Comparison of clinical and laboratory characteristics during two major paediatric meningitis outbreaks of echovirus 30 and other non-polio enteroviruses in Germany in 2008 and 2013.

Viral meningitis is mainly caused by non-polio enteroviruses (NPEV). Large-scale data on the clinical characteristics between different outbreaks within the same region are lacking. This study aimed to analyse a possible influence of the circulating NPEV genotype on the disease outcome of affected children. A retrospective cohort study analysing two major outbreaks of NPEV meningitis in Germany in 2008 and 2013 was conducted in cooperation with the National Reference Centre for Poliomyelitis and Enteroviruses (NRC PE) and five German children's hospitals. A total of 196 patients with laboratory-confirmed NPEV meningitis were enrolled. In 2008, children with NPEV meningitis had significantly higher fever and showed more behavioural changes and less back pain. To better define typical findings in echovirus 30 (E-30) meningitis, patients were split into the following three groups: E-30 positive patients, patients with "Non E-30" infection and patients with "Untyped" NPEV infection. E-30 positive patients were significantly older and their disease course was more acute, with early admission to but also early discharge from hospital. E-30 positive patients showed a significantly higher rate of headache and meningism, and a lower rate of diarrhoea and clinically defined septicaemia when compared to the others. Regarding laboratory testing, E-30 positive patients presented with significantly elevated peripheral blood neutrophil counts when compared to patients with "Non E-30" or "Untyped" NPEV infection. In conclusion, E-30 meningitis in children shows a characteristic pattern of clinical features. To further characterise NPEV strains worldwide, continuous surveillance and typing of NPEV strains causing central nervous system disease is warranted.

Urine neopterin concentrations as a marker for successful blastocyst implantation after assisted reproductive technologies.

Successful blastocyst implantation requires intricately orchestrated adaptation processes involving maternal and fetal mediators. The pivotal role of distinct immune response pathways in early pregnancy is widely acknowledged. Pro-inflammatory cytokines, e.g. interferon-gamma (IFN-gamma), are the primary inducers of tryptophan-degrading enzyme indoleamine 2,3-dioxygenase (IDO) and of neopterin biosynthesis by GTP-cyclohydrolase I. IDO activity has been proposed to be of high clinical relevance in the context of pregnancy. To date, insights arising from clinical studies on IDO activity and neopterin concentration during the very early days of pregnancy are still few. Early morning urinary neopterin concentrations in 61 women undergoing assisted reproduction treatment (72 cycles in total) were examined, upon exclusion of infections, daily over a period of 2 weeks after embryo transfer. Twenty of the study participants (28%) became successfully pregnant, and four women experienced abortion. Neopterin concentrations significantly increased after blastocyst transfer when implantation was successful (chi-squared=23.291, P<0.01; Friedman test), opposed to non-significant changes of neopterin in women with unsuccessful treatment (chi-squared=8.203). The steady increase of neopterin concentrations upon blastocyst transfer indicates that heightened production of neopterin in very early phases of pregnancy may serve as an early predictor of successfully progressing pregnancies in humans.

[Treatment of hernia ventralis permagna]. / Resení obrovských ventrálních hernií.

The authors present case report about two patients with hernia ventralis permagna. Both patients were treated urgently for strangulation in hernial bag. The elective surgery was delayed for various reasons and, at the end, they were operated acutely using the polypropylene net. The authors prefer the more active approach to the indication of elective surgery.

[Postoperative pulmonary thromboembolism and nosocomial pneumonias: differential diagnosis]. / Pooperacní plicní tromboembolie a nozokomiální (tzv. pooperacní) pneumonie: diferenciální diagnóza.

After a surgical intervention patient can face pulmonary complication that was formerly recognised as postoperative pneumonia. This term described the clinical picture which was diagnosed after abdominal or thoracic operations, after polytraumatic lesions, especially with elderly patients that were for a longer time confined to bed rest. The clinical symptoms incl. the X ray picture were consistent with those of pneumonia - such pneumonias are nowadays classified as nosocomial infections. These complications sometimes ended fatally. The post-mortem examination revealed either pneumonia or often pulmonary thromboembolism (PTE). Occasionally it happened that PTE was incorrectly clinically diagnosed as pneumonia and the patient was treated with antibiotics instead of with heparin. The present paper brings discussion on the differential diagnosis between postoperative nosocomial pneumonia and PTE. Clinical casuistic is also added.

Rhinovirus inhibits IL-17A and the downstream immune responses in allergic asthma.

The proinflammatory cytokine interleukin-17A (IL-17A) is known to mediate antimicrobial activity, but its role during rhinovirus (RV) infections and in asthma needs further investigation. Therefore, we addressed the role of IL-17A during allergic asthma and antiviral immune response in human and murine immunocompetent cells. In this study we found that asthmatic children with a RV infection in their upper airways have upregulated mRNA levels of the antiviral cytokine interferon type I (IFN)-ß and the transcription factor T-box 21 (TBX21) and reduced levels of IL-17A protein in their peripheral blood mononuclear cells (PBMCs). We also found that IL-17A inhibited RV1b replication in infected human lung epithelial cells A549. Furthermore, by using gene array analysis we discovered that targeted deletion of Il17a in murine lung CD4(+) T cells impaired Oas1g mRNA downstream of Ifnß, independently from RV infection. Additionally, in PBMCs of children with a RV infection in their nasalpharyngeal fluid OAS1 gene expression was found downregulated. Finally RV1b inhibited IL-17A production in lung CD4(+) T cells in a setting of experimental asthma. These results indicate that the RV1b inhibits IL-17A in T helper type 17 cells and IL-17A clears RV1b infection in epithelial cells. In both cases IL-17A contributes to fend off RV1b infection by inducing genes downstream of interferon type I pathway.

The effect of fructose infusions in the course of labor upon parturient and fetus.

Fructose infusions were administered to parturients with healthy term fetuses at a speed of 1 g/min for 106 on the average. The results confirm that fructose has the expected properties. The blood glucose and FFA levels show that a substantial part of the infused fructose is indeed stored and that only a small portion is used to cover immediate energy needs. This positive result is predominant by a considerable degree of acidosis arising in the parturient in spite of the fact that fructose was infused at a slower rate than in the majority of papers published so far. Since the fructose infusions were intended for premature fetuses, which already have an increased tendency toward acidosis, the results confirm the unsuitability of such a treatment.

[Comparison of treatment of fractures of the tibia by plates and by küntscher nails.]. / Srovnání výsledku osetrení zlomenin tibie dlahovou technikou a Küntscherovým hrebováním.

In a retrospective investigation the authors compare the results achieved in a group of casualties with a fresh fracture of the tibia/fracture of the leg as a single injury, who were treated by osteosynthesis with a plate (15 patients) or an intramedullary Küntscher nail (19 patients). The two groups were evaluated as identical and the achieved results do not differ significantly. An intramedullary nail has a wider range of use, it is irreplaceable in fractures with a long comminuted zone or fractures at different levels. Satisfactory results can be obtained by both approaches, if the indication is adequate. Key words: fractures of the tibia (leg), synthesis with the plate technique, synthesis with an intramedullary nail, comparison of groups.

[Feminar with whey (serum) proteins prepared by thermal denaturation. Nitrogen and lipid balance in neonates with a low birth weight]. / Feminar se syrovátkovými (sérovými) bílkovinami pripravenými termální denaturací. Dusíkové a tukové bilance u novorozencu nízké porodní hmotnosti (NNPH).

For the newborn with low birth weights the Dairy Research Institute and Dairy Industry prepared an adapted dried milk--Feminar where most of the casein was replaced by whey proteins, prepared by thermal denaturation F-BTD. The results of the nitrogen and lipid balance made in low birth weight neonates fed this milk were compared with the results of balances in infants fed commonly prepared Feminar and Feminar where whey proteins were prepared by ultrafiltration F-BU. The balances were made in a total of 23 low birth weight neonates (always four balance days). The nitrogen and lipid retention after F-BTD was higher, and concurrent investigation of metabolites revealed lower blood urea concentration.

[Differences in free amino acid serum levels in premature neonates fed Feminar supplemented with whey proteins]. / Rozdíly v koncentraci volných aminokyselin v plazme nedonosených novorozencu zivených Feminarem se syrovátkovými bílkovinami.

Free amino acids were examined in plasma of premature infants fed adapted dried milk (15 and 22 infants resp.) and breastfed infants (20). The dried milk was Feminar (casein: whey protein 40:60) where the whey (serum) proteins were prepared either by thermal denaturation (F-TD) or by ultrafiltration (F-U). The concentration of different amino acids in infants fed F-TD were closer to those recorded in breastfed infants, as compared with F-U where greater differences (higher values) were recorded.

[Subcapsular hematoma--a grade I liver injury]. / Subkapsulární hematom--I. stupen poranení jater.

The authors give an account of 11 patients hospitalized in 1975-1988 in the Traumatological Research Institute in Brno with a subcapsular haematoma of the liver. In case of suspected liver injury they use nowadays examination by ultrasound. Laparotomy must not be delayed in patients with unstable vital functions only because of various diagnostic examinations. The therapeutic success in liver injuries depends on early operation, correct resuscitation and selection of an optimal surgical procedure which depends above all on the type and grade of severity of the injury.

[The compartment syndrome after fractures of the calf]. / Kompartment syndrom po zlomeninách bérce.

In the submitted paper the authors summarize views regarding the definition, causes of compartment syndrome, its classification, the diagnostic and therapeutic procedure. In a group of 165 fractures of the leg treated in 1984-1987 in the Traumatological Research Institute in Brno the compartment syndrome was found in 26 patients. The author supplements the problem by case-histories of two patients with compartment syndrome. He discusses the need of early and correct diagnosis, differential diagnosis, therapy, involving in the manifest form of the syndrome decompression by fascitotomy.

[Personal experience with liver injuries]. / Nase zkusenosti s poranením jater.

The authors give an account of 69 patients hospitalized in 1975-1986 in the Traumatological Research Institute in Brno on account of liver injuries. The mean age of the patients was 38.3 years. The liver injury was very frequently associated with serious craniocerebral injuries, with injuries of the chest and other intraabdominal organs and the total lethality was 62.3%. The most frequent cause were traffic injuries (50 cases). Blunt liver injuries accounted for 92.8% of the cases.

[Injury of the extrahepatic bile ducts in multiple injuries]. / Poranení extrahepatických zlucových cest pri polytraumatu.

During the ten-year period between 1982-1991 the authors operated in the Institute 12 casualties after perforation and avulsion of the gallbladder, 8 patients on account of injuries of the hepatocholedochus and 15 patients where after injury posttraumatic acute cholecystitis developed. The authors evaluate critically the asset of new diagnostic preoperative procedures for assessment of early indication of surgery. In the surgical tactics they prefer reconstruction procedures which prevent such serious postoperative complications as relapsing cholangitis or stricture with cholestatic affection of the liver [1,3].

[Use of the tissue glue, Tissucol, in experimental liver injuries]. / Pouzití tkánového lepidla Tissucol pri poranení jater v experimentu.

The authors investigated in experiments on rabbits the course of recovery of liver injuries after treatment with the fibrin glue Tissucol, as compared with a control group of animals where the injured liver was not treated. Healing was followed-up at several time intervals. Rupture of the liver left to spontaneous healing was at first unsatisfactory from the histological aspect (wide demarcation margin near the necrosis). Subsequently the margin disappeared however. The scar was minimal after two months and were no manifestations of inflamed parenchyma surrounding the scar. When Tissucol was used, as a rule favourable healing was achieved. Scarring was satisfactory although the connective tissue was somewhat wrinkled and the scar was not linear. On the whole the tissue glue Tissucol is favourable in the final stage despite the fact that during healing a granulomatous reaction to the glue developed and the proliferation of the minor biliary pathways persisted also in the final stage of the experiment.

[Treatment of liver rupture in an experiment]. / Osetrení jaterních ruptur v experimentu.

The authors investigated in experiments on rabbits healing of liver incisions under various circumstances: spontaneous healing, liver incisions treated by suture by application of the tissue glue Tissucol, the collagenous haemostatic felt Collastypt combined with one stitch. Healing was followed up after several time intervals. From normal, i.e. the group of spontaneous healing, differed the groups treated by Tissucol and Collastypt where marked encapsulating fibrous tissue reactions round the necroses on the wound margins were found with numerous eosinophils as a transient phenomenon. The final result (with a maximum of cca two months) was adequate in all groups--as a rule a thin fibrous tissue scar with few remnants of atrophic hepatic trabeculae. In the treatment of small injuries it seems best to use the collagenous haemostatic Collastypt. In the treatment of sutures in rare instances a large number of leucocytes was found in the area of the necrosis and stitches, perhaps as result of contamination of the wound or sewing material.

[Problems with continence in rectal injuries]. / Problematika kontinence pri poranení rekta.

Authors analyse the group of 17 patients operated for rectal and anal injury. In this group 7 patients were operated primarily after injury and in 11 patients the secondary reconstruction was performed. Authors called the attention to the high diagnostic difficulty before the planned and indicated secondary reconstruction. Based on assessment of own clinical material and conforming with literature, authors conclude that secondary reconstruction are more difficult, and this difficulty is the higher, the less qualified the primary treatment was performed.

[Central rupture of the liver in multiple injuries]. / Centrální ruptury jater u polytraumatizovaných.

Authors evaluate clinical material of polytraumatized patients operated on account of liver injury during the last 15 years. The contribution of new imaging techniques is analyzed, especially of spiral computed tomography, for the diagnosis of liver injuries and associated injuries of the abdomen and retroperitoneum. These techniques enable in stabilized patients with the trauma I, II injuries and in some cases of grade III injuries to prefer conservative treatment. During the last 3 years the authors treated 5 polytraumatized patients with central liver rupture. Consistent with experience of major trauma centres in USA and Switzerland, criteria for conservative treatment are outlined, especially in patients of younger age groups.