To bypass malignant bile duct strictures are challenging for gastroenterologists. Endoscopic retrograde cholangio-pancreatography (ERCP), percutaneus transhepatic drainage (PTD) and surgical bypass were the gold standard methods for the management of bile passage this time. Endoscopic ultrasound-guided bile duct drainage (EUS-BD) is the latest method, which could be an alternative procedure in the management of malignant bile duct strictures.

Because of bile duct obstruction ERCP and papillotomy has been performed on an 80 years old female patient. Two days after ERCP she presented chest pain, in the beginning with normal hypersensitive troponin-T levels. Next morning her symptoms reoccurred with elevated troponin levels and negative T waves on the ECG. With the suspicion of non-Q myocardial infarct the patient was transferred to PCI center. Coronarography did not show any significant coronary lesion, and no intervention was needed. On echocardiography hypokinesis of the apex was detectable and the cardiologists diagnosed Takotsubo syndrome. The patient received antiplatelet therapy and was discharged from hospital. Takotsubo cardio­myopathy is a transient hypokinesis of the apex and left ventricle, without any significant coronary obstruction. The exact pathomechanism is unknown, but various hypotheses have been suggested, including coronary microvascular dysfunction and cathecolamin-induced cardiotoxicity. Its onset is connected to physical or strong emotional stress, that’s why it is also called „broken heart syndrome”.

Chronic mesenteric ischemia (CMI) is a rare disease. Abdominal symptoms develop when significant stenosis of at least 2 mesenteric vessels are present. CMI usually occurring among patients above 50 years causing hardly manageable malabsorption and maldigestion and mimic the clinical course of severe inflammatory bowel diseases, unrecognised coeliac disease or other gastrointestinal diseases involving mall bowel. During workup CMI should be suspected when diagnosis is questionable and the case do not respond to standard therapy.

Nowadays, histopathological samples do not only serve pathological diagnostics, but are also subjects of biomarker tests for prognosis and prediction of drug effects. Based on a recently published guide line, we review the practice of pathological biomarkers assessment of colorectal tumours. In view of its importance, particular attention is paid to the aspects of microsatellite instability.