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Primary colonic lymphoma is a very rare malignant disease of the gastrointestinal tract, accounting for 14% of all malignant diseases in this location. It is classified in the group of extranodal lymphomas; its long-term asymptomatic progression makes it different from common colorectal carcinomas making its diagnosis very difficult, more often accidental. Gallstone ileus is quite an uncommon complication of cholecystolithiasis diagnosed with difficulty. Up to 50% of cases are diagnosed during surgery. The obturated location depends on the size of the stone, location of the conjunction between the biliary and gastrointestinal tracts, and also on any preexisting stenosis due to another unknown pathology.We present a case of an 86-year-old man treated for acute diverticulitis with typical clinical symptoms. Following further examination (colonoscopy, computed tomography) revealed a tumour-like infiltration in the sigmoid colon wall and a voluminous polyp was suspected according to the colonoscopy. Computed tomography described an obstruction by a biliary stone tumbling through the cholecystocolonic fistula. Subsequent biopsy supported the suspected malignant etiology. The patient underwent resection of the sigmoid colon sec. Hartmann; an infiltration was found in the subhepatic space, which corresponded to the described fistulisation between the biliary tract and the colon. A large 40 mm gallstone was found in the resected sigmoid colon over the stenosis and the bowel wall showed diffuse thickening with several polyps; final histopathological assessment confirmed malignant lymphoma of the plasmocytoma type. No serious complications occurred in the postoperative period; after healing, the patient was transferred to hematooncology care.The article describes the presence of two rare diseases - colonic lymphoma and gallstone ileus. Clearly, without the biliary stone obstruction in the preexisting tumorous stenosis in the sigmoid colon, the malignant hematooncology disease would not have been diagnosed.primary colonic lymphoma - gallstone ileus - complication of the cholecystolithiasis - extranodal lymphoma - acute diverticulitis.

Leptin is a protein hormone synthesized by adipocytes. Its serum concentrations reflect the total body fat content. Serum leptin concentrations are significantly higher in obese than in lean people and in women than in men. However little information about the influence of physical activity on serum leptin concentrations is available. We have compared the body weight, the body mass index (BMI), the body fat content (measured by caliper as skinfold thickness) and the serum concentrations of leptin, triglycerides, total, high density and low density lipoprotein (LDL) cholesterol in 14 top rugby players and 10 healthy controls. We found that serum leptin, total and LDL cholesterol concentrations were significantly lower in the rugby players group than in the control subjects. The body weight and BMI were significantly higher in the rugby players, while the body fat content was only slightly (non-significantly) higher in the control group. The serum leptin concentrations in both groups positively correlated with the BMI and body fat content and also with LDL concentrations in the control group. The serum leptin concentrations in the rugby players were lower than in the non-sporting subjects despite a similar body fat content in both groups. We would therefore suggest the possibility that regular hard physical training decreases serum leptin concentrations not only by the decrease of total body fat content, but also by a separate mechanism, which is not directly dependent on the changes in the amount of body adipose tissue.

The aim of the study was to evaluate aerobic fitness trends in the Czech adult white collar population within last 20 years. Aerobic fitness parameters were obtained by bicycle spiroergometry. The workrates 1.0 and 2.0 W · kg−1 were performed for 4 min each. After 2 min break the maximal workrate up to vita maxima was performed so that the examined person would reach the reference W peak· kg−1 in the fifth minute. Aerobic fitness in the Czech population changed unfavorably. The decrement was moderate in men and severe in women. Relative number of subjects performing regular exercise activity declined. Smoking habits increased significantly, especially in men. Body fat increased significantly in both male and female populations. The enhancement of body fat correlated to aerobic fitness. According to the accessible literature, the authors evaluate the aerobic fitness of white collar Czech population as lower than that in the USA and West European countries.

Observational studies in human patients and animal experiments suggested that statins have a potential in slowing the growth of small abdominal aortic aneurysms (AAA). Our aim was to quantify histological postoperative changes of AAA in porcine experimental model of AAA with and without administration of atorvastatin.The AAA was induced by intraaortic infusion of porcine pancreatic elastase and subrenal application of plastic cuff. The AAA statin group (N.=14) received atorvastatin 1 mg/kg daily for 28 days, the other AAA group (N.=13) did not. The aortic diameter was measured by ultrasonography. Aortic samples were described using eleven quantitative histological parameters and compared with healthy aortae.There was no difference in aortic diameter between the AAA with statin when compared to AAA without statin. Administration of atorvastatin led to a better postoperative histological condition of the aortic elastin network, preservation of contractile phenotype of vascular smooth muscle, a higher density of vasa vasorum, it prevented thickening of intima and media. The increase in wall thickness in AAA without atorvastatin has not been accompanied by a proportional increase in number of vasa vasorum.The effects of atorvastatin seem to prevent the histopathological progression of AAA.

Angioimmunoblastic T-lymphoma (AITL) is a poor prognosis malignancy. Because of relatively rare incidence and lack of publications in Czech, we decided to share our experience.Retrospective analysis of newly diagnosed AITL patients treated at our institution between 1/2000-12/2010.Twelve patients with median age of 64 (43-82) years were analysed. Two patients over 80 years were treated with corticosteroids. Ten patients were treated with 6 cycles of CHOP-21 chemotherapy resulting in: 2/10 (20%) stable disease, 5/10 (50%) partial remission and 3/10 (30%) complete remission. The median EFS and OS of chemotherapy-treated patients were 8 and 10 months, resp. The EFS and OS were both significantly longer in patients who achieved complete remission within the first line of CHOP or autologous stem cells transplantation therapy: 43 vs 6 (p = 0.0052) and 46 vs 6 months (p = 0.0023), respectively. It was not possible to perform autologous transplantation in 4/7 (57%) patients in need for further reduction of the disease because of poor performance status or early progression of lymphoma and death during salvage chemotherapy.AITL is a poor prognosis malignancy with a very high risk of early relapse after CHOP induction chemotherapy. In fit patients, autologous transplantation should be performed immediately after induction chemotherapy; information about availability of stem cells donor, both in the family or any available register, should be found during the induction treatment.

The greatest danger to the future of human life is Man. Environmental issues are becoming highly topical, with attention focusing on nuclear power plants and their operational hazards. The main concern tends to be their technological reliability rather than the fact that humans are in control. In its long-term research project, the Institute of Sports Medicine, which belongs to the 1st Medical School of Charles University in Prague, is primarily concerned with examinations of the most exposed workers in nuclear and thermal power plants. As all of them are under supervision of their plant physicians, the purpose of the project is to uncover possible hidden health hazards that could result in a sudden collapse of the person concerned and bring about a disaster with far-reaching consequences. This paper presents only a small fraction of the results obtained to date. In functional anthropology and functional exercise dianostics we focused on certain signs that could be interpreted as risk factors for cardiopulmonary failure especially due to CHD, frequently found in middle-aged men. We also discuss the changes that have taken place in the 76 investigated nuclear power plant operators and managers during the three-year observation period.

The histologic diagnosis of reflux esophagitis is still complicated by the lack of a consensus opinion on what is the normal mucosa in the area of the gastroesophageal junction (GEJ). Most authors consider GEJ as the junction between the squamous and the cardiac epithelium. The cardiac mucosa is composed of mucinous or mixed mucinous-oxyntic glands. These glands are in fact indistinguishable from metaplastic mucosa that arises in the distal esophagus in consequence of gastroesophageal reflux (GER). The cardiac mucosa shows invariably chronic inflammatory changes referred to as "carditis". The cause of "carditis" is GER and/or Helicobacter pylori (HP) infection. In our series of 120 endoscopic biopsies of the GEJ and distal esophagus the cardia type mucosa (CM) was always present. In 15 cases, it was accompanied by oxyntocardiac mucosa. Both mucosa types showed chronic inflammation that is after exclusion of HP infection regarded as a strong diagnostic sign of the gastroesophageal reflux disease (GERD). In two cases with clinical symptoms of GERD, a few HP were found on the CM. Therefore we diagnosed them as GERD with secondary HP infection. In 17 cases, CM displayed intestinal metaplasia (IM) predominantly of incomplete type and no dysplasia. This IM expressed MUC6 in the glandular zone of the mucosa like it did in the neighboring glands, whereas in the surface and foveolar epithelium the MUC6 was negative or only slightly and focally positive. On the other hand, IM in the surface and foveolar epithelium was reactive for MUC5AC. The positivity and distribution of CK7 and CK20 was very similar in the Barrett's mucosa, cardiac mucosa and antral mucosa. In one specimen of esophagus resected for adenocarcinoma, CM with incomplete IM was found in the vicinity of the tumor. Squamous metaplastic epithelium was often seen near the orifices of submucosal esophageal glands in these areas, indicating the metaplastic nature of the glandular mucosa in the distal esophagus. In the GEJ of 5 autopsy cases of children with spastic quadriplegia (age range 7-10 years) CM in a short segment (0.5-3 mm in length), probably of metaplastic origin was identified, showing chronic inactive inflammation.

Sessile serrated adenoma (SSA) is a newly characterized type of the large bowel adenoma. It arises in hyperplastic polyp (HP) and represents a precursor lesion of colorectal carcinoma with microsatellite instability. SSAs differ from common HPs by abnormal proliferation of the crypt epithelium and by nuclear atypia. We examined 15 SSAs from 15 patients. The age range was 25-80 years (average 60 years). Six patients were females and 9 were males. For comparison, we examined 10 conventional tubular adenomas and 10 common HPs with vesicular cells. The sites of SSAs were as follows: 8 in rectum, 4 in rectosigmoid colon, 1 in transverse colon, 1 next to mucinous carcinoma of ascending colon, 1 in anastomosis after resection of the transverse colon adenocarcinoma. The diameter of the lesions ranged from 5 to 12 mm. Histologically, SSAs showed asymmetrical proliferation of the epithelium, irregular shape of the crypts with their branching and some crypt dilatations especially in the basal parts of the crypts. Cellular atypia (dysplasia) was usually low. In 5 cases the nuclei were focally stratified and localized in the lower part of the cells. High-grade dysplasia was found only in SSA adjacent to mucinous adenocarcinoma. Immunohistochemically, SSAs showed secretion of gastrointestinal mucin expressing MUC2 and MUC5A. Both MUC2 and MUC5A were also positive in mucinous carcinoma. In previous studies these expressions were considered specific for serrated type of carcinogenesis. However, our study found positivity of MUC2 and MUC5A also in conventional adenomas. Expression of p53 in SSAs was minimal. SSAs have malignant potential comparable with conventional adenomas and for this reason they must be distinguished from HPs.

The histopathological diagnosis of autoimmune gastritis (AG) in its early stages can be a diagnostic challenge. Even some advanced cases with complete atrophy of the corpus mucosa may be difficult to recognize. To establish the diagnosis of autoimmune gastritis, several histological features should be assessed and combined with immunostains for enterochromaffin cell-like (ECL) cells and G-cells. The main histological criteria include a mononuclear infiltrate within the lamina propria, foci of destruction of oxyntic glands, intestinal metaplasia (IM), pyloric metaplasia, and parietal cell pseudohypertrophy. These criteria were evaluated in our series of 25 patients with achlorhydria and/or megaloblastic anemia. Some of our patients presented with nonspecific gastrointestinal symptoms. The age ranged between 46 and 79 years; one male patient was only 31 years old. Histologically, the corpus mucosa displayed in all cases chronic inflammation with focal complete IM and advanced pyloric metaplasia. In 4 patients, oxyntic glands were destructed in some sites. There was a pancreatic metaplasia of acinar type in 2 patients and a minimal focal pseudohypertrophy of parietal cells in the 31-year-old man. A tubular adenoma with a low-grade dysplasia was found in one female patient. Immunohistochemically, chromogranin-A highlighted linear or nodular hyperplasia of ECL cells in 19 patients, and adenomatoid ECL hyperplasia in one case (80%). In the remaining cases hyperplasia of ECL cells could not be recognized from their normal count. In 13 cases (52%) a few ECL cells were seen also in IM. Regarding associated pathology, in one woman with nodular ECL cell hyperplasia, a gastric carcinoid was removed endoscopically. The reaction with gastrin antibody revealed in 11 cases (44%) a small number of G cells in IM in the corpus mucosa. In 18 patients, antral mucosa was examined as well. In 8 patients, the mucosa was normal; in 10 cases, a mild chronic inactive gastritis was diagnosed, and in 15 patients G-cell hyperplasia was found. In accordance with other studies, we show that the diagnosis of AG may be established microscopically in endoscopic specimens of the gastric body mucosa when histologic features and immunohistochemical detection of ECL and G cell hyperplasia are combined.

A summary work presenting technically difficult to process lesion samples and those which cannot be diagnosed on peroperative biopsy. The authors specify arguments against examinations of small mammary gland tumors (measuring less than 1 cm in diameter), post-bioptic tumors and sentinel lymph nodes. Furthermore, the authors describe difficulties in processing the adipose tissue resulting in complicated evaluation of the mammary gland tumors in the resection line. Obstacles in the peroperative examination of the thyroid gland lesions are also listed here. In this case, the freezing technique results in smearing specific cytological featuries of the examined tissue. Diagnostic criteria for all non-papillary tumors of the thyroid gland are explained in this article. Application of the above mentioned criteria is, however, worthless in the peroperative biopsy, which is also explained in this work. In the last part of this study, the authors describe macroscopic featuries of the mucinous ovarial tumors and their differentiation from the gastrointestinal tract adenocarcinoma metastases, using macroscopy and histological techniques.

Review of prognostic factors of the cervical carcinoma, new perspective methods.Department of Obstetrics and Gynecology, Medical Faculty Hospital, Plzen.Review article.The most important prognostic factors of the early cervical carcinoma are the stage and regional lymph node status followed by the depth of stromal invasion, tumor volume, and lymphovascular invasion. Other factors are still only subjects of research.A detailed knowledge of particular prognostic factors of the cervical carcinoma is necessary for optimal treatment and flow-up strategy.

Daunorubicin (DNR) and doxorubicin (DOX) have significant antitumor activity in acute myeloid leukemias (AML) and non-Hodgkin's lymphomas (NHL) but their use is limited by their life-threatening cumulative dose related cardiotoxicity. It is generally recommended not to administer DOX or DNR to patients in doses greater than 500 mg/sqm or 700 mg/sqm, respectively. the aim of the study was to follow up cardiotoxicity and efficacy of DNR or DOX above these limits in the 2nd complete remission (CR) patients pretreated with anthracyclines when they were given 30 minutes after cardioprotective agent dexrazoxane (DRZ) in the ratio 1:10 of DZR.Two patients (54 and 53 years old) with mantle cell or diffuse large cell B-NHL, stage IV, who had relapsed after 6-8 cycles of classical CHOP therapy, reached their 2nd CR after 2-3 cycles of IDEA therapy (ifosfamide 1000 mg/sqm/day x 4, dexamethasone 30 mg/sqm/day x 4, etoposide 75 mg/sqm/day x 4, DOX 30 mg/sqm/day on days 1 and 3). Then they received further 3 cycles IDEA with DRZ 300 mg/sqm before every dose of DOX. After cumulative doses of DOX 600 mg/sqm and 700 mg/sqm these patients survived 12 months in their 2nd CR without significant signs of cardiotoxicity, even after their successful autologous peripheral stem cells transplantation. Their left ventricular ejection fraction (LVEF) remained above 60%. Six patients with AML in their 2nd CR were treated with consolidation cycles consisting of 10 high doses of cytosine arabinoside (2000 mg/sqm/12 hr) plus 2 doses of DNR 45 mg/sqm on the day 4 and 5. Two patients received cumulative doses corresponding to 1300 mg/sqm and 1000 mg/sqm of DNR, the other received DNR doses 550-850 mg/sqm. No signs of significant cardiotoxicity were observed in all 6 patients and their LVEF remained over 50%. One of two patients, transplanted with HLA-identical sibling bone marrow in her 2nd complete remission (CR), is still 8 years in her 2nd CR. Dexrazoxane enables to administer anthracyclines in doses over the recommended cumulative ones in pretreated patients with B-NHL or AML in their 2nd CR with the follow-up of their LVEF.

Presentation of variable morphology of the so-called matrix-producing carcinoma, the rare variant of metaplastic breast carcinoma. Establish the extent of myoepithelial phenotype by immunohistochemistry and assess behaviour of the lesion.Review of clinicopathologic data of 11 cases.Private Biopsy Lab s.r.o., Pilsen and Sikl's Department of Pathology, Charles University and Faculty Hospital, Pilsen.Included are eleven cases from Breast Registry, Biopsy Lab s.r.o., Pilsen and Pathology Department, Faculty Hospital in Hradec Králové and Martin and from Biopsy Lab in Horovice. Analyzed were morphology, stage, grade and follow up. Myoepithelial phenotype was demonstrated immunohistochemically by LSAB+ system (DAKO) and seven conventional myoepithelial markers (GFAP, aktin S, calponin, cytokeratin 14, p63, CD10 and P-cadherin) were used. Oncogene p53 and Her2/neu were also detected.Matrix-producing carcinoma is an extremely rare type of metaplastic carcinoma of the breast, where high-grade epithelial component continually merges with heterologous mesenchymal chondroid component without overt spindle cell sarcomatoid pattern in between. There were all women at the age of 32 to 86-years (average 54 years, median 52 years) and the maximum tumor diameter ranged from 18 to 60 mm (average 32 mm). The axillary LN was positive in six cases in the time of diagnosis. The follow up available in 9 women ranged from three months to ten years (average 24 months); dissemination of the disease was observed in three cases; 2 of these patients died of disease after three and ten years, respectively. The heterologous mesenchymal chondroid component was produced in two different ways; one displayed typical structure of low-grade hyaline cartilage, in the second one the epithelial tumorous cells were embedded in the homogenous eosinophilic extracellular matrix giving appearance of chondroid aura. Metaplastic component constituted 5-75% of the tumor volume. Immunohistochemical evidence of myoepithelial differentiation in all neoplasms was demonstrated, with at least two conventional myoepithelial markers (actin S, calponin, GFAP, CK14, CD10, p63 and P-cadherin) being positive in every case. Expression of p53 was identified in six cases, all tumors were Her2/neu negative. Histologically the metastases were formed either by carcinoma cells only, or more frequently, they replicated the structure of primary lesion.As a rare entity, matrix-producing carcinoma of breast displaying myoepithelial phenotype, deserves separate position in tumor classification. It differs from conventional myoepithelial carcinoma and from heterologous metaplastic carcinoma, where the matrix emanate from undifferentiated sarcomatous tissue, but precise histogenesis in not clear yet. This is a very aggressive lesion and our findings show that previous reports of indolent behaviour were preliminary. Spectrum of differential diagnosis, namely benign mixed tumor, phylloid tumor, primary breast sarcoma and colloid carcinoma warrant clear knowledge about this unique entity.

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.

Our study included 46 cases of B-chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL), 25 mantle cell lymphomas (MCL), and 40 follicular lymphomas (FL). The lymphomas were diagnosed according to current morphological, immunohistochemical, and in some cases molecular-genetic criteria. The patterns of follicular dendritie cells (FDCs) were studied in paraffin sections using the anti CD21, anti CD23, and CNA.42 antibodies. The differences in staining patterns of FDCs among the studied lymphomas were statistically significant. The absence or small number of FDC clusters are typical of B-CLL/SLL, while FDC meshwork limited to peripheral parts of neoplastic follicles is characteristic for FL. In contrast, MCL is characterized by irregular FDC meshwork or by FDC clusters present in the centres of residual follicles. Thus, we have demonstrated that the patterns of FDCs is an independent diagnostic feature for distinguishing between B-CLL, FL, and MCL.

Cell cycle progression is governed by cyclin dependent kinases (CDK) that are activated by cyclin binding and inhibited by CDK inhibitors. Protein p27Kip1 functions as a CDK inhibitor, which controls the progression from G1 to S phase. Further, p27Kip1 may have a positive regulative influence. In nonneoplastic tissues and in the majority of tumors investigated so far, the immunohistochemical positivity of p27Kip1 showed an inversely proportional relationship to the proliferation index. Among B-cell non-Hodgkin lymphomas, the exceptions to this rule are represented by mantle cell lymphoma, hairy cell leukemia, and the immunoblastic Epstein-Barr virus latent membrane antigen positive diffuse large B-cell lymphoma in AIDS patients. The loss of p27Kip1 expression is a negative prognostic factor in numerous tumors, including the majority of B-cell lymphomas.

Sodium polystyrene sulphonate (Resonium A) in sorbitol given as an enema or orally to treat hyperkalaemia has been described to induce intestinal necrosis in uraemic patients. We report a case of a premature infant with acute renal insufficiency who developed focal transmural necrosis and perforation of the small intestine after 10 days of administration of calcium polystyrene sulphonatum (Calcium Resonium) in sorbitol by enema and by nasogastric tube. On histological examination of the resected part of the small intestine, numerous strongly basophilic angular crystals of resonium were found in the lumen, in the necrotic wall, as well as in the organized exudate on the peritoneal surface. The crystals showed a strong direct Schiff positivity without preoxidation. They were also stained using PAS, Giemsa, Ziehl-Neelsen, Schmorl, and Gram method. In contrast, the crystals were Congo red and Alcian blue (pH 2.5) negative and non-birefringent. The direct Schiff positivity without preoxidation is virtually pathognomonic for resin crystals in routinely processed tissues. The same crystals were observed in the lumen of the small intestine and in peritoneal adhesions at autopsy. Thus our case provides additional evidence that Resonium A/Calcium Resonium in sorbitol administered as an enema or orally can lead to intestinal necrosis in uraemic patients.

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.

The immunohistochemical detection of syndecan-1 (belonging to the cluster CD138) is a sensitive and reliable method for identifying normal and neoplastic plasma cells. It may be used in paraffin-embedded bone marrow specimens, as well as in extramedullary tumours of unknown origin. The three anaplastic tumours reported by us in the lymph node, the gingiva, and pleura were negative for other markers, but the syndecan-1 positivity elucidated their plasmocytic histogenesis.

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.

The authors describe a group of six patients (two men and four women) operated at the Surgical Clinic in Plzen during 1995-2000 on account of a carcinoid of the GIT. The mean age of the patients was 48.6 years, the range 14-77 years. In five instances a carcinoid of the appendix was detected. In a separate case-record they evaluate a carcinoid of the ileocaecal transition with symptoms of acute abdomen, early surgery, its extent incl. the postoperative procedure.

Leptin is a protein hormone produced predominantly by adipocytes. Its serum concentrations usually reflect the total body fat content i.e. they are higher in obese than in lean subjects. The aim of our study was to follow the influence of the regular hard physical training on the serum leptin levels. Therefore, the serum leptin levels in top rugby players, top race walkers and age and gender-matched control group were compared. The relationship between serum leptin concentrations and body mass index and body fat content was also studied. It was found that serum leptin levels in rugby players were significantly higher than in race walkers group, but lower than in control one. Serum leptin levels in race walkers were lower than those of rugby players and of control group. The body fat content in race walkers was lower than in resting two groups. There was no significant difference in body fat content between control and rugby players group. Serum leptin levels correlated positively with body mass index and body fat content both in control and in rugby players group. No statistically significant relationship was found between leptin and body mass index or body fat content respectively in race walkers group. We conclude that serum leptin levels in top sportsmen are lower than in non-sporting healthy age and gender-matched controls. The lower leptin levels in top sportsmen are probably in part the result of lower body fat content and in part the result of complex neurohormonal adaptation on the long term physical training.

Leptin is a protein hormone produced by adipocytes. Its serum concentration in the most of cases precisely reflect the total body fat content. The aim of our study was to follow up the influence of regular aerobic training on serum leptin levels. Therefore the serum leptin levels, basic anthropometric parameters and serum lipids were compared in 11 intensively trained race walkers and 10 age-matched non sporting control subjects. We have found, that serum levels, body weight, body mass index, body fat content, total and LDL-cholesterol were significantly decreased in walkers group in comparison with control subjects. Serum leptin levels positively correlated with body fat content and body mass index only in control group, in the walkers group the correlation was non-significant. The results of our study demonstrate, that regular aerobic training accompanied with the decrease of body fat content leads to the significant drop of serum leptin levels.

Risk factors of coronary artery disease (CAD) between a group of patients suffering of chronic fatigue syndrome (CFS) and a control group of healthy persons (whose exercise activity was not health-limited) were compared. Thirty three patients (27 women, 6 men, average age 39.9 +/- 11.7 years) and the same number of controls matched in age (39.8 +/- 10.3 years), gender and body weight. The Minnesota Questionnaire (by Taylor) and the Compendium of Physical Activities (by Ainsworth) were used to estimate total energetic expenditure in exercise activity as well as in job. The risk factors of CAD in the patients with CFS were not higher than in the control group. Aerobic physical fitness, basic anthropometric data, blood pressure, spectrum of blood lipoproteins, blood uric acid and smoking habits were not different between the compared groups. Patients suffering from CFS had lower total energetic expenditure in exercise activity. Nevertheless, this significant difference in sports activity was not large enough to cause any difference in risk factors of CAD between the CFS patients and the control group.

Common mortality and especially mortality on CAD is increased by low aerobic component of physical fitness. A study dealing with physical fitness changes of the Czech population has been still missing in our bibliography. The aim of the study was to evaluate physical fitness changes in the Czech male population since last 20 years.Physical fitness in 494 men in the age range of 20 - 60 years was compared to the men fitness examined 20 years ago. In the men of 20 - 29.9 years peak power (3.90 W vs 3.46 W, p0.01) and maximal ventilation (1.38 l.min-1 vs 1.24 l.min-1, p0.05) decreased. In the men 30 - 39.9 years old only peak aerobic power (37.2 ml.min-1 vs 35.7 ml.min-1, p0.05) slightly decreased. In the men 40 - 49.9 years old Vemax.kg-1 (1.38 l.min-1 vs 1.18 l.min-1, p0.001) and VO2max.kg-1 (35.6 ml.min-1 vs 32.4 ml.min-1, p0.001) severely decreased as well as in 50 - 59.9 years old men VEmax.kg-1 (1.23 l.min-1 vs 1.13 l.min-1, p0.05) and VO2max.kg-1 (32.7 ml.min-1 vs 29.4 ml.min-1, p0.001).Physical fitness of the Czech white-collar men decreased. The decline of physical fitness was related not only to lower exercise activity, but also to significant increment of body fat. Physical fitness, especially its aerobic component, decreased in Czech older men since last 20 years.

E.Z. former world champion and holder of several gold and silver medals from Olympic Games as long-distance runner, underwent at the age of 71 comprehensive investigations. In 1993 following methods were used to establish E.Z. body build and health: Family, personal and sports history, anthropometry, somatotype, body composition posture values, sports medicine examination, ECG at rest, X-rays of the lung and heart, echocardiography at rest, systolic time intervals at rest, spirography at rest, hematology, biochemistry, X-rays of bones, exercise ECG changes and spiroergometry. Today, a typical feature of E.Z.'s bodybuild is a great amount of body fats, flabby musculature, faulty posture, restricted mobility of the spinal column and surprisingly good foot arches. The clinical findings are appropriate for his age, on his ECG at rest are signs of subendocardial ischemia above the left ventricle, atrial fibrillation and ventricular extrasystoles (Lown 1 a-b). Exercise ECG resulted in a deepening of the ischaemic changes already at a working load of 50 W. Hematology revealed normochromic macrocyt anaemia, biochemistry a borderline mineralogram, hyperuricaemia, higher S-GMT and HDL-C, T-C at the limit of normal values. X-rays of the bones were remarkable in two findings of that age. The pelvis, lumbar spine and knee joints were free of the usual pathological findings (osteoarthrosis), but presented with an exceptionally advanced osteoporosis.

Nuclear and thermal power plants are seen as one of the threats to human health. Most investigations explore the potential hazards of radiation and the potential impact of a polluted environment. Less attention is being paid to the human factor, i.e. to the people who actually are directly involved in the generation of electrical power and whose sudden collapse could result in a disaster. In this paper dealing with the prevention of CHD we submit, in a condensed form, the results of our long-term testing of operators and managers from one nuclear and two thermal power plants, located in totally dissimilar regions of the Czech Republic. In our investigations, which are still going on, we are using a whole battery of methods--case history, anthropological, clinical and functional tests. Our test subjects are middle-aged men, an age group most prone to CHD. The most favourable results of the vast majority of tests were obtained at the nuclear power plant in southern Moravia, while the most adverse ones--with respect to the danger of CHD--in the men from the thermal power plant in Prague. For the most part these results, in the light of a thorough analysis of the case history, anthropological, clinical, functional and biochemical investigations of these middle-aged men, should be seen as the cumulative effect of both their way of life (locomotor activities, nutrition) and the environment, in which they live. The men working at the nuclear power plant live in the least polluted environment. People's way of life may to some extent be influenced and some preventive steps along these lines have already been taken.

Leptin is a hormone that reflects the body fat content. It was reported that serum leptin levels were decreased in highly endurance-trained sportsmen in comparison with control non-sporting subjects. The aim of our work was to study the relation of serum leptin to blood viscosity and selected spiroergometric parameters of endurance capacity in a group of top rugby players and top race walkers. We have found that both body fat content and serum leptin levels were significantly lower in race walkers than in rugby players (9.68+/-3.65 vs 15.95+/-3.15% and 2.84+/-1.1 vs 3.89+/-1.09 ng x ml(-1) respectively, p0.05). The positive correlation of serum leptin levels with body fat in both groups. The level of endurance training status was significantly higher in the race walkers group. Serum leptin levels significantly negatively correlated oxygen uptake per body and pulse oxygen per body weight only in rugby players but not in race walkers. Partial correlation test after adjusting for the effect of body fat content showed that leptin itself is not an independent predictor of endurance trainability in this group. Serum leptin levels correlated positively with blood viscosity only in race walkers, but not in the rugby players group. We conclude that serum leptin levels in top sportsmen parallel the changes in body fat content and are not an independent predictor of endurance training of these subjects.