Last updated: August 25, 2006
Abstract
Introduction: Chronic pancreatitis could be well diagnosed by
histopathology, but for clinical purposes, differential diagnostics and
patient follow-up we use mainly imaging procedures and non-invasive
pancreatic function tests, if available. In this study we report the 4
years experiences with noninvasive test of exocrine pancreatic function
– breath test with 13C-mixed triglycerides (MTG-BT). The diagnostic
significance has been compared with determination of fecal
elastase-1 in relation to new clinically oriented classification of
chronic pancreatitis (Buchler and Malfertheiner, Bern 2000).
Aims and Methods: We studied 180 subjects with suspected
chronic pancreatitis (CHP). The grading of CHP was evaluated in 169
patients. MTG-BT test was performed with 250mg of Glyceryl-1,3-
dioctadecanoate-2-octanoate-1-13C, 13C:12C ratio was analysed by
infrared Isomax 4,000 analyser. Cummulative recovery of 13C was calculated
by two methods, Body Surface Area and Basal Metabolic Rate.
Fecal elastase 1 (FELA) was determined using monoclonal antibody
(ScheboTech, Germany).
Results: Cummulative recovery (cPDR) significantly distinguishes
severe CHP (grade C3) from all other groups, mild CHP
(grade A) is significantly higher compared to other groups of CHP.
Precision NDIRS x IRMS was checked 15 times using calibration
IRMS reference calibrators the mean difference was 4.9% (Pearson’s
coeff. = 0.990). Concordant results of MTG and FELA were found in
79.6%. The highest percentage (70.0%) of disconcordant results (low
FELA, normal MTG) was in group CHP-B and CH-C3.
Conclusions: Measurement of fecal elastase 1 is simple, noninvasive,
robust test which well correlates with extent of tissue damage.
MTG-BT is better in evaluation of dynamic and kinetic aspects, real
digestive ability and response to stimulation. MTG-BT is, contrary to
FELA, suitable to evaluate pancreatic supplementation therapy.
Faecal Elastase I. Assessment – Its Use in Diagnosis of Chronic Pancreatitis (Article in Czech)
Cas. Lek. Ces., 145 (6), 2006, p. 480 - 483.
Krechler T., Kocna P., Vaníčková Z., Švestka T., Lukáš M., Doseděl J., Kohout P., Žák A.
IV. interní klinika 1. LF UK a VFN, Ústav klinické biochemie a laboratorní diagnostiky 1. LF UK, Nemocnice U Milosrdných sester sv. Karla Boromejského, Fakultní Thomayerova nemocnice 1. LF UK, Praha
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Abstract
Background. The diagnosis of chronic pancreatitis is based on the imaging methods. These imaging methods show the main morphological changes in the pancreatic ducts and its parenchyma, but they do not define the function of the pancreas. The aim of our study was Faecal Elastase I. determination in patients with chronic pancreatitis. The test is a simple, non-invasive method of the investigation of the pancreatic exocrine insufficiency. The Faecal Elastase I occurring in the stool was correlated with the level of the damage of pancreatic tissue together with the control group of the patients with different diagnoses. Methods and Results. Faecal Elastase I (mean values in ug/g of stool) detection is a simple, non-invasive method which correlates well with the damage of pancreatic tissue, stemming from chronic pancreatitis. This test is routinely used especially in the diagnosis of chronic pancreatitis. The classification of chronic pancreatitis currently depends on the morphological changes of the pancreatic duct system (the patho-morphological changes). We are currently missing the classification describing simultaneously the morphological changes of the gland and the function of the pancreas. In our studies we have used a newly proposed classification system, which was put together in Bern, 2000 (1). This new system encompasses morphological and functional changes. Faecal Elastase I was determined by a microplate ELISA method using monoclonal antibody to human pancreatic protein. The Faecal Elastase I. was tested in the stool of the 196 patients with chronic pancreatitis stemming from alcoholism. The occurrence of Faecal Elastase I. was classified according to the levels assigned by the classification system. The control group used in this study included 144 patients with different diagnoses. The results demonstrate a very good correlation of Faecal Elastase I. with the grading of the newly proposed classification system of chronic pancreatitis. Patients with the highest levels of the damage of the pancreas had a significantly lower occurrence of Faecal Elastase I. in comparison with the non-pancreatic control group and in patients with chronic pancreatitis who had no clinical complications or damage of endocrine and exocrine functions of the pancreas.
Isotope Selective Nondispersive Infrared Spectrometry Can Compete with Isotope Ratio Mass Spectrometry in Cumulative
13CO2 Breath Tests: Assessment of Accuracy
Klin. Biochem. Metab., 13 (34), 2005, No. 2, p. 92–97.
Chleboun J., Kocna P.
Mathematical Institute, Academy of Sciences and Faculty of Mechanical Engineering,
Czech Technical University; Institute of Clinical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University,
Prague, Czech Republic
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Abstract
To measure a patient’s metabolic response to an administered 13C-enriched substrate, isotope selective nondispersive
infrared spectrometry is used. Isotope abundance levels are relative, i. e., reported as differences between a tested
sample and a reference sample. The reference 13C abundance is not known exactly. This uncertainty, uncertainty in CO2
production, and the inaccuracy of the measuring instrument contribute to the uncertainty in the results of breath tests. In
this study, the particular impacts of uncertainty are estimated and expressed in a mathematical way by an uncomplicated
formula illustrated by an example dealing with real-life data. It is shown that the uncertainty in the reference 13C
abundance does not have severe consequences, so that the method can compete with the spectrometry methods that
are able to deliver an absolute value of the 13C abundance. The inaccuracy of the measuring instrument is also
manageable, though its influence is greater than in the previous case. The analysis reveals that the uncertainty in CO2
production deserves great attention because it is difficult to estimate and its influence is rather strong. The problem of
determination of a proper cut-off level is outlined.
Distribution of molecular markers in sporadic colorectal cancer, adjacent and distant mucosa
Folia Gastroenterol Hepatol 2004; 2 (2): 62 - 71
Frič P, Sovová V, Roth Z, Šloncová E, Kocna P, Jirásek A, Čermák J.
Second Department of Medicine, Central Military Hospital, Postgraduate Institute of Medicine and Department of Gastroenterology
and Hepatology, Institute of Clinical Biochemistry and Laboratory Diagnostics, Institute of Pathology,
Department of Surgery, First Faculty of Medicine, Charles University;
Institute of Molecular Genetics, Czech Academy of Sciences; Department of Biostatistics and Informatics, State Health Institute;
Praha, Czech Republic
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Abstract
Purpose: Molecular markers of carcinomatous transformation of the colonic mucosa have been predominantly
determined in the tumour tissue. Their behaviour in the neighbouring mucosa has been only seldom
followed and data on comparison of their distribution in individual locations are rare.
Methods: In 53 consecutive subjects with sporadic colorectal cancer the frequency and intensity of expression
of p53, c-Src protein kinase activity, c-erbB2, EGF-r, PCNA and arginase activity were followed in the tumour
tissue, the adjacent (less than 2 cm) and distant (more than 5 cm from the tumour margin) mucosa.
Results: Frequency and intensity of the expression of molecular markers displayed two different distribution
patterns. A decreasing pattern (the highest value in the tumour and the lowest in the distant mucosa) was observed
in p53, arginase and to some extent also in c-Src protein kinase activity. An increasing pattern was found in
c-erbB2 and EGF-r. Logistic regression analysis of frequency expression gave the following data: 1. p53, c-erbB2
and arginase displayed significant differences among tumour and mucosal locations. 2. In the case of arginase
the frequency of expression between both mucosal locations was also significantly different. 3. Individual subjects
differed in their ability to express EGF-r and arginase. Intensity of expression (paired t-test: 2-tailed) was
significantly different among tumour and adjacent as well as distant mucosa in p53, c-erbB2 and arginase. In c-
Src protein kinase activity the intensity of expression differed significantly in both mucosal locations. In relation
to Dukes staging (stages AB versus CD) the intensity of expression was significantly different (non-paired t-test:
2-tailed) only in PCNA (distant mucosa) and arginase (adjacent mucosa).
Conclusions: Different distribution patterns of frequency and intensity of the expression of individual molecular
markers in colorectal cancer and neighbouring mucosa reflect the complex character of carcinomatous transformation
of the epithelial cells. The results may be exploited in prospective prognostic studies with the use of
molecular markers.
Test exokrinní funkce pankreatu - 13C-MTG dechový test. (Czech Article)
HPB Bulletin 2004, 12; 3: 76 - 77
Kocna, P.; Vaníčková, Z.; Krechler, T.; Lukáš, M.; Doseděl, J.
Ústav klinické biochemie a laboratorní diagnostiky 1.LF UK a VFN; 4. interní klinika 1.LF UK a VFN; Interní oddělení Nemocnice milosrdných sester sv. Karla Boromejského, Praha
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Abstract
13C-MTG substrát je přednostně hydrolyzován pankreatickou lipázou, která odštěpuje stearyl v poloze 1 a 3 a vzniklý 13C-octanoát je pak metabolizován jaterní b-oxidací. Stanovení nerozštěpeného substrátu ve stolici, resp. 13C markeru, metodou GC-MS prokázalo zbytkovou frakci 13C-substrátu ve stolici v rozmezí 1 - 5 %. Kumulativní exkrece cPDR významně koreluje s výdejem pankreatické lipázy (r = 0.89) a rovněž s kvantitativním ukazatelem steatorhey.
Naše dvouleté zkušenosti potvrzují význam 13C-MTG dechového testu pro hodnocení exokrinní funkce pankreatu. Ve srovnání s kvantitativním ukazatelem koncentrace pankreatické elastázy ve stolici (FELA), která velmi dobře koreluje s gradingem chronické pankreatitidy, umožňuje 13C-MTG dechový test posouzení dynamiky trávicího procesu, jeho kinetiku a optimalizaci substituční terapie pankreatickými enzymy. Diagnostický význam jednotlivých ukazatelů 13C-MTG dechového testu - cPDR, DOBmax, DOBtime, charakter křivky - je předmětem další studie, která vyžaduje především rozšíření jednotlivých skupin CHP a jejich detailní analýzu. Závěry hodnocení 108 provedených testů prokazují rozdílnost výsledků dvou testů exokrinní funkce pankreatu ve 24 %, ve skupině CHP-B je frekvence nejvyšší - 41,2b %. Funkční testy FELA a 13C-MTG proto mají odlišnou indikaci v diagnostickém algoritmu CHP.
IgA and IgG Antigliadin, IgA Anti-tissue Transglutaminase and Antiendomysial Antibodies in Patients with Autoimmune Thyroid Diseases and Their Relationship to Thyroidal Replacement Therapy
Physiol. Res. 52: 79-88, 2003
J.Jiskra, Z. Límanová, Z. Vaníčková, P. Kocna
Third Medical Department and 1Department of Clinical Biochemistry, First Medical Faculty, Charles University, Prague, Czech Republic
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Abstract
Celiac disease is a chronic illness of the small bowel caused by gliadin intolerance in genetically predisposed subjects. The aim of this study was to investigate serum levels of IgA and IgG antigliadin antibodies, IgA antiendomysial antibodies, and IgA anti-tissue transglutaminase antibodies in 169 patients with autoimmune thyroid diseases, i.e. chronic thyroiditis and Graves´ disease. Antiendomysial antibodies were positive in 2 out of 169 persons (1.18 %), IgA antigliadin antibodies in 15.98 %, IgG antigliadin antibodies in 51.48 %, and IgA anti-tissue transglutaminase in 14.79 %. The prevalence of positivity was higher compared to the 1312 control blood donors described in our previous study (Vančíková et al. 2002) (p<0.05). Patients with chronic thyroiditis treated with a high replacement dosage of levothyroxin (125-200 µg daily) had higher serum levels of IgA antigliadin antibodies in comparison with patients treated with a lower dosage (50-100 µg daily) (medians: 13.00 vs. 19.69, p=0.033). We found a negative correlation of IgA anti-tissue transglutaminase antibodies and total calcium serum levels (r = –0.480, p=0.0236, n=22). We can conclude that in persons with autoimmune thyropathy there is a high prevalence of positive antigliadin, anti-tissue transglutaminase and antiendomysial antibodies. Latent celiac disease may lead to impaired resorption of therapeutically administered levothyroxine, calcium, or other substances.
Faecal Elastase Perfomance In Relation To The Level Of Severity In Chronic Pancreatitis
Gut 2003; 52 (Suppl VI) A168 - A169
T. Krechler, P. Kocna, T. Svestka, Z. Vanickova, M. Bortlik, M. Lukas
IVth Medical Department, General Faculty Hospital, Institute of Clinical Biochemistry and Laboratory Diagnostics,
Charles University, Prague, Czech Republic
Abstract
INTRODUCTION: For the diagnosis of chronic pancreatitis (CP), we currently use the following main imaging methods: ERCP, MRCP. CT, Endosonography and Abdominal Ultrasonography. These imaging methods don't actually tell us anything about the function of the pancreas, however they show the main morphological changes in the pancreatic ducts and its parenchyma. The classification of CP currently comes after the examination of the morphological changes in the pancreatical duct system (Cambridge, Marseille, 1984) or the examination of the patho-morphological changes (Marseille, Rome, 1988). Faecal elastase I (FELA, mean values in ug/g of stool) is a simple, non-invasive method which correlates well with the damage of pancreatic tissue, stemming from CP. This test is routinely used in the diagnosis of CP.
AIMS & METHODS: In our studies we have used a newly proposed classification system, which was created in Bern, 2000 (Buchler and Malfertheiner). This new system encompasses morphological and functional changes, which include: Steatorrhea (STE), Diabetes mellitus (DM) and organic complications of the chronic pancreatitis (ORG). This classification system is brokem down into these levels: Grade A (no STA, no DM, no ORG), Grade B (no STE, no DM, with ORG), Grade C1 (STE or DM, no Org), Grade C2(STE and DM, no ORG) and Grade C3(STE and/or DM, with ORG). The FELA occurring in the stool was taken from 67 patients who had been diagnosed with CP, stemming from alcoholism. The occurrence FELA was classified according to the levels assigned by the classification system.
The control group used in this study had 51 patients diagnosed with a different kind of disease. FELA was determined by a microplate ELISA method using monoclonal antibody to human pancreatic protein (Schebo Tech, Germany).
RESULTS: The occurrence of FELA in the control group (579 ug/g) was similar to a group of patients with CP Grade A (500 ug/g). Patients classified in Grade B (314 ug/g) and C1 (297 ug/g), the occurrence of FELA was significantly lower. Levels of FELA were even lower in patients classified in Grades C2 and C3 (69 ug/g and 76 ug/g).
CONCLUSION: The results demonstrate a very good correlation of FELA with the grading of the newly proposed classification system of CP. Patients with the highest levels (C2 and C3) had a significantly lower occurrence of FELA in comparison with the non-pancreatic control group and in patients with CP who have no clinical complications or damage of endocrine and exocrine functions of the pancreas.
Tissue Transglutaminase-Serology Markers for Coeliac Disease
Clin Chem Lab Med 2002; 40 (5): 485 – 492
Petr Kocna, Zdislava Vaníčková, Jindřiška Perušičová and Miloš Dvořák
Institute of Clinical Biochemistry, 3rd Clinic of Internal Medicine, 4th Clinic of Internal Medicine, 1st Faculty of Medicine & General Faculty Hospital, Charles University, Prague, Czech Republic
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Abstract
Serology markers of coeliac disease (CD) – antigliadin IgA/IgG antibodies (AGA/AGG) with purified a-gliadin,
antiendomysium IgA antibodies (EmA) and anti-tissue transglutaminase (atTG) IgA/IgG antibodies – determined
in 1451 serum samples, were analysed with respect to different screening algorithms. Determination
of atTG using five ELISA methods was compared taking into account the impact of human recombinant
antigen and IgG class of atTG. A subgroup of 119 patients undergoing small intestinal biopsy was used to
calculate sensitivity and specificity of CD markers. The highest sensitivity (94%) was obtained for AGG, and
the highest specificity (93.5%) was obtained for EmA. All coeliac disease patients were detected using the
combination of all four CD markers, resulting in 100% sensitivity. CD and type 1 diabetes mellitus autoantigens
were determined in 139 diabetic patients. The atTG IgA mean value (16.7 IU/ml) was higher in the
antiglutamate dehydrogenase antibody (GAD)-positive subgroup, where at least one CD marker was positive
in 83.6% subjects. In the GAD-negative subgroup atTG IgA was 8.73 IU/ml and at least one CD marker
was positive in 57.4% subjects. atTG in IgA and IgG classes could be recommended as valuable serological
markers of CD in the differential diagnosis of malabsorption as well as in various screening algorithms.
ELISA determination of atTG with human antigen could increase the specificity, especially in patients
with other autoimmune diseases.
13C-breath test, non-invasive functional diagnostics in gastroenterology
Clin.Chem.Lab.Med. 2002, 40; Suppl. M-AN-094, s.109
Petr Kocna, Zdislava Vaníčková, Milan Lukáš, Tomáš Krechler
Institute of Clinical Biochemistry and 4th Clinic of Internal Medicine, 1st Medical Faculty and Faculty Hospital, Charles University, Prague
Abstract
Aim of this study was evaluating of Isomax-4000 Point-of-care (POCT) instrument with different 13C-labelled substrates for functional diagnostics in gastroenterology.
Methods: Helicobacter pylori (UBT) tests were performed with 100mg of 13C-urea; 2 breath samples in 0 and 30 minutes. Test of pancreatic function (15 patients) were performed with 250mg of Glyceryl-1,3-dioctadecanoate-2-octanoate-1-13C, 4 slices maize bread (gluten-free) and 40g of vegetable fat (without milk protein); 7 breath samples were collected for 6 hours. Test of small bowel bacterial overgrowth (15 patients) were performed with 100mg of 13C-D-xylose, 7 breath samples were collected for 6 hours. Three calculation models were compared for 13C-cummulative recovery values.
Results: Analytical accuracy were evaluated by 200 measurements in quadriplicate. The intraassay variability was 8.1% in range 1. 0 - 4.00 of 13C-delta values and 3.3% in range 4.00 - 25.00. Cummulative recovery of administred 13C was significantly higher (mean difference 7.0%) using Basal-metabolic rate (BMR), reflecting age and sex, compared to routinelly used calculation based on body surface only.
Conclusions: Analytical accuracy of 13C-delta values measured by NDIRS analyser was evaluated with 13C-substrates for Helicobacter pylori, pancreatic function and small-bowel bacterial overgrowth. This study will continue with determination of diagnostic cut-off levels and clinical efficiency.
Laboratory screening of coeliac disease - tissue transglutaminase
Journal of Gastroenterology and Hepatology (2002) 17 (Suppl.) A78 Abstract WGC, Bangkok - February 2002
Petr Kocna, Zdislava Vaníčková, Jindra Perušičová, Miloš Dvořák
Institute of Clinical Biochemistry, 3rd Clinic of Internal Medicine and 4th Clinic of Internal Medicine, 1st Medical Faculty and Faculty Hospital, Charles University, Prague
Abstract
Screening for asymptomatic - silent - coeliac disease could be prefereably realized by serology markers. Antigliadin antibodies of IgA (AGA) and IgG (AGG) classes were used for many years. Autoantibodies to endomysium (EmA) and to tissue transglutaminase (atTG)are more specific and an optimal set of laboratory methods is discussed, especially in high-risk population, patients with other autoimmune diseases, patients with diabetes mellitus 1.type (IDDM). Coeliac disease (CS; gluten enteropathy) belongs to autoimmune diseases and it could be found very often together with other autoimmunity. The association with IDDM was reported in 2-7% of coeliac patients and very frequent is also coeliac disease described in diabetics, mainly in children. Now is reported the determination of atTG in 270 diabetic patients - IDDM patients (n=225) compared to groups of 2nd type-diabetics (n=45). The values of atTG (IU/ml) were 13.45 and 8.53 respectively whereas the atTG level was higher in patients GAD-positive (18.1) compared to GAD-negative (8.45) ones. The EmA antibodies were positive in 8 of 225 patients with DM1 and in only 1 of 45 with DM2. Antigliadin antibodies indexes of AGA were 19.77 and 21.31, indexes of AGG were 33.71 and 23.88 respectively. Screening with all four CS markers has been performed in total of 1410 patients of which 150 has atTG level higher than 25 IU/ml (2.5-times up normal level 10 IU/ml). Patients with highly positive all markers were indicated to biopsy (n=50) and 38 cases were confirmed as florid coeliac disease. The initial diagnosis of 38 confirmed florid coeliac disease were in 36% non - gastrointestinal type (diabetes mellitus, anemia, rheumatoid arthritis, metabolic disorders and others).
Conclusion: ELISA determination of atTG could be recommended as one of serology markers for screening of silent coeliac disease in patients with other autoimmune diseases, especially with 1.type of diabetes mellitus.
Fecal Occult Blood - Immunochemical Detection Using ImmoCare Test
GUT, 2001, 49, Suppl.III, A1416 Abstract UEGW, Amsterdam - October 2001
Petr Kocna, Zdislava Vaníčková, Miloš Dvořák
Institute of Clinical Biochemistry and 4th Clinic of Internal Medicine, 1st Medical Faculty and Faculty Hospital, Charles University, Prague
Abstract
Fecal occult blood (FOB) tests are used as a screening tool for early detection of colorectal tumors and follow-up of high-risk patients. Immunochemical Hemolex and HemeSelect tests were compared with Haemoccult previously, in this study we evaluated the ImmoCare test, immunochromatography based test with analytical sensitivity 20 mmg hemoglobin/ml. The diagnostic efficiency of ImmoCare has been tested in a group of 300 patients indicated for colonoscopy, they received both tests - Haemoccult and ImmoCare. The test was returned by 278 (92.6%) subjects, from them were rejected six (tests performed incorrectly) and 17 (colonoscopy not performed). Both FOB tests were positive in 29 cases, ImmoCare was positive in additional 40 cases (Haemoccult negative). The sensitivity of ImmoCare and Haemoccult was 62.1% and 29.4%, respectively; specificity of both tests was similar - 95% and 98%; positive predictive value was 88% and 90%; negative predictive value was higher for ImmoCare 81%, compared to 68% for Haemoccult; overall diagnostic accuracy of ImmoCare was also higher 82%, compared to 72% for Haemoccult. These results indicate some advantages of the immunochemical detection of fecal occult blood and the assumed area if its application.
Tissue Transglutaminase as a New Marker of Coeliac Disease in Diabetic Patients
GUT, 2000, 47, A199 Abstract UEGW, Brussels - November 2000
Petr Kocna, Zdislava Vaníčková, Jindra Perušičová, Miloš Dvořák
Institute of Clinical Biochemistry, 3rd Clinic of Internal Medicine and 4th Clinic of Internal Medicine, 1st Medical Faculty and Faculty Hospital, Charles University, Prague
Abstract
Coeliac disease (CS; gluten enteropathy) belongs to autoimmune diseases and it could be found very often together with other autoimmunity. One of the frequent coincidences is diabetes mellitus 1.type (IDDM). The association with IDDM was reported in 2 - 7% of coeliac patients and very frequent is also coeliac disease described in diabetics, mainly in children. Tissue transglutaminase has been identified as the main autoantigen of endomysial antibodies in CS and a possible pathogenetic mechanism has been postulated. The deamidation of gliadin may be the initial step to create an epitope for DQ2 and DQ8 binding recognized by coeliac - specific T cells.
In our previous study we compared four ELISA methods for atTG IgG antibodies determination and the diagnostic kit Genesis - Dialab was recommended for the routine serology determination.
Now is reported the determination of atTG in IDDM patients (n=186), compared to groups of 2nd type-diabetics (n=26), CS patients and group of patients with autoimmune thyreoiditis (n=96). The values of atTG (IU/ml) were 14.4, 11.3, 32.2 and 6.15 respectively. The atTG level is higher in patients GAD-positive (18.1) compared to GAD-negative (8.45) ones. The positivity of antiendomysium antibodies (EmA) were 4.2, 0, 16.6 and 1.1 respectively; antigliadin (AGA) IgA antibodies index were 18.4, 13.9, 52.7 and 19.3 respectively. Patients with positive markers were indicated to biopsy (n=37) and 33 cases were confirmed as florid coeliac disease.
Conclusion: ELISA determination of atTG could be recommended as one of serology markers for screening of silent coeliac disease especially in patients with other autoimmune diseases.
Serum level of pepsinogen-I determined by ELISA method
Biochemica Medica 2000, 10, 1-2, 104 Abstract Alps-Adria '2000, Opatija
Kocna P., Uhrová J., Švestka T., Vaníčková Z.:
Institute of Clinical Biochemistry, 4th Clinic of Internal Medicine, 1st Medical Faculty and Faculty Hospital, Charles University, Prague
Abstract
The relationship of pepsinogens serum level with gastric pathology has been reported. Low pepsinogen-I in combination with higher level of IgA Helicobacter pylori antibodies may be used as a marker for gastric adenomas and carcinomas. The group of 80 patients with suspected gastric pathology was used for this preliminary study concerned on the methodology of ELISA determination of pepsinogen-I. The serum level of pepsinogen-I was determined by ELISA and RIA methods, serum gastrin level by RIA method, antibodies to Helicobacter pylori IgA and IgG by ELISA method and results were compared with CLO test (Rapid urease test) and endoscopic examination. Results of serum pepsinogen-I level determined by RIA and ELISA methods could not be compared. The RIA technique is based on competitive principle and ELISA test on non-competitive sandwich principle with monoclonal antibody. The results of CLO test were positive in 18 of 36 patients with 100% concordance to Helicobacter pylori presence documented by microscopy; increased level of IgG Helicobacter pylori antibodies was detected in 21 of 33 patients. The serum level of pepsinogen-I was significantly higher (mean 127 µg/l) in patients with bulbitis and Helicobacter pylori (CLO test positive) compared to 93 µg/l in the group with bulbitis without Helicobacter pylori (CLO test negative).
Image Documentation and Telemedicine: WWW Prezentation of Atypical cases
Lékař a technika, 1999, 30(4), 78-80 (Article in Czech)
Kocna P.:
Summary
The paper deals with the application of telemedicine to gastroenterology and endoscopy. As an example we used a presentation of unusual, atypical cases on the Internet described by gastroenterology Center of 4th Internal Medicine Clinic of the General Teaching Hospital and 1st Medical Faculty of Charles University, Prague. Electronic documentation of the Clinical information system with GastroBase-II module including on-line image processing of endoscopy, X-Ray and ultrasound images was used as the main source for WWW pages.The paper is complemented by Internet resources and URL addresses.
Datová struktura pro přenos pacientských dat mezi informačními systémy zdravotnických zařízení - upgrade.
Multimedia electronic textbook on CD-ROM - the way from electronic patient record with image documentation to the education
Abstract
Electronic-patient-record [EPR] system GastroBase has been developed in 1990 as a full structured text editor; suitable for documentation of gastroenterological endoscopy. This system running on Btrieve data manager [Novell NetWare 3.12] is routinely used at our clinic as a clinical information system - incorporates patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related information. A graphic library developed in the past years and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record.
The graphic-library modules of GastroBase system could be easily used for educational purposes. Searching by keyword enables us to demonstrate specific procedure, individual stages of this procedure, relation to different examination techniques (i.e. combination of endoscopy with X-ray or with ultrasound) or a specific diagnosis or pathological result.These image-data are used for pre-graduate as well as post-graduate educational activities. Our teaching and seminar room is now equipped with modern computer presentation unit including LCD panel projection with Cyclop option.
The multimedia electronic textbook on CD-ROM has been developed for post-graduate education. The user interface programme is written in Visual Basic for Windows environment. The CD-ROM contains video sequences (cca 20 minutes; commented by specialists), more than 400 images (endoscopic, X-ray, ultrasound), tables, schemes, hypertext links, index and full-text search.
Electronic patient record in the GastroBase-II system - structured text, expert modules and image documentation
Patient-identification database represents the main core of this information system. Graphic library developed in the past years and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record.
Medical-records in GastroBase are written and stored by using of the standardized texts/codes (minimal data set) covering the whole range of the gastroenterology, developed at our department in 1990-1992 years. These codes are constructed in general rules as abbreviation (codes for tumors start with "t" etc.) and are composed by a combination of the proper code, numeric parameters (size, distance) and anatomical localizations. This minimal-data set is closely related to the International-Endoscopy OMED-terminology. Examination reports are typed quicker, in a standardized form and can be easily searched and evaluated by simple expert-system modules, incorporated into GastroBase-II. The expert-system modules are used as example for automatic generation of the health-insurance payment, request of histopathology examination of tissue samples yielded by endoscopic procedure.
Separate routines involve screening, prevention and follow-up for colorectal cancer and a national registry of the familiar polyposis of the large bowel.
GastroBase EPR can be shared with other departments, connected by network, all EPR could be exported in text, structured data or database form. The system enables communication with other department, clinical and haematology laboratories and can import and convert results of these departments.
Images - real time screen pictures - from videoendoscopy, ultrasound, endosono-graphy and X-ray contrast pictures (ERCP) could be stored and retrieved as a part of patient's documentation. These images are captured by video-cards connected to PC in the PC-network, processed in true-color Targa (TGA) format and archived after compression to the standard GIF (Graphic Interface Format). Microimages - 'thumbprint' for each image 120 x 120 pixels are stored in the graphic library. These microimages could be easy retrieved and linked to medical record and serves as a summary of the whole medical procedure. Different microimages [endoscopic, X-ray, ultrasound] could be previewed on the true-color display. A graphic library module has been developed as a tool to capture, process and manage images and responding microimages.
ENDOSCOPIC IMAGE DOCUMENTATION - CLINICAL AND EDUCATIONAL EXPERIENCES
Images - real time screen pictures - from videoendoscopy, ultrasound, endosonography and X-ray contrast pictures (ERCP) could be stored and retrieved as a part of patient's documentation. These images are captured by video-cards connected to PC in the PC-network, processed in true-color Targa (TGA) format and archived after compression to the standard GIF (Graphic Interface Format).
The multimedia electronic textbook on CD-ROM has been developed for post-graduate education. The user interface programme is written in Visual Basic for Windows environment. The CD-ROM contains video sequences (cca 20 minutes; commented by specialists), more than 400 images processed from EPR-GastroBase (endoscopic, X-ray, ultrasound), tables, schemes, hypertext links, index and full-text search.
Antigliadin antibodies in the diagnosis of coeliac disease
- the present and the future
Antigliadin antibodies IgA (AGA-A) and IgG classes (AGA-G) were determined by the ELISA method developed in our laboratory with purified alpha-gliadin. All results during last eight years are expressed as an index to our intralaboratory standard. This enables us a long-term follow-up of patients with coeliac disease as well as to monitor their diet adherence. Some of the examples are displayed. We have tested more than 1300 samples for AGA-A and AGA-G level. In the group of coeliac disease (n=302) were 157 IgA+ (mean index 62.4) and 239 IgG+. In the group of insulin-dependent diabetes mellitus we found 39 of 256 IgA+ (mean index 57.5) and 70 IgG+ (mean index 57.8).
Our ELISA method was compared with three commercially available kits for AGA determination and the best correlation we found with Alpha-Gliatest (Eurospital, Italy) using alpha-gliadin as the antigen too.
The screening programs arrangements are based on the determination of AGA-A, AGA-G and endomysial antibodies (EmA) by the immuno-fluorescent method. The recent progress in serology methods is concerned to the antitransglutaminase (anti-tTG) available as an ELISA technique. We compared a group of 38 coeliac patients with positive EmA antibodies to their positivity of anti-tTG. A sensitivity of 92.1% were found for anti-tTG in this group of coeliac patients (positivity 35/38). The suitability of ATTG in the screening programs is now to be tested in respect to the specificity in groups with other gastrointestinal and autoimmune diseases.
COELIAC DISEASE DIAGNOSTIC WITH ANTIGLIADIN, ANTIENDOMYSIUM AND ANTITRANSGLUTAMINASE ANTIBODIES
Arginase Activity Determination - A Marker of the Large Bowel Mucosa Proliferation
Summary
Multimedia electronic textbook on CD-ROM
Electronic-patient-record [EPR] system GastroBase has been developed in 1990 as a full structured text editor; suitable for documentation of gastroenterological endoscopy. A graphic library developed in the past years and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record. These image-data are used for pre-graduate as well as post-graduate educational activities.
The multimedia electronic textbook has been developed for post-graduate education. The user interface programme is written in Visual Basic for Windows environment. The CD-ROM contains video sequences (cca 20 minutes; commented by specialists), more than 400 endoscopic, X-ray and ultrasound images, tables, schemes, hypertext links, index and full-text search.
Glutenová enteropathie - nové diagnostické přístupy a screening
Úvod.
Patogenetické mechanizmy glutenové enteropatie dosud nebyly jednoznačně definovány. Byla prokázána genetická vazba s výskytem produktu hlavního histokom-patibilního komplexu HLA-DQw2 ve vazbě s HLA-A1, B8 a DR3/DRw17. Céliakální sprue je řazena k autoimunitním onemocněním a je posána její ko-incidence s dalšími autoimunitními chorobami, především s podobným HLA haplotypem. Duhringova herpetiformní dermatitida je kožním onemocněním popsané v roce 1884. V 60tých letech byly u nemocných prokázány slizniční léze shodné jako u céliakie, shodný je HLA haplotyp a dnes je toto onemocnění považováno za jednu z forem glutenové enteropathie. Do skupiny ko-incidentních chorob patří insulin-dependentní diabetes mellitus (I.typu), autoimunní thyreoitida, IgA nefropatie, revmatoidní arthritida a další. Základním léčebným opatřením je nasazení bezglutenové (bezlepkové) diety, tj. vyloučení všech potravin, k jejichž přípravě je použito mouky z pšenice, žita ječmene i ovsa; náhradou je mouka rýžová a sojová. Dodržování této bezlepkové diety je celoživotním opatřením. Po vyloučení glutenu z potravy dochází u nemocných s klasickou formou céliakie k remisi, ústupu obtíží a při vyšetření bioptických vzorků je prokázán normální histologický obraz.
Klinický obraz onemocnění nemusí provázet charak-teristické rysy malabsorpčního syndromu. Incidence glutenové enteropathie je podle nejnovějších, epidemiologických studií podstatně vyšší, než naznačovaly ukazatele klinické diagnostiky. Na základě těchto studií byl definován "ledovcový model" céliakie (obrázek č.1). Incidence v evropských zemích se pohybuje v rozmezí 1:200 - 1:250, tj. dosavadní údaje o počtu klinicky diagnostikovaných onemocnění představují jen vrchol ledovce a nejméně 80% nemocných zůstává nediagnostikováno. Model ledovce tak zahrnuje klasickou formu céliakie s charakteristickými projevy malabsorpce, dále tzv. tichou (silent) formu bez symptomatologie onemocnění trávicího ústrojí, formu latentní bez prokazatelného poškození sliznice tenkého střeva a konečně formu tzv. potenciální céliake, kam patří případy geneticky predisponovaných osob a rodinní příslušnící pacientů s céliakií.
Laboratorní diagnostika
Serologické markery
Screeningové programy
Multimedia electronic textbook - the way from clinical information to education
Introduction
GastroBase-II description.
Images (real time screen pictures) from videoendoscopy, ultrasound, endosonography and X-ray contrast pictures (ERCP) could be stored and retrieved as a part of patients' documentation. These images are captured on-line by video-cards connected to PC in the PC-network, processed in true-color Targa (TGA) format and archived after compression to the standard GIF (Graphic Interface Format). Microimages - 'thumbprints' for each image 120 x 120 pixels are stored in the graphic library. These microimages could be easy retrieved and linked to a medical record and serves as a summary of the whole medical procedure. Different microimages (endoscopic, X-ray, ultrasound) could be previewed on the true-colour display. An off-line digitalization procedure by using color-scanner (A4 form, 600/1200 dpi) could be used for another pictures, not available on-line at this time.
Graphic library and multimedia
The multimedia electronic textbook on CD-ROM has been developed for post-graduate education. The user interface programme is written in Visual Basic for Windows environment (Windows 3.1x, Windows 95). The CD-ROM contains video sequences (cca 30 minutes; speech-commented by specialists), more than 400 images (endoscopic, X-ray, ultrasound), tables, schemes, hypertext links, indexes and full-text search functions.
Author
References
Digitalization, archivation and application of image documentation with the GastroBase-II system
Electronic Medical Record in GastroBase-II.Clinical and Educational Aspects
Abstract.
1. Introduction
2. GastroBase Description
Medical-records in GastroBase are written and stored by using of the standardized texts/codes (minimal data set) covering the whole range of the gastroenterology, developed at our department in 1990-1992 years. These codes are constructed in general rules as abbreviation (codes for tumors start with "t" etc.) and are composed by a combination of the proper code, numeric parameters (size, distance) and anatomical localizations. This minimal-data set is closely related to the International-Endoscopy OMED-terminology. Examination reports are typed quicker, in a standardized form and can be easily searched and evaluated by simple expert-system modules, incorporated into GastroBase-II. The expert-system modules are used as example for automatic generation of the health-insurance payment, request of histopathology examination of tissue samples yielded by endoscopic procedure.
Separate routines involve screening, prevention and follow-up for colorectal cancer and a national registry of the familiar polyposis of the large bowel.
GastroBase EPR can be shared with other departments, connected by network, all EPR could be exported in text, structured data or database form. The system enables communication with other department, clinical and haematology laboratories and can import and convert results of these departments.
3. Image processing and archivation [PACS]
The data security is covered by daily backup of all data to another file server in LAN, long - term archivation is now made on CD-ROM twice per year.
4. Educational aspects
5. References
13C-DECHOVÉ TESTY PRO DIAGNOSTIKU V GASTROENTEROLOGII
Dechové testy se stávají moderní variantou funkční diagnostiky v gastroenterologii. V současné době není na trhu dostupný ALTAB test pro diagnostiku exokrinní funkce pankreatu ani souprava stanovení chymotrypsinu ve stolici, není dostupný stimulační pentagastrin pro funkční testy žaludeční sekrece a pro funkční diagnostiku tenkého střeva je velmi ojediněle používán zátěžový test s xylózou. Pro funkční diagnostiku v gastroenterologii je tedy z klasických testů dostupno zanedbatelné minimum. Dechové testy zde nabízejí řešení v plné šíři problematiky gastroenterologie.
Toto sdělení je zaměřeno na přehled současných poznatků o dechových testech, jejich principech a klinických aplikacích, především v oblasti funkčních testů v gastroenterologii. Zvláštní pozornost je věnována testům s uhlíkem 13C, způsobu analýzy CO2 ve vydechovaného vzduchu, a přístrojové technice typu GC-MS s poměrovým hmotnostním spektrometrem. Aplikací dechových testů v klinické praxi stále přibývá. Pro ilustraci uvádím počty prací, ve kterých je používáno dechových testů, jak byly prezentovány v minulých 4 letech na gastroenterologickém fóru - Digestive Disease Week. Počty abstrakt jsou následující: 44/1994 (New Orleans), 98/1995 (San Diego), 115/1996 (San Francisco) a 137/1997 (Washington D.C.). Počty prací, jejichž primárním zaměřením jsou dechové testy jsou následující 9/1994, 23/1995, 28/1996 a 35/1997. Více než 50% je věnováno detekci Helicobacter pylori ureázovým testem, počty dalších funkčních testů však rovněž výrazně stoupají a to takto : 7/1994, 9/1995, 14/1996 a 16/1997. V uvedených abstraktech je publikováno 27 substrátů pro dechové testy. Pro H2-dechové testy je to glukóza, xylóza, laktóza a lactulóza; k substrátům značeným uhlíkem 14C patří cholesteryl-octanoát, octanoic acid, mixed triglycerides, xylóza a aminopyrin. Nejširší nabídka je v oblasti substrátů značených stabilním izotopem uhlíku 13C, které již komerčně nabízí celá řada výrobců. Dechové testy s 13C značenými substancemi pokrývají komplexně funkční diagnostiku v gastroenterologii.
CLINICAL INFORMATION SYSTEM - GASTROBASE: INTEGRATION OF IMAGE PROCESSING AND LABORATORY COMMUNICATION.
GASTROBASE DESCRIPTION
Medical-records in GastroBase are written and stored by using of the standardized texts/codes (minimal data set) covering the whole range of the gastroenterology, developed at our department in 2 years. These codes are constructed in general rules as abbreviation (codes for tumours start with "t" etc.). and are composed by a combination of the proper code, numeric parameters (size, distance) and anatomical localizations. Examination reports are typed quicker, in a standardized form and can be easily searched and evaluated, by our code-structure, compared to free-text form. A full-text-form of the reports is displayed and printed in connection to additional code-text databases. Separate routines involve screening, prevention and follow-up for colorectal cancer and a national registry of the familiar polyposis of the large bowel.
Images-real time screen pictures from videoendoscopy, ultrasound, endosonography and X-ray contrast pictures (ERCP) could be stored and retrieved as a part of patient's documentation. These images are captured by video-cards connected to PC in the PC-network, processed in true-color Targa (TGA) format and archived after compression to the standard GIF (Graphic Interface Format). Microimages - 'thumbprints' for each image 120 x 120 pixels are stored in the graphic library. These microimages could be easy retrieved and linked to medical record and serves as a summary of the whole medical procedure [examination, therapy]. Different microimages [endoscopic, X-ray, ultrasound] could be previewed on the true-colour display. A graphic library module has been developed as a tools to capture, process and manage images and responding microimages. Long-term storage on optical disc (CD-ROM) and educational-postgraduate multimedia tool will be developed.
REFERENCES
SERUM LIPASE ACTIVITY - EVALUATION OF DIFFERENT ASSAYS.
Diagnostic significance of the serum lipase activity in differential diagnosis of pancreatic disorders is discussed for many years. Comparable relevance has been stated for lipase activity and amylase-pancreatic isoenzyme in clinical studies. The turbidimetric [or nephelometric] determination, used for many years, has some difficulties for clinical interpretation.
The 'pseudolipase' (serum clearing factor) resulting false-positive test has been found in 36.4% of the group with high lipase value. We developed the modified turbidimetric test using ß-mercaptoethanol preincubation eliminating this 'pseudolipase' activity.
This study was undertaken to evaluate usefullnes of different lipase assays. We compared 3 comercially available turbidimetric method, with our modification [preincubation with ß-mercaptoethanol] and 3 comercially available colorimetric assay using the new 1,2-diglyceride substrate.
The results indicate that new colorimetric lipase assay with 1,2-diglyceride substrate eliminating problems of turbidimetric method is a usefull method for differential diagnosis of pancreatic disorders.
Okultní krvácení ve stolici - screening a metody detekce
Stanovení okultního krvácení ve stolici je z hlediska metodického možno provádět dvojím způsobem.
Druhým přístupem je imunochemická detekce hemoglobinu reakcí s monoklonální protilátkou proti lidskému hemoglobinu. Na imunochemickém principu jsou založeny testy hemaglutinační, latexové imunoprecipitace, radiální imunodifúze i imunoafinitní chromatografie. Detekce proteinu [lidského hemoglobinu] monoklonální protilátkou vylučuje možnost ovlivnění jiným zdrojem hemoglobinu [potrava], odpadá interference chemických látek, není nutna specielní dieta. Citlivost imunochemických testů je výrazně vyšší; v závislosti na technice i > 0.1 mg hemoglobinu/g stolice. K imunochemickým testům patří např. latexový test Hemolex [Orion], na principu reversní pasivní hemaglutinace Heme-Select [Smith Kline Diagnostics], imunoafinitní chromatografie ImmoCare [Care Diagnostica].
Zásadní otázkou pro použití testů detekce okultního krvácení je indikace tohoto stanovení. Screening jako úvodní metoda depistážních programů pro vyhledávání kolorektálních nádorů u asymptomatických jedinců je nutno provádět testem, který splňuje stanovená kriteria. Depistážní programy jsou založeny na opakovaném stanovení v pravidelných intervalech jednoho až dvou let. V případě pozitivního výsledku testu musí následovat cílené gastroenterologické [endoskopické] vyšetření k objasnění příčiny pozitivity testu. Z těchto důvodů nelze pro screening použít testů imunochemických, které mají výrazně vyšší citlivost a poskytují tak podle našich studií 4 - 7% falešnou pozitivitu. Haemoccult testem jsem ve studii našeho pracoviště prokázali u > 95 tisíc asymptomatických osob pozitivitu 2.8%, falešná pozitivita testovaná při srovnání s imunochemickými testy byla nulová. Imunochemické testy jsou vhodné pro detekci [vyloučení krvácení] u symptomatických nemocných, kde test okultního krvácení je jedním z řady vyšetřovacích postupů.
Electronic Medical Record with Image Processing - GastroBase-II
Electronic-patient-record [EPR] system GastroBase-I has been developed in 1990 as a full structured text editor; suitable for documentation of gastroduodenoscopy, ERCP, colonoscopy, proctosigmoidoscopy, including all therapeutic techniques, ultrasonography, laparoscopy as well as to describe histology, X-ray and surgical reports in connections with haematology and clinical chemistry laboratories. The GastroBase-II system running on Btrieve data manager [Novell NetWare 3.12] is routinely used at our department since June 1995 and program modules are written in C-language.
GastroBase-II as a clinical information system - incorporate patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related information. Patient-identification database represents the main core of this information systems. Graphic library developed in the past years and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record.
Medical-records in GastroBase are written and stored by using of the standardized texts/codes (minimal data set) covering the whole range of the gastroenterology, developed at our department in years 1990-1992. This minimal-data set is closely related to the International-Endoscopy OMED-terminology.
Images - real time screen pictures - from videoendoscopy, ultrasound, endosonography and X-ray contrast pictures (ERCP) could be stored and retrieved as a part of patient's documentation. These images are captured by video-cards connected to PC in the PC-network, processed in true-color Targa (TGA) format and archived after compression to the standard GIF (Graphic Interface Format).
The graphic-library modules of GastroBase-II system could be easily used for educational purposes. Searching by keyword enables to demonstrate specific procedure, individual stages of this procedure, relation to different examination techniques (i.e. combination of endoscopy with X-ray or with ultrasound) or a specific diagnosis or pathological result. We have now more than 1500 images accessible on network disc, and long-term storage archive on optical disc (CD-ROM. The educational-postgraduate multimedia tool will be developed.
Icons for Webmasters :
Structure of data enabling transfer of electronic patient records between different information systems - upgrade.
Kongres MEFA 1999, Brno (Abstract in Czech)
Kocna P., Zámečník M.:
Anotace
Základní informace o současných platných metodických pokynech Ministerstva zdravotnictví ČR a příslušných přílohách a studiích, které se zabývají problematikou zajištění a zabezpečení komunikace mezi zdravotnickými informačními systémy. Informace o současném aktuálním inovovaném tvaru datové struktury verze 01.11 a o současném tvaru Národního číselníku laboratorních položek verze 01.01.
1. Úvod
Pro přenos dat mezi informačními systémy zdravotnických zařízení slouží datová struktura, která byla publikována ve Věstníku MZ ČR, ročník 1997, částka 7, strana 5 až 12. K objednávání a sdělování laboratorních vyšetření a k předávání formalizovaných vyšetření je využíván Národní číselník laboratorních položek, který byl publikován ve Věstníku MZ ČR, ročník 1997, částka 7, strana 2 až 4. Datová struktura i Národní číselník laboratorních položek jsou průběžně aktualizovány a průběžně vydávány prostřednictvím MZ ČR, poslední významná aktualizace obou dokumentů proběhla v květnu roku 1998. V současné době je připraven významný upgrade datové struktury i národního číselníku, ve kterém jsou realizovány praxí požadované změny a doplňky (zejména v oblasti přenosu obrazových informací) a je doplněn velký počet laboratorních položek.
2. Změny v datových blocích datové struktury
Původní datová struktura, která byla do praxe zavedena metodickým návodem Ministerstva zdravotnictví ČR v červenci 1997 a byla označena jako verze 01.10, se prakticky nemění a platí nadále. Ke změnám dochází v přílohách k této datové struktuře, které jsou nyní označovány verzí 01.12 a společně s nimi je i současný aktuální datový standard označován verzí 01.12 (květen 1999).
3. Změny v obsahu Národního číselníku laboratorních položek
Původní definice pojmů, struktura popisu položek a význam Národního číselníku laboratorních položek, které byly do praxe zavedeny metodickým návodem Ministerstva zdravotnictví ČR v červenci 1997 a byly označeny jako verze 01.00, se nemění a platí nadále. Ke změnám dochází v obsahu Národního číselníku laboratorních položek, který byl výrazně rozšířen o řadu nových položek i interních číselníků zařazením nových laboratorních položek z oborů biochemie, hematologie, imunologie a nukleární i transfúzní medicíny. Národní číselník laboratorních položek včetně všech číselníků interních bude vydán v hypertextové podobě na CD.
4.Zařazení struktury pro přenos obrazové dokumentace
Datový standard je rozšířen o položky pro přenos obecně binarních datových struktur, především obrazové dokumentace, tak aby vyhovoval požadavkům pro komunikaci a předávání elektronických záznamů pacienta (electronic patient records).
5. Soubory a dokumenty, které jsou v současné době k dispozici
Soubory a dokumenty jsou zveřejňovány na WWW serveru
Ministerstva zdravotnictví ČR
a pracovní i aktuální verze na WWW stránce autora.
6. Kontaktní adresy
ing. Miroslav Zámečník a
MUDr.Petr Kocna CSc.
Computers in Medicine, Prague, Czech Republic, February 1998
Kocna Petr
Department of Medical Informatics, 1.st Medical Faculty & Faculty Hospital, Charles University, Prague, Czech Republic
The multimedia electronic textbook, hypertext, fulltext search, images processing and digitalized video sequences on CD-ROM as well as accessed by Internet coming now as new tools in the education process. In this paper we would like to present the way from electronic-patient-record to the electronic textbook on CD-ROM.
Computers in Medicine, Prague, Czech Republic, February 1998
Kocna Petr
Department of Medical Informatics, 1.st Medical Faculty & Faculty Hospital, Charles University, Prague, Czech Republic
Abstract
Electronic-patient-record [EPR] system GastroBase-I has been developed in 1990 as a full structured text editor; suitable for documentation of gastroenterological endoscopy. The GastroBase-II system running on Btrieve data manager [Novell NetWare 3.12] is routinely used at our department since June 1995. GastroBase-II as a clinical information system - incorporates patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related information.
World Congresses of Gastroenterology - WCOG'99, Vienna, Austria, 1998
P.Kocna, 1st Medical Faculty, Charles University, Prague, Czech Republic
Electronic-patient-record [EPR] system GastroBase-I has been developed in 1990 as a full structured text editor; suitable for documentation of gastroenterological endoscopy. The Gastro Base-II system running on Btrieve data manager [Novell NetWare 3.12] is routinely used at our department since June 1995 as a part of clinical information system [ComSyD, Prague]. Medical records in GastroBase-II are written and stored by using of the standardized texts/codes (minimal data set) covering the whole range of the gastroenterology, developed at our department in 1990-1992 years.This minimal-data set is closely related to the International-Endoscopy OMED-terminology.
5th Int.Congress of Clinical Chemistry, Alps-Adria'98, Karlovy Vary, Czech Republic, 1998
1Kocna P., 1Bezdíčková D., 2Tučková L., 2Sánches D.
1Dept.Clinical Chemistry 1st.Medical Faculty ,Charles University, 2Dept.Immunol.&Gnotobiol. Inst.Microbiol. CAS, Prague, Czech Republic
Determination of antigliadin antibodies (AGA) has been used in the routine diagnostics in our laboratory since 1991. The aim of this paper is to summarize our results, to compare different test assays and to discuss the perspectives of a serology test in the coeliac screening.
XVII Int.Congress of Clinical Chemistry, IFCC-WorldLab, Firenze, Italy, 1999
1Kocna P.,1Bezdíčková D.,2Tučková L.,2Tlaskalová H.,2Sánches D.,1Vaníčková Z.,3Dvořák M.
1Dept.Clin.Chem.,34th.Clin.of Internal.Med., 1st.Med. Faculty, Charles Univ., 2Dept.Immunol.& Gnotobiol. Inst.Microbiol. CAS, Prague, Czech Republic
Determination of antigliadin antibodies (AGA) has been used in the routine diagnostics in our laboratory since 1991. Antigliadin antibodies IgA (AGA-A) and IgG classes (AGA-G) were determined by the ELISA method developed in our laboratory with purified alpha-gliadin. Results are expressed as an index to our intralaboratory standard enabling us a long-term follow-up of coeliac patients. More than 1400 samples was tested for AGA-A and AGA-G level. In the group of coeliac disease (n=302) were 157 IgA+ (mean index 62.4) and 239 IgG+. In the group of insulin-dependent diabetes mellitus we found 39 of 256 IgA+ (mean index 57.5) and 70 IgG+ (mean index 57.8). Our ELISA method was compared with three commercially available kits for AGA determination and the best correlation we found with Alpha-Gliatest (Eurospital, Italy) using alpha-gliadin too. The routine laboratory tests include the determination of AGA-A, AGA-G and endomysial antibodies (EmA) with immunofluorescent method. The recent progress in serology methods is concerned to the antitransglutaminase (anti-tTG) available as an ELISA technique. We compared a group of 38 coeliac patients with EmA+ to their positivity of anti-tTG. A sensitivity of anti-tTG was 92.1% (positivity 35/38). The suitability of anti-tTG for routine clinical use is now tested.
Eur.J.Clin.Chem.Clin.Biochem., 34 (8), 619-623, 1996
Authors:
Petr Kocna, Přemysl Frič, Miroslav Zavoral and Tomáš Pelech
Laboratory of Gastroenterology and Department of Internal Medicine
1.st Medical Faculty, Charles University, Prague, Czech Republic
Arginase activity of the intestinal mucosa was tested as proliferative marker in the adenoma - carcinoma sequence. The enzyme activity was determined by an end-point colorimetric method with L-arginine as substrate. Arginase activity was evaluated in 430 biopsy samples of large bowel mucosa, polyps and cancer tissue. The activities (mean ± SE; n) were: normal mucosa 83.2 ± 7.3; 25, adenomas 199.4 ± 19.1; 40, carcinomas 1269.7 ± 174.9; 40, inflammatory bowel disease 1210.7 ± 247.1; 34. The arginase activity differs significantly in the adenoma carcinoma sequence according to the Duncan's test (p<0.05).
AMEE Prague Conference, Prague, Czech Republic, 1998
Kocna Petr M.D., Ph.D.
Dept.Clinical Chemistry & Dept.Medical Informatics
General Faculty Hospital & 1st Medical Faculty, Charles University
Prague, Czech Republic
Abstract
The multimedia electronic textbook, hypertext, fulltext search, images processing and digitalized video sequences on CD-ROM as well as accessed by Internet coming now as new tools in the education process. In this paper we would like to present the way from electronic-patient-record to the electronic textbook on CD-ROM.
3.Sjezd Společnosti klinické biochemie, Hradec Králové, Czech Republic, 1997
Klinická biochemie a metabolismus, 5S, 20-23, 1997
P.Kocna
Laboratoř gastroenterologie 1.Lékařské fakulty, Universita Karlova, Praha
Souhrn
Přehled současných poznatků o céliakální sprue (gluten-sensitivní enteropathie), patogenetických mechanismech a nových diagnostických přístupech. Zvláštní pozornost je věnována problematice serologické diagnostiky pomocí antigliadinových a antiendomysiálních protilátek a jejich využití ve screeningových programech.
Klíčová slova: céliakální sprue, glutenová enteropatie, antigliadinové, antiretikulinové a antiendomysiální protilátky, screeningové programy.
Summary
Kocna P.: Gluten enteropathy - new diagnostic methods and screening
Review of recent information on coeliac disease (gluten-sensitive enteropathy), on their patogenetic mechanisms and new diagnostic methods. A particular interest is attended to the serological diagnostics using antigliadin, antireticulin and antiendomysial antibodies and application to screening programmes.
Key words: coeliac disease, gluten enteropathy, antigliadin, antireticulin, antiendomysium antibodies, screening programmes.
Céliakální sprue (céliakie) je onemocnění spojené s permanentní intolerancí lepku (glutenu, resp. jeho složek) a céliakie je proto označována jako gluten-senzitivní enteropathie. Základní patogenetickou látkou je gliadin z pšeničné mouky. Gliadiny tvoří heterogenní skupinu bílkovin a jejich další charakterizace je odvozena od pohyblivosti jednotlivých frakcí při gelové elektroforéze (typ a-, b-, g-, w-). Pšeničné gliadiny, které jsou jednoznačně zodpovědné za vznik a rozvoj onemocnění, vykazují významnou sekvenční homologii s geneticky příbuznými prolaminy dalších obilovin. Společným rysem těchto proteinů jsou opakující se sekvence s vysokým obsahem prolinu a glutaminu. Průkaz vztahu glutenu k onemocnění céliakií byl popsán před téměř 50 lety (Dicke, Utrecht 1950) Výzkum v oblasti etiopatogenetických faktorů céliakie je soustředěn na studium gliadinových peptidů (Kocna 1983, 1988, 1991) a jejich biologickou aktivitu.
Céliakální sprue je primárním malabsorpčním syndromem. Laboratorní diagnostika je proto primárně zaměřena na diferenciální diagnostiku malabsorpčního syndromu. Základním, orientačním stanovením absorpční funkce tenkého střeva je sérová hladina ß-karotenu. Přesnější kvantifikaci poskytují zátěžové, toleranční testy s D-xylózou a A-vitaminem, podezření na glutenovou enteropatii lze podpořit stanovením serologických markerů. Moderní variantou funkčních testů se nyní stávají dechové testy s 13C-značenými substráty nebo H2-dechové testy, např. xylózový test (Cassellas, 1996). Jednoznačným diagnostickým kriteriem zůstává histologickým průkaz v bioptickém vzorku střevní sliznice. Podle doporučení ESPGAN (Společnost pro dětskou gastroenterologii a výživu) vyžaduje průkaz onemocnění 3 bioptické odběry a to 1.průkaz atrofie při normální dietě, 2.normalizaci po bezlepkové dietě a 3.relaps, tj. znovu prokázáné poškození sliznice při návratu k normální dietě obsahující gluten. Tato diagnostická kriteria jsou nyní revidována s přihlédnutím k využití serologických markerů. Diagnostická kriteria a screening céliakie byly jedním z hlavních témat odborného 7.Mezinárodního symposia céliakie, které se konalo v září 1996 ve Finském Tampere.
zahrnují detekci protilátek ke gliadinu (třídy IgA a IgG) a autoprotilátek k retikulinu resp. endomysiu třídy IgA. Podle revidovaných kriterií ESPGAN je k průkazu céliakie nutná pozitivita alespoň dvou ze tří serologických markerů při současném histologickém průkazu atrofické sliznice.
Antigliadinové protilátky (AGA) jsou produkovány B-lymfocyty ve střevní slizniciu nemocných s céliakální sprue. K průkazu se většinou používá ELISA techniky na mikrotitračních destičkách s antigenem = gliadinem. Specificita a senzitivita stanovení je závislá na typu použitého antigenu, resp. na způsobu jeho purifikace. Specificita AGA IgA protilátek je uváděna v rozmezí 84-100%, senzitivita 65-95%, hladina klesá při bezlepkové dietě více u IgA než IgG třídy protilátek. IgG protilátky vykazují specificitu 70-95% a sensitivitu 80-95%. Naše pracoviště používá ke stanovení antigliadinových protilátek ELISA desky s purifikovaným a-gliadinem. Aplikace a-gliadinu jako antigenu zvyšeuje podle některých studií senzitivitu testu 3x při porovnání se surovým gliadinem. Vzhledem ke značené heterogenitě používaných antigenů je zcela zásadní otázkou standardizace tohoto vyšetření. Mezinárodní, mezilaboratorní systém standardizace je již realizována v některých evropských zemích systémem, který vypracoval prof.Stern z Tübingen v Německu. Tento standardizační projekt byl prezentován na symposium v Tampere v minulém roce (Stern, 1996).
Antiretikulinové (ARA) a antiendomysiální (EmA, AEA) protilátky prokazatelné v séru u nemocných s céliakii jsou dokladem autoimunitních charakteru tohoto onemocnění. Protilátky reagují pravděpodobně se strukturami intercelulární matrix, s retikulinovými vlákny a s endomysiem hladkého svalstva. Dosud nebyly identifikovány cílové struktury autoantigenů ani úloha těchto protilátek v etiopatogenezi onemocnění. K průkazu se používá imunofluorescenční techniky, substrátem pro ARA protilátky je nejčastěji tkáň krysí ledviny, pro EmA hladká svalovina opičího jícnu nebo lidského pupečníku. Specificita EmA je uváděna v rozmezí 90-100%, senzitivita 97-100%. EmA a ARA protilátky (třídy IgA) nelze prokázat u nemocných s céliakií, kteří mají současně selektivní IgA deficit (2-3% pacientů s céliakií). Antiretikulinové protilátky třídy IgA mají senzitivitu i specificitu kolem 90%, stanovení ARA třídy IgG se již opouští.
Na základě zkušeností z evropských epidemio-logických studií byl vypracován doporučený postup screeningu, založený na kombinaci AGA a EmA (obrázek č.2). Senzitivita AGA-A, AGA-G, EmA a kombinace všech tří testů je podle studie prof.Sterna 95, 92, 97 a 98%, specificita testů je 67, 81, 90 a 100%, prediktivní efektivita je 88, 89, 95 a 100%. Sekvenční přístup je ekonomicky výhodnější: prvním krokem je stanovení AGA protilátek IgA a IgG třídy. Při pozitivitě stanovujeme EmA protilátky a jsou-li EmA protilátky positivní, nebo EmA negativní s IgA AGA positivitou (tj. zachycení nemocných s deficitem IgA) je doporučena střevní enterobiopsie. Tímto postupem byla provedena studie (obrázek č.3) na souboru 17201 asymptomatických studentů (Catassi 1996) a bylo dignostikováno 82 případů céliakie (incidence je zde 1:210).
Klinický význam screeningu
vyplývá z již uvedených výsledků evropských studií. Závažnost nerozpoznané céliakie však spočívá v možnosti vzniku řady komplikací, které vyplývají z malabsorpce, která není-li diagnostikována, není ani patřičně léčena. Nemocní s céliakií (a to i bez klinických příznaků) patří do vysoko-rizikové skupiny s vyšším výskytem maligních tumorů. Dodržování bezlepkové diety u těchto nemocných riziko malignity výrazně snižuje a právě tato skutečnost je závažným důvodem k screeningu céliakie pomocí serologických markerů. U nemocných s céliakií se malignity (sqamózní CA jícnu a faryngu, střevní adenokarcinom a lymfom) vyskytují signifikantně častěji a úmrtí na tyto nádory jsou 1.9x častější než v ostatní populaci. Striktní dodržování bezlepkové diety by snížilo morbiditu nádorovými onemocněními u nemocných céliakií až 11x (Howdle, 1992). V souboru 487 pacientů s Duhringovou herpetiformní dermatitidou bylo prokázáno 8 případů lymfomu a to výhradně u nemocných, kteří nedodržovali bezlepkovou dietu (Lewis 1996).
Toward An Electronic Patient Record - TEPR'97, Nashville TN, U.S.A., 1997
Kocna Petr
Laboratory of Gastroenterology & Department of Medical Informatics, 1.st Medical Faculty & Faculty Hospital, Charles University, Prague, Czech Republic
Abstract
The multimedia electronic textbook, hypertext, fulltext searches, images processing and digitalized video sequences on CD-ROM as well as accessed by Internet coming now as new tools in the education process. The program GastroBase is described that primary serves for documentation in gastroenterology ambulance and endoscopic workplaces. The last version of the program GastroBase makes possible to include also image documentation and serves as the PACS. This IS - GastroBase is now running more than six years in daily routine and the database contains > 75.000 medical records and 3000 images. In this paper we would like to present the way from electronic-patient-record, in the information system - GastroBase-II, to the multimedia, electronic textbook on CD-ROM.
Electronic-patient-record (EPR) system GastroBase-I has been developed in 1990 as a FoxBase+/LAN application and the last version (GastroBase-II) written in C-language including a graphic library has been incorporated into a clinical-information system (CIS-ComSyD), which is under developing at the University Clinic in Prague. The GastroBase system has been developed as a full structured text editor, suitable for documentation of gastroduodenoscopy, ERCP, colonoscopy, proctosigmoidoscopy, including all therapeutic techniques, ultrasonography, laparoscopy as well as to describe histology, X-ray and surgical reports in connections with hematology and clinical chemistry laboratories. This system is now running on Btrieve data manager (Novell NetWare 3.12) and it is routinely used at our clinic as a clinical information system - incorporating patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related information. A graphic library developed in the past years and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record. The multimedia, electronic textbook entitled "Endoscopy methods - ERCP and colonoscopy" on the CD-ROM was published in 1996.
Medical-records in GastroBase are written and stored by using of the standardized texts/codes (minimal data set) covering the whole range of the gastroenterology, developed at our department in two years. These codes are constructed in general rules as abbreviation (codes for tumors start with "t" etc.) and are composed by a combination of the proper code, numeric parameters (size, distance) and anatomical localizations. Examination reports are typed quicker, in a standardized form and can be easily searched and evaluated, by our code-structure, compared to free-text form. This type of report-input has been described also in the overview in Endoscopy (Classen 1991, Endoscopy 23: 29). A full-text-form of the reports is displayed and printed in connection to additional code-text databases. An expert system is used to check and control data input as well as to analyze medical reports. An automated accounting system for health insurance companies has been developed by using national specific rules and coding database. Separate routines involve screening, prevention and follow-up for colorectal cancer and a national registry of the familiar polyposis of the large bowel.
The graphic-library modules of GastroBase system could be easily used for educational purposes. Searching by keyword enables us to demonstrate specific procedure, individual stages of this procedure, relation to different examination techniques (i.e., combination of endoscopy with X-ray or with ultrasound) or a specific diagnosis or pathological result. This image-data is used for pre-graduate as well as post-graduate educational activities. Our teaching and seminar room is now equipped with modern computer presentation unit including LCD panel projection with Cyclop option.
Petr Kocna M.D.,Ph.D., born March 1955 in Prague. Graduated at Medical Faculty of Charles University in 1981 and post-graduated with thesis "Isolation and characterization of a-gliadin and their proteolytic fragments" in 1989. Since 1990 he is working at this position as scientific worker participating on the project of the markers for colorectal cancer screening, as well as developing of a computer assisted documentation. At the Medical Faculty he is lecturing the clinical chemistry and medical informatics.
E-mail: kocna@cesnet.cz
Kocna, P.; Kocna, J.; Frič, P.: Computer data processing in clinical gastroenterology.Comp.in Medicine and Health Care; Karlovy Vary; 1990; 256
Kocna, P.; Kocna, J.; Frič, P.: Computer-aided documentation in clinical gastroenterology - GastroBase. Proceedings MEDINFO'92 Geneva
September 6-10; 1992; 1: 158
Kocna, P.; Kocna, J.; Neuwirt, K.; Frič, P.: Computer-aided documentation in Clinical Gastroenterology - GastroBase. Health Systems-The Challenge of Change; 1992; 1353-1356
Kocna, P.; Kocna, J.; Frič, P.: Endoscopic results and images using Gastrobase - Computer data processing in clinical gastroenterology.
Endoscopy; 1993; 25: 5, 353
Kocna, P.: The clinical information system GastroBase: Integration of image processing and laboratory communication. MEDINFO'95 Proceedings ed.R.A.Greenes; 1995; 1: , 441
Kocna, P.: Electronic medical record in GastroBase-II. Clinical and educational aspects. MIE'96 Proceedings ed. J.Brender, IOS Press, 1996, 440-442
Časopis lékařů českých, 136 (10), 311-314, 1997
Kocna P.
Summary
"GastroBase-II" is a module of the clinical information system "KIS-ComSyD". The main part is represented by structured data-text with an expert system including on-line image digitalization in gastroenterology (incl. endoscopic, X-ray and endosonography pictures). The hardware and software of the GastroBase are described as well as six-years experiences with application of digitalized image data. An integration of a picture into text, reports, slides for a lecture or an electronic atlas is documented with examples. Briefly are reported our experiences with graphic editors (PhotoStyler), text editor (WordPerfect) and slide preparation for lecturing with the presentation software PowerPoint. The multimedia applications on the CD-ROM illustrate a modern trend using digitalized image documentation for pregradual and postgradual education.
Medical Informatics Europe - MIE'96, Copenhagen, Denmark, 1996
Petr KOCNA
Laboratory of Gastroenterology & Department of Medical Informatics. Faculty Hospital, 1st.Medical Faculty, Charles University, CZ-121-11 Prague, Czech Republic,E-mail: kocna@csearn.bitnet, kocna@earn.cvut.cz
GastroBase - as a clinical information system - incorporates patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related information. Program modules are written in C-language, all data are processed by using Novell-Btrieve data manager. Patient-identification database represents the main core of this information systems. Graphic library developed in the past year and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record. GastroBase is routinely used now more than five years and the database contains > 60.000 medical records and 2000 images. The educational aspects of clinical data are discussed and a CD-ROM electronical textbook is prepared.
The importance of computing medical documentation is not doubted. All data stored in the computer memory are easy to access, share and search, replace the written documentation, and decrease the non-medical (administrative work) of medical staff. The GastroBase program is suitable for documentation of gastroduodenoscopy, ERCP, colonoscopy, proctosigmoidoscopy, including all therapeutic techniques, ultrasonography, laparoscopy as well as to describe histology, X-ray and surgical reports in connections with hematology and clinical chemistry laboratories. The GastroBase has been developed in 1990 as a Fox Base+ LAN application [1-2] and the last version written in C-language including a graphic library was incorporated into a clinical-information system, which is under developing at the University Clinic in Prague.
Electronic-patient-record [EPR] system GastroBase-I has been developed in 1990 as a full structured text editor; suitable for documentation of gastroenterological endoscopy. The GastroBase-II system running on Btrieve data manager [Novell NetWare 3.12] is routinely used at our department since June 1995. GastroBase-II as a clinical information system - incorporates patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related information. Patient-identification database represents the main core of this information system. Graphic library developed in the past years and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record.
Images - real time screen pictures - from videoendoscopy, ultrasound, endosono-graphy and X-ray contrast pictures (ERCP) could be stored and retrieved as a part of patient's documentation. These images are captured by video-cards connected to PC in the PC-network, processed in true-color Targa (TGA) format and archived after compression to the standard GIF (Graphic Interface Format). Microimages - 'thumbprint' for each image 120 x 120 pixels are stored in the graphic library. These microimages could be easy retrieved and linked to medical record and serves as a summary of the whole medical procedure. Different microimages [endoscopic, X-ray, ultrasound] could be previewed on the true-color display. A graphic library module has been developed as a tool to capture, process and manage images and responding microimages.
The graphic-library modules of GastroBase-II system could be easily used for educational purposes. Searching by keyword enables us to demonstrate specific procedure, individual stages of this procedure, relation to different examination techniques (i.e. combination of endoscopy with X-ray or with ultrasound) or a specific diagnosis or pathological result. We have now more than 2000 images accessible on network disc, and long-term storage archive on optical disc (CD-ROM. These image-data are used for pre-graduate as well as post-graduate educational activities. Our teaching and seminar room is now equipped with modern computer presentation unit [including LCD panel with Cyclope, Ovation 820 system]. Clinical data are presented by using a GastroBase-II software or these images are incorporated into presentations prepared in Microsoft PowerPoint. The educational - postgraduate multimedia - a CD-ROM electronical textbook - will be developed. This CD-ROM is prepared by using VisualBasic as a hyper-text oriented electronic book with full-text searching, images and video-sequences covering endoscopy, X-ray and endo-ultrasound examinations.
[1] Kocna, P.; Kocna, J.; Frič, P.: Computer data processing in clinical gastroenterology. Abs.Comp.in Medicine and Health Care; Karlovy Vary; 1990; 256
[2] Kocna, P.; Kocna, J.; Frič, P.: Computer-aided documentation in clinical gastroenterology - GastroBase. Proceedings MEDINFO'92 Geneva September 6-10; 1992; 1: 158
[3] Kocna, P.; Kocna, J.; Neuwirt, K.; Frič, P.: Computer-aided documentation in Clinical Gastroenterology - GastroBase. Health Systems-The Challenge of Change; 1992; 353-1356
[4] Kocna, P.; Kocna, J.; Frič, P.: Endoscopic results and images using Gastrobase - Computer data processing in clinical gastroenterology. Endoscopy; 1993; 25: 5, 353
[5] Kocna, P.: The clinical information system GastroBase: Integration of image processing and laboratory communication. MEDINFO'95 Proceedings ed.R.A.Greenes; 1995; 1: 441
[6] Kocna, P.: Electronic Medical Record - Images Integration and Educational Aspects. Abstract of EuroMISE 95 Conference, Prague October 1995; 38
III.Zjazd Slovenskej spoločnosti klinickej bochémie, Novolubovnianské kúpele, Slovakia, 1998
Kocna P.
Oddělení klinické biochemie VFN a 1.LF UK, Laboratoř gastroenterologie, Praha
World Congress of Medical Informatics - MEDINFO'95, Vancouver, Canada 1995
P.Kocna
Lab.Gastroenterol.,1st Med.Faculty, Charles University, CZ-121-11 Prague, Czech Republic
ABSTRACT
GastroBase - as a clinical information system - incorporate patient identification, medical records, images, laboratory data, patient history, physical examination and other patient related informations. Programme modules are written in C-language, all data are processed by using Novell-Btrieve data manager. Patient-identification database represents the main core of this information systems. Graphic library developed in the past year and graphic modules with a special video-card enables to store, archive and link different images to the electronic patient-medical-record. GastroBase is now running more than 4 years in daily routine and the database contains > 25.000 medical records and 1500 images. This new version of GastroBase is now incorporated into a clinical-information system of University Clinic in Prague.
The GastroBase program is suitable for documentation of gastroduodenoscopy, ERCP, colonoscopy, proctosigmoidoscopy, including all therapeutic techniques, ultrasonography, laparoscopy as well as to describe histology, X-ray and surgical reports in connections with hematology and clinical chemistry laboratories. The GastroBase has been developed in 1990 as a FoxBase+/LAN application [1-2] and the last version written in C-language including a graphic library and image processing was incorporated into a clinical-information system, which is under developing at the University Clinic in Prague [3].
1 P.Kocna, J.Kocna, P.Frič: Proceedings MEDINFO'92 Geneva September 6-10; 1992; 1: 158
2 P.Kocna, J.Kocna, K.Neuwirt, P.Frič: Health Systems-The Challenge of Change; 1992; 1353-1356
3 P.Kocna, J.Kocna, P.Frič: Endoscopy 1993, 25:353 - Abstract Barcelona EDDW'93
11th.Europ.Congress of Clinical Chemistry, Tampere, Finland, 1995
P.Kocna1, P.Schneiderka2, L.Dohnal2
1) Laboratory of Gastroenterology and 2) Department of Clinical Chemistry, 1st Medical Faculty, Charles University, CZ-121-11 Prague-2, Czech Republic
PragoMedica Symposium - Prague, Czech Republic, 1996
MUDr.Petr Kocna CSc.
Laboratoř gastroenterologie 1.LF UK, Karlovo náměstí 32, 121-11 Praha-2
Pseudoperoxidázová reakce hemoglobinu je základem řady testů, které obsahují testovací medium [papírek] impregnovaný většinou guajakovou pryskyřicí, nebo derivátem benzidínu - např. dimethyl-benzidin [o-tolidin]. Bezbarvá leukoforma těchto látek je v přítomnosti peroxidu vodíku katalyzována hemoglobinem na barevnou [chromogenní] formu. Vzhledem k chemickému principu oxidační reakce jsou testy ovlivněny přítomností oxidačních látek [C-vitamin], přítomností hemoglobinu z potravy [maso, krev] a v závislosti na uspořádání testu je doporučováno dietní omezení. Citlivost testů s guajakovou pryskyřicí je řádově nižší ve srovnání s testy imunochemickými. Mezi nejčastěji používané testy patří především Haemoccult [Röhm Pharma], HemoCare [Care Diagnostica], HemDetect, HemaCheck, ColoScreen a další. Detekční papírek impregnovaný o-tolidinem je v soupravě dříve často používaného německého Krypto-Haem-SSW testu.
EAS-AAP Project Meeting, Düsseldorf, Germany, 1996
WebMaster: Petr Kocna -
kocna@cesnet.cz
HomePage: medical oriented or church and theology oriented
