AIM: Transbronchial cryobiopsies are increasingly used for the diagnosis of interstitial lung disease (ILD), but there is a lack of published information on the features of specific ILD in cryobiopsies. Here we attempt to provide pathological guidelines for separating usual interstitial pneumonia (UIP) of idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis (FHP) and connective tissue disease-associated ILD (CTD-ILD) in cryobiopsies. METHODS: We examined 120 cryobiopsies from patients with multidisciplinary discussion (MDD)-established CTD-ILD and compared them to a prior series of 121 biopsies from patients with MDD-established IPF or FHP. RESULTS: A non-specific interstitial pneumonia (NSIP) pattern alone was seen in 36 of 120 (30%) CTD-ILD, three of 83 (3.6%) FHP and two of 38 (5.2%) IPF cases, statistically favouring a diagnosis of CTD-ILD. The combination of NSIP + OP was present in 29 of 120 (24%) CTD-ILD, two of 83 (2.4%) FHP and none of 38 (0%) IPF cases, favouring a diagnosis of CTD-ILD. A UIP pattern, defined as fibroblast foci plus any of patchy old fibrosis/fibrosis with architectural distortion/honeycombing, was identified in 28 of 120 (23%) CTD-ILD, 45 of 83 (54%) FHP and 27 of 38 (71%) IPF cases and supported a diagnosis of FHP or IPF. The number of lymphoid aggregates/mm2 and fibroblast foci/mm2 was not different in IPF, CTD-ILD or FHP cases with a UIP pattern. Interstitial giant cells supported a diagnosis of FHP or CTD-ILD over IPF, but were infrequent. CONCLUSIONS: In the correct clinical/radiological context the pathological findings of NSIP, and particularly NSIP plus OP, favour a diagnosis of CTD-ILD in a cryobiopsy, but CTD-ILD with a UIP pattern, FHP with a UIP pattern and IPF generally cannot be distinguished.
- MeSH
- biopsie metody MeSH
- dospělí MeSH
- idiopatická plicní fibróza patologie komplikace diagnóza MeSH
- intersticiální plicní nemoci * patologie diagnóza komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci pojiva * komplikace patologie diagnóza MeSH
- plíce patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Stability of concentrations of urinary stone-related metabolites was analyzed from samples of recurrent urinary stone formers to assess necessity and effectiveness of urine acidification during collection and storage. METHODS: First-morning urine was collected from 20 adult calcium-stone forming patients at Tomas Bata Hospital in the Czech Republic. Urine samples were analyzed for calcium, magnesium, inorganic phosphate, uric acid, sodium, potassium, chloride, citrate, oxalate, and urine particles. The single-voided specimens were collected without acidification, after which they were divided into three groups for storage: samples without acidification ("NON"), acidification before storage ("PRE"), or acidification after storage ("POST"). The analyses were conducted on the day of arrival (day 0, "baseline"), or after storage for 2 or 7 days at room temperature. The maximum permissible difference (MPD) was defined as ±20 % from the baseline. RESULTS: The urine concentrations of all stone-related metabolites remained within the 20 % MPD limits in NON and POST samples after 2 days, except for calcium in NON sample of one patient, and oxalate of three patients and citrate of one patient in POST samples. In PRE samples, stability failed in urine samples for oxalate of three patients, and for uric acid of four patients after 2 days. Failures in stability often correlated with high baseline concentrations of those metabolites in urine. CONCLUSIONS: Detailed procedures are needed to collect urine specimens for analysis of urinary stone-related metabolites, considering both patient safety and stability of those metabolites. We recommend specific preservation steps.
- MeSH
- analýza moči metody MeSH
- dospělí MeSH
- koncentrace vodíkových iontů MeSH
- kyselina močová moč MeSH
- lidé středního věku MeSH
- lidé MeSH
- močové kameny * moč MeSH
- odběr biologického vzorku metody MeSH
- recidiva * MeSH
- sbírání vzorku moči metody MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- drenáž klasifikace metody MeSH
- katetrizace močového měchýře * klasifikace metody MeSH
- lidé MeSH
- močové katétry klasifikace MeSH
- novorozenec MeSH
- sbírání vzorku moči metody MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive disease characterized by disproportionate ventricular enlargement at brain imaging with gait disturbance and an increased risk of falling. Gait assessment is a key feature in the diagnosis of iNPH and characterization of post-surgical outcomes. RESEARCH QUESTION: How do gait parameters change 24 h after CSF tap test (CSFTT) and after ventriculoperitoneal shunt surgery? METHODS: The PRISMA guidelines were used to perform the systematic review. We conducted a search of the following electronic databases: PubMed, Medline, Web of Science and EBSCO. We included studies focusing on gait changes occurring 24 h after a CSFTT or after ventriculoperitoneal shunt surgery in patients with iNPH. All articles were assessed for methodological quality using an adapted version of The Standard Quality Assessment Criteria for Evaluating Primary Research Papers checklist. RESULTS: Twenty-seven studies were included in the systematic review. Studies were highly heterogeneous due to lack of standardization of CSFTT or shunt surgery methodology, with varying amounts of CSF removed during the tap test (20-50 ml) and varying time of outcome assessment after shunt surgery. Dynamic equilibrium measurements are generally used to assess preoperative levels of cardinal symptoms and postoperative outcomes in iNPH. The most sensitive spatio-temporal parameter assessed 24 h after CSFTT was self-selected walking speed followed by stride length, which increased significantly. Cadence is hence not suitable to consider in the evaluation of effect of CSFTT and shunt surgery. Changes in balance-related gait parameters after CSFTT and shunt surgery are still a controversial area of research. CONCLUSION: Gait assessment is a key feature in the diagnosis of iNPH and characterization of post-surgical outcomes. Dynamic equilibrium measurements are generally used to assess preoperative levels of cardinal symptoms and postoperative outcomes in iNPH, but quantitative and standardized gait analysis procedures are missing. Changes in balance-related gait parameters after CSFTT might be useful in deciding whether to perform shunt surgery in iNPH patients who hope for improvement in gait ability. The dual-task paradigm after CSFTT could improve the clinical evaluation of higher level frontal gait disturbances in patients with suspected iNPH before shunting.
- MeSH
- chůze (způsob) * fyziologie MeSH
- lidé MeSH
- normotenzní hydrocefalus * chirurgie patofyziologie mozkomíšní mok diagnóza MeSH
- shunty pro odvod mozkomíšního moku MeSH
- spinální punkce metody MeSH
- ventrikuloperitoneální zkrat MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
Endometrial biopsies are important in the diagnostic workup of women who present with abnormal uterine bleeding or hereditary risk of endometrial cancer. In general, approximately 10% of all endometrial biopsies demonstrate endometrial (pre)malignancy that requires specific treatment. As the diagnostic evaluation of mostly benign cases results in a substantial workload for pathologists, artificial intelligence (AI)-assisted preselection of biopsies could optimize the workflow. This study aimed to assess the feasibility of AI-assisted diagnosis for endometrial biopsies (endometrial Pipelle biopsy computer-aided diagnosis), trained on daily-practice whole-slide images instead of highly selected images. Endometrial biopsies were classified into 6 clinically relevant categories defined as follows: nonrepresentative, normal, nonneoplastic, hyperplasia without atypia, hyperplasia with atypia, and malignant. The agreement among 15 pathologists, within these classifications, was evaluated in 91 endometrial biopsies. Next, an algorithm (trained on a total of 2819 endometrial biopsies) rated the same 91 cases, and we compared its performance using the pathologist's classification as the reference standard. The interrater reliability among pathologists was moderate with a mean Cohen's kappa of 0.51, whereas for a binary classification into benign vs (pre)malignant, the agreement was substantial with a mean Cohen's kappa of 0.66. The AI algorithm performed slightly worse for the 6 categories with a moderate Cohen's kappa of 0.43 but was comparable for the binary classification with a substantial Cohen's kappa of 0.65. AI-assisted diagnosis of endometrial biopsies was demonstrated to be feasible in discriminating between benign and (pre)malignant endometrial tissues, even when trained on unselected cases. Endometrial premalignancies remain challenging for both pathologists and AI algorithms. Future steps to improve reliability of the diagnosis are needed to achieve a more refined AI-assisted diagnostic solution for endometrial biopsies that covers both premalignant and malignant diagnoses.
- MeSH
- biopsie MeSH
- hyperplazie MeSH
- lidé MeSH
- počítače * MeSH
- reprodukovatelnost výsledků MeSH
- studie proveditelnosti MeSH
- umělá inteligence * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.
- MeSH
- biopsie tenkou jehlou pod endosonografickou kontrolou MeSH
- endosonografie metody MeSH
- gastrointestinální endoskopie * výchova MeSH
- kurikulum * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- centrální nervový systém anatomie a histologie fyziologie MeSH
- disekce MeSH
- elektroencefalografie MeSH
- lidé MeSH
- mozek * anatomie a histologie chirurgie fyziologie patologie MeSH
- neurozobrazování metody MeSH
- poruchy vědomí MeSH
- teoretické modely MeSH
- vědomí fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
ANCA-asociované vaskulitidy jsou nekrotizující vaskulitidy malých cév s minimem imunodepozit. Obvykle jsou doprovázené pozitivitou ANCA protilátek (AntiNeutrophil Cytoplasmic Antibody, protilátky proti cytoplazmě neutrofilů), jejichž cílovými antigeny může být proteináza 3 (PR3-ANCA) nebo myeloperoxidáza (MPO-ANCA). Mezi ANCA-asociované vaskulitidy patří granulomatóza s polyangiitidou (dříve Wegenerova), mikroskopická polyangiitida a eozinofilní granulomatóza s polyangiitidou (dříve syndrom Churga a Straussové). Nejčastěji postiženými orgány bývají plíce a dýchací cesty, ORL oblast a ledviny. Při postižení ledvin je typickým projevem pauciimunní nekrotizující srpkovitá rychle progredující glomerulonefritida. Akutním život ohrožujícím stavem je pulmo-renální syndrom s krvácením do plic a selháváním ledvin. V diagnostice se využívá stanovení ANCA protilátek, zobrazovací metody a biopsie. Pro dobrou prognózu je nezbytné časné stanovení správné diagnózy i časné podání adekvátní terapie, kterou dnes nejčastěji bývá kombinace kortikosteroidů a buď cyklofosfamidu nebo rituximabu (monoklonální protilátky proti antigenu CD20). Stále je možné zvážit v léčbě těžkých případů přidání plazmaferézy. Rituximab je lékem volby v terapii relabující vaskulitidy. Adresa pro korespondenci: MUDr. Zdenka Hrušková, PhD. Klinika nefrologie VFN a 1. LF UK U Nemocnice 499/2 128 08 Praha 2 email: hruskova.zdenka@vfn.cz
ANCA-associated vasculitides (AAV) are small-vessel necrotizing vasculitides, with no or few immune deposits. They are usually associated with the presence of ANCA antibodies (AntiNeutrophil Cytoplasmic Antibody), targeted either against proteinase 3 (PR3-ANCA) or myeloperoxidase (MPO-ANCA). ANCA-associated vasculitides include granulomatosis with polyangiitis (formerly Wegener‘s), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome). The most commonly afflicted organs involve the lungs and the respiratory tract, ENT area, and the kidneys. Renal involvement typically manifests as pauci-immune necrotizing crescentic rapidly progressive glomerulonpehritis. Pulmo-renal syndrome with lung haemorrhage and deteriorating kidney function may be acutely life-threatening. Diagnostic methods include ANCA measurement, imaging methods and biopsy. Early recognition of the diagnosis and an early start of adequate treatment are necessary for a good outcome. The current treatment typically consists of corticosteroids and either cyclophoshapmide or rituximab (a monoclonal antibody directed against CD20 antigen). The addition of plasma exchange may be considered in severe cases. Rituximab is preferred for the treatment of all relapsing forms of this vasculitis.
Gastrointestinální trakt představuje častou lokalitu pro dobře diferencované neuroendokrinní tumory (NET). Jejich výskyt u pacientů s ulcerózní kolitidou (UC) není častý, je však dobře dokumentovaný. Případný kauzální vztah mezi rozvojem NET a chronickým zánětem střevní sliznice či dysplázií epitelu nicméně zůstává nejasný. Výskyt NET v ileálním pouchi u pacientů s UC byl dosud popsán jen v několika kazuistických sděleních. Prezentujeme zde případ takovéhoto nádoru vznikajícího ve sliznici pouche u pacienta s UC asociovanou s primární sklerozující cholangoitidou, který podstoupil transplantaci jater a restorativní kolektomii s následnou ileální pouch-anální anastomózou. Popis případu je doplněn o přehled dostupné literatury.
Gastrointestinal tract is the most common locality for well-differentiated neuroendocrine tumors (NET). While their occurrence in patients with ulcerative colitis (UC) is uncommon, it has been well documented. However, the causal relationship between development of NET and chronic intestinal inflammation or dysplasia remains controversial. The presence of NET in the ileal pouch in UC patients has been described only in a few reports to date. In this article, we present a case of such a tumor arising in the pouch in a patient with primary sclerosing cholangitis-associated UC, who underwent a restorative proctocolectomy with ileal pouch anal anastomosis and liver transplantation. The case is supported by a review of a relevant literature. Correspondence address: Ondrej Fabian Clinical and Transplant Pathology Centre Institute for Clinical and Experimental Medicine Videnska 1958/9 Prague, 14021 Czech Republic ondrej.fabian@ikem.cz; ondrejfabian5@gmail.com
BACKGROUND: Cross-sectional anatomy is a challenging yet a vital foundation to clinical practice. The traditional teachings of gross anatomy cadaveric dissections do not cover adequate training of recognizing anatomical structures on CT, MRI and sonographic cross-sections. New modern technologies are emerging as teaching tools in anatomy aiming to deliver visual interactive experience. The Visible Human Project provides a library of cross-sectional images compiled from cryosectioned body donors that was utilized by modern technologies such as the virtual dissection table (Anatomage) in constructing 3D software applications visualizing the internal composition of the human body virtually. Hereby, this article explores an integrative approach utilizing the Visible Human Project based applications and basic radiological modalities. PURPOSE: The purpose of our newly implemented teaching approach was to test and assure technology fitness to the medical curriculum and its potential influence on students' performance in learning gross as well as cross-sectional anatomy in much depth. BASIC PROCEDURES: A three years (2021-2024) observational study was conducted by implanting a practical cross-sectional anatomy optional course by selectively utilizing Anatmage interactively beside CT, MRI and ultrasound practice. The performance of 50 participants was evaluated in the form of a written test comprised of labeling of ten cross-sectional images and drawing of two cross-section schemes. Their optional course test scores were compared to their obligatory anatomy subject test scores; and to a non-participants control group of 50 retrospective obligatory anatomy subject test scores. In addition, the participants' attitude toward the training lessons was assessed through a survey focused on satisfaction level, competence and ability to recognize structures on radiological images. MAIN FINDINGS: The participants reported a high level of practical engagement. The test scores in the anatomy obligatory subject were positively influenced by this implemented practical course. Students showed improved test scores in the standardized labeling keyword questions, while the scheme questions showed discrepancy. PRINCIPAL CONCLUSIONS: Integrating Visible Human Project based applications with radiological modalities showed positive efficacy on the students' engagement and learning performance. Inevitably, cadaveric dissection and prosection remain the cornerstone of gross anatomy education. Integrating both modalities of teaching would excel students' practical skills in applied clinical anatomy.
- MeSH
- anatomie průřezová * výchova MeSH
- anatomie výchova MeSH
- disekce výchova MeSH
- dospělí MeSH
- kurikulum * MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mladý dospělý MeSH
- mrtvola MeSH
- projekty vizualizace člověka * MeSH
- průřezové studie MeSH
- školy lékařské MeSH
- studenti lékařství MeSH
- studium lékařství pregraduální metody MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
