BACKGROUND: Lung cancer is one of the leading causes of death worldwide, with incidence and mortality significantly affected by population ageing and changes in the prevalence of risk factors. Lung nodules, which are often detected incidentally on imaging studies, pose a significant diagnostic challenge as they may indicate both benign and malignant processes. Correct diagnosis and management of these nodules is therefore essential to optimize clinical outcomes. PURPOSE: This article provides a comprehensive review of diagnostic and therapeutic approaches to pulmonary nodules, focusing on the assessment of malignant potential based on nodule morphology, size and growth potential. Risk factors influencing the decision-making process such as smoking, age and exposure to carcinogens are also discussed. In addition, key recommendations from the Fleischner Society and the British Thoracic Society are discussed in detail. The article analyses the benefits of modern imaging techniques, including the use of artificial intelligence (AI) in the diagnosis of lung nodules. AI technologies, particularly deep learning techniques, have shown high accuracy in detecting and assessing malignancy risk, and their use is increasingly complementary to expert clinical judgement. Finally, the article highlights the importance of a multidisciplinary approach to the diagnosis and management of lung nodules, and also mentions the implementation of a pilot lung cancer screening programme in the Czech Republic aimed at early detection of the disease. This programme has the potential to significantly reduce lung cancer mortality and improve patient prognosis.
- Klíčová slova
- CT, cervix, dispensary, long-term follow-up, lung cancer, pulmonary nodule, pulmonary nodule management,
- MeSH
- časná detekce nádoru MeSH
- lidé MeSH
- mnohočetné plicní uzly * terapie diagnóza diagnostické zobrazování MeSH
- nádory plic * diagnóza terapie MeSH
- rizikové faktory MeSH
- solitární plicní uzel terapie diagnóza diagnostické zobrazování MeSH
- umělá inteligence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Prognosis of patients with metastatic gastric cancer is abysmal, usually just a few months. S-1 is a peroral fluoropyrimidine antitumor drug. It is a fixed combination of three effective drugs - tegafur, gimeracil and oteracil potassium. CASE: This is a case report of a 71-year-old man treated for local advanced and metastatic gastric carcinoma treated with combination of S-1 and cisplatin as a first line of therapy. Treatment response reached partial remission and lasted for six months. Treatment was very well tolerated, with no grade 3 and 4 toxicity. After progression, the patient was treated with further lines of therapy. CONCLUSION: In the Czech Republic, experience with S-1 drug is very limited. Our case report showed a good treatment response and minimal toxicity of this treatment, in concordance with results of the study FLAGS.
- MeSH
- cisplatina aplikace a dávkování MeSH
- fixní kombinace léků MeSH
- ftorafur aplikace a dávkování MeSH
- karcinom farmakoterapie sekundární MeSH
- kyselina oxonová aplikace a dávkování MeSH
- lidé MeSH
- nádory žaludku farmakoterapie patologie MeSH
- protinádorové antimetabolity terapeutické užití MeSH
- protinádorové látky terapeutické užití MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití MeSH
- pyridiny aplikace a dávkování MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Geografické názvy
- Česká republika MeSH
- Názvy látek
- cisplatina MeSH
- fixní kombinace léků MeSH
- ftorafur MeSH
- gimeracil MeSH Prohlížeč
- kyselina oxonová MeSH
- protinádorové antimetabolity MeSH
- protinádorové látky MeSH
- pyridiny MeSH
- S 1 (combination) MeSH Prohlížeč
OBJECTIVE: Large artery occlusion (LAO) in patients with major stroke predicts poor revascularization by intravenous thrombolysis (IVT) and more likely results in a poor outcome. We focused on the effects of intra-arterial thrombolysis (IAT) and endovascular mechanical recanalization (EMR) as rescue therapies in major strokes refractory to IVT. METHODS: A retrospective analysis of 87 patients (National Institutes of Health Stroke Scale >20), who did not respond to full-dose IVT due to LAO, was performed based on their endovascular therapy status. IAT was performed as an intraclot infusion of alteplase, and EMR was provided by the Solitaire device™ (Covidien, Dubin, Ireland). The recanalization and 3-month outcome rates after IAT/EMR were correlated with a group of patients who were scheduled to receive endovascular treatment but who underwent only IVT. RESULTS: We achieved successful recanalization by IAT and EMR in 68.7% and 76.1% of patients, respectively. Despite no significant differences in mortality between IAT and EMR, a trend towards better outcomes after IAT and a statistically significant increase for outcome-modified Rankin scale (mRS) 0-3 (45.7%) and mRS 0-2 (34.9%) after EMR was noted when compared with IVT. The degree of recanalization did not correlate with the functional results except for the good-moderate outcome after successful recanalization by EMR. CONCLUSION: EMR by the Solitaire device is a safe and beneficial method for the rescue treatment of patients with major stroke whose neurological status does not improve and who fail to recanalize the LAO after a 1-h full dose of IVT. ADVANCES IN KNOWLEDGE: The article verifies efficiency of the Solitaire device in major strokes.
- MeSH
- arteriální okluzní nemoci epidemiologie terapie MeSH
- cévní mozková příhoda epidemiologie terapie MeSH
- endovaskulární výkony přístrojové vybavení metody MeSH
- fibrinolytika aplikace a dávkování MeSH
- kombinovaná terapie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mechanická trombolýza přístrojové vybavení metody MeSH
- neúspěšná terapie MeSH
- retrospektivní studie MeSH
- revaskularizace mozku přístrojové vybavení metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenty * MeSH
- tkáňový aktivátor plazminogenu aplikace a dávkování MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Spojené státy americké MeSH
- Názvy látek
- fibrinolytika MeSH
- tkáňový aktivátor plazminogenu MeSH
BACKGROUND: Spontaneous hepatic bleeding is a rare but potentially life-threatening complication of primary systemic amyloidosis. Although the liver is a common site of amyloid deposition, clinical presentation is usually mild or absent. CASE: We report a case of a female patient, who had been repeatedly surgically revised because of liver rupture and hemoperitoneum. Initially, the computed tomography finding was interpreted as liver hemangioma. However, based on liver biopsy, the diagnosis had to be changed to primary systemic amyloidosis, and the patient was referred to our hematooncology department. Due to a considerably advanced disease, the patient was eligible only for palliative chemotherapy with cyclophosphamide and dexamethasone, which could not deflect the course of rapidly progressing liver destruction. CONCLUSION: The cause behind ruptured and bleeding liver does not always need to be hemangioma but rather amyloidosis. In cases of advanced disease and in patients with contraindications for aggressive treatment, the outlook for complete hematological and organ treatment response is very limited. An early diagnosis is of utmost importance. Although liver biopsy brings the definite results, screening for monoclonal protein in serum or urine, leading to a search for AL amyloidosis, may be sufficient for diagnosis. The presence of some of the warning signs (B-symptoms such as fevers or subfebrile temperatures, fatigue, weight loss; and paraneoplastic laboratory findings such as elevated C-reactive protein and erythrocyte sedimentation rate) should raise suspicion of a lymphoproliferative disease.
- MeSH
- amyloidóza komplikace diagnóza MeSH
- diferenciální diagnóza MeSH
- hemangiom diagnóza MeSH
- hemoperitoneum etiologie MeSH
- krvácení etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jater diagnóza MeSH
- nemoci jater diagnóza etiologie MeSH
- primární amyloidóza MeSH
- recidiva MeSH
- spontánní ruptura MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
At the clinic of imaging method St. Annas University Hospital solved complications arising after ortotopic liver transplantation. For more than 15 years of cooperation with CKTCH Brno intervention was performed on both the arterial and venous system, but most on the biliary tract. The order was a unit patients, which correlates with other comparable work. In the years 1998- 2013 we conducted one intervention on arterial bed, 3× intervention in hepatic venous system and we solved biliary complications in 7 transplant. .
- MeSH
- intervenční radiologie metody MeSH
- lidé MeSH
- nemoci jater chirurgie MeSH
- pooperační komplikace terapie MeSH
- transplantace jater * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Choledocholithiasis is the most common cause of biliary obstruction. Each of the testing methods used in its diagnosis has its advantages and disadvantages. OBJECTIVE OF THE STUDY: The objective of this prospective study is to compare endoscopic retrograde cholangiopancreatography with magnetic resonance cholangiopancreatography in the diagnosis of choledocholithiasis on the basis of own experience and literature data. Set of patients and methodology: The set was studied from the beginning of 2007 to the end of 2012 (i.e. six years). The study assessed prospectively 45 patients (age range 28- 72 years) with symptoms of biliary obstruction, who first underwent magnetic resonance cholangiopancreatography and subsequently endoscopic retrograde cholangiopancreatography. RESULTS: The sensitivity, specificity and diagnostic accuracy of magnetic resonance cholangiopancreatography was lower, both in our set of patients and according to the literature data, compared to the endoscopic retrograde cholangiopancreatography (92%, 91% or 93 %). CONCLUSION: Considering the frequency of complications (in some cases serious ones) following endoscopic retrograde cholangiopancreatography, the magnetic resonance cholangiopancreatography is, in spite of its lower sensitivity, the method of choice in the diagnosis of choledocholithiasis by means of noninvasive methods, on the basis of which it is possible to refer the patients subsequently for therapeutic endoscopic retrograde cholangiopancreatography.
- MeSH
- cholangiopankreatografie endoskopická retrográdní * škodlivé účinky MeSH
- choledocholitiáza diagnóza MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční cholangiopankreatografie * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
BACKGROUND: Multiple myeloma pathogenesis, pathology, symptoms and imaging techniques used in clinical diagnostic algorithm, the indications and the differences between currently available imaging methods. DESIGN: The article describes advantages and disadvantages of basic X-ray imaging and recommended skeleton screening, as the method of first choice, followed by description of the most frequently affected areas and Mirels score. The present golden standard magnetic resonance (MR) imaging, its potential and also recommended MR indications. Concerning computer tomography (CT) imaging, mainly comparison between CT and MR and X-ray imaging its indications and benefits as the interventional instrument are mentioned. The arcticle also focuses on the role of skeleton scintigraphy with Tc-pyrophosphate, which is not recommended today, and the role of positron emission tomography with fluorodeoxyglucose (FDG-PET) in the assessment of the therapy effectiveness and prognosis for patients, its future and present limitations. The next commonly used radioisotope imaging with 99Tc-sestamibi (MIBI) and its comparison to other methods, especially to the FDG-PET and recommended indications for both techniques. Last aim is description of specification of bone tissue density with Dual Energy X-ray Absorption scanning method (DEXA). CONCLUSION: These imaging methods are commonly used as additional diagnostic tests in initial diagnostic -work-up and in follow-up due to frequent relapses of multiple myeloma.
Histiocytic diseases caused by proliferation and accumulation of phagocytosing macrophages (foamy macrophages) have many clinical forms. These are classified under "juvenile xanthogranuloma" within the WHO classification of blood disorders. Localized forms with benign course include normolipaemic xanthomatosis, xanthogranuloma and necrobiotic xanthogranuloma. Disseminated forms in children take a form of so called "disseminated juvenile xanthogranuloma" or Erdheim-Chester disease in adults. We describe a case of a patient who, at 53 years of age, first noticed yellow granulomas on her eyelids. The disease progressed gradually and, at 59, affects the eyelids as well as their closest surroundings. According to MR and PET-CT, the disease gradually infiltrated the inside of the orbit, orbital fat as well as extraocular muscles and started to cause exoftalmus of one of the eyes. Propagation of the xanthogranuloma into the orbit and infiltration of extraocular muscles might impair eye function. Over the last year, the patient complained of cough. Pulmonary function evaluation confirmed recent asthma bronchiale. These findings correspond to periocular xanthogranuloma associated with adult-onset asthma. No other abnormities have been shown in this patient. Exoftalmus was observed in 2011 after 6 years of monitoring with very slow progression of eyelid and extraocular infiltration. Therefore, prednisone was initiated in 2011, leading to cessation of exoftalmus. It is not known at present whether this is a permanent improvement with a suppression of histiocytary proliferation or whether this was a temporary improvement due to suppression of inflammatory changes in the xanthogranuloma with no effect on histiocytary proliferation. Progression during therapy with corticosteroids would warrant cytostatic treatment. The discussion section provides an overview of diseases caused by foamy histiocytes with illustrations and an overview of experiences with their treatment.
- MeSH
- bronchiální astma komplikace MeSH
- Erdheimova-Chesterova nemoc diagnóza MeSH
- granulom komplikace patologie MeSH
- juvenilní xantogranulom diagnóza terapie MeSH
- kašel komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci očních víček komplikace diagnóza patologie MeSH
- xantomatóza komplikace patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUNDS: Multiple angiomatosis is a rare disease causing angiomatous lesions in multiple organs and tissues with a risk of life-threatening haemorrhage. OBSERVATION: A young man was diagnosed with multiple angiomatosis at the age of 28 after two years of back and abdominal pain. Laparotomy revealed multiple spongy lesions mostly within the retroperitoneal space. Also, an involvement of the gut wall, bones and mediastinum was evident. After 6 years of treatment, the disease has been stabilized. Bone pain ceased with a significant contribution of zoledronate. Using CT and MR imaging, the effectiveness of antiangiogenic drugs was evaluated. Furthermore, treatment response was evaluated using laboratory values for coagulation and blood count, as angiomatous proliferation is known to be associated with disseminated intravascular coagulation and anaemia. RESULTS: Baseline laboratory examination revealed elevated D-dimer (more than 20 µg/mL), low fibrinogen (1.4 g/L), and the presence of fibrin monomers. After treatment with 6 mil. IU of interferon-alpha thrice weekly, there was only partial improvement in D-dimer (17.2 µg/mL) and fibrinogen (1.5 g/L) concentrations but fibrin monomers remained positive. After thalidomide (100 mg daily), D-dimer decreased to 6.1 µg/mL and fibrinogen levels increased to 1.9 g/L with the disappearance of fibrin monomers. CT scanning showed significant regression of angiomatous lesions. Progressive neuropathy was the reason to lower the dose of thalidomide by half and this caused D-dimer to rise again. Switching to lenalidomide 10 mg daily led to an increase in D-dimer to 10.8 µg/mL and decrease in haemoglobin concentration to 124 g/L. Fibrin monomers became positive again. Combined therapy with thalidomide (50 mg/day) and lenalidomide (10 mg days 1-21 in 28-day cycles) has led to stabilisation of the disease. Median concentration of haemoglobin increased to 131 (84-141) g/l. The median of D-dimer decreased to 9.3 (8.0-17) µg/mL. CONCLUSION: Thalidomide in the dose of 100 mg daily led to better stabilisation of the disease than interferon-alpha. However, lowering the dose because of adverse effects failed to be effective sufficiently. Lenalidomide 10 mg daily was well-tolerated but insufficient to improve D-dimer and haemoglobin concentrations. Therefore, for further treatment we have decided to use the combination of lenalidomide and thalidomide in doses of 10 mg and 50 mg, respectively because both drugs have desirable antiangiogenic activities with different adverse effect profiles. On this therapy, the patients disease has been stable for 9 months.
- MeSH
- angiomatóza diagnóza patologie MeSH
- dospělí MeSH
- lidé MeSH
- nádory břicha diagnóza farmakoterapie MeSH
- nádory hrudníku diagnóza farmakoterapie patologie MeSH
- nádory kostí diagnóza farmakoterapie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
In adult patients, Langerhans cell histiocytosis (LCH) manifests most frequently with one or more osteolytic lesions or, alternatively, with pulmonary involvement with nodules and cysts or with skin lesions. Infiltration ofthe central nervous system is a rather rare sign of LCH. The LCH cells have an unexplained affinity to hypothalamus and to pituitary stalk and, consequently, central diabetes insipidus is the most frequent clinical sign of brain involvement in LCH. We describe treatment of 2 adult patients with LCH in whom central diabetes insipidus was the first sign of LCH and MR confirmed pituitary stalk infiltration. The first man was diagnosed with diabetes insipidus and pituitary stalk infiltration at 33 years of age. LCH was confirmed 2 years later by histology of verrucous lesions on the skin of perianal area. The disease affected the skin and CNS. The patient was treated with 2-chlorodeoxyadenosine (5 mg/m2 s.c. for 5 consecutive days of a 28-day cycle). No pituitary infiltration was evident on an MR image after the 4th cycle. Residual perianal infiltration was irradiated. The patient has been in complete remission for 44 months following treatment completion, although vasopressin and testosterone substitution is required. The second man was also diagnosed with diabetes insipidus and pituitary stalk infiltration at 33 years of age. Pulmonary involvement was identified with high resolution CT(HRCT) and high CD1a and S-100 positive elements with bronchoalveolar lavage. This patient further had external auditory canal infiltrations causing chronic discharge from the ears. The patient was treated with 2-chlorodeoxyadenosine as above. A follow up MR after the 4th cycle showed reduction in the infiltration diameter from 5.5 to 3.0 mm. Therefore, 2-chlorodeoxyadenosine 5 mg/m2 s.c. was combined with dexamethasone 20 mg p.o. during the 5th and 6th cycle. The MR image after treatment completion showed remission of the pituitary stalk infiltrate. External auditory canal infiltration diminished as did the nodules in pulmonary parenchyma. Nevertheless, vasopressin substitution is still required. The patient has been in complete remission for 8 months from the completion of the treatment. Pituitary stalk infiltration disappeared after the treatment with 2-chlorodeoxyadenosine in 2 patients; after 4 cycles in the first and after 6 cycles (with an addition of dexamethasone during the last 2 cycles) in the second.
- MeSH
- centrální diabetes insipidus komplikace MeSH
- dospělí MeSH
- histiocytóza z Langerhansových buněk komplikace diagnóza farmakoterapie patologie MeSH
- hypofýza patologie MeSH
- kladribin terapeutické užití MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- nemoci hypofýzy diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- kladribin MeSH
