Objectives: To extend and revise the diagnostic value of contrast-enhanced ultrasonography (CEUS) for differentiation between malignant and benign thyroid nodules. Methods: This single-institution prospective study aims to compare CEUS qualitative and objective quantitative parameters in benign and malignant thyroid nodules. Consecutive cohort of 100 patients was examined by CEUS, 68 out of them were further analysed in detail. All included patients underwent cytological and/or histopathological verification of the diagnosis. Results: Fifty-five (81%) thyroid nodules were benign, and 13 (19%) were malignant. Ring enhancement pattern was strongly associated with a benign aetiology (positive predictive value 100%) and heterogeneous enhancement pattern with malignant aetiology (positive predictive value 72.7%). The shape of the TIC (time-intensity curve) was more often identical in the benign lesion (98.2%) than in malignant lesions (69.2%), p=0.004. Conclusions: This study indicates that CEUS enhancement patterns were significantly different in benign and malignant lesions. Ring enhancement was a very strong indicator of benign lesions, whereas heterogeneous enhancement was valuable to detect malignant lesions.
- Publikační typ
- tisková chyba MeSH
PURPOSE: To analyse whether endobiliary radiofrequency ablation prior metal stent insertion in malignant biliary stenosis show improved survival or stent patency. METHODS: 76 patients with histologically proven malignant biliary stenosis have been enrolled in a prospective, randomized study. In control arm, 40 patients underwent self-expandable metal stent insertion. In experimental arm, the endoluminal ablation with a bipolar radiofrequency catheter was performed immediately before stent insertion. A subgroup analysis of cholangiocarcinoma was performed (22 vs 21 patients). The objective of the study was to determine the rate of complications, duration of the stent patency and the survival of patients (Kaplan-Meier analysis). RESULTS: No major complications related to the stent insertion and the endoluminal ablation were found. The mean primary stent patency was 5.2 (95% CI 0.7-12.8) vs 4.8 months (95% CI 0.8-18.2) months (p = 0.79) in control and experimental group, respectively, in the subgroup analysis with cholangiocarcinoma 4.5 (95% CI 0.8-10.3) and 9.6 (95% CI 5.2-11.2) months (p = 0.029). The median survival since the insertion of the stent was 6.8 (95 %CI 3.0-10.6) vs 5.2 (95 %CI 2.4-7.9) months (p = 0.495) and since the initial drainage 9.8 (95 %CI 6.9-12.7) vs 9.1 (95 %CI 5.4-12.7) months (p = 0.720) in the control and experimental arm. CONCLUSION: Endobiliary radiofrequency ablation prior metal stent insertion showed increased patency rate only in patients with cholangiocarcinoma, on the other hand, no improvement in survival was demonstrated in this randomized clinical study.
- MeSH
- cholestáza * chirurgie MeSH
- katetrizační ablace * MeSH
- lidé MeSH
- nádory žlučových cest * chirurgie MeSH
- prospektivní studie MeSH
- radiofrekvenční ablace * MeSH
- stenóza MeSH
- stenty MeSH
- výsledek terapie MeSH
- žlučové cesty intrahepatální MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: The incidence of difficult airway in paediatric patients is lower than that the adult population, and the majority should be predictable. AIMS: The primary aim of this trial was to evaluate the incidence of difficult airway in pediatric patients. The secondary aim was to predict difficult airway in these patients. METHODS: Paediatric patients undergoing elective surgery under general anaesthesia in a tertiary university hospital were examined, and a panel of difficult airway prediction tests was performed. We recorded the incidence, risk factors for difficult airway and events associated with difficult airway together with the sensitivity and specificity of tests for difficult airway and events associated with difficult airway prediction. RESULTS: We prospectively included 389 paediatric patients. The incidence of difficult airway was 3.6%; the incidence of events associated with difficult airway was 10%. The sensitivity for prediction of events associated with difficult airway during the pre-anaesthesia evaluation was 5.3% with the specificity 93.3%. In the operating room, the sensitivity of prediction was 15% with 97.8% specificity. CONCLUSION: We found minimal efficacy for preanaesthesia difficult airway prediction.
- MeSH
- celková anestezie * MeSH
- dítě MeSH
- dospělí MeSH
- elektivní chirurgické výkony * MeSH
- intratracheální intubace MeSH
- lidé MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senzitivita a specificita MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie 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 MeSH
- chirurgická rána * imunologie MeSH
- chirurgie trávicího traktu * metody škodlivé účinky MeSH
- Crohnova nemoc * chirurgie diagnóza epidemiologie imunologie MeSH
- endoskopie trávicího systému metody statistika a číselné údaje MeSH
- ileocekální chlopeň chirurgie patologie MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace chirurgie diagnóza MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
Úvod: Krvácení do horního gastrointestinálního traktu (GIT) patří mezi život ohrožující stavy, které vyžadují aktivní přístup a dynamický management akutní péče. Gastroskopie představuje zásadní diagnostický a terapeutický krok. Bohužel mnoho menších nemocnic nemá možnost provést gastroskopii mimo pracovní dobu. Glasgow-Blatchford skóre (GBS) představuje nástroj umožňující odhad vývoje stavu pacienta s krvácením do horního GIT. Evropská guidelines doporučují ambulantní řešení pacientů s GBS rovno 0 nebo 1. Cílem naší studie bylo posoudit použitelnost GBS na české populaci a zhodnotit bezpečnost vyšší hranice GBS pro řešení pacientů v ambulantním režimu. Metody: Retrospektivní sběr dat pacientů, kteří byli hospitalizováni a endoskopováni v Nemocnici Boskovice pro symptomy krvácení z horního GIT od října 2018 do prosince 2019. Výsledky: Data hodnotící celkový průběh onemocnění naznačují, že optimální GBS pro stanovení pacienta s nízkým rizikem je ≤ 3, ale s přihlédnutím k endoskopickým nálezům lze za bezpečné pro ambulantní léčbu považovat GBS ≤ 2. ≥ 10 pak předpovídá závažný celkový průběh nemoci a závažné endoskopické nálezy. Závěr: Dle našich dat lze zvýšit hodnotu GBS na 2 pro ambulantní řešení pacientů, což by mohlo snížit délku hospitalizace a tlak na urgentní endoskopie. Tyto závěry je nutné ověřit dalším výzkumem ideálně multicentrickou prospektivní studií s velkým množstvím analyzovaných pacientů.
Introduction: Upper gastrointestinal (GI) bleeding is a medical emergency that requires rapid assessment and dynamic management. Gastroscopy represents a crucial part of the diagnostic and therapeutic process. Unfortunately, in many hospitals emergency endoscopy is not easily available outside working hours. The Glasgow Blatchford score (GBS) predicts the outcome of patients at present. The European guidelines recommend outpatient management for a GBS of 0 or 1. The aim of our study was to validate the applicability of GBS in a population of Czech patients and to evaluate whether extending the GBS allows for early discharge while keeping the patient safe. Methods: Retrospectively collected data of patients who underwent gastroscopy in the endoscopy ward of Boskovice Hospital for symptoms of upper GI bleeding between October 2018 and December 2019. Results: Data based on the overall course of the disease suggest that the optimal GBS for determining a low-risk patient is 3, but concerning the endoscopic findings, GBS ≤ 2 should be considered safe for outpatient management. A GBS ≥ 10 predicts a severe overall course of the disease and a severe endoscopic finding. Conclusion: According to our data, the GBS could be extended to 2 for safe outpatient management, which might reduce the length of stay at the hospital and the pressure for urgent endoscopies. Further studies with more patients are necessary.
- Klíčová slova
- Glasgow-Blatchford skóre,
- MeSH
- ambulantní péče MeSH
- gastrointestinální krvácení * diagnostické zobrazování terapie MeSH
- gastroskopie MeSH
- hodnocení rizik MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- stupeň závažnosti nemoci * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Celiac disease (CD) is an immune-mediated enteropathy that is primarily treated with a gluten-free diet (GFD). Mucosal healing is the main target of the therapy. Currently, duodenal biopsy is the only way to evaluate mucosal healing, and non-invasive markers are challenging. Persistent elevation of anti-tissue transglutaminase antibodies (aTTG) is not an ideal predictor of persistent villous atrophy (VA). Data regarding prediction of atrophy using anti-deamidated gliadin peptide antibodies (aDGP) and abdominal ultrasonography are lacking. AIM: To evaluate the ability of aTTG, aDGP, small bowel ultrasonography, and clinical and laboratory parameters in predicting persistent VA determined using histology. METHODS: Patients with CD at least 1 year on a GFD and available follow-up duodenal biopsy, levels of aTTG and aDGP, and underwent small bowel ultrasonography were included in this retrospective cohort study. We evaluated the sensitivity, specificity, and positive and negative predictive values of aTTG, aDGP, small bowel ultrasonography, laboratory and clinical parameters to predict persistent VA. A receiver operating characteristic (ROC) curve analysis of antibody levels was used to calculate cut off values with the highest accuracy for atrophy prediction. RESULTS: Complete data were available for 82 patients who were followed up over a period of four years (2014-2018). Among patients included in the analysis, women (67, 81.7%) were predominant and the mean age at diagnosis was 33.8 years. Follow-up biopsy revealed persistent VA in 19 patients (23.2%). The sensitivity and specificity of aTTG using the manufacturer's diagnostic cutoff value to predict atrophy was 50% and 85.7%, respectively, while the sensitivity and specificity of aDGP (using the diagnostic cutoff value) was 77.8% and 75%, respectively. Calculation of an optimal cutoff value using ROC analysis (13.4 U/mL for aTTG IgA and 22.6 U/mL for aDGP IgA) increased the accuracy and reached 72.2% [95% confidence interval (CI): 46.5-90.3] sensitivity and 90% (95%CI: 79.5-96.2) specificity for aDGP IgA and 66.7% (95%CI: 41.0-86.7) sensitivity and 93.7% (95%CI: 84.5-98.2) specificity for aTTG IgA. The sensitivity and specificity of small bowel ultrasonography was 64.7% and 73.5%, respectively. A combination of serology with ultrasound imaging to predict persistent atrophy increased the positive predictive value and specificity to 88.9% and 98% for aTTG IgA and to 90.0% and 97.8% for aDGP IgA. Laboratory and clinical parameters had poor predictive values. CONCLUSION: The sensitivity, specificity, and negative predictive value of aTTG and aDGP for predicting persistent VA improved by calculating the best cutoff values. The combination of serology and experienced bowel ultrasound examination may achieve better accuracy for the detection of atrophy.
- MeSH
- atrofie MeSH
- autoprotilátky * analýza MeSH
- biopsie MeSH
- celiakie * diagnóza patologie MeSH
- gliadin MeSH
- imunoglobulin A MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- transglutaminasy MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: To determine the benefit of contrast-enhanced ultrasound (CEUS) in the assessment of breast lesions. METHODS: A standardized contrast-enhanced ultrasound was performed in 230 breast lesions classified as BI-RADS category 3 to 5. All lesions were subjected to qualitative and quantitative analysis. MVI (MicroVascular Imaging) technique was used to derive qualitative analysis parameters; blood perfusion of the lesions was assessed (perfusion homogeneity, type of vascularization, enhancement degree). Quantitative analysis was conducted to estimate perfusion changes in the lesions within drawn regions of interest (ROI); parameters TTP (time to peak), PI (peak intensity), WIS (wash in slope), AUC (area under curve) were obtained from time intensity (TI) curves. Acquired data were statistically analyzed to assess the ability of each parameter to differentiate between malignant and benign lesions. The combination of parameters was also evaluated for the possibility of increasing the overall diagnostic accuracy. Biological nature of the lesions was verified by a pathologist. Benign lesions without histopathological verification (BI-RADS 3) were followed up for at least 24 months. RESULTS: Out of 230 lesions, 146 (64%) were benign, 67 (29%) were malignant, 17 (7%) lesions were eliminated. Malignant tumors showed statistically significantly lower TTP parameters (sensitivity 77.6%, specificity 52.7%) and higher WIS values (sensitivity 74.6%, specificity 66.4%) than benign tumors. Enhancement degree also proved to be statistically well discriminating as 55.2% of malignant lesions had a rich vascularity (sensitivity 89.6% and specificity 48.6%). The combination of quantitative analysis parameters (TTP, WIS) with enhancement degree did not result in higher accuracy in distinguishing between malignant and benign breast lesions. CONCLUSIONS: We have demonstrated that contrast-enhanced breast ultrasound has the potential to distinguish between malignant and benign lesions. In particular, this method could help to differentiate lesions BI-RADS category 3 and 4 and thus reduce the number of core-cut biopsies performed in benign lesions. Qualitative analysis, despite its subjective element, appeared to be more beneficial. A combination of quantitative and qualitative analysis did not increase the predictive capability of CEUS.
- MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- kontrastní látky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory prsu diagnostické zobrazování patologie MeSH
- prospektivní studie MeSH
- prsy diagnostické zobrazování patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- stupeň nádoru MeSH
- ultrasonografie prsů metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem 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
