1
|
Šumnik Z, Pavlíková M, Neuman V, Petruželková L, Konečná P, Venháčová P, Škvor J, Pomahačová R, Neumann D, Vosáhlo J, Strnadel J, Kocourková K, Obermannová B, Šantová A, Plachý L, Průhová S, Cinek O. Glycemic Control by Treatment Modalities: National Registry-Based Population Data in Children and Adolescents with Type 1 Diabetes. Horm Res Paediatr 2023; 97:70-79. [PMID: 37100041 DOI: 10.1159/000530833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA. METHODS CwD younger than 19 years with T1D duration >1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups. RESULTS Data of a total of 3,251 children (mean age 13.4 ± 3.8 years) were analyzed. 2,187 (67.3%) were treated with MDI, 1,064 (32.7%) with insulin pump, 585/1,064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3) and lowest GRI 29.1 (7.8), both p < 0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (nonsignificant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 [IQR 4.5], 50.7 [4.5], and 52.7 [5.7] mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality. CONCLUSION This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.
Collapse
Affiliation(s)
- Zdenek Šumnik
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Marketa Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czechia
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Lenka Petruželková
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Petra Konečná
- Department of Pediatrics, University Hospital Brno, Brno, Czechia
| | - Petra Venháčová
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czechia
| | - Jaroslav Škvor
- Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, Czechia
| | - Renata Pomahačová
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czechia
| | - David Neumann
- Department of Pediatrics, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Jan Vosáhlo
- Department of Pediatrics, 3rd Faculty of Medicine, Prague, Czechia
| | - Jiri Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia
| | - Kamila Kocourková
- Department of Pediatrics, Hospital České Budějovice, České Budějovice, Czechia
| | - Barbora Obermannová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Alzbeta Šantová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
- 1st Faculty of Medicine, Prague, Czechia
| | - Lukas Plachý
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Stepanka Průhová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Ondrej Cinek
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| |
Collapse
|
2
|
Lenz J, Klubíčková N, Ptáková N, Hájková V, Grossmann P, Šteiner P, Kinkor Z, Švajdler M, Michal M, Konečná P, Macháčová D, Hurník P, Tichý M, Tichý F, Kyllar M, Fiala L, Kavka M, Michal M. Extraskeletal myxoid chondrosarcoma: A study of 17 cases focusing on the diagnostic utility of INSM1 expression and presenting rare morphological variants associated with non-EWSR1::NR4A3 fusions. Hum Pathol 2022; 134:19-29. [PMID: 36563884 DOI: 10.1016/j.humpath.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma of uncertain lineage. Insulinoma-associated protein 1 (INSM1) has recently been described as a highly specific and sensitive immunohistochemical marker for EMC. The goal of this study was to evaluate the diagnostic significance of INSM1 immunohistochemistry in EMC. Furthermore, correlations between molecular and morphological findings were performed. Sixteen of 17 EMC cases were stained with the INSM1 antibody. Tumors with at least 5% INSM1-positive cells and any staining intensity were considered positive. Molecular testing was successfully performed in 12/17 cases. The immunohistochemical analysis detected 13 INSM1-positive (81%) and 3 INSM1-negative tumors (19%). The extent of the staining was classified as 1+ in 7 cases (44%), 2+ in 2 cases (13%), 3+ in 2 cases (13%) and 4+ in 2 cases (13%). Intensity of immunostaining was weak in 5 cases (31%), moderate in 2 cases (13%) and strong in 6 cases (38%). Molecular assays revealed 8 EWSR1::NR4A3 positive tumors (67%), 2 TAF15::NR4A3 positive tumors (17%), 1 TCF12::NR4A3 positive tumor (8%) and 1 NR4A3 positive tumor (8%) in which no other gene alteration was identified. Two of them, namely TCF12 positive and one TAF15 positive tumors, were highly cellular and partially associated with pseudopapillary architecture. Our study found that moderate/strong expression of INSM1 in more than 25% of tumor cells was present in only 31% of cases. Thus, the diagnostic utility of INSM1 is rather low. Two morphologically unique cases of non-EWSR1 rearranged EMC with an extremely rare pseudopapillary growth pattern are also reported.
Collapse
Affiliation(s)
- Jiří Lenz
- Department of Pathology, Znojmo Hospital, MUDr. Jana Janského 2675/11, 669 02 Znojmo, Czech Republic; Cytohisto S.r.o., Bří. Mrštíků 3065, 690 02 Břeclav, Czech Republic; Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Natálie Klubíčková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Nikola Ptáková
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Veronika Hájková
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petr Grossmann
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petr Šteiner
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Zdeněk Kinkor
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Marián Švajdler
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petra Konečná
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Dominika Macháčová
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Pavel Hurník
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Michal Tichý
- Department of Pathology, Masaryk Memorial Cancer Institute, Žlutý Kopec 543/7, 602 00, Brno, Czech Republic.
| | - František Tichý
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Michal Kyllar
- Institute of Morphology, Department of Pathobiology, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Luděk Fiala
- Cytohisto S.r.o., Bří. Mrštíků 3065, 690 02 Břeclav, Czech Republic; Charles University Prague, First Faculty of Medicine, Kateřinská 1660/32, 121 08 Prague, Czech Republic.
| | - Miroslav Kavka
- Department of Surgery, Znojmo Hospital, MUDr. Jana Janského 2675/11, 669 02 Znojmo, Czech Republic.
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| |
Collapse
|
3
|
Cinek O, Slavenko M, Pomahačová R, Venháčová P, Petruželková L, Škvor J, Neumann D, Vosáhlo J, Konečná P, Kocourková K, Strnadel J, Průhová Š, Šumník Z. Type 1 diabetes incidence increased during the COVID-19 pandemic years 2020-2021 in Czechia: Results from a large population-based pediatric register. Pediatr Diabetes 2022; 23:956-960. [PMID: 35982508 PMCID: PMC9538386 DOI: 10.1111/pedi.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/16/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To explore type 1 diabetes incidence patterns during the pandemic years 2020 and 2021 in Czechia, to compare them to the trends from the previous decade, and to test its association with indicators of containment measures and of pandemic severity (school closing and the all-cause excess mortality). METHODS The Czech Childhood Diabetes Register is a population-based incidence register recording patients age 0-14.99 years at diabetes onset. Type 1 diabetes incidence in the pandemic period (April 2020-end of observation Dec 2021) was compared by Poisson regression models to the incidence patterns over the past decade 2010-2019. RESULTS During the pandemic years 2020-2021, 956 children 0-14.99 years old manifested with type 1 diabetes in Czechia. The observed incidence (27.2/100,000/year) was significantly higher than what was expected from the trends over 2010-2019 (incidence rate ratio, IRR = 1.16, 95%CI 1.06-1.28, p = 0.0022). The incidence had a trough during the first lockdown (March-May 2020), then it rose above expected values with no usual summer decrease. The assessed pandemic indicators (school closing and all-cause excess mortality) were not associated with the incidence levels. CONCLUSIONS The COVID-19 pandemic was associated with a notable upward inflection of the type 1 diabetes incidence curve; the early months of the first lockdown were however hallmarked by a significant dip in new diabetes diagnoses. Long-term observation will show whether the increased incidence originated only from accelerating an advanced preclinical Stage 2 to overt diabetes, or whether the pandemic triggered new cases of islet autoimmunity.
Collapse
Affiliation(s)
- Ondřej Cinek
- Department of PediatricsMotol University HospitalPragueCzech Republic
| | - Matvei Slavenko
- Department of PediatricsMotol University HospitalPragueCzech Republic,Department of Probability and Mathematical Statistics, Faculty of Mathematics and PhysicsCharles UniversityPragueCzech Republic
| | - Renata Pomahačová
- Department of PediatricsUniversity Hospital PilsenPilsenCzech Republic
| | - Petra Venháčová
- Department of PediatricsUniversity Hospital OlomoucOlomoucCzech Republic
| | | | - Jaroslav Škvor
- Department of PediatricsMasaryk HospitalÚstí nad LabemCzech Republic
| | - David Neumann
- Department of PediatricsUniversity HospitalHradec KrálovéCzech Republic
| | - Jan Vosáhlo
- Department of Pediatrics3rd Faculty of MedicinePragueCzech Republic
| | - Petra Konečná
- Department of PediatricsUniversity Hospital BrnoBrnoCzech Republic
| | - Kamila Kocourková
- Department of PediatricsHospital České BudějoviceČeské BudějoviceCzech Republic
| | - Jiří Strnadel
- Department of PediatricsUniversity Hospital OstravaOstravaCzech Republic
| | - Štěpánka Průhová
- Department of PediatricsMotol University HospitalPragueCzech Republic
| | - Zdeněk Šumník
- Department of PediatricsMotol University HospitalPragueCzech Republic
| | | |
Collapse
|
4
|
Šumník Z, Pavlíková M, Pomahačová R, Venháčová P, Petruželková L, Škvor J, Neumann D, Vosáhlo J, Konečná P, Čížek J, Strnadel J, Průhová Š, Cinek O. Use of continuous glucose monitoring and its association with type 1 diabetes control in children over the first 3 years of reimbursement approval: Population data from the ČENDA registry. Pediatr Diabetes 2021; 22:439-447. [PMID: 33533545 DOI: 10.1111/pedi.13184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Increased access to modern technologies is not always accompanied by a decrease in HbA1c. The aim of this study was to identify changes in the proportion of continuous glucose monitoring (CGM) users since 2017, when general reimbursement for CGM became effective in Czechia, and to test whether HbA1c is associated with the percentage of time spent on CGM. RESEARCH DESIGN AND METHODS All T1D children in the Czech national ČENDA registry (3197 children) were categorized according to their time spent on CGM and associations with age, sex, center size, and HbA1c were tested with calendar year as a stratification factor. RESULTS The proportion of children with any CGM use increased from 37.9% in 2017 to 50.3% in 2018 and 74.8% in 2019. Of the CGM users, 16%, 28%, and 41% of the children spent >70% of their time on CGM over the 3 years of the study period, with an overrepresentation of children in the <10 years age group versus the older age groups (p < 0.001). The proportion of CGM users differed among centers and was positively associated with a large center size (>100 patients) (p < 0.001). HbA1c was negatively associated with the time spent on CGM (p < 0.001). CONCLUSIONS A rapid increase in CGM use was reported over the 3 years after general reimbursement. HbA1c was associated with time spent on CGM, a continuing decrease was observed in the >70% category. Reimbursement for CGM likely contributes to the improvement of T1D control at the population level.
Collapse
Affiliation(s)
- Zdeněk Šumník
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Renata Pomahačová
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czech Republic
| | - Petra Venháčová
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lenka Petruželková
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Jaroslav Škvor
- Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - David Neumann
- Department of Pediatrics, University Hospital, Hradec Králové, Czech Republic
| | - Jan Vosáhlo
- Department of Pediatrics, 3rd Faculty of Medicine, Prague, Czech Republic
| | - Petra Konečná
- Department of Pediatrics, University Hospital Brno, Brno, Czech Republic
| | - Jindřich Čížek
- Department of Pediatrics, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Jiří Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Štěpánka Průhová
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Ondřej Cinek
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | | |
Collapse
|
5
|
Abstract
Primary urethral adenocarcinomas are very rare neoplasms accounting for <10% of all urethral carcinomas. Site of their origin is unclear, but they seem to arise from Skene's paraurethral glands, which is the female homologue of the male prostate. The aim of this article is to report the first case of Skene's gland adenocarcinoma in which a molecular genetic profiling was performed. The patient was a 73-year-old woman with a polypoid lesion sized 3 × 2 cm located at the interface between the bladder neck and the proximal urethra. Transurethral resection was performed and small tissue fragments with positive margins were obtained. Histology revealed an epithelial neoplasm consisting of cribriform structures located in the subepithelial connective tissue of the bladder wall and proximal urethra. The lesion showed positive immunohistochemical staining with prostate specific antigen, prostatic acid phosphatase, NKX3.1, and alpha-methylacyl-CoA racemase. Using the Illumina TruSight Tumor 170 next-generation sequencing assay, a mutation and loss of heterozygosity of the phosphatase and tensin homologue (PTEN) gene was detected. No fusion in any of the examined genes was found using this assay as well as FusionPlex Solid Tumor Kit and FusionPlex Sarcoma kit assays from ArcherDX. Given the rarity of Skene's gland adenocarcinoma, it is uncertain whether the same grading and prognostic criteria that are currently used for prostatic cancer apply here as well. It is also unclear what treatment strategy should be applied, but according to the available literature, it seems that local excision or wide surgical resection could represent sufficient therapeutic modalities.
Collapse
Affiliation(s)
- Jiří Lenz
- Department of Pathology, 48246Znojmo Hospital, Czech Republic.,48384Cytohisto s.r.o., Breclav, Czech Republic.,Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic
| | - Michal Michal
- Department of Pathology, 60569Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd., Pilsen, Czech Republic
| | - Michael Michal
- Department of Pathology, 60569Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd., Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ondřej Hes
- Department of Pathology, 60569Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd., Pilsen, Czech Republic
| | - Petra Konečná
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic
| | - David Lenz
- 48384Cytohisto s.r.o., Breclav, Czech Republic
| |
Collapse
|
6
|
Šumník Z, Venháčová J, Škvor J, Pomahačová R, Konečná P, Neumann D, Vosáhlo J, Strnadel J, Čížek J, Obermannová B, Petruželková L, Průhová Š, Pavlíková M, Cinek O. Five years of improving diabetes control in Czech children after the establishment of the population-based childhood diabetes register ČENDA. Pediatr Diabetes 2020; 21:77-87. [PMID: 31605416 DOI: 10.1111/pedi.12929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 09/02/2019] [Accepted: 09/18/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The Czech National Childhood Diabetes Register (ČENDA) is a web-based nationwide database that collects treatment and outcome data in children and adolescents with diabetes. Here, we present data from the first 5 years of ČENDA (2013-2017). METHODS Data include characteristics of disease onset and annual summaries of key clinical care parameters from every patient treated by participating pediatric diabetes outpatient clinics. RESULTS The database contains data of 4361 children (aged 0-19 years) from 52 centers (85% of all Czech pediatric patients). Of these, 94% had type 1 diabetes (T1D), 4.5% had genetically proven monogenic or secondary, and 1.5% had type 2 diabetes. In children with T1D, median glycated hemoglobin (HbA1c) decreased throughout the observed period from 66.3 to 61.0 mmol/mol (P < .0001, 95% confidence interval [CI] for change -5.6 to -4 mmol/mol). Consequently, the proportion of children reaching the target therapeutic goal of 58.5 mmol/mol increased from 28% in 2013 to 40% in 2017. The proportion of children treated with insulin pumps (CSII) remained stable over the observed period (25%). In a subanalysis of 1602 patients (long-standing T1D diagnosed before 2011), the main predictors associated with lower HbA1c were treatment with CSII, male sex and care provided at a large diabetes center (>100 patients). CONCLUSIONS A significant continuous decrease in HbA1c was observed in Czech children over the past 5 years. As this improvement was not accompanied by appreciable changes in the mode of therapy, we assume that the establishment of our nationwide register has itself constituted a stimulus towards improvement in the care process.
Collapse
Affiliation(s)
- Zdeněk Šumník
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Jitřenka Venháčová
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jaroslav Škvor
- Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Renata Pomahačová
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czech Republic
| | - Petra Konečná
- Department of Pediatrics, University Hospital Brno, Brno, Czech Republic
| | - David Neumann
- Department of Pediatrics, University Hospital, Hradec Králové, Czech Republic
| | - Jan Vosáhlo
- Department of Pediatrics, 3rd Faculty of Medicine, Prague, Czech Republic
| | - Jiří Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jindřich Čížek
- Department of Pediatrics, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Barbora Obermannová
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Lenka Petruželková
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Štěpánka Průhová
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Ondřej Cinek
- Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | | |
Collapse
|
7
|
Lenz J, Chvátal R, Konečná P. Dissecting leiomyoma of the uterus with unusual clinical and pathological features. Ceska Gynekol 2020; 85:197-200. [PMID: 33562973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Case description of dissecting uterine leiomyoma with extrauterine extension and infiltration of right parametrium, ureter and bladder wall. DESIGN Case report. SETTING Department of Pathology, Znojmo Hospital. METHODS A 64-year-old woman with chronic pelvalgia and loss of renal function of the right kidney due to urinary tract obstruction is presented. Ultrasound examination, magnetic resonance imaging and computer tomography scan revealed a pelvic tumour affecting the right edge of the uterine wall, the right parametrium, distal part of the right ureter, the right and partially the cranial bladder wall. Due to this finding, hysterectomy, unilateral parametrectomy, partial resection of the bladder wall and resection of the distal part of the ureter was performed. Histology revealed morphologically bland spindle-cell smooth-muscle tumour corresponding to conventional uterine leiomyoma. Tumour necrosis, cellular atypia, vascular invasion or hydropic degeneration were not observed. A final diagnosis of dissecting leiomyoma of the uterus was made. CONCLUSION The diagnosis of dissecting leiomyoma should be considered in all malignant tumours affecting the uterine corpus.
Collapse
|
8
|
Procházková D, Jarkovský J, Haňková Z, Konečná P, Benáková H, Vinohradská H, Mikušková A. Long-term treatment for hyperphenylalaninemia and phenylketonuria: a risk for nutritional vitamin B12 deficiency? J Pediatr Endocrinol Metab 2015. [PMID: 26226119 DOI: 10.1515/jpem-2014-0489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The objective of the study was to determine the incidence of vitamin B12 deficiency in patients under long-term treatment for phenylketonuria (PKU) and hyperphenylalaninemia (HPA), as well as its associations with B12 vitamin parameters (holotranscobalamin - active vitamin B12, serum folate, total plasma homocysteine, and plasma methylmalonic acid concentration). PATIENTS AND METHODS The group consisted of 51 PKU (n=29) and HPA (n=22) patients aged 3-48 years (28 children, 23 adults). RESULTS A significant difference in serum folate levels was discovered between adult HPA patients and PKU patients (p=0.004, Mann-Whitney U-test). A significant difference in plasma homocysteine concentrations within the normal levels (p=0.032, χ2-test) was detected between adult HPA and PKU patients. In the group of adults, we also found significant differences in serum holotranscobalamin concentrations regarding both concentration levels and the proportion of patients with concentrations within the normal levels (p=0.031, Mann-Whitney U-test; p=0.006, χ2-test). CONCLUSION We have proven that adult patients with PKU and HPA are at risk of vitamin B12 nutritional deficiency. The most effective parameter for these adults is the monitoring of holotranscobalamin in the serum.
Collapse
|
9
|
Procházková D, Jarkovský J, Vinohradská H, Konečná P, Machačová L, Doležel Z. Controlled diet in phenylketonuria and hyperphenylalaninemia may cause serum selenium deficiency in adult patients: the Czech experience. Biol Trace Elem Res 2013; 154:178-84. [PMID: 23771645 DOI: 10.1007/s12011-013-9724-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
Phenylketonuria is an inherited disorder of metabolism of the amino acid phenylalanine caused by a deficit of the enzyme phenylalanine hydroxylase. It is treated with a low-protein diet containing a low content of phenylalanine to prevent mental affection of the patient. Because of the restricted intake of high-biologic-value protein, patients with phenylketonuria may have lower than normal serum concentrations of pre-albumin, selenium, zinc and iron. The objective of the present study was to assess the compliance of our phenylketonuric (PKU) and hyperphenylalaninemic (HPA) patients; to determine the concentration of serum pre-albumin, selenium, zinc and iron to discover the potential correlation between the amount of proteins in food and their metabolic control. We studied 174 patients of which 113 were children (age 1-18), 60 with PKU and 53 with HPA and 61 were adults (age 18-42), 51 with PKU and 10 with HPA. We did not prove a statistically significant difference in the concentration of serum pre-albumin, zinc and iron among the respective groups. We proved statistically significant difference in serum selenium concentrations of adult PKU and HPA patients (p = 0.006; Mann-Whitney U test). These results suggest that controlled low-protein diet in phenylketonuria and hyperphenylalaninemia may cause serum selenium deficiency in adult patients.
Collapse
Affiliation(s)
- Dagmar Procházková
- Department of Pediatrics, University Hospital Brno, Medical Faculty of Masaryk University Brno, Cernopolni 9, Brno 62500, Czech Republic.
| | | | | | | | | | | |
Collapse
|