[Avulsion of the Proximal Hamstring Insertion. Case Reports]. / Avulzní poranení spolecného zacátku svalu zadní strany stehna ­ kazuistiky.

Proximal hamstring avulsion is an uncommon muscle injury with a lack of consensus on indications and the timing and technique of surgery. Poor clinical symptoms and difficulties in the diagnostic process can lead to a false diagnosis. The authors present three cases of proximal hamstring avulsion, two complete and one partial ruptures of the biceps femoris muscle. MRI and ultrasound scans were used for optimal treatment alignment. Acute surgery reconstruction (< 4 weeks) was done in two patients. Re-attachment of the full thickness ruptures was performed to the original place and secured by suture anchors, the partial rupture was fixed by a simple suture. Two patients were free of any symptoms at 6 months after surgery, the last one had pain in the subgluteal area and a mild deficit in hamstring strength. Two interesting systematic reviews published on the treatment of proximal hamstring avulsion are discussed in the final part of the paper. Key words: hamstring, rupture, avulsion.

[Impingement of an accessory intraabdominal organ as an uncommon intraoperative diagnosis--a case review]. / Uskrinutí akcesorního orgánu brisní dutiny jako neobvyklá peroperacní diagnóza - kazuistika.

In this case report is described a patient with an abdominal pain, who came to surgery. Intraoperatively was found the infarcted formation of unknown origin in the omentum--suspicion of accessory spleen. Histologically was elucidated, that the formation consisted of ischemic adipose tissue--there was a torsion of a large caul.

[Hypoglycaemic periodic paralysis in hyperthyroidism patients]. / Hypokalemická periodická paralýza u pacientu s hypertyreózou.

Hypokalemic periodic paralysis (HPP) is a rare disorder characterised by acute, potentially fatal atacks of muscle weakness or paralysis. Massive shift of potassium into cells is caused by elevated levels of insulin and catecholamines in the blood. Hypophosphatemia and hypomagnesemia may be also present. Acidobasic status usually is not impaired. HPP occurs as familiar (caused by ion channels inherited defects) or acquired (in patients with hyperthyroidism). On the basis of two clinical cases we present a review of hypokalemic periodic paralysis in hyperthyroid patients. We discuss patogenesis, clinical and laboratory findings as well as the principles of prevention and treatment of this rare disorder.

[The relation between nutritional risk category identified by the modified Nutritional Screening 2002 and mortality in metabolic intensive care unit]. / Vztah mezi výsledkem nutricního screeningu a mortalitou na jednotce intenzivní metabolické péce.

INTRODUCTION: The presence of malnutrition is connected with the significantly higher mortality and morbidity. Its early detection is very important for the institution of nutrition intervention that has favourable impact on patient's prognosis. The nutrition screening is the simple and fast way of nutrition risk assessment. The aim of our study was to evaluate the relation of the modified Nutrition Risk Screening 2002 (NRS 2002) with mortality of patients admitted to metabolic intensive care unit (MICU) in prospective study. METHODS: Nutrition screening has been examined in all the patients admitted to MICU over half year period since January till June 2006. According to the screening result the patients were divided into three groups: with low, moderate and high nutrition risk. The relation of nutrition screening result with mortality in MICU was statistically evaluated. RESULTS: Data of 291 patients admitted to MICU have been collected. The modified nutrition screening revealed low risk in 130 (45%), moderate risk in 111 (38%) and high nutrition risk in 50 (17%) patients. 28 patients (9.6%) died during stay in MICU. 3 patients (2.3%) with low, 10 (9%) with moderate and 15 (30%) with high nutrition risk passed away in MICU (p < 0.001). CONCLUSION: The significant relation between the grade of nutrition risk evaluated by modified NRS 2002 and mortality in MICU has been found in our study.

[Experience with early enteral nutrition application in critically ill patients in medical intensive care unit]. / Zkusenosti s podáváním casné enterální výzivy kriticky nemocným na jednotce intenzivní metabolické péce.

BACKGROUND: Early enteral nutrition is recommended in patients with critical illness. Generally implementing of nutritional support algorithm is advised. The aim of study was evaluation of early enteral nutrition application in critically ill patients in medical intensive care unit. METHODS AND RESULTS: Early enteral nutrition was given according to written protocol in medical intensive care unit. During the first 96 hours hypocaloric nutrition 20-25 calories/kg was applied, followed by increase to 25-30 calories/kg at the end of the first week of admission. Apart from the patients who reached 25-30 calories/kg we recorded the number of patients who tolerated hypocaloric enteral nutrition and evaluated the number of patients with complications due to enteral nutrition. Early enteral nutrition was given to 44 out of 99 patients admitted to intensive care unit with life threatening diasese and indication for nutrition support. Out of 44 critically ill patients (35 with sepsis, 9 with another medical emergency) 22 died during admisssion in intensive care unit (50%). Hypocaloric enteral nutrition during the first 96 hours was given to 36 patients (82%). In 8 patients enteral nutrition had to be stopped and substituted for parenteral one due to complications. Three patients suffered from abdominal distension, 2 from profused diarrhea, 1 from combination of diarrhea and abdominal distension and 2 from aspiration. Twenty seven patients tolerated the application of enteral nutrition via nasogastric tube. In 10 patients nasogastric tube had to be replaced for nasojejunal one for high gastric aspirate volume. The caloric intake of 25-30 calories/kg was reached by the end of the first week of admission in 26 patients (60%). CONCLUSIONS: Early enteral nutrition applied according to protocol was given succesfully to the substantial number of the critical patients. In 18% of the patients enteral nutrition had to be replaced for parenteral one due to complications. The caloric intake 25-30 calories/kg was reached in 60% of patients.

[Our experience in continuous administration of insulin using infusion dispenser at a metabolic intensive care unit (MICU)]. / Nase zkusenosti s kontinuálním podáváním inzulinu pomocí infuzního dávkovace na jednotce intenzivní metabolické péce (JIMP).

INTRODUCTION: The article summarises the experience of the authors in the administration of insulin using an infusion dispenser at a metabolic intensive care unit (MICU) both to patients with decompensated diabetes mellitus and to patients admitted with a sepsis or other life-threatening condition of internal nature. PATIENTS AND RESULTS: Insulin was administered with the use of a dispenser to a total of 50 patients during 6 months of 2005. 13 of those patients showed signs of ketoacidotic or hyperosmolar coma in the course of diabetes mellitus. All of these patients were compensated within 24 hours and transferred to a standard ward for further treatment within 48 hours. 37 patients were admitted in a critical condition, the cause ofwhich was sepsis and a serious internal disease in 29 and 8 patients, respectively. 12 of the patients died during their hospitalisation at MICU, of which 8 in the first 3 days after admission. No significant correlation between the age, diabetes mellitus diagnosis or an associated cardiovascular morbidity and the death at MICU was discovered, but there was a very close ling between the mortality at the intensive care unit and the baseline blood level of C-reactive protein (160 mg/l; 32-352 in the patients who died, and 111 mg/l 15-168 in the patients who survived), p < 0.01. Glycaemia at admission did not differ significantly for the patients who dies and those who survived, but average glycaemia for all three measurements at MICU was significantly higher in the patients who died (10.4 mmol/l; 6.2-22.4) as compared with those who survived (7.8 mmol/l; 5.8-16.6), p < 0.01. The time of insulin administration was significantly shorter in patients who died (3.3 days; 1-6) as compared with those who survived (5.2 days; 3-10), p < 0.01. There was no significant difference between hourly insulin dose in the patients who died (2.8 j/hour; 0.6-8.6) and in those who survived (2.6 j/hour; 0.8-7.6). A trend towards lower mortality was recorded for the group of patients with average glycaemia below 8 mmol/l and/or those in whom glycaemia mostly ranged between 4.4 and 8.0 mmol/l, but the difference was not statistically significant. A significantly lower consumption of insulin was recorded for the patients with average glycaemia below 8 mmol/l and/or those whose glycaemia measurements mostly ranged between 4.4 and 8.0 mmol/l. Hypoglycaemia defined as glycaemia below 4.4 mmol/l was present in 2% of all measurements, in 11 patients on the total, and their results were not significantly associated with mortality at MICU. CONCLUSION: Mortality of patients admitted with sepsis or other life-threatening condition of internal nature was significantly higher in the group of patients with higher average glycaemia among all the measurements performed at MICU. In patients who died, the total time of insulin administration was significantly shorter, but there was no difference between the average hourly insulin dose in the group of the patients who died and those who survived.

Antibodies against the GB virus C envelope 2 protein before liver transplantation protect against GB virus C de novo infection.

GB virus C (GBV-C) is a newly discovered RNA virus related to the Flaviviridae family. Although GBV-C is not yet associated with any cause of liver disease, a humoral immune response against the GBV-C envelope 2 (E2) protein has been observed. Therefore, we studied the prevalence and clinical relevance of GBV-C RNA and anti-E2 antibodies in patients undergoing orthotopic liver transplantation (OLT). In addition, we tested whether the prevalence of anti-E2 antibodies may protect against GBV-C infection. Of the 182 liver recipients included in this study, 117 of these were evaluated for GBV-C recurrence or de novo infection. GBV-C RNA was detected in sera or plasma using single-tube, reverse-transcriptase polymerase chain reaction, and anti-E2 antibody was detected by enzyme immunoassay (EIA). Cumulative patient and graft survival was tested by using Kaplan-Meier analysis. The independence of prognostic values was assessed by using Cox regression analysis. Before OLT, GBV-C RNA and anti-E2 were detected in 4.0% to 28.6% and 10.0% to 68.8%, respectively, of patients suffering from different forms of chronic liver diseases. GBV-C reinfection after OLT was determined in 85.7%. Of the patients without evidence of exposure to GBV-C before OLT, 30 of 65 (46.2%) became GBV-C RNA positive after OLT. None of the 38 patients who were anti-E2 antibody positive before OLT became GBV-C RNA positive after OLT. Neither patient nor graft survival was significantly affected by the presence of either GBV-C RNA or anti-E2 antibody before OLT. Our data indicate that 1) GBV-C RNA positive patients have a high risk of reinfection after OLT, and 2) the presence of anti-E2 antibodies before OLT is associated with an absence of GBV-C infection after OLT, which may indicate a protective role of anti-E2 antibodies.

Detection of GB virus C by the RT-PCR LCx system.

The recent publication of representative genomic sequences of GBV-C has permitted the selection of PCR primers for detection of GBV-C in clinical samples by PCR techniques. Traditional amplification methodologies which couple reverse transcription polymerase chain reaction (RT-PCR) and Southern blot detection are slow, cumbersome, and can be technique dependent. This has hampered studies to determine the clinical significance of GBV-C. We report the selection of highly conserved PCR primers and a probe useful for semi-automated RT-PCR using the Abbott LCx system. This adaptation of the LCx system expands its capabilities to include the detection of RNA by RT-PCR, in addition to DNA detection by ligase chain reaction (LCR).

Detection of HCV RNA by the asymmetric gap ligase chain reaction.

The ligase chain reaction (LCR) and the gap ligase chain reaction (gLCR) are exponential amplification techniques for the detection of DNA sequences in a sample. Both techniques depend on the enzyme, DNA ligase, to join adjacent probes annealed to a DNA molecule. However, DNA ligase joins DNA inefficiency on an RNA target. Consequently, LCR and gLCR cannot amplify RNA efficiency. RNA detection methods using LCR or gLCR require a cDNA synthesis step. The carryover of four dNTPs from the cDNA reaction inhibits gLCR. Although LCR can use cDNA reaction products directly, background generated by blunt-end ligation does not allow the high sensitivity typically needed for HIV or HCV detection. The asymmetric gap ligase chain reaction (AGLCR) is a modification of gLCR that allows for the detection of RNA by using < or = 3 of the 4 nucleotides in the cDNA step and the gLCR step. Fewer than 50 copies of synthetic RNA transcript can be reproducibly detected. HCV, an RNA virus with no DNA intermediate, was chosen as the initial RNA model system. HCV antibody-positive and normal samples were analyzed, and the results were found to correlate with the results obtained using nested RNA-PCR. AGLCR provides a new nucleic acid amplification technique that can aid in the diagnosis of disease when the detection of RNA is critical.

[Ranitidine VUFB in the treatment of peptic ulcer]. / Ranitidin VUFB v lécbe peptických vredu.

The authors tested in an open clinical investigation in a group of 30 patients the therapeutic effectiveness and tolerance of the newly developed preparation Ranitidine VUFB in the treatment of peptic gastroduodenal ulcers. The preparation was administered to patients with an endoscopically confirmed diagnosis, 300 mg/day by the oral route, for a period of 4 weeks. A positive and rapid effect on regression of subjective complaints was observed and a very favourable effect on healing of the ulcer. After four weeks complete healing of gastroduodenal ulcers was recorded in 73% of the patients, in another 10% marked diminution of the ulcer occurred with a tendency to heal. The preparation was tolerated very well by the patients and there were no serious side-effects. The assembled results are comparable with data on similar preparations prepared abroad and Ranitidine VUFB should be included among desirable and useful anti-ulcer drugs.

The adenovirus EII early promoter has multiple EIA-sensitive elements, two of which function cooperatively in basal and virus-induced transcription.

The mechanism by which the adenovirus-encoded nuclear oncogene EIA activates transcription of several viral and host promoters is an important issue in the regulation of eucaryotic gene expression and virus-host cell interactions. Identification of cis-acting elements of the promoters and the cognate host transcription factors that are targets for EIA action is crucial for our understanding of the EIA-mediated control of coordinately regulated genes. The adenovirus EII early promoter has a complex architecture and contains two overlapping promoters with start sites at +1 (major promoter) and -26 (minor promoter). The major promoter responds strongly to virus-encoded trans activators EIA and EIV and contains four elements: a TAGA motif analogous to the TATA box, two EIIF sites present in an inverted orientation, and an ATF/CREB site. To determine precisely the roles played by these cis-acting elements in both basal and virus-induced transcription when the promoter is situated in its natural context, we investigated the phenotype of a series of linker scan promoter substitution mutants inserted into the viral chromosome. Promoter constructs harboring linker scan mutations in each element were rebuilt into a novel EIA- adenovirus vector, and transcriptional activity was monitored in virus-infected cells. In the absence of virus-encoded trans activators, basal activity in vivo was dependent on all four cis-acting elements. Surprisingly, a promoter mutant with only one of the two EIIF sites intact could not promote transcription in vivo, suggesting that the two EIIF sites function cooperatively even in basal transcription. Promoters harboring mutations in either of these two EIIF sites also failed to bind to an infection-specific form of EIIF in gel shift assays and competed only very weakly for EIIF binding with the wild-type promoter fragment. The dramatic cooperativity shown by the two inverted EIIF sites of the EII promoter both in vivo and in vitro could reflect simultaneous contact of both sites by the transcription factor EIIF. Furthermore, promoter mutants with mutations in the TAGA motif, the two EIIF sites, and the single ATF site all failed to respond to virus-encoded trans activators. Whereas recent results demonstrate that EIIF activity can be modulated independently by EIV, leading to transactivation of this promoter, our results and those published previously strongly indicate that the three different transcription factors that bind to TAGA, EIIF, and ATF motifs of the EII early promoter are all targets for EIA regulation in vivo. Thus, strong transactivation of the EII early promoter through these multiple EIA-sensitive elements and independently by the recently discovered EIV pathway suggests that the EII early promoter is stringently regulated in virus-infected cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of structural and nonstructural proteins of virulent and less virulent Theiler's virus isolates using two-dimensional gel electrophoresis.

The Theiler's murine encephalomyelitis viruses (TMEV) are important neurotropic picornaviruses because they persist in the central nervous system (CNS) and produce an inflammatory demyelinating disease in the mouse, their natural host. Insight into the pathogenesis of this disease may come from studying the genetic and biochemical compositions of these viruses; therefore, in this report, the structural and nonstructural proteins specified by both highly and less virulent TMEV were examined. Using two-dimensional gel electrophoresis, structural and nonstructural proteins, originating from each of the three regions of the picornavirus genome (Kitamura et al., 1981; Rueckert and Wimmer, 1984), from nine TMEV isolates were compared on the basis of isoelectric points (pI). Proteins of two virulent TMEV (GDVII and FA viruses) had almost indistinguishable pI values, whereas two of the three major capsid proteins of the less virulent TMEV varied considerably. For example, the structural proteins VP1 and VP3 from seven less virulent viruses ranged from pI 6.3 to 6.9 and 6.5 to 8.3, respectively. On the other hand, the pI values of VP2 and nonstructural proteins from the less virulent TMEV varied relatively little. In general, structural proteins of each TMEV group had pI ranges unique to their respective biological group, while most nonstructural proteins were similar for all TMEV. The virus-specified proteins of Vilyuisk virus, which is serologically related to the TMEV and a possible cause of encephalomyelitis in man, had pI values similar to the less virulent TMEV. Finally, VP3 not only showed the greatest variation in pI among the less virulent TMEV, but it also was preferentially radioiodinated in intact virus from each of the two biological groups using the lactoperoxidase technique.

Theiler's virus antigen detected in mouse spinal cord 2 1/2 years after infection.

Spinal cord sections from mice injected with Theiler's murine encephalomyelitis virus (TMEV) and surviving for 1 year and longer after infection were stained for virus antigen by two immunohistochemical techniques. Virus antigen was detected from 1 to 2 1/2 years after infection, a time when no virus was recovered at an assay sensitivity of 50 plaque-forming units per gram of tissue. The implication this has regarding the detection of a virus in MS is discussed.

Analysis of genetic variation in Theiler's virus during persistent infection in the mouse central nervous system.

The genetic changes occurring in the BeAn strain of Theiler's murine encephalomyelitis virus (TMEV) during persistent infection in the mouse central nervous system (CNS) were studied. RNase T1-oligonucleotide fingerprinting of the RNAs of 28 BeAn viruses isolated at various times postinfection (p.i.) demonstrated that mutation occurred throughout the infection. Although plaque-purified BeAn virus was used to inoculate mice intracerebrally, genetically different viruses were recovered from the CNS. One to three oligonucleotide changes were found up to Day 152 p.i., but all three viruses isolated at Day 180 had four to nine oligonucleotide changes. No pattern of oligonucleotide changes occurring in different virus isolates was found, yet three viruses isolated from different animals at Day 180 had the same four new oligonucleotides. Overall, the number of oligonucleotide changes represented a 0.1 to 1.2% change in the virus genome. In addition, the analytical two-dimensional gel technique of P.Z. O'Farrell, H.M. Goodman, and P.H. O'Farrell (Cell 12, 1133-1142, 1977) suggested that mutation occurred in all virus isolates. In nine isolates, one to three proteins were found to have charge changes, and in general, as many nonstructural proteins had charge changes as structural proteins. P20, a nonstructural protein probably equivalent to the protease described for encephalomyocarditis virus, was found to have shifted cathodally in six different viruses. Several virus isolates had doublet patterns, suggesting the possibility that within the CNS, subpopulations existed which had proteins of slightly different charge or that virus-specified proteins had been modified after translation. Finally, antigenic variation of neutralizing site(s) on BeAn virus isolates as a way for virus to evade immune surveillance and thereby maintain the persistent state was studied. The ability of mouse serum to neutralize persisting virus isolates was not significantly different from the ability to neutralize the infecting virus. Therefore, antigenic variation does not appear to be a factor in TMEV persistence.

Blood pressure and proteinuria in adolescents.

The study was conducted in two groups of factory apprentices including boys aged 15 to 17 years. The first group consisted of a randomly selected 10% sample of 231 apprentices of the total number of 2,300 boys. The second group included 77 boys with casually found proteinuria. In both groups, the distribution of blood pressure and of the body mass and changes in these indices were followed up over a period of two years. The boys with proteinuria had a significantly higher systolic and diastolic blood pressure and a lower body mass index. Their systolic and diastolic blood pressure was rising more steeply in regression to the body mass. The casual finding of asymptomatic proteinuria in juveniles always calls for a long-term follow-up. It signalizes, inter alia, also the presence of a factor raising blood pressure probably independently of body height and body mass.

[Sodium and magnesium levels in the vitreous body]. / Mnozstiví sodíku a horcíku v ocním sklivci.

The technique of atomic absorption spectrophotometry was employed for the estimation of sodium and magnesium in 50 deceased persons. No dependence on the time elapsed after death was found. Significantly higher average quantities of sodium were proved in subjects who had died as a result of brain contusion; higher quatities of magnesium were found in subjects who had suffered from chronic liver involvement.

[The proportion of potassium and calcium in the vitreous body in relation to the time of death]. / Mnozství draslíku a vápníku v ocním sklivci v závislosti na dobe smrti.

The method of atomic absorption spectrophotometry was employed to estimate the proportion of potassium and calcium in vitreous humour in 47 deceased persons. The amount of both was found to increase in linear proportion to the time elapsed from death. The correlation can be expressed in the form of equations. The simultaneous estimation of the proportion of potassium and calcium in vitreous humour enables a more precise ascertainment of the time of death than the estimation of merely one of the two elements. In persons who died of brain injuries, strangulation or who had suffered from conditions associated with metabolic breakdown, the time of death should not be determined according to the amount of calcium in vitreous humour; in such cases only the proportion of potassium should be exploited.