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P Mukensnabl

Publications and source records attributed to P Mukensnabl.

At least 19 recordsLinked to original sources
PubMed2006

[Videothoracoscopy in local anesthesia diagnosis and therapy of pleural effusions].

Videothoracoscopy (VTS) has been performed in the Department of Pneumology in Plzen since the year 2001. Up to-September 2005 there were realized 75 videothoracoscopies, all under local anaesthesia with analgosedation and during the spontaneous ventilation. The objective of the present work is to demonstrate that the so called "medical" videothoracoscopy is very well tolerated, quick and accurate miniinvasive method of examination of pleural pathological states, which has a high diagnostic effect and minimal complications. During the exploration it is possible to carry out, besides the collection of bioptic samples from parietal as well as visceral pleura, a whole range of therapeutical acts - evacuation of effusion, mechanical disruption of adhesions in case of empyema with its subsequent drainage or pleurodesis with talc in case of malignant exudates. As for the basic indication of the medica VTS, we consider it to be the differential diagnosis of a pleural effusion of unclear etiology, consisting mostly in the confirmation or exclusion of malignant exudates. The differential diagnosis with the help of VTS between the nonmalignant (mostly inflammatory) and malignant exudate was successful, in our group of patients, in 96 %. The operation was well tolerated by all patients and in none of them occurred significant complications or consequences.

Adult↗
PubMed2005

[Carcinoids of the appendix].

The appendical carcinoids represent a heterogeneous group of tumors of different morphology, biological features and treatment. Our study aims to inform clinical practitioners, mainly surgeons and oncologists, about individual types of the appendical carcinoids, which are considered the most frequent carcinoid tumors the clinical practitioners come into contact with at all levels of the hospital care. Our work describes the types of the appendical tumors from the histological point of view, as well as from the prognostic and therapeutical points of view. At the end of the study report, a brief table summarizing the most important features of the individual histological types of the appendical carcinoids, is attached.

Appendiceal Neoplasms↗
PubMed2005

[Malignancies in patients on dialysis].

Incidence of malignancies in patients on dialysis is higher than in the comparable population. The topic is discussed from different points of view: A. Malignancy as a cause of renal failure (renal and urinary tract tumors, von Hippel-Lindau disease, Wilms tumor, multiple myeloma, tumors that compress urinary tract). B. Treatment of malignancies may result in renal failure and dialysis (nephrectomy, tumor-lysis syndrome, postradiation fibrosis, direct toxic effect of chemotherapy). C. Dialyzed patients are in higher risk of malignancies, especially those of the kidney and urinary tract but also of pharynx and larynx, thyroid gland etc. The following factors may play some roles: the basic disease, (e.g. analgesic and Balcan nephropathies, China Herba nephropathy etc.), changed metabolic milieu with retention of carcinogens, deficiency of selenium and other substances, acquired renal cysts, compromised immunity, decreased "wash-effect" in oligo-anuria and possible influence of dialysis itself (contact with phtalates, ethylenoxide, nitrosamines etc.). D. Special problems in diagnostics of malignancies. Controversial validity of s.c. "tumor markers" is mentioned. Among the causes of death in dialyzed patients cardiovascular and infectious diseases predominate. The active search for renal and urinary tract tumors should be performed. All other diagnostic procedures depend on the individual patient's risk profile. E. Methods of renal substitution are used in the treatment of malignancies (e.g. dialysis in the tumor-lysis syndrome, plasma filtration to remove paraproteins, intraperitoneal administration of chemotherapy similar to peritoneal dialysis approach). F. Malignant tumors and dialysis--some ethical problems. Withdrawal of dialysis in severely suffering patients should be approved by an informed patient and followed by maximal palliative therapy including palliative ultrafiltration if threat of lung edema occurs.

Humans↗
PubMed2004

The histological findings in the gastroesophageal junction of fetuses.

The development of the esophageal and gastric mucosa in the gastroesophageal junction was studied in 61 fetuses of 13-41 weeks of the gestational age. During the 13th-15th week, the esophageal multilayered epithelium was covered by a continuous layer of columnar mucous ciliated cells which were present only focally till the 25th week and disappeared later. Before the 15th week, the gastric mucosa was formed by pits only. The glands started as proliferating tubules in the basal parts of the pits in the 15th week. Further, they differentiated into oxyntic glands. The mucosa of the corpus was fully developed in the 27th week. The cardiac mucosa was absent in all the 10 fetuses examined between the 27th and 41st week of gestation. This supports the view that the gastric cardiac mucosa is not a physiological structure but that it results from glandular metaplasia of the distal esophageal mucosa due to gastroesophageal reflux.

Esophagogastric Junction↗
PubMed2004

Perineurial cells and nerve axons in gastrointestinal schwannomas: a similarity with neurofibromas. An immunohistochemical study of eight cases.

Gastrointestinal schwannoma (GIS) is a distinctive and extremely rare lesion showing some differences from conventional soft tissue schwannoma and some similarities with common soft tissue neurofibroma. Soft tissue neurofibromas and schwannomas differ by contents of specific types of nerve sheath cells, such as Schwann cells, perineurial cells and CD34+ cells. To compare GIS with these soft tissue lesions, eight cases of typical GIS were studied immunohistochemically to evaluate their nerve sheath cell types. Epithelial membrane antigen (EMA) and claudin-1 as perineurial cell markers, and neurofilament protein as a marker for intratumoral axons were used. In addition, the tumors were stained for cytokeratin, CD117 (C-KIT), alpha-muscle specific actin, S100 protein and CD34. EMA- and claudin-positive cells were seen in 2 (25%) and one lesion, respectively, thus resembling cellular composition of neurofibroma. Intratumoral neurofilament protein positive axons otherwise typical of neurofibroma were found inside 4 tumors (50%). CD34 positivity was found in 6 tumors (75%) and often revealed a diffuse pattern as seen in neurofibroma and not a zonal pattern as described in schwannomas. These results show that GIS has some features that are more typical for neurofibroma than for conventional schwannoma. In surgical pathology practice, a finding of intratumoral axons and positivity for claudin-1 and especially for EMA should not preclude diagnosis of GIS.

Adult↗
PubMed2004

[Ulcerative colitis--contemporary morphological criteria].

Regular bioptical examinations of patients with ulcerative colitis (UC) performed in recent years show that the inflammatory changes of the mucosa of the large intestine are not necessarily diffuse, and that their extent may vary in the course of the disease. To establish the diagnosis of UC and to assess the treatment efficacy it is important to examine histologically multiple mucosal specimens from different levels of the large intestine. In our series of 27 patients with ulcerative colitis (18 men and 9 women at the age of 17 to 76 years), active or active and inactive pancolitis was diagnosed in 25 cases (93%). In 11 of these, the whole of the large intestine was affected. Two patients showed diffuse pancolitis without caecal involvement, in 5 cases there was inactive inflammation in the rectum or in the sigmoid colon. Seven patients had active colitis of the rectum and sigmoid. In another 2 patients (7%), the inflammation was limited to several segments of the large intestine only (the descending colon, and the descending and transverse colon). On bioptical examination of 6 patients repeated after 2-29 months (mean 14 months), there were changes in the distribution and appearance of the inflammation. Thus our findings correspond with the results of previous studies: UC does not always affect the mucosa of the large intestine diffusely. Further, the extent and distribution of inflammatory changes vary in the course of the disease.

Adolescent↗
PubMed2003

[Intralobar pulmonary sequestration].

Sequestration is defined as an area of abnormal pulmonary tissue not connected with the bronchial tree, supplied by an aberrant systemic artery and without a normal pulmonary function. Extralobar (ELS) and intralobar (ILS) forms are distinguished. During the year 2002 the authors diagnosed and operated upon two cases of the intralobar form of pulmonary sequestration, and in last 25 years five cases - 4 x ILS and 1 x ELS. Reported are a 35 year old man with relapsing infections of the sequester and a 21 year old woman where the sequestration was accidentally found without clinical symptoms. The focus was localized in both cases in the left lower lobe of the lungs, anomalous supply arteries derived from the thoracic aorta. Venous drainage of the sequester was different - in the man a systemic drainage via the v. azygos, in the woman via the pulmonary veins was found. In one case the diagnosis was made on the basis of angiography and computer tomography, in the other case it was made on the basis of multidetector CT angiography (MDCTA). Both findings were treated by primary surgical intervention lobectomy. The postoperative course was uneventful.

Adult↗
PubMed2003

[Less common tumors of the pleural cavity].

Among tumourous affections of the pleural cavity dominate metastatic processes while primary pleural neoplasms are relatively rare (only 5%). The authors present 4 case-records of less common primary benign pleural tumours which were operated at the Surgical Clinic of the Faculty Hospital in Plzen during 2000. Three women and one man of different age groups were involved. In three patients accidental findings were involved, in one instance in conjunction with multiple injuries, the fourth patient was examined on account of pulmonary complaints. The diagnosis was based on the skiagram and specially on the CT of the lungs, individually also other methods were used. All findings were radically eliminated--twice by thoracotomy, twice using miniinvasive procedures. Histological examination revealed twice desmoidal fibromatosis, once a benign fibrous pleural tumour and once a rare variant of Castleman's disease. The postoperative period was free from major complications, without the need of surgical revision. Two years after surgery all patients are free from detectable signs of relapse. The authors submit at the same time an integrated view on the problem of pleural neoplasias, they discuss in particular the pitfalls of the diagnosis of these lesions, possible treatment, incl. the use of suitable endoscopic methods, and the prognosis of different types of tumours. A more detailed histopathological analysis of the described findings is given.

Adult↗
PubMed2003

[Patient survival analysis in surgery of bronchogenic carcinoma from 1986 to 1997].

Surgery is the most effective treatment of lung cancer (LC) in early stage disease (I-IIIa) of non small cell lung carcinoma (NSCLC). Even in resectable patients there are differences in survival accordingly to some prognostic factors. In 12 years period (1986-1997) there were 363 resected patients, in 350 of them lung cancer was confirmed. This group was analysed according to morphologic types, stages, and sex of patients, co morbidity and the type subsequent adjuvant therapy in relation to survival. Sensitivity and specificity of staging methods were also evaluated as well as the impact of staging accuracy to survival. Epidermoid cancer was found in 193 patients (55%), adenocarcinoma in 124 (36%), large cell-anaplastic type in 29 patients (8%) and small cell lung cancer in 4 patients (1%). Early postoperative mortality is 4%. 5 year after surgical resection survive 26% (90 patients). Other results are given in the text. Surgery of LC remains optimal therapeutic method. Survival of patients after lung resection doesn't change significantly in last years, even that we can use much more better diagnostic methods now. The way for the future seems to be the preoperative chemotherapy and the biologic target therapy. We need more precious staging procedures and more effective adjuvant therapeutic schedules in early as well as more advanced stages.

Adult↗
PubMed2003

[Congenital cytomegalovirus infection].

Cytomegalovirus (CMV) belongs to the herpesvirus family. Its distribution is ubiquitous in man and many other mammals. CMV causes a typical cytopathic effect with enlargement of the cells that contain intranuclear and cytoplasmic inclusions. CMV is spread directly or by a contact with secretions. Nosocomial transmission can occur during blood transfusion or organ transplantation. Virus excretion after infection continues for a long time. CMV is the most frequent cause of congenital infections (1-2% children). A foetal infection can lead to a preterm labour. Most of CMV congenital infections are benign, only a small proportion of children develop a disease with sensorineural hearing loss or a life threatening multiorgan disease. The diagnosis can be done on the basis of identification of specific antibodies, virus cultivation and PCR from urine, saliva, blood, and cerebrospinal fluid. An antiviral drug ganciclovir can be used for treatment. Anti-CMV vaccines are under the development. Three cases of a congenital CMV infection are described in the paper.

Adult↗
PubMed2002

[Lymphoproliferative disease after transplantation].

Herein we describe 7 cases of posttransplantation lymphoproliferative disease (PTLD), 5 in men and 2 in women (aged from 25 to 62 years), occurring from 4 months to 12 years (mean, 7 years) after transplantation. Our patients were recipients of kidney, kidney and pancreas, heart, and autologous peripheral haematopoetic stem cells. Four cases were diagnosed as monomorphic and three as polymorphic type of PTLD according to the WHO classification. Monoclonal immunoglobuline heavy chain gene rearrangement was detected in two monomorphic lesions and one polymorphic lesion by polymerase chain reaction (PCR). In the two cases of polymorphic and the one case of monomorphic PTLD, the presence of EBV was visualised by immunohistochemical staining of some transformed lymphoid cells for latent membrane protein (LMP) of EBV. The presence of type A EBV was demonstrated by PCR. The patients were treated by reduction or discontinuation of immunosuppression and by chemotherapy. In 2 cases, a part of the organ affected by lymphoma (sigmoid colon and pancreas) was surgically resected. Four patients died of causes related to PTLD (2 to 15 months after the diagnosis), mainly of infectious complications. Two other patients who achieved remission died of unrelated causes. Only the youngest man is alive and in the complete remission 10 months after the diagnosis of PTLD.

Adult↗
PubMed2002

[Septic conditions caused by yeasts and their diagnosis].

The authors present a review of factors making possible the penetration of yeasts into the blood stream, development of Candinaemia and sepsis, and a group of tests which have been used for the diagnosis of sepsis evoked by Cryptococcus neoformans, Candida albicans, C. glabrata, C. melinii and C. krusei.

Adult↗
PubMed2001

Small cell variant of renal oncocytoma--a rare and misleading type of benign renal tumor.

Here we report 3 cases of renal oncocytoma with a dominating small cell component arising in adult women. These 3 cases of small cell variant of renal oncocytoma were found among 134 cases of oncocytomas of the kidney in the routine and consultation files of the authors. Two of 3 cases were initially thought to be a malignant tumor by the referring pathologists. In all 3 cases minor areas of the tumors, which were identical to the classical renal oncocytomas were found. The small cell areas were arranged in a characteristic organoid pattern different from all the known types of the renal benign and malignant tumors. We summarize all morphologic, immunohistochemical, and ultrastructural features of this unusual oncocytoma variant with regard to its differential diagnosis. Int J Surg Pathol 9(3):215-222, 2001

Adenoma, Oxyphilic↗
PubMed2001

Chlorpromazine-induced cholestatic liver disease with ductopenia.

We describe a 30-year-old pregnant woman in whom cholestatic liver disease developed 16 resp. 18 days after the medication of chlorprothixeni hydrochloridum and chlorpromazine treatment in the 33rd week of pregnancy. Clinically, the course was characterized by severe jaundice lasting 10 months, fever, pruritus, high serum alkaline phosphatase level, transient aminotransferase elevation, and hypercholesterolemia. The pregnancy was terminated in the 35th week by cesarean section with the birth of a premature female newborn without any signs of liver damage. The histological examination of the mother's liver revealed ductopenia, defined by the absence of interlobular bile ducts in at least 50% of the small portal tracts, and long-standing cholestasis with pseudoxanthomatous transformation of hepatocytes and ductular epithelia, and small lobular xanthomas. The jaundice resolved very slowly after ursodeoxycholic acid therapy. The liver function tests 26 months after the onset of jaundice showed only a slight elevation of alkaline phosphatase and aminotransferases. In the control liver biopsy, non-active periportal and septal fibrosis without signs of cholestasis was seen. To our knowledge this is the sixth report to document chlorpromazine-induced ductopenia in pregnancy and the first to describe a newborn without any liver damage.

Adult↗
PubMed2001

[Sclerosing epithelioid fibrosarcoma].

Sclerosing epithelioid fibrosarcoma (SEF) was first described in 1995 and since then 39 cases have been reported. Here we describe 6 cases of SEF (3 in women and 3 in men). The patients aged from 22 to 79 years. The tumours were located in soft tissues of the extremities (in 3 cases in the lower, in 2 instances in the upper extremity) and of the trunk (in 1 case). The lesions were partially nodular, of gray-white colour, and hard in consistency. Histologically, they were composed of epithelioid round to ovoid small cells with a sparse cytoplasm and a very low mitotic activity. The tumour cells formed cords and alveoli or were scattered individually within a dense hyalinized collagenous stroma. The neoplasms also contained foci of conventional fibrosarcoma, necrosis, calcification, and metaplastic bone. On immunohistochemistry, the neoplastic cells were positive for vimentin. Two cases were immunoreactive for epithelial membrane antigen and one tumour also for cytokeratins. The proliferative activity, assessed by MIB 1 antibody (Ki-67), was detected in 1-6% of neoplastic cells in primary tumours. Follow-up information was available in 5 patients. In two cases, there were local recurrences and distant metastases (in the lungs, upper extremity, and mediastinum). One of these patients died of SEF. The differential diagnosis of this relatively low-grade fibrosarcoma is broad and includes, along with a variety of benign and malignant soft tissue lesions, infiltrating carcinoma, and, to a lesser extent, sclerosing lymphoma.

Adult↗
PubMed2000

Prolapse of the fallopian tube after hysterectomy associated with exuberant angiomyofibroblastic stroma response: a diagnostic pitfall.

We report two cases of prolapse of the fallopian tube associated with an exuberant angiomyofibroblastic stroma response, which occurred after hysterectomy and which is a hitherto unreported feature of this lesion. The tumors were composed of richly vascularized stroma arranged in a retiform pattern and mildly atypical glandular inclusions, which had the morphology of tubal epithelium. The stroma of the lesion was composed of either thin bipolar cells with tapered nuclei and stellate-shaped cells with minimal amount of cytoplasm or small epithelioid-looking cells with eosinophilic cytoplasm. The tubal glandular inclusions displayed mildly atypical nuclear features. If the tubal glandular component was overlooked, these tumors might be erroneously diagnosed as mesenchymal lesions of the vagina, such as vaginal fibroepithelial polyp, angiomyofibroblastoma, aggressive angiomyxoma, or superficial myofibroblastoma.

Adult↗