Field-Level Exposure of Bumble Bees to Fungicides Applied to a Commercial Cherry Orchard.

Bumble bees, Bombus spp. (Apidae), are important native pollinators; however, populations of some species are declining in North America and agricultural chemicals are a potential cause. Fungicides are generally not highly toxic to bees, but little is known about sublethal or synergistic effects. This study evaluates bumble bee exposure to fungicides by quantifying concentrations of boscalid and pyraclostrobin in nectar and pollen collected by colonies of Bombus huntii Greene, 1860 (Hunt bumble bee) deployed in a commercial cherry Prunus avium L. orchard in the spring of 2016. Seven colonies were placed adjacent to an orchard block that was sprayed with a fungicide mixture of boscalid and pyraclostrobin and a control group of seven colonies was placed next to an unsprayed block of orchard 400 m away from the treated block. Nectar and pollen were collected daily, beginning 1 d before spray application and continuing for a total of 12 d, and analyzed for both fungicides. Fungicide concentrations varied spatially by colony and temporally by day. The highest concentrations in nectar occurred 1 and 3 d after spraying: up to 440 ng/g boscalid and 240 ng/g pyraclostrobin. Six days after application, pollen from cherry flowers contained the highest concentrations of the fungicides: up to 60,500 ng/g boscalid and 32,000 ng/g pyraclostrobin. These data can help to determine field-level fungicide concentrations in nectar and pollen and direct future work on understanding the effects of these compounds, including their interactions with important bumble bee pathogenic and beneficial symbionts.

Cyanide poisoning in patients with inhalation injury - the phantom menace.

Inhalation injury is a serious complication in patients with burns that dramatically increases their morbidity and mortality. These patients are always suspected of having inhalation injury with potential intoxication. We usually encounter carbon monoxide intoxication, but it is necessary to think about the possibility of poisoning by other combustion products. Cyanide intoxications are less common, but their diagnosis and treatment are more complicated. The diagnosis can only be based on the history, clinical findings, and indirect laboratory signs. Direct determination of plasma cyanide levels is not generally adopted in routine clinical practice. Nowadays, several specific antidotes with different mechanisms of action are available. There are no clear guidelines on the antidote of choice, as the evidence base is limited by a lack of randomised controlled trials in humans. In two mini case reports, we present our experience with the diagnosis and therapy of patients with suspected cyanide poisoning.

[Surgical decompression of the peroneal nerve at the level of the fibular head]. / Operative Dekompression des Nervus peroneus auf Höhe des Fibulaköpfchens.

OBJECTIVE: Functional and sensible regeneration of deficits related to common peroneal nerve palsy. INDICATIONS: Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait. CONTRAINDICATIONS: Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma. SURGICAL TECHNIQUE: Surgery in lateral position and thigh tourniquet. L­Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage. POSTOPERATIVE MANAGEMENT: Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months. RESULTS: From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.

[Autologous fat grafting in breast surgery : results of a retrospective study]. / Lipofilling in Rahmen der Mammachirurgie : Ergebnisse einer retrospektiven Analyse.

BACKGROUND: Autologous fat has many qualities for an ideal filler and is widely used in reconstructive and aesthetic surgery, especially in the treatment of primary and secondary deformities of the breast. METHODS: From May 2007 to September 2012 298 autologous fat graftings were performed in 199 patients. Fat was harvested using the Tissue-Trans™ (Shippert Medical), Lipivage™ (Polytech) or a self-developed harvesting system and injected without any further processing into subcutaneous and/or intramuscular layers. RESULTS: The mean patient age was 45 years. Main indications were contour deformities and volume loss after breast cancer surgery as well as asymmetry, hypoplasia, Poland syndrome or tuberous breasts. The average volume of grafted fat was 90 ml per surgery. Most patients received one (42 %) or two (31 %) sessions of treatment. The infection rate was 2 % which was further treated with oral antibiotics. CONCLUSION: Autologous fat grafting represents an important tool for the management of deformities of the breast not only by filling deformities and adding volume, but also by improving the quality of scars. It is a simple, fast and effective treatment option with few complications.

[Risk factors for anastomotic leakage following rectal resection - multicenter study]. / Rizikové faktory anastomotické insuficience po resekcích konecníku - Multicentrická studie.

INTRODUCTION: Anastomotic insufficiency (anastomotic leakage) is one of the most serious complications of the sphincter-saving rectal resections, with significant impact on patient morbidity and mortality. The risk rate of anastomotic leakage may be influenced by local anatomic conditions - tumour localisation and stage, possible technical problems in anastomosis construction (ischaemia, anastomosis under tension), and by complex factors associated with the patient - malnutrition, obesity, smoking, corticosteroid therapy and preoperative chemoradiation. MATERIAL AND METHODS: All sphincter-saving rectal resections that were performed between September 2011 and April 2014 in three centres of colorectal surgery, i.e. at Atlas Hospital in Zlín, the Czech Republic, and at Kosice-Saca Hospital and Dérers University Hospital in Bratislava, Slovakia, were included in the present multicentric prospective study. The incidence of anastomotic leakage in laparoscopic and open surgery was compared and the risk factors resulting in leakage occurrence were analyzed. RESULTS: Anastomotic leakage developed in 12 (10.9%) out of the total number of 110 patients. In the laparoscopic group (58 patients), the insufficiency occurred 4x (6.9%), in the 17 converted patients 3x (17.6%), and in the open surgery group (35 patients) the leakage occurred 5x (14.3%). There was no statistically significant difference between these groups. Nevertheless, patients with anastomotic leakage were only males (P=0.006), they had significantly lower pre-operative albumin levels (35.8 g/l vs. 38.3 g/l; P=0.03), as well as a lower pre-operative total protein level (60.8 g/l vs. 64.1 g/l; P=0.07), when compared to patients without insufficiency. Tumour distance from the anal verge in patients with anastomotic leakage was also significantly lower (10.8 cm vs. 12.8 cm; P=0.05). CONCLUSION: The following risk factors for anastomotic insufficiency after rectal surgery were identified: male gender, low pre-operative albumin and total protein levels, as well as decreasing tumour distance from the anal verge. The difference in the incidence of anastomotic insufficiency between laparoscopic and open surgery groups was not statistically significant.

[Soft tissue reconstruction in the extremities and the head and neck area using the anterolateral thigh free flap]. / Die freie anterolaterale Oberschenkellappenplastik zur Weichteilrekonstruktion an den Extremitäten und im Kopf-Hals-Bereich.

OBJECTIVE: Stable soft tissue coverage of exposed bone, tendons, or hardware in the extremities or the head and neck area with a microsurgically grafted free flap. INDICATIONS: Soft tissue defects measuring up to 42 × 15 cm in the extremities and the head and neck region. CONTRAINDICATIONS: Previous surgery or trauma in the anterolateral thigh region. Insufficient personnel and/or technical resources. SURGICAL TECHNIQUE: A line is marked from the anterior superior iliac spine to the superolateral patella pole, approaching the intermuscular septum between the rectus femoris and vastus lateralis muscle. The flap is centred on this line and after medial incision the perforators of the descending branch of the lateral circumflex femoral artery are identified and dissected to their origin. Afterwards the lateral incision is carried out and flap dissection is completed. After flap transfer microsurgical anastomoses are performed and the flap is sutured to the recipient region. POSTOPERATIVE MANAGEMENT: Flap monitoring for 1 week. Strict elevation and immobilization after flap transfer to the extremities; bedrest for 1 week. Thrombosis prophylaxis. RESULTS: From 2008-2011, 41 free anterolateral thigh flaps in 5 women and 36 men with an average age of 53 years (38-70 years) were performed for microsurgical soft tissue reconstruction. Total flap loss rate was 2.4 % and reoperation due to complications, e.g., hematoma, problems with microsurgical anastomosis, and partial flap loss was necessary in 13.8 % of patients.

[Vaccination against hepatitis B in patients with chronic renal failure--twenty years follow-up]. / Ockování proti virové hepatitide B u pacientu s chronickým selháním ledvin--dvacetileté zkusenosti.

AIM: The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010. PATIENTS AND METHODS: Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 microg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 microg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1-2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated. RESULTS: Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (> or = 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988-1994. Anti-HBc seroconversion was observed in 10 patients. CONCLUSION: Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.

[The anterolateral thigh flap: its versatility in oncological soft tissue reconstruction of the head and neck region]. / Der anterolaterale Oberschenkellappen : Seine Vielseitigkeit bei der onkologischen Weichteilrekonstruktion im Kopf-Hals-Bereich.

The anterolateral thigh flap (ATL) has become a standard procedure in reconstructive microsurgery. In this study the results with the ALT for reconstruction in the head and neck area after tumor resection in 33 patients were retrospectively analyzed. Patients included 28 men and 5 women aged 47-70 years who suffered from intraoral and extraoral tumors. Satisfactory soft tissue coverage could be achieved in all patients and no flaps were lost. The ALT is a versatile free flap enabling reliable soft tissue reconstruction of complex defects in the head and neck region. Flap dissection and preparation of the recipient area can usually be performed simultaneously. Additional advantages include the long and strong caliber vascular pedicle, the low donor site morbidity and the different possibilities of tissue composition, making the ALT a workhorse flap in modern reconstructive microsurgery.

Management of full-thickness skin defects in the hand and wrist region: first long-term experiences with the dermal matrix Matriderm.

The gold standard for the coverage of full-thickness skin defects is autologous skin grafts. However, poor skin quality and scar contracture are well-known problems in functional, highly strained regions. The use of dermal substitutes is an appropriate way to minimise scar contraction and, thereby, to optimise the quality of the reconstructed skin. The aim of this study was to evaluate the impact of the collagen-elastin matrix, Matriderm, for the single-step reconstruction of joint-associated defects of the upper extremity. Seventeen patients with full-thickness skin defects of the upper extremity were treated with the dermal substitute, Matriderm, and unmeshed skin graft in the functional critical region of the distal upper extremity in a single-step procedure. The take rate of the matrix-and-skin graft was 96%. Long-term follow-up revealed an overall Vancouver scar scale of 1.7. No limitation concerning hand function was observed; DASH-score analysis revealed excellent hand function in patients with burn injury and patients with a defect due to the harvest of a radial forearm flap achieved satisfying hand function. This matrix represents a viable alternative to other types of defect coverage and should therefore be considered in the treatment of skin injuries, especially in very delicate regions such as the joint regions. The possibility of performing a one-stage procedure is supposed to be a major advantage in comparison to a two-stage procedure.

The treatment of deep dermal hand burns: How do we achieve better results? Should we use allogeneic keratinocytes or skin grafts?

The treatment of deep dermal burns has a broad spectrum and has been subject to discussion over the past years. The treatment of hand burns is challenging due to the high requirements to aesthetic and functional outcome. 27 patients, 7 women and 20 men with deep dermal hand burns with a mean age of 41.3+/-16.5 and a mean TBSA of 15%+/-19.6% were treated either with allogeneic cryopreserved keratinocytes or with split skin grafts. Long-term follow-up revealed no statistical significant differences between the two groups concerning Vancouver Scar Scale as well as hand function judged by the DASH score; however there was a tendency to higher VSS scores and impaired aesthetic results in the keratinocyte group. Allogeneic keratinocytes are a suitable armentarium for the treatment of deep dermal hand burns; and, if used correctly, they can produce a timely healing comparable to split-thickness skin grafts. Limited availability, high costs as well as the need for special skills are key factors, which render application of this technique outside specialist burn centres virtually impossible. In our opinion, the cultivation and use of keratinocytes should be reserved to these centres in order to facilitate a sensible application for a full range of indications. We recommend usage of allogeneic keratinocytes for deep dermal hand burns only in severely burned patients with a lack of donor sites. Patients with unrestricted availability of donor sites seem to profit from the application of split-thickness skin grafts according to our results.

Our experience in the nutritional support of a burned child treated with integra.

Integra artificial skin was applied on 16% of TBSA after necrectomy on a 7-month-old girl who was scalded on 26% of TBSA by her mother when she was cooking goulash. Nutritional parameters were monitored during the period of 25 days from the 1st necrectomy and application of Integra up to the first autotransplantation--in the period when the other burnt surfaces were almost healed. The average intake of proteins and energy to achieve normal levels of monitored nutritional parameters was lower than that recommended by calculations for similarly burnt children. Our observation is similar to that of King.

Procalcitonin--a marker and mediator of inflammation.

Evaluation of procalcitonin levels is a sensitive investigation which is significant for differentiation between microbial and non-microbial infection, a determination of its dynamics and a prediction of therapy results. It is, however, necessary to evaluate its levels in relation to other investigations and their dynamics (other inflammatory markers, organ function dynamics), which specify diagnosis with the clinical condition of a patient. Even today, 10 years after the discovery of procalcitonin as an inflammatory marker and likely mediator of a cytokine cascade, there are many unanswered questions regarding its production in relation to physiological significance during the defensive response of an organism (12). Boucher formulated a simple conclusion in 2000: Procalcitonin should not be seen as the marker of sepsis but as one of many potentially useful markers.

Critical and severe burn injury in children.

The authors present a data file of 279 children with severe and critical burn injury, hospitalized in the Intensive Care Unit or the Pediatric Resuscitation Unit of the FNsP Hospital in Ostrava in the years 1999 - 2003. The severity of the burn trauma in children is determined by age, extent, depth, localization, circumstances of the injury, its mechanism, and by other serious illnesses of a child. The authors have divided the data file into two groups, severe and critical, using classification of a burn injury in children according to the extent of injury as well as localization and other circumstances (1). Complex therapy of extensive burn injuries in children is based on adequate fluid resuscitation, treatment of burned areas, algosedation, and appropriate antibiotic therapy. The authors have unequivocally confirmed that in the group of children with diagnosis of critical burns complications occur more often, while the overall course of illness is serious and requires more therapeutical interventions than in the group of children with severe burns.

Current problems of diagnostics and treatment of urinary incontinence in females.

The incidence and prevalence of urinary incontinence in females is high, in women older than 60 yr of age it affects 30-60 per cent of them. The etiology of urinary incontinence is multifactorial. Urinary incontinence can be classified as stress, urgent, reflex, combined urinary incontinence and paradox ischuria.

[Surgical risk in treatment of a bleeding gastroduodenal ulcer in the era of invasive endoscopy]. / Prehlad rizík chirurga pocas liecby krvácajúceho vredu gastroduodena v ére invazívnej endoskopie.

OBJECTIVE: Objectivization of the asset of the present therapeutic algorithm in patients with haemorrhage from peptic gastroduodenal ulcers using invasive endoscopic and surgical haemostasis. METHOD: Comparison of quantitatively and qualitatively equivalent groups of 341/318 patients, the first group without application of invasive endoscopy, the second one with its application. RESULTS: Surgical haemostasis was called for in 12.3/11.6% cases. 92.9/59.5% operations were resections and bionomic operations, the mortality of the patients was 14.3/21.6%, re-operation was necessary in 7.1/13.5% cases. At the time of operation 57.1/78.3% patients were a high risk, the length of the "critical" interval of haemorrhage in the second group increased by 48.3%. CONCLUSIONS: The present accepted procedure of haemostasis is associated with risks of limited selection of the optimal method of invasive endoscopy, the protraction of the interval of haemorrhage with an adverse rise of the index of the patient's risk, inadequate stabilization of the patient during the interval of haemorrhage and controversial indication of surgery in case of intractable haemorrhage.

Treatment by continuous renal replacement therapy in patients with burn injuries.

Continuous renal replacement therapy (CRRT) is a relatively new therapeutic procedure which helps in the treatment of critically ill patients with renal failure as well as those without renal failure. CRRT effectively removes urea and creatinine and maintains a balanced milieu interleur and water balance. A role in the elimination of pro-inflammatory cytokines is also ascribed to this method. Most frequently venovenous haemofiltration and venovenous haemodiafiltration are used. The authors present their experience with the CRRT treatment of 40 patients in the Burn Centre Ostrava and with the results attained.

Self-consistency requirement in high-energy nuclear scattering.

Practically all serious calculations of exclusive particle production in ultrarelativistic nuclear or hadronic interactions are performed in the framework of Gribov-Regge theory or the eikonalized parton model scheme. It is the purpose of this paper to point out serious inconsistencies in the above-mentioned approaches. We demonstrate that requiring theoretical self-consistency reduces the freedom in modeling high-energy nuclear scattering enormously, and we introduce a fully self-consistent formulation of the multiple-scattering scheme in the framework of a Gribov-Regge--type effective theory. In addition, we develop new computational techniques which allow for the first time a satisfactory solution of the problem in the sense that calculations of observable quantities can be done strictly within a self-consistent formalism.

[Acute cholecystitis during the time of minimally invasive abdominal surgery] ]. / Akútna cholecystitída v miniinvazívnom období brusnej chirurgie.

OBJECTIVE: To define optimal rules for the treatment of acute cholecystitis taking into account possible laparoscopic surgery. METHOD: Critical analysis of the authors' group of 90 patients with acute cholecystitis. RESULTS: Optimal results were achieved with surgical treatment within 72 hours after the first clinical symptoms of the disease without the need of conversion of the laparoscopic operation in the authors' group. Surgery between the third and tenth day of hospitalization is unfavourable with a conversion rate of 18%. CONCLUSION: Acute cholecystitis with complications calls for urgent classical surgery, acute cholecystitis without complications laparoscopic operation within 72 hours after the first clinical symptoms. In critically ill patients alternative cholecystostomy or puncture of the gallbladder may be used.