[Secondary peritonitis prognosis assessment]. / Hodnocení prognózy tezké sekundární peritonitidy.

INTRODUCTION: Secondary peritonitis is a severe disease with high mortality and morbidity. In the last 20 years the results of treatment of this disease have improved markedly. AIM OF THE STUDY: To determine statistically significant risk factors for mortality in patients with severe secondary peritonitis. MATERIAL AND METHODS: We studied in retrospective analysis the cohort of patients treated at our clinic in the period 2005-2010. 65 patients (38 men and 27 women) with an average age of 60.7 years were included. 27 patients died (41.5%). The average age of the died patients was 72 years. The average value of APACHE II was 20.77, which corresponds to the prediction of lethality 41.8%. The average value of the SOFA score was 11.87. RESULTS: The performed statistical analysis showed age over 65 years, bronchopneumonia, obesity, ischemic heart disease, artificial ventilation over 6 days and circulatory support over 10 days as statistically significant independent factors for mortality. Patients older than 65 years had 8.9 times greater risk of death. In the case of bronchopneumonia was the risk 4.8 times higher. Obesity increased the risk of death 3.1 times and ischemic heart disease 2.4 times. In the case of mechanical ventilation for more than 6 days and circulatory support for more than 10 days, these increased the risk of death 4.1 times respectively 4.3 times. DISCUSSION: The benefit for determining the prognosis secondary peritonitis is the use of scoring systems. It was also shown that the basic clinical data may have the same benefit for predicting the prognosis of patients as a sophisticated scoring systems. CONCLUSION: The performed retrospective analysis age over 65 years, bronchopneumonia, obesity, artificial ventilation and circulatory support as statistically significant independent factors for prediction of poor survival. These basic clinical factors correlated with scoring systems APACHE II a SOFA.

Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation.

Both preemptive therapy and universal prophylaxis are used to prevent cytomegalovirus (CMV) disease after transplantation. Randomized trials comparing both strategies are sparse. Renal transplant recipients at risk for CMV (D+/R-, D+/R+, D-/R+) were randomized to 3-month prophylaxis with valacyclovir (2 g q.i.d., n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia (>/=2000 copies/mL by quantitative PCR in whole blood) assessed weekly for 16 weeks and at 5, 6, 9 and 12 months. The 12-month incidence of CMV DNAemia was higher in the preemptive group (92% vs. 59%, p < 0.001) while the incidence of CMV disease was not different (6% vs. 9%, p = 0.567). The onset of CMV DNAemia was delayed in the valacyclovir group (37 +/- 22 vs. 187 +/- 110 days, p < 0.001). Significantly higher rate of biopsy-proven acute rejection during 12 months was observed in the preemptive group (36% vs. 15%, p = 0.034). The average CMV-associated costs per patient were $5525 and $2629 in preemptive therapy and valacyclovir, respectively (p < 0.001). However, assuming the cost of $60 per PCR test, there was no difference in overall costs. In conclusion, preemptive valganciclovir therapy and valacyclovir prophylaxis are equally effective in the prevention of CMV disease after renal transplantation.

Clinicopathological assessment and quantitative estimation of the matrix metalloproteinases MMP-2 and MMP-7 and the inhibitors TIMP-1 and TIMP-2 in colorectal carcinoma tissue samples.

BACKGROUND: The matrix metalloproteinases (MMP) are a family of proteolytic enzymes involved in tumor growth and in the process of invasion. The aim of our study was to test the levels of MMP-2, MMP-7, and the MMP inhibitors TIMP-1 and TIMP-2 mRNA in colorectal carcinoma tissue samples with the clinicopathological status of the disease. PATIENTS AND METHODS: Colorectal carcinoma tissue samples were obtained from 38 patients who underwent resection of colorectal carcinoma. The expression levels of mRNA of MMP-2, MMP-7, TIMP-1, TIMP-2 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as a housekeeping gene were quantified in these tissue samples using the method of reverse transcription real-time PCR. RESULTS: It was found that the levels of mRNA expression of MMP-2, TIMP-2, MMP-7 and TIMP-1 were significantly higher in tumor tissue samples than in the normal colorectal tissue (p < 0.0020, p < 0.0467, p < 0.0007 and p < 0.0003 respectively). The level of mRNA expression of MMP-2, MMP-7, TIMP-2 and TIMP-1 did not correlate with the stage of the disease, localization of the tumor, metastatic spread or with disease-free survival (DFI). We recorded a statistically significant inverse negative correlation (r = -0.85; p < 0.0001) between the levels of MMP-7 mRNA and TIMP-2 mRNA. Correlations between the values of mRNA MMP-7 vs. TIMP-1, MMP-2 vs. TIMP-2, MMP-2 vs. TIMP-1 and MMP-2 vs. MMP-7 were not statistically significant. CONCLUSION: We found that there were statistically significant differences in the levels of MMP-2, MMP-7, TIMP-1, TIMP-2 mRNA between normal colorectal tissue and tumor tissue, but we did not find any statistically significant correlation between mRNA levels of MMP-2, MMP-7, TIMP-1, TIMP-2 expression and localization of tumor, clinical stage or course of disease. We found an inverse negative statistically significant correlation between mRNA levels of MMP-7 and TIMP-2. On the basis of these results the clinical use of this approach to the determination of a prognosis is ambiguous.