Insulin treatment in diabetics 75+ years: experiences and results in outpatient care.

Diabetes mellitus (DM) has a crucial impact on personal and social health. In the very old age it significantly affects also the social status of the individual. In the elderly 75+ y. DM occurs often in the domain of multi-morbidity and can conduce to incurrence and development of serious disability, which can significantly influence further therapeutic procedures. The study was aimed at analyzing the situation connected with the DM development, duration, insulin therapy period and overall approach in persons 75+ y. at 8 diabetological outpatient clinics of the Brno city. In the study we included 337 older diabetics 75+ y. who were long-term observed in the above mentioned diabetological outpatient clinics. There were 129 men and 208 women of the average age 79,3+/-4,9 y. (range 75-97 y.) out of this number. DM in patients of our set was detected in the age of 59,9+/-12,9 y. Its duration in the time of this study was 18,8+/-12,9 y. and the insulin therapy duration was 8,0+/-7,3 y. Good mobility was present in 303 persons (89,7%); 73 diabetics suffered from serious cognitive impairment - almost as to beginning dementia (22%). 159 seniors altogether had urinary incontinence, i.e. 47%. Within the study we analyzed such questions as: who applies insulin in the elderly; with whom he or she lives (24% of them are totally alone); how many times per day insulin is applied; which kind of insulin is used and whether there are hypoglycemias. We also took into consideration, if the senior owns a portable glucometer and who helps him or her with self-monitoring. Permanent insulin therapy represents in old age the kind of treatment which is very demanding for the old diabetic as well as for the nursing staff and the patient's close environment. A geriatric patient faces a long-term threat of decompensation of his/ her functional status and therefore he/she requires specific modification of the specialist's approach when deciding on the regimen and therapeutic measures.

Breakthrough fungaemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro.

Breakthrough fungaemias due to Candida albicans and Candida parapsilosis appearing during fluconazole therapy in neonates and infants were assessed for risk factors and outcome. Forty fungaemias occurred during therapy with fluconazole within a 12 year national survey and were compared with 161 cases of non-breakthrough paediatric fungaemias. The agar disc diffusion test method was used for antifungal susceptibility testing and the Vitek system for species identification. Univariate and multivariate analysis for risk factors for breakthrough fungaemia were carried out. All the fungaemias were a result of strains susceptible to fluconazole at 0.25-4 mg/L in vitro [C. albicans (85%) and C. parapsilosis (15%)]. The mean number of positive blood cultures per episode was 2.2. Sixteen children had 'early' breakthrough fungaemias (within 4-5 days) and 24 fungaemias appeared on day 6 and later. Mean fluconazole MICs in the 'early' group were 1.2, and 2.8 mg/L in the 'late' group (P < 0.03, t-test). However, no difference was observed in the average dose of fluconazole used in the two groups. Neonatal age, total parenteral nutrition, very low birth weight, before surgery, central or umbilical venous catheterization and artificial ventilation were all significantly related to breakthrough fungaemia in univariate analysis but only central or umbilical venous catheterization were significant in multivariate analysis. The outcome of breakthrough fungaemia was better overall and attributable mortalities in non-breakthrough fungaemia was significantly higher in comparison with breakthrough fungaemia.

Nosocomial fungemia due to amphotericin B-resistant Candida spp. in three pediatric patients after previous neurosurgery for brain tumors.

Amphotericin B (AmB) resistance in Candida spp. is very rare. Three cases of fungemia, due to amphotericin B-resistant Candida spp. in pediatric patients after previous neurosurgery for brain tumors, are reported. The Candida strains - one C. guillermondii, one C. lusitaniae, and one C. parapsilosis - showed minimum inhibitory concentrations (MICs) to AmB of 2-4 microg/ml. Two of the three patients had been pretreated with AmB for 5-11 days. All three patients were successfully treated with intravenous fluconazole (6-10 mg/kg per day) for 16-28 days, and all survived. Despite AmB resistance in Candida spp. being very rare, C. lusitaniae, C. guillermondii, and C. parapsilosis isolates in documented infections should be tested for AmB resistance, mainly in patients not responding to therapy with AmB.

[Tolerance and results of treatment of Hodgkin's disease]. / Tolerance a výsledky lécby Hodgkinovy choroby.

At present the accepted standard chemotherapeutic treatment of Hodgkin's disease is therapy according to the MOPP pattern (mustargen, vincristine, procarbazine and prednisone) alternating with the ABVD therapeutic pattern (adriamycin, bleomycin, vinblastine and dacarbazine). It is substantial for achieving optimal results to administer the planned treatment in non-reduced doses and at the scheduled time. In the submitted paper the authors describe the tolerance of chemotherapy and its results in 15 patients and the tolerance of radiotherapy in another four patients suffering from Hodgkin's disease. Complications of chemotherapy (leukopenia and infection) caused an overall average retardation of chemotherapy of 37 days per patient. This interval would be certainly longer if the patients were not given Leucomax Schering Plough. From a total of four patients given radiotherapy Leucomax had to be administered to two, otherwise radiotherapy would have had to be discontinued on account of a decline of leucocytes.

[Treatment of adult acute lymphatic leukemia with polychemotherapy supported by the leukocyte growth factor G-CSF]. / Lécba akutní lymfatické leukémie dospelých polychemoterapií s podporou leukocytárního rustového faktoru G-CSF.

The treatment results in 13 patients with acute lymphatic leukemia are reported. All patients were treated according to the Hoelzer protocol. Granulocyte colony-stimulating factor (G-CSF) was administered till the onset of neutropenia and was continued as long as the leukocyte number increased above 3 x 10(9)/l. In phase I of Hoelzer's protocol G-CSF was administered on the average for 12 days, in phase II for 15 days. The chemotherapy of phase I was administered in scheduled time to 11 patients. In phase II the average delay against the scheduled time was 14 days. Reductions of dose were made only in 2 person. After finishing phase II 9 patients were in complete remission. Three patients died during therapy, one patient with small response died one month after completing phase II therapy. We believe that the administration of G-CSF only at the onset of leukopenia also abbreviate its duration as if the application were started immediately with the chemotherapy.

[Renal venous thrombosis in neonates]. / Renálna venózna trombóza u novorodenca.

The authors present an account on a neonate with dextro-lateral renal venous thrombosis. They focus attention on the diagnostic and therapeutic procedure and compare it with available data from the literature. Contrary to data in the literature, they did not observe in the acute stage of renal venous thrombosis signs of disseminated intravascular coagulation in peripheral blood. It did not prove possible to elucidate the action of any of the factors leading to the development of renal venous thrombosis. After evidence of permanent functional loss of the right kidney nephrectomy was performed. Histopathological examination provided evidence of obliterating thrombosis of the renal veins with partial recanalization and calcifications. The authors emphasize the necessity of early diagnosis of renal venous thrombosis and adequate treatment based on the revealed findings.