[Minimal residual disease in pancreatic cancer--our first experiences]. / Minimální reziduální choroba u karcinomu pankreatu--nase prvotní zkusenosti.

INTRODUCTION: Pancreatic cancer is one of the most aggressive malignity with the statistically shown an upward trend and a very poor prognosis. The causes we follow up in the local recurrence and in the early dissemination, either through hematogenic or lymphogenic way. Conventional methods are not able to capture these cells, just the modern molecular-biological methods make possible to fix the so-called minimal residual disease, that is the presence of isolated tumor cells in the patient's body. MATERIAL AND METHODS: The study included 52 patients operated on the Clinic of Surgery I. in the University Hospital Olomouc for pancreatic cancer in different stages. QRT-PCR method was determined expression of hTERT, EGFR 1 and CEA both in peripheral blood, portal blood, bone marrow, peritoneal lavage and the tumor itself. RESULTS AND CONCLUSION: The results of this pilot study demonstrated a high sensitivity and specificity of the PCR method for detection of circulating tumor cells in patients with pancreatic cancer, extending this methodology, we are able to provide prognostic value of minimal residual disease and its significance for the indication of radical surgery for pancreatic cancer.

Prevalence of extended-spectrum beta-lactamase-positive Klebsiella pneumoniae isolates in the Czech Republic.

This study focused on the prevalence and molecular biology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae isolates collected in the Czech Republic. Clinical material from patients hospitalised in 16 Czech hospitals in September 2004 was used to isolate K. pneumoniae strains. Strains were identified by standard identification procedures. Susceptibility of the strains to antibiotics was tested using a microdilution method. The double-disk synergy test and combination disk method were used to determine ESBL production. Molecular biology characteristics of ESBL-positive isolates were determined using genomic DNA isolation, XbaI restriction digestion and pulsed-field gel electrophoresis differentiation. The acquired restriction maps of individual isolates were compared using GelCompar II software and their relationships were determined. During the 3-week period, 483 K. pneumoniae strains causing clinically detectable diseases were isolated. Of these, 117 (24.2%) were determined to be ESBL-positive. The prevalence of ESBL-positive isolates was 38.9% in Intensive Care Units (ICUs) and 13.1% in standard wards. More than 50% of ESBL-positive isolates were treated effectively only with meropenem (98%), cefoperazone/sulbactam (61%) and amikacin (54%). Conversely, ESBL-negative isolates showed high susceptibility to all tested antibiotics (76-99%). Molecular biology analysis identified 18 clonal types containing two to six identical isolates. Seventeen clones usually contained isolates from only one hospital; isolates from two hospitals were identified only in one clone. Based on the abovementioned results, the prevalence of ESBL-positive K. pneumoniae isolates in the Czech Republic can be perceived as relatively high, especially in ICUs. Extensive spread of 'epidemic clones' within Czech hospitals and, to a limited extent, between them can be demonstrated.

Genotypic characterisation of vancomycin-resistant Enterococcus faecium isolates from haemato-oncological patients at Olomouc University Hospital, Czech Republic.

This study describes the first molecular characterisation of clinical isolates of vancomycin-resistant enterococci (VRE) in the Czech Republic. Of 2647 patient isolates of Enterococcus spp. from 1997-2002, 121 (4.6%) were identified as VRE. The most common isolates were VanA+ Enterococcus faecium (78%) and VanB+ Enterococcus faecalis (10%). In addition, five VanA+ E. faecium isolates were obtained from environmental and staff sampling. Macrorestriction analysis of SmaI restriction fragment length polymorphism was performed for 54 VanA+ E. faecium clinical isolates and the five VanA+ E. faecium environmental isolates. Thirty-two unique restriction endonuclease patterns were identified, including two predominant clonal types represented by five or more isolates. Two environmental VanA+ E. faecium isolates were closely related to two patient isolates, which had an identical SmaI macrorestriction pattern. The results indicated potential survival of strains in the hospital environment and possible subsequent transmission to hospitalised patients.