[Injury of Medial Structures in Ankle Fractures - Epidemiological Aspects and Outcomes of Treatment]. / Poranení mediálních struktur u zlomenin hlezna ­ epidemiologické aspekty a hodnocení výsledku lécby.

PURPOSE OF THE STUDY Ankle fractures are characterised by a high variability of damage to bone and ligament structures which leads to diverse clinical conditions. This study aims to analyse a group of patients with surgically treated ankle fractures, with a focus on evaluating the outcomes of treatment of ankle joint medial structure injuries (medial malleolar fracture, ligament lesions). MATERIAL AND METHODS The analysed group included 186 patients (102 men and 84 women), in whom an ankle fracture surgery was performed in 2015 and 2016. The outcomes of the treatment were evaluated in 111 patients with type B and type C fractures, who underwent a follow-up examination at one year after the surgery consisting in subjective and objective assessment of the condition and an ankle radiograph. The obtained outcomes were processed using the techniques of descriptive statistics and subsequently evaluated through the Pearson´s chi-square test at 5% significance level, or the Fisher´s exact test for low frequencies. RESULTS The mean age of patients in the group was 48.6 years, while it was lower in men than in women (42.8 years compared to 53.9 years). According to Weber classification, 1 % of fractures were classified as a type A fracture, 68 % as a type B, 27 % as a type C. The group of isolated medial malleolar fractures represented 4 % of cases. The medial side of the ankle joint more frequently suffered a ligament lesion (56 %) than a medial malleolar fracture (44 %). The mean age of the patients with a medial malleolar fracture was 51.9 years, whereas the mean age of the patients with a ligament lesion on the medial side of the ankle was 44.2 years. When evaluating the outcomes using the OMA score at one year postoperatively, a statistically significant difference was found (p = 0.002) between the patients with a medial malleolar fracture (OMA 79.9) and the patients with a ligament lesion at the medial side of the ankle joint (OMA 91.2). DISCUSSION The aim of the study was to add more information on medial structures of ankle joint that are of major importance for ensuring stability of ankle fractures. In agreement with the literature, when managing the ankle fractures with an injury suffered on the medial side there is obviously a more uniform approach in cases with medial malleolar fractures. The situation is different in case of the deltoid ligament lesion, when historically there is a certain level of non-uniformity in indications for revision surgeries and treatment of the injured ligament structures. In our group, in the case of ligament lesion on the medial side of the ankle joint an emphasis is put on the fluoroscopy control of the symmetry of tibiotalar joint space before the beginning of the surgery and also after the fibular fracture stabilisation. The revision surgery was indicated in cases where asymmetry of ankle fork was found. The patients considered the treatment outcome better in cases with a ligament lesion than in cases with a medial malleolar fracture. CONCLUSIONS Proper treatment of medial structures of the ankle joint is important for ensuring the stability of ankle fractures. The patients with type B fractures reported better results at one year postoperatively compared to the patients with type C fracture according to the Weber classification. A statistically significantly better results after the ankle fracture surgery were achieved in patients with the presence of a medial ligament lesion compared to the patients with a medial malleolar fracture. Key words:ankle fracture, injury of medial structures, epidemiology, outcomes of treatment.

Radiocarbon concentration in tree-ring samples collected in the south-west Slovakia (1974-2013).

Radiocarbon measurements of tree-ring samples collected in Vysoká pri Morave were compared with tree-ring data of the Zlkovce monitoring station situated 5km south-east from the Jaslovské Bohunice Nuclear Power Plant (NPP). Radiocarbon concentrations in Vysoká pri Morave and in Zlkovce tree rings were decreasing exponentially with decay constants of 14.48±1.23 y and 17.96±1.97 y, respectively, in agreement with similar results obtained at other radiocarbon stations. The Suess effect, represented by a dilution in 14C levels by fossil fuel CO2 emissions, was observed in both tree-ring data sets. The Vysoká pri Morave 14C data were during 1974-1995 systematically lower by about 50‰ than the Schauinsland (Germany) clean air reference values due to a regional fossil-fuel impact. However, after 1996 the Vysoká pri Morave 14C data were closer to the Schauinsland data due to lower CO2 emissions as a result of closing some of the heavy industry technologies in the region.

[José Juan Verocay, "el patólogo de Praga" (on occasion of the 100th anniversary of his habilitation in Prague)]. / José Juan Verocay, "el patólogo de Praga" (ke 100. výrocí jeho prazské habilitace).

José Juan Verocay was born on June 16, 1876 in Paysandú, Uruguay to Italian immigrants; in 1887 they sent him to Cortina d'Ampezzo to learn languages first; he then graduated from the high school in Trento (1897) and from the German Medical Faculty in Prague (1904) where he, a disciple of Hanns Chiari, became the 1st demonstrator (1902), 3rd (1904) to 1st assistant (1905), and volunteer (from 1908) at the Department of Pathological Anatomy. He repeatedly substituted the professors Chiari (until 1906), Kretz (1907-1910), and Ghon (from 1910) during their absence. Anomalies and neoplasms prevailed among his research subjects. In the paper "Zur Kenntnis der ¼Neurofibrome«" (1910) he introduced the term "neurinoma" for a tumor with characteristic structures later named "Verocay bodies". On the basis of the paper he was habilitated for pathological anatomy as private docent at the German Medical Faculty in Prague (1911). During World War I he served for the Austro-Hungarian army at military hospitals in Chrudim (Bohemia) and Vienna. After the war he returned to Uruguay to work as a general practitioner in his native region (1919-1921), thereafter in Montevideo as head of pathological laboratories at the military hospital (1921-1925), at the Dental School (1925-1927), and at the Medical Faculty Department of Neurology (from March 19, 1927). As early as on May 3, 1927, however, he had to retire due to rapid worsening of his pulmonary tuberculosis. The renowned scientist remained a stranger in his own country ("el patólogo de Praga"); he never gained professorship except for a symbolic proclamation by devoted students on August 24, 1927, two days before he left for Europe to undergo treatment. On December 26, 1927 he died in Dubí (a spa near Teplice in Bohemia, Czechoslovakia, now Czech Republic).

[Electronic system for correct head position control after some vitreoretinal surgeries]. / Elektronický systém pro kontrolu správné polohy hlavy po nekterých vitreoretinálních operacích.

Team of authors consisting of vitreoretinal surgeons and biomedical engineers developed and tested an electronic system helping the patients after some vitreoretinal surgeries to keep the recommended head position. The authors describe the principle of this system and its use in clinical practice.

[Ten years after the latest revision International Anatomical Terminology]. / Deset let nového anatomického názvosloví.

Ten years ago, the latest revision of the Latin anatomical nomenclature was approved and published as Terminologia Anatomica (International Anatomical Terminology), and is acknowledged by the organization uniting national anatomical societies--International Federation of Associations of Anatomists. The authors concentrate on new terms included in the nomenclature and on the linguistic changes of terminology. The most frequent errors done by medical specialists in the usage of the Latin anatomical terminology are emphasized and the situation of eponyms in contemporary anatomy is discussed in detail as well. The last version of the nomenclature makes its way very slowly in the professional community and it is necessary to refer to positive changes and advantages it has brought. The usage of this Latin anatomical nomenclature version is suggested by the International Federation to follow in theoretical and clinical fields of medicine. The authors of the article strongly recommend using the recent revision of the Latin anatomical nomenclature both in the oral and written forms, when educating and publishing.

[Colorectal carcinoma as a cause of acute abdominal illness]. / Kolorektální karcinom jako prícina náhlých príhod brisních.

Colorectal carcinoma (KCR) is the commonest malignancy in male patients and the second commonest in female patients in the Czech Republic. During 1990-2006, 1162 patients with colorectal carcinomas were operated in the FTNsP (Faculty Thomayer Hospital) Surgical Clinic. 212 patients aged between 39 to 94 y.o.a.(the median of 70 y.o.a) were managed urgently for acute abdominal illness. In this group of urgently managed patients, the mortality rate was 17% and the morbidity rate was 38%. Future prospects of any colorectal carcinoma patient with acute abdominal illness depend on the procedure's radicality, which is limited by the overall patient's condition. The preoperative care aims to improve the patient's overall condition to such a degree, to allow for surgery fulfilling principles of oncosurgical radicality. According to this report's data, such urgent surgical procedures do not result in increased mortality or morbidity rates, compared to these in planned procedures, and show the best results in this patient group.

CD44-positive colorectal adenoma cells express the potential stem cell markers musashi antigen (msi1) and ephrin B2 receptor (EphB2).

The majority of colorectal adenomas contain a mutation in the APC gene activating the wnt pathway. As wnt signalling preserves stem cell functions, it would be expected that stem cells would be enriched in adenomas. We have shown expression of the wnt target gene CD44, which may characterize the expanded stem cell compartment, in colorectal tumours. To investigate this possibility, we performed an immunohistological survey of CD44 expression in relation to the proliferation marker Ki67 and apoptosis in colorectal tumour tissue, and have isolated a CD44-positive subpopulation of the human colorectal adenoma cell line LT97 for cell biological analysis. In tissues, CD44 expression was not related to Ki67, but was associated with lower apoptosis in the CD44-positive areas. CD44-positive and -negative populations isolated from LT97 cultures were identical in their Ki-ras and p53 status but differed in their growth and survival characteristics. While CD44-positive cells attached and grew to reconstitute the original culture, the CD44-negative cells rapidly underwent apoptosis and were unable to resume growth. In comparison to unsorted growing LT97 cells, the CD44-positive cells had shifted beta-catenin into the nucleus and expressed beta-catenin target genes, such as ephrin B receptor (ephB2) and musashi antigen (msi1). By contrast, CD44-negative cultures contained no cells with nuclear beta-catenin. In summary, the CD44-positive cells accumulating in colorectal tumours have increased survival capacity both in vivo and in vitro. They also express markers typical of colorectal progenitor cells, msi1 and ephB2, in the premalignant progenitor population.

Morphology and some biomechanical properties of human liver and spleen.

The aim of the study was an experimental determination of some morphological and mechanical properties of human liver and spleen (amount of collagen in organ capsules, their critical tension and density), followed by a definition of the threshold of critical acceleration, above which the organs can be injured during a car crash. Experiments were done on 33 fresh cadavers (18 males, 15 females; age 3 months to 88 years), and completed by sled tests on dummies testing the loads of both hypochondrial regions protected by air bags and/or seat belts. Results obtained were the following: (1). liver: capsule collagen 14-35%, critical tension 0.066-0.386 MPa, density 0.92-1.19 g/ml, critical acceleration 48-155 g; (2). spleen: capsule collagen 1.8-24.4%, critical tension 0.022-0.652 MPa, density 0.85-1.25 g/ml, critical acceleration 33-149 g. Loads of both hypochondrial regions measured on dummies during a predefined sled test were 34-67 g. Results obtained were evaluated qualitatively and discussed from the point of view of their possible use in future passive safety engineering and design calculations.

[The Coris, a married couple native to Prague and Nobel laureates]. / Manzelé Coriovi, prazstí rodáci s Nobelovou cenou.

The husband and wife Carl Ferdinand Cori (1896-1984) and Gerty Theresa Radnitz-Cori (1896-1957), two of five Prague-born Nobel laureates (the only ones in medicine), have so much slipped away from the citizens' memory in the course of the half-century totalitarian rule over the country of birth, that hardly anybody knows them nowadays, nothing to say of their relation to Prague. At pains to rescue them from oblivion, a recent search for the lost traces of Coris and their ancestors had revealed a number of hitherto unknown facts that have fundamentally contributed to the Corian genealogy; identification of both forgotten birth-houses (6 Salmovská st., 29 Petrská st.) at long last resulted in placement of memorial tablets (October 26th, 2000) to display the birth-place's pride and gratitude.

[The surname of Adamkiewicz in the medical terminology in the last three decades of the 20th century]. / Nazwisko Adamkiewicza w slownictwie medycznym w ostatnich trezech dekadach XX wieku.

Nearly eighty years after his death, Albert Adamkiewicz (1850-1921) has still been persisting in both the history of medicine owing to his work and in the medical terminology owing to eponymy: since his flourishing period toward the end of the XIXth century, the surname Adamkiewicz has entered the language of science as a proper-name constituent of anatomical, pathological, neurological, surgical as well as orthopaedic terms, combing with the appellatives stain, corpuscle or demilune, reaction or test, serum, syndrome as well as artery. Estimation of the actual vitality of particular eponymous terms compared with non-eponymous synonyms had to be the aim of the presented search in the scientific literature a century after. In contrast with the inert non-periodical (encyclopaedic) literature, periodicals have revealed all the eponymous terms fallen in oblivion except the 'Adamkiewicz artery' that has only recently been introduced in encyclopaedias although constantly preferred in periodicals of the period under investigation (appearing in 75% articles) over the most frequent non-eponymous synonym 'arteria radicularis magna / great(er) radicular artery' (scarcely 11% articles). Thanks to the 'artery' - joining furthermore several synonyms to appear nearly in 86% articles altogether - the surname Adamkiewicz persists in the living language of science; that is why its bearer ought to be remembered and mentioned even on the threshold of the XXIst century.

High- and low-affinity receptors regulate platelet responses to phorbol diesters and teleocidin.

We examined binding of 3H-phorbol dibutyrate (3H-PDBu) to gel filtered human platelets (GFP) and discovered that GFP possess two classes of receptors for phorbol diesters (PDE). High-affinity (HA) receptors, approximately 5000/GFP, bound 3H-PDBu with an apparent dissociation constant (KD) of approximately 12 nM. Low-affinity receptors were approximately 5 times more numerous (2.4 X 10(4)/GFP) and had a 10-fold lower affinity for 3H-PDBu (apparent KD = 115 nM). The potencies of phorbol myristate acetate (PMA) and PDBu paralleled their binding affinities to the PDE receptors. Teleocidin (Tel), although structurally distinct from PDE, competed with 3H-PDBu for its HA-receptors (KI Tel = 1.9 nM). Binding of PDE to HA- or LA- receptors was rapid, reversible, saturable and stereospecific. The HA- and LA-receptors modulated different platelet responses. HA-receptors regulated the secretion of beta-thromboglobulin from alpha-granules and the release of N-acetyl-beta-D-hexosaminidases from lysosomes. LA-receptors mediated both platelet aggregation and the release of serotonin from dense granules. This is the first demonstration of two physiologically active classes of PDE/Tel receptors in human platelets, and demonstrates that particular platelet responses may be directed by distinct classes of receptors for specific agonists.

Effects of phorbol diesters and teleocidin on normal human platelets.

Teleocidins are newly described indole alkaloid tumor promoters that are structurally distinct from phorbol diesters (PDE). We compared the effects of teleocidin and selected PDE on platelet aggregation, secretion and aspects of arachidonate metabolism. Three tumor-promoting PDE (phorbol myristate acetate (PMA), phorbol dibutyrate (PDBu) and 4-beta-phorbol didecanoate (4-beta-PDD] and a non-tumor promoting PDE (4-alpha-phorbol didecanoate (4-alpha-PDD] were used. Teleocidin and tumor promoting PDE caused platelet aggregation after a delay that was inversely related to tumor promoter concentration and also triggered secretion of alpha- and dense granules and selective release of lysosomal enzymes. Aggregation and its associated 125I-fibrinogen binding to platelets were both inhibited by Na2EDTA. 4-alpha-PDD was ineffective. Analysis of platelet aggregation responses and activation kinetics revealed that PDBu was 11.7 times less potent than teleocidin PMA, or 4-beta-PDD. Neither PDE nor teleocidin stimulated 14C-arachidonate release from normal human platelets, and both aggregated aspirin-treated platelets. These results show that representatives of two structurally distinct classes of tumor promoters, phorbol diesters and indole alkaloids, are potent activators of platelet aggregation, fibrinogen binding, and granule/lysosomal secretion, by a mechanism that bypasses arachidonate release and formation of cyclooxygenase-dependent arachidonate metabolites.

Oxygen metabolism of phagocytosing human polymorphonuclear leucocytes in diabetes mellitus.

Zymosan stimulated oxygen metabolism was investigated in polymorphonuclear leucocytes (PMN) from 6 diabetic patients. Oxygen uptake and superoxide production were continuously measured in the presence of autologous or control serum and non-opsonized zymosan, or in the absence of serum and preopsonized zymosan. The only significant impairment in the diabetic cells studied was a lower oxygen uptake in the presence of autologous serum. This defect was normalized by addition of control serum or by omitting the serum and stimulating with opsonized zymosan. In the absence of serum, the oxygen consumption was markedly diminished in only one subject, whereas two subjects showed a decrease of superoxide production in the presence of control serum. An inverse correlation between fasting glucose concentration and oxygen uptake could be demonstrated. However, exposure of normal PMN to hyperglycemic glucose concentration in vitro did not significantly alter their oxygen metabolism, suggesting that glucose alone could not be the only factor responsible for the impaired oxygen consumption in diabetic cells.

Heterogeneity of human neutrophil phagolysosomes: functional consequences for candidacidal activity.

Opsonized yeast phase Candida albicans, incubated with human neutrophils, are internalized into two classes of phagosomes. One class, termed "unsealed vacuoles," comprises approximately 40% of the total and maintains functional communication to the cell's exterior that is sufficient to permit ingress of dyes, such as trypan or methylene blue. The remaining cell-associated yeasts are contained in "sealed vacuoles," completely sequestered from the external milieu. Approximately 71.8% of C albicans within sealed vacuoles are rendered nonviable within 60 minutes, whereas only 14.5% of organisms within unsealed vacuoles are killed during this time. We conclude that vacuolar sealing mechanisms are imperfectly developed in normal human neutrophils and that incompletely sealed vacuoles support antimicrobial processes substantially less well than do completely sealed ones.

Phagolysosomal pH of human neutrophils.

Human neutrophils sequester yeast cells or zymosan particles in two classes of phagocytic vacuoles: sealed and unsealed. The pH of sealed vacuoles was measured by a newly devised fluorometric procedure that used fluoresceinated zymosan particles, derived from Saccharomyces cerevisiae, as a pH probe. Five minutes after initiation of phagocytosis, sealed vacuoles were alkaline, exhibiting a pH of 7.80 +/- 0.19 (mean +/- SEM). Their acidity subsequently increased, so that the pH fell to 7.38 +/- 0.25 after 15 min. 6.35 +/- 0.35 after 30 min, and 5.68 +/- 0.26 after 60 min. The implications of these findings for neutrophil microbicidal mechanisms are discussed.

Partial myeloperoxidase deficiency in preleukemia.

In seven subjects with partial and apparently acquired form of myeloperoxidase (MPO) deficiency, some functional properties of neutrophils (PMNs) were studied. Five patients suffered from preleukemia, one from diabetes mellitus and one from carcinoma of the breast with bone marrow metastases. Intracellular bactericidal activity, oxygen consumption and superoxide radical production were within normal limits. In three patients with preleukemia, the serum opsonic activity was markedly reduced (less than m-3SD) in an autologous system, but normal in the presence of pooled normal serum. Decreased opsonic activity was also found when these patient's sera were assayed in the presence of normal PMNs. Since the levels of IgG and C3 were comparable in the patients' sera and the pooled serum, a deficiency of another unknown opsonin or the presence of an opsonization inhibitor has to be postulated. The partial MPO defect apparently doesn't decrease the intracellular killing of Staphylococcus aureus by PMNs. The known susceptibility to bacterial infections in preleukemia may be explained by the reduction of serum opsonization conducing to a secondary decrease of the ingestion and killing of bacteria by the PMNs.