[Ethical problems in molecular genetics and their reflection in clinical medicine].

R Pullmann, K Bosmanský, M Sámel

Vnitr Lek 1997, 43(3):131-136

There are at least two groups of issues connected with an impact of a realization of the "Human Genome Project": a) philosophical; b) ethical, which can be divided into four groups: 1) the influence of DNA technologies on everyday applications of bioethical principles; 2) ethical aspects of genetic diversity; 3) ethical aspects of genetic screening; 4) somatic and germ-cell gene therapy; Unlike essential philosophical issues practical realization of issues in question can be largely expressed as only revitalization of old ones and concerns: the principle of justice-equal access and priorities; protection of reproductive choices; disclosure to patients...

[Clinical experience with changing type I diabetics from animal to human insulin administered by the NovoPen 3 applicator].

S Lacigová, J Perusicová, L Dohnalová, J Mertl

Vnitr Lek 1997, 43(3):137-141

The objective of the study was to assess the safety of changing ambulatory patients from animal insulin produced in the Czech Republic administered by classical insulin syringes to human insulins of the Danish firm Novo Nordisk, using a NovoPen 3 applicator. Furthermore antibody levels against hog, bovine and human insulin were assessed. Forty-seven patients with diabetes type I stabilized on an intensified insulin regime were after a four-day preparatory period divided at random into two groups. Patients in group A (n = 22) were after randomization changed to human insulin, patients in group B (n = 25) eight weeks later. From the onset of treatment...

[An explanation of the mechanism of attacks of atrial fibrillation in individuals without detectable heart disease].

V Malinovská, L Malinovsky, P Dítě, D Andrea

Vnitr Lek 1997, 43(3):142-145

The authors investigated 10 men aged 30 to 60 years who developed repeatedly attacks of atrial fibrillation. In all patients previous alcohol consumption was recorded in the case-history. In none of the patients organic heart disease was detected. In previous experiments the authors induced by alcohol administration to rats in the tracheal cells and paratracheal myelinated nerves an increased occurrence of lamellar bodies which is consistent with data in the literature which confirmed the presence of lamellar bodies in the human heart muscle in idiopathic cardiomyopathy. The authors assume therefore that alcohol induced increased presence of lamellar...

[The 104th Internal Medicine Seminar, Bratislava, 17 October 1996. Preoperative preparation of the patient].

Vnitr Lek 1997, 43(3):146-153

[Tumors of the liver and biliary system].

A Chlumská

Vnitr Lek 1997, 43(3):154-156

The classification of tumours is based on the traditional classification into epithelial, mesenchymal and less common types. The most frequent epithelial tumour is hepatocellular carcinoma, which usually develops in a cirrhotically altered liver. Its differentiation from regenerative and hyperplastic liver changes by needle biopsy may prove very difficult. Malignant mesenchymal liver tumours are rare. Because of a more frequent incidence and uncertain biological behaviour epitheloid haemangioendotheliomas are more important. Newly described units include also inflammatory pseudotumours and primary MALT lymphoma of the liver.

[Selected presentations delivered at the May Hepatology Seminar in Carlsbad on 16-17 May 1996].

Vnitr Lek 1997, 43(3):154-188

[Etiology and epidemiology of hepatocellular carcinoma].

M Brodanová

Vnitr Lek 1997, 43(3):157-161

Hepatocellular carcinoma (HCC) is a highly malignant tumour with a poor prognosis. Its incidence is rising. The estimate incidence worldwide is 1 million cases. Most frequently it develops in livers already affected by cirrhotic transformation. How cirrhosis predisposes for the development of HCC is not clear. It is probably associated with the increased DNA synthesis in regeneration nodules. In micronodular transformation (most frequently alcoholic) the incidence is less frequent than in the macronodular from (mostly posthepatitic). The relationship of HCC and viral hepatitis is beyond doubt-this applies in particular to hepatitis B and C. Chronic...

[The clinical picture and diagnosis of liver tumors].

M Kaláb

Vnitr Lek 1997, 43(3):162-166

In the diagnosis of hepatic tumour it is most important to differentiate primary carcinoma of the liver from secondary metastatic tumours and focal and infiltrative changes. Primary hepatocellular carcinoma is usually a complication of cirrhosis of the liver. The clinical symptoms therefore correspond especially to an accentuation of the symptomatology of cirrhosis of the liver and complications. The diagnosis is based above all on modern imaging methods such as ultrasonography, computed tomography, nuclear magnetic resonance, examination of tumour markers. Examination by needle biopsy is important and is nowadays usually done under ultrasonographic...

[Tumor markers in the diagnosis of tumors of the liver and biliary tract].

Z Marecek

Vnitr Lek 1997, 43(3):167-170

Tumour markers are a valuable contribution to the diagnosis and monitoring of tumours processes in the liver. They are used for early diagnosis as well as for monitoring of treatment. In particular monitoring of the dynamic of changes is important. A dominating place is still held by alpha fetoprotein. The importance of CEA is in differentiation of metastatic processes. In the diagnosis of neoplastic processes in the biliary pathways antigen CA 19-9 is most important. An important finding is also than non-specific increases of tumours markers occur in some chronic processes of the liver and biliary pathways. Despite the large number of tumour markers...

[Regional chemotherapy of liver tumors].

J Zaloudík, I Kocák, Z Pacovský, P Karásek, V Fait, H Bartonková, M Nekulová

Vnitr Lek 1997, 43(3):171-172

Based on experience with regional intrahepatic chemotherapy in 67 patients with inoperable primary, and in particular secondary liver tumours, which comprises several hundred administered cycles of mostly continuous regional regimens, the authors summarize briefly the main principles and possibilities of this treatment. In a review of randomized studies they provide evidence for the advantage of regional chemotherapy, as compared with systemic treatment, in particular with regard to the higher percentage of therapeutic responses. In correctly indicated, and if possible early cases of hepatic tumourous affections, it is possible to potentiate the effect...

[Cytokines in regional immunochemotherapy of liver tumors].

J Zaloudík, P Karásek, I Kocák, V Fait, R Talac

Vnitr Lek 1997, 43(3):173-176

Regional intrahepatic chemotherapy of inoperable primary and secondary liver tumours can achieve, as compared with the little effective systemic chemotherapy, a higher percentage of therapeutic responses. The objective of regional chemoimmunotherapy, i.e. the use of cytokines, in particular interferon alpha (IFN-a) and interleukin-2 (IL-2) in the therapeutic regimens is to improve the survival of patients with malignant liver tumours. One of the main prerequisites of the effect of locally administered cytokines is activation of hepatic lymphocytes (LAL)-liver associated lymphocytes, effectors with specific phenotype and potential anti-tumourous effect...

[Transhepatic therapy of tumors of the biliary system].

J Petrtýl

Vnitr Lek 1997, 43(3):177-179

The transhepatic percutaneous approach is a supplementary diagnostic and therapeutic method in case of biliary obstruction, in particular when the endoscopic approach fails. The bile ducts are punctured by a thin needle and then drained, followed if desired by insertion of a prosthesis. Although the method is associated with more complications than standard endoscopy, it markedly improves therapeutic possibilities.

[Treatment of liver tumors with ethanol injection].

M Kaláb

Vnitr Lek 1997, 43(3):180-183

Ethanol injection into the focus by means of a thin needle under ultrasonographic guidance has become part of treatment of primary carcinoma of the liver-hepatocellular carcinoma. It is a palliative method suitable for the treatment of small foci of hepatocellular carcinoma in a uniocular or oligolocular form. The limiting factor are in particular the number of foci, their size, depth and stage of hepatic cirrhosis in the remainder of the live parenchyma. Treatment is well tolerated and the survival of patients, if they are properly selected, is similar as in surgical resection.

[Epidemiology and etiology of tumors of the biliary tract].

T Krechler, P Urbánek

Vnitr Lek 1997, 43(3):184-185

A review of etiological factors participating in the development of tumours of the biliary pathways. Epidemiological data on the incidence of tumours of the biliary pathways in different part of the world are presented.

[Intraluminal brachytherapy in tumors of the biliary system].

R Brůha

Vnitr Lek 1997, 43(3):186-188

The therapeutic possibilities in tumour of the biliary pathways are rather limited and the survival of patients treated by palliative methods is usually short. The most frequent complication of tumours of the biliary tract is biliary obstruction. A palliative treatment involves surgical derivation of bile the endoscopic or percutaneous route. Irradiation as part of palliative therapy is limited by the relatively low sensitivity of the tumours to radiation and the close contact with various radiosensitive organs. One of the possibilities how to avoid damage of neighbouring organs is local actinotherapy. A suitable approach for introducing a radiation...