OBJECTIVE:To evaluate transperitoneal laparoscopic adrenalectomies performed at the University Hospital, Olomouc over a period of 20 years. INTRODUCTION:Thanks to the increased availability of imaging, the detection of adrenal disease is increasing. Laparoscopic adrenalectomy is now regarded as the gold standard for the treatment of adrenal disease due to its safety and efficacy despite the increasing popularity of robotic-assisted surgery. METHODS:Over a period of 20 years, from 2002 to 2021, we retrospectively evaluated a cohort of 405 patients who had undergone laparoscopic adrenalectomy. The indication criteria for laparoscopic adrenalectomy were hormonally active symptomatic tumours (pheochromocytoma, Conn's syndrome, Cushing's syndrome, etc.), symptomatic cysts or myelolipomas, carcinomas, metastatic disabling or incidentalomas, growing at a rate >1 cm or more per year. Data collected focused on sex, age, medical classification, imaging, operative time, side dominance, hormonal activity, complications associated with surgery, length of hospital stay, and histopathologic verification. No patient who had undergone laparoscopic adrenalectomy was excluded from the cohort. Patients in our cohort were not operated by a single surgeon. RESULTS:Women accounted for 52.1% (211) and men 47.9% (194). The mean age was 55.6 years, BMI 28.7, and median ASA score was 2. Preoperative imaging included abdominal CT in 352 (86.9%) patients, abdominal MRI with contrast agent in 8 (2.0%), and PET/CT in 45 (11.1%) patients. More frequent findings were on the right side in 223 (54.39%) patients. Hormonal activity was found in 271 patients (67 %). Hormone overproduction from the right adrenal gland was found in 120 (44.3%) patients, and from the left in 151 (55.7%). Adenoma was the most frequent histological finding, followed by hyperplasia. Conversion to open surgery was due to bleeding in 2 patients. There was no perioperative or postoperative mortality. According to the Clavien-Dindo classification, minor complications (Grade I) occurred in 375 patients (92.6%). Grade II complications were reported in 17 patients (4.2%). Grade III complications were identified in 13 patients (3.2%) due to operative field bleeding; in three cases (0.7%), surgical revision of the adrenalectomy bed was required. CONCLUSION:Laparoscopic adrenalectomy is a safe surgical method for the management of adrenal disease and our retrospective follow-up confirmed that it remains the gold standard.

Background Structural variants (SVs) are increasingly recognized as key contributors to human diseases. However, our understanding of SVs in health and disease is limited, mainly due to their structural complexity and variable length in individuals, as well as limitations inherent to the available genomic technologies and reference genome used.Results To systematically evaluate SVs across human whole-genome samples using hg38/GRCh38 and gapless T2T-CHM13 references, we introduced an innovative multiplatform approach, LongReadChecker (LoReC), which advances SV comparison and annotation based on distance variance, intersection, gene overlap, and the closest SV in the clinical database. Comparison of the performance in detecting SVs from public and our own whole-genome datasets from short-read sequencing (SRS), available long-read sequencing (LRS) platforms, and optical genome mapping (OGM) revealed that most SVs detected by SRS were confirmed by LRS, but LRS can identify twice as many SVs (25,000 SVs/genome) with greater read mapping accuracy. Our LongReadChecker (LoReC) analysis further highlights the utility of the T2T-CHM13 reference in SV detection, as 20% more deletions and 20% less insertions were detected compared with hg38/GRCh38, which was particularly evident in long-read datasets. Since 80% of the SVs detected by LRS/SRS are smaller than 0.5 kbp, OGM did not detect them.Conclusions Our study revealed that introducing distance variance, intersection, gene overlap, and the closest SV in the clinical database may help compare and annotate SVs in diagnostics. Our data showed that LRS, together with T2T-CHM13 gapless sequences, can improve the diagnostics of patients with human diseases when SRS fails to identify the cause.

The topic of the diagnosis of phaeochromocytomas remains highly relevant because of advances in laboratory diagnostics, genetics, and therapeutic options and also the development of imaging methods. Computed tomography still represents an essential tool in clinical practice, especially in incidentally discovered adrenal masses; it allows morphological evaluation, including size, shape, necrosis, and unenhanced attenuation. More advanced post-processing tools to analyse digital images, such as texture analysis and radiomics, are currently being studied. Radiomic features utilise digital image pixels to calculate parameters and relations undetectable by the human eye. On the other hand, the amount of radiomic data requires massive computer capacity. Radiomics, together with machine learning and artificial intelligence in general, has the potential to improve not only the differential diagnosis but also the prediction of complications and therapy outcomes of phaeochromocytomas in the future. Currently, the potential of radiomics and machine learning does not match expectations and awaits its fulfilment.

Objective: Our study aimed to evaluate clinical and laboratory predictors of outcome of unilateral adrenalectomy in patients with primary aldosteronism (PA). Design and method: Data from patients with unilateral PA verified by adrenal venous sampling who subsequently underwent transperitoneal laparoscopic adrenalectomy between 2008 and 2019 were analyzed. We assessed patient demographics, preoperative and postoperative clinical, pharmacological, laboratory, and radiological data. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication. Statistical assessments included univariable and multivariable logistic regression analysis. Results: 87 patients with PA were enrolled. Complete biochemical success of surgery, defined as normalisation of the aldosterone-to-renin ratio and correction of hypokalaemia, was reached in 67 patients (77%), 19 patients (22%) had partial biochemical success (please see the Figure). Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure - partial clinical success. Multivariable logistic regression showed that complete clinical success was independently associated with female gender (odds ratio: OR 3.71, 95% CI 1.16–11.87, P = 0.027) and baseline sum of antihypertensive drugs DDD < 4 (OR 5.30, 95% CI 1.68–16.67, P = 0.004). None of the analysed clinical or laboratory parameters was found to be a significant predictor of biochemical success. Conclusion: A majority of patients undergoing unilateral adrenalectomy for PA achieved markedly improved hypertension control while almost halving their antihypertensive medication. Females and patients using lower number of antihypertensive drugs preoperatively were more likely to be completely cured by the surgery.

Purpose To evaluate laboratory and clinical results after unilateral adrenalectomy in patients with primary aldosteronism (PHA). Methods A cross-sectional analysis was performed using data from patients who underwent transperitoneal laparoscopic adrenalectomy for PHA, between January 2008 and December 2019. Surgical indications were based on adrenal venous sampling without ACTH stimulation. Analyses included patient demographics; preoperative clinical, pharmacological, laboratory, and radiological data; and postoperative results assessed after a median of 4 months. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication, thus enabling standardized comparison of dosage between the drug classes. Statistical assessments included univariable and multivariable logistic regression analysis. Results This study enrolled 87 patients. The patients were taking 5.4 DDD of antihypertensive medication before surgery, and 3.0 DDD after surgery. Complete biochemical success of surgery was reached 67 patients (77%), 19 patients (22%) had partial biochemical success. Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure—partial clinical success. Thus, in 76 (87%) of all enrolled patients, surgery had an overall positive effect on hypertension control. Multivariable logistic regression showed that complete clinical success was independently associated with female gender and baseline sum of antihypertensive drugs DDD < 4. Conclusion A majority of patients undergoing unilateral adrenalectomy for PHA achieved markedly improved hypertension control, despite almost halving their antihypertensive medication. Almost a quarter of patients were cured and able to cease using all antihypertensive drugs.

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Our review summarizes the possible differential diagnoses of hypoglycemia. It confirms the absolute necessity of fulfilling all the three Whipple hypoglycemia criteria. Briefly is mentioned Clinical symptoms of hypoglycemia are briefly mentioned and several ways to classify the hypoglycemic events are offered. Highlighted is the recommended approach to distinguish patients as seemingly ill and healthy and also as hypoglycemia occurring in diabetic and non-diabetic. All the classifications and recommendations are summarized in attached tables and schemes.

Tumory předniho mediastina zahrnuji pestrou skalu malignich i benignich nalezů a jejich vcasne dosetřeni může vest ke zlepseni přežiti a kvality života pacientů. V nasi kazuistice se snažime prezentovat posun v možnostech diagnostiky tumorů předniho mediastina za použiti CT navigovaných biopsii s citlivým odběrem materialu k histologicke verifikaci, ve srovnani s přimou mediastinoskopii uživanou v minulých dekadach. Thymom je relativně vzacný nador předniho mediastina.

Various types of tumors (either benign or malignant) can be found in mediastinum. Early diagnosis and treatment may help to improve survival and quality if life in these patients. Compared to direct mediastinoscopy, used for obtaining a specimen for histological analysis in previous decades, modern imaging methods, specifically the CT navigated biopsy, represent an effective and less invasive approach to the diagnosis. In our publication, we present a patient with thymoma, rather rare type of anterior mediastinum tumor.

Background and Objectives: Our aim was to verify the optimal cut-off value for unenhanced CT attenuation and the percentage of negative voxels in the volume CT histogram analysis of adrenal masses. Materials and Methods: We retrospectively analyzed the CT data of patients who underwent an adrenalectomy in the period 2002–2019. In total, 413 adrenalectomies were performed. Out of these, 233 histologically verified masses (123 adenomas, 58 pheochromocytomas, 18 carcinomas, and 34 metastases) fulfilled the inclusion criteria and were selected for analysis. The mean unenhanced attenuation in Hounsfield units (HU) and the percentage of voxels with attenuation less than 0 HU (negative voxels) were measured in each mass. Results: The mean unenhanced attenuation with a cut-off value of 10 HU reached a sensitivity of 59.4% and a specificity of 99.1% for benign adenomas. The mean unenhanced attenuation with a cut-off value of 15 HU reached a sensitivity of 69.1% and a specificity of 98.2%. For the histogram analysis, a cut-off value of 10% of negative pixels reached a sensitivity of 82.9% and a specificity of 98.2%, whereas a cut-off value of 5% of negative pixels reached a sensitivity of 87.8% and a specificity of 75.5%. The percentage of negative voxels reached a slightly better area under the curve (0.919) than unenhanced attenuation (0.908). Conclusion: Mean unenhanced attenuation with a cut-off value of 10 HU represents a simple tool, and the most specific one, to distinguish adrenal adenomas from non-adenomas. CT histogram analysis with cut-off values of 10% of negative voxels improves sensitivity without any loss of specificity.

In patients with metastatic melanoma the advent of targeted therapy and immune checkpoint inhibitors has transformed the management of advanced and metastatic disease, resulting in improved outcomes. Neopterin is a biomarker of immune activation increased in cancer as well as in other conditions associated with immune activation. We present a case of a patient with advanced metastatic melanoma responding to the combination targeted therapy with dabrafenib and trametinib. The treatment was complicated by a fever that was accompanied by a marked rise in serum and urinary neopterin concentrations. Present case report illustrates not only the efficacy of combined targeted therapy, but also the utilization of neopterin measurements in the diagnosis and monitoring of pyrexia in patients with metastatic malignant melanoma.

Introduction: Neurogenic pulmonary oedema (NPE) is a very rare complication of epileptic seizures, which could potentially increase mortality. Material and methods: The case of a 66-year-old male patient with NPE caused by repeated epileptic seizures is reported. Rapid resolution of pulmonary oedema is well documented by X-ray and computed tomography images. Conclusions: Neurogenic pulmonary oedema could potentially increase mortality, and thus, it is important to perform a chest X-ray in all patients presenting with seizures and dyspnoea.