Neuropathic complications after 157 procedures of continuous popliteal nerve block for hallux valgus surgery. A retrospective study.

BACKGROUND: Continuous peripheral nerve block (CPNB), in particular at the popliteal fossa, is widely used in orthopedic surgery, allowing good postoperative analgesia. Possible neuropathic complications, however, remain poorly known. OBJECTIVE: To review the characteristics of peripheral neuropathy (PN) after sciatic CPNB at the popliteal fossa, estimating prevalence, severity, evolution and possible risk factors, especially those relating to the procedure. METHODS: Retrospective study of PN associated with popliteal fossa CPNB for hallux valgus surgery, between November 1st, 2005 and November 1st, 2009. All procedures were analyzed (type of anesthesia, approach, nerve location technique, number of procedures by operator) with, for each case of PN, analysis of clinical and electromyographic data. RESULTS: One hundred and fifty seven sciatic CPNBs were performed (92% women; mean age, 55 years). The approach was lateral (n=62), posterior (n=74) or unknown (n=21). Ultrasound guidance was combined to neurostimulation for 69 patients (44%). Three women (prevalence=1.91%), aged 19, 24 and 65 years respectively, developed associated common superficial peroneal and sural nerve injury (2), axonal on electromyography, with motor (n=1) and/or sensory (n=3) residual dysfunction. DISCUSSION: The higher prevalence found in the present study than in the literature (0 to 0.5%) raises questions of methodological bias or technical problems. The common peroneal and sural nerves seem to be exposed, unlike the tibial. Several mechanisms can be suggested: anesthetic neurotoxicity, direct mechanical lesion, or tourniquet-related ischemia and conduction block. Further studies are necessary to determine the ideal anesthetic procedure. CONCLUSION: Patients should be informed of the potential risk, however rare, even during mild surgery. The best possible technique should be implemented, with reinforced surveillance.

[Ischemic stroke as the first manifestation of Wegener's granulomatosis]. / Une manifestation inaugurale inhabituelle de la granulomatose de Wegener : l'accident vasculaire cérébral ischémique.

The most characteristic clinical manifestations of Wegener's granulomatosis are upper and lower respiratory tract and renal involvement. The central nervous system manifestations are uncommon and occur usually late in the course of the disease. We report a 48-year-old man who presented with an ischemic stroke as the first manifestation of Wegener's granulomatosis. Wegener's granulomatosis should be considered in the differential diagnosis of ischemic stroke even in the absence of extraneurological involvement.

[Etiology and prognosis of highly elevated C-reactive protein levels (≥500 mg/L): a retrospective study about 168 measures in a series of 113 patients]. / Profil étiologique et pronostique des valeurs extrêmes (≥500 mg/L) de protéine C-réactive : étude rétrospective de 168 valeurs chez 113 patients.

PURPOSE: The C-reactive protein (CRP) is a useful inflammatory marker with a rapid kinetics during the inflammatory process. The objective of this study was to determine the etiology and prognosis of extremely elevated CRP values greater or equal to 500 mg/L. METHODS: We performed an exhaustive retrospective study from January 2004 to July 2009, in a general hospital, of all patients with a CRP value above 500 mg/L, admitted in all clinical departments. Clinical data were collected by a single observer using a standardized questionnaire. RESULTS: One hundred and sixty-eight CRP values greater or equal to 500 mg/L were identified amongst 106,758 tests (0.16%) corresponding to 113 patients: 51% were men and their mean age was 59.5 years. Mean CRP value was 561 mg/L (500-772). An immunocompromised condition was observed in 52% of the patients. All but 13 patients presented an infectious disease. Microbiological analysis of the infected patients identified 59 Gram-positive cocci (20 Staphylococcus spp., 35 Streptococcus spp. including 21 Streptococcus pneumoniae), two Gram-negative cocci, 48 Gram-negative bacilli (including 19 Escherichia coli), three Gram-positive bacilli, 16 fungal infections, one viral infection. Site of infection was respiratory in 63%, urinary in 17% and abdominal in 16%. At day 30, mortality rate was 27% and only 41% of the patients were discharged at home. CONCLUSION: CRP value above 500 mg/L is highly related to bacterial infections, without over-representation of a given microorganism. One-month mortality is high (27%).

Seroprevalence of hantavirus antibodies among chronic hemodialysis patients in the Czech Republic.

A total of 348 serum samples were collected from 301 hemodialysis patients with chronic renal failure of four healthcare settings in Western Bohemia. The sera were screened for the presence of hantavirus antibodies using ELISA kits (PROGEN Biotechnik GmbH) with Hantaan and Puumala antigens. Specific anti-Puumala antibodies were detected in five patients (1.7%). Although hantaviruses are known to cause primarily acute renal damage (interstitial nephritis) in Eurasia, chronic effects of hantavirus infection and the detection of specific antibodies in hemodialysis patients have also been reported. Nonetheless, the detection of seropositivity is not proof of an etiological link between hantaviruses and chronic renal failure. The hantavirus seropositivity rate in hemodialysis patients was not significantly higher than that in the general population. Our findings are consistent with the literature data and do not contradict the contribution of hantaviruses to the pathogenesis of chronic renal damage in the Czech Republic.

Identification of Staphylococcus aureus based on PCR amplification of species specific genomic 826 bp sequence derived from a common 44-kb Sma I restriction fragment.

Primers were designed for polymerase chain reaction (PCR)-amplification of a genomic sequence specific to Staphylococcus aureus strains. The sequence corresponds to a part of the 44-kb Sma I fragment (fragment L on the S. aureus NCTC 8325 restriction map) which was found to be common to strains of the S. aureus species (Pantucek et al 1996, International Journal of Systematic Bacteriology, 46: 216-222). The labelled 44-kb Sma I restriction fragment derived from S. aureus NCTC 8325-4 was hybridized to the Eco RI restriction patterns of genomic DNA from 13 strains representing different macrorestriction types of S. aureus subsp. aureus. This made it possible to reveal the 2052 bp Eco RI restriction subfragment and to demonstrate its presence in all the tested strains. From the sequence of this subfragment, primers were designed by means of which the 826 bp amplicons were obtained in all 216 tested strains of S. aureus. No hybridization and PCR-products were observed in 40 collection strains of other staphylococcal species and subspecies as well as in 45 clinical strains of coagulase-negative staphylococci. These results lead us to the conclusion that the use of the above primers makes it possible to identify rapidly and reliably S. aureus strains of various provenance and different genotypes.

Occurrence of variants with temperature-dependent susceptibility (TDS) to antibiotics among Stenotrophomonas maltophilia clinical strains.

Susceptibility to 20 antibiotics was tested in 104 Stenotrophomonas maltophilia strains at 37 and 30 degrees C by means of a dilution micromethod to verify the phenomenon of temperature-dependent susceptibility (TDS). Trimethoprim-sulfamethoxazole, pefloxacin and ofloxacin were the most active preparations at 37 degrees C (93, 90, and 86% of susceptible strains, respectively), whilst trimethoprim-sulfamethoxazole, cefoperazone-sulbactam and pefloxacin performed best at 30 degrees C (94, 94, and 76% of susceptible strains, respectively). Variants 37TDS (minimum inhibitory concentration, MIC, of tested antibiotics at least 4-times lower at 37 than at 30 degrees C) occurred in 60%. Variants 30TDS (at least 4-times lower value of MIC at 30 than at 37 degrees C) were found in 7.7%. Both variants in susceptibility to tested antibiotics appeared in 23.1%, whilst neither of them was observed in 9.6%. The 37TDS phenomenon was recorded most of all with gentamicin (51% of strains), amikacin (47), colistin (44) and tetracycline (34). The 30TDS phenomenon was found particularly with cefoperazone-sulbactam (16.0% of strains) and colistin (10.0%). The above phenomena may be due to changes in membrane permeability, temperature-dependent ribosomal changes, and insufficient adaptation to higher temperatures of some strains of the originally environmental species S. maltophilia.

[Development of a vaccine for treatment of urinary tract infections]. / Vývoj vakcíny pro lécbu zánetlivých onemocnení mocových cest.

Receiving uroinfections are predominantly treated with antibiotics and chemotherapeutics. An effective alternative treatment can be immunotherapy with inactivated bacteria. The authors have focused on the development of polybacterial vaccine with both specific and nonspecific immunostimulatory activity. The vaccine contains killed bacteria which most frequently occur as an etiological agent in urinary tract infections. Determining for the selection of particular strains for the vaccine preparation were their immunostimulatory properties evaluated after intraperitoneal application of killed cells to mice. The results were evaluated according to weight gain of liver and spleen and verified by histological examination of these organs. The final form of the vaccine URVAKOL contains immunogenically most active strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Enterococcus faecalis, representing specific effective part of the preparation, adjuvant activity is provided by Propionibacterium acnes. (Tab. 1, Fig. 2, Ref. 27.)

[Immunomodulation of recurrent urinary tract infections with Urvakol vaccine]. / Imunomodulace recidivujících uroinfekcí vakcínou URVAKOL.

The authors present the results of the URVAKOL vaccine use in clinical practice. The vaccine was administered in the treatment of recurrent cystitis, persistent lower urinary tract infection, chronic pyelonephritis and prostatovesiculitis. The clinical efficacy of the vaccine was assessed by detection of bacteria and leukocytes in the urine, subjective complaints, skin tests and the assessment of selected specific and nonspecific immunity parameters in the urine and saliva. Significantly positive clinical and laboratory responses were observed in patients with uncomplicated cystitis. In the group of persistent urinary tract infections excellent responses were detected in one half of the patients. The remainder half stated disappearance of subjective complaints, but with persistence of pyuria or bacteriuria. Similar results of "improvement" were observed in 10 patients with chronic pyelonephritis. There were no changes of the clinical state observed in patients with chronic prostatitis. (Tab. 5, Fig. 2, Ref. 7.)

Development of bacterial resistance to the third generation cephalosporins and their clinical use.

Development of Gram-negative rods resistance to the third generation cephalosporins (cefotaxime, ceftazidime, cefoperazone) in connection with their application at the University Hospital in Olomouc was evaluated in this study. The highest increase in resistance to cefotaxime was detected in Enterobacter cloacae (from 22.9% in 1995 to 49.0% in 1997) and Enterobacter agglomerans strains (28.0% - 40.5%). In addition, increased resistance to ceftazidime in Acinetobacter baumannii (12.5% - 35.1%), Enterobacter aerogenes (7.4% - 20.9%), Enterobacter cloacae (16.7% - 47.2%) and Pseudomonas aeruginosa (4.0% - 26.3%) was observed. Finally, the greatest increase in frequency of strains resistant to cefoperazone was observed in E. aerogenes (18.4% - 30.1%), E. agglomerans (31.0% - 52.3%), E. cloacae (35.5% - 47.2%) and Providencia rettgeri (26.5% - 53.2%). A 23.5% increase in third generation cephalosporin use was evident by evaluation of RDDD(ATB) parameters in 1996 and 1997. Corresponding values for individual antibiotics were 26.5% cefotaxime, 20.7% ceftriaxone, and 40.3% ceftazidime increase. However, cefoperazone use decreased by 10.9%.

[Immunostimulating activity of vaccines in the treatment of recurrent urinary tract infections. I]. / Immunostimulacní aktivita vakcíny pro lécbu recidivujících uroinfekcí. I.

The authors inform about the immunomodulatory properties of the vaccine URVAKOL aimed for the treatment of recidiving urinary infections. The results of immunostimulatory activity of the preparation and its effects on cellular and humoral immunity in mice following intraperitoneal administration of the vaccine are presented. The vaccine markedly increases cytotoxic activity of adhering peritoneal cells and has protective effects in model infection induced by intracellular pathogen Francisella tularensis (strain 15 L). (Tab. 6, Fig. 6, Ref. 9.)

Recommended minimal standards for description of new staphylococcal species. Subcommittee on the taxonomy of staphylococci and streptococci of the International Committee on Systematic Bacteriology.

In accordance with Recommendation 30b of the International Code of Nomenclature of Bacteria, minimal standards are proposed for the genus Staphylococcus and the description of newly recognized species in this genus. Assignment of a strain to the genus Staphylococcus requires that it is a Gram-positive coccus that forms clusters, produces catalase, has an appropriate cell wall structure (including peptidoglycan type and teichoic acid presence) and G + C content of DNA in a range of 30-40 mol%. The recommended minimal standards for describing a new Staphylococcus species are based on the results of phenotypic and genomic studies of at least five independently isolated strains. They include colony morphology and the results of the following conventional tests: pigment production, growth requirements, fermentative and oxidative activity on carbohydrates, novobiocin susceptibility, enzymic activities (nitrate reductase, alkaline phosphatase, arginine dihydrolase, ornithine decarboxylase, urease, cytochrome oxidase, staphylocoagulase in rabbit plasma, heat-stable nuclease, amidases, oxidases, clumping factor, and haemolytic activity on sheep or bovine blood agar). DNA-DNA hybridization experiments may distinguish species when the difference between the binding in the homologous reaction and the binding in the heterologous reaction expressed as a percentage is less than 70%. In addition, rRNA signature sequence criteria, ribotyping characterization of the nomenclature type strain and other strains of the species, and reference strains of other species is recommended to describe the strains of the new species with sets of genetic attributes and reveal possible grouping errors. This proposal has been endorsed by the members of the Subcommittee on the taxonomy of staphylococci and streptococci of the international Committee on Systematic Bacteriology.

Characteristics of Acinetobacter strains (phenotype classification, antibiotic susceptibility and production of beta-lactamases) isolated from haemocultures from patients at the Teaching Hospital in Olomouc.

A total of 85 strains of the genus Acinetobacter were isolated from haemocultures at the Institute of Microbiology of the Teaching Hospital in Olomouc over the period January 1993 to June 1997. Sixty-two (73.0%) strains of the Acinetobacter calcoaceticus-baumannii complex (Acb complex) were the most frequent. In 3 (3.5%) strains it was impossible to decide whether they belonged to the Acb complex. Other acinetobacter species were represented by 20 (23.5%) strains. The greatest amount (28.2%) of these strains was collected from the Clinic of Internal Medicine. Leukemias, lymphomas and myelodysplastic syndromes were the most frequent clinical diagnoses (20.0%) of the patients with a positive haemoculture. The most effective antimicrobial preparations tested were as follows: meropenem (98.8% of susceptible strains), colistin (94.1%), quinolones (90.6-94.1% according to the type of agent) and amikacin (91.8%). The Acb complex strains were less susceptible to antimicrobial agents than other acinetobacters. Production of inductive chromosomal beta-lactamases AmpC was proved in 42 (49.4%) strains whilst no occurrence of extended-spectrum beta-lactamases (ESBL) in the isolated organisms was recorded.

[Immunostimulatory activity of the vaccine used in the treatment of recurrent urinary infections. II]. / Imunostimulacní aktivita vakcíny pro lécbu recidivujících uroinfekcí. II.

The authors describe on the immunostimulatory properties of the vaccine URVAKOL aimed for the treatment of recurrent urinary infections. Detection of immunostimulatory activity of the preparation and its effects on the humoral and cellular immunity were performed after oral administration of the preparation. Important was the evidence of nonspecific immunity of mice against intracellular pathogen Francisella tularensis induced with URVAKOL strain 15L. (Tab. 4, Fig. 1, Ref. 8.)

[Personal experience with classification of yeast microorganisms. I. The combined biotyping method of Mencl and Otcenásek and typing using the "killer" phenomenon]. / Nase zkusenosti s klasifikací kvasinkovitých mikroorganismu. I. Kombinovaná biotypizacní metoda podle Mencla a Otcenáska a typizace s vyuzitím "killer" fenoménu.

Using a group of 150 isolates of Candida albicans, C. glabrata, C. krusei, C. tropicalis, C. parapsilosis a C. kefyr the differentiating capacity of two biotyping systems was tested-the combined method according to Mencl and Otcenásek, and typing using the so-called killer phenomenon. With the combined method comparable results with the original work of the authors were obtained. This applies to the number of biotypes as well as to the ratio of the dominant biotype. As regards the differentiating characteristics of different biotypes the two studies differed fundamentally. As to typing, using the "killer" phenomenon, its practical usefulness was tested, the differentiating capacity of the method was, however, very much influenced by the small number of available killer-positive yeast strains.

[Occurrence of gram-negative non-fermenting rods in hemocultures and their sensitivity to antimicrobial agents]. / Výskyt gramnegativních nefermentujících tycinek v hemokulturách a jejich citlivost na antimikrobní preparáty.

In the period from January 1993 to June 1996 were at the Department of Microbiology of the University Hospital in Olomouc 122 strains of Gram-negative nonfermentative rod-shaped bacteria isolated from haemocultures. The majority represented the group of 51 strains of the genus Acinetobacter (41.8%), complex A. calcoaceticus-baumannii (Acb complex). The second largest group were 21 strains (17.2%) of Pseudomonas aeruginosa. These were followed by 17 strains (13.9%) of Stenotrophomonas maltophilia, 8 strains (6.6%) of non-Acb complex acinetobacters, 6 strains (4.9%) of Pseudomonas putida and 5 strains (4.1%) of Alcaligenes xylosoxidans. The remaining species were represented only by 1-2 strains. In three isolations was the identification impossible. The majority of strains (24.6%) were from the Department of Haematology of the University Hospital in Olomouc. The most frequent diagnoses in patients with positive haemocultures were leukemias and lymphomas (24.6%). The most effective tested antimicrobial agents were ceftazidime (93.4% of sensitive strains) and ofloxacin (91.7%). From the total number of 80 strains detected using the equipment BacT/Alert 120, 22 (27.5%) were isolated repeatedly confirming their role in the etiology of bacteriemic or septic episodes. Because only one blood sample was obtained in 34 cases (58.6%) of the remaining 58 only once detected strains, it was impossible to confirm their etiologic role by repeated isolation. (Tab. 6, Ref. 22.)

Cognitive and functional assessments of stroke patients: an analysis of their relation.

OBJECTIVES: To improve the assessment of stroke patients for the purpose of designing rehabilitation treatments and predicting rehabilitation outcomes. Specific objectives included the evaluation of the power of functional scales to properly assess both physical and cognitive disabilities, and the evaluation of the relations between functional, neurological, physical, and cognitive assessments. The hypothesis was that the relations between different assessment types (eg, functional, neurological, etc) can be assessed by the relations between the results of these assessments when administered to stroke patients. DESIGN: Sixty-six stroke patients were administered a series of tests including functional assessments (Functional Independence Measure, barthel Index, Rankin Functional Scale), neurological assessments (Canadian Neurological Scale, National Institute of Health Stroke Scale), physical assessments (Stages of Motor Recovery, Clinical Outcome Variables Scale), and cognitive assessments (Stroke Unit Mental Status Examination, Mini Mental State, Raven Matrices, Boston Naming Test). RESULTS: Analysis of correlation coefficients revealed that the stronger relationships were observed between functional assessments and physical assessments, and between functional assessments and neurological assessments. Cognitive tests did not correlate highly with any of the functional tests used in this study. Three factors were extracted using factor analysis. They were interpreted as being a physical disability factor (50% of the variance), a cognitive disability factor (23% of the variance), and a dementia factor (12% of variance). Functional scales obtained higher loads on the physical disability factor only. CONCLUSIONS: Considering that cognitive functions are frequently affected in stroke patients, cognitive impairment needs to be more seriously considered when describing and/or predicting a patient's level of independence. In brain injured patients, such as stroke patients, we suggest that the total score provided by standardized functional scales should be interpreted with care. We believe that rehabilitation outcome could be better predicted if the results of functional assessment were coupled with in-depth cognitive assessment.

Borreliae in immature Ixodes ricinus (Acari:Ixodidae) ticks parasitizing birds in the Czech Republic.

Of 411 forest birds of 33 species examined near Valtice, Czech Republic, 29% were infested with Ixodes ricinus (L.); 2.2% were parasitized by Haemaphysalis concinna Koch. Borreliae were detected in 5.1 and 11.7% of larval and nymphal I. ricinus, respectively. None of the 13 H. concinna tested was infected. In total, 3.2% of the birds examined were parasitized by I. ricinus immatures infected by borreliae. Borreliae-containing ticks parasitized European robin, Erithacus rubecula (L.); Eurasian blackbird, Turdus merula L.; Blackcap, Sylvia atricapilla (L.); Eurasian chiffchaff, Phylloscopus collybita (Vieillot); Great tit, Parus major L.; and Eurasian jay, Garrulus glandarius (L.). The isolate BR-34 from a nymphal I. ricinus off a Eurasian blackbird had a sodium dodecyl sulfate-polyacrylamide gel electrophoresis protein pattern, reactions to monoclonal antibodies, and fragments of HindIII digested DNA probed with fla and ospA genes that suggested to us that it belongs to the genospecies Borrelia garinii. Free-living birds may be involved in the circulation of B. burgdorferi sensu lato principally as disseminators of infected ixodid ticks to new area.

Staphylococcus saprophyticus subsp. bovis subsp. nov., isolated from bovine nostrils.

A new coagulase-negative subspecies, Staphylococcus saprophyticus subsp. bovis, is described on the basis of a study of five strains isolated from the anterior nares of cows. This subspecies is differentiated from the other novobiocin-resistant staphylococci by its phenotypic properties, cell wall composition, and levels of genetic relatedness. The type strain of the new subspecies is KV 12 (=CCM 4410).

[Comparison of the results of antibiotics sensitivity tests using the standard microdilution method on isolated bacteria and the direct disc method on positive hemocultures from the automatic BacT/Alert system]. / Porovnání výsledku testování citlivosti k antibiotikum standardní dilucní mikrometodou u izolovaných bakterií a "prímou" diskovou metodou u pozitivných hemokultur z automatického systému BacT/Alert.

During a six-month period 2,221 haemocultures obtained from patients hospitalized in the Faculty Hospital Olomouc were examined. In all 304 isolated bacteria the sensitivity was assessed by the standard dilution micromethod and moreover all positive haemocultures were examined the "direct" disc method. Agreement between the results of the two methods was proved in 84% of pairs of tests and within a range from 67 to 100%, depending on the type of antimicrobial preparation. Based on these findings it may be stated that assessment of the sensitivity by the "direct" method agrees significantly with assessment of the sensitivity according to minimal inhibitory concentrations (MIC). In patients with septicaemia this procedure makes it possible to change empirical antibiotherapy by 24 hours sooner to aimed therapy.