Biomedical subjects
Publications and source records attributed to M Lukás.
On the basis of retrospective five years analysis the authors process the problematic of idiopatic bowel disease--Morbus Crohn and ulcerative colitis. They pay main attention to surgical issue--types of operations, differences between acute and elective surgery, perioperative problems and results.
BACKGROUND: The diagnosis of chronic pancreatitis is based on the imaging methods. These imaging methods show the main morphological changes in the pancreatic ducts and its parenchyma, but they do not define the function of the pancreas. The aim of our study was Faecal Elastase I. determination in patients with chronic pancreatitis. The test is a simple, non-invasive method of the investigation of the pancreatic exocrine insufficiency. The Faecal Elastase I occurring in the stool was correlated with the level of the damage of pancreatic tissue together with the control group of the patients with different diagnoses. METHODS AND RESULTS: Faecal Elastase I (mean values in ug/g of stool) detection is a simple, non-invasive method which correlates well with the damage of pancreatic tissue, stemming from chronic pancreatitis. This test is routinely used especially in the diagnosis of chronic pancreatitis. The classification of chronic pancreatitis currently depends on the morphological changes of the pancreatic duct system (the patho-morphological changes). We are currently missing the classification describing simultaneously the morphological changes of the gland and the function of the pancreas. In our studies we have used a newly proposed classification system, which was put together in Bern, 2000 (1). This new system encompasses morphological and functional changes. Faecal Elastase I was determined by a microplate ELISA method using monoclonal antibody to human pancreatic protein. The Faecal Elastase I. was tested in the stool of the 196 patients with chronic pancreatitis stemming from alcoholism. The occurrence of Faecal Elastase I. was classified according to the levels assigned by the classification system. The control group used in this study included 144 patients with different diagnoses. The results demonstrate a very good correlation of Faecal Elastase I. with the grading of the newly proposed classification system of chronic pancreatitis. Patients with the highest levels of the damage of the pancreas had a significantly lower occurrence of Faecal Elastase I. in comparison with the non-pancreatic control group and in patients with chronic pancreatitis who had no clinical complications or damage of endocrine and exocrine functions of the pancreas. CONCLUSIONS: Feacal Elastase I performance plays an important role in diagnosing of the severe cases of chronic pancreatitis and in the follow-up of the chronic pancreatitis in the patients with the intermediate damage of the pancreas.
BACKGROUND: Acute lower gastrointestinal bleeding is a rare complication in Crohn's disease (CD). MATERIALS AND METHODS: We characterized the clinical features and course of such bleeding in six of 156 patients with CD, treated between 1985 and 2003 at our institution. The data on the patients were gathered through retrospective data analysis. RESULTS: The six patients discussed here consisted of three males and three females, ranging in age from 17 to 42 years. Three patients were known to have CD, whereas three presented with acute bleeding, as the initial symptom of CD. There were 11 separate episodes of severe hemorrhage: three patients bled only once, two bled twice, and one bled four times. The precise bleeding site was correctly identified in four of eleven episodes: twice by colonoscopy and twice by angiography. Primary bleeding episodes subsided without surgery in four of six patients, but three of these four patients re-bled massively, and surgery followed in two of these cases. An emergency surgery was necessary to stop the hemorrhage in four patients; two of them underwent surgery during their first haemorrhagic episodes, and two patients underwent surgery during a repeated episode of hemorrhage. As a consequence, one ileectomy and three ileocolectomies had to be performed. During follow-up of the resected patients, no recurrence of haemorrhagic or non-haemorrhagic CD was observed in three patients two, five, and six years after surgery and only one patient required further therapy three years after surgery for recurrent bleeding. For this, super selective embolization of the periphery branch of the superior mesenteric artery was used. Two non-resected patients are doing well in a course of remission. CONCLUSION: A conservative approach may be suggested as first-line therapy, but surgery is inevitable in patients suffering from massive bleeding and in patients with recurrent bleeding.
Inflammatory bowel diseases, Crohn's disease and ulcerative colitis, were discovered in the twentieth century. The etiology and pathogenesis has been unsolved until now. At present, three etiological mutually involved factors can be considered. The most important turned out to be the genetics component, which can lead to the chronic inflammation of the bowel. The significant effects of infectious and environmental factors were proven in the pathogenesis of inflammatory bowel diseases. Despite many years elapsed, the "The binary pathogenesis theory of ulcerative colitis", postulated by Maratka in the sixties, can be still accepted.
A fistule is defined as a canal or a cavity, created by necrotic degradation of the tissue, which may, (but not necessarily has to) communicate directly with the digestive tract via an internal orifice. In case of the Crohn's disease, the abscesi and fistules result from the same pathological process and are caused by penetration of the inflammatory process through the wall of the digestive tube and to its outer side. The authors, having initially described the types and the pathogenesis of the anal fistules in the Crohn's disease, present a brief examination algorithm including examination of the whole digestive tract, based on the pan-entero-colitic character of the disorder. Sound diagnostics and establishment of the disease activity is very important, beacuse the treatment strategy differs from that of other perianal inflammatory affections. Furthermore, options for both the surgical and conservative treatment are listed in this work, including experience with use of the advancement flap. According to some authors, the success-rate of this treatment reaches up to 80%.
BACKGROUND AND AIMS: Evidence exists for the pathogenic role of the enteric flora in inflammatory bowel disease. Probiotics contain living microorganisms which exert health effects on the host. We compared the efficacy in maintaining remission of the probiotic preparation Escherichia coli Nissle 1917 and established therapy with mesalazine in patients with ulcerative colitis. PATIENTS AND METHODS: In total, 327 patients were recruited and assigned to a double blind, double dummy trial to receive either the probiotic drug 200 mg once daily (n = 162) or mesalazine 500 mg three times daily (n = 165). The study lasted for 12 months and patients were assessed by clinical and endoscopic activity indices (Rachmilewitz) as well as by histology. The primary aim of the study was to confirm equivalent efficacy of the two drugs in the prevention of relapses. RESULTS: The per protocol analysis revealed relapses in 40/110 (36.4%) patients in the E coli Nissle 1917 group and 38/112 (33.9%) in the mesalazine group (significant equivalence p = 0.003). Subgroup analyses showed no differences between the treatment groups in terms of duration and localisation of disease or pretrial treatment. Safety profile and tolerability were very good for both groups and were not different. CONCLUSIONS: The probiotic drug E coli Nissle 1917 shows efficacy and safety in maintaining remission equivalent to the gold standard mesalazine in patients with ulcerative colitis. The effectiveness of probiotic treatment further underlines the pathogenetic significance of the enteric flora.
BACKGROUND: The aim of the present study was to evaluate the relationship between Pancreatic Cancer and Type 2 Diabetes Mellitus, which represents a higher risk of many human tumors. In patients with Pancreatic Cancer, Type 2 Diabetes Mellitus occurs approximately in 30%. METHOD AND RESULTS: Fifty patients with newly diagnosed Pancreatic Cancer were analysed in a retrospective pilot study where the staging of the tumor and the case history of the patients were studied. This data were compared in three groups of patients: the control group without diabetes, one with Impaired Fasting Glucose, and patients with Diabetes Mellitus. Incidence of Diabetes Mellitus and that of Impaired Fasting Glucose were also followed in patients with Pancreatic Cancer and Colorectal Cancer. The retrospective study confirmed the late diagnosis of Pancreatic Cancer. The tumors were actually in clinical stage IV in 50% of the patients. Diabetes Mellitus was present in 34% of patients with Pancreatic Cancer; in 44% of these patients the Impaired Fasting Glucose was also diagnosed while the normal glucose status was seen in 22% of patients. Incidence of Impaired Fasting Glucose and that of Diabetes Mellitus in groups of patients with Pancreatic Cancer and Colorectal Cancer was studied. Diabetes Mellitus was present in 12.5% patients with Colorectal Cancer. CONCLUSIONS: In spite of modern diagnostic methods, the early diagnosis of Pancreatic Cancer remains a great problem. Incidence of Diabetes Mellitus in patients with Pancreatic Cancer was significantly higher in comparison with the Colorectal Cancer group (P0.01). A significant number of patients with Impaired Fasting Glucose were also present in the group with Pancreatic Cancer. Analysis of the relationships between Pancreatic Cancer and Impaired Glucose Metabolism could contribute to the early diagnosis of this serious malignant disease.
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A 29-year-old male patient with the anamnesis of inflammatory bowel disease and Grave-Basedowov disease was hospitalized because of rapidly spreading skin defect with affected muscle on the left shin. This skin defect appeared after the significant decreasing of corticoids. The small skin trauma preceded the pyoderma gangrenosum. First the skin disease was not right diagnosed and patient was cured by the excision of the defect. It caused tissue disintegration, muscle necrosis and extension of the defect. The whole leg was endangered. Patient was cured with corticoids and cyclosporin A after the right diagnosis. The defect healed and laboratory inflammatory markers decreased. The immunosuppresive therapy was changed to azathioprin, the corticoid therapy was interrupted. After three months the defect was healed.
Case-control study comparing 81 patients with chronic renal failure (CRF) with 58 patients without renal disease who were evaluated by endoscopy of upper and/or lower gastrointestinal tract (GIT) for gastrointestinal bleeding or dyspepsia. The success of endoscopic examinations was the same in both groups. Patients with CRF more often underwent endoscopic examination because of gastrointestinal bleeding and they presented more often by hematochezia. Patients with CRF were more often found to have hemorrhagic gastropathy or duodenopathy and angiodysplasia of upper and lower GIT. However, duodenal ulcer was significantly more common in the control group without renal disease. Incidence of Helicobacter Pylori infection was low in both groups.
The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.
UNLABELLED: Barrett's esophagus (BE) the serious complication of gastroesophageal reflux disease (GERD) is discussed. BE has been defined as the complete intestinal metaplasia of distal esophagus. The most serious complication of BE is esophageal adenocarcinoma. We present our results with the group of patients with GERD from the years 1998-2000. We prospectively followed 67 patients with GERD (group A) and 8 patients with GERD/BE (group B). All patients underwent laparoscopic fundoplication. The average length of the Barrett's segment was 4.3 cm. Average time of the surgery was 75 min. Nissen fundoplication was used in seven cases in group B, in one case we used Rossetti laparoscopic fundoplication. The postoperative endoscopic controls were performed at two months after surgery and then every one-year. RESULTS: In one case we observed the complete reepithelization with the mixed spinocelullar and columnar components. We didn't observe any one case of histological deterioration. There was on any difference between two groups regarding the subjective complains. Six patients form group B reported complete disappearing of pyrosis. Two patients reported significant improvement, with very rare pyrosis or dysphagia. Our experience (together with the literature) proved the surgical antireflux therapy is very safe, very effective and with very long lasting effect. The effectivity of surgical therapy is increased by the laparoscopy. Described laparoscopic approaches can lead to the reepithelization of Barrett's metaplasia or, at least, they can diminish the symptoms without any long-term medication. Surveillance endoscopy and biopsy are strictly recommended in all patients with BE and also in the patients with BE after antireflux surgery. The intervals depend on the grade of dysplasia in metaplastic epithelium.
In this review the authors focus on the adverse GIT events during long-term treatment with non-steroid anti-inflammatory drugs, and explain pathogenesis of the NSA induced gastropathy and enteropathy. The risk groups of patients and prophylactic and therapeutic modalities are discussed. There are indices that most of the NSA gastric ulcers don't induce clinical symptoms, and massive bleeding may be the first clinical manifestation. This is why the clinical symptoms cannot be used as predictors of NSA gastropathy. It seems, on the author's clinical experience, that more than half cases of massive non-variceal bleeding from upper GIT is induced by non-steroid anti-inflammatory drugs and acetylsalicylic acid. NSA-gastropathy often presents with multifocal ulcers and erosions in the antrum of the stomach. The course of massive bleeding induced by NSA is associated with high rate of lethality.
Toxic megacolon belongs to the severe acute complications of inflammatory bowel diseases. The frequency is 1.6-21.4% among patients with ulcerative colitis and 0.3-2% in those with Crohn's disease. The main characteristics of toxic megacolon are toxemia, sepsis and distension of the colon due to the diminished muscular tone, loss of motor activity and increased amount of colonic gas. Sepsis and/or perforation of the large bowel can complicate this situation. The most important diagnostic procedure is the abdominal X-ray. Should the diameter of colonic distension exceed 60 mm, the diagnosis of toxic megacolon has been confirmed. Conservative treatment of toxic megacolon consists of water and electrolyte replacement, total parenteral nutrition, administration of corticosteroids and broad-spectrum antibiotics and repeat patient's prone positioning. If medical therapy is not successful during the first 72 hours, surgical intervention is indicated. The most common procedure is subtotal colonic resection with creation of an ileostomy. Patients with toxic megacolon should be managed at specialised centers, where cooperation of experienced gastroenterologists, surgeons and intensive care experts is possible.
BACKGROUND: High doses of mesalazine usually result in an inconvenient dosage schedule and reduced compliance. The goal of this trial was to compare the effects of mesalazine 4 g daily given as prolonged-release granules in packets of 1 g with that of prolonged-release tablets of 0.5 g. METHODS: Two hundred twenty-seven patients with mild-to-moderate ulcerative colitis were randomized to treatment with two packets twice daily (Gr-b.i.d.), 1 packet four times daily (Gr-q.i.d.) or 2 tablets four times daily (Ta-q.i.d.) for 8 weeks. A disease activity index (ulcerative colitis disease activity index: UC-DAI) was calculated, and the granules were defined as noninferior to the tablets if the lower limit of the 95% CI for the differences was more than -1 UC-DAI score unit. RESULTS: Noninferiority of the granules compared with the tablets was demonstrated. The mean improvement in the UC-DAI in the treatment groups Gr-b.i.d., Gr-q.i.d., and Ta-q.i.d. were 3.2, 2.9, and 2.4, respectively; the proportion of complete responders in the three groups 39%, 37%, and 31%, respectively. There were no differences in side effects. CONCLUSION: Mesalazine 4 g daily given as prolonged-release granules twice and four times daily is at least as effective as prolonged-release tablets four times daily in patients with mild to moderate ulcerative colitis. The patients preferred the twice daily dosing.
INTRODUCTION: Inflammatory bowel diseases (IBD), with Crohn's disease (CD) and ulcerative colitis (UC) as the two main disorders, is a heterogeneous group of diseases of unknown etiology. Actually we have no ideal disease marker, to identify people at risk of the disease, which can differentiate CD from UC, be highly specific for CD or UC and easily applicable in routine laboratory praxis. AIMS: Determine the clinical significance of serological testing p-ANCA and ASCA in patients with IBD. METHODS: P-ANCA in IgG isotype were detected by indirect fluorescence assay on human ethanol-fixed granulocytes, ASCA antibodies in IgG and IgA isotypes were determined by ELISA with mannan as a target antigen. RESULTS: P-ANCA and ASCA were studied in a group of 86 patients (38 CD, 26 UC, 3 non-inflammatory gastrointestinal disorder, 19 health controls). P-ANCA was associated with UC in 46%. ASCA was associated with CD in 76%. Specificity of ANCA for UC compared to healthy controls was 100%, specificity of ASCA for CD compared to healthy controls was 89.5%. CONCLUSION: Although the sensitivity of ASCA and p-ANCA is low, their specificity is high, especially when combining these two markers. We think that combined assay for ASCA and p-ANCA is more useful in IBD.
During the last twenty years a significant reduction of the number of gastric resections on account of peptic ulceration occurred due to better therapeutic possibilities in gastrodudodenal ulcers and due to changes in the epidemiology of gastric tumours. However, resections are made, frequently on account of complicated cases of unsuccessful treatment of ulcers in "treatment at any cost". This problem was frequently the subject of professional discussions. Therefore we consider it important to remind young colleagues of the omitted chapter of possible pathological conditions which develop after gastric resections. The latter include a group of vasomotor, gastrointestinal and humoral symptoms which develop as a result of the loss of reservoir function and the function of the closing mechanism of the pyloroantral part of the stomach after gastric resections in derivation surgery. In addition to data in the literature reporting that dumping syndrome is encountered only in 2-3% of any gastric operation the authors describe two of their own observations and the results of their surgical treatment.
The First Surgical Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment of pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional cases MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 15 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was performed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 111 patients a drainage and duodenum sparing operation was performed. Of these in 46x according to Neger, 9x according to Frey, 10x modification of these operations, 37x Partington-Rochelle's procedure. The authors did not record postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patient s co-operation round 87% while after longitudinal drainage of the duct a satisfactory result was recorded in 78% of the operated patients. The authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deterioration of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 170 operated patients one patient with decompensated diabetes died. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.