Slovakia online
Volume 97 / No. 1 / 1996
TRANSPLANTATION — A CHALLENGE FOR TREATMENT IN ADVANCED CONGESTIVE HEART FAILURE
FABIAN, J., FISCHER, V., FRIDRICH, V., KRCMERY Jr., V., NYULASSY, S., PECHAN, I., PRIBILINCOVA, V., RIECANSKY, I., SLUGEN, I.
The authors present epidemiological data about congestive heart failure,
its most common etiology and prognosis. They justify the performance of
heart transplantation (HTx) in the treatment of congestive heart failure.
They analyze the present state of HTx in the world and describe also the
history of HTx in Slovakia. They present the review of contraindications
and indications for the inclusion of recipients into the HTx programme
and describe the further fates of these patients. They regard the HTx as
an integral component of the therapeutical approach to the precisely defined
group of patients with otherwise refractory congestive heart failure. (Tab.
4, Fig. 6, Ref. 38.)
Key words: ischaemic heart disease, congestive heart failure,
heart failure, heart transplantation, indications and contraindications
to heart transplantation.
Bratisl Lek Listy 1996; 97: 5–11
INDICATIONS AND CONTRAINDICATIONS FOR LIVER TRANSPLANTATION
HRUSOVSKY, S., DANNINGER, F., KUPCOVA, V., BECKER, M.C., MANTION, G., MIGUET, J.P.
Liver transplantation (LT) is a therapeutic method in many, otherwise
infaust diseases of the liver. During the recent de-cade the experimental
therapeutic procedure has become a rou-tine therapeutical method. The stage
of clinical experiment was ultimated by the Washington Conference held
on the consensus in LT indications (1983). Large centries (USA, England,
Germany) yield 80—100 liver transplantations per year.
The recent years have recorded a change in some principal opinions
on LT. It is possible to state that liver transplantation is being abstained
from cases with more extensive primary neoplamatic affliction of the liver.
Conservative therapy in primary biliary cirrhosis of the liver by means
of ursodeoxycholic acid has shifted the LT indication into the later stages
of the disease. The opinions on the meaning of LT in alcoholic cirrhosis
remain still unsettled. LT remains unambiquously indicated in life-endangering
fulminant and subfulminant liver failures. Among the viral diseases, attention
is paid to liver cirr-hosis caused by infection by the hepatitis C virus.
Cirrhosis due to hepatitis B has a better prognosis, owing to the complex
antiviral therapy. Liver transplantation represents, beside the main indications,
the therapy of first selection, e.g. also in Wilson’s disease, alpha-1-antitrypsin
deficiency, alveolar echino-coccosis etc. (Tab. 1, Fig. 2, Ref. 54.)
Key words: liver, transplantation of the liver, indication for
the LT, contraindication for the LT.
Bratisl Lek Listy 1996; 97: 12–18
CHEMOPREVENTION OF CANCER
UJHAZY, V.
Chemoprevention, as one of the newest components of the fight against
cancer, deals with various chemical compounds which can prevent the occurrence
of malignant tumours. New experimental results achieved during the recent
decades in the field of understanding of the process of carcinogenesis,
have enabled a more rational approach to the prevention of normal cell
malignization. It has been shown, that a number of investigated compounds
are able to interact selectively with the particular phase (initiation,
promotion, progression) of the multistep process of carcinogenesis.
Activity of chemopreventive compounds can be evaluated by systematic
analysis of various biomarkers in patients who are in high risk. The biomarkers
include genetic markers (mutations, gene amplification), cellular markers
(rate of proliferation), histologic markers (leukoplakia, metaplasia),
or biochemical markers (blood level of various enzymes, or tumour antigens).
The number of extensive clinical trials has recently increased and
some positive results have been reported in the testing of various compounds
preventing the appearance of some malignant tumours (breast, colon, prostate,
etc.).
The search for new, effective chemopreventive compounds might provide
a valuable new tool aimed at the decrease in both cancer morbidity and
mortality. (Ref. 37.)
Key words: chemoprevention, cancer, malignant tumours, carcinogenesis,
chemopreventive compounds.
Bratisl Lek Listy 1996; 97: 19–23
EPIDEMIOLOGICAL AND MICROBIOLOGICAL ASPECTS OF MYCOBACTERIOSES IN SLOVAKIA - M. AVIUM COMPLEX
BADALIK, L., SVEJNOCHOVA, M., HONZATKOVA, Z., KRISTUFEK, P.
Background: Mycobacteria belonging to M. Avium Complex (MAC)
are strains very similar in structure and biochemistry but very different
from the point of serology.
Objectives: They are divided into 28 serotypes. The objective
of the research is to describe the epidemiological situation in myco-bacterioses
caused by Mycobacterium Avium Complex in Slo-vakia and to compare it with
the situation in the developed countries.
Methods: The study is methodologically based on the surveil-lance
of tuberculosis and applied to the problem of mycobacterioses.
Results: During the period of 19 years we have registered in
Slovakia 43 new cases caused by Mycobacterium Avium Complex. The number
of new cases per year ranged from 0 to 4 cases. The majority of cases were
males in permanent residence in Slovakia. 74.4 % of them were from central
and eastern Slovakia.
Conclusions: Over the past 19 years the stabilized trend of
incidence of mycobacterioses caused by Mycobacterium Complex has not changed.
(Ref. 22.)
Key words: epidemiology, mycobacterioses, Mycobacterium avium
complex.
Bratisl Lek Listy 1996; 97: 24–27
CROHN’S DISEASE AND APPENDICITIS SYMPTOMS
PECHAN, J., PROCHOTSKY, A., PRIKAZSKA, M.
Retrospective analysis of 47 patients surgically treated at the IInd
Surgical Clinic LFUK due to Crohn’s disease and its complications indicates
that in 16.3 % of patients the diagnosis of Crohn’s disease was stated
in coincidence with laparotomy which had been indicated due to the suspicion
of appendicitis. The reasons of this situation, as well as the recomendation
of surgical tactics are analysed. (Tab. 3, Ref. 11.)
Key words: Crohn’s disease, appendicitis symptoms, laparotomy.
Bratisl Lek Listy 1996; 97: 28–30
FAMILY OCCURRENCE OF TUMOURS AND DEVELOPMENTAL ANOMALIES OF THE TESTIS
ONDRUS, D., CHRENOVA, S., KUBA, D., MATOSKA, J.
Background: Family occurrence ranks belong the factors fol-lowed
in etiology and pathogenesis of germ-cell tumours of the testis. Its association
with abnormal testicular development, respectively with other risk factors
is relatively frequent.
Objectives: The aim of this study was to indicate this coher-ence
by means of case histories of author’s patients and to propose further
procedures.
Methods and results: There were 535 patients treated for testicular
cancer in the period of 1982—1994. Family occurrence was observed in 6
cases (1.12 %), most frequently in combination with maldescensus testis.
Individual families were ana-lysed in detail, including HLA typization.
Bilaterality of testicular cancer was observed in two brothers who were
HLA identical. Other two brothers had the history of bilateral maldescensus
testis, one of whom was subdued to bilateral orchiectomy in childhood,
the other at the age of 16, a tumour in one testicle following orchidopexy
performed in childhood. The history of maldesensus testis was observed
in four members of an-other family, two of whom developed tumours.
Conclusions and meaning for practice: Authors recommend supplementation
of the initial examination of each patient with suspective testicular cancer
with detailed family history aim at the occurrence of urogenital anomalies
and tumours. Gen-eral knowledge of the first-degree relatives about the
possibility of family occurrence of tumours, and instructions for testicular
self-examination are considered as the most suitable method from the stand
point of secondary prevention. (Ref. 21.)
Key words: testicular cancer, family occurrence, maldescensus
testis.
Bratisl Lek Listy 1996; 97: 31–33
IATROGENNE PORANENIA VELKYCH CIEV
BOBER, J., BLAZEJ, I., VRZGULA, A., SUDAK, M.
At the beginning of the article the authors emphasized that the frequency
of iatrogenic injuries of great vessels is very high now. They draw attention
to the damage caused in coincidence with invasive diagnostic or therapeutic
methods. The iatro-genic injuries are brought about during extensive operations
due to advanced tumors, during transplantations and extensive reconstructive
or corrective operations. But even some simple and common operations are
not protected from these complications. The authors present their series
of 10 patients with iatrogenic injuries treated during the years 1989—1991.
The submitted case reports indicate interesting aspects of these- accidents.
The conclusions show the importance and danger of these accidents,
and also the possibility of incorrigible results being caused by incorrect
steps. (Tab. 1, Ref. 14.)
Key words: iatrogenic injuries, large vessels, extensive operations,
dangerous accidents.
Bratisl Lek Listy 1996; 97: 34–36
RADIOTHERAPY OF CHIASMAL GLIOMAS IN CHILDREN
HELCL, F.
Chiasmal gliomas are rare tumors occurring predominantly in children.
Their treatment consists of surgery, radiotherapy and chemotherapy. Surgical
removal can usually be only partial, and radiotherapy frequently follows.
There are supporters of radio-therapy, as well as opponents. The author
has been engaged in problems of optimal treatment of this entity for more
than 10 years. He offers a review of knowledge provided by literature concerning
radiotherapy of this disease in children. In the past he was enthusiastic
for radiotherapy. Nevertheless after passing the Postgraduate course in
paediatric neurosurgery in Bonn (1989), where J.F. Hirsch demonstrated
very pessimistic pro-gressive long-term harmful sequellae of irradiation
of the developing child’s brain, the author has re-evaluated his attitude
to this therapy. The short history and basic physical principles of radiotherapy
are reviewed. Some new trends of this therapy are also mentioned (hyperbaric
oxygenation, radiosensitizing agents, hyperthermia etc.). Great attention
is paid to the deleterious adverse effects of radiotherapy and to the possible
technical parameters enabling to avoid them (optimal daily fractions, optimal
total dose, limiting age in infants etc.). Harmful effects of radiotherapy
are reviewed in detail. The most frequent are chronic sequellae: brain
atrophy, radiation-induced brain necrosis, progressive intellectual deterioration,
growth retardation, panhypopituitarism, galactorea, learning disabilities,
moya-moya syndrome, radiation-induced secondary brain tumors (especially
gliomas). Risks of radiotherapy combined with chemotherapy are also emphasized.
Nevertheless radiotherapy has remained an important therapeutical measure
in the treatment of chiasmal gliomas in children with progressive disease
in cases when surgery and chemotherapy have failed. (Ref. 29.)
Key words: radiotherapy, chiasmal gliomas in children, deleterious
sequellae.
Bratisl Lek Listy 1996; 97: 37–42
DIAGNOSTICS OF RENAL TUMOURS BY PUNCTURE BIOPSY
DANIS, D., PAUER, M., SLUGEN, I., HORNAK, M., HLAVCAK, P., FURKOVA, K., PAVLOVIC, M.
The authors describe four, out of 506 cases of renal biopsies in which
this diagnostic procedure enabled to reveal a tumour. Two cases of tumours
which were intentionally subdued to renal biopsy justified an angiomyolipoma
and a focus (metastasis) of tubulopapillomatous carcinoma) in the kidney.
In one case the renal biopsy revealed renal infiltration thus enabling
to state the diagnosis of chronic lymphatic leukaemia subsequently, and
in the last case where the diagnosis of chronic lymphatic leukaemia had
been stated in advance, the renal biopsy was performed due to suspective
glomerulonephritis. In these cases the unexpected results of renal biopsy
were of great diagnostic value. Such intentional use of biopsy is rare.
(Fig. 3, Ref. 6.)
Key words: renal biopsy, renal tumours
Bratisl Lek Listy, 1996; 97: 43–45
ENDOANAL TRANSRECTAL USG IN DIAGNOSIS AND DISPENSARIZATION OF PATIENTS WITH RECTAL CARCINOMA
SLEZAK, V., PROCHOTSKY, A., KORCEK, J.
Endoanal sonography in rectal tumor is diagnostically significant. This
method helps to specify the prognosis of patients with malignant rectal
tumor. Endoanal sonography examination before the operation corresponds
with postoperative histopatological findigns (endoanal sensitivity uT —
91.6 %). The method is most important during the follow-up of patients
after- surgery and in ascertainment of local recurrence (endo-anal sensitivity
recidivation uT — 86 %). The authors present their experience with 402
patients. The advantages of endo-anal transrectal sonography are possibilities
of determination of staging the tumors which can not be reached physically,
information of the way of spreading and penetration depth of the tumor,
information about their growth, simplicity and easy- repetition of the
process and economical convenience. (Tab. 2, Fig. 2, Ref. 14.)
Key words: rectal carcinoma, local recurrence, endoanal transrectal
sonography, preoperative staging.
Bratisl Lek Listy 1996; 97: 46–49
THE IMPACT OF RISK FACTORS UPON PERIOPERATIVE COMPLICATIONS AND LETHALITY OF PATIENTS OPERATED DUE TO COLORECTAL CARCINOMA
PRIBELSKY, M., PORUBSKY, J., SCHNORRER, M.
The authors analyzed the risk factors and their impact on perioperative
complications and mortality in aged patients electively operated due to
colorectal cancer at the II. Surgical Clinic LFUK in Bratislava during
the period from January 1, 1986 to October 31, 1994. The patients were
divided into three groups- according to WHO criteria, those younger than
65, from 65 to 75, and older than 75 years of age. The results are in correlation
with the data published in literature. According to the accomplished results
the age per se does not represent contraindication to surgical intervention.
However the lethality in the aged patients with two or more risk factors
significantly in-creases. In regard to the latter the authors recommend
a strict-ly individual consideration as to whether these patients would
benefit more from palliative therapy procedures as to life prolongation
and its quality improvement. (Tab. 5, Ref. 25.)
Key words: colorectal cancer, risk factors, age.
Bratisl Lek Listy 1996; 97: 50–53