tumour. The 67Ga-citrate scintigraphy for restaging of malignant melanoma was performed. The double-head gamma camera VariCam (Elscint) with infrared body countouring and the large field of view was used. The gamma camera was fitted with medium-energy, parallel-hole collimators. Images were evaluated by processing system Xpert-Pro (Elscint). RESULTS: The whole body planar scintigraphy from anterior and posterior view was negative without pathological uptake of 67Ga-citrate, but the subsequent chest SPECT revealed oval focus (4 x 5 x 4 cm) of the pathological uptake in the right heart ventricle. The SPECT slices and whole body planar scans were evaluated as the suspect isolated metastasis of a malignant melanoma in the right ventricle (it was proven by biopsy) without others metastases. The woman underwent percutaneous transcatheter biopsy from the right heart ventricle and malignant melanoma metastasis was proven. CONCLUSION: The chest SPECT improved the sensitivity of 67Ga-citrate scintigraphy. The suspect malignant character of cardiac involvement was proven by 67Ga-citrate scintigraphy.

Interactions between smoking and other exposures associated with lung cancer risk in women: diet and physical activity.

UNLABELLED: The objective of the study is to estimate the differences in the impact of diet and physical exercise on lung cancer risk in female nonsmokers vs. smokers, and reveal interactions, if any. In a hospital based case-control study, data collected by in-person interviews from 569 female lung cancer cases and 2120 controls were analyzed using unconditional logistic regression stratifying by appropriate factors. Protective effects were observed for intake of milk/dairy products (OR=0.57, 95%CI 0.35-0.94), vegetables (OR=0.60, 95%CI 0.40-0.91), apples (OR=0.69), wine (OR=0.77), and physical exercise (OR=0.59, 95%CI 0.42-0.83) among smokers only, while no similar effects were found among nonsmokers. In contrast, the intake of black tea was associated with a protective effect (OR=0.66, 95%CI 0.47-0.94) among nonsmokers only. Comparing the effects of dietary items and physical activity on lung cancer risk among nonsmokers versus smokers, statistically significant effect modifications were found for black tea (P 0.005), and milk/dairy products (P 0.047). Borderline effect modifications emerged for physical exercise (P 0.077). CONCLUSIONS: These results indicate protective effects of some components of healthful diet and physical exercise among smokers, and of the intake of black tea among nonsmokers. The observed interactions of the impact of black tea, milk/dairy products and physical activity upon lung cancer risk in women at different levels of the smoking habit deserve further studies.

[Microsurgical subinguinal varicocelectomy in children and adolescents]. / Mikrochirurgická subingvinální varikokélektomie u detí a dospívajících.

BACKGROUND: Microsurgical varicocele repair has become the gold standard in adults and only a few reports are available in children and adolescents. We present our experience with this method and concentrate on the technical performance, complications and development of testicular size. METHODS AND RESULTS: 47 patients aged 11 to 18 years (x15.4) underwent microsurgical subinguinal repair for varicocele grade II.-III. Operation was indicated because of hypoplastic testicle (expressed by the atrophy index > 25%), pain, large varicocele or parents preference. The patients were examined clinically, by ultrasound including the Doppler study; hormonal examination was added using the gonadoreline stimulation test. Microscope has been used to identify the internal spermatic artery, to dissect the artery from the complex of small surrounding veins and to identify the lymphatic vessels. We found 3 recurrences in 46 patients (6%) operated for primary varicocele. The atrophy index decreased from x19.7 to 12.7%, without any association with pubertal stage. Atrophy of the testis was not found in any patient. Hydrocele was detected in one patient (2.1%), and left testicular hypertrophy also in one patient (2.1%). CONCLUSIONS: Microsurgical subinguinal varicocelectomy is a safe and efficacious method in children and adolescents; using the microscopic dissection, the internal spermatic artery and accompanying lymphatic vessels are safely spared.