[A case report of ocular complications of leptospirosis]. / Kazuistika ocní komplikace leptospirózy.

Ocular complications are very frequent in leptospirosis and may develop in both the acute (bacteriemic) and the second (immunologic) phases of the disease. A delayed onset of these complications, even after months or years, is also possible. Keratoconjunctivitis and panuveitis belong to the most frequent signs. Targeted search for patients suspected of having leptospirosis and regular ophthalmological examinations even after cure of the acute illness may lead to early detection of ocular complications and to their specific treatment. Presented are a case report of complicated uveitis due to infection with Leptospira grippotyphosa and a literature overview.

[Antibiotic prophylaxis in colorectal surgery]. / Antibiotická profylaxe v kolorektální chirurgii.

OBJECTIVE: Antibiotic (ATB) prophylaxis is generaly recommended in surgery. There is an important role in colorectal surgery especially. Colorectal surgery is associated with a particularly high risk of post-operative infection because of contamination of the wound with faecal bacteria. ATB prophylaxis decreases surgical wound infection, morbidity and mortality as well. Morbidity and mortality are associated with longer hospital stays and increased costs of care. METHOD: At surgical department of Faculty hospital Brno, during March-June 2008 an 88 patients were operated because of different diagnoses in colorectum. Both an emergent and schedule operations were made. Type of ATBs, time of application before operation, reapplication after operation and surgical site infection (SSI), in - hospital stay were followed up prospectively. SSI were divided into superficial, deep and intraabdominal. Data were analyse statistically. RESULTS: The most used combination of ATBs, almost in 91%, were Cefazoline and Metronidazole. In 50% were time of application till 20 minutes before incision. Only in 17% were time of application in interval 20-30 minutes before incision, which is recommended. We noticed 25 SSI. We prove that patients with SSI has almost two-times longer in-hospital stay. Enterococcus and enterobacterias were the most common etiological agents. CONCLUSION: ATB prophylaxis is indicated in colorectal surgery. It has to be applied in correct dose and right time before operation to decrease SSI.

[Incidence of pancreatic carcinoma in persons with chronic pancreatitis]. / Incidence pankreatického karcinomu u osob s chronickou pankreatitidou.

INTRODUCTION: Pancreatic carcinoma is one of the diseases which mostly fail to be diagnosed on a timely basis, and there is no way to effectively screen patients for pancreatic carcinoma either. An option for the diagnosis of the "early glandular carcinoma" therefore resides in identification and systematic screening of patients with risk of pancreatic carcinoma. METHOD: We monitored 223 patients with chronic pancreatitis on a systematic basis from 1992 to 2005. During this 14-year period, we monitored the number of cigarettes smoked per year in addition to standard parametres measured by biochemical methods, endosonography, CT and ERCP exams, and assigned the alcoholic form of chronic pancreatitis to patients consuming more than 80g of alcohol per day on a systematic basis for more than 5 years in the case of men, and 50 g of alcohol per day in the case of women, and classed the patients according the TIGARO classification. RESULTS: Alcoholic etiology was proven in 73.1% of the examined patients, chronic obstructive form of pancreatitis was diagnosed in 21.5% of patients, and only 5.4% of patients were classified into the idiopathic pancreatitis group. Pancreatic carcinoma in the region of chronic pancreatitis was found in 13 patients (5.8%); stomach carcinoma was diagnosed in 3 patients with chronic pancreatitis, and oesophageal carcinoma in 1 patient of the total of patients monitored. Malignant pancreatic disease was diagnosed primarily in patients with alcoholic pancreatitis (4.5%). During the period of 14 years, 11 patients died, 8 of the deaths being associated with pancreatic carcinoma. CONCLUSION: Both pancreatic and extrapancreatic carcinoma in gastrointestinal location is a serious complication of protracted chronic, non-hereditary pancreatitis. Systematic identification and treatment of patients with chronic pancreatitis is therefore necessary for timely diagnosis ofgastrointestinal and pancreatic malignancies.

Unsuccessful therapy of combined mycotic infection in a severely burned patient: a case study.

Patients with burn trauma are always in danger of contracting an infection. Although invasive mycotic infections are not as frequent as bacterial infections, high mortality and in many cases difficult diagnostics pose a serious threat not only for neutropenic patients. In more extensive burns the status is further complicated by specifically compromised immunity. The most frequent species of micromycetes isolated in burn patients are Candida spp. and Aspergillus spp. Zygomycetes represents a relatively uncommon isolation worldwide (up to 2% of all fungi. We present a case study of a young patient with 82% TBSA (total body surface area) burns, where we isolated simultaneously 3 different types of micromycetes (Aspergillus fumigatus, Fusarium sp., Absidia sp.). Mycotic infection is understood primarily as a complication in neutropenic patients and, after prophylactic antibiotic and antimycotic administration, in extensive burn trauma patients. The case ended with the death of the patient due to severe sepsis caused by the multiresistant strain Pseudomonas aeruginosa.

Occurrence of metabolic osteopathy in patients with chronic pancreatitis.

INTRODUCTION: Chronic pancreatitis is an inflammatory disease manifested by maldigestion and, in an advanced stage, by malabsorption. The aim of our research was to monitor the occurrence of metabolic osteopathies (osteopenia, osteoporosis and osteomalacia) in patients with chronic pancreatitis. PATIENTS AND METHODS: The group consisted of 73 patients (17 women and 56 men) in different stages of chronic pancreatitis. In all patients we determined serum concentrations of Ca, P, 25-OH vitamin D, 1,25-(OH)(2) vitamin D, alkaline phosphatase and its bone isoenzyme. Bone mineral density was measured by dual-energy X-ray absorptiometry (DXA) in the lumbar spine (L(1)-L(4)) and in the proximal femur. When bone pathology was identified by DXA, we determined the other to exclude other causes of secondary osteopathy and the 24-hour loss of calcium and phosphorus in the urine. RESULTS: Osteopathy was found in 39% of patients, i.e. osteopenia in 26%, osteoporosis in 5% and osteomalacia in 8% of cases. CONCLUSION: The occurrence of relatively high percentages of metabolic osteopathies in patients with chronic pancreatitis may correlate, namely in advanced stages of the disease, with the malabsorption of vitamin D to the enterohepatic circulation. In initial forms of pancreatitis, it is not possible to exclude progression of osteopathy due to changes of the intestinal flora, with disturbance of vitamin D absorption to the intestinal mucosa.

[Spontaneous bacterial peritonitis in the Czech Republic]. / Spontánní bakteriální peritonitida v Ceské republice.

The objective of the study was to assess the prevalence and more detailed data pertaining to the incidence of spontaneous bacterial peritonitis (SBP) in the Czech Republic. The authors examined 99 patients with cirrhosis of the liver and ascites. SBP was diagnosed in a high percentage--35 patients, i.e. 35.4%. It was found more frequently in patients with an alcoholic etiology of cirrhosis who had a history of subfebrile and febrile temperatures and increasing trend of ascites. For the diagnosis the increase of leucocytes in serum and C reactive protein levels may prove useful. Lower values of total protein and albumin in ascites predispose to the development of this infection. Reduction of the number of thrombocytes in the group of patients with SBP indicates the influence of portal hypertension in the etiology of this disease.

[Diagnosis and treatment of chronic vaginal candidiasis]. / Diagnostika a lécba chronické posevní kandidózy.

OBJECTIVE OF STUDY: The objective of the study is to determine the optimum diagnostics of vaginal yeast infections and to compare the effects of treatment of these infections by Natamycin with those by Clotrimazol. TYPE OF STUDY: Prospective comparison of both option of treatment of vaginal infections. NAME AND PLACE OF RESEARCH: Obstetrics and gynaecology department, Brno-Bohunice. METHODS: 30 patients treated with hydrophobe Natamycin and 20 patients treated with hydrophyll Clotrimazol formed a sample of 50 women. Regular checks were made on the 10th and 30th day after the beginning of treatment. Diagnosis was performed by means of native microscopy supplemented by an examination for cultivated yeasts in the culture medium "FUNGI-QUICK". At the same time a microscopic examination of slides stained by Gram and Giems was made. RESULTS: A correlation between the evaluated native slide and the culture examined thereafter was 96%. Statistical evaluation of the difference of the rate of success of treatment between the two groups by means of the t-test revealed a value of 0.29, the level of probability was 0.05 at N1 = 0.1795 and N2 = 0.2179. CONCLUSION: Native microscopy is irreplaceable in the diagnosis of vaginal candidosis. No significant differences in the effects of treatment with Natamycin and Clotrimazol were found. On the basis of these results we made some recommendations on the principles of optimum treatment.

[Prevalence of Helicobacter pylori infection in the Czech Republic--the South Moravia Region]. / Prevalence infekce Helicobacter pylori v CR--region jizní Morava.

The prevalence of Helicobacter pylori is influenced in a significant way by geographical conditions and depends to a certain extent also on the economic standard of different countries. Some published work provides evidence that Helicobacter pylori infections in eastern European countries are in general more frequent than in western European countries. It cannot be ruled out, however, that in different countries there are regional differences as far as Helicobacter pylori is concerned. In a group of 309 subjects, none of those treated previously to eradicate H.pylori, at least three weeks before blood sampling no preparations of the type of H2 blockers, proton pump blockers or drugs containing bismuth were administered. In these patients serological examinations of H.pylori antibodies were made, using kits of TEST-LINE Brno. The examined subjects were divided into six age groups by decades, starting at the age of 20 years. The general prevalence of H.pylori in the examined group was 58.8%, in the group of 20-year-old ones less than 46%. The highest prevalence was recorded in subjects aged 50-59 years and amounted to 67.3%. The authors compare their own results with findings assembled in the Czech Republic and abroad and draw attention to the necessity of an extensive epidemiological survey of H.pylori prevalence in the Czech Republic. The survey should be done by regions, using the same diagnostic method.

Effect of chlorobenzoates on the degradation of polychlorinated biphenyls (PCB) by Pseudomonas stutzeri.

Chlorobenzoic acids (CBA) are frequently dead-end products of partial aerobic biodegradation of polychlorinated biphenyls (PCB). When CBA produced from PCB accumulate in the growth medium, they can inhibit the bacterial growth and consequently, slow down PCB biodegradation. In this study, the effects of seven mono- and dichlorinated CBA on growth of Pseudomonas stutzeri on different substrates and on the PCB degradation by this strain in a liquid mineral medium were tested. 3-CBA was the strongest growth inhibitor for P. stutzeri growing on glucose, benzoate and biphenyl. It was found to inhibit heavily the elimination of some di- and trichlorinated biphenyls. In contrast, its influence on the elimination of more chlorinated congeners was much less significant.

[Results of microbiological examination of 12,064 blood cultures in patients with suspected bacteremia]. / Výsledky mikrobiologického vysetrení 12,064 hemokultur u pacientu se suspektní bakteriémií.

During 1991 to 1993 12,064 blood cultures from patients with suspected bacteraemia were examined in a newly established Microbiology Department of the Brno-Bohunice Faculty Hospital. A total of 1,790 (14.8%) blood cultures were positive, 746 (6.2%) were contaminated. The incidence of positive blood cultures was 7.1/1,000 patients admitted in 1991, 10.0/1,000 in 1993. From the positive blood cultures 853 different microbes were isolated: 486 gram-negative bacteria (56.9%), 315 gram-positive ones (36.9%), 9 anaerobes (1.1%) and 44 yeasts (5.2%). In 69 cases (3.8%) more than one agent was recovered from one blood culture. The most frequently isolated microbes were gram-negative non-fermenting rods other than P. aeruginosa (15.7%), E. coli (12.1%), S. aureus (11.4%) and coagulase-negative staphylococci (10.1%). From direct inoculation of blood 22.6% blood cultures were positive, and another 55.3% positive after 1-day growth in broth. In 1993 there were 306 patients with positive blood cultures; in those blood for the culture was collected during the first 48 hours after admission: in 76 (32.7%) admitted to medical wards, in 7 (9.6%) to surgical wards. The mortality of patients with positive blood cultures was 23.5%.