Pheochromocytomas (PCCs) are rare neuroendocrine tumors derived from the chromaffin cells of the adrenal medulla. When these tumors have an extra-adrenal location, they are called paragangliomas (PGLs) and arise from sympathetic and parasympathetic ganglia, particularly of the para-aortic location. Up to 25% of PCCs/PGLs are associated with inherited genetic disorders. The majority of PCCs/PGLs exhibit indolent behavior. However, according to their affiliation to molecular clusters based on underlying genetic aberrations, their tumorigenesis, location, clinical symptomatology, and potential to metastasize are heterogenous. Thus, PCCs/PGLs are often associated with diagnostic difficulties. In recent years, extensive research revealed a broad genetic background and multiple signaling pathways leading to tumor development. Along with this, the diagnostic and therapeutic options were also expanded. In this review, we focus on the current knowledge and recent advancements in the diagnosis and treatment of PCCs/PGLs with respect to the underlying gene alterations while also discussing future perspectives in this field.
- MeSH
- feochromocytom * diagnóza genetika terapie MeSH
- karcinogeneze MeSH
- lidé MeSH
- nádorová transformace buněk MeSH
- nádory nadledvin * diagnóza genetika terapie MeSH
- paragangliom * diagnóza genetika terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. METHODS: A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. RESULTS: The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). CONCLUSION: Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.
- MeSH
- břišní absces * diagnostické zobrazování etiologie chirurgie MeSH
- Crohnova nemoc * komplikace chirurgie MeSH
- dospělí MeSH
- drenáž MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři MeSH
- seznamy čekatelů MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Pancreatic ductal adenocarcinoma (PDAC) is now the 11th most common cancer and in 2018 there were 458,918 new cases worldwide. In the Czech Republic, a total of 2,173 patients were diagnosed in 2015, ranking the second in incidence worldwide. In contrast to other malignancies, recent research has not brought any major breakthrough in the treatment of PDAC and hence the prognosis remains very serious. Radical resection is the only curative approach, but after the initiation of the standard pathological evaluation of the resected tissue, according to the Leeds protocol, 80% of the resections are R1 (resections with microscopically positive margins). The results of studies in patients with borderline resectable or locally advanced PDAC prefer neoadjuvant chemotherapy or chemoradiotherapy. This approach leads to a higher number of radical R0 resections and better survival. For neoadjuvant treatment in patients with primarily resectable PDAC, most results come from retrospective analysis or phase II trials. However, recently, data from three randomized clinical trials with neoadjuvant therapy for resectable PDAC were presented. These results support the use of chemotherapy or chemoradiotherapy prior to surgery. In the trials published to date, there are differences in chemotherapeutic regimens, cytostatic doses, and the definition of resectability. Thus, up-front resection with adjuvant chemotherapy is still the standard of care and a well-designed randomized trial using neoadjuvant therapy is now necessary.
- MeSH
- duktální karcinom pankreatu * farmakoterapie chirurgie MeSH
- lidé MeSH
- nádory slinivky břišní * farmakoterapie chirurgie MeSH
- neoadjuvantní terapie MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- randomizované kontrolované studie jako téma MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
1: ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2: ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3: ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4: ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5: ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6: ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7: ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8: ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9: ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.
1: ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2: ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3: ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4: ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5: ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6: ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7: ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8: ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.
- MeSH
- ampulla Vateri * diagnostické zobrazování chirurgie MeSH
- gastrointestinální endoskopie MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory ductus choledochus * diagnostické zobrazování chirurgie MeSH
- nádory duodena * MeSH
- vývody pankreatu MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Konfokální laserová endomikroskopie využívající sondy (probe‑based confocal laser endomicroscopy – pCLE) je nová diagnostická metoda určená pro endoskopii, která umožňuje mikroskopické vyšetření na buněčné úrovni v reálném čase. Endoskopická diagnostika časných neoplastických lézí distálního jícnu není snadná a často tyto léze mohou být přehlédnuty. Cílem pilotní studie bylo získat charakteristické pCLE obrazy u onemocnění jícnu pro další studie a vyhodnotit možnou roli pCLE v diagnostice dysplastického Barrettova jícnu (Barrett ́s esophagus – BE) a časného adenokarcinomu jícnu (esophageal adenocarcinoma – EAC). Metody: Nejprve byl vyhledán přehled současné literatury s následným nastudováním předchozích publikací obsahující pCLE obrazy a jejich klasifikací u onemocnění jícnu. V druhé fázi byli do této pilotní studie zařazeni pacienti s onemocněním jícnu, kteří podstoupili horní endoskopické vyšetření s pCLE. Zařazena byla i zdravá kohorta osob. Výsledky: Od ledna roku 2019 do července roku 2019 bylo vyšetřeno celkem 14 pacientů v rámci této prospektivní pilotní studie: 3 pacienti s refluxní ezofagitidou, 4 s BE, 3 s EAC a 4 zdravé osoby. Byla provedena endoskopie s pCLE a získány charakteristické pCLE obrazy. Správná diagnóza byla endoskopistou stanovena pomocí pCLE (real‑time) celkem u 11 ze 14 vyšetřených pacientů (78,6 %). Závěr: Bylo možné získat typické pCLE obrazy u onemocnění jícnu během standardní endoskopie s využitím capu. pCLE se zdá být novou slibnou metodou k surveillance BE a detekci časných neoplastických lézí. Na druhou stranu je zapotřebí více dalších studií a dat na větším souboru pacientů.
Background: Probe‑based confocal laser endomicroscopy (pCLE) is a novel diagnostic technique for endoscopy which enables a microscopic view at a cellular resolution in real‑time. Endoscopic detection of early neoplasia in the distal esophagus is difficult and often these lesions can be missed. The aim of the pilot study was to obtain characteristic pCLE figures in esophageal diseases for following studies, and to evaluate the possible future role of pCLE in the diagnostics of dysplastic Barrett's esophagus (BE) or early esophageal adenocarcinoma (EAC). Methods: A review of the current literature was performed and previously published pCLE images and classifications of esophageal diseases were searched and studied first. In phase two of the pilot study patients with esophageal diseases such as reflux esophagitis, BE and EAC were enrolled and scheduled for upper endoscopy with pCLE. A healthy cohort was also included. Results: From January 2019 to July 2019, a total of 14 patients were enrolled in this prospective pilot study: 3 patients with reflux esophagitis, 4 with BE, 3 with EAC and 4 persons were included in the healthy cohort. The endoscopy with pCLE was performed and characteristic pCLE figures were obtained. The correct diagnoses based on real‑time pCLE were evaluated by an endoscopist in 11 of the 14 cases (78.6 %). Conclusion: It was possible to obtain typical pCLE images of esophageal diseases during a standard cap‑assisted endoscopic procedure. pCLE seems to be a feasible new technique in BE surveillance and early neoplastic lesion detection. However, more studies and data on larger number of patients are needed.
- Klíčová slova
- konfokální laserová endomikroskopie,
- MeSH
- Barrettův syndrom * diagnóza MeSH
- ezofagitida * diagnóza MeSH
- gastrointestinální endoskopie metody MeSH
- konfokální mikroskopie metody MeSH
- lidé MeSH
- nádory jícnu * diagnóza MeSH
- pilotní projekty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Souhrn: Herpetická ezofagitida je onemocnění diagnostikované zejména u imunokompromitovaných pacientů. U imunokompetentních jedinců se jedná o vzácné onemocnění, na které je ale třeba pomýšlet při akutně vzniklé triádě potíží – odynofagie, bolesti na hrudi a horečka nejasného původu. Nejčastějším původcem je herpes simplex virus typu 1 (HSV1). Ve většině případů vzniká onemocnění reaktivací latentní infekce HSV1, vzácněji při primoinfekci. Základem diagnostiky je endoskopické vyšetření jícnu s provedením biopsie a přímým průkazem přítomnosti viru v bioptickém vzorku. U imunokompromitovaných pacientů je vždy indikována léčba acyklovirem, který je v této indikaci virostatikem první volby. U imunokompetentních pacientů se jedná o tzv. selflimiting onemocnění, kdy v naprosté většině případů postačuje symptomatická léčba. Kazuistika popisuje imunokompetentního pacienta s náhle vzniklou typickou triádou potíží způsobených herpetickou ezofagitidou. Diagnóza byla potvrzena průkazem přítomnosti virové DNA metodou PCR ze vzorku odebraného při endoskopickém vyšetření. Vzhledem k těžšímu průběhu onemocnění byl pacient přeléčen acyklovirem a došlo k rychlé úpravě celkového stavu i lokálního endoskopického nálezu.
Summary: Herpetic esophagitis is a disease diagnosed especially in immunocompromised patients. Although the disease is rare in immunocompetent individuals, the diagnosis should be considered in the presence of its acute triad of clinical symptoms – odynophagia, chest pain, and fever of unknown origin. Herpes simplex virus type 1 (HSV1) is the most common causative agent. In the majority of cases, the disease develops by re-activation of latent HSV1 infection or, rather rarely, by primo-infection. The basis of diagnosis is endoscopic examination of the esophagus with biopsy and direct detection of the virus in the bioptic sample. In immunocompromised patients, treatment with acyclovir, which is the first-line virostatic in this indication, is always indicated. In immunocompetent patients, this is a self-limiting disease, where in most cases merely symptomatic treatment is sufficient. This case report describes an immunocompetent patient with a suddenly occurring typical triad of symptoms caused by herpetic esophagitis. The diagnosis was confirmed by the presence of viral DNA as determined by polymerase chain reaction from a sample taken during endoscopic examination. Due to the more severe course of the disease, the patient was treated with acyclovir and the general condition and local endoscopic findings then quickly improved.
- Klíčová slova
- herpetická ezofagitida,
- MeSH
- acyklovir terapeutické užití MeSH
- dítě MeSH
- endoskopie metody MeSH
- ezofagitida * etiologie mikrobiologie terapie MeSH
- herpetické infekce komplikace MeSH
- lidé MeSH
- lidský herpesvirus 1 izolace a purifikace MeSH
- polymerázová řetězová reakce metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Pancreatic carcinoma is an aggressive tumor with a grim prognosis. Accurate staging is essential for indicating surgery in patients with borderline resectable tumors. This paper examines the correlation between pre-operation characteristics of tumors found on CT, infiltration of individual resection margins as confirmed by a pathologist, and the survival of patients with resectable pancreatic head ductal adenocarcinoma. This prospective cohort study involved patients operated on for pancreatic head adenocarcinoma, which was clearly resectable based on the staging CT and intraoperative observation between 2011-2014. Only patients without postoperative complications who underwent adjuvant chemotherapy were analyzed. Seventy-nine patients were assessed, of which 16 (20.3%) had R0 resection and 63 (79.7%) had R1 resection. Patients with R1 results had up to 2.7 times higher risk of death than patients with R0 resection. We found a trend towards shorter survival associated with a closer relationship of the tumor to the superior mesenteric vein/portal vein (SMV/PV) wall in the pre-operation CT examination. Patients with a tumor interface between the vein wall of up to 180 ° circumference had up to 1.97 times higher risk of death than patients without (p=0.131). The results of our work confirmed that in our center, even surgically treated, clearly resectable pancreatic head tumors still have a high occurrence of positive surgical margins (R1 resection) and that tumors with R1 resection had statistically significantly reduced survival compared to R0 resection. A trend for shorter overall survival was found after tumor resection depending on the increasing interface between the tumor and the SMV/PV wall, but this result was not statistically significant.
- MeSH
- adenokarcinom * diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- míra přežití MeSH
- nádory slinivky břišní * diagnostické zobrazování chirurgie MeSH
- pankreatoduodenektomie * MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- resekční okraje MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Prevalence of inflammatory bowel disease (IBD), a chronic inflammatory disorder of the gut, has been on the rise in recent years-not only in the adult population but also especially in pediatric patients. Despite the absence of curative treatments, current therapeutic options are able to achieve long-term remission in a significant proportion of cases. To this end, however, there is a need for biomarkers enabling accurate diagnosis, prognosis, and prediction of response to therapies to facilitate a more individualized approach to pediatric IBD patients. In recent years, evidence has continued to evolve concerning noncoding RNAs (ncRNAs) and their roles as integral factors in key immune-related cellular pathways. Specific deregulation patterns of ncRNAs have been linked to pathogenesis of various diseases, including pediatric IBD. In this article, we provide an overview of current knowledge on ncRNAs, their altered expression profiles in pediatric IBD patients, and how these are emerging as potentially valuable clinical biomarkers as we enter an era of personalized medicine.
- MeSH
- biologické markery analýza MeSH
- Crohnova nemoc genetika MeSH
- dítě MeSH
- genetické markery genetika MeSH
- idiopatické střevní záněty genetika MeSH
- individualizovaná medicína trendy MeSH
- lidé MeSH
- nekódující RNA analýza MeSH
- signální transdukce genetika MeSH
- transkriptom MeSH
- ulcerózní kolitida genetika MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- úvodní články MeSH
BACKGROUND AND AIMS: The pathogenesis and risk factors for early postoperative endoscopic recurrence of Crohn's disease [CD] remain unclear. Thus, this study aimed to identify whether histological inflammation at the resection margins after an ileocaecal resection influences endoscopic recurrence. METHODS: We have prospectively followed up patients with CD who underwent ileocaecal resection at our hospital between January 2012 and January 2018. The specimens were histologically analysed for inflammation at both of the resection margins [ileal and colonic]. We evaluated whether histological results of the resection margins are correlated with endoscopic recurrence of CD based on colonoscopy 6 months after ileocaecal resection. Second, we assessed the influence of known risk factors and preoperative therapy on endoscopic recurrence of CD. RESULTS: A total of 107 patients were included in our study. Six months after ileocaecal resection, 23 patients [21.5%] had an endoscopic recurrence of CD. The histological signs of CD at the resection margins were associated with a higher endoscopic recurrence [56.5% versus 4.8%, p < 0.001]. Disease duration from diagnosis to surgery [p = 0.006] and the length of the resected bowel [p = 0.019] were significantly longer in patients with endoscopic recurrence. Smoking was also proved to be a risk factor for endoscopic recurrence [p = 0.028]. CONCLUSIONS: Histological inflammation at the resection margins was significantly associated with a higher risk of early postoperative endoscopic recurrence after an ileocaecal resection for CD.
- MeSH
- anastomóza chirurgická škodlivé účinky MeSH
- chirurgická rána imunologie MeSH
- chirurgie trávicího traktu škodlivé účinky metody MeSH
- Crohnova nemoc * diagnóza epidemiologie imunologie chirurgie MeSH
- disekce MeSH
- endoskopie trávicího systému * metody statistika a číselné údaje MeSH
- ileocekální chlopeň patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace * diagnostické zobrazování imunologie patologie MeSH
- recidiva MeSH
- rizikové faktory MeSH
- zánět patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
