Infections and exposure to anti-infective agents and the risk of severe mental disorders: a nationwide study.

OBJECTIVE: Severe infections are associated with increased risks of mental disorders; however, this is the first large-scale study investigating whether infections treated with anti-infective agents in the primary care setting increase the risks of schizophrenia and affective disorders. METHOD: We identified all individuals born in Denmark 1985-2002 (N = 1 015 447) and studied the association between infections treated with anti-infective agents and the subsequent risk of schizophrenia and affective disorders during 1995-2013. Cox regression analyses were adjusted for important confounders. RESULTS: Infections treated with anti-infective agents were associated with increased risks of schizophrenia by a hazard rate ratio (HRR) of 1.37 (95%-CI = 1.20-1.57) and affective disorders by a HRR of 1.64 (95%-CI = 1.48-1.82), fitting a dose-response and temporal relationship (P < 0.001). The excess risk was primarily driven by infections treated with antibiotics, whereas infections treated with antivirals, antimycotics, and antiparasitic agents were not significant after mutual adjustment. Individuals with infections requiring hospitalization had the highest risks for schizophrenia (HRR = 2.05; 95%-CI = 1.77-2.38) and affective disorders (HRR = 2.59; 95%-CI = 2.31-2.89). CONCLUSION: Infections treated with anti-infective agents and particularly infections requiring hospitalizations were associated with increased risks of schizophrenia and affective disorders, which may be mediated by effects of infections/inflammation on the brain, alterations of the microbiome, genetics, or other environmental factors.

[Fluorescence cystoscopy using 5-aminolevulinic acid]. / Fluorescencní cystoskopie za pouzití 5-aminolevulové kyseliny.

BACKGROUND: Fluorescence diagnosis has an increasing importance in different medical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented. METHODS AND RESULTS: From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spots were found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases). CONCLUSIONS: The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.

Convergent strategies for the attachment of fluorescing reporter groups to peptide nucleic acids in solution and on solid phase.

The site-selective conjugation of peptide nucleic acids (PNA) with fluorescent reporter groups is essential for the construction of hybridisation probes that can report the presence of a particular DNA sequence. This paper describes convergent methods for the solution- and solid-phase synthesis of multiply labelled PNA oligomers. The solid-phase synthesis of protected PNA enabled the selective attachment of fluorescent labels at the C-terminal end (3' in DNA) which demonstrated that further manipulations on protected PNA fragments are feasible. For the conjugation to internal sites, a method is introduced that allows for the on-resin assembly of modified monomers thereby omitting the need to synthesise an entire monomer in solution. Furthermore, it is shown that the application of a highly orthogonal protecting group strategy in combination with chemoselective conjugation reactions provides access to a rapid and automatable solid-phase synthesis of dual labelled PNA probes. Real-time measurements of nucleic acid hybridisation were possible by taking advantage of the fluorescence resonance energy transfer (FRET) between suitably appended fluorophoric groups. Analogously to DNA-based molecular beacons, the dual labelled PNA probes were only weakly fluorescing in the single-stranded state. Hybridisation to a complementary oligonucleotide, however, induced a structural reorganisation and conferred a vivid fluorescence enhancement.

[Percutaneous antegrade endopyelotomy]. / Perkutánní antegrádní endopyelotomie.

Between 1987 and 1996 forty eight endypyelotomies (EPT) were performed in our institute on account of ureteropelvic junction (UPJ) obstruction. Forty three obstructions were primary, five secondary. Three EPT were made under fluoroscopic control but with poor results. Twenty one EPT were antegrade, percutaneous and 24 EPT were retrograde, ureteroscopic. The criteria of EPT as successful were improvement of radiological parameters, patient symptomatology and urinary bacteriology. The overall success rate of antegrade EPT was 81%. The results of retrograde EPT are similar as the antegrade ones, but follow up is too short to evaluate them. The results support the view, that EPT should be considered as first choice therapy for most UPJ obstructions.

[Subjective symptoms before and after prostate surgery. The International Symptom Scoring System, I-PSS]. / Subjektivní príznaky pred a po operaci prostaty. Mezinárodní symptomový skóring I-PSS.

In this thesis are evaluated the questionnaires of the I-PSS retrieved from 415 patients (TVPE 104, TURP 272, TUIP + PRP 25 and TUIP 14) operated on the BPH at the department of Urology, FN Motol, during 1988-1993. The average value of S in the whole group of patients was 18.9 in the pre-surgery period and 6.9 after surgery. Before the surgery, the prominent difficulties were recorded in 50.8% of patients (S = 20-35) and after surgery this number fell down to 7%. Without any major difficulties (S = 0-7) were 66.3% of patients after the surgery. The average value of L before and after surgery was 4.2 and 1.6 respectively. The quality of life after the surgery was perceived by the patients more convenient than should correspond to the symptom scoring value. The best results (both the average S and L) were recorded in patients after TVPE (S 5.1 and L 1.1), followed by TURP (S 7.4 and L 1.7), than TUIP + PRP (S 8.4 and L 2.1) and only TUIP alone closed scale (S 8.9 and L 2.4). The differences of postsurgery S and L are statistically significant (p < 0.05). The comparison between the subjective better performance and the quality of life, when taken from TVPE resp. TURP point of view, does not prove to be the statistical difference. The comparison between S changes after the standard operation (TVPE and TURP) and minor prostatic surgery (TUIP + PRP and TUIP) also does not occur as statistically significant. Only the quality of life (L changes) is recorded by the patients as significantly worse after the minor prostatic surgery (p < 0.05). The pre-surgery worst perceived symptoms are: weak stream, nycturia and polakisuria (questions Nr. 5.7 and 2). After the surgery, nycturia is the leading worst symptom.

[Results of surgical treatment of benign prostatic hyperplasia]. / Výsledky chirurgické lécby benigní hyperplazie prostaty.

The authors have evaluated the results of the BPH surgery in the computer study on 669 patients (out of them 181 after TVPE and 488 after TURP) operated on at the department of Urology, FN Motol during 1988-1992. The average age of the patients was 70.6 years. The occult cancer was found in 6.7%. The incidence of bladder stones rose with the age (in the 8th decade at the quarter of patients). The average weight of the resected tissue was 63.7 gms in TVPE and 16.7 gms in TURP and it rose with the age. The average surgery time 47.1 mins at TVPE and 50.8 mins at TURP did not change statistically. The average demand on the blood transfusion was higher at TVPE (440.1 mls) than at TURP (95.5 mls) and rose with the resected tissue. The death rate was 0.5% among all the patients included (TVPE 0, TURP 0.6%). All three patients after TURP died from myocardial infarction. In this thesis is evaluated the number of early and late complications (incl. the transient incontinence), which have occurred in five consecutive years. The total morbidity was 27.2% and the further surgery was necessary in 2.8% after TVPE and 5.7% after TURP respectively. The pre-surgery performance status was aggravated in 79.4% of patients. In spinal anesthesia was operated on in 84.2% (subarachnoidal 56.5% and epidural 27.7%) and in general anesthesia in only 15.8% of patients. The pre-surgery urinary infection was found in 38.7% and after operation in 29.3%. Out of the latter, 30% were nosocomials. This was in accordance with the higher rate of late complications after both types of operations.

[Sexual consequences of benign prostatic hyperplasia]. / Sexuologické konsekvence benigní hyperplazie prostaty.

In this thesis are evaluated the sexual questionnaires retrieved from 412 patients (TVPE 101, TURP 272, TUIP + PRP 25, TUIP 14), who had been operated on during 1988-1993 for the BPH at the department of Urology, FN Motol. Before the surgery, 69.7% of patients were sexually active yet (28.6% regularly, 41% irregularly). Without sexual intercourse were 29.9% in the time of surgery and 2 patients (0.5% did not respond the questions. The sexual activity was rapidly declining in the 7th decade, in the 8th decade still 41% of the patient argued sexual activity prior to surgery. The libido remained unchanged in 62.9%, worsened in 24.3% and improved in 10.7%. The changes in libido was neither parallel to the aging nor the type of prostatic surgery. After the surgery, the intercourse was admitted only by 49.3% of patients. Without any intercourse remained 50%. The difference compared to the pre-surgery responds is statistically proved (p < 0.01). The erectile dysfunction seemed to be the main cause of sexual intercourse decline. The impotence margin after TVPE or TURP is not statistically significant. On the other hand, the reawakening of the sexual activity at the patients, who had already not experienced intercourse preoperatively, was recorded only in 6 cases (1.5%). The unchanged ejaculation after surgery argued 13.1% of patients, the weaker ejaculation was recorded in 21.6% of patients and ejaculation was completely absent in 62.4% (retrograde ejaculation). Between TVPE and TURP was no significant margin found. The ejaculation damage after minimal prostatic surgery (TUIP + PRP and TUIP alone) is significantly minor (p < 0.01) than after the standard prostatectomy (TVPE and TURP).

[Percutaneous nephrolithotomy]. / Perkutánní nefrolitotomie.

Within eight years, since October 1985 till June 1993, we had been operating on 409 patients, who had been subjected to 500 percutaneous nephrolithotomies. In 30% per cent of all the operations we had used mechanical, electrohydraulic or ultrasound lithotripsy. Out of the total number of the patients, 7 per cent had been discharged with the residual stones, but in 5.6 per cent the ESWL or spontaneous exodus had been presumed. Serious complications we had registered at 10 patients (e.g. 2 per cent of all operations). None of them however had required an emergency nephrectomy. The authors discuss the today's position of the PNL among the other operative methods of treatment of urolithiasis.

[Personal experience with uretero-renoscopy]. / Nase zkusenosti s ureterorenoskopií.

The authors submit evaluation of 188 patients operated on during five years (1989-1993). Using the ureterorenoscopic technique (URS), 207 operations have been performed. The average age in the group of patients was 56.1 years. In general anesthesia 151 operations were completed, in spinal anesthesia 54, in neuroleptanalgesia 1 and without any anesthesia 1. The postoperative ureteric intubation was accomplished 128 times (61.8%). The moderate dilatation of the hollow system of the kidney was proved ultrasonographically in only 7 cases. The average postoperative hospitalization reached 5.8 days. Out of 207 operations, we have reached successful result 177 times (85.5%) and 30 times (14.5%) we were not able to accomplish the operation only by means of the URS. 184 operations were performed because of urolithiasis (88.9%) and 23 (11.1%) for other reasons. Out of 184 URS for urolithiasis, 156 (84.8%) were successful and there was no difference found between pelvic (85.4%) and lumbal (83.6%) localization of urolithiasis in the view of success rate. The authors summarize the causes of mishaps and following solutions. The biochemical analyses of 153 concrements are added.

[Generalized melanoblastoma of the lower urinary tract]. / Generalizovaný melanoblastom dolních mocových cest.

The primary metastatic melanoblastoma presented with macroscopic haematuria as a first sign is described. So far it is our first experience with such a type of tumor in lower urinary tract in ageing man. The references in literature are scarce on this subject.

[CT in the prognostic evaluation of apoplexy]. / CT i prognostisk apopleksivurdering.

The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke. Two-hundred and forty-five consecutive stroke patients were included. Each underwent detailed neurological assessment and cranial computed tomography without intravenous contrast injection. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model. Computed tomography showed that 76% of the patients had infarcts. 11% had haemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarcts. The temporal, parietal and frontal regions and the basal ganglia were most often affected. We concluded that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.

Computed tomography in prognostic stroke evaluation.

BACKGROUND AND PURPOSE: Computed tomography is now routinely used in many hospitals to investigate cerebrovascular disease. The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke. METHODS: Two-hundred forty-five consecutive stroke patients were included in the project during a 1-year period. Each had a detailed neurological assessment 24-72 hours after stroke onset and underwent cranial computed tomography without intravenous contrast injection within the first week after admission. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model with survival/death as the binary variable. RESULTS: Computed tomography showed 76% of the patients had infarcts, 11% had hemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarctions. The temporal, parietal, and frontal regions and the basal ganglia were most often affected. CONCLUSIONS: We conclude that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.

[Is implantation of a unipolar femoral endoprosthesis obsolete?]. / L'implantation d'endoprothèses fémorales unipolaires est-elle obsolète?

The authors are presenting a retrospective study of the long-term results of 702 femoral cephalic endoprostheses (451 unipolar and 251 bipolar prostheses). The mean age of the patients at operation was 80.1, in the majority of the cases the indication was a fracture of the femoral neck. The average follow-up was 33 months for the unipolar, and 24 months for the bipolar prostheses. The rate of reoperations is similar in both series, but the rate of dislocations is slightly lower for the unipolar prostheses. 82 patients (out of 120 surviving) have been controlled with an average follow-up of 6.51 and 4.76 years. The unipolar prostheses have a lower average New Mayo Hip Score (58.5 vs. 68.2). Radiologically, there are 7 acetabular protrusions in the group of unipolar prostheses and none in the other group. If both types of prostheses have their place in surgery of the hip, the authors recommend to implant bipolar prostheses in younger and more active patients, where a survival of many years is expected.

[Pregnancy and Parkinson disease]. / Graviditet og Parkinson's sygdom.

Parkinson's disease rarely occurs in women of the fertile age. A case in a woman aged 42 is reported. The diagnosis of Parkinson's disease was established three years before her second pregnancy. Medicinal treatment with antiparkinson drugs during pregnancy is briefly discussed.

[Cephalic prosthesis for fractures of the femoral neck (702 cases). Comparative results of simple and intermediate cephalic prostheses]. / Prothèse céphalique pour fracture du col fémoral (702 cas). Résultats comparatifs des prothèses céphaliques simples et des prothèses intermédiaires.

The authors are presenting a retrospective study of the long time results of 702 femoral cephalic endoprostheses, 451 unipolar and 251 bipolar. The mean age of the patients at the moment of intervention was 80 years, the operation was done in the majority of the cases for a fracture of the femoral neck. The average follow-up was 33 months for the unipolar, and 24 months for the bipolar prostheses. The rate of reoperations was similar in both series, but the rate of luxations was slightly lower for the unipolar prostheses. 82 patients (out of 120 surviving) have been controlled with an average follow-up of 6.5 and 4.5 years. The unipolar prostheses had a lower average New Mayo Hip Score (58.5 vs. 68.2). Radiologically, there were 7 acetabular protrusions in the group of unipolar prostheses and none in the other group. If both types of prostheses have their place in surgery of the hip, the authors recommend to implant bipolar prostheses in younger and more active patients, where a survival of many years is expected.

Branched chain enriched amino acid versus glucose treatment of hepatic encephalopathy. A double-blind study of 65 patients with cirrhosis.

We studied the effects of infusion of a branched chain enriched amino acid mixture versus glucose on acute hepatic encephalopathy in patients with cirrhosis. Sixty-five patients were randomly treated with 1 g/kg per day of an amino acid mixture with 40% branched chain contents (32 patients), or isocaloric glucose (33 patients) for a maximum of 16 days. The regimens further included glucose infusion to a total of 26.5 kcal/kg per day and lactulose. The patients took part in the study for 5-6 days. In each group 17 patients woke up. In the amino acid group eleven died and four developed renal failure. In the glucose group ten died, three developed renal and two respiratory failure, and one remained encephalopathic. The coma score worsened in three of the patients who died in the amino acid group, but in all patients who died in the glucose group. The negative nitrogen balance on entry reversed in the amino acid group, but not in the glucose group. Thus, the branched chain enriched amino acid supplement did not change the prognosis for wake-up, but had other effects on the cerebral state and on nitrogen homeostasis.

Life events and social support in prediction of stroke outcome.

A prospective study of 252 patients (average age 73, range 26-95) admitted to a regional general hospital over a 12-month period was carried out. 241 patients had stroke verified by the initial neurological examination and CT scan, and of these baseline data were not available on 27%. 34% died before or were not willing or able to provide data at follow-up. 39% survived and completed the study. Prestroke life events and social support could not predict the outcome of stroke rehabilitation measured as survival, length of stay, functional recovery (Barthel's Index) or placement at the follow-up 12 months after the onset of stroke. Age and arteriosclerotic heart disease predicted poor survival at follow-up. Premorbid hypertension, stroke, diabetes, obesity, tobacco smoking, and alcohol consumption did not significantly influence the outcome. Problems in stroke rehabilitation research are discussed.

Misonidazole neuropathy. A prospective study.

The frequency with which polyneuropathy developed was investigated in patients with cancer of the larynx and pharynx who participated in a double-blind trial of the radiosensitizing drug misonidazole. Fourteen of 36 patients receiving misonidazole (total dose of about 11 g/m2) developed neuropathy, while this occurred in only 2 of 34 patients in the placebo group. Vibration perception threshold increased in all patients who developed neuropathy, but also in 12 (5 misonidazole and 7 placebo treated) without other symptoms or signs of neuropathy. Pharmacokinetic studies of misonidazole revealed a correlation between development of neuropathy and a high 'peak plasma concentration/g misonidazole in each fraction' and especially a high 'area under plasma concentration curve/g misonidazole in each fraction'.

Misonidazole neuropathy.

Neurotoxic side effects of misonidazole with peripheral neuropathy was investigated in two series of patients. The first series consisted of eight patients with carcinoma of the pharynx, larynx or lung who, during treatment with misonidazole, developed peripheral neuropathy dominated by severe sensory symptoms and signs localized mainly to the lower extremities. Misonidazole was given for three to seven weeks in a total dose of 9.6 - 12.6 g/m2 (11 g/m2 or more in four of the patients). The symptoms subsided partially within a few months after cessation of the therapy. Electrophysiological and histological findings indicated axonal neuropathy with loss of large fibres and secondary demyelination. The second series consisted of 70 patients with carcinoma of the pharynx or larynx who, in addition to radiotherapy, were given either placebo or misonidazole over four weeks in a total dose of 11 g/m2. Fourteen patients out of 36 receiving misonidazole (38%) developed peripheral polyneuropathy, mostly in the feet, while this occurred in only two of the 34 patient placebo group.