- MeSH
- adenom diagnóza terapie MeSH
- anastomóza chirurgická MeSH
- dospělí MeSH
- familiární adenomatózní polypóza * chirurgie diagnostické zobrazování komplikace MeSH
- kolektomie MeSH
- lidé MeSH
- meduloblastom * chirurgie diagnóza terapie MeSH
- peritonitida diagnóza terapie MeSH
- pouch MeSH
- tlusté střevo chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND & AIMS: Fecal tests currently used for colorectal cancer (CRC) screening show limited accuracy in detecting early tumors or precancerous lesions. In this respect, we comprehensively evaluated stool microRNA (miRNA) profiles as biomarkers for noninvasive CRC diagnosis. METHODS: A total of 1273 small RNA sequencing experiments were performed in multiple biospecimens. In a cross-sectional study, miRNA profiles were investigated in fecal samples from an Italian and a Czech cohort (155 CRCs, 87 adenomas, 96 other intestinal diseases, 141 colonoscopy-negative controls). A predictive miRNA signature for cancer detection was defined by a machine learning strategy and tested in additional fecal samples from 141 CRC patients and 80 healthy volunteers. miRNA profiles were compared with those of 132 tumors/adenomas paired with adjacent mucosa, 210 plasma extracellular vesicle samples, and 185 fecal immunochemical test leftover samples. RESULTS: Twenty-five miRNAs showed altered levels in the stool of CRC patients in both cohorts (adjusted P < .05). A 5-miRNA signature, including miR-149-3p, miR-607-5p, miR-1246, miR-4488, and miR-6777-5p, distinguished patients from control individuals (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.79-0.94) and was validated in an independent cohort (AUC, 0.96; 95% CI, 0.92-1.00). The signature classified control individuals from patients with low-/high-stage tumors and advanced adenomas (AUC, 0.82; 95% CI, 0.71-0.97). Tissue miRNA profiles mirrored those of stool samples, and fecal profiles of different gastrointestinal diseases highlighted miRNAs specifically dysregulated in CRC. miRNA profiles in fecal immunochemical test leftover samples showed good correlation with those of stool collected in preservative buffer, and their alterations could be detected in adenoma or CRC patients. CONCLUSIONS: Our comprehensive fecal miRNome analysis identified a signature accurately discriminating cancer aimed at improving noninvasive diagnosis and screening strategies.
- MeSH
- adenom * diagnóza genetika MeSH
- kolorektální nádory * diagnóza genetika MeSH
- lidé MeSH
- mikro RNA * analýza MeSH
- nádorové biomarkery analýza MeSH
- průřezové studie MeSH
- sekvenční analýza RNA MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
BACKGROUND AND AIMS: Colonoscopy with polypectomy are associated with a reduction in the incidence of colorectal cancer (CRC), as well as mortality, secondary to CRC. Because of the variation in physicians' performance and the risk of interval CRC after a colonoscopy, several quality indicators have been established. ADR (adenoma detection rate) is a generally accepted quality indicator. But it is also a target of possible gaming and achieving an adequate number of colonoscopies only from screening may be a problem for some practices. The aim of this study was to compare ADR for colonoscopies done for various indications and to look for correlations between the ADR of screening and all examinations. METHODS: We retrospectively assessed the quality indicators of all colonoscopies performed in a nonuniversity hospital, Frydek-Mistek, from January 2013 to December 2017. We calculated the ADR for all colonoscopies in patients over 50 years of age (subdivided into screening, surveillance, diagnostic) and separately only for screening colonoscopies. Correlations were made using the Pearson's correlation coeficient. RESULTS: The sample was composed of 6925 patients over 50 years of age (3620 men, 3305 women, mean age 66.2 years). The ADRs for screening and surveillance were higher than for diagnostic colonoscopies for all of the endoscopists, and the ADRs for all colonoscopies were lower than for screening, but sufficiently over 25%. There was a positive correlation between the ADR of screening and all colonoscopies (r=0.906, P<0.005). CONCLUSIONS: The calculation of ADR for all colonoscopies was possible in our endoscopic department, and there was a positive correlation with ADR for screening colonoscopies. ADR for all colonoscopies is a good tool for calculating real ADR from large sample sizes without gaming. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03730441).
Cíl studie: Popis vzácného případu Cushingova syndromu vyvolaného adrenálním adenomem v těhotenství s úspěšnou terapeutickou strategií. Vlastní pozorování: Prezentujeme výjimečný případ Cushingova syndromu u 30leté tercipary s rozvíjejícími se příznaky od 18. týdne gravidity. Pomocí laboratorních testů byl zjištěn primární Cushingův syndrom s nadprodukcí kortizolu a s nízkým adrenokortikotropním hormonem. Nativní magnetickou rezonancí potvrzen tumor pravé nadledviny. Ve 28. gestačním týdnu byla provedena laparotomická pravostranná adrenalektomie a histologicky potvrzen adrenální adenom. S nasazenou glukokortikoidní substitucí gravidita pokračovala do 38. týdne, kdy byl vaginálně porozen zdravý chlapec. Závěr: Cushingův syndrom se v těhotenství vyskytuje zřídka, často není rozpoznán nebo je diagnostikován postpartálně. Diagnostiku v průběhu gravidity komplikuje fyziologická nadprodukce kortizolu s aktivací hypotalamo-hypofyzární osy a snadná záměna symptomů za potíže vyvolané graviditou. Hlavním laboratorním parametrem je několikanásobně zvýšený volný kortizol v moči a vymizení cirkadiánního rytmu sérového kortizolu. Při včasné diagnostice a chirurgické terapii jsme schopni významně snížit míru výskytu mateřských a fetálních komplikací.
Objective: The description of a rare case of Cushing's syndrome caused by an adrenal adenoma in pregnancy with successful treatment. Case presentation: 30-ear-old Gravida 3 female was admitted to our hospital with hypertension at the 18th week of gestation. Hormonal analyses revealed primary Cushing's syndrome with high plasma cortisol levels and low levels of adrenocorticotropic hormone. Magnetic resonance imaging demonstrated a mass on the right-side of the adrenal gland. Adrenalectomy was performed in the 28th week of gestation and the following histopathology revealed an adrenocortical adenoma. Pregnancy continued until the 38th week of gestation with glucocorticoid replacement therapy and the patient gave birth vaginally to a healthy boy in the 38th week of gestation. Conclusion: Cushing's syndrome in pregnancy rarely occurs; diagnosis may be dismissed or determined after birth in most cases. Misdiagnosis of Cushing's syndrome is common because of physiological increase of corticotropin hormones and cortisol levels and overlapping symptoms that can occur even during physiological pregnancy. Cushing's syndrome should have a place in the differential diagnosis of hypertension in pregnancy (especially before the 20th week of gestation). Analysis of the urinary free cortisol level and circadian rhythm blood cortisol can provide a reasonable strategy to diagnose Cushing's syndrome in pregnant women. Early diagnosis and surgical treatment can significantly reduce maternal and fetal complications.
- MeSH
- adenom chirurgie diagnóza MeSH
- Cushingův syndrom * chirurgie etiologie MeSH
- dospělí MeSH
- hypertenze etiologie MeSH
- komplikace těhotenství MeSH
- lidé MeSH
- nádorové komplikace v těhotenství chirurgie diagnóza MeSH
- nádory nadledvin chirurgie diagnóza MeSH
- těhotenství MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND AND AIMS: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. METHODS: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. RESULTS: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). CONCLUSIONS: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
Here, we present a rare case of middle ear adenoma in a 58-year-old female, which uniquely presented as an unstable open cavity after an endaural atticoantrotomy. Immunohistochemistry confirmed that the tumor produced endocrine and exocrine secretions. The tumor was radically surgically removed.
- MeSH
- adenom diagnóza MeSH
- diferenciální diagnóza MeSH
- lékařské ilustrace MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory ucha diagnóza MeSH
- otologické chirurgické výkony škodlivé účinky MeSH
- pooperační komplikace diagnóza MeSH
- střední ucho patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Autoři předkládají případ 38leté pacientky s asymetrickým zbytněním bradavky. Histologické vyšetření potvrdilo diagnózu benigního adenomu mamily. Článek shrnuje klinický a histopatologický obraz včetně klinicko-patologické korelace.
The authors present a case of a 38-year-old female patient with asymmetrical nipple enlargement. Histological examination confirmed the diagnosis of benign nipple adenoma. The article summarizes clinical and histolopathological presentation including clinicopathological correlations.
S100 proteins are involved in biological events related to colorectal carcinogenesis. Aim of this prospective study was to assess serum concentration of S100A6, A8, A9 and A11 proteins in patients with colorectal neoplasia. Eighty-four subjects were enrolled: 20 controls (average risk population with normal findings on colonoscopy; 7 men, 13 women, age 23-74, mean 55 ± 14), 20 patients with non-advanced colorectal adenoma (non-AA, 10 men, 10 women, age 41-82, mean 62 ± 11), 22 with advanced colorectal adenoma (AA, 15 men, 7 women, age 49-80, mean 64 ± 8) and 22 with colorectal cancer (CRC, 12 men, 10 women, age 49-86, mean 69 ± 10). Peripheral venous blood was obtained. Serum S100 proteins were investigated by enzyme immunoassay technique. Serum S100A6 was significantly lower in CRC (mean 8530 ± 4743 ng/L), p = .035 compared to controls (mean 11308 ± 2968 ng/L). Serum S100A8 was significantly higher in AA (median 11955 ng/L, IQR 2681-34756 ng/L), p = .009 and in CRC (median 27532 ng/L, IQR 6794-35092 ng/L), p < .001 compared to controls (median 2513 ng/L, IQR 2111-4881 ng/L). Serum S100A9 concentrations did not differ between any tested group and controls, p > .05. Serum concentration of S100A11 was significantly lower in non-AA (mean 3.5 ± 2.4 μg/L), p = .004 and in CRC (mean 3.4 ± 2.4 μg/L), p = .002 compared to controls (mean 5.9 ± 2.5 μg/L). Sensitivity and specificity for S100A8 protein in patients with CRC were 94% and 73%; positive predictive value 68% and negative predictive value 95%. Patients with colorectal neoplasia have significantly lower serum S100A6 and S100A11 levels, significantly higher S100A8 and unaltered serum S100A9 levels.
- MeSH
- adenom krev diagnóza genetika patologie MeSH
- dospělí MeSH
- ELISA MeSH
- exprese genu MeSH
- kalgranulin A krev genetika MeSH
- kalgranulin B krev genetika MeSH
- karcinogeneze genetika metabolismus patologie MeSH
- kolorektální nádory krev diagnóza genetika patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádorové biomarkery krev genetika MeSH
- prospektivní studie MeSH
- protein S100A6 krev genetika MeSH
- proteiny buněčného cyklu krev genetika MeSH
- proteiny S100 krev genetika MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The adenoma detection rate (ADR) is the primary quality indicator for colonoscopies. The polyp detection rate (PDR) is available from administrative data and does not depend on histology verification. The correlation between PDR and ADR and the ADR/PDR conversion factor in preventive colonoscopies were evaluated. In the prospective study, asymptomatic individuals aged 45-75 years with preventive colonoscopy in 2012-2016 were included. Spearman's correlation coefficient was used to assess PDR/ADR for each endoscopist. Conversion factor predicting ADR from PDR was obtained by linear regression and subsequently compared with adenoma to polyp detection rate quotient. One thousand six hundred fourteen preventive colonoscopies performed by 16 endoscopists in 8 screening colonoscopy centres in the Czech Republic were analysed. Correlation between PDR and ADR in all preventive colonoscopies was high and statistically significant (Rs 0.82; P < 0.001). There was a strong correlation between PDR and ADR in men (Rs 0.74; P = 0.002) and in screening colonoscopies (Rs 0.85; P < 0.001). The conversion factor to convert ADR from PDR was 0.72 in all preventive colonoscopies, 0.76 in FOBT+ colonoscopies and 0.67 in screening colonoscopies. ADR may be replaced by PDR in the assessment of colonoscopy quality. The value of the conversion factor varies according to colonoscopy indication and gender of examined individuals; in this Czech study, it was 0.72 in all preventive colonoscopies. The minimum requested ADR of 25 % corresponds to a PDR of 35 %, when converted with the appropriate conversion factor.
- MeSH
- adenom diagnóza epidemiologie patologie prevence a kontrola MeSH
- administrativní požadavky na zdravotní péči statistika a číselné údaje MeSH
- časná detekce nádoru metody statistika a číselné údaje MeSH
- hodnocení rizik metody statistika a číselné údaje MeSH
- kolon diagnostické zobrazování MeSH
- kolonoskopie statistika a číselné údaje MeSH
- kolorektální nádory diagnóza epidemiologie patologie prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- plošný screening metody statistika a číselné údaje MeSH
- polypy tlustého střeva diagnóza epidemiologie patologie MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sexuální faktory MeSH
- střevní sliznice diagnostické zobrazování patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
V kazuistice popisujeme neobvyklý případ rezistence na krku, jehož příčinou bylo zakrvácení do adenomu příštítného tělíska. 72letá pacientka byla vyšetřena pro rezistenci na krku, v diferenciální diagnostice bylo uvažováno o nádoru štítné žlázy. Zároveň byla u pacientky biochemicky diagnostikována primární hyperparatyreóza. Při operaci byl z krční incize odstraněn tuhý uzel odpovídající hemoragicky změněnému adenomu příštítného tělíska. Ačkoliv příčinou tuhé rezistence na krku je zřídka adenom příštítného tělíska, měl by na ni endokrinolog či chirurg pomýšlet.
The case report describes an unusual case of the resistance of the neck caused by bleeding into the parathyroid adenoma. A 72-year-old female patient was examined for resistance of the neck, differential diagnosis was a thyroid tumor. At the same time, primary hyperparathyroidism was confirmed by the patient. During surgery, a rigid node corresponding to the haemorrhagically altered parathyroid adenoma was removed from the cervical incision. Although the cause of the resistance of the neck is rarely the parathyroid adenoma, the endocrinologist or surgeon should think of it.
- MeSH
- adenom chirurgie diagnóza komplikace MeSH
- hyperkalcemie etiologie MeSH
- krvácení etiologie MeSH
- lidé MeSH
- nádory příštítného tělíska * chirurgie diagnóza komplikace MeSH
- primární hyperparatyreóza diagnóza komplikace MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
