Intraperitoneal onlay mesh - an analysis of the patients cohort.

INTRODUCTION: Incisional hernias represent one of the most complex and widely discussed issues of abdominal wall surgery. 10-20% of the cases occur following abdominal surgery. The aim of this study is to describe our surgical experience and determine whether the intraperitoneal onlay mesh (IPOM) procedure is suitable for hernia surgery with minimal postoperative complications. METHOD: The paper focuses on patients operated on by the IPOM technique between 2015 and 2016. The group involved 53 patients with median or paramedian defects after acute or elective abdominal surgery. In patients with comorbidities, thorough preoperative examination was completed including abdominal ultrasound, colonoscopy and spirometry. In the postoperative period, we evaluated pain using the visual analogue scale, wound healing, relapses and patient´s satisfaction with functional as well as aesthetic outcomes of the surgery. RESULTS: Our group comprised 53 patients operated on using the IPOM technique. They were 4879 years old with a body mass index exceeding 30 kg/m2. 18 patients had a paramedian hernia and 35 patients median hernia. 4 patients suffered a perioperative iatrogenic injury of the intestine, 8 cases developed postoperative paralytic ileus. Wound infection or infection of the mesh was not recorded. 2 patients with hernia recurrence were followed up for one year. CONCLUSIONS: Incisional hernias represent an important surgical issue. Management is often complex. IPOM as the treatment of choice for patients with incisional hernias appears to be beneficial. However, it requires careful patient selection, patient preparation for surgery and their compliance, the surgeons extensive experience as well as excellent postoperative care with limited postoperative pain. The success rate of this method is high in carefully selected patients. Key words: IPOM - incisional hernia - patient compliance.

Reconstitution of cytomegalovirus-specific T-cell response in allogeneic hematopoietic stem cell recipients: the contribution of six frequently recognized, virus-encoded ORFs.

BACKGROUND: The reactivation of human cytomegalovirus (HCMV) in immunosuppressed patients is associated with significant morbidity. Testing HCMV-specific T-cell responses can help determine which patients are at high risk of HCMV disease. We optimized selection of HCMV antigens for detection of T-cell response of patients after allogeneic hematopoietic stem cell transplantation (HSCT) with the aim of identifying patients with insufficient control of HCMV reactivation. METHODS: T-cell immune response to HCMV was monitored in 30 patients during the first year after HSCT. The HSCT recipients were classified according to their anti-HCMV T-cell response and the presence of HCMV DNA in the blood. RESULTS: We observed an inverse relationship between the magnitude of HCMV-specific T-cell responses against CMV lysate, phosphoprotein (pp) 65, immediate early-1 (IE-1), UL36, and UL55, but not to US3 and US29 detected by interferon-gamma (IFNγ)- ELISPOT and the level of HCMV DNA in the blood of patients during the 30 days following sampling. The study has revealed that patients who received a graft from a seronegative donor have a lower T-cell response against HCMV and increased probability of HCMV reactivation in comparison to the patients who had received their graft from a seropositive donor. CONCLUSION: The individual peptide pools and native HCMV antigens were useful for monitoring the time course of the anti-HCMV response by IFNγ-ELISPOT, which proved to have a prognostic value. Besides widely employed peptide pools of pp65 and IE-1, the use of antigens UL36 and UL55, but not US3 or US29, increased sensitivity of the test.

[The ONSTEP inguinal hernia repair technique]. / Operace tríselné kýly technikou ONSTEP.

The ONSTEP (Open New Simplified Totally Extraperitoneal) inguinal/femoral hernia repair technique is an innovative procedure presented by Portuguese surgeons Augusto Lourenço and Rui Soares da Costa within the EHS/AHS Congress in March 2012. The first institutions to perform this kind of hernia surgery in the Czech Republic are the Department of Surgery at Prostejov Hospital and the Department of Surgery at Frydlant Hospital. The ONSTEP technique represents a minimally traumatizing frontal approach to inguinal hernia repair using a special self-expanding mesh patch (an oval, anatomically-shaped moderate-pore polypropylene mesh with the circumferential memory-ring consisting of polyethylene terephthalate). The main advantages of this method are: short duration of surgery, the possibility of performing the procedure under local anaesthesia, short recovery time and rapid return to daily activities, low incidence of chronic post-operative groin pain, low recurrence rate, short hospital stay, good cosmetic effect and a low price. It is suitable for institutions performing outpatient surgery.

Planktonic or non-planktonic food in young-of-the-year European perch Perca fluviatilis in ponds.

Higher biomass especially of some aquatic macrophyte species offered a higher density of phytophilous zoobenthos, but did not increase the proportion of non-planktonic to planktonic prey in young-of-the-year perch Perca fluviatilis. Both abundance and biomass of non-planktonic prey dominated over planktonic prey in the pond with lower biomass of aquatic macrophytes and lower food. Survival of P. fluviatilis was lower (20%) in the pond with lower food than in the other pond (34%), however, specific growth rate (1.3% day(-1) ) and final Fulton's condition factor of P. fluviatilis were similar in both ponds.

Antitumor activity and immunogenicity of recombinant vaccinia virus expressing HPV 16 E7 protein SigE7LAMP is enhanced by high-level coexpression of IGFBP-3.

We constructed recombinant vaccinia viruses (VACVs) coexpressing the insulin-like growth factor-binding protein-3 (IGFBP-3) gene and the fusion gene encoding the SigE7Lamp antigen. The expression of the IGFBP-3 transgene was regulated either by the early H5 promoter or by the synthetic early/late (E/L) promoter. We have shown that IGFBP-3 expression regulated by the H5 promoter yielded higher amount of IGFBP-3 protein when compared with the E/L promoter. The immunization with P13-SigE7Lamp-H5-IGFBP-3 virus was more effective in inhibiting the growth of TC-1 tumors in mice and elicited higher T-cell response against VACV-encoded antigen than the P13-SigE7Lamp-TK(-) control virus. We found that high-level production of IGFBP-3 enhanced virus replication both in vitro and in vivo, resulting in more profound antigen stimulation. Production of IGFBP-3 was associated with a higher adsorption rate of P13-SigE7Lamp-H5-IGFBP-3 to CV-1 cells when compared with P13-SigE7Lamp-TK(-). Intracellular mature virions (IMVs) of the IGFBP-3-expressing virus P13-SigE7Lamp-H5-IGFBP-3 have two structural differences: they incorporate the IGFBP-3 protein and they have elevated phosphatidylserine (PS) exposure on outer membrane that could result in increased uptake of IMVs by macropinocytosis. The IMV PS content was measured by flow cytometry using microbeads covered with immobilized purified VACV virions.

Nitrites and nitrates in exhaled breath condensate in cystic fibrosis: relation to clinical parameters.

OBJECTIVES: To evaluate correlation of exhaled breath condensate (EBC) nitrite and nitrate concentrations with disease severity in cystic fibrosis (CF) patients. BACKGROUND: Nitrites and nitrates are products of oxidative metabolism of nitric oxide. Impaired metabolism of nitric oxide plays a role in pathogenesis of CF. METHODS: EBC was collected from 46 stable CF patients and from 21 healthy controls. EBC concentrations of nitrites and nitrates were correlated with parameters of lung disease and nutritional status and with systemic inflammatory markers. RESULTS: EBC nitrates concentrations in CF patients were lower than in healthy subjects (5.8 vs 14.3 µmol/l, p<0.001). They correlated positively with FEV1 (p=0.025) and serum albumin values (p=0.016) and negatively with chest radiograph Northern score (p=0.015) and serum C-reactive protein values (p=0.005). EBC nitrites concentrations in CF patients did not differ from those in healthy subjects and were not correlated to any studied parameter. CONCLUSIONS: EBC nitrates concentrations correlate with disease severity in CF patients and are lower than in healthy subjects (Tab. 4, Fig. 1, Ref. 48).

Probably the oldest patient with the diagnosis of medullar conus teratoma.

BACKGROUND: Authors present a case report of a 60 year old patient suffering from several movement and sensitivity disorders lasting for several months. On magnetic resonance scans a huge extramedular intradural structure was described. Patient underwent three operations and the same number of histological investigations. Furthermore we have performed bacteriological investigations because of the presence of suspicious pus during the surgery. RESULTS: Even after the third investigation the evidence of mature teratoma has been established. After successful passing of three surgeries, the patient has no sphincter disorders and she is able to walk with the sticks and she has only small sensitivity deterioration. CONCLUSION: All forms of teratoma are chemo- and radioresistent, so beside total extirpation we have no relevant possibilities to cure this tumour. The size of the extirpation is mostly limited by the time of appearance, the size of the tumour and by the potential damages of the normal spinal cord tissue, which could be protected by using neurophysiology (Fig. 3, Ref. 9).

[Twenty years of care for cystic fibrosis adults in Czech Republic]. / Dvacet let péce o dospelé nemocné s cystickou fibrózou v Ceske republice.

INTRODUCTION: Most of cystic fibrosis (CF) patients survive now into adulthood and they are transferred to pulmonologist care. AIMS: An overview of progress in care for CF adults in Czech Republic and evaluation of relationship of pulmonary function, nutritional status and airway colonization. METHODS: All adult CF patients followed in pulmonary departments from December 1987 to December 2007 were included into study. Data about survival status, pulmonary function, nutritional status, airway colonization and other pulmonary and extrapulmonary manifestations of CF were collected from patients' records. RESULTS: Total of 206 patients (96 females) were followed. Pancreatic insufficiency was present in 175 (85.0%), liver disease in 61 (29.6%) and insulin treatment in 58 (28.2%) patients. Bone disease was found in 70 (46.7%) from 150 examined patients. Sixty-two patients (23 females) died at mean age 25.4 +/- 5.5 years (median 24.3 years). Worse survival was recorded in patients with Burkholderia cepacia complex (BCC) airway colonization (24.4 +/- 4.0 vs 28.5 +/- 7.0 years, p = 0.012). One hundred forty-four living patients were followed to date of the 31st December 2007 with mean age 27.5 +/- 6.5 years (median 26.5 years), FEV1 64.4 +/- 28.5% pred. and BMI 20.9 +/- 3.1 kg/m2. Worse pulmonary function was present in patients with BCC colonization (FEV1 58.8 +/- 21.9 vs 67.8 +/- 27.3% pred., p = 0.041) and in malnourished patients (FEv1 49.5 +/- 18.5 vs 69.7 +/- 25.9% pred., p < 0.0001). BCC colonization was found in 54 (37.5%), Pseudomonas aeruginosa (PA) colonization in 92 (63.9%) and colonization without BCC or PA in 40 (27.8%) patients, respectively. Malnutrition (BMI < 19.0 kg/m2) was recorded in 38 (26.4%) patients. CONCLUSION: This study confirms growing number of CF adults in Czech Republic, close relationship of pulmonary function and nutritional status and also unfavourable influence of BCC colonization.

Two-Functional Direct Current Sputtered Silver-Containing Titanium Dioxide Thin Films.

The article reports on structure, mechanical, optical, photocatalytic and biocidal properties of Ti-Ag-O films. The Ti-Ag-O films were reactively sputter-deposited from a composed Ti/Ag target at different partial pressures of oxygen pO(2) on unheated glass substrate held on floating potential U(fl). It was found that addition of ~2 at.% of Ag into TiO(2) film has no negative influence on UV-induced hydrophilicity of TiO(2) film. Thick (~1,500 nm) TiO(2)/Ag films containing (200) anatase phase exhibit the best hydrophilicity with water droplet contact angle (WDCA) lower than 10° after UV irradiation for 20 min. Thick (~1,500 nm) TiO(2)/Ag films exhibited a better UV-induced hydrophilicity compared to that of thinner (~700 nm) TiO2/Ag films. Further it was found that hydrophilic TiO(2)/Ag films exhibit a strong biocidal effect under both the visible light and the UV irradiation with 100% killing efficiency of Escherichia coli ATCC 10536 after UV irradiation for 20 min. Reported results show that single layer of TiO(2) with Ag distributed in its whole volume exhibits, after UV irradiation, simultaneously two functions: (1) excellent hydrophilicity with WDCA < 10° and (2) strong power to kill E. coli even under visible light due to direct toxicity of Ag.

High-rate low-temperature dc pulsed magnetron sputtering of photocatalytic TiO2films: the effect of repetition frequency.

The article reports on low-temperature high-rate sputtering of hydrophilic transparent TiO2thin films using dc dual magnetron (DM) sputtering in Ar + O2mixture on unheated glass substrates. The DM was operated in a bipolar asymmetric mode and was equipped with Ti(99.5) targets of 50 mm in diameter. The substrate surface temperature Tsurfmeasured by a thermostrip was less than 180 °C for all experiments. The effect of the repetition frequency frwas investigated in detail. It was found that the increase of frfrom 100 to 350 kHz leads to (a) an improvement of the efficiency of the deposition process that results in a significant increase of the deposition rate aDof sputtered TiO2films and (b) a decrease of peak pulse voltage and sustaining of the magnetron discharge at higher target power densities. It was demonstrated that several hundreds nm thick hydrophilic TiO2films can be sputtered on unheated glass substrates at aD = 80 nm/min, Tsurf < 180 °C when high value of fr = 350 kHz was used. Properties of a thin hydrophilic TiO2film deposited on a polycarbonate substrate are given.

[Pathogenesis of the chronic obstructive pulmonary disease (COPD)]. / Patogeneze chronické obstrukcní plicní nemoci (CHOPN).

An inflammation in the bronchial wall is usually present already in an early stage of the disease. An inflammatory infiltration cause predominantly mononuclear cells in the mucous membrane and neutrophiles in the phlegm produced by airways. Also eosinophiles can participate in the inflammation. Lymphocytes distribution is different from asthma because there is mainly submucosa infiltrated in COPD. Metaplasia of goblet cells appears. Chronic bronchial obstruction characterizing COPD is induced by conjunction of small airways disease (obstructive bronchiolitis) and a destruction of pulmonary parenchyma (emphysema) which both contribute to an impairment and differ form person to person. Chronic inflammation is a cause of remodeling and narrowing of small airways. Destruction of pulmonary parenchyma and the inflammation cause loss of alveolar connection with small airways and elastic pulmonary stress decreases. Two theories try to explain COPD--a theory of imbalance between proteinases and antiproteinases and a theory of oxidation stress.

[Treatment principle of the chronic obstructive pulmonary disease (COPD) exacerbation]. / Zásady lécby exacerbace chronické obstrukcní plicní nemoci (CHOPN).

COPD is often accompanied with acute symptoms exacerbations. Patients in Ist stage: slide grade of COPD and IInd stage: middle grade of COPD suffer exacerbations accompanied with increased dyspnoea often together with increased cough and increased production of sputum. Patients in IIIrd stage (serious) and IVth stage (very serious) experience during exacerbations development of respiration insufficiency or its worsening and thus are usually treated in hospital. The most frequent causes of exacerbations are tracheobronchial tree infections and air pollution. The cause of approximately one third of serious exacerbations is not disclosed. Conditions which can resemble acute exacerbation are pneumonia, congestive heart failure, pneumothorax, pleural exudation, pulmonary embolism, and arrhythmia. Exacerbation treatment is symptomatic. Obstruction symptoms are treated with bronchodilatants and corticosteroids administration, hypoxemia with oxygen administration and signs of bacterial infection with antibiotics.

[Lead systems in orthogonal electrocardiography]. / O ortogonalite elektrokardiografických svodových systému.

The paper deals with evaluating quality of some orthogonal and pseudoorthogonal electrocardiographic lead systems as Frank lead system, signals derived from standard electrocardiographic leads by Levkov's transform and some signals of the standard 12 lead system that roughly fulfill condition of geometrical orthogonality. The signals of the lead systems were assessed by means of a mathematical criterion of two vector orthogonality which was originally proposed for purposes of electrocardiography and proved by Netusil. Experiments done with signals of the CSE database of short-time rest ECG records have revealed that the best ECG lead orthogonality has been found for signal sets of I-aVF-V2, and I-III-V2 leads, resp. Unfortunately nearly the worst results were obtained for the widely used Frank orthogonal lead system. It means that this lead system can lead (under some specific conditions) to missing diagnostically important information.

[Is nebulized ipratropium bromide effective in the treatment of exacerbations of chronic obstructive pulmonary disease?]. / Je úcinné podání ipratropium bromidu nebulizací pri lécbe exacerbace chronické obstrukcní plicní nemoci (CHOPN)?

The author administrated to 20 patients hospital on account of exacerbation of chronic obstructive pulmonary disease nebulized ipratropium bromide 0.5 mg on admission. Nebulized was repeated, using the same dose after 30 mins. The PEF value increased significantly after the first and second nebulization. After the two nebulizations dyspnoea was alleviated. The value of the respiration rate was significantly lower after both nebulizations as compared with the value before treatment. PaO2 increase significantly as compared with the value before treatment. PaO2 and the pulse rate did not change. An undesirable effect was recorded in one patient. Ipratropium bromide administration in effective and safe.

[A simple stereotaxic surgical apparatus]. / Jednoduchý stereotaktický operacní prístroj, SOP.

A simple apparatus based on the classical stereotactic method of surgery offers the opportunity to master miniinvasive procedures in neurosurgery and neurotraumatology. This device is particularly helpful in evacuation of intracerebral spontaneous and traumatic haematomas and in stereobiopsies, i.e. the most frequent operations in clinical practice, without the need of general anaesthesia, craniotomy and interference with cerebral tissue. The reliability of the stereotactic apparatus was positively evaluated by three independent surgeons. The apparatus was registered for use in the health services.

Acute effects of using a mobile phone on CNS functions.

Twenty volunteers participated in two experiments exploring the acute effects of using the mobile phone Motorola GSM 8700 on the functions of the CNS. When speaking (5 minutes reading a text from daily newspapers) the electromagnetic fields from the mobile apparatus did not affect the visual evoked potentials. Also a 6-min exposure did not reveal any effect of electromagnetic fields on the results in two tests (memory and attention) performed while speaking into the mobile. On the other hand the phone call itself strongly influenced the performance in a secondary task applying a test of switching attention which is a good model for driving a car. The response and decision speed were significantly worse. This is a proof that even a slight psychological stress involved in calling while driving can be a great risk.

[The effect of ambulatory nutritional intervention using defined enteral nutrition on the nutritional status of selected adult patients with cystic fibrosis]. / Vliv ambulantní nutricní intervence prostrednictvím definované enterální výzivy na nutricní stav vybraných dospelých nemocných s cystickou fibrózou.

The prevalence of mild and serious nutritional disorders in patients with cystic fibrosis is high. One of the possible ways how to supplement the necessary nutrients is the administration of defined supplementary enteral nutrition. The objective of the presented work is to evaluate the effect of supplementary domiciliary enteral nutrition in adult patients with cystic fibrosis. To eight patients with cystic fibrosis, mean body weight 51.77 +/- 10.63 kg, mean age 24.7 +/- 1.9 years for a period of 6 +/- 1 months enteral nutrition was administered (containing 40 and 55.1% energy as fat) with a caloric density of 10 kcal/kg as supplementary domiciliary nutrition. The mean body weight increased from 51.77 +/- 10.63 to 53.13 +/- 10.59 kg (p < 0.02), the mean skinfold thickness increased from 7.98 +/- 6.04 to 8.65 +/- 6.30 mm (p < 0.05) and the mean serum albumin concentration increased from 33.66 +/- 0.97 to 37.29 +/- 3.33 g/l (p < 0.05). No undesirable side-effect associated with the administration of enteral nutrition were observed. The nutritional intervention by domiciliary enteral nutrition produced no undesirable side-effects and led to a statistically significant improvement of parameters of the nutritional status.

[What dosage is sufficient in combined inhalation therapy (fenoterol + ipratropium bromide) in patients with exacerbation of chronic obstructive lung disease?]. / Jaká dávka je dostatecná pri kombinované inhalacní lécbe (fenoterol + ipratropium bromid) u nemocných s exacerbací chronické obstrukcní plicní nemoci (CHOPN)?

The authors compared in a prospective study the bronchodilatating and undesirable effects of combined inhalation treatment (phenoterol + ipratropium bromide) in the treatment of patients with exacerbation of chronic obstructive pulmonary disease, using different dosages. The patients were divided at random into two groups--group one inhaled berodual sol 3.5 ml/day (i.e. 1.75 mg phenoteroli + 0.875 mg ipratropii bromidium), the second group had a dose of double size. During the trial the authors monitored the peak expiration rate, the heart and respiration rate, blood gases and the subjective state of dyspnoea, using a 10 cm line. By comparison of bronchodilatating and undesirable effects they reached the conclusion that a daily dose of 3.5 ml berodual sol. is sufficiently effective. Increasing the daily dose to 7 ml did not produce a greater therapeutic effect nor increase the risk of undesirable effects.