Multilocular infection caused by hypervirulent Klebsiella pneumoniae.

Hypervirulent strains of Klebsiella pneumoniae (hvKP) can cause atypical multilocular infections in otherwise healthy patients. Diagnosis of infection caused by hvKP is based mainly on clinical findings and laboratory results, including detection of virulence genes. It typically manifests as hepatic abscess with metastatic spread. Treatment is based on surgical intervention in combination with targeted antimicrobial therapy. The occurrence of hvKP infection is relatively common in Asia, and while still rare in Europe, incidence is increasing. The article aims to provide a short overview of the issue and increase awareness of the possible occurrence of hvKP infections.

Epidural hematoma - benign or potentially malignant disease?

INTRODUCTION: Epidural hematoma (EDH) is generally considered to be a condition with a good prognosis. However, postoperative results of numerous studies have shown that mortality and morbidity remain relatively high. The aim of our article is to evaluate surgical outcomes in patients undergoing EDH evacuation over the last five years. METHODS: Data were analysed retrospectively. Pre-operative GCS was assessed. Location and incidence of associated head injuries were recorded. Two groups were established: 1. "immediate-care-requiring" and "followed-up" patients. Time interval CT - surgery was measured in the first group and the number of CT scans in the second group. Complications were divided into general and surgical. Outcome was evaluated on GOS. RESULTS: 67 patients underwent the surgery. At admittance, GCS was 13-15 in 55%, 9-12 in 8% and 3-8 in 37% of the patients. EDH was mostly located in the temporal region - in 52%. Associated head injuries occurred in 76%. Mean interval CT - operation lasted 2h 15min in the first group. Two pre-operative CT scans were done in 88% of the patients in the second group. General complications occurred in 34% and surgical in 15%. Mortality rate was 6%. 20% of the patients had a GOS of 1-3 and 80% of them had a GOS of 4-5. CONCLUSION: Our results have shown that morbidity and mortality after EDH evacuation are still relatively high. 14% of the patients remained disabled, and 6% died. The outcome depends mostly on preoperative clinical picture and timing of the surgery. Key words: epidural hematoma - evacuation - neurological outcome - timing of the surgery.

Subdural empyema case report of a rare disease with a high mortality.

Subdural empyema is a rare purulent intracranial infection. Outcome is dependent on the preoperative level of consciousness, therefore an early diagnosis and urgent neurosurgical intervention are necessary. Mortality of subdural empyema remains high, ranging from 6% to 15%. The case report presents a patient with subdural empyema which resulted from sinusitis. The integral and first part of therapy was an urgent neurosurgical drainage of subdural empyema, followed by functional endoscopic sinus surgery performed by ENT surgeon. Conservative treatment consisted of systemic antibiotics and antiedematous therapy. Later the patient developed post-infectious hydrocephalus, which was solved by implantation of a ventriculo-peritoneal shunt. Consequently, cranioplasty was performed. Despite acute onset of the disease and severe neurologic deficit prior to the first neurosurgical intervention, the clinical condition of the patient is favorable after multiple surgeries. The patient is able to live independently without any significant limitations in everyday activities. The presenting symptoms of subdural empyema are reflective of increased intracranial pressure, meningeal irritation, and cerebritis. Radiographic imaging (contrast CT, DWI-MRI, contrast MRI) is an essential diagnostic tool. The integral part of therapy is a neurosurgical evacuation of subdural empyema combined with intravenous antibiotic therapy. Subdural empyema is a rare, rapidly progressing disease which is underestimated by the physicians in many cases. Diagnosis is often delayed and therefore, despite recent progress in treatment, the mortality rate remains high. Key words: empyema - subdural - sinusitis - diagnostic imaging - surgical method.

Benefits of repeated CT scan in patients with neurosurgical-neurological problems in intensive care retrospective analysis.

INTRODUCTION: CT examination of the brain is an integral part of neurointensive care. The examination, however, represents a risk for patients and has side effects. Indications for the procedure should therefore be carefully considered. The aim of the study was to analyze the indications for brain CT and the influence of its result on further treatment. METHOD: A retrospective analysis of CT examinations of the brain performed during 2010 in 263 patients admitted to neurointensive care. The study assessed whether the indication for a CT scan was due to a change in the patient's neurological status or routine, and also whether pharmacological sedation was used. Implications of the CT scan results for the course of treatment were evaluated. RESULTS: 763 CT examinations of brain were performed in the study group. 81% of the patients were under pharmacological sedation at the time of the exam indication, 19% had no sedation and could be clinically evaluated. In both groups, 80% of examinations were indicated on a routine basis. More than half of all CT examination results were evaluated as no change or improvement. Two thirds of them had no impact on the course of further treatment. Results of CT scans indicated due to a change in neurological status led to a change of therapy more often than in routine indications (24.8 vs. 14.2%). The difference was even greater in patients indicated for surgery (19 vs. 8.4%). CONCLUSION: CT scans of the brain are and will continue to be a fundamental part of neurointensive care but cannot replace clinical examination, which is influenced by pharmacological sedation. Results of brain CT scans have led to a change in the course of therapy more frequently when indicated due to a change in neurological status. Rational indication of sedation can contribute to rational indication for brain imaging. Key words: neurointesive care - sedation - CT of the brain.

[Toxic shock syndrome]. / Syndrom toxického soku.

The authors present an up-to-date review of toxic shock syndrome (TSS) - a life-threatening condition where toxins of the Gram-positive bacteria Staphyloccocus aureus and Streptococcus pyogenes play a key role in the pathogenesis. The authors provide insight into the epidemiology and pathogenesis of the disease and point out the relevant patient history data and clinical signs and symptoms that may indicate progression of TSS. Last but not least, the state of the art diagnostic and therapeutic approaches to early and full blown TSS are summarized. Case reports are presented to illustrate two different etiological forms of this relatively rare nosological entity.

[The current view of the diagnosis and management of amebiasis in the light of the authors own case reports]. / Soucasný pohled na diagnostiku a lécbu amébózy ve svetle vlastní kazuistické zkusenosti.

This comprehensive review is focused on a serious protozoan disease, amebiasis. This disease is caused by the human parasite Entamoeba histolytica (E. histolytica), the second leading cause of mortality due to protozoan disease worldwide (the leading cause is malaria). The incidence of amebiasis in the Czech Republic is very low, but it may be underreported as the disease often escapes diagnosis. Intestinal colonisation by E. histolytica may be asymptomatic. The clinical picture ranges from diarrhea to colitis or fulminant colitis when the parasite progresses to the trophozoite stage. Secondary dissemination in the blood or lymph system may induce systemic signs of the disease. Liver abscess is the most common extraintestinal form of amebiasis. The diagnosis of intestinal amebiasis is based on the clinical picture and parasitological examination of the stool. To diagnose extraintestinal amebiasis, serology tests are used to detect antibodies in the blood. Recently, molecular methods have been increasingly used for the detection of the nucleic acids of the pathogen in biological specimens. The first line therapy for amebiasis are 5-nitroimidazole drugs, currently available in the Czech Republic. However, surgical intervention should also be considered in patients with a severe course of the disease. Included in the review are the case reports of patients with severe concomitant intestinal and extraintestinal amebiasis.