When diagnosing primary aldosteronism, the measurement of urinary aldosterone after oral sodium loading is one of the currently recommended confirmatory tests. The aim of the study was to assess the repeatability and interpretation of urinary aldosterone in patients examined for suspected primary aldosteronism. Sixty-four hypertensive patients with suspected primary aldosteronism were prospectively enrolled and examined according to the study protocol. After antihypertensive medications interfering with renin-angiotensin- aldosterone system were withdrawn for at least 2 weeks, the confirmatory testing was performed: oral sodium loading preceded the collection of 24-h urine sample and subsequent saline infusion test. The identical procedures were repeated after 2 weeks. The concordant results of both saline infusion tests served for confirmation/exclusion of pri-mary aldosteronism. Forty-nine patients were included in data analysis. Primary aldosteronism was excluded in 16, and confirmed in 33 individuals. The repeatability of urinary aldosterone was evaluated in 44 patients: the difference of urinary aldosterone levels ranged between 1 and 88 % (median 31 %). Ninety-three urine samples from 49 patients were used to validate the interpretation of urinary aldosterone in respect to the diagnosis of primary aldosteronism made by saline infusion testing; 96 % sensitivity was characterized by urinary aldosterone >= 19 nmol/day, and 96 % specificity was associated with urinary aldosterone >= 92 nmol/day. In 22 (45 %) patients, urinary aldosterone remained in the "gray" zone between 19 and 92 nmol/day in all provided samples. The estimation of urinary aldosterone excretion after oral sodium loading is associated with marked intraindividual variability, and significant number of inconclusive results.

Purpose: Limited data are available regarding the efficacy of hepatic arterial infusion (HAI) of oxaliplatin in patients with liver metastases from colorectal carcinoma (CRC). The aim of the present study was to evaluate the results of HAI of oxaliplatin combined with 5-fluorouracil (5-FU) and leucovorin (LV) in patients with such metastases.Methods: A retrospective analysis of 22 CRC patients treated with HAI of combination of oxaliplatin and 5-FU and LV was performed.Results: Partial response (PR) was observed in 4 (18%) patients and stable disease (SD) in 7, with an overall disease control rate of 50%. The median progression-free (PFS) and overall survival (OS) were 7 and 11 months, respectively. Two patients treated with first-line treatment underwent subsequent liver resection. In 2 patients, HAI of oxaliplatin, 5-FU and LV was combined with systemic administration of bevacizumab.Conclusion: Our data demonstrate reasonable efficacy of HAI with oxaliplatin, 5-FU and LV in patients with liver metastases from CRC.

Numerous abnormalities of thyroid hormones in end-stage renal disease (ESRD) have been described. Our aim was to analyze the impact of these abnormalities on survival. In 167 hemodialyzed ESRD patients, TSH and thyroid hormone levels (T4, fT4, T3, fT3, rT3) were determined. The patients were then prospectively followed up for up to 5 years and the possible impact of any observed abnormalities on their mortality was studied. Only 16.8 % patients had all six tests within the reference range. The pattern of nonthyroidal illness syndrome was found in 56.3 %. Low T3 was particularly common (44.3 %), and clearly associated with increased 6- and 12-month mortality and decreased overall survival (log rank test, P=0.007). Independent of T3 levels (Spearman correlation, NS), increased rT3 was more frequently observed (9.9 %) than expected from the literature, and was also related to increased mortality and decreased survival (log rank test, P=0.021). Increased rT3 may be more common in ESRD patients than previously described, and together with decreased T3 it may serve as an indicator of poor prognosis in subsequent months.

Context. In patients with suspected primary aldosteronism (PA), the aldosteronetorenin ratio (ARR) is the most frequently recommended screening test. Further evaluation is based on hormonal changes during volume expansion. Both analyses arc critically dependent on an accurate estimation of renin concentration. Direct active renin (DAR) is a novel laboratory technique used for plasma renin assessment.Objective. The objective of this study was to evaluate DAR for use in PA diagnostic work-ups.Subjects and Methods. The study enrolled 69 healthy volunteers. Blood sampling was conducted before and after an increase in oral salt intake. Furthermore, a subset of 32 individuals underwent a saline infusion suppression test. DAR and serum aldosterone were measured in all blood samples. To calculate the ARR, serum aldosterone and DAR were expressed in ng/L.Results. ARR values [median (range); 97.5 percentile] associated with normal and elevated oral salt intake were 8.4 (0.6-37.7); 26.3, and 6.8 (1.1-37.7); 19.6, respectively, DAR and serum aldosterone concentrations [median (range); 97.5 percentile] after saline infusion suppression were 2.9 (2.7-10.7); 7.2 ng/L and 30 (30-72); 54 pmol/L, respectively.Conclusions. The observed values may be useful in excluding a diagnosis of PA.

We present here a case of a BRCA1 mutation carrier with repeat responsiveness of recurrent EOC to paclitaxel/platinum. The patient had complete response to the combination of paclitaxel/platinum in the first line. Subsequent four recurrences also showed a complete response to this combination. The chronic toxicity, including hypersensitivity and nephrotoxicity could be controlled by modifying the regimen. In conclusion, recurrent EOC in BRCA1 mutation carriers may retain sensitivity to paclitaxel/platinum combination chemotherapy, and this combination could be therapy of first choice in this patient population.

The brain represents a rare site of metastasis in patients with epithelial ovarian carcinoma (EOC). In recent decades there has been an apparent increase in the number of EOC patients diagnosed with brain metastases, probably as a result of improved prognosis of patients with advanced tumors, but cases of meningeal carcinomatosis complicating EOC remain rare. A patient with Stage III EOC had brain metastases diagnosed 31 months after primary surgery. The isolated brain metastases were controlled with radiosurgery, surgery and chemotherapy. Forty-five months after the diagnosis of brain metastases, meningeal carcinomatosis was diagnosed which led, despite intrathecal therapy, to a fatal outcome. At autopsy, the disease was limited to the central nervous system. Meningeal carcinomatosis may represent a late fatal complication of brain metastases of EOC.

In previous studies, mostly in patients with early stage colorectal carcinoma, neopterin, an indicator of systemic immune activation, has been associated with poor prognosis. The aim of the present study was to evaluate urinary neopterin in patients with advanced or metastatic colorectal carcinoma treated with chemotherapy. A retrospective analysis was performed of urinary neopterin, determined by high-performance liquid chromatography, in 88 patients with advanced or metastatic colorectal carcinoma. Peripheral blood cell count and serum carcinoembryonic antigen (CEA) were determined in 72 patients before the start of chemotherapy. Urinary neopterin in colorectal carcinoma patients was significantly increased compared to controls, but lower than in patients with inflammatory bowel disease. Neopterin correlated significantly with serum CEA, age, peripheral blood leukocyte and platelet counts. The median survival of colorectal carcinoma patients with urinary neopterin below 214 micromol/mol creatinine was significantly longer compared to that of patients with higher neopterin concentrations (median 18 vs 5 months, log-rank test p=0.003). CEA and hemoglobin were also associated with survival in univariate analysis, but in multivariate analysis only urinary neopterin and serum CEA were independent predictors of survival. High urinary neopterin during follow-up was also predictive of poor prognosis.

Cil: Neinvazivni diagnostika malignich onemocněni je přanim vsech lekařů. V teto praci je publikovan soubor nemocných vysetřených neinvazivnim laboratornim testem pro diagnostiku recidivy nadoru mocoveho měchýře.Metodika: Autoři předkladaji výsledky ze souboru 64 pacientů postižených recidivou nadoru mocoveho měchýře. Pacientům byly kvantitativně vysetřeny hladiny cytokeratinů 8 a 18 v moci UBC IRMAR testem (Urinary Bladder Cancer test). Byla hodnocena schopnost UBC IRMAR testu diagnostikovat recidivu urotelialniho karcinomu mocoveho měchýře.Výsledky: V souboru bylo zjistěno 44 pozitivnich vysetřeni. Senzitivita testu byla 0,6875 (69 %) a specificita 0,6470 (65 %), nespravna pozitivita testu 0,3529 (35 %) a nespravna negativita testu 0,3125 (31 %). Prediktivni hodnota pozitivniho testu 0,88. Prediktivni hodnota negativniho testu 0,35.Zavěr: V souboru pacientů s urotelialnim karcinomem mocoveho měchýře byly prokazany zvýsene hladiny cytokeratinů 8 a 18 oproti populaci bez tohoto onemocněni.

Background/Aims: Regional chemotherapy represents an effective approach for the control of isolated liver metastases of colorectal cancer. Fluoropyrimidines have been the basis of systemic and regional chemotherapy of this disease for several decades, but recent studies have demonstrated that the addition of irinotecan (CPT-11) ameliorates the results of systemic treatment.Methodology: Fifteen patients with isolated liver metastases of colorectal carcinoma were treated with regional administration of CPT-11 in combination with 5-fluorouracil/folinic acid (5-FU/FA). CPT-11 (100-200mg, mean: 93 +/- 25, range: 51-125mg/m(2)) was administered weekly in combination with 5-FU (1000-2000mg, 857 +/- 182, range: 538-1301mg/m(2)) and FA (100-350mg). Peripheral blood leukocyte phenotype was examined during the treatment in selected patients.Results: One patient achieved complete response, 4 patients had partial response, 7 patients had stable disease, 1 patient progressed and 2 patients were not evaluable. The response rate was 38% in evaluable patients, and a more than 50% decrease in serum carcinoembryonic antigen levels was observed in 12 out of 14 patients. The treatment was generally well tolerated. All patients, except one, are currently alive at mean follow-up of 11 +/-6 (median: 10, range: 5-24) months. The therapy is still being continued in 8 patients.Conclusions: Weekly CPT-11/5-FU/FA is highly effective in the treatment of patients with metastatic colorectal cancer limited to the liver, even after failure of previous 5-FU/FA. The present regimen should be tested as a first line treatment in phase III trial.

Till now. the ability of prolactin (PRL) levels to predict treatment response during neuroleptic therapy has been explored with inconclusive results. Studies exploring PRL response in a test dose design are very scarce, PRL response to a chlorpromazine test dose failed to predict the outcome in a study by Meltzer et al. - We have investigated prolactin levels after a single oral dose of isofloxytepin or haloperidol in 29 schizophrenic patients, who were subsequently treated by the same neuroleptic. - In multiple regression analysis the set of 5 variables (baseline PRL level and PRL levels 2 and 6 hours after the test dose, drug group and sex) was significantly related to improvement (R2 = 0.69; F = 6.76; p = 0.0003). Only baseline PRL and drug group did not contribute significantly, a significant interaction of drug group and PRL levels suggests a different relationship between improvement and prolactin elevation in each treatment group, partial coefficients of determination for PRL levels 2 and 6 hours after the challenge dose and for PRL treatment group interactions were all about 30 %. Patients improved after isofloxythepin had higher PRL levels (52.5 ng/ml) than non-improvers (16.5 ng/ml) after 6 hours. Methodological constraints of the study and reasons for differences in relationships of prolactin and improvement in various patient groups are discussed.