TRH-like peptides are characterized by substitution of basic amino acid histidine (related to authentic TRH) with neutral or acidic amino acid, like glutamic acid, phenylalanine, glutamine, tyrosine, leucin, valin, aspartic acid and asparagine. The presence of extrahypothalamic TRH-like peptides was reported in peripheral tissues including gastrointestinal tract, placenta, neural tissues, male reproductive system and certain endocrine tissues. Work deals with the biological function of TRH-like peptides in different parts of organisms where various mechanisms may serve for realisation of biological function of TRH-like peptides as negative feedback to the pituitary exerted by the TRH-like peptides, the role of pEEPam such as fertilization-promoting peptide, the mechanism influencing the proliferative ability of prostatic tissues, the neuroprotective and antidepressant function of TRH-like peptides in brain and the regulation of thyroid status by TRH-like peptides.

Pheochromocytoma (pheo) is adrenal or less frequently extraadrenal tumour of chromafine tissue. Pheos are rare, but cardiovascular and metabolic abnormalities are common. Unrecognised pheo may lead to fatal hypertensive crisis during anesthesia or other stresses. Proper diagnosis of pheo is thus of utmost importance. 24-h blood pressure (BP) monitoring may contribute to the diagnosis of pheo due to increased BP variability and absence of night BP decline. Pheo contains large amount of enzyme catechol-O-methyl transpherase (COMT) with subsequent excessive production of COMT metabolites like metanephrines. Measurement of plasma free metanephrines or urinary fraccionated metanephrines has usually higher sensivitivity and specificity compared with plasma or urinary catecholamines. Morphological diagnosis of adrenal/extraadrenal pheo is based on CT/MR visualisation and 123I-metaiodobenzylguanidin (MIBG) or PET 18F-fluorodeoxyglucose scan. Genetic analysis should be performed in all confirmed pheo cases, especially in younger subjects below 50 years of age in order to detect mutations of following genes: von Hippel-Lindau (VHL), RET- protooncogen, genes encoding B, C and D subunit of mitochondrial sukcinat dehydrogenaze (SDHB, SDHC, SDHD) and neurofibromatosis type I gene. Pharmacological treatment is based on alpha blockers with subsequent (after 24-48 hours) administration of beta-blockers/especially in patients with tendency to tachycardia/. Following this therapy normalisation of BP is common and laparoscopic excision of pheo tumour can be realised. Malignant pheos are difficult to treat due to early occurrence of metastasis and lack of response to chemotherapy or iradiation in most cases.

Pyeloureteric iunction obstruction is the most common inborn error of the upper urinary pathways. In the time of routine prenatal ultrasound examination, this disease is discovered in the child's age, when it is treated most frequently. Publication summarizes the results of modern laparoscopic management in the adults, who had not been diagnosed previously and symptoms occurred many years after their birthdate. The surgical treatment has been changed in the approach, but not the goal of desobtruction. The results in the adults are influenced not only by the operation technique, but also by the length of time the obstruction lasted and by the number and severity of the inflammatory changes.

The mid-term results (5 yr) after radical retropubic prostatectomy (RRP) are outlined and compared with pre- and postoperative parameters of patients. While 5 years survival could be expected in as many as 92.4%, relatively higher age (majority over 65) brings a higher risk of complications with it, though fully comparable with international standards. No perioperative mortality was recorded (0%), obstructive symptoms post-operatively developed in 13.4% patients, who were subsequently managed successfully endoscopically. Continence with maximum one pad per 24 hours was recorded in 77.2%, the severe incontinence was only in 3.3%. Spontaneous erection was reported in 4.3%, but except for higher age, the other objective factors were involved.

The function of chromogranin A (CGA) is reviewed, and the radioimmunometric determination of plasma CGA was evaluated as a marker of pheochromocytoma using a comparison of pheochromocytoma patients immediately before surgery (group P, n=25, 635+/-451 ng/ml) with other groups of patients, i.e. pheochromocytoma patients approximately 1 year after removal of tumor (group PP, n=13, 69+/-33 ng/ml), medullary thyroid carcinoma patients (group M, n= 22, 106+/-59 ng/ml), congenital adrenal hyperplasy patients (n=33, 65+/-40 ng/ml), and controls (n=31, 66+/-29 ng/ml). A CGA level above cut off value 130 ng/ml was found in 24 of 25 patients in group P, 1 (relapse) of 13 patients in group PP, and 4 of 22 patients in group M. In the group P we found a significant association between the size of the tumors removed and plasma CGA concentrations (p=0.0016), and also a significant (p=0.0016) relationship between plasma CGA concentrations and PASS score rating the malignity of pheochromocytoma. We can conclude that plasma CGA concentration as determined by radioimmunometric assay (which is simple without the necessity of special laboratory equipment) is an effective marker of pheochromocytoma with association to malignity and tumor mass.

Laparoscopic radical nephrectomy (LRN) is method of choice in malignant renal tumors (RCC) stage T1-3. Procedure has proved to be technically safe with low post-operative morbidity and standard oncological results, provided the patients are secondaries free in the time of surgery, and there was no positive margin in resected tissue. There was no recurrence even after 6 years of follow-up. The most influential variables regarding the survival of patients postoperatively were: presence of metastases in the time of surgery p <0.0001, pathological grade p < 0.001, stage p < 0.018 and p < 0.046, respectively, if the tumors were 4 cm and bigger. It could be concluded, that laparoscopic way of removing the tumor with the kidney has proved the same oncological results even in the mid-term follow-up, if compared with classical open surgery done lege artis.

Cil: Odhad patologicke klasifikace karcinomu prostaty (CaP) po radikalni prostatektomii a urceni předoperacnich rizikových faktorů pro lokalně pokrocilý karcinom.Material a metodika: V letech 2000-2006 podstoupilo celkem 471 mužů radikalni prostatektomii (RP) pro karcinom prostaty. U každeho pacienta byl zaznamenan věk, předoperacni hodnota prostatickeho specifickeho antigenu (PSA), klinicka klasifikace, Gleasonovo skore (GS) a maximalni hodnota Gleasonova stupně v biopsii. V definitivnim preparatu jsme hodnotili pT klasifikaci, GS, perineuralni siřeni a stav chirurgických okrajů. Vliv předoperacnich parametrů na pT klasifikaci byl stanoven metodou Spearmanova koeficientu korelace, pro každý parametr bylo dale stanoveno relativni riziko lokalně pokrocileho onemocněni.Výsledky: Průměrný věk byl 62 let, průměrna předoperacni hodnota PSA 10,55 ng/ml, klinicky jako Tle bylo klasifikovano 67,2 % pacientů. Patologicky lokalizovaný CaP byl nalezen u 72,9 % pacientů. U 20,3% definitivnich preparatů bylo identifikovano GS vyssi než sest. Pozitivni chirurgicke okraje byly popsany u 12,7 % a perineuralni siřeni u 46,3 % nalezů. Vsechny sledovane předoperacni parametry byly statisticky významne ve vztahu k patologicke klasifikaci CaP (p < 0,05).Zavěr: Vsechny sledovane hodnoty byly statisticky významne, s nejvyssim rizikem lokalně pokrocileho karcinomu pro pacienty s bioptickým GS vyssim než sedm, palpacně suspektnim nalezem a/nebo předoperacni hladinou PSA vyssi než 10 ng/ml.

Objective The study was aimed at assessment of the effects of specific treatment of primary aldosteronism (PA) on the arterial stiffness. Design and Methods 28 patients with confirmed PA (14 with aldosterone-producing adenoma treated by unilateral laparoscopic adrenalectomy, 14 with idiopathic hyperaldosteronism (treated with spironolactone) were investigated by Sphygmocor applanation tonometer using measurement of pulse wave velocity (PWV) and augmentation index (AI) at the time of the diagnosis and then again 1 year after the specific treatment. Results The mean 24h-BP levels decreased from 149 ± 18/92 ± 11mmHg to 128 ± 15/81 ± 10mmHg (p<0,01) after adrenalectomy (p<0,01), and from 155 ± 16/94 ± 12 to 140 ± 18/88 ± 8mmHg (p<0,05; n.s.). on spironolactone. The PWV significantly decreased after surgery from 9,3 ± 3 na 7,6 ± 2,1 m/s (p = 0,002), also the AI decreased significantly from 25 ± 9 na 17 ± 8% p = 0,006. However, no significant improvement of the arterial stiffness indices was found in the patients treated with spironolactone (PWV before 9,3 ± 1,6, after 8,9 ± 1,3 m/s, n.s.; AI 24 ± 9.25 ± 8%, n.s.). After correction for differences in 24-h BP fall stays the AI fall more significant (p<0,01)in the surgically treated than spironolactone treated patients. Conclusions The causal surgical treatment of PA is significantly more effective in improving arterial stiffness than conservative treatment with spironolactone, also after correction for 24-h BP difference. This could indicate a possibility, that the aldosterone receptor blockade by spironolactone doesn’t fully prevent arterial wall damage mediated by aldosterone, and that nongenomic aldosterone effects could possibly play a role in patophysiology of arterial wall damage.

We suggest efficient and relatively simple method for TRUS Bx decision making derived from non-linear logistic regression. Based on age (linear), others suggesting core positivity are not. To minimize the failure, the firm criteria on biopsy, population and personal were applied.

BACKGROUND:Radical cystectomy with pelvic lymphadenectomy and urinary diversion is standard treatment in patients with muscle-invasive and selected high-risk superficial bladder cancers. The aim of our study was to evaluate oncological results and correlate prognosis with the extent of the disease.METHODS AND RESULTS:Data of 125 patients (33 females and 92 males) with mean age of 59.8 years were analysed. Histological diagnosis was urothelial carcinoma in 114, squamous cell carcinoma in 8 and small-cell carcinoma in 3 patients respectively. During the mean follow-up of 22.4 months the disease-free survival (DFS) and disease-specific survival (DSS) were evaluated according to the extent of the disease. Tumours were classified as pTa, pT1, pTis in 31 (24.8%), as pT2 in 39 (31.2%), as pT3 in 24 (19.2%) and pT4 in 20 (16%) patients respectively. There was no tumour detected in the specimen in 11 (8.8%) of cases (pT0). Lymph node metastases were confirmed in 36 (28.8%) of patients. Three-year DFS and DSS were 100% and 100% in pT0, 76% and 87.1% in pTa, pT1, pTis, 69.2% and 82.9% in pT2, 32.9% and 62.4% in pT3 and 39.5% and 36.8% in pT4 tumours respectively (p = 0.0001, p = 0.0004). Three-year DFS and DSS reached 69.4% and 51.8% in patients with negative lymph nodes and 51.8% and 44.8% in patients with lymph node involvement (p = 0.0008, p < 0.0001).CONCLUSIONS:DFS and DSS after radical cystectomy depend from the local extent of the tumour and from lymph node status, which is a strong argument for its timely indication.

BACKGROUND:Percutaneous nephrolithotomy is an effective less invasive method for the treatment of nephrolithiasis. Authors retrospectively analysed results of this procedure performed in a single centre (Department of Urology, General University Hospital, Prague) from January 2005 till June 2007.METHODS AND RESULTS:Patients were acquired by an analysis of operating reports performed over a period January 2005 till June 2007 and subsequently a retrospective analysis of electronic and paper patient's records was carried out. Percutaneous nephrolithotomy was performed in 150 patients. Of those, 117 (78%) patients underwent primary and 33 (21.3%) secondary procedure. Analysed group consisted of 85 (56.7%) men and 65 (43.3%) women. Right-sided procedure was performed in 46% (69 times) and left-sided in 54% (81 times) of cases. Mean patient's age was 52.9 years (SD +/- 16.3). Mean stone size was 18.3 (SD +/- 9.5) mm. Staghorn calculi were present in 19 (12.7%) patients and 77 (51.3%) patients had more than 1 stone. Intracorporeal lithotripsy was necessary in 82 (54.7%) cases. Seventy eight (52.9%) patients were stone free after the procedure. There were 24 (16%) patients with an anatomic abnormality of upper urinary tract. The most common (in 64.3%) component in analysed stones was a calcium oxalate.CONCLUSIONS:The amount of stone free patients is rather lower compared to the literature results. However, definitive results are always affected by auxiliary procedures (mainly extracorporeal shock wave lithotripsy), which are not included in the analysis.

Radical cystectomy with pelvic lymphadenectomy and urinary diversion is an important component in the treatment of bladder cancer. It is considered the most important method in the therapy for muscle invasive and selected high-risk non-muscle invasive tumours with excellent local control and high complete remission rate. It consists of complete removal of tumour tissue in the bladder, small pelvis and regional lymph nodes. In males, urinary bladder and prostate are routinely removed; in females, bladder, uterus and anterior vaginal wall are removed. Urethrectomy is indicated only in selected situations. An integral part of the operation is the bilateral pelvic lymphadenectomy. Extravesical disease extension and lymph node positivity are unfavourable prognostic factors. Better prognosis is expected in patients with less than 5 positive nodes. Important prognostic factor is also the number of removed lymph nodes, which is a strong argument for meticulous bilateral pelvic lymphadenectomy. Lymph node density (number of positive nodes/ number of removed nodes) is considered as very important prognostic factor. Better prognosis can be expected in patients with less positive and more removed nodes.

BACKGROUND Early diagnostics of prostate cancer is still the most important factor in tumor-specific survival of patients harbouring this malignant disease. Without better understanding of the etiology and without relevant markers of the disease progression, only the early diagnostics of organ-confined disease can save the patient's life. METHODS AND RESULTS Throughout 7 consecutive years, 1464 transrectal prostate biopsies in 1302 patients were performed. In all cases, the age, DRE (positive or negative), prostatic volume (ccm), total PSA in peripheral blood (ng/ml) were assigned, as well as free/total PSA ratio (%) in most of them. Apart from previously used linear regression, we applied logistic regression, since only age grows linear and DRE is determined only as positive or negative. The surrogate endpoint was ROC, which determines the area applying to the relations of sensitivity and specificity of any marker. Multifactorial logistic regression then reached best results at values over 0.8 in all tested age categories with maximal deviation of 8%, which had not been achieved before. CONCLUSIONS Despite hundreds of papers published on this topic, the question of when and how the patient is indicated to the biopsy of the prostate has not been solved. A computer driven model based on 1464 documented examinations on the relatively homogeneous population is presented. On the basis of the combination of biological and statistical methods, the model can give correct predictions in 9 out of 10 cases.