[Pilonidal sinus - diagnosis at the intersection of general and plastic surgery]. / Pilonidální sinus - diagnóza na pomezí vseobecné a plastické chirurgie.

INTRODUCTION: Pilonidal sinus predominantly affects young patients. Improper treatment results in long-term restrictions in everyday life and incapacity for work. The aim of the study was to find out what the results and current treatment options of pilonidal sinus are. MATERIAL AND METHODS: This is a retrospective analysis of 67 patients treated at the Department of Surgery of the Second Medical Faculty of Charles University and Motol Hospital in the period 20102013. We evaluated the type of surgery and infectious complications in the wound, as well as age, sex, BMI, smoking, employment of the patients, duration of wound drainage, length of hospital stay, time required to complete healing of the surgical wound, the surgeons erudition and disease recurrence. RESULTS: 50 (75%) patients underwent primary closure in the midline, Limberg flap was used in 15 (22%) patients. In 2 (3%) patients, the wound was left without suture. In the group of patients who had not undergone flap reconstruction, secondary wound healing occurred in 20 (40%) patients. In the group of patients where flap reconstruction was used, secondary healing occurred in 3 patients (20%). Relapse of the disease within one year occurred in the group of patients with primary suture in the midline in 4 (8%) patients; other patients had no recurrence. CONCLUSION: According to our experience as well as literary data, the treatment of choice is the extirpation of the sinus with primary suture beyond the midline using a flap reconstruction technique.

Effect of ursodeoxycholic acid supplementation on growth, carcass characteristics, and meat quality of Wagyu heifers (Japanese Black cattle).

Ursodeoxycholic acid (UDCA), which is used as a hepatic and digestive medicine in humans and domestic animals, was added to the diet of Wagyu beef cattle to investigate its effects on growth, carcass characteristics, and meat quality. The study involved 20 Japanese Black heifers. Animals were divided into the following 2 groups, a control group and a UDCA group (diet supplemented with UDCA), with each group containing 10 animals. The UDCA was administrated at a dose of 2.5 g/(animal/d) to each heifer 24 times over a period of 7 mo in the finishing period. The heifers were slaughtered at 29 mo of age, and carcass characteristics and meat quality were determined. Both the UDCA group and the control group showed similar (P > 0.1) final BW, fattening periods, and daily BW gain. Supplementation of UDCA significantly increased meat quality grade (P < 0.05) and marbling (P < 0.01) and but did not show a significant (P > 0.1) effect on dressing percentage, fat thickness, rib thickness, or ribeye area. The percentage of ether extract in the LM was significantly greater (P < 0.05) in the UDCA group (43.2%) than in the control group (37.8%), whereas the percentage of moisture was significantly less in the former than the latter (P < 0.05).The L* (lightness) values of the muscles were greater (P < 0.05) in the UDCA group than in the control group. No significant differences (P > 0.1) were observed between groups in water-holding capacity, fatty acid composition, and vitamin E content of the LM or in intermuscular fat characteristics. Supplementation of the diet with UDCA can increase marbling without causing growth defects and can improve carcass characteristics in Wagyu cattle.

The effect of Assertive Community Treatment in Japan.

OBJECTIVE: The aim of this study was to evaluate the effects of the Assertive Community Treatment (ACT) program in a Japanese mental health service setting. METHOD: This study was a randomized controlled trial. ACT was the intervention condition (n = 59), and the usual hospital-based rehabilitation program was the control condition (n = 59). Outcome indicators include in-patient days, psychiatric symptoms, social functioning, quality of life, and client satisfaction. The follow-up period was 12 months after the intervention. RESULTS: We found a significant reduction of in-patient days for the ACT group demonstrated by t-test (t = 2.33, P = 0.02). However, the results of ancova did not show significant differences for in-patient days between the two groups (F = 1.85, P = 0.18). The depression score for Brief Psychiatric Rating Scale for the ACT group was significantly lower than the control group at the 12-month follow-up assessment (F = 5.57, P = 0.03). According to the t-test, the ACT group had a higher client satisfaction than the control group (t = 2.08, P = 0.05). CONCLUSION: We concluded that ACT had a positive influence, as evidenced by a reduction of in-patient days, lower depressive symptoms, and higher client satisfaction.

Vegetarian diet ameliorates symptoms of atopic dermatitis through reduction of the number of peripheral eosinophils and of PGE2 synthesis by monocytes.

Many patients with atopic dermatitis are dissatisfied with conventional treatments based on topical steroids and have experienced some traditional remedies and alternative therapies. However, most of such therapies have not been evaluated scientifically and clinically by specialists. This study was designed to assess whether a certain vegetarian diet might be effective for atopic dermatitis and if so, to identify the mechanisms of this remedy through analyses of immunological parameters. An open-trial study was carried out in twenty patients with atopic dermatitis. An improvement of dermatitis was evaluated by SCORAD index and serological and immunological parameters were monitored. After a two-month treatment, the severity of dermatitis was strikingly inhibited, as assessed by SCORAD index and serological parameters including LDH5 activity and a number of peripheral eosinophils. A sharp reduction in eosinophils and neutrophils was observed prior to improvement in the skin inflammation. In addition, PGE2 production by peripheral blood mononuclear cells was reduced by this treatment. In contrast, serum IgE levels did not change during the same period. Although this study is an open-trial one, it suggests that this treatment may be useful for the treatment of adult patients with severe atopic dermatitis.

[A study of recovery factor about drug addiction recovery center "DARC"].

This study examines the effectiveness of the 'DARC' (Drug Addiction Rehabilitation Center) and its program in treating patients with drug dependence. DARC is the only rehabilitation facility group managed by recovered drug users in Japan. It uses the 'Twelve Step Program' as part of its recovery regime. Through structured questionnaires, the changes of participants' and ex-participants' everyday behavior, their acceptance of spirituality, attitude toward drugs, self-esteem, their coping skills and loneliness were examined. The results revealed: a.. Negative partial correlation between loneliness and everyday behavior. b.. Negative partial correlation between loneliness and positive/effective coping skills. c.. Positive partial correlation between acceptance of 'spirituality' and attitude toward drugs. d.. Positive partial correlation between acceptance of 'spirituality' and positive/effective coping skills. These results suggest that the acceptance of 'spirituality' and decreasing loneliness are important factors in the recovery from drug dependence.

[Evaluation of the activity and effects of combinations of various antibacterial agents against methicillin-resistant Staphylococcus aureus in vitro].

MICs of various antibacterial agents against methicillin-resistant Staphylococcus aureus (MRSA) were measured. Furthermore, we evaluated the effects of combinations of antibacterial agents against MRSA in vitro. In 24 cases out of 37, in which MRSA was isolated from inpatients, other microorganisms, such as Candida spp., Entrococcus spp., and Pseudomonas aeruginosa, were simultaneously isolated. From the results of minimum inhibitory concentrations (MICs), obtained from micro broth-dilution method, of various antibacterial agents against MRSA, range of MICs of arbekacin (ABK), vancomycin (VCM) and teicoplanin (TEIC) were < or = 0.25-4.0, 0.5-1.0 and 0.25-4.0 micrograms/ml respectively, and no strains of MRSA showed resistance to ABK, VCM and TEIC, so that we concluded that these three antibacterial agents were effective for MRSA infection. On the in vitro study of combination-effect of antibacterial agents, significant synergistic effects were achieved in the combination of VCM and flomoxef (FMOX) (Synergism rate was 97.3%) or VCM and imipenem (IPM) (Synergism rate was 97.2%). From the results that the fractional inhibitory concentration index in the combination of VCM with IPM was smaller than that with FMOX and that P. aeruginosa or Enterococcus spp. were simultaneously isolated in high frequency in the MRSA-isolated cases, we thought that the combination of VCM with IPM is more useful, because IPM is effective against P. aeruginosa but FMOX is not.

Low-energy diet in atopic dermatitis patients: clinical findings and DNA damage.

Undernutrition without malnutrition (low-energy diet) increases maximum longevity, reduces the incidence of several cancers and delays their onset, in animal studies. It has also been demonstrated by experimental study that caloric restriction provides a beneficial effect on various inflammatory diseases. In this study, we offered a low-energy diet to patients with atopic dermatitis (AD). Nineteen adult patients (5 males and 14 females aged 15 to 36 years) were enrolled in the study which lasted 8 weeks. The energy intake was 55% of nutritional requirements; protein was 75%, calcium 180%, iron 130%, vitamin A 105%, vitamin C 250% and vitamin E 110% of the daily requirement. No patient experienced adverse reaction, and none dropped out of the trial. Body weight, body mass index (BMI), and systolic blood pressure had decreased significantly by the end of study. The SCORAD (scoring atopic dermatitis) index, which combines objective (extent and intensity of lesions) and subjective (daytime pruritus and sleep loss) criteria, was reduced significantly. In 11 patients with severe AD, there was a significant reduction in oxidative DNA damage. The change in the inflammatory intensity score and the change in BMI caused by energy restriction showed a significant positive correlation. The change in oxidative DNA damage levels and the change in BMI showed a positive correlation. These results clarify the relationship between weight loss and the improvement of AD. It may be hypothesized that this low-energy diet which included several additional nutrients has a possibility to reduce inflammatory symptoms of patients with AD.

[Estimation of antibacterial activity of various antibiotics against Pseudomonas aeruginosa by score method].

Antibacterial activity of various antibiotics against Pseudomonas aeruginosa isolated from each hospitals depends on the variety or amount of antibiotics used in each hospital. The antibiotic, which is effective to P. aeruginosa in a certain hospital is not always effective to that in other hospital. The excellent antibiotics in antibacterial activity have low MIC and hard to progress in resistance, and such antibiotics may be effective against P. aeruginosa isolated from any hospitals. Therefore we thought that the antibiotic, which was progress to resistance, would show a great difference in MIC among hospitals, and we investigated MIC and difference of MIC of various antibiotics against P. aeruginosa isolated from six hospitals. Furthermore, we converted the data of MICs and difference of MIC among six hospitals into the score, and tried to estimate antibacterial activity of various antibiotics by using those scores. From the results of analysis in this report, we think the antibiotics actually surpass in antibacterial activity may be imipenem, cefozopran, cefsulodin and amikacin. New analytical method proposed in this report will become one of potential methods to estimate antibacterial activity of antibiotics against bacteria isolated from inpatient with bacterial infections.

New cyclization mechanism for squalene: a ring-expansion step for the five-membered C-ring intermediate in hopene biosynthesis.

Three triterpenes having the 6/6/5-fused tri- and 6/6/6/5-fused tetracyclic skeletons were isolated from an incubation mixture of the mutated F601A enzyme, these products being in accordance with a Markovnikov closure. Successful trapping of the tricyclic cationic intermediate by using the squalene analog having a highly nucleophilic hydroxyl group leads us to propose that the ring expansion process of the 5-membered C-ring is involved in the squalene cyclization cascade.

[Reliability of disc-diffusion susceptibility testing for arbekacin, vancomycin and teicoplanin against methicillin-resistant Staphylococcus aureus].

We investigated the differences in judgments among four disc-diffusion methods on susceptibility testing of arbekacin (ABK), vancomycin (VCM) and teicoplanin (TEIC) against 37 strains of methicillin-resistant Staphylococcus aureus (MRSA). These results were compared with minimum inhibitory concentrations (MICs) obtained from micro broth-dilution method. A marked difference was noted in the judgment of susceptibility to TEIC in Tri-disc method, that is 2 strains (5.4%) fell into sensitive (+3) 34 strains (91.9%) into moderately sensitive (+2) and 1 strain (2.7%) into moderately resistant (+), while in Sensi-disc method all strains fell into sensitive (S). According to the MICs, no strain of the MRSA tested revealed resistance to ABK, VCM and TEIC. Consequently, these three antimicrobial agents were thought to be effective on MRSA infections. From these results, we concluded that Tri-disc method for glycopeptide against MRSA, especially for TEIC, is not recommendable as a disc-diffusion method in susceptibility testing.

[Evaluation of antibacterial activities of various antibiotics against glucose non-fermentative gram-negative rods other than Pseudomonas aeruginosa].

MICs of piperacillin, sulbactam/cefoperazone, minocycline (MINO), gentamicin, amikacin, flomoxef, ceftazidime, cefozopran, cefsulodin and imipenem were determined, against 189 clinical isolated strains of glucose non-fermentative Gram-negative Rods (NFGNR; Acinetobacter baumannii (44), Alcaligenes faecalis (5), Alcaligenes xylosoxidans (25), Burkholderia cepacia (12), Chryseobacterium indologenes (23), Chryseobacterium meningosepticum (9), Pseudomonas fluorescens (8), Pseudomonas putida (12), Stenotrophomonas maltophilia (51). Most species of these NFGNR show resistance to many antibiotics tested. Among the antibiotics used in this study, the only antibiotic effective against all species of NFGNR tested is MINO. The spectrums of antibacterial activities of various antibiotics determined by MICs may be useful in preliminary test for identification of these NFGNR.

[Detection of Helicobacter pylori by culture and the 13C-urea breath test using an automated breath 13C analyzer].

Up to now, the diagnosis of H. pylori infection has been made by the breath test using 13C-urea. In this study, 13C-urea breath samples were tested in 34 patients (peptic ulcer scar 17, chronic gastritis 17 cases) with an automated breath 13C analyzer (ABCA. Europa Scientific, Crewe, UK) and compared with the results of endoscopical diagnosis for H. pylori infection. Endoscopic and 13C-urea breath test (13C-UBT) were performed before eradicative medication. We described a modified protocol for the growth grade of H. pylori colonies in microbiology (H. pylori score), and for the delta 13C area under curve (AUC; permil*hr) obtained from each sample of expired breath. There was a significant correlation between delta 13C-AUC and the delta 13C level of each sample, but the correlation coefficient obtained at 10min (R2 = 0.582) was lower than that obtained at the other four time points (20min; 0.891, 30min; 0.949, 40min; 0.946, 50min; 0.946, 60min; 0.820). The delta 13C-AUC well correlated with H. pylori score (p < 0.01), none of 26 H. pylori positive patients detected by culture was 13C-UBT negative (delta 13C-AUC < 8.2 permil*hr in mean + 2SD of H. pylori negative group). In conclusion, 13C-UBT using ABCA has high sensitivity and specificity, and it provides a non-invasive method for the detection of H. pylori urease activity.

[In vitro antibacterial activities of carbapenems and other antibiotics against Pseudomonas aeruginosa determined using low-amino-acid agar].

MICs of imipenem (IPM), panipenem (PAPM), cefozopran (CZOP), cefpirome (CPR), gentamicin (GM), tobramycin (TOB) and amikacin (AMK) against Pseudomonas aeruginosa were determined using Mueller-Hinton agar and low-amino-acid agar. On Mueller-Hinton agar, the antibacterial activity of TOB was superlative, followed in order by GM, CZOP, IPM, AMK, PAPM and CPR, whereas on low-amino-acid agar, the order changed to IPM, PAPM, TOB, CZOP, GM, AMK and CPR. The largest decrease of MICs was seen with PAPM on low-amino-acid agar, and the antibacterial activity of PAPM was not stronger than that of IPM. The growth of P. aeruginosa on the low-amino-acid agar were significantly weaker than that on Mueller-Hinton agar, hence the evaluation of appearance colonies was difficult and misjudgement may result. Based on the above observations, we believe further investigations are needed before the application of low-amino-acid agar becomes routine.

[Annual number of Pseudomonas aeruginosa isolated inpatients, and antibacterial activity of various antibiotics against P. aeruginosa isolated from clinical specimens of inpatients].

In recent years, isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) has decreased, while the rate of Pseudomonas aeruginosa has increased. This phenomenon may be a result of regulation of use of antibiotics which belongs to the third cephems and extensive preventive measures against hospital acquired infections due to MRSA. Based on our investigation in which we determined MICs of various antibiotics against P. aeruginosa strains isolated from inpatients, the antibacterial activities of cefclidin (CFCL) was superior to those of other antibiotics. The antibacterial activity of CFCL against P. aeruginosa tested was similar to or stronger than that of tobramycin.

[A study of neuropeptides and cytokines in sera from patients with rheumatoid arthritis].

Neuropeptides and cytokines are known as substances which produce various effects on local disease sites. Many studies of these substances role in rheumatoid arthritis (RA) have been carried out in connection with synovial effusion and synovium, but very few in connection with sera. We studied the substances in sera from patients with RA, hypothesizing that the serum levels should reflect the degree of RA activity. We selected nine neuropeptides and cytokines, and measured their serum levels in twenty-five RA patients. For comparison, ten healthy persons were also studied. The results showed that low levels of CRF, ACTH and cortisol, and the high levels of SP, IL-6 and TNF-alpha in sera from the patients with RA compared with those from healthy persons. IL-6 and TNF-alpha correlated with RA activity indexes. We conclude that some neuropeptides and cytokines should act actively on RA through the circulatory blood. The measurement of serum neuropeptides and cytokines in patients with RA is a useful indicator of the degree of RA activity.

[In vitro effects of combinations of antibiotics against highly-fosfomycin-resistant, methicillin-resistant Staphylococcus aureus. With special reference to efficacies of combinations of imipenem/cilastatin and cephems].

The author evaluated in vitro effects of combinations of antibiotics against 27 clinical isolates of highly-fosfomycin (FOM)-resistant, methicillin-resistant Staphylococcus aureus (MRSA). In combinations of FOM and cephems (CEPs), MICs of CEPs were decreased by FOM significantly, and synergistic effects were observed when the MIC of FOM was below 50 micrograms/ml. Combinations of imipenem/cilastatin (IPM/CS) and CEPs, however, was superior to those of FOM and CEPs in terms of synergistic effects. In these combinations, good synergism was found when the MIC of IPM/CS was below 25 micrograms/ml and those of CEPs were relatively low. In combinations of aminoglycoside and CEPs, no apparent synergism was observed. Most significant synergistic effect was achieved in the combination between IPM/CS and cefamandole. We believe that both fractional inhibitory concentration indices and achievement rates of effective serum concentrations should be taken into account to determine an effective combination of antibiotics.

[Combined effect of sulbactam/cefoperazone and other antibiotics against clinical isolates of multi-resistant strains. II. In vitro combined effects of sulbactam/cefoperazone with imipenem/cilastatin, cefuzonam, flomoxef, amikacin or tobramycin].

We evaluated combined effects of sulbactam/cefoperazone (SBT/CPZ) with each of imipenem/cilastatin (IPM), cefuzonam, flomoxef, amikacin (AMK) and tobramycin (TOB) against 324 clinical strains. Through this study, we obtained the following results. 1. Against Serratia marcescens and Enterobacter cloacae, good synergism was obtained by combining SBT/CPZ with IPM, AMK, or TOB. 2. Against Pseudomonas aeruginosa, good synergism was obtained by combining SBT/CPZ with AMK or TOB. 3. When SBT/CPZ was used in combination with IPM, antagonism was observed among about 45% of strains of P. aeruginosa.

[Estimate of aztreonam (AZT) hydrolyzing enzymes from clinically isolated AZT-resistant gram-negative bacilli].

The MICs of Aztreonam (AZT) against 590 clinical isolates of Gram-negative bacilli were determined. About 13.4% (79 strains) of the isolates were AZT-resistant (MIC; 12.5 micrograms/ml less than or equal to). The resistance pattern against various beta-lactams and the effects on MICs of combination of Clavulanic acid (CVA) and AZT against AZT resistant strains suggested that AZT was inactivated by either type of IV (K1), Va (OXA1), or PSE2 beta-lactamases.