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Veteskova L.,Centrum kardiovaskularni a transplantacni chirurgie | Kysela P.,Chirurgicka Klinika LF MU a FN Brno | Bohata S.,Radiologicka Klinika LF MU a FN Brno | Parenica J.,Interni kardiologicka klinika LF MU a FN Brno
Vnitrni Lekarstvi | Year: 2014

Rupture of the liver is a rare but a very serious complication of cardiopulmonary resuscitation. The presented case report describes a young patient with acute myocardial infarction with ST segment elevation treated by primary PCI. Just during admission to the hospital she had ventricular fibrillation with prolonged resuscitation. Subsequently due to a decrease of hemoglobine a liver rupture with hemoperitoneum was diagnosed by ultrasonography and computed tomography (CT). Conservative therapy with repeated ultrasonography and CT examinations was successful even without discontinuation dual antiplatelet therapy. Frequency of this rare complication, diagnostics and therapeutic options are discussed. Source

Szturz P.,Interni Hematologicka a Onkologicka Klinika LF MU a FN Brno | Adam Z.,Interni Hematologicka a Onkologicka Klinika LF MU a FN Brno | Rehak Z.,Oddeleni Nuklearni Mediciny | Koukalova R.,Oddeleni Nuklearni Mediciny | And 6 more authors.
Klinicka Onkologie | Year: 2013

Background: Castleman disease is a non-clonal lymphoproliferative disorder with 2 clinical (unicentric, multicentric) and 4 histomorphological (hyaline vascular, plasma cell, mixed, plasmablastic) forms which combine creating a pleomorphic picture of this rare entity. In our work, the largest documented cohort in the Czech Republic was analyzed focusing on diagnostics and particularly on therapy. Patients and Methods: The retrospective study (1998-2013) included 10 patients, 6 males, 4 females. Patients with unicentric form (3) underwent surgical sanation. Patients with multicentric form (7) were followed-up only (2) or extirpation of the largest mass was carried out (1) or a systemic therapy was administered (4) which comprised the following regimens: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), CTD/CAD/CVD (cyclophosphamide, thalidomide/adriamycin/bortezomib, dexamethasone), further including monotherapies with tocilizumab, thalidomide and lenalidomide and in one case (associated POEMS syndrome, i.e. polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) autologous stem cell transplantation after melphalan conditioning was performed. During treatment response monitoring, all patients underwent PET/CT examination (fluorodeoxyglucose positron emission tomography/computed tomography). Results: The remission rate was 50% (3 unicentric forms with remission lasting 51, 8 and 9 months, resp.; 2 multicentric forms with remission lasting 3 months during thalidomide therapy and 12 months after lenalidomide therapy), stable disease was observed in 40% of cases (multicentric forms, 2 without any treatment followed-up for 171 and 24 months, resp.; 1 after systemic therapy followed-up for 23 months; 1 after two extirpations with stable lymphadenopathy for 15 years, where the first operation was 27 years ago). In one patient (10%), the associated POEMS syndrome progressed rapidly with fatal consequences (4 months follow-up). Conclusion: Unlike unicentric forms completely curable by excision, multicentric forms are often treatment-refractory. Concerning high cost-effectiveness, good tolerability and documented efficacy also in rituximab-resistant cases, we prefer immunomodulatory drugs (particularly thalidomide) for managing multicentric Castleman disease in our center. Source

Jakubcova R.,Radiologicka Klinika LF MU a FN Brno | Moulis M.,Ustav Patologie LF MU a FN | Salek D.,Interni hematoonkologicka klinika FN | Foukal J.,Radiologicka Klinika LF MU a FN Brno
Ceska Radiologie | Year: 2010

Aim. On the basis of correlation of ultrasound and histological findings to determine changes in the structure of examined benign and malignant lymph nodes, that led to various types of enhancement in contrast-enhanced ultrasound examination. Method. 78 patients with peripheral lymphadenopathy were examined from January 2008 to July 2009 (27 women and 51 men, age 22-86 years), total number of 82 lymph nodes were extirpated. All patients were examined with Philips iU22 ultrasound machine with 17MHz probe natively and with 9MHz probe after intravenous application of 1.5 ml sulphur hexafluoride contrast agent (SonoVue®, Bracco, Italy). According to postcontrast enhancement lymph nodes were divided into benign and malignant group. Lymph nodes were subsequently extirpated and examined histologically. Ultrasound and histological findings were correlated. Results. The overall accuracy of the method was 92,7% for CEUS. In total 76 lymph nodes (92,7%) were correctly evaluated in terms of their benign or malignant changes. Five histologically benign lymph nodes (6,1%) were incorrectly identified as malignant ones. One malignant node was incorrectly classified as benign by CEUS. In most cases of malignant lymphadenopathy it was possible to distinguish between metastasis and lymphoproliferative disorder. Conclusion. Various processes developing in the lymph node are also reflected in the macroscopic image of the node in contrast-enhanced ultrasound examination. Depending on the type of contrast agent distribution in the node, we can assess the maintenance or, on the contrary, disappearance of its normal structure in most cases, and thus to distinguish between benign and malignant process. Source

Polak P.,Masaryk University | Husa P.,Radiologicka Klinika LF MU a FN Brno | Bohata S.,Radiologicka Klinika LF MU a FN Brno
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2015

Skull-base osteomyelitis is a rare disease affecting predominantly patients with diabetes mellitus or with immune dysfunction. The major symptoms include intensive local pain and usually unilateral cranial neuropathy. Pseudomonas aeruginosa or Staphylococcus aureus are the leading causative agents. The diagnosis is confirmed with magnetic resonance imaging (MRI) or single-photon emission tomography (SPECT), eventually combined with computer tomography (SPECT/CT). Broad- spectrum antibiotic treatment with effective pharmacokinetics to bone structures over several weeks is needed. The authors present a case report of a 75-years-old woman with skull-base osteomyelitis who was erroneously treated for neuroborreliosis. The MRI showed an extensive destructive process of the skull-base affecting clivus, left mandible and the first 3 cervical vertebrae. The 14 days lasting treatment with meropenem and subsequent long-term combination treatment with rifampicin/co-trimoxazole led to remission of the disease. Source

Kala Z.,Chirurgicka Klinika LF MU a FN Brno | Marek F.,Chirurgicka Klinika LF MU a FN Brno | Valek V.A.,Radiologicka Klinika LF MU a FN Brno | Bartusek D.,Radiologicka Klinika LF MU a FN Brno
Vnitrni Lekarstvi | Year: 2014

Surgery of Crohn's disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohn's disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries. Source

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