[Survival Analysis Three-year Follow-up of Pacients with Head and Neck Cancer]. / Analýza prezití tríletého sledování nemocných s rakovinou hlavy a krku.

BACKGROUND: Patients with head and neck cancer are predominantnly at the risk for malnutrition. Monitoring of nutritional status and pre-treatment variables can favorably observe many prognostic indicators for overall survival in head and neck cancer before and during oncological treatment up to three years in head and neck cancer pacients. MATERIALS AND METHODS: In 726 patients diagnosed head and neck cancer patients with curative intent, were collected data according to the monitoring scheme of observation. As a clinical important of uninteded weight loss was defined weight loss 10% in input (T0). Differences in groups were analysed by Coxs regression with adjustments for important demografic and tumor-related data. RESULTS: The acceptance of the percutaneous endoscopic gastrostomy was a key factor for less complications and to improve tolerance of anticancer treatment. Men-smokers have the highest risk of cardiovascular mortality. Men-stop-smokers have the most significant life extension of 11 to 22 months; p < 0.007. Men-non-smokers have a life extension of 15 to 23 months (p < 0.005) and having its lowest cardiovascular mortality (11%). Women tolerate cancer better, have minor subjective complaints and a lower number of complications but significantly higher consumption of antidepressants (p < 0.003). While men have higher analgesic consumption (p < 0.001). Weight loss > 10% significantly correlates with the clinical manifestations of malnutrition and is associated with an increase in complications and mortality dependent cancer (p < 0.008). CONCLUSION: Consistent assessment of nutritional status with early intervention is considered as an essential part of comprehensive anticancer treatment. An independent risk factor for cancer-dependent mortality is considered weight loss of > 5% with a BMI < 21 at time T0 or weight loss > 10% weight T0 in BMI 21- 29 and continuing weight loss to T12 and also BMI 30. The highest-risk profile has a male sex-smoker, age > 63, hypopharyngeal carcinoma, stage III- IV, weight loss of > 10% and non-acceptance of percutaneous endoscopic gastrostomy. Another long-term observation of monitored nutritional status with intervention, clinical status and quality of life are needed.

[Ganciclovir treatment failure in adult allogeneic hematopoietic stem cell transplant recipients with cytomegalovirus infection--a single centre experience]. / Klinická rezistence lidského cytomegaloviru pri lécbe gancyklovirem u pacientu po alogenní transplantaci hematopoetických bunek--zkusenosti jednoho centra.

OBJECTIVE: To determine the incidence of infection with ganciclovir-resistant cytomegalovirus (CMV) in adult allogeneic hematopoietic stem cell transplant (HSCT) recipients. Clinical resistance or treatment failure was defined as persistent DNAemia or increasing viral load in peripheral blood after 2 weeks of virostatic treatment. The association between the treatment failure and viral resistance was analysed. The presence of ganciclovir-resistant CMV strains was confirmed by genotypic testing able to detect mutations conferring resistance. METHODS: In 2012 and 2014, 40 patients who underwent allogeneic HSCT for hematologic malignancies and were treated for human CMV reactivation/disease were followed up prospectively. In patients with treatment failure, CMV DNA was isolated and analysed by nucleotide sequence analysis of the UL 97 and UL 54 genes conferring resistance to the virostatic agent. RESULTS: The treatment failure occurred in seven patients, but ganciclovir resistance conferring mutations were only detected in two of them (mutations L595F and M460I in the UL 97 gene). Another mutation in the UL 97 gene (N510S) was found in a patient with recurrent CMV replication who needed to be retreated but did not meet the criteria for treatment failure. CONCLUSION: The low incidence of genetically confirmed ganciclovir-resistant CMV isolates in HSCT recipients with relatively common clinical treatment failure suggests that the mechanism underlying slower viral clearance is often other than mutations conferring ganciclovir resistance to the virus.

[Long Term Monitoring of Nutritional, Clinical Status and Quality of Life in Head and Neck Cancer Patients]. / Dlouhodobé sledování nutricního, klinického stavu a kvality zivota u nemocných s rakovinou hlavy a krku.

BACKGROUND: Malnutrition in head and neck cancer (HNC) patients decreases survival, quality of life (QOL) and oncological outcomes. The aim of the prospective three-year study was to compare QOL, clinical symptoms and variables (complications, survival and mortality rates in HNC patients). PATIENTS AND METHODS: A total of 726 patients aged 55 to 72 years with treatable HNC were included from January 2004 to December 2009; these patients were randomized to either group with PEG and enteral nutrition and nonPEG group with nutritional counselling according to nutritional care. We used EORTC questionnaires QOL C-30 and Head and neck module (HN-35) for measuring of QOL. The following variables due to expectable influence on QOL (demographic data, oncological data, nutritional screening, Clinical symptom score, Karnofsky performance status score, Charlson comorbidity index) were included. Monitoring was done five times in three years. RESULTS: In the first six months, we found decrease of weight and body mass index (BMI). After this critical time point and finish of oncological treatment, a marked difference in the development of patients treated with PEG. Negative factors influencing patients survival, QOL, clinical status were males aged > 63 years, hypopharyngeal cancer (stage III- IV), smoking, weight loss > 10%, BMI < 21 and disallowance of PEG. CONCLUSIONS: QOL is an essential factor for cancer patients. Our study showed that nutritional intervention with early enteral nutrition may improve QOL and survival in HNC patients. The PEG group better tolerated oncological treatment, had lower incidence of complications, shorter time to re-entry of permanent increase in weight, lower rate of rehospitalization and its shorter length. We found QOL questionnaires to be very important for better understanding and communication and a key instrument for improving solution of patients difficulties during their therapy in multidisciplinary approach.

Antibodies against Pneumococcal Capsular Polysaccharides and Natural Anti-Galactosyl (Alpha-Gal) in Patients with Humoral Immunodeficiencies.

Humoral deficiencies represent a broad group of disorders. The aim of the study was to compare the levels of antibodies against pneumococcal capsular polysaccharides (anti-PCP) and natural anti-galactosyl (anti-Gal) antibodies in (1) patients with chronic lymphocytic leukaemia (CLL), (2) patients with common variable immunodeficiency (CVID), and (3) a healthy population and to explore their diagnostic and prognostic potential. Serum immunoglobulin levels and levels of anti-Gal IgG, IgA, and IgM and anti-PCP IgG and IgG2 were determined in 59 CLL patients, 30 CVID patients, and 67 healthy controls. Levels of IgG, IgA, IgM, anti-Gal IgA, anti-Gal IgM, and anti-PCP IgA were lower in CLL and CVID patients than in healthy controls (p value for all parameters < 0.0001). Decrease in the levels of IgA, IgM, anti-Gal IgA, and anti-PCP IgA was less pronounced in the CLL group than in the CVID group. IgA decline, anti-Gal IgA, anti-PCP IgA, and anti-PCP IgG2 were negatively correlated with CLL stage. We devise the evaluation of anti-Gal antibodies to be a routine test in humoral immunodeficiency diagnostics, even in cases of immunoglobulin substitution therapy. Significant reductions, mainly in anti-Gal IgA, IgM, and anti-PCP IgA levels, may have prognostic importance in CLL patients.

[Assisted reproduction in patients with food intake disorders--clinical and ethical aspects]. / Asistovaná reprodukce u pacientek s poruchou príjmu potravy--klinické a etické aspekty.

Fertilization treatment is established therapy of infertility in the cases, where other approaches have failed or were impossible. In eating disorders, majority of fertility problems has been secondary and so fully reversible if appropriately treated. Fertilization treatment should not be used in patients refusing the psychological treatment of the illness. In patients in active phase of the illness fertility treatment at fertility are contra-indicated. Two cases of negative impact of fertility treatment in patients with anorexia nervosa are presented.

Antagonistic blue- and red-light regulation of cab-gene expression during photosynthetic adaptation in Scenedesmus obliquus.

During adaptation of the photosynthetic apparatus of the green alga Scenedesmus obliquus to various light qualities, the accumulation of chlorophylls and pigment-protein complexes (with specific consideration of chlorophyll a/b-binding (Cab) proteins) and cab-gene expression were determined. The fluence rate dependences for chlorophyll accumulation and cab-gene expression were very different. Very low fluence rates of violet (404 nm), blue (461 nm) and red (650 nm) light below the photosynthetic threshold, i.e. between 10(-3) and 10(-1) mumol m-2 s-1, inhibited all of these reactions in cells grown under heterotrophic conditions. At elevated fluence rates (above 1 mumol m-2 s-1), red light retained its negative regulation, whereas blue light stimulated pigment accumulation. Under autotrophic conditions the pattern was more complex, because chlorophyll accumulation was unaffected by light below the photosynthetic threshold. However, the expression of cab-genes was inhibited by red light but stimulated by blue light. Cells adapted to fluence rates, which ensured photosynthetic energy supply (above 1 mumol m-2 s-1), showed an increase in chlorophyll accumulation, blue light being more effective than red light. The results confirm and extend our previous discovery of two antagonistically acting photoreceptors in Scenedesmus which mediate and coordinate the complex functional and structural changes associated with photosynthetic adaptation. One of these receptor pigments is a blue-light receptor with positive action; the other is a violet-red-light receptor which can operate far below the photosynthetic threshold and exerts a negative regulation.

[Adolescent development]. / Vývoj v adolescenci.

The specificities of the adolescent period are completion of somatic, sexual, emotional, cognitive, intellectual and social maturation. After having coped with this "existential crisis", the adolescents is able to accept new roles, a new identity. Offer described and characterized in detail three types of normal development of adolescents: continual development, accelerated development and precocious development. From the aspect of child and adolescent psychiatry all three described types of development are found in mentally healthy subjects who take life as an open chance.

[Anatomic puppets. (An aid in examinations of sexually abused children)]. / Anatomické loutky. (Pomucka pri vysetrování sexuálne zneuzitých detí.

Evaluation, assessment and statement whether sexual abuse is involved is based largely on the statement of the victim--the child or adolescent. The author describes the differences of games of abused and not abused children. From available sequences recommended and generally accepted during investigations where there is suspicion of sexual abuse she describes in detail the technique of using anatomical dolls.

[Aggression in children and adolescents]. / Agrese u detí a adolescentu.

The author defines the terms aggression and aggressiveness. She discusses the relationships between aggressiveness and neurotransmitters, organic change, aggression and punishment. Aggression as a feature of developmental change, aggression and social ethology, development of violence. She describes the problem of self-damage and self-injuring behaviour. The author analyzes comprehensive therapy of aggressive behaviour-preventive, family, behavioural and psychopharmacological treatment (neuroleptics, incl. atypical ones-doses used in children and adolescents, antidepressants, incl. AD of the third generation, anxiolytics, incl. atypical ones, antiepileptics and lithium). Psychopharmaceutical preparations in self-injuring behaviour are reviewed and problems of external stimulation are analyzed.

[True and false accusations in cases of child sexual abuse]. / Pravdivá a falesná obvinení v prípadech sexuálního zneuzití detí.

The authors deal with the problem of true and false accusations of sexual abuse by children. They try to describe the characteristics of the family system from which the child comes and draw attention to circumstances which may make the truthfulness of the child doubtful. They remind of criteria needed of professional caution as regards conclusions on the truthfulness of statements in cases of sexual child abuse.

[Early onset schizophrenia (case report)]. / Schizofrenie s casným zacátkem (katamnestická studie).

A total of 120 children and adolescents with the diagnosis of schizophrenia were hospitalized at the psychiatric clinic in Prague in 1946-1975. Of the 120 patients (58% males and 42% females) 12.5%, i.e. 15 died by 1988. The results are consistent with data in the literature which pertain to pregnancy, family background, relations with people already before the disease developed, social maladaptation, more frequent loss of a parent, depressive symptoms at the onset of the disease, changes on the EEG and neurological examination. The results differ as regards--1. A much greater hereditary load in grade II relatives 45% (19% psychoses, 14% suicides, 12% alcoholism). 2. A greater hereditary load in grade I relatives-parents and siblings (16% psychoses and suicides, 5% alcoholism, 12% personality disorders). 3. The authors detected more psychoses among grade I relatives 14% (11% schizophrenia, 3% manic-depressive psychosis). The hereditary load in the narrower sense of the word in grade I relatives is significantly elevated 16% (14.5% psychoses, 1.5% suicides). Based on the results pertaining to the 15-42-year catamnestic investigation of education, occupation, attempts to work, a certain socialization, attacks and remissions, the authors elaborated the prognosis. The author's prognosis of early onset schizophrenia: 10% complete cure, 17% remission alternating with relapses, 73% chronic patients (20% are capable of a certain socialization; in 53% permanent care by another person is necessary-this applies to chronic patients with a defect-deterioratio and postpsychotic psychopathization.

[Developmental psychopathology]. / Vývojová psychopatologie.

The author describes the part played by developmental psychopathology in the epidemiology of psychiatric disorders. Analysis of three basic perspectives. The problem of age and developmental trends due to the incidence of certain psychiatric diagnoses at a certain age (in a certain developmental period). Continuity and discontinuity of normal and pathological forms of behaviour from childhood to adult age. Time patterns of continuity in diagnostic categories of depression, behavioural disorders and schizophrenia. Perspective of causal mechanisms, where two pathways seemed feasible: research of factors reducing the deviant behaviour and investigation of harmonious marriages.

[Hyperkinetic disorder--a new view? (Generalized resistance to thyroid hormone)]. / Hyperkinetická porucha--nový pohled? (Generalizovaná rezistence k tyreoidnímu hormonu).

A psychiatric disorder well known for more than fifty years in children and adolescents has changed several times its name. Mild child encephalopathy, minimal (mild) cerebral dysfunction, impaired attention, hyperkinetic disorder. The cause is not known, there is, however, evidence of familial disposition. Symptoms of this disorder were fully manifested in patients with generalized resistance to thyroid hormone. The disease is due to a genetic mutation of the beta-thyroid receptor and characterized by a reduced response of the pituitary and peripheral tissue to thyroid hormone. The authors refer to the work of authors, who discovered the association between the hyperkinetic disorder and generalized resistance to thyroid hormone.

[Diagnosis of behavior disorders according to the ICD-10]. / Diagnostika poruch chování dle ICD-10.

The author defines the character and symptoms of behavioural disorders in childhood and adolescence. The material is classified according to the concept of continuity and discontinuity of psychiatric symptoms or syndromes and diagnostic entities from childhood to adult age.

[Moral development in children]. / Morální vývoj u detí.

In child psychiatry the developmental aspect is emphasized. Recognition of normal sequence of development in so-called "normal children" makes it possible to reveal pathological conditions (either retardation or acceleration of development, distortion or atypical development). Change-motion-development are philosophical categories considered a manifestation or life--of psychobiological maturation and growth. When investigating the moral development three theories were applied: the developmental theory (Piaget)--learning (Kohlberg), the dynamic theory (Sandler). Among factors which influence in a certain way the moral behaviour the following were selected: age, sex, temperament, family environment. The author describes three stages of moral development in children: preventional stage (moral heteronomy) up to the age of 8 years, conventional and pst conventional (moral autonomy) in adolescence.

[Rett's syndrome]. / Rettuv syndrom.

The authors describe Rett's syndrome, its diagnostic criteria--indispensible, supplementary and eliminating symptoms. Historical development and description and prevalence on a world-wide scale. Detailed account of symptoms of different stages, differential diagnosis (in particular of Rett's and Kanner's syndrome). Course of disease and final stage. The aetiology is obscure, the majority of research workers are inclined to accept the assumption of genetic conditioning of Rett's syndrome.