BACKGROUND: Bacterial pneumonia is one of the most common causes of acute respiratory distress syndrome. In fulminant cases, when mechanical ventilation fails, veno-venous extracorporeal membrane oxygenation is required. However, this method is still associated with significant mortality and a wide range of potential complications. However, there are now many case reports of good outcomes even in patients with prolonged extracorporeal oxygenation, as in our rather complicated case report. CASE PRESENTATION: Our case report describes a complicated but successful treatment of a severe, devastating bacterial pneumonia in a 39-year-old European polymorbid woman with a rare form of diabetes mellitus, which had been poorly compensated for a long time with limited compliance, in the context of a combined immunodeficiency that strongly influenced the course of the disease. The patient's hospitalization required a total of 30 days of veno-venous extracorporeal membrane oxygenation therapy and more than 50 days of mechanical ventilation. Numerous complications, particularly bleeding, required seven chest drains, two extracorporeal membrane oxygenation circuit changes, and one surgical revision. The patient's mental state required repeated psychiatric intervention. CONCLUSION: It is possible that even the initially severely damaged lung parenchyma can develop its regenerative potential if suitable conditions are provided for this process, including a sufficiently long period of extracorporeal membrane oxygenation. We believe that this case report may also contribute to the consideration of the indications and contraindications of extracorporeal support. The authors also discuss the limitations and risks of prolonged veno-venous extracorporeal membrane oxygenation support and periprocedural anticoagulation strategies.

• Klíčová slova
• Bacterial pneumonia, Bleeding, Case report, VV–ECMO,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• bakteriální pneumonie * terapie   komplikace   MeSH
• dospělí MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• syndrom dechové tísně terapie   MeSH
• umělé dýchání MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH
• Názvy látek
• antibakteriální látky MeSH

BACKGROUND: Persistent left superior vena cava (PLSVC) is the most common variant of systemic venous drainage. In the absence of the right superior vena cava (RSVC), implantation of a right ventricular pacing lead may be challenging. Therefore specific implantation techniques and experiences in PLSVC are worth reporting. CASE PRESENTATION: We present a case report of a 90-year-old Caucasian female patient with PLSVC during single chamber pacemaker implantation due to the third-degree atrioventricular block. With common implantation techniques, we did not even reach the right ventricle. Therefore slittable CPS Direct ™ Universal sheath was employed to overcome the acute angle from PLSVC to tricuspid valve and ensure more fixation stability for longer 100-cm right ventricular lead placement. CONCLUSION: This case demonstrates safe implantation of 100-cm long right ventricular bipolar active fixation pacing lead using common slittable CPS Direct ™ Universal sheath after failed attempts with "C" and "J" stylet shaped electrode. This sheath provides different angle towards tricuspid valve and more fixation stability in patient with PLSVC and absent connection to right atrium.

• Klíčová slova
• Cardiac pacing, PLSVC, Persistent left superior vena cava, RSVC, Right superior vena cava, Slittable sheath,
• MeSH
• atrioventrikulární blokáda * MeSH
• kardiostimulátor * MeSH
• lidé MeSH
• perzistující levostranná vena cava superior * MeSH
• senioři nad 80 let MeSH
• srdeční komory diagnostické zobrazování   MeSH
• vena cava superior diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Celiac disease is an immune-mediated enteropathy triggered by gluten in genetically susceptible individuals. Diagnosis is based on evaluating specific autoantibodies and histopathologic findings of duodenal biopsy specimens. The only therapy for celiac disease is a gluten-free diet. Celiac disease can be complicated by malnutrition, other autoimmune diseases, refractoriness to treatment, and gastrointestinal tumors. This article presents seven cases of malignancies in patients with celiac disease. Its objective is to raise awareness of the malignant complications of celiac disease, leading to earlier diagnosis and improved outcomes. CASE PRESENTATION: Seven cases of malignant complications of celiac disease occurred among 190 patients followed at the Department of Internal Medicine and Gastroenterology, University Hospital Brno from 2014 to 2021. We describe these cases and the presentation, diagnostic process, course, management, and outcomes for each, along with proposed potential risk factors of malignant complications. There was one Caucasian man who was 70 years old and six Caucasian women who were 36, 46, 48, 55, 73, and 82 years old in our cohort. Of the seven cases of malignancies in our cohort, four patients were diagnosed with small bowel adenocarcinoma, one with diffuse large B-cell lymphoma, one with carcinoma of the tongue, and one with colorectal carcinoma. CONCLUSIONS: Malignancies occurred in 3.7% of patients followed up for celiac disease. Awareness of the malignant complications of celiac disease, risk factors, presentation, and disease course could lead to earlier diagnosis and improved outcomes.

• Klíčová slova
• Carcinoma, Case report, Celiac disease, Complication, Lymphoma, Malignancy,
• MeSH
• autoimunitní nemoci * MeSH
• autoprotilátky MeSH
• bezlepková dieta MeSH
• celiakie * komplikace   diagnóza   MeSH
• lidé MeSH
• nádory duodena * MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH
• Názvy látek
• autoprotilátky MeSH

BACKGROUND: Primary treatment of central neurocytomas is surgical resection. Gamma Knife surgery is considered a valuable therapeutic option in case of residual (after subtotal resection) or recurrent central neurocytomas. Here, we focused on the role of F-18 fluroethyltyrosine as a marker to document tumor progression after initial resection, in the context of an atypical central neurocytoma. We also describe MIB-1's role in evaluating therapeutic decision-making. CASE PRESENTATION: Two patients with central neurocytomas were treated by Gamma Knife surgery in our center. The first case (31-year-old Caucasian male) had atypical central neurocytoma. Four and a half years after surgical resection, magnetic resonance imaging and F-18 fluroethyltyrosine documented clear progression of residual central neurocytoma, further treated by Gamma Knife surgery (18 Gy at 50%, target volume 1.4 cc, and prescription isodose volume 1.8 cc). The initial post-Gamma Knife surgery clinical course was uneventful, with progressive volumetric reduction of residual tumor up to 4.5 years, when out-of-field recurrence was suspected and confirmed by local F-18 fluroethyltyrosine hyperactivity. Second single-fraction Gamma Knife surgery was performed (18 Gy at 50%, target volume 0.49 cc, prescription isodose volume 0.72 cc). The second (32-year-old Caucasian female) had previous subtotal resection and typical central neurocytoma. Seven years later, she had residual tumor progression. Single-fraction Gamma Knife surgery was performed (16 Gy at 50% isodose line, target volume 1.7 cc, and prescription isodose volume 2.5 cc). Last follow-up showed tumor volume reduction. Follow-up magnetic resonance imaging showed important volumetric reduction of both treated lesions. CONCLUSIONS: In atypical central neurocytomas, F-18 fluroethyltyrosine could be used as postoperative examination to detect small tumor remnants, follow-up evaluation following the Gamma Knife surgery or, in select cases, following surgical resection. The role of MIB-1 is important in therapeutic decision-making, as tumors with MIB-1 exceeding 2% are characterized by more aggressive clinical course. Single-fraction Gamma Knife surgery remains a valuable therapeutic option for postoperative residual atypical central neurocytomas and central neurocytoma recurrences.

• Klíčová slova
• Central neurocytoma, F-18 FET, Gamma Knife, Radiosurgery,
• MeSH
• dospělí MeSH
• lidé MeSH
• neurocytom * diagnostické zobrazování   radioterapie   MeSH
• progrese nemoci MeSH
• radiochirurgie * přístrojové vybavení   MeSH
• reziduální nádor MeSH
• tyrosin aplikace a dávkování   analogy a deriváty   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• (18F)fluoroethyltyrosine MeSH Prohlížeč
• tyrosin MeSH

BACKGROUND: Advanced renal cell carcinoma in some cases causes malignant intravascular thrombus with the potential for growth into the inferior vena cava or even the right atrium. Renal cell carcinoma is accompanied by malignant intravascular thrombus in up to 10% of cases. We present an overview of three patients diagnosed as having renal cell carcinoma with malignant intravascular thrombus requiring radical nephrectomy combined with inferior vena cava thrombectomy. CASE PRESENTATION: Three patients diagnosed as having renal cell carcinoma were indicated for renal cell carcinoma combined with inferior vena cava thrombectomy between 2014 and 2017 at our department: a 69-year-old white Caucasian woman, a 74-year-old white Caucasian woman, and a 58-year-old white Caucasian woman. According to the Novick classification of inferior vena cava tumor thrombus, there was one infrahepatic (level II) and two supradiaphragmatic (level IV) malignant intravascular thrombi. The average age of these patients was 67 years (range 58-74 years). All patients underwent radical nephrectomy combined with inferior vena cava thrombectomy through transabdominal approach. In patients with level IV malignant intravascular thrombus, transesophageal echocardiogram was used to guide the placement of the inferior vena cava cross-clamp above the diaphragm. In one patient the pericardium was opened to place a cross-clamp above a tumor just below the right atrium. There were no postoperative mortalities to date with an average follow-up of 23 months (range 2-48 months). To date, no patient has demonstrated recurrent inferior vena cava malignant intravascular thrombus requiring secondary inferior vena cava thrombectomy or any other treatment. A comparison of estimated blood loss and transfusion rate was not significantly different in all three cases. CONCLUSION: Despite the technical complexity of the procedure, caval thrombectomy combined with radical nephrectomy currently represents the only radical treatment for renal cell carcinoma accompanied by malignant intravascular thrombus with good mid-term oncological outcomes.

• Klíčová slova
• Inferior vena cava, Nephrectomy, Renal cell carcinoma, Thrombectomy, Thrombus, Transperitoneal,
• MeSH
• břicho chirurgie   MeSH
• echokardiografie transezofageální MeSH
• karcinom z renálních buněk komplikace   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin komplikace   diagnostické zobrazování   MeSH
• nefrektomie * MeSH
• senioři MeSH
• trombektomie * MeSH
• vena cava inferior chirurgie   MeSH
• výsledek terapie MeSH
• žilní trombóza diagnostické zobrazování   etiologie   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Great progress has recently been made in the treatment of metastatic renal cell carcinoma, including the introduction of nivolumab, an immune checkpoint inhibitor. Despite promising results, this treatment brings a completely new spectrum of adverse events, distinct from those experienced with small-molecule kinase inhibitors. Neurologic immune-related adverse events may be serious and potentially life-threatening complications requiring immediate immunosuppressive therapy. Only a few cases of immune-related encephalitis induced by checkpoint inhibitors have been described and the data regarding the management of this serious adverse event are limited. CASE PRESENTATION: We report the case of a 63-year-old white man with metastatic renal cancer who developed severe chorea-like dyskinesia during nivolumab therapy. The findings on brain magnetic resonance imaging and flow cytometry of cerebrospinal fluid, and the positivity of anti-paraneoplastic antigen Ma2 immunoglobuline G class autoantibodies were consistent with a diagnosis of immune-related encephalitis. High-dose intravenous corticosteroid therapy was started immediately, with no signs of improvement, even when infliximab was added. Our patient refused further hospitalization and was discharged. Three weeks later, he presented with signs of severe urosepsis. Despite intensive treatment, he died 4 days after admission. CONCLUSIONS: The management of less frequent immune-related adverse events has not been fully established and more information is required to provide uniform recommendations. Immune-related encephalitis is a severe and potentially fatal complication requiring immediate hospital admission and extensive immunosuppressive therapy. The examination of cerebrospinal fluid for paraneoplastic antibodies, such as anti-N-methyl-D-aspartate receptor and anti-Ma2 antibodies, in order to distinguish autoimmune etiology from other possible causes is essential and highly recommended.

• Klíčová slova
• Case report, Encephalitis, Immune-related adverse event, Nivolumab, Renal cancer,
• MeSH
• encefalitida chemicky indukované   MeSH
• karcinom z renálních buněk farmakoterapie   sekundární   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin farmakoterapie   patologie   MeSH
• nivolumab škodlivé účinky   MeSH
• protinádorové látky imunologicky aktivní škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• nivolumab MeSH
• protinádorové látky imunologicky aktivní MeSH

INTRODUCTION: Peripheral nerve hyperexcitability disorders are characterized by constant muscle fiber activity. Acquired neuromyotonia manifests clinically in cramps, fasciculations, and stiffness. In Morvan's syndrome the signs of peripheral nerve hyperexcitability are accompanied by autonomic symptoms, sensory abnormalities, and brain disorders. CASE PRESENTATION: A 70-year-old Caucasian man developed, in the course of 3 months, polyneuropathy with unpleasant dysesthesia of lower extremities and gradually increasing fasciculations, muscle stiffness and fatigue. Subsequently, he developed a prominent insomnia with increasing psychological changes and then he attempted a suicide. Electromyography confirmed a sensory-motor polyneuropathy of a demyelinating type. The findings included fasciculations as well as myokymia, doublets and multiplets, high frequency discharges, and afterdischarges, following motor nerve stimulation. No auto-antibodies were found either in his blood or cerebrospinal fluid. Magnetic resonance imaging of his brain showed small, unspecific, probably postischemic changes. A diagnosis of Morvan's syndrome was confirmed; immunoglobulin (2g/kg body weight) was applied intravenously, and, subsequently, carbamazepine 2 × 200 mg, venlafaxine 150 mg, and mirtazapine each night were prescribed. His sleep improved, suicidal tendencies stopped, less fasciculations occurred, and muscle hypertonia also improved. Hyperexcitation also partially remitted including the electromyography finding. CONCLUSIONS: We described here the case of a patient with Morvan's syndrome; his case is rare because of severe psychical changes with a suicide attempt, short admission to a psychiatric ward, prominent electromyographic changes, and because antibodies were not detected. After therapy with immunoglobulins followed by corticosteroids with sodium channel blocker, his motor, autonomic, psychical signs and symptoms, and electromyography changes substantially improved.

• MeSH
• alfa blokátory terapeutické užití   MeSH
• antidepresiva druhé generace terapeutické užití   MeSH
• elektromyografie MeSH
• intravenózní imunoglobuliny terapeutické užití   MeSH
• Isaacsův syndrom diagnóza   farmakoterapie   psychologie   MeSH
• lidé MeSH
• mianserin analogy a deriváty   terapeutické užití   MeSH
• mirtazapin MeSH
• pokus o sebevraždu * MeSH
• polyneuropatie farmakoterapie   MeSH
• poruchy iniciace a udržování spánku farmakoterapie   MeSH
• senioři MeSH
• venlafaxin hydrochlorid terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• alfa blokátory MeSH
• antidepresiva druhé generace MeSH
• intravenózní imunoglobuliny MeSH
• mianserin MeSH
• mirtazapin MeSH
• venlafaxin hydrochlorid MeSH

INTRODUCTION: Vascular malformations of the thyroid gland represent a very rare, often accidentally diagnosed, disease that in the case of eufunctional goitre may be the cause of mechanical neck syndrome. The authors present here the complex differential-diagnosis and treatment approach and stress the importance of histopathology for determining the final diagnosis. CASE PRESENTATION: Using various imaging methods (ultrasound, multidetector computed tomography of the neck), the cause of breathing difficulties in a 64-year-old old man from the Czech Republic with normal thyroid gland function was found to be an arteriovenous malformation of the left lobe of his thyroid gland, 80 × 70 × 55 mm in size, reaching retrosternally between the major arteries branching from his aortic arch and displacing his trachea 10mm to the right. In preparation for surgery, he underwent a radio-interventional procedure with embolisation of the arteries supplying the left lobe. This was followed by a lobectomy on the left via a partial sternotomy. The definitive histology result confirmed that the arteriovenous malformation was the benign cause of the mechanical neck syndrome. CONCLUSIONS: The case report presented here extends the differential diagnostic options in cases of mechanical neck syndrome. It describes a very rare disease of the thyroid gland, which prior to surgery may arouse suspicion of malignancy. It stresses the importance of close team cooperation between the endocrinologist, interventional radiologist and surgeon within the framework of preoperative diagnosis as well as preparation for surgery. Determination of the definitive histopathological diagnosis requires a pathologist experienced in such issues.

• MeSH
• arteriovenózní malformace komplikace   diagnostické zobrazování   terapie   MeSH
• diferenciální diagnóza MeSH
• krk diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukce dýchacích cest diagnostické zobrazování   etiologie   terapie   MeSH
• počítačová rentgenová tomografie MeSH
• štítná žláza krevní zásobení   diagnostické zobrazování   chirurgie   MeSH
• syndrom MeSH
• terapeutická embolizace MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Optic nerve compression is an uncommon disorder leading to deterioration or complete loss of vision. CASE PRESENTATION: We describe the case of a 14-year-old Caucasian girl with a gradual deterioration of vision in her right eye. Using modern imaging techniques and endonasal endoscopic surgery, we identified the cause and removed the pathology. CONCLUSIONS: The cause of optic nerve compression was a rare exostosis in the optic canal. An endonasal endoscopic approach is the optimal choice for management of optic nerve pathologies. It is a gentle and minimally invasive surgical technique. Interdisciplinary cooperation, especially with the eye doctor and radiologist, is required in these cases.

• MeSH
• exostózy komplikace   diagnóza   chirurgie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• nemoci zrakového nervu diagnóza   etiologie   chirurgie   MeSH
• nervus opticus diagnostické zobrazování   patologie   MeSH
• počítačová rentgenová tomografie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Taxine alkaloids cause fatal poisoning, in particular due to the compound's toxic effect on the cardiovascular apparatus. CASE PRESENTATION: We describe the case of a 39-year-old Caucasian man with common yew intoxication for whom cardiopulmonary resuscitation using all available methods, although delayed and extended, was successful. CONCLUSIONS: Extended and delayed cardiopulmonary resuscitation can be used successfully to treat common yew intoxication.

• Publikační typ
• časopisecké články MeSH