Ectopic thyroid with benign and malignant findings: A case series.

INTRODUCTION: Ectopia is the most common sporadically occurring thyroid heterotopy. We present three cases of ectopic thyroid tissue with compression of the upper aerodigestive tract. The first case involved ectopic thyroid tissue in the lingual area of a 60-year-old male with dysphagia, swelling at the base of the tongue, and stomatolalia. The second case was a 66-year-old female with papillary thyroid carcinoma (PTC) in a thyroglossal duct cyst. The third patient was a 50-year-old female with aberrant thyroid tissue in the right submandibular region, with a cribriform-morular variant of PTC (CMV-PTC). METHODS: After resecting the heterotopic tissue and verifying the presence of PTC, the second and third cases underwent total thyroidectomy, and the third patient also underwent radioactive iodine ablation (RAI). Postoperative athyreosis was compensated by permanent levothyroxine substitution. RESULTS: The diagnosis of ectopic thyroid tissue is challenging. Clinical examination together with imaging methods play a key role, especially postoperative histological examination along with scintigraphy and single photon emission computed tomography (SPECT). Ultrasonography should be used to exclude normally localized thyroid tissue and to distinguish other tumorous diseases. In the pre-operative examination, ultrasound-guided fine-needle aspiration biopsy (US-FNAB) often results in technically-difficult sampling and non-diagnostic cytology. CONCLUSION: Resection is the most suitable therapy for clinical symptoms of a foreign body in the upper aerodigestive tract and inflammatory complications; total thyroidectomy follows in case of malignant transformation. Thyroid heterotopy is a rare pathological condition, yet it should be taken into consideration during differential diagnosis of tumorous oropharyngeal and neck lesions.

Molecular study of mycobacterial strains prevalent in the Czech Republic in 2014.

AIM: To identify Mycobacterium tuberculosis strains prevalent in the Czech Republic in 2014. MATERIAL AND METHODS: DNA from 269 M. tuberculosis strains obtained from patients residing in the Czech Republic in 2014. Based on a step-by-step analysis, the strains were classified into genetically related groups using the MIRU-VNTRplus website. RESULTS: Four global lineages were identified: 1 Indo-Oceanic, 2 East-Asian (13.8%), 3 Central-Asian, and 4 Euro-American (83.6%) with the following sublineages: Haarlem (44.2%), H37Rv, Cameroon, Latin American-Mediterranean (LAM), Haarlem / X, NEW-1, URAL, S, X, TUR, and UgandaI. Fully identical repetitive sequences were found in 27.1% of strains belonging to two global lineages: 2 East-Asian (2 groups) and 4 Euro-American (21 groups): sublineages Haarlem (11 groups), H37Rv (3 groups), Cameroon (2 groups), Haarlem / X (2 groups), X (1 group), LAM (1 group), and S (1 group). In the set of study strains, seven were multidrug resistant without clustering. Four MDR strains belonging to global lineage 2 East-Asian (Beijing) and three MDR strains belonging to global lineage 4 Euro-American (2 strains of sublineage Latin American-Mediterranean (LAM), and 1 strain of sublineage Haarlem). CONCLUSIONS: A one-year study aimed at the identification of mycobacterial strains prevalent all over the Czech Republic in 2014. The study is the first to present data on the geographical distribution of M. tuberculosis strains in the population.

Molecular epidemio-logy of tuberculosis in the capital of Prague in 2013 and 2014.

AIM: Phylogenetic analysis of Mycobacterium tuberculosis strains by the MIRU-VNTR method and their assignment to lineages and sublineages. MATERIAL AND METHODS: DNA of 132 strains of M. tuberculosis was recovered from patients in the capital of Prague in 2013 and 2014. The MIRU-VNTR method was used. Using the MIRU-VNTRplus website tools, the strains were identified and assigned to genetically related groups. RESULTS: The highest prevalence of TB was reported in males aged between 45 and 54 years. The isolates of M. tuberculosis show high polymorphism in the number of repetitive sequences. Three global lineages were identified: 1 - Indo-Oceanic, 2 - East-Asian, and 4 - Euro-American, represented by 85.6 % of strains, comprising nine sublineages: Haarlem (40.9 %), H37Rv (25.8 %), S, Cameroon, LAM, X, NEW-1, URAL, and Delhi/CAS. Fully identical repetitive sequences were found in 28.0 % of strains (nine groups) of global lineage 4 - Euro-American, sublineages Haarlem (four groups), H37Rv (three groups), Cameroon (one group), and S (one group). Among the strains analyzed, four multi-drug resistant (MDR) strains were identified without clustering (one in 2013 and three in 2014). Two MDR strains were assigned to Euro-American lineage 4 and two MDR strains to East-Asian lineage 2. CONCLUSIONS: Genotyping of M. tuberculosis strains by the MIRU-VNTR method allows for rapid genetic identification and assignment to lineages and sublineages. The identification of strains of M. tuberculosis, their assignment to lineages, and line-age distribution make it possible to monitor their movement not only within a country but also worldwide. Genotyping data obtained over years make it possible to track the infection source and transmission pathways.

Rifampicin-resistant Mycobacterium tuberculosis: susceptibility to isoniazid and other anti-tuberculosis drugs.

Based on data from 14 Supranational Tuberculosis (TB) Reference Laboratories worldwide, the proportion of rifampicin (RMP) resistant isolates that were isoniazid (INH) susceptible by phenotypic drug susceptibility testing varied widely (0.5-11.6%). RMP-resistant isolates that were INH-susceptible had significantly lower rates of resistance to other first- and second-line anti-tuberculosis drugs (except rifabutin) compared to multidrug-resistant isolates. RMP resistance is not always a good proxy for a presumptive diagnosis of multidrug-resistant TB, which has implications for use of molecular assays that identify only RMP resistance-associated DNA mutations.

[Multiresistant tuberculosis in the Czech Republic (1999-2001)]. / Multirezistentní tuberkulóza v Ceské republice (1999-2001).

BACKGROUND: Multidrug-resistant (MDR) tuberculosis, defined as a disease caused by Mycobacterium tuberculosis strains, which are resistant to more antituberculous drugs (at least to isoniazid and rifampicin), is a problem frequently discussed in the Czech Republic. Cases of specific disease refractive to causal antituberculous therapy are associated with the risk of the spread of the causative agent among the population. METHODS AND RESULTS: The National Reference Laboratory for Mycobacteria collected 2813 Mycobacterium tuberculosis strains isolated by Czech mycobacteriological laboratories in 1999 to 2001. All strains were tested for susceptibility to basic antituberculous drugs and then the MDR strains were further tested for susceptibility/resistance to other antituberculous and antibacterial drugs. The MDR strains were studied by DNA analysis (DNA fingerprinting restriction analysis, RFLP-Restriction Fragment Length Polymorphism) as well. Thirty-nine patients who had MDR tuberculosis were excretors of 56 Mycobacterium tuberculosis strains. In average, MDR tuberculosis accounted for 1.96% (1.7-2.4) of all cases of bacillary tuberculosis. The most frequent type of the multidrug resistance was that resistant to four basic antituberculous drugs (isoniazid, rifampicin, ethambutol and streptomycin). It was confirmed in 48.2% multidrug resistant strains. CONCLUSIONS: Isepamicin, clofazimin, capreomycin and amikacin are considered to be the most promising antituberculosis drugs. Based on RFLP profiles, 61.5% of strains were placed into 8 clusters while the other strains remained unclustered. No significant differences in geographical distribution and population structure were found between the excretors of clustered strains and those of unclustered strains. Preliminary comparison with restriction profiles of the MDR Mycobacterium tuberculosis strains in the international database suggests the uniqueness of Czech strains showing the profiles not found elsewhere to date.

Determination of sulphated glycosaminoglycans by automated potentiometric titration with simple coated-wire electrodes.

A method for the determination of sulphated glycosaminoglycans is based on their precipitation with (1-ethoxycarbonyl)pentadecyltrimethylammonium bromide (Septonex), the excess of which is back-titrated with sodium tetraphenylborate. The titration is monitored by a simple coated-wire ion-selective electrode with a plasticized poly(vinyl chloride) membrane on aluminium wire. Under certain conditions the results are almost independent of the relative molecular mass of glycosaminoglycans. The method has been applied to the determination of the active ingredient in the pharmaceutical preparation, heparon injection.

Gas chromatographic determination of chlorinated phenols in the form of various derivatives.

Derivatization of chlorophenols prior to gas chromatographic analysis resulted in a significant improvement of their chromatographic behaviour. Chlorophenols in the form of anisoles, acetates, and pentafluorobenzyl ethers were separated either on a HP-1 wide-bore capillary column or on a capillary column coated with a film of SE-54. Due to an enhancement of the poor electron-capture detection response of mono- and dichlorophenols, pentafluorobenzylation made it possible to determine trace amounts in spiked water. Moreover, simultaneous analysis of phenoxyalkanoic acids was accomplished under the same conditions.

Effect of heparin and heparinoids on platelet aggregation.

Biological effectiveness of bovine lung heparin and porcine mucosal heparin was tested in vitro and compared with the effectiveness of 12 semisynthetic heparinoids obtained by sulfation of waste heparin mucopolysaccharides and other biomolecules. Equieffective concentrations of these substances were determined in the sense of prolongation of the thrombin time and the APTT, inhibition of the thrombin- and collagen-induced aggregation, and potentiation of the primary ADP-induced aggregation. The influence of sulfation was proved on the biological effectiveness as well as the significance of the proper choice of the parent structure. Some polycondensates of the polysaccharide type were effective altogether with the sulfated waste heparin mucopolysaccharides. On the contrary, protein structures and low molecular weight glycosides exhibited little or no activity. The effective substances were related to heparin not only by the anticoagulant activity but also by the inhibitory action on the thrombin- and collagen-induced platelet aggregation. Contrary to heparin, higher concentrations of the studied heparinoids strongly potentiated the ADP-induced aggregation response. Strong inhibition of the collagen-induced aggregation was proved after administration of heparin to patients with end-stage renal failure on days without haemodialysis. Less significant changes in the secondary aggregation were observed also after administration of S-heparin (one of the studied heparinoids) to volunteers in the form of the rectal suppositories.