Initiation of first disease-modifying treatment for multiple sclerosis patients in the Czech republic from 2013 to 2016: Data from the national registry ReMuS.

BACKGROUND: Proper management of multiple sclerosis (MS) requires feedback from clinical practice via registries. OBJECTIVE: To introduce the Czech national multiple sclerosis registry, ReMuS, and explore the availability and use of disease-modifying drugs (DMD). METHODS: The analysis focused on patients who started their first DMD, either with first-line or second-line medication and was based on reimbursement criteria set by Czech regulators. Baseline information was used to predict relapses after DMD initiation and to compare patients that started DMD in different years. RESULTS: A total of 3,328 patients started DMD treatment for MS between 2013 and 2016; 3,203 on first-line and 125 on second-line medication. The proportion of patients starting on second-line drugs increased from 1.8% in 2013 to 4.7% in 2016. The occurrence of a relapse within one year of DMD initiation was significantly related to (1) the Expanded Disability Status Scale (EDSS) score immediately prior to starting DMD and (2) the number of previous relapses. Both parameters were significantly lower in patients starting in later years of the explored interval. CONCLUSION: Data from the ReMuS registry highlights improvements made in the management of MS in the Czech Republic. However, a relatively low percentage of patients started treatment using second-line drugs, in contrast to trends in other countries.

[Ganglioneuroma, a rare cause of soft neck tissues tumor in adult age]. / Ganglioneurom, raritní prícina nádoru mekkých tkání krku v dospelosti.

We present the case of a 26-year-old female patient with coincidental ultrasound finding of a neck tumour located below the left thyroid lobe. The tumour slightly increased in size over a year. Fine needle aspiration indicated the neuroectodermal origin of the tumour and surgical removal was performed. Although the tumour mass was carefully and successfully removed, post-operational Horners syndrome appeared. The tumour tissue was diagnosed as ganglioneuroma by histopathology.

[Ectopic parathyroid glands. Imaging methods and surgical access]. / Ektopická parathyreoidea, zobrazovací metody a chirurgické prístupy.

We discuss the benefits of imaging methods in localizing ectopic parathyroid glands in patients with primary hyperparathyroidism. The ectopic localizations are discussed within the context of the orthotopic norm. In the sample of 123 patients, a 23% rate of ectopic parathyroid glands was detected. Three selected case studies are presented, supporting the benefit of SPECT/CT imaging in terms of surgical access strategy selection.

Impact of MDR1 genetic polymorphisms on postoperative piritramide analgesia.

OBJECTIVES: The aim of prospective study was to evaluate the therapeutic efficacy of piritramide in patients after removal of parathyroid glands in relation to MDR1 genotype. In the treatment of moderate acute postoperative pain, piritramide plays a major role. It is difficult to predict its optimal therapeutic efficacy and tolerability in individual patients. METHODS: We compared the effect of piritramide in 56 patients after surgical removal of parathyroid glands in a prospective study. We evaluated pain intensity, pain difference and sum of pain difference (SPID) using visual analogue scale (VAS in mm) and adverse effects in the relationship with the MDR1 - polymorphism of G2677T/A. RESULTS: In the wild-type group (2677GG), there was maximal pain difference of 30.6 ± 24.9 and SPID of 209.33 ± 95.80 while in genotype 2677TT and 2677GT, the corresponding values were 19.5 ± 25.5 and 147.07 ± 91.38, respectively. In group of patients with wild type of 2677GG genotype, there was 80 % of responders with more than 50 % reduction in VAS as compared to baseline while in group with carriers of 2677T allele, there are only 39 % of responders present (χ² = 5. 83; p = 0.016). Furthermore, the total consumption of piritramide was lower in comparison with the variant-allele carrying group (p = 0.008). The total incidence of adverse drug reactions was observed in 40 % of patients with wild type of 2677GG genotype when compared to 83% in the group carrying the variant allele (χ² = 7.92; p = 0.005). Significantly more patients in the wild-type group were satisfied with postoperative pain treatment in comparison to the variant allele group (χ² = 6. 49; p = 0.0109). CONCLUSION: We observed a better analgesic effect of piritramide and a decreased incidence of side effects in the wild-type genotype (2677GG) group, when compared with variant-allele carrying patients (Tab. 2, Fig. 1, Ref. 7).

[Personal experience with the stress test before thoracic surgery procedures]. / Nase zkusenosti s pouzitím zátezových testu pred torakochirurgickými výkony.

Physical loads can to a certain extent the surgical stress and postoperative load. Since 1987 the authors started to use loading tests when evaluating the surgical risk and during the preoperative preparation of patients before surgery of the lungs and before two-cavity operations in oesophageal disease. Since 1989 the authors used in patients 2-minute isotemporal graded submaximal loading tests on a bicycle ergometer with three-minute breaks between individual loads. The tested patients were high risk patients-ASA 3-4. From the investigation ensues that a major surgical operation greatly increases the specificity and reduces the false positivity of the preoperative loading examination. Detection of functional fitness or functional reserves of the cardiovascular and cardiopulmonary system before operation leads to a more aimed preoperative preparation and postoperative therapy. Indications for major surgery in high risk patients is according to the authors' experience an even more marked impulse for preoperative loading tests than the patient's age. In 60-year-old patients and older ones the loading tests are also very valuable from the clinical aspect; the authors, however, were not able to prove the necessity of routine testing of this group of patients before every surgical operation. In these instances in indication for a loading tests the opinion of the specialist for internal medicine will be decisive.