Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre.

BACKGROUND: Incidence of anal carcinoma is increased in people living with HIV (PLWH). Due to the improved life expectancy in PLWH, identifying appropriate prevention strategies for non-AIDS-defining cancer types such as anal carcinoma has become a priority in managing PLWH today. OBJECTIVE: We aimed to evaluate anal cytology assessment as screening tool for anal dysplasia and/or carcinoma in PLWH, regardless of gender or sexual orientation. Additionally, we investigated the correlation between cancer risk factors and abnormal screening results in our patient cohort. METHODS: People living with HIV from the Interdisciplinary HIV Centre of the University Hospital rechts der Isar in Munich, Germany (IZAR), were screened for anal carcinoma by single cytobrush examination and anal Papanicolaou (PAP) smear assessment from 2013 to 2015. Patients with abnormal PAP smear result were offered a follow-up examination after 12 months. Differences between two groups were tested for statistical significance using Student's t-test and Mann-Whitney U-test, as appropriate. RESULTS: In total, 101 PLWH were included. 26.7% of subjects (n = 27) were PAP IIID, and 9.9% (n = 10) were PAP IVa. Seven female subjects had an abnormal finding at screening. Smoking was significantly associated with abnormal findings at screening (P = 0.005). In addition, our study found an association between sexually transmitted infections (STI) and anal dysplasia. Condylomata acuminata were increased in subjects with PAP IIID/PAP IVa (P = 0.045). Reactive syphilis serology was found to be significantly associated with abnormal screening results (P = 0.016), respectively. CONCLUSION: Our results demonstrate that smoking and two common STIs, condylomata acuminata and syphilis, are risk factors associated with advanced anal intraepithelial neoplasia (AIN) stages in our PLWH cohort. While further analysis is needed to determine diagnostic guidelines concerning AIN in PLWH, these results suggest that interdisciplinary lifestyle prevention strategies are required to reduce the risk factors for AIN in PLWH in an outpatient setting.

[Technique of implantation and experience with temporary mechanical cardiac support in right ventricular failure]. / Technika implantace a zkusenosti s docasnou mechanickou srdecní podporou pri selhání pravé komory.

AIM: Severe right heart failure remains unfrequent but fatal complication of cardiac surgical procedures. Implantation of temporary right ventricular assist device may be life-saving procedure in various situations of right heart failure as: heart transplantation, LVAD therapy and post-cardiotomy failure. The aim of the study is an introduction of the implantation technique and retrospective review of current experience with the method. MATERIAL AND METHODS: Since January 2007 isolated right ventricular assist device Levitronix CentriMag has been implanted in 16 patients. Patients were divided into 3 groups: post transplantation (post-Tx), post LVAD implantation (post-LVAD) and other cardiac procedures (OCP). Success rate of weaning from RVAD, 30-days mortality and major complications has been assessed. OUTCOMES: Distribution of implants in groups was: post-Tx 5 pts (31%), post-LVAD 6 pts (38%) and 5 in OCP group (31%). The mean support time was 12 days. Off-pump implantation was achieved in 9 pts. The device was successfully weaned in 13 (81%) patients. 30-days mortality occurred in 1 case only. CONCLUSION: Presented outcomes are encouraging for broader acceptance of the therapy. Excellent success rate has been reached in post-Tx and post-LVAD. This study emphasises decesive role of proactive approach in early indication of RVAD implantation for achieving satisfactory results.

[Cardiosurgical procedures in patients refusing blood transfusions: IKEM outcomes]. / Kardiochirurgické operace u pacientu odmítajících krevní transfuze: výsledky v IKEM.

INTRODUCTION: Jehovah's Witnesses who require cardiac operation represent a specific challenge to the physicians. Members of this faith will not accept blood or blood products under any circumstances on the basis of religious grounds. Nevertheless cardiac operations belong to surgical interventions with potential severe bleeding and necessity of blood transfusions. THE AIM OF THE STUDY: The aim of this retrospective study was to analyze clinical data, operative and postoperative courses of patients operated at IKEM who refused blood transfusions. METHODS AND RESULTS: From January 1995 to August 2010, 73 Jehovah's Witnesses ranging in age from 19 to 82 years underwent cardiac surgery at our institute. Aortocoronary bypass were performed in 34 patients, valve surgery in 25 patients, 6 patients underwent concomitant aortocoronary bypass and valve surgery, 2 patients underwent aortocoronary bypass and resection of the left ventricle aneurysm and 2 patients underwent atrial septal defect repair and tricuspid valve anuloplasty. Ventricular septal sefect repair, atrial septal defect repair, Cor Cap device implantation and left ventricular epicardial electrodes implantation were performed in the other patients. Early 30-days mortality was 2.8 % (2 patients). CONCLUSION: We can conclude that cardiac surgery in Jehovah's Witnesses can be performed safety without blood transfusion and belongs to standard operating procedures at our institution.

Late effect of early hypoxic disturbance in the rat heart: gender differences.

Perinatal hypoxemia may have serious long-term effects on the adult cardiovascular system and may lead to sex-dependent changes in cardiac tolerance to acute ischemia in adult life. The aim of the study was to answer the question whether gonadectomy of the male and female rats in the early phase of ontogenetic development affects the late effect of perinatal hypoxia. Pregnant Wistar rats were placed into a normobaric hypoxic chamber (12 % O(2)) 7 days before the expected date of delivery. Newborn pups were kept in the chamber with their mothers for another 5 days after birth. After hypoxic exposure all animals were kept for 3 months in room air. Some of the pups were gonadectomized right after removal from the hypoxic chamber. Ventricular arrhythmias were assessed on isolated perfused hearts. Castration did not influence arrhythmogenesis in the adult normoxic or perinatally hypoxic female hearts. Nevertheless, the number of arrhythmias was decreased in perinatally hypoxic gonadectomized males. In conclusion, we have shown that perinatal normobaric hypoxia increased cardiac tolerance to acute ischemia in adult male rats; however, it had no late effect in females. Gonadectomy did not affect arrhythmogenesis in both normoxic and hypoxic female hearts, whereas in males significantly decreased the number of arrhythmias.

[Management of deep device related infection in patient implanted with mechanical cardiac support device using V.A.C. system]. / Terapie závazných raných infekcí u pacientu se zavedenou mechanickou srdecní podporou pomocí V.A.C systému.

Infection remains the most significant cause of morbidity and mortality in pacients implanted with mechanical circulatory support devices (MCSD), reaching prevalence of 40-60% according various authors. Successful treatment of the whole spectrum of infectious complications is the basic determinant in archieving good results in MCSD patients. The treatment involves standard surgical procedures, as well as the use of vacuum assisted closure (V.A.C.) therapy in the last few years. We demonstrate successful management of deep device related infection using V.A.C therapy in a patient with MCSD, giving him the opportunity to heart transplantation, and thereafter successful treatment of poststernotomy mediastinitis in this imunosupressed pacient after heart transplantation.

Spironolactone and hydrochlorothiazide in normal-renin and low-renin essential hypertension.

The relative blood pressure response and side effects of spironolactone (S), 400 mg/day, and hydrochlorothiazide (H), 100 mg/day, were evaluated in a double-masked crossed comparison. Subjects were 24 essential hypertensives, 13 normal and 11 with low renin activity. Upright renin levels were determined in the AM after 3 days of moderately low sodium diet (less than 100 mEq/day) and at the end of each drug treatment period. The values were not revealed to one investigator until completion of the study. After 4-week placebo control periods, either S or H was given in divided doses for 6 weeks. Blood pressure measurements and side effects were evaluated at biweekly intervals. The fall in blood pressure from control was the same for each drug and was independent of renin activity. Side effects occurred more often in patients treated with S, and H was judged superior by risk/benefit analysis. We conclude that S is no more beneficial than H in hypertensive patients with either low or normal renin activity but induces a higher incidence of adverse effects in the dose used in this study. We found no evidence for a greater effectiveness of S in low-renin essential hypertension.

Plasma glucagon in simple obesity: effect of exercise.

Obesity is uniformly associated with hyperinsulinemia, but studies of glucagon have produced conflicting results. We have studied glucagon, insulin, and growth hormone levels in response to a submaximal exercise in a group of normal and obese nondiabetic women. Basal plasma insulin levels were higher in the obese women and remained so throughout the experiment. Fasting and post exercise glucagon levels were similar in both groups. Basal growth hormone levels were lower in the obese group and remained suppressed, whereas a significant increase in growth hormone levels was observed among normal women in response to exercise. We conclude that in response to a submaximal exercise the glucagon levels in obese women are not different compared to normal, despite hyperinsulinemia and suppressed growth hormone levels in the former.

Synthesis of the Lewis b hexasaccharide and squarate acid-HSA conjugates thereof with various saccharide loadings.

The Lewis b hexasaccharide, alpha-L-Fucp-(1 --> 2)-beta-D-Galp-(1 --> 3)-[alpha-L-Fucp-(1 --> 4)]-beta-D-GlcpNAc-(1 --> 3)-beta-D-Galp-(l --> 4)-beta-D-Glcp, has been synthesised using a convergent synthesis. Starting from ethyl 4,6-O-benzylidene-2-deoxy-2-phthalimido-1-thio-beta-D-glucopyranoside, a thioglycoside tetrasaccharide donor block, was constructed through two orthogonal glycosylations with glycosyl bromide donors. First, the galactose moiety was introduced using silver triflate as a promoter and then the two fucose residues under halide-assisted conditions. Finally, this tetrasaccharide was linked to a spacer-equipped 3I,4I-diol lactose acceptor in a DMTST-promoted coupling to give, after deprotection, the Lewis b hexasaccharide as its 2-aminoethyl spacer-equipped derivative. This was coupled to human serum albumin (HSA), using the squarate ester methodology, in various saccharide-protein ratios, to give neoglycoconjugates with different saccharide loadings in about 50%) efficiency.

Synthesis of colitose-containing oligosaccharide structures found in polysaccharides from Vibrio cholerae O139 synonym Bengal using thioglycoside donors.

The syntheses of the two colitose-containing trisaccharides 8-methoxycarbonyloctyl (3,6-dideoxy-alpha-L-xylo-hexopyranosyl)-(1-->2)-beta-D-galactopyranosyl -(1-->3)-2-acetamido-2-deoxy-beta-D-glucopyranoside and 8-methoxycarbonyloctyl beta-D-galactopyranosyl-(1-->3)-[(3,6- dideoxy-alpha-L-xylo-hexopyranosyl)-(1-->4)]-2-acetamido-2-deoxy-beta-D- glucopyranoside, and tetrasaccharide 8-methoxycarbonyloctyl (3,6-dideoxy-alpha-L-xylo-hexopyranosyl)-(1-->2)-beta-D-galactopyranosyl - (1-->3)-[(3,6-dideoxy-alpha-L-xylo-hexopyranosyl)-(1-->4)]-2-acetamido-2 -deoxy- beta-D-glucopyranoside are described. The oligosaccharides correspond to structures found in the capsular polysaccharide and the lipopolysaccharide of Vibrio cholerae O139 and also to lipopolysaccharide structures of E. coli O55 and Salmonella greenside. The colitose residues were introduced via dimethyl(methylthio)sulfonium trifluoromethanesulfonate promoted glycosylations using colitose thioglycosides as glycosyl donors.

Sexual abuse of children: clinical findings and implications for management.

To increase understanding of childhood sexual abuse, we reviewed the hospital records of 113 girls and 17 boys who were the victims of sexual offenses. They were two to 16 years of age and seen in an 18-month period. Thirty had had medical or social problems. Four had previously been raped. Children under eight years old were more likely to know the assailant, to be victims of recurrent sexual or physical abuse, to report crimes without intercourse, and to present with an abused sibling (P less than 0.05). Incest victims were younger than other victims (P less than 0.05). Forty-three children had physical trauma. No pregnancies occurred, although diethylstilbestrol was not routinely used. Three girls had gonorrhea. Seventy-two patients were referred to hospital social services, and 41 to 17 other agencies. Victims and their siblings are at high risk of repeated abuse. Antibiotics and diethylstilbestrol are not routinely indicated. Follow-up may be best achieved by a central agency.