Pancreatic cancer in chronic pancreatitis – the diagnostic and therapeutic dilemma; an overview of cases

Introduction: Any mass in chronic pancreatitis (CP) is a difficult diagnostic and therapeutic problem. The aim of the study is a) to use our own group to determine the actual incidence of non-malignant masses in CP where any mass is highly suspected of being malignant; and b) to determine the actual incidence of malignant tumors in CP. Methods: We present a retrospective analysis of our group of patients operated in 2015–2019 for CP, a mass in CP and suspected malignancy in the mass in CP. Additionally, we present difficult cases in terms of preoperative diagnosis. Results: Thirty-three of 340 (9.7%) pancreatic resection were done due to any form of chronic pancreatitis in 2015–2019. A mass in the pancreatic head was present in 16 (48%) patients; of these, pancreatic ductal adenocarcinoma (PDAC) was suspected in 10 (62%) patients based on EUS, CT or PETCT, and also based on positive tissue diagnosis using EUS-FNA in 6 cases. Bypass or Frey procedure were done in 59 patients (HJA, PJA, Frey). Preoperative tissue sampling was done in 8 (13%) patients and malignancy was suspected in 25%. Intraoperatively, malignancy was confirmed only in one patient assessed as non-malignant in the preoperative period. The clinical course in 3 other patients undergoing HJA, although tumor-free at the time of the surgery, indicated PDAC in CP. Conclusion: The ability to detect malignant cells in a mass in CP remains poor even using all of the available sophisticated methods and the success depends on many variable factors. The rate of “unnecessary” right-sided resections of a mass in CP reached 48% in our patient group, while the rate of resections which should have been performed instead of bypass procedures was 7%. A certain percentage of the so-called excessive pancreatic resections, as well as the failure to perform a resection due to an undetected/unrecognized pancreatic tumor in CP should continue to be expected.

Extracorporeal shockwave lithotripsy in combination with endoscopy as a treatment modality for painful chronic obstructive pancreatitis – a case report

Chronic pancreatitis (CP) is a serious condition with a great impact on the quality of life, and it can lead to some serious long-term consequences such as pancreatic cancer or secondary diabetes mellitus. Associated pancreatic exocrine insufficiency leads to malnutrition with weight loss; however, the main symptom of the disease is abdominal pain, often very severe. The primary treatment option for painful CP is pharmacotherapy (pancreatic enzyme replacement therapy, analgesics). If this is not effective, CP can be treated via endoscopy, extracorporeal shockwave lithotripsy (ESWL), their combination, or surgery. We present a case of painful chronic obstructive pancreatitis in a patient successfully treated with ESWL in combination with endoscopy.

First Search for Exclusive Diphoton Production at High Mass with Tagged Protons in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for exclusive two-photon production via photon exchange in proton-proton collisions, pp→pγγp with intact protons, is presented. The data correspond to an integrated luminosity of 9.4  fb^{-1} collected in 2016 using the CMS and TOTEM detectors at a center-of-mass energy of 13 TeV at the LHC. Events are selected with a diphoton invariant mass above 350 GeV and with both protons intact in the final state, to reduce backgrounds from strong interactions. The events of interest are those where the invariant mass and rapidity calculated from the momentum losses of the forward-moving protons match the mass and rapidity of the central, two-photon system. No events are found that satisfy this condition. Interpreting this result in an effective dimension-8 extension of the standard model, the first limits are set on the two anomalous four-photon coupling parameters. If the other parameter is constrained to its standard model value, the limits at 95% confidence level are |ζ_{1}|<2.9×10^{-13}  GeV^{-4} and |ζ_{2}|<6.0×10^{-13}  GeV^{-4}.

Interactive effects of nitrogen, UV and PAR on barley morphology and biochemistry are associated with the leaf C:N balance

Environmental conditions to which plants acclimate prior exposure to abiotic or biotic stressors can greatly affect their subsequent resilience. This may have a significant impact on the response to ongoing climate change and can be useful for increasing the food security under adverse weather conditions associated with climate change.Within this study, we tested the hypothesis that plant morphological and biochemical acclimation to radiation conditions and nitrogen (N) availability is closely linked with carbon (C) and N balance. Four barley (Hordeum vulgare) varieties, differing in their morphological characteristics and sensitivity to photooxidative stress, were grown at two levels of N supply and four radiation regimes combining distinct levels of ultraviolet (UV) and photosynthetically active radiation (PAR). Changes in root and shoot morphology, accumulation of phenolic compounds, amino acids, and sugars were studied together with the analysis of C and N content in leaves. Both UV and PAR reduced leaf length and increased root-to-shoot ratio (R:S). Such effect was more pronounced under high N availability. High N supply reduced R:S, but this effect showed significant interactions with UV and PAR, and also with barley variety. Changes in R:S were positively related to C:N ratio in leaves that varied in response to both N availability and radiation treatments. UV radiation, particularly in combination with high PAR intensity, led to increases in most phenolic compounds (particularly flavones such as saponarin, homoorientin and isovitexin) which was also closely associated with changes in C:N ratio, while specifically phenolic acids (vanillic and syringic acids) decreased under high levels of UV and PAR, and hydroxycinnamic acids responded positively mainly to PAR. Although high N availability generally reduced the accumulation of phenolic compounds, this effect was genotype-specific and modulated by the radiation regime. A similar antagonistic effect of radiation treatment and N availability was also found for the accumulation of sugars (pentoses), resulting in a close relationship between the accumulation of pentoses and C:N ratio. The accumulation of most amino acids, in contrary to phenolic compounds, increases at high N and is also stimulated by high PAR and UV intensities. We conclude that radiation conditions and N availability have opposite effects on plant morphology and accumulation of most phenolic compounds and modulate the amino acid and sugar metabolism. Strong associations of these responses with changes in C:N ratio indicates that plant stoichiometry integrates acclimation processes and induction of relevant defence mechanisms.

Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements

We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96  TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.

Genotype and soil substrate effects on the wood quality of poplar grown in a reclaimed lignite-mining area

An understanding of the structural organisation and chemistry of the cell walls in woody tissues is crucial from the perspective of plant mechanical strength, water transportability, as well as subsequent commercial utilisation of the wood. Poplar trees (Populus sp.), grown on two reclamation substrates ("Humus" and "Sand") under the extreme soil conditions of an external coal mining spoil heap of the lignite mine in Bełchatów (Central Poland), were examined. Conventional parameters - tree-ring width (TRW) and wood density (WD) resolved annually (years 2008-2017) were corroborated by a novel approach of Raman spectroscopic analysis. Annually resolved Raman spectroscopic data representing the lignin-to-cellulose ratio (Li/Ce) enabled to estimate trends of lignification. The above traits were obtained for the three poplar genotypes: H-275, Grandis, and Androscoggin to assess the suitability of their plantation on the reclaimed heap. Our results show a significant effect of genotype on TRW, WD, and the Raman Li/Ce, while the effect of the soil substrate was less pronounced. The highest Li/Ce was identified in the H-275 genotype grown on a substrate with hummus. H-275 also showed higher TRW values compared to the other genotypes. WD was significantly higher in Grandis and Androscoggin genotypes grown on the "Sand" substrate. Associations between tree-ring parameters and climatic variables (temperature and precipitation) were mostly low and not statistically significant. Our findings from individual tree rings indicate that the genotype is the crucial factor influencing the lignification of poplar trees grown on post-mining lands.

Measurement of single-diffractive dijet production in proton-proton collisions at s = 8 Te with the CMS and TOTEM experiments

Measurements are presented of the single-diffractive dijet cross section and the diffractive cross section as a function of the proton fractional momentum loss ξ and the four-momentum transfer squared t. Both processesp p → p X andp p → X p , i.e. with the proton scattering to either side of the interaction point, are measured, whereX includes at least two jets; the results of the two processes are averaged. The analyses are based on data collected simultaneously with the CMS and TOTEM detectors at the LHC in proton-proton collisions ats = 8 Te during a dedicated run withβ ∗ = 90 m at low instantaneous luminosity and correspond to an integrated luminosity of 37.5 nb - 1 . The single-diffractive dijet cross section σ jj p X , in the kinematic region ξ < 0.1 ,0.03 < | t | < 1 Ge 2 , with at least two jets with transverse momentump T > 40 Ge , and pseudorapidity | η | < 4.4 , is 21.7 ± 0.9 (stat) - 3.3 + 3.0 (syst) ± 0.9 (lumi) nb . The ratio of the single-diffractive to inclusive dijet yields, normalised per unit of ξ , is presented as a function of x, the longitudinal momentum fraction of the proton carried by the struck parton. The ratio in the kinematic region defined above, for x values in the range - 2.9 ≤ log 10 x ≤ - 1.6 , is R = ( σ jj p X / Δ ξ ) / σ jj = 0.025 ± 0.001 (stat) ± 0.003 (syst) , where σ jj p X and σ jj are the single-diffractive and inclusive dijet cross sections, respectively. The results are compared with predictions from models of diffractive and nondiffractive interactions. Monte Carlo predictions based on the HERA diffractive parton distribution functions agree well with the data when corrected for the effect of soft rescattering between the spectator partons.

Measurement of single-diffractive dijet production in proton-proton collisions at s = 8 Te with the CMS and TOTEM experiments

Measurements are presented of the single-diffractive dijet cross section and the diffractive cross section as a function of the proton fractional momentum loss ξ and the four-momentum transfer squared t. Both processes p p → p X and p p → X p , i.e. with the proton scattering to either side of the interaction point, are measured, where X includes at least two jets; the results of the two processes are averaged. The analyses are based on data collected simultaneously with the CMS and TOTEM detectors at the LHC in proton-proton collisions at s = 8 Te during a dedicated run with β ∗ = 90 m at low instantaneous luminosity and correspond to an integrated luminosity of 37.5 nb - 1 . The single-diffractive dijet cross section σ jj p X , in the kinematic region ξ < 0.1 , 0.03 < | t | < 1 Ge 2 , with at least two jets with transverse momentum p T > 40 Ge , and pseudorapidity | η | < 4.4 , is 21.7 ± 0.9 (stat) - 3.3 + 3.0 (syst) ± 0.9 (lumi) nb . The ratio of the single-diffractive to inclusive dijet yields, normalised per unit of ξ , is presented as a function of x, the longitudinal momentum fraction of the proton carried by the struck parton. The ratio in the kinematic region defined above, for x values in the range - 2.9 ≤ log 10 x ≤ - 1.6 , is R = ( σ jj p X / Δ ξ ) / σ jj = 0.025 ± 0.001 (stat) ± 0.003 (syst) , where σ jj p X and σ jj are the single-diffractive and inclusive dijet cross sections, respectively. The results are compared with predictions from models of diffractive and nondiffractive interactions. Monte Carlo predictions based on the HERA diffractive parton distribution functions agree well with the data when corrected for the effect of soft rescattering between the spectator partons.

Percutaneous endoscopic cecostomy in the treatment of recurrent colonic pseudo-obstruction a case report of the first procedure in the Czech Republic

We present the case of an 89-year-old polymorbid female patient with recurrent acute colonic pseudo-obstruction who was treated by performing percutaneous endoscopic cecostomy as the first procedure of its kind in the Czech Republic. The patient presented repeatedly with ileous conditions without evidence of an organic cause. Surgical colostomy was proposed with a possibility of subtotal colectomy as an ultimum refugium due to an insufficient effect of maximum conservative management and a need for repeated endoscopic decompression. In this particular patient, however, any kind of surgical intervention posed a major risk and was eventually abandoned. Finally, percutaneous endoscopic cecostomy was proposed as an alternative to resolve the situation. The procedure was carried out without complications and with an immediate effect. The patient has been free of the symptomatology of intestinal obstruction in the long term having the option of intermittent intestinal decompression as needed.

Another case of coincidental Giardia infection and pancreatic cancer

Until now, few cases of coincidental giardiasis and pancreatic tumors have been described. Among these cases, three described giardiasis cases coincided with confirmed pancreatic cancer. We present another case of Giardia infection coexisting with pancreatic cancer in a 67-year-old man who suffered from stenosis of the distal ductus choledochus combined with a hypoechoic mass in the head of the pancreas. The diagnostic conclusion of suspicious adenocarcinoma was based on endoscopic ultrasound fine-needle aspiration (EUS-FNA) biopsy and confirmed by a partial duodenopancreatectomy. On bloody cytology smears prepared from the EUS-FNA specimen, trophozoites of Giardia intestinalis accompanying an inflammatory background and features that fulfilled the morphological criteria of malignancy were observed. In histological sections from the duodenopancreatectomy specimens, the parasites were observed attached to the epithelium, but individual Giardia parasites were also observed beneath the epithelial lining. According to conventional genotyping, the infecting Giardia belonged to sub-assemblage AII.

Interactive effects of ultraviolet radiation and elevated CO2 concentration on photosynthetic characteristics of European beech saplings during the vegetation season

To test the hypothesis that ultraviolet radiation (UV) modulates photosynthetic responses to elevated CO₂ concentration ([CO₂]) in plants, saplings of European beech were grown for two vegetation seasons under ambient (400 ppm) and elevated (700 ppm) atmospheric [CO₂]. From April to November the saplings were exposed to (i) ambient UV radiation, (ii) excluded and (iii) enhanced UV (150% of ambient). Gas-exchange and chlorophyll fluorescence techniques were used throughout the second vegetation season together with biochemical analyses of the amount and activity of the Rubisco enzyme. We found support for the hypothesis that an impact of elevated [CO₂] on photosynthesis is substantially modulated by UV radiation. Moreover, we found that the [CO₂] × UV interaction is changing along the vegetation season: an enhanced UV radiation stimulated a positive effect of elevated [CO₂] on plant photosynthesis at the beginning of the vegetation season (short-term effect), whilst long-term cultivation reduced the stimulatory effect of elevated [CO₂] (a clear down-regulation of photosynthesis). Down-regulation was, however, not found in plants grown under the conditions of excluded UV radiation. We found evidence that the down-regulation of photosynthesis is associated with a complex acclimation at different hierarchical and functional levels, including an acclimation of primary photochemical reactions, carboxylation activity of Rubisco enzyme, and stomatal conductance.

There is no correlation between signs of reflux laryngitis and reflux oesophagitis in patients with gastro-oesophageal reflux disease symptoms

The objective of the present study was to determine if there is correlation between signs of reflux laryngitis (RL) and reflux oesophagitis (RE) in patients with gastro-oesophageal reflux disease (GORD) symptoms. Laryngeal photography obtained from patients during oesophagogastroduodenoscopy were examined by two otolaryngologists experienced in the field of extra-oesophageal reflux regarding the presence and severity of RL. The presence of RE was evaluated by gastroenterologist. Smokers, heavy drinkers and patients with bronchial asthma were excluded from the statistical analysis. A total of 681 patients were analysed. RL was diagnosed in 367 (53.9%) cases, of whom 182 patients had mild, 118 moderate and 67 severe (Reflux Finding Score > 7) RL. RE was diagnosed in 103 (28.1%) patients with RL and in 80 (25.7%) patients without RL. Neither the difference between the overall group of patients with RL and those without (OR 1.141, 95% CI 0.811-1.605, p = 0.448), nor the differences between the respective subgroups of patients with mild, moderate and severe RL and those without RL were statistically significant. The OR and 95% CI for mild, moderate and severe RL were 1.042, 95% CI 0.712-1.526, p = 0.834, 1.182, 95% CI 0.764-1.831, p = 0.453 and 1.0, 95% CI 0.566-1.766, p = 0.999 respectively. It can be concluded that there is no correlation between RL and RE in patients with GORD symptoms.

[Combination of endoscopic mucosal resection and full-thickness resection in the treatment of local residual neoplasia of the colon two case reports]

We present the case of a 61-year-old patient with local residual neoplasia (LRN) of the rectum and the case of a 65-year-old patient with LRN of the cecum. In both cases, the lesion measured 25 mm in diameter and its center was fixed by submucosal fibrosis causing the non-lifting sign. For endoscopic treatment, which was uneventful,a combination of endoscopic mucosal resection (EMR) and full-thickness resection (FTR) was used. In both cases, histological examination showed completely resected tubular adenoma with HGIN.Key words: colorectal carcinoma local residual neoplasia full-thickness resection endoscopic mucosal resection.

Similar local, but different systemic, metabolomic responses of closely related pine subspecies to folivory by caterpillars of the processionary moth

Plants respond locally and systemically to herbivore attack. Most of the research conducted on plant-herbivore relationships at element and molecular levels have focused on the elemental composition or/and certain molecular compounds or specific families of defence metabolites showing that herbivores tend to select plant individuals or species with higher nutrient concentrations and avoid those with higher levels of defence compounds. We performed stoichiometric and metabolomics, both local and systemic, analyses in two subspecies of Pinus sylvestris under attack from caterpillars of the pine processionary moth, an important pest in the Mediterranean Basin. Both pine subspecies responded locally to folivory mainly by increasing relative concentrations of terpenes and some phenolics. Systemic responses differed between pine subspecies, and most of the metabolites presented intermediate concentrations between those of the affected parts and unattacked trees. Our results support the hypothesis that foliar nutrient concentrations are not a key factor for plant selection by adult female processionary moths for oviposition, since folivory was not associated with any of the elements analysed. Phenolic compounds generally did not increase in the attacked trees, questioning the suggestion of induction of phenolics following folivory attack and the anti-feeding properties of phenolics. Herbivory attack produced a general systemic shift in pines, in both primary and secondary metabolism, which was less intense and chemically different from the local responses. Local pine responses were similar between pine subspecies, while systemic responses were more distant.

[Precancerous conditions and lesions of the stomach]

Gastric carcinoma is a common malignant disease associated with an unfavorable prognosis in the case of late dia-gnosis. The most significant precancerous condition is chronic atrophic gastritis and intestinal metaplasia caused by Helicobacter pylori infection. These longlasting changes may lead to formation of dysplastic precancerous lesions. Upper endoscopy and histologic examination of forceps bio-psy specimens play a key role in the dia-gnosis of gastric precancerous conditions and lesions. Helicobacter pylori eradication therapy and endoscopic surveillance are main therapeutic modalities of gastric precancerous conditions. Localized precancerous lesions and early gastric neoplasia without the risk of lymphatic spread could be cured by means of endoscopic resection techniques.

Cool water vs warm water immersion for minimal sedation colonoscopy: a double-blind randomized trial

AIM

Water-aided insertion as an alternative colonoscopy technique reduces patient discomfort. Warm water has been used in most published trials, but the use of cool water is easier and, if equally effective, could support the use of the water-aided technique in routine practice.

METHOD

A double-blind, randomized, single-centre study was performed in which 201 patients were randomized to either cool (20-24 °C) or warm (37 °C) water immersion insertion. The primary outcome was caecal intubation time. The success rate of minimal sedation and patient discomfort were also assessed.

RESULTS

The caecal intubation time for cool and warm water was similar (6.9 ± 3.5 vs 7.0 ± 3.4 min, P = 0.64). The respective success rates of minimal sedation colonoscopy (89.1% vs 90%, P = 1.00) and discomfort (P = 0.51) were no different. All other outcomes except a greater need for abdominal compression in the cool water arm (P = 0.04) were similar including the total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, non-standard position rate, difficulty of the procedure and the patient's temperature sensation.

CONCLUSION

The use of cool water did not modify the caecal intubation time compared with warm water. Exception for abdominal compression, all other end-points were no different. Cool water immersion is an alternative to the technically more demanding warm water immersion colonoscopy.

[A detailed study of colon polyps]

INTRODUCTION, STUDY AIM: Colorectal carcinoma is one of the most frequent malignancies. Most frequently, neoplasms, including malignant precursors, are in the form of polyps, although these might be of a non-tumour origin. The aim of this prospective multicentre study was to provide an overview of coloscopic identification and biological nature of polyps.

RESULTS

3,400 consecutive coloscopies performed between 2009 and 2010 were analyzed. At different centres, the top of the cecum was reached in 89% to 93% and terminal ileum in 73% to 87% of cases. In the above 40 age group, 26.6% were screening coloscopies. The mean age of the above 40 patients was 56 years. The incidence of potential neoplastic lesions (polyps, carcinomas), advanced adenomas and carcinomas were: 7.8 %, 0.8 % and 0.16 %, respectively, in the above 40 age group, 41.5 %, 9.8 % and 1.6 %, respectively, in the 40-50 years age group and 70.5 %, 31.3 % and 6.8 %, respectively, in the above 50 age group. The incidence of tubular adenoma and hyperplastic polyps was 23.9% and 66.2%, respectively, in the below 40 age group and 53.1% and 26.1% in the above 50 age group. 57.8% of advances neoplasms were located in the rectosigmoid a descendent colon. The incidence ratio for adenomas and hyperplastic polyps was 76.6% and 14%, respectively, for rectosigmoid colon, 63.6 and 17.4 %, respectively, for descendent colon, 63.6 and 11.4 % for traverse colon and 63,4 a 17,9 %, respectively, for cecum and ascendant colon. The incidence of tubulovillous adenomas and hyperplastic polyps in pedunculated polyps larger than 1 cm was 19.4 % and 20.4 %, respectively, and 34.2 % and 13.1 %, respectively, in other polyps. The incidence of potential lesions (polyps and carcinomas), advanced adenomas, carcinomas and advanced neoplasms was 66.7 %, 23.1 %, 5.8 % and 28.9 %, respectively, in women and 63.1 %, 30.0 %, 5.7 % and 34.7 %, respectively, in men.

CONCLUSION

The top of the cecum was reached in a higher proportion of cases than required, although this was lower than in the majority of other recent studies. Terminal ileum was reached in high number of cases. The incidence of polyps and neoplasms rose sharply from 40 years of age. Therefore, the screening threshold should be extended to the below 50 age group. Hyperplastic polyps predominated in younger age and adenomas in the above 40 age group. Histological profile was similar and did not suggest importantly different pathogenesis with respect to localization. There were relatively fewer adenomas and more hyperplastic polyps in pedunculated polyps and vice verse in other types of polyps, suggesting a higher risk associated with non-pedunculated lesions. Both sexes differed less than suggested based on epidemiological statistics.

[Screening of celiac disease in patients with osteoporosis and osteopenia]

The celiac disease is traditionally viewed as the children's disease with a typical form accompanied mainly by intestinal symptoms and malabsorption. This opinion is still generally accepted by the medical community. Findings based on the area-wide screening show that the prevalence has risen from the original 1 : 1 000-1 500 to 1 : 70-550. The average prevalence in the western countries is nearly 1 : 100. The prevalence of the celiac disease in the Czech republic is estimated to be approximately 1 : 200-250. It means that the number of people in the Czech republic who are likely to be affected is about 40,000-50,000 people. Currently only 10-15% of the total number of the ill people are diagnosed and monitored. Adult patients represent the main diagnostic problem because their clinical pictures are individual and the main symptoms are atypical (nonenteral). These are anaemia (mainly sideropnic), early/premature osteoporosis, herpetiformic (Duhring) dermatitis, polyneurititis, ataxia, depression, behavioural disorders, menstrual cycle disorders and infertility. Therefore our attention is currently focused on the screening of these groups of subjects. The purpose of our study was to check the frequency of the celiac disease with patients with diagnosed osteoporosis and osteopenia. In our study we have confirmed the assumption that the prevalence ofthe celiac disease in the group of subjects was 1 : 50, which means that 2.2% of patients with osteoporosis and osteopenia are affected by celiac sprue and therefore screening examination of these patients with the subsequent causal treatment (gluten-free diet) is recommended.

Soil [N] modulates soil C cycling in CO2-fumigated tree stands: a meta-analysis

Under elevated atmospheric CO(2) concentrations, soil carbon (C) inputs are typically enhanced, suggesting larger soil C sequestration potential. However, soil C losses also increase and progressive nitrogen (N) limitation to plant growth may reduce the CO(2) effect on soil C inputs with time. We compiled a data set from 131 manipulation experiments, and used meta-analysis to test the hypotheses that: (1) elevated atmospheric CO(2) stimulates soil C inputs more than C losses, resulting in increasing soil C stocks; and (2) that these responses are modulated by N. Our results confirm that elevated CO(2) induces a C allocation shift towards below-ground biomass compartments. However, the increased soil C inputs were offset by increased heterotrophic respiration (Rh), such that soil C content was not affected by elevated CO(2). Soil N concentration strongly interacted with CO(2) fumigation: the effect of elevated CO(2) on fine root biomass and -production and on microbial activity increased with increasing soil N concentration, while the effect on soil C content decreased with increasing soil N concentration. These results suggest that both plant growth and microbial activity responses to elevated CO(2) are modulated by N availability, and that it is essential to account for soil N concentration in C cycling analyses.

[Endoscopic diagnostics and treatment of flat intestinal lesions]

The aim of the article is to provide information on current options for endoscopic diagnostics and treatment of flat tumor intestinal lesions. These neoplasms are frequently and inaccurately described as sessile polyps, which have different genetic and diagnostic features, different prognosis and therapy. Although until recently, the lesions have been managed using surgery, the current approach is predominantly endoscopic.

Variability of catechin and 4-hydroxyacetophenone distribution in Norway spruce needles in relation to their position, age, and growing conditions

The amount of catechin and 4-hydroxyacetophenone in the methanolic extract of the Norway spruce needles at the locality Bílý Kríz (Moravian-Silesian Beskydy Mts.) was found in the range 2.8-12.1 mg g(-1) (dry weight) and 0.2-17.7 mg g(-1) (dry weight), respectively. Total amount of catechin (sum of the last three needle year-classes) is statistically higher (p<0.01) in the sparse areas compared to the dense ones and similar trends were recorded for catechin content in current and one-year-old needles. These results may support an idea about primary control of phenolic production by the incident solar radiation, which depends on the social position of the tree and canopy closure degree.

[Treatment of chronic postirradiation proctitis with argon plasma coagulation ]

Chronic radiation proctitis calls for a disease of the rectum due to irradiation of pelvic malignancies. The results of treatment of 8 patients with hematochezia from chronic radiation proctitis are presented here. They were treated with argon plazmakoagulation during 1-4 sessions. Hematochezia has disappeared in all cases. Rectal pain was the reason for hospitalization in one case. After the treatment, improved quality of live was claimed by all patients.

Influence of laminar flow on preorientation of coal tar pitch structural units: Raman microspectroscopic study

In order to estimate the role of laminar flow of viscous, aromatic matter of carbonaceous precursor on microtextural preorientation in pregraphitization stage, we performed experiments with coal tar pitch (CTP). The principal hypothesis of preorientation of basic structural units (BSUs) in the case of laminar flow (pressure impregnation of CTP into porous matrix) and secondary release of volatiles during carbonization were studied. Glass microplates, planar porous medium with average distance between single microplates 5 microm were used as suitable porous matrix. Samples of CTP were carbonized up to 2500 degrees C. Optical microscopy reveals large flow domains in the sample of cokes carbonized between glass microplates. Raman microspectroscopy and high resolution transmission electron microscopy (HRTEM) show that at nanometric scale, the samples do not support the proposed hypotheses. With increasing temperature of pyrolysis, the graphitization of CTP impregnated into porous matrix proceeds to lower degree of structural ordering in comparison with single pyrolyzed CTP. This is explained by the release of volatile matter during carbonization in geometrically restricted spaces. More evident structural changes were discovered with the sample of single coke, where parts of fine grain mosaics, relicts of 'so called QI parts', reveal higher structural organization, in comparison with large and prolonged flow domains, similar to flow domains of cokes from microplates.

[Clostridium difficile infection associated with pseudomembranous colitis in district hospitals]

At a regional hospital serving 150,000 inhabitants, the authors were tracking the occurrence of antibiotic-associated diarrhea caused by a nosocomial infection of the Clostridium difficile, especially its most serious form--pseudomembranous colitis. Six cases of the disease were found in a retrospective study in 2001, another 20 cases were diagnosed while actively searching for the disease from January till September of 2002. The patients suffered from many complications, were of an average age of 69.24 years, their hospitalization averaged 34 days and 15 (52%) of them underwent surgery during their hospitalization. It could be demonstrably proved that 25 cases of nosocomial infection occurred during hospitalization and 3 patients were admitted to hospital with the disease. However, 2 of them had been released from hospital less than 20 days before being admitted again. Twenty-five patients (96%) had been treated with antibiotics, often in combined therapy. Most often this involved penicillin with betalactamas activity (50%), clindamycin (42%) and cefalosporins (42%). We used methods for detecting enterotoxin A in the stool, rectoscopy and anaerobic cultivation of the stool in the diagnostic process. Rectoscopy discovered pseudomembranous colitis in 14 of 17 patients examined this way. The sensitivity for proving enterotoxin A in the stool using EIA, for patients with proven pseudomembranous colitis via rectoscopy, was 75%. Anaerobic cultivation of the stool was done in 12 patients and all the results were negative. The mortality rate of 38% for our group of patients testifies to the seriousness of this disease, which we consider to be the results of antibiotic therapy. In conclusion, nosocomial infection caused by Clostridium difficile is quite often a nosocomial disease, a prognosis that especially worsens for seriously ill patients.

[Screening for colorectal carcinoma in the region surrounding the city of Frýdek-Místek between 1999 - 2001]

The results of the colorectal carcinoma screening project in the region of Frýdek-Místek for the period of 1999 - 2001 are presented here. Of the 225 patiens diagnosed with carcinoma, 9 of the cases (4 %) were detected using the fecal occult bleeding test. Of 1000 people tested, a factor of 2.9 patients with carcinoma and 12.5 patients with adenomatous polyps were diagnosed, with 7.3 % test positivity. A statistically significant shift has been noted to detection in earlier stages of the disease (p = 0.05). From 49 - 53 % of the patients operated on in the period of 1999 - 2001 had their tumors in the stage A or B according to Dukes, a 13 - 17 % increase over the year of 1998. This shift was due above all to educating the local population.

[Spinocellular carcinoma in a patient with Fanconi's anemia]

The authors describe the case of a 24-year-old female patient with Fanconi's anaemia where they diagnosed spinocellular carcinoma of the oesophagus. At the same time they found skeletal abnormalities, caked kidney with pelvic dystopia and uterus unicornis. In patients with Fanconi's anaemia frequently acute leukaemia, liver tumours and spinocellular carcinoma are described. The knowledge of these facts makes early diagnosis of these associated diseases possible.

[Choledochal cyst]

Cysts of the choledochus are the most frequent type of cystic dilatation of the biliary pathways. The authors describe the case of a 24-year-old patient with a history of biliary complaints. A cyst of the choledochus was suspected after sonographic examination. The diagnosis was confirmed by infusion cholangiography and endoscopic retrograde cholangiography. The patient was indicated for surgery, i.e. resection of the cyst with hepaticojejunoanastomosis Roux-en-Y.

[Helicobacter pylori: new answers to old questions]

Infection with Helicobacter pylori affects 20-40% of the adult population in advanced countries. A causal relationship between Helicobacter pylori and gastritis type B was proved. There is some indirect conclusive evidence of an aetiological association with peptic gastroduodenal ulceration. Attention is drawn to possible associations with gastric malignities. The author reviews aetiopathogenetic relations between Helicobacter pylori infection and these diseases.

Food safety and inspection service update on food safety of animals derived from biotechnology experiments

Recent progress in the field of biotechnology and the production of transgenic livestock has raised a question regarding the need for the regulation of these animals. There is also the need to regulate nontransgenic animals resulting from transgenic animal research. It is anticipated that several governmental agencies will be involved in regulatory issues pertaining to these animals. The United States Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS) will ultimately be responsible for ensuring that transgenic animals intended for human consumption are wholesome, unadulterated, and properly labeled. The FSIS has implemented a program for the regulation of slaughtering nontransgenic animals resulting from transgenic animal experiments. However, the FSIS has not yet approved any transgenic livestock for slaughter. Scientists from the FSIS, in conjunction with other government agencies, are currently developing guidelines for the slaughter of transgenic animals.