BACKGROUND: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure. METHODS: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group. RESULTS: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years. CONCLUSION: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.
- MeSH
- dávka záření MeSH
- dospělí MeSH
- fluoroskopie metody MeSH
- ganglion trigeminale chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- neuralgie trigeminu * chirurgie diagnostické zobrazování radioterapie MeSH
- počítačová rentgenová tomografie * metody MeSH
- radiační expozice * prevence a kontrola MeSH
- retrospektivní studie MeSH
- rizotomie * metody MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Ročně v České republice diagnostikujeme kolem 6 000 nových případů karcinomu plic. Mutace receptoru 2 pro lidský epidermální růstový faktor (human epidermal growth factor receptor 2, HER2) patří mezi vzácné mutace, které se vyskytují cca u 1-4 % nemocných s NSCLC. V případě prokázané mutace HER2 je možné používat léčebně přípravek trastuzumab deruxtekan. Trastuzumab deruxtekan je konjugát protilátky a léku, který kombinuje humanizovanou monoklonální protilátku trastuzumab s inhibitorem topoizomerázy I deruxtekanem. Tento lék se váže na HER2 na nádorových buňkách. Cytostatikum deruxtekan je společně s HER2 internalizován do nádorové buňky, kde způsobí její destrukci. Kazuistika pacientky léčené trastuzumab deruxtekanem dokládá význam plošného použití sekvenování příští generace v indikovaných případech, zejména u nekuřáků s neskvamózní histologií. Dále ukazuje na nutnost správného čtení výsledků genetického testování a zaznamenávaní výsledků do dokumentace nemocného, aby se informace o přítomné řídicí mutaci v průběhu léčby neztratila.
Around 6,000 new cases of lung cancer are diagnosed annually in the Czech Republic. Human epidermal growth factor receptor 2 (HER2) mutations are rare mutations that occur in approximately 1-4% of patients with NSCLC. In the case of a proven HER2 mutation, it is possible to use the drug trastuzumab deruxtecan in the treatment. Trastuzumab deruxtecan is an antibody-drug conjugate that combines the humanized monoclonal antibody trastuzumab with the topoisomerase I inhibitor deruxtecan. This drug binds to HER2 receptors on tumor cells. The cytostatic drug deruxtecan, together with the HER2 receptor, is internalized into the tumor cell, where it causes its destruction. The case report of a patient treated with trastuzumab deruxtecan demonstrates the importance of widespread use of next generation sequencing in indicated cases, especially in non-smokers with non-squamous histology. It also points to the necessity of correct reading of the genetic testing results and recording the results in the patient's documentation so that information about the present control mutation is not lost during the treatment.
- MeSH
- kardiovaskulární nemoci diagnostické zobrazování MeSH
- lidé MeSH
- nemoci srdce diagnostické zobrazování MeSH
- počítačová rentgenová tomografie * metody MeSH
- transplantace cév MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION: Combined immuno-oncology (IO) regimens are the cornerstone of the current front-line systemic therapy for metastatic renal cell carcinoma (mRCC). Despite the fact that combined IO regimens show high efficacy, they are often accompanied by a wide spectrum of immune-related adverse effects (irAEs). CASE PRESENTATION: We describe a case of rare irAEs manifested as giant cell temporal arteritis (GCA) followed by severe encephalopathy occurring after continuing immunotherapy in a 66-year-old man with mRCC receiving a combination of ipilimumab and nivolumab in the first line of systemic therapy. GCA occurred 4 months after the initiation of IO and responded promptly to the low-dose prednisone therapy. Four months after the continuation of nivolumab maintenance, the patient was hospitalized due to severe irAE encephalopathy which presented as psycho-behavioral abnormalities and progressive cognitive decline. He was treated with high-dose methylprednisolone which led to complete resolution of the symptoms and IO was permanently discontinued. The patient achieved a durable partial response. CONCLUSION: Both GCA and the subsequent encephalopathy in our patient responded well to the corticosteroid therapy, leading to the complete resolution of the symptoms and the patient achieved a durable partial response. Although the risk of severe neurologic irAEs affecting the central nervous system induced by IO re-administration, following previous discontinuation due to irAE, is not well-defined because of their rarity, this case highlights the need for caution, particularly in cases with a history of previous irAE-associated GCA.
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Možnost řešení objemné ureterokély v dětském věku. Prezentujeme kazuistiku chlapce, který byl na našem pracovišti operován pro ureterokélu s mnohočetnou ureterolitiázou.
The possibility of solving a bulky uretererocele in childhood. We present a case report of a boy who was operated on at our institution for ureterocele with multiple ureterolithiasis.
- MeSH
- diagnostické techniky urologické MeSH
- dítě MeSH
- endoskopie metody MeSH
- lidé MeSH
- nefrolitiáza terapie MeSH
- ureterokéla * diagnostické zobrazování diagnóza komplikace terapie MeSH
- urolitiáza diagnostické zobrazování terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Castleman ́s disease is an extremely rare heterogenous lymphoproliferative pathology with a mostly benign behavior. It is a localized or generalized lymph node enlargement of an unknown aetiology. Unicentric form is typically a slow-growing solitary mass occurring mostly in the mediastinum, abdominal cavity, retroperitoneum, pelvis and neck. Aetiology and pathogenesis of CD is probably diverse, varying in different types of this heterogeneous disease. MATERIALS AND METHODS: Authors present a review of this issue based on their extensive experience. The aim is to summarize the crucial factors in the management of diagnostics and a surgical treatment of the unicentric form of Castleman ́s disease. One of the key issues in the unicentric form is precise preoperative diagnostics and thus choosing the right surgical treatment strategy. Authors highlight pitfalls of the diagnosis and surgical treatment. RESULTS: All histological types such as a hyaline vascular type, plasmacytic type and a mixed type are presented as well as options of surgical and conservative treatment. Differential diagnosis and malignant potential is discussed. CONCLUSION: Patients with Castleman ́s disease should be treated in the high- volume centers, with a great experience in major surgical procedures as well as with preoperative imaging diagnostic techniques. Specialized pathologists and oncologists focusing on this issue are also absolutely necessary to avoid misdiagnosis. Only this complex approach can lead to excellent outcomes in patients with UCD.
- Publikační typ
- systematický přehled MeSH
