Intra-abdominal candidiasis in surgical intensive care unit - epidemiology characteristics and trends.

OBJECTIVES: Intra-abdominal candidiasis (IAC) is an invasive fungal infection representing the most common type of invasive Candida infection in surgical intensive care units (ICUs). Recently, decreased antifungal susceptibility and progressive shift in the aetiology of invasive candidiasis has been observed worldwide. We explored IAC epidemiology in surgical ICU. MATERIAL AND METHODS: We retrospectively reviewed the records of 64 patients with IAC admitted at our surgical ICU over a 4-year period (2013-2016). IAC incidence, microbiological results, antifungal therapy, and mortality were analysed. RESULTS: The cumulative IAC incidence was 18.4 cases per 1000 admissions (2013: 12.6; 2014: 17.7; 2015: 16.8; 2016: 24.5), including hospital-acquired IAC incidence (2013: 9.8; 2014: 13.3; 2015 10.1; 2016: 13.3) and community-acquired IAC incidence (2013: 2.8; 2014: 4.4; 2015: 6.7; 2016: 11.2). Candida albicans represented the most common species (n = 35, 50.0%) followed by Candida glabrata (n = 15, 21.4%), Candida tropicalis (n = 6, 8.6%) and other yeasts (each < 5.0%). Incidence rate of C. albicans (2013: 7(78%); 2014: 10(59%); 2015: 6(35%); 2016: 12(44%)) and incidence rate of C. non-albicans (2013: 2(22%); 2014: 7(41%); 2015: 9(53%); 2016: 14(52%)) were different in trend. All fungal isolates were susceptible to echinocandins, amphotericin B and voriconazole. Regarding fluconazole susceptibility, C. krusei (n = 3) was resistant and C. glabrata (n = 9) was susceptible-dose dependent (SDD). The ratio of SDD C. glabrata isolates to all isolated C. glabrata strains was 9/15 (60%) (2013: 0/2; 2014: 0/2; 2015: 1/3; 2016: 8/8). Decreased fluconazole susceptibility for C. glabrata isolates was reported in both community-acquired IAC (n = 3) and hospital-acquired IAC (n = 6). Overall 30-day mortality rate was 25.0% (16/64). CONCLUSIONS: We have revealed slowly raising of overall IAC incidence, more increasing trend in incidence of community-acquired IAC compared to rather steady incidence of hospital-acquired IAC. During period 2013-2016 we have observed a significant shift in the aetiology of IAC towards an increased proportion of non-albicans Candida species, particularly C. glabrata. Acquired decreased fluconazole susceptibility was related to C. glabrata isolates exclusively. Emergence of decreased antifungal susceptibility has been preceded by increase of non-albicans Candida isolates.

Inverted Meckel´s diverticulum: a rare cause of ileo-ileal intussusceptions and lower gastrointestinal bleeding.

Intussusception due to an inverted Meckel's diverticulum in adults is rare. We present a case report of a 28-year-old man with Meckel's diverticulum as a cause of ileo-ileal intussusceptions and lower gastrointestinal bleeding. The patient was admitted to the hospital with incomplete small bowel obstruction, abdominal pain and massive rectal bleeding. Surprisingly, pre-operative abdominal USG revealed inhomogeneous target-like mass in the right lower abdominal quadrant as intussusception with an intraluminal polypoid lesion. The patient underwent urgent laparotomy which confirmed ileo-ileal intussusception. The involved segment of small intestine (70 cm) was resected. The surgical specimen contained an elongated polypoid lesion of 8×2.5×2 cm within the ileal lumen. Histopathological examination ascertained an inverted Meckel's diverticulum. In the discussion, we deal with diagnosis and treatment issues of Meckel's diverticulum. Key words: inverted Meckel's diverticulum - intussusceptions - gastrointestinal bleeding - acute abdomen.

[Management of acute postoperative pain following thoracotomy - state of the art]. / Lécba akutní pooperacní bolesti po torakotomii - soucasné moznosti.

UNLABELLED: Postoperative pain management is an important part of complex perioperative care in patients undergoing thoracotomy, irrespective of the procedure type. Adequate pain relief leads to early mobilisation, improves respiratory functions and decreases global stress response. Thus, good perioperative pain management significantly reduces postoperative complications. Currently, numerous analgesic methods are available for the management of acute postthoracotomy pain including patient- or nurse-controlled systemic administration of analgesics, infiltration with local anaesthetics, intrapleural or intercostal nerve blockades and neuroaxial blocks (paravertebral, intrathecal, epidural). The aim of this review is to analyze the currently used methods in postthoracotomy pain management, their benefits in the light of current guidelines, and potential risks. KEY WORDS: thoracotomy - chest surgery analgesia.

[Protein S100b in differential diagnosis of brain concussion and superficial scalp injury in inebriated patients]. / Protein S-100b v diferenciální diagnostice komoce mozkové a povrchního poranení hlavy u pacientu v ebriete

INTRODUCTION: Concussion cannot be differentiated from superficial scalp injury, especially in inebriated or uncooperative patients. This can have serious medical or forensic consequences. The aim of the study was to determine whether serum concentrations of S-100b in mild traumatic brain injury (MTBI) patients are significantly higher than those in patients with superficial scalp injury with scalp wound and alcohol intoxication. MATERIAL AND METHODS: A total of 50 patients with head injury, 25 with mild concussion without scalp wound and alcohol intoxication, 25 superficial scalp injury patients with scalp wound and clinical signs of inebriety. Neurological status and cranial CT scan were evaluated 60-120 minutes after injury in all the 50 patients to exclude focal cerebral injury or skull fracture. RESULTS: The serum levels of S-100b were significantly increased in patients with concussion (median 0.36 ± 0.15 µg/l ) in comparison with the group of patients with scalp injury and alcohol intoxication (median 0.09 ± 0.002 µg/l). All 50 patients had a normal cranial CT finding and neurological status. In all superficial scalp injury patients alcohol intoxication was confirmed (0.96 - 3.11s). CONCLUSION: We proved significantly higher values of S-100b in patients with brain concussion. Diagnostically decisive value of S-100b concentration in the serum was set at 146 µg/l and higher (94% sensitivity and 100% specificity). Alcohol intoxication (up to 3.11 s) and scalp wound seem to have had no crucial impact on serum S-100b level.

[Bedside ultrasonographic examination of a critically ill surgical patient]. / Ultrazvukové vysetrení u luzka kriticky nemocného v chirurgii.

INTRODUCTION: Bedside ultrasonography is a modern and progressive examinating method. During the past two decades, performing of bedside ultrasonography has repeteadly shown its clinical and economical advantages. Bedside ultrasonography appears to be cost-effective method which provides minimall patient and staff stress. AIM AND METHOD: 132 critically ill patients were involved, regardless of basic diagnosis and surgical procedure they undervent. In these patients both bedside USG and CT were performed in order to prove a fluid collections in one of the following anatomical locations pleural cavity, peritoneal cavity and abdominal wall. The prospective study assessed and compared sensitivity of bedside USG to CT. Results of the study should by further applied in hardly transportable critically ill, for that CT could be hazardous. RESULTS AND CONCLUSION: Bedside USG had comparable sensitivity to CT in fluidothrorax and abdominal wall colections detection, in some cases even more. For intraabdominal fluid USG represent less accurate method to CT, benefit of CT should be then discussed in each patient individually considering general health condition and basic diagnosis.

[GIST as a cause of the small intestine invagination]. / GIST jako prícina invaginace na tenkém streve.

A case report describing intusussception on small bowell as a one of the less frequent causes of ileus in adults. A gastointestinal stromal tumor ( GIST) was found as a lead point of the intusussception on the basis of abdominal CT. Patient underwent resection of small bowel with tumor. Basic knowledge of GISTs is discussed.

[Acute abdomen in elderly patients]. / Náhlé príhody brisní v seniorském veku.

BACKGROUND: Ageing of Czech population and the increase of numbers of elderly people gives new tasks to whole medicine and surgery too. METHOD AND RESULTS: Presented paper shows some aspects of occurrence, diagnostics and treatment of acute abdomen diseases--inflammatory and intestinal obstruction--in patients older than 60 years. It compares the occurrence and treatment results at an identical surgical department 30 and 60 years ago and nowadays. CONCLUSIONS: Number of the treated patients older than 60 years increased four times during the followed period. Opposite to that, death rate of operated patients declined from 37.2% to today's 16.4%--undoubtedly thanks to modern good-quality perioperational treatment.