[Paraneoplastic neurological syndromes in gynecological malignancies]. / Paraneoplastické neurologické syndromy u gynekologických malignit.

OBJECTIVE: The demonstration of life-threatening paraneoplastic syndrome with dominant neurological symptomatology in germinal ovarian malignancy. DESIGN: Literature review with case report. SETTING: Department of Gynecology and Obstetrics, Faculty of Medicine Masaryk University and University Hospital Brno. METHODS: The review outlines the issue of paraneoplastic syndromes. It describes the etiopathogenesis, the range of clinical symptoms, the diagnostic and therapeutic possibilities, along with a relevant case study which focuses on the paraneoplastic neurological symptoms in malignant germinal ovarian tumor. CONCLUSION: Although paraneoplastic symptomatology is rather rare, it constitutes an important part of the clinical picture of malignant tumors. In a number of cases, the paraneoplastic neurological syndrome (PNNS) symptoms precede the actual tumor diagnosis. The awareness of this connection can thus be important in early diagnostics, which in turn can significantly affect a patients prognosis. Another important benefit of familiarity with the symptoms of neurological paraneoplasia is the fact that some PNNS are associated with specific tumors. Interdisciplinary cooperation is necessary in the case of PNNS for early tumor diagnostics. Treatment of the primary tumor is the key in diagnosed malignancies. With effective oncological treatment, adequate regression of paraneoplastic symptoms can be observed.

Urinary tract infections in patients with multiple sclerosis and different methods of bladder evacuation.

INTRODUCTION AND OBJECTIVES: To evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. MATERIALS AND METHODS: Patients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. RESULTS: 54 MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<0.05). Causative agents significantly differed in both groups (P=0.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>0.99 at visit 0, 1 and 3, P=0.078 at visit 2). CONCLUSIONS: There is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation.

Infecciones del tracto urinario en pacientes con esclerosis múltiple y los diferentes sistemas de vaciado vesical / Urinary tract infections in patients with multiple sclerosis and different methods of bladder evacuation

Introducción y objetivos: Evaluar la incidencia y la evolución de las infecciones del tracto urinario (ITU) en pacientes con esclerosis múltiple (EM) y su relación con el sistema de vaciado vesical. Materiales y métodos: Se incluyeron en el estudio pacientes con disfunciones miccionales neurógenas debido a la EM (n=111). Durante un año de seguimiento, se realizó una evaluación clínica con cultivo de orina cada 4 meses o ante la presencia de síntomas. El grupo de control incluyó a pacientes con ITU sintomática sin enfermedad neurológica o autoinmune. Se evaluó estadísticamente la incidencia de bacteriuria sintomática y asintomática, el efecto del drenaje urinario en la incidencia de ITU y el efecto del tratamiento antibiótico. Resultados: Cincuenta y cuatro pacientes con EM completaron el protocolo. La incidencia media de bacteriuria sintomática y asintomática en el grupo de EM fue del 12,5% y del 29,6%, respectivamente. Se observó una tendencia decreciente en la incidencia de la bacteriuria sintomática y una tendencia creciente en la incidencia de la asintomática. La erradicación de la ITU en los pacientes sintomáticos con EM fue significativamente menor que en los controles (37,75% frente a 92,93%, p<0,05). Los agentes causales fueron significativamente diferentes en ambos grupos (p=0,0005). No se rechazó la hipótesis de que la incidencia de ITU en los pacientes con EM es independiente del sistema de evacuación vesical (p>0,99 en las visitas 0, 1 y 3; p=0,078 en la visita 2). Conclusiones: Existe una diferencia significativa entre los agentes causales de la ITU en ambos grupos. La erradicación de la bacteriuria en los pacientes sintomáticos con EM es difícil en comparación con la población normal. No disponemos de pruebas suficientes para confirmar la relación entre la incidencia de ITU y el sistema de evacuación vesical. (AU)

Introduction and objectives: To evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. Materials and methods: Patients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. Results: Fifty-four MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<.05). Causative agents significantly differed in both groups (P=.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>.99 at visit 0, 1 and 3, P=.078 at visit 2). Conclusions: There is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation. (AU)

Imbalance in T-cell and cytokine profiles in patients with relapsing-remitting multiple sclerosis.

Multiple sclerosis (MS) is characterized by autoimmune attack leading to demyelination of the white matter in the central nervous system with devastating clinical consequences. Several immune-mediated destruction mechanisms were previously proposed including different T-cell subsets but complex view on immune system function in patients with MS is missing. In the present study, T-lymphocyte populations and pro-inflammatory as well as suppressive cytokine profiles were evaluated in detail in previously untreated patients with relapsing-remitting MS (RRMS). CD4(+) and CD8(+) naïve, central memory (Tcm), effector memory (Tem), terminal effector memory (Ttem), CD4(+) regulatory T-cells (Treg) and CD8(+) T-suppressor cells (Ts) were analysed using flow cytometry, and levels of ten plasma cytokines were determined using fluorescent bead-based immunoassay. We evaluated two groups of RRMS with minor (n=33) and major (n=25) clinical impairment and compared them with healthy controls (n=40) in order to detect any correlation between severity of MS clinical symptoms and immune disturbances. Significant differences were noted in CD4(+)CD45RA(+)CCR7(+) naïve T-cells, CD4(+)CD45RO(+)CCR7(-) and CD8(+)CD45RO(+)CCR7(-) Tem cells, while no differences were recognized in Tcm, Ttem, Treg and Ts cells in RRMS patients. Nine out of ten studied cytokines were disturbed in plasma samples of patients with RRMS. In conclusion, we demonstrate complex immune dysbalances in untreated MS patients.