Change in fatty acid composition of serum lipids in obese females after short-term weight-reducing regimen with the addition of n-3 long chain polyunsaturated fatty acids in comparison to controls.

Short-term weight-reducing regimens were shown to influence fatty acid composition of serum lipids unfavorably. Adding long chain n-3 polyunsaturated fatty acids (n-3 LC PUFA) to a low-calorie diet (LCD) could avoid these changes. The aim of this study was to examine the effect of a short-term in-patient weight-reducing regimen including LCD with yogurt enriched by low doses of n-3 PUFA (n-3 LCD). The enriched yogurt contained 790 mg of fish oil, predominantly eicosapentaenoic (20:5n-3; EPA) and docosahexaenoic (22:6n-3; DHA). Forty obese women were randomly assigned to the group consuming LCD and joghurt either with or without n-3 enrichment. Following the 3-week diet in the n-3 LCD group a significantly higher increase in the proportion of n-3 LC PUFA (sum of n-3 FA, EPA and DHA) in serum lipids was confirmed. In phospholipids (PL) a significant difference in the sum of n-6 fatty acids was found, a decrease in the n-3 LCD group and an increase in LCD group. Significantly higher increase in the PL palmitate (16:0) was shown in the LCD group. The results suggest that low doses of n-3 fatty acid enrichment can help to avoid unfavorable changes in fatty acid composition in serum lipids after a short-term weight-reducing regimen.

Bilateral radial nerve palsies from use of the standard birthing bar.

BACKGROUND: Serious injury can result from improper use of the birthing bar. CASE: A 31-year-old woman delivered a neonate using a birthing bar for her entire second stage of labor. Shortly after delivery, she experienced bilateral upper extremity weakness from compression of the radial nerve. She was treated with physical therapy and electromuscle stimulation and regained functional use of her upper extremities within 3 months. One year after delivery, the patient continued to display bilaterally only 80% muscle strength in her radial-innervated musculature. CONCLUSION: Improper use of the birthing bar during labor can cause serious and permanent injury to the radial nerve. Care should be taken when instructing patients on how to use the birthing bar to avoid this complication.

Glenohumeral gliding manipulation following interscalene brachial plexus block in patients with adhesive capsulitis.

Previous studies describing nonconservative treatment of shoulder adhesive capsulitis include distention arthrography, brisement techniques, arthrotomy of the anterior/inferior axillary fold and subscapularis tendon, and manipulation under general anesthesia. The purpose of this study was to develop and describe an alternative treatment method that utilizes glide manipulation under interscalene brachial plexus block. Eight patients (four females and four males), age 31-55 years, with a mean age of 44 years, were treated conservatively for adhesive capsulitis of the shoulder and failed to produce increased measurable objective active or passive ranges of motion. Symptoms of adhesive capsulitis in these patients range from 3 to 16 months, 7 months average. Premanipulation treatment ranged from 1 to 21 weeks, with an average of 9 weeks. Two additional patients were considered for manipulation after a trial of conservative treatment, but the interscalene brachial plexus block and manipulation were not performed. One patient was eliminated from the study due to excessive osteoarthritis in the shoulder girdle, and the other patient was eliminated from the study due to a high cardiac risk. The eight patients chosen for manipulation underwent interscalene brachial plexus blocks. They were immediately sent to the physical therapist for manipulation under anesthesia following the interscalene brachial plexus blocks. Immediately following manipulation, the average increases in passive range of motion for flexion, abduction, external rotation, and internal rotation were 68 degrees, 77 degrees, 49 degrees, and 45 degrees, respectively. At the time of discharge, average increases in passive range of motion/active range of motion for flexion, abduction, external rotation, and internal rotation were 76/67 degrees, 82/73 degrees, 50/44 degrees, and 49/40 degrees, respectively. All patients manipulated showed increases in function, such as overhead activities, dressing activities, and hair care. These preliminary findings show that effective gliding manipulation can be carried out under regional blockade and performed in an office setting by practitioners knowledgeable in manipulation techniques.

Ruptured abdominal aortic aneurysm--outcomes in the last ten years.

Ruptured abdominal aortic aneurysm (AAA) remains to be represent a common and highly lethal problem. We reviewed the records of 92 patients (73 men and 19 women) operated on for ruptured infrarenal AAA within the past 10 years (January 1989 to October 1999) in the 2nd Department of Surgery in Brno, Czech Republic. The mean age was 71 years (range 57 to 92 years). Only 10 patients (10.9%) were known to have an AAA before the rupture. Preoperative systolic blood pressure below 90 mmHg was present in 70 patients (76%) and 15 patients (16.3%) experienced cardiac arrest before surgery. The in-hospital mortality rate was 47.8% (44 patients). Among the total of 92 patients, haemoperitoneum was discovered only in 30 patients (32.6%) with the mortality rate of 40% (12 patients). In 62 patients (67.4%) also hemoperitoneum was present, the mortality rate was 51.6% (32 patients) in these patients. Multiorgan failure due to an irreversible hemorrhagic shock was the main cause of death in 23 patients (25%). Further causes were: heart failure--8 patients (8.7%), pulmonary complications--5 patients (5.4%), renal failure--4 patients (4.3%), bleeding--3 patients (3.3%), and sepsis--1 patient (1.1%). The patient's prognosis depends on early diagnostics and on the quality of peroperative and postoperative care. (Tab. 2, Ref. 8.)

[Ischemic disease of the lower extremity and lumbar sympathectomy]. / Ischemická choroba dolních koncetin a lumbální sympatektomie.

We consider lumbar sympathectomy (LSE) to be the last attempt to improve the condition of the limb. Though being aware of inconsistent opinions on LSE, we are not opponents of this method, particularly if it is carried out in a selected group of patients, that is in case of: 1) treatment of frostbites, 2) treatment of patients at an early stage of advanced ischemia whose main symptom is moderate night pain at rest, 3) desiccation of chronically moist ulcerations between the toes, 4) treatment of patients with reflex symptomatic dystrophy (causalgia), 5) Buerger's disease.

[Acute biochemical effects of calcium: comparison of two dosage forms of calcium carbonate (powder and effervescent tablets) and milk in healthy women]. / Akutní biochemické úcinky vápníku: srovnání dvou ruzných lékových forem uhlicitanu vápenatého (prásek a effervescentní tableta) a mléka u zdravých zen.

BACKGROUND: The aim of this study was to assess acute biochemical changes after the administration of two different pharmaceutical forms of calcium carbonate or milk. METHODS AND RESULTS: The group of 12 young (aged 20-27 years) and 12 older women (aged 63-71 years). After overnight fasting, each of the volunteers received a 1 g of elemental calcium in either form of the tested preparation: powder form of calcium carbonate--Vitacalcin pulvis (Slovakofarma, SR) or effervescent tablet--Calcium 500 mg Pharmavit (Pharmavit, MR) or in 250 ml of milk enriched with the milk calcium complex. Between each test the interval of 1-2 weeks was held. Samples of blood and urine were taken in the fasting state before and during 5.5 h following ingestion of the calcium load. Both calcium carbonate and milk induced a significant increase in the serum ionised calcium (iCa) and a significant decrease in plasma parathormone level (PTH) in comparison with the baseline levels in both groups of women. Comparison between individual preparations and between preparations and milk did not reveal any significant differences in suppression of PTH. Comparison of the effects between young and elderly women did not show any statistically significant difference in any measured parameter. CONCLUSIONS: Our results confirmed the good bioavailability of calcium from milk and from both calcium preparations in both age groups of women. Significantly more frequent hypercalcemia in the young women (p < 0.05) and also the slightly higher hypercalciuria occurred after the application of calcium in the pharmaceutical form of effervescent tablet than after the application of calcium in the form of powder or after the application of milk.

[Problems in indications for vascular reconstructive surgery]. / Indikacní problémy u cévních rekonstrukcních operací.

The authors discuss examinations made before a planned vascular reconstruction operation. As the number of vascular reconstruction operations is steadily increasing, and the operations affect the entire organism, and the operations are associated with a relatively high mortality rate, the authors try to reduce the latter by the correct classification into a risk group, select the correct order of surgical operations, and last not least, on the basis of these conclusions they try to define also the surgical procedure proper during reconstruction. As atherosclerotic affections can be isolated or combined, the authors divide the patients into three groups. The first group can be subjected to a reconstruction operation without special preparation. The second group comprises patients where it is either necessary to confirm or rule out affection of extracranial cerebral arteries and the third group comprises patients where it is necessary to confirm or rule out affection of the coronary arteries. The aim of this comprehensive procedure is to reduce as much as possible the surgical mortality.

[Resection of the first rib for the upper thoracic outlet syndrome-- long-term experience]. / Resekce 1. zebra pro syndrom horní hrudní apertury--TOS-- dlouholeté zkusenosti.

The authors describe their own experience with the surgical treatment of the upper thoracic aperture syndrome-TOS-during the period of 14 years. During this period on account of this diagnosis at the Surgical Clinic in Brno 112 patients were operated, whereby the resection of the first rib was always done by the transaxillary approach. The authors describe in detail the symptomatology, diagnosis and surgical treatment. They emphasize the advantages of the transaxillary approach. In the conclusion the authors discuss the fact that only in 45% of the operated patients the symptoms disappeared. This leads to reflections on more strict criteria for the surgical treatment of this syndrome.

[Carotid-subclavian bypasses (1985-1996)]. / Karoticko-subklaviální bypassy (1985-1996).

A carotic-subclavian bypass is an extraanatomical reconstruction. It is one of the possibilities how to connect the ipsilateral common carotid and subclavian artery. The authors evaluate carotic-subclavian bypasses made during the past 11 years at the Second Surgical Clinic in Brno. In all twelve cases carotico-subclavian bypasses were involved, in none of the patients a subclavian-carotid bypass was involved or direct anastomosis. The author discusses in detail preoperative complaints, associated diseases, postoperative complaints. In his opinion absolute indications for surgery are neurological symptomatic affections even of one trunk, incl. subclavian steal syndrome. They indicate asymptomatic affections for surgery if at least two trunks are affected. The greatest pitfall of the operation is in their opinion the selection of the length and type of vascular prosthesis. They find that the interval patency rate 100% and the cumulative patency rate 85% evaluated by the method of "Life table analysis" with a standard error of patency rate of 9% are comparable with similar reports from abroad.

[Embolisms of the abdominal aortic bifurcation]. / Embolisationes bifurcationis aortae abdominalis.

The authors evaluate in the submitted paper the results of surgical treatment of embolization into the bifurcation of the abdominal artery at the Second Surgical Clinic in Brno during 1990-1996. A total of 5 patients was involved whereby in all a cardiac cause of the embolization was obvious. The authors deal also with the time which has elapsed between the development of complaints and surgery, the type of anaesthesia, average length of operation. The operation is implemented concurrently by two teams as antero- and retrograde simultaneous bi-transfemoral embolectomy. The authors emphasize the importance of the metabolic condition of the patient as well as cardiac and renal functions before, during and after surgery. They consider the application of peroperative haemodialysis essential. During the postoperative period it is important to find the objective cause of the cardiac deficiency and treat it. Their results--a 40% mortality are comparable with those of other specialized departments. By comparison with a similar group treated at the same department twenty years previously the authors find a decline in the incidence of this disease and explain this phenomenon by an increased number of cardiosurgical operations in this area.

[Aneurysm of the splenic artery]. / Aneurysmata arteriae lienalis.

The authors describe in their paper possibilities of surgical and intervention treatment of an aneurysm of the lienal artery, their advantages and disadvantages. They evaluate the results of treatment of aneurysms of the lienal artery in three patients treated at the Second Surgical Clinic in Brno in 1993-1996. In the first patient the aneurysm was resected concurrently with splenectomy. In the second patient resection of the aneurysm with end to end anastomosis of the lienal artery was made. In the third patient the method of artificial embolization of the aneurysm of the lienal artery was used. The results are good. The first two patients were discharged ten and nine days resp. after surgery and are in a good clinical condition. The third patient had treatment in four sessions within two months and the final effect is a completely embolized aneurysm of the lienal artery with a preserved blood supply of the spleen and its intact function. The authors maintain that when dealing with an aneurysm of the lienal artery the surgeon has several possibilities and it is up to him which possibility he will chose with regard to anatomical conditions, the patients general condition and his own abilities and possibilities. The authors recommend if possible to preserve the spleen as a functioning organ or to preserve at least its immunological function.

[An unusual embolization of a projectile in the superficial femoral artery]. / Neobvyklá embolizace projektilu do povrchní stehenní tepny.

The authors present an account on a gunshot wound which penetrated into the lateral side of the distal chest on the right. They describe acute treatment of severe haemorrhagic shock by suture of a lacerated with liver segment and resection of the upper pole of the right kidney. The projectile was not searched for because of the patients general serious condition. After 30 days the patient was discharged in a good condition. Shortly after discharge, i.e. cca one month after the injury, the patient developed signs of chronic ischaemia of the left lower extremity-finally claudications after 150 meters. Based on peripheral arteriography, which revealed the projectile in the area of the beginning of the superficial femoral artery and an ample collateral circulation, surgery was initiated. The bullet was extracted from the lumen of the superficial femoral artery from longitudinal arteriotomy. The artery was then treated by thrombectomy and a venous patch. Peroperative arteriography indicates satisfactory passage into the periphery. The authors try to reconstruct the pathway of the shot and in particular how the projectile penetrated into the artery. They emphasize the necessity to look for the projectice at the site of the shot wound. The objective of the paper is to make readers familiar with a case of uncommon embolization of a projectile into the superficial femoral artery and mistakes which may occur during treatment of a gunshot wound. The result is that the patient is quite free from complaints, as was confirmed by repeated out-patient check-ups.

[Ruptured abdominal aortic aneurysms]. / Rupturující aneuryzma abdominální aorty.

The authors present the results of a retrospective study concerning 96 patients with an abdominal aortic aneurysm rupture who underwent surgery in the 2nd Department of Surgery in Brno in the time period from 1989 to 1999. In 30 cases (31.2%) there was an isolated retroperitoneal rupture, 66 patients (68.8%) also had haemoperitoneum. The mean age of the patients was 74 years and the male/female ratio was 76 (79.2%): 20 (20.8%). Twelve patients (40%) did not survive the retroperitoneal rupture, and 34 patients (51.5%) did not survive the intraabdominal rupture. Total mortality in the study group was 47.9%. The type of the rupture and the size of the haematoma that is in correlation with the time of diagnosis and operation, are among the most decisive prognostic factors. Patients with a small haematoma show higher survival rates. In large retroperitoneal haematomas accompanied by a haemorrhagic shock, the mortality was about 40% in the presented study group, in intraabdominal ruptures the mortality rate increases to values over 50%. The results are in accordance with foreign literature data, and the authors agree with the opinion that haemodynamically unstable patients with suspected abdominal aortic aneurysm rupture should be, after necessary preparations, urgently operated without complementary examinations.

Mycobacterium avium subsp. paratuberculosis survival during fermentation of soured milk products detected by culture and quantitative real time PCR methods.

Mycobacterium avium paratuberculosis (MAP), etiological agent of paratuberculosis in ruminants, is able to survive extreme conditions like very low pH (stomach), high temperature (pasteurization) or low temperature (refrigerated storage). Cheese, infant powder milk, cream and other milk and dairy products might thus be considered as possible sources of MAP for humans. The aim of this study was to investigate the survival of two MAP field isolates during fermentation of three different types of soured milk products (SMP; yogurt, acidophilus milk and kefir) under laboratory conditions. Pasteurized MAP-free milk was artificially contaminated with 10(6)MAPcells/mL and survival and absolute numbers of MAP were monitored during fermentation (4 or 16 h) and after six weeks of storage at 4°C by culture and quantitative real time PCR (qPCR). Viability of MAP was determined by culture using Herrold's egg yolk medium and Middlebrook 7H10 with antibiotics, supplemented with Mycobactin J and incubated at 37°C for up to 12 weeks. The absolute numbers of MAP were quantified by previously published qPCR assays targeting F57 and IS900 loci in MAP genome. We herein confirm that MAP can survive pH reduction, however, longer exposure to pH below 4 in SMP seems to be critical because it inhibits growth. Therefore, it is suggested that probiotic cultures that can decrease pH below 4 during fermentation could provide better inactivation of MAP in SMP.