Recommendations on diagnostic tools for Batrachochytrium salamandrivorans.

Batrachochytrium salamandrivorans (Bsal) poses a major threat to amphibian, and more specifically caudata, diversity. Bsal is currently spreading through Europe, and mitigation measures aimed at stopping its spread and preventing its introduction into naïve environments are urgently needed. Screening for presence of Bsal and diagnosis of Bsal-induced disease in amphibians are essential core components of effective mitigation plans. Therefore, the aim of this study was to present an overview of all Bsal diagnostic tools together with their limitations and to suggest guidelines to allow uniform interpretation. Here, we investigate the use of different diagnostic tools in post-mortem detection of Bsal and whether competition between Bd and Bsal occurs in the species-specific Bd and Bsal duplex real-time PCR. We also investigate the diagnostic sensitivity, diagnostic specificity and reproducibility of the Bsal real-time PCR and show the use of immunohistochemistry in diagnosis of Bsal-induced chytridiomycosis in amphibian samples stored in formaldehyde. Additionally, we have drawn up guidelines for the use and interpretation of the different diagnostic tools for Bsal currently available, to facilitate standardization of execution and interpretation.

Erbium laser in gynecology.

The aim of this paper is to present a novel laser technology utilizing the erbium YAG laser for various minimally invasive, non-surgical procedures in gynecology. Non-ablative, thermal-only SMOOTH-mode erbium pulses are used to produce vaginal collagen hyperthermia, followed by collagen remodeling and the synthesis of new collagen fibers, resulting in improved vaginal tissue tightness and elasticity. This erbium laser technology is used for treatments of vaginal laxity, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. In the period from 2010 to 2014, several clinical studies covering all four indications were conducted with the aim to prove the efficacy and safety of this novel technology. An overview is presented of the results of these studies where several objective as well as subjective assessment tools were used. The results have shown that SMOOTH-mode erbium laser seems to be an effective and safe method for treating vaginal laxity, stress urinary incontinence, pelvic organ prolapses and vaginal atrophy.

Influence of Salmonella enterica serovar enteritidis infection on the development of the cecum microbiota in newly hatched chicks.

Terminal restriction fragment length polymorphism and quantitative PCR showed that the cecal microbiota of chicks up to the age of 21 days was dominated by representatives of the orders Enterobacteriales, Clostridiales, and Lactobacillales. Salmonella enterica serovar Enteritidis infection caused the greatest changes in the gut microbiota when 1-day-old chicks were infected, compared with the infection of 4- and 16-day-old chicks.

Longitudinal cystic fibrosis care.

Cystic fibrosis is a complex disease entity that presents considerable lifelong challenges. Implementation of medical and surgical treatment options involves multisystem interventions to prevent and treat lung and gastrointestinal manifestations of cystic fibrosis and associated comorbidities. From birth through adulthood, cystic fibrosis care entails a longitudinal regimen aimed at achieving relief of disease symptoms and enhanced life expectancy. With increased knowledge of the molecular behavior of the cystic fibrosis transmembrane conductance regulator (CFTR) in health and disease, clinical practice has been enriched by the prospect of novel strategies, including mutation-specific drug and gene therapy targeting restoration of corrupted transepithelial ion transport. Emerging paradigms of comprehensive care increasingly enable personalized solutions to address the root cause of disease-transforming management options for individuals with cystic fibrosis.

Weak cytotoxic activity of miltefosine against clinical isolates of Acanthamoeba spp.

Hexadecylphosphocholine (miltefosine) is an anticancer drug active in vitro against various protozoan parasites, and recently used for the treatment of disseminated Acanthamoeba infection. In the present study, we present results of weak cytotoxic activity of this potential amoebicidal agent for 2 of 3 clinical isolates of Acanthamoeba spp. Although the inhibition effect for all tested concentrations was apparent, and showed 100% eradication of trophozoites of Acanthamoeba castellanii strain at a concentration of 62.5 µM after 24 hr, the strains Acanthamoeba sp. and Acanthamoeba lugdunensis exhibited low sensitivity to hexadecylphosphocholine, even in high concentrations. The determined minimal trophocidal concentrations were 250 µM for Acanthamoeba sp. and 500 µM for A. lugdunensis after 24 hr of exposure. Although hexadecylphosphocholine is a potential agent for treatment of Acanthamoeba keratitis and systemic infections, in clinical practice the possible insusceptibility of the amoebic strain should be considered for optimizing therapy.

Double innominate osteotomy and the Smith-Petersen technique in the treatment of developmental hip disorder.

PURPOSE: The purpose of our study was to present results of different surgical orthopaedic approaches in the treatment of children with developmental hip disorder. MATERIAL AND METHODS: At the University Childrens Hospital in Belgrade, 21 young adults diagnosed with developmental hip disorder were treated with double osteotomy and with a modified Smith-Peterson approach during a period of 10 years, from 1997 to 2007. All patients were clinically and radiographically evaluated. RESULTS: We were successful with 23 hips in 20 patients, since some patients underwent surgery of both hips. The evaluation of improvement was done according to the Merle d'Aubigne and Postel system which indicated very satisfied outcome in five patients, satisfied in 8, fair in 7 and poor in one patient. CONCLUSIONS: In this paper we discuss the advantages and disadvantages of double osteotomy procedures compared with others that are used in the correction of developmental hip disorder. The best solution is adequate and timely diagnosis with proper correction of the deformity.

Congenital muscular torticollis in children: distribution, treatment duration and out come.

AIM: The aim of the study was to evaluate the proportion of left and right congenital muscular torticollis (CMT) in both genders and age groups of the patients as well as to evaluate the duration of physical therapy and treatment outcome in observed population. METHODS: In our study, 980 children with CMT without hematoma were treated at University children's Hospital of Belgrade (Serbia). They were divided into 2 groups: group with left torticollis and group with right torticollis. Boys and girls were separately evaluated. Patients were classified into 5 age groups: group of children less than one month of life, group above one to 3 months, group above 3 months to 6 months, group above 6 months to 12 months and group of children above 12 months of life. Optimal time for physical therapy was analyzed in every age group. RESULTS: We diagnosed 496 torticollis in boys and 484 torticollis in girls. There were 458 children with left torticollis and 522 children with right torticollis. In group of children less than one month of life median duration of physical therapy was 1.5+/-0.3 months, in group above one to 3 months of life 5.9+/-0.6, in group above 3 to 6 months 7.2+/-0.6, in group above 6 to 12 months 9.8+/-0.6 and in group of children above 12 months of life 10.3+/-0.8 months. CONCLUSION: Right torticollis is frequent in both genders and age groups. Younger children have lower treatment duration and better treatment outcome. Boys have longer treatment duration and not significantly better treatment outcome.

Net carbon storage in a poplar plantation (POPFACE) after three years of free-air CO2 enrichment.

A high-density plantation of three genotypes of Populus was exposed to an elevated concentration of carbon dioxide ([CO(2)]; 550 micromol mol(-1)) from planting through canopy closure using a free-air CO(2) enrichment (FACE) technique. The FACE treatment stimulated gross primary productivity by 22 and 11% in the second and third years, respectively. Partitioning of extra carbon (C) among C pools of different turnover rates is of critical interest; thus, we calculated net ecosystem productivity (NEP) to determine whether elevated atmospheric [CO(2)] will enhance net plantation C storage capacity. Free-air CO(2) enrichment increased net primary productivity (NPP) of all genotypes by 21% in the second year and by 26% in the third year, mainly because of an increase in the size of C pools with relatively slow turnover rates (i.e., wood). In all genotypes in the FACE treatment, more new soil C was added to the total soil C pool compared with the control treatment. However, more old soil C loss was observed in the FACE treatment compared with the control treatment, possibly due to a priming effect from newly incorporated root litter. FACE did not significantly increase NEP, probably as a result of this priming effect.

Continent appendicostomy in the treatment of fecal incontinence.

BACKGROUND: Fecal incontinence is common in children with anorectal anomalies or spina bifida. If it is possible to achieve fecal control, patients are given a large volume of enema once a day. Retrograde enemas are often unpleasant in children, particularly in adolescents. Malone procedure of antegrade appendicostomy achieves antegrade colonic irrigation. MATERIAL AND METHODS: From 1996 to 2003 Malone antegrade appendicostomy was performed in 10 patients with fecal incontinence. The patients were aged from 5 to 24 years. In 4 patients fecal incontinence was due to an anorectal anomaly, and in 6 patients spina bifida. Preoperatively, all patients were given a clysma to control fecal incontinence. The patients, who remained clean with regular usage of the clysma for 24 hours or longer, fulfilled the criterion for the formation of continent appendicostomy. In 9 patients the cecal appendix was used to create a stoma, while in another one a lateral tubularized cecal flap was applied. In 3 patients a continent conduit was also done due to urinary incontinence. The follow-up period was from 1 to 8 years. A patient was reoperated due to stenosis of the stomal aperture, while another one has not been using the stoma because of social reasons. CONCLUSION: Continent appendicostomy is a simple surgery, which is effective in the control of fecal incontinence in most children. It is indicated only in patients in whom the rerograde clysma successfully cleans the colon and if patient and parents are motivated to use it. Possible complications, among which stenosis is the most frequent, can be solved with a reoperation.

Free-air CO2 enrichment (FACE) enhances biomass production in a short-rotation poplar plantation.

This paper investigates the possible contribution of Short Rotation Cultures (SRC) to carbon sequestration in both current and elevated atmospheric CO2 concentrations ([CO2]). A dense poplar plantation (1 x 1 m) was exposed to a [CO2] of 550 ppm in Central Italy using the free-air CO2 enrichment (FACE) technique. Three species of Populus were examined, namely P. alba L., P. nigra L. and P. x euramericana Dode (Guinier). Aboveground woody biomass of trees exposed to elevated [CO2] for three growing seasons increased by 15 to 27%, depending on species. As a result, light-use efficiency increased. Aboveground biomass allocation was unaffected, and belowground biomass also increased under elevated [CO2] conditions, by 22 to 38%. Populus nigra, with total biomass equal to 62.02 and 72.03 Mg ha-1 in ambient and elevated [CO2], respectively, was the most productive species, although its productivity was stimulated least by atmospheric CO2 enrichment. There was greater depletion of inorganic nitrogen from the soil after three growing seasons in elevated [CO2], but no effect of [CO2] on stem wood density, which differed significantly only among species.

Surgical treatment of cloacal anomalies.

From 1989-1998 14 patients were treated with cloacal anomalies: 5 typical cloacas (PC), 5 posterior cloacas, and 4 cloacal exstrophies (CE); 12 underwent surgery. Four typical cloacas were resolved with posterior sagittal anorectovagino-urethroplasty (PSARVUP), whereas in the 5th total urogenital mobilization (TUM) was used. Three PCs were managed with transanorectal TUM and 2 with anterior TUM without opening the anal canal and rectum (without a protective colostomy). Two CEs were treated with atypical procedures. Two patients with CE died without surgery and 2 died after surgery due to complex associated anomalies. During postoperative follow-up of 1-8 years, 5 children had voluntary bowel movements and no soiling while the others had soiling with or without enemas; 1 had stress incontinence; 3 were on clean intermittent catheterization due to neurogenic bladder and were dry. PSARVUP provides a satisfactory result if there is no sacral anomaly. TUM makes this operation easier to perform. In patients with a PC it is sometimes possible using TUM to separate the urinary from the genital tract and remove the accessory urethra without opening the anus and rectum.

[Ultrasound in the diagnosis of hypertrophic pyloric stenosis]. / Ultrasvuk u dijagnostici hipertroficne stenoze pilorusa.

The paper deals with the advantages of ultrasound diagnosis of hypertrophic pyloric stenosis in newborns. Ultrasound decreases the number of radiological examinations of gastroduodenum and reduces diagnostic exposure of children to X-rays. In the last three years 107 children had manifested clinical signs of hypertrophic pyloric stenosis. The ultrasound studies revealed hypertrophic pyloric stenosis in 55 patients (51.4%). There were 48 boys (87.3%) and 7 girls (12.7%). Patients were aged 17 to 75 days (average about 40 days). The sonogram finding was typical for hypertrophic pylorus, which made the diagnosis easier. There were no false positive or false negative ultrasound findings. All patients with hypertrophic pyloric stenosis were operated on and diagnosis was confirmed. Ultrasound is reliable in diagnosis of hypertrophic pyloric stenosis. Ultrasound examination is technically easy and fast, what is important for urgent surgical therapy. In children with persistent projectile vomiting, suspected of hypertrophic pyloric stenosis, ultrasound is the method of choice and should replace X-ray examinations.

Calculation of crater shape in pulsed laser ablation of hard tissues.

BACKGROUND AND OBJECTIVE: An expression describing the ablation crater shape as a function of lateral fluence distribution has been derived in a recent paper by Ostertag et al. [Lasers Surg Med 1997; 21:384-394]. STUDY DESIGN/MATERIALS AND METHODS: The ablation model presented therein is improved by taking into account the influence of the ablation front inclination on the ablation dynamics. RESULTS: The resulting crater profiles deviate from the previously predicted ones (which reflect the Gaussian fluence distribution of the impinging laser beam) progressively with increasing pulse fluence. CONCLUSION: The ablation front inclination must be taken into account to predict the ablation crater shapes and volumes correctly.

[Multicystic dysplastic kidney. Therapeutic dilemmas and personal experience]. / Multicisticni displazicni bubreg. Terapijske dileme i nase iskustvo.

A multicystic dysplastic kidney (MCDK) is one of the most frequent causes of abdominal mass in the neonate. Prenatal echography permits early and frequent diagnostics. It is a nonfamilial disease without associated cystic disease of the pancreas, liver or lungs. Indications for elective surgery are clear when there is a symptomatic disease. However, treatment of asymptomatic patients is controversial. A rising number of authors prefer nonsurgical approach, leaving MCDK intact with a close follow-up of patients for possible severe complications (malignancy, hypertension, infection, pain, rupture). We treated 15 patients with MCDK from 1984 to 1994. Diagnosis was passed antenatally in 7 (47%) patients, accidentally in 2, and based on the presence of abdominal mass in 6 patients. Two patients had renal failure due to the abnormal contralateral kidney. Nine patients were operated on and 6 were treated nonsurgically. The risk of complications associated with nonsurgical treatment, easiness of efficient surgery at the age of 3-6 months, avoiding stress in the child and family due to long-term follow-up, all suggest operative treatment. We suggest to parents both operative and nonoperative options, explaining the risk and danger of both. We believe that nephrectomy is the best solution in a child with MCDK who is growing, develops hypertension, with uncertain diagnosis or when adequate follow-up is impossible.

[Hyperparathyroidism and parathyroidectomy in dialyzed patients]. / Hyperparatyreóza a paratyroidektomie u dialyzovaných nemocných.

The authors present older and more recent views regarding the pathogenesis of hypocalcaemia and secondary hyperparathyroidism in patients with chronic renal failure with emphasis on the impact of inorganic phosphate retention and lack of 1,25-dihydroxyvitamin D3 in body fluids. As regards therapeutic procedures the initial problem is to control hyperphosphataemia and to suppress the increased parathormone secretion in particular in dialyzed patients. When treating hyperphosphataemia it is necessary with regard to the severity of the finding to use concurrently several procedures and avoid aluminium phosphate binders. Aimed reduction of high parathormone levels in the blood stream can be achieved by medicamentous--pharmacological means, using 1,25 (OH)2 D3 or surgery of the hypertrophic parathyroid glands. The term parathyroidectomy can comprise also percutaneous infiltration of the parathyroid glands with ethanol. From this aspect under certain circumstances a combination of different therapeutic procedures may prove useful. In the conclusion the authors mention basic data on para-thyroidectomies performed in their department: the favourable long-term results of operations amounted to 80.4%.

Influence of trace metals on growth and toxin production of Microcystis aeruginosa.

The growth and toxicity of various Microcystis aeruginosa strains were tested. Six of 14 strains were lethal to mice, five of which produced microcystin. Of these, M. aeruginosa PCC 7806 produced the most toxin per biomass and was thus used to examine the influence of various trace metals on exponential growth rate and production of microcystin. Zinc was shown to be required for optimal growth as well as toxin production. Al, Cd, Cr, Cu, Mn, Ni, and Sn did not significantly affect toxin yield at non-toxic concentrations of the metals. In contrast, iron had a pronounced effect on growth rate and toxin yield. In the absence and at low concentrations of Fe (< or = 2.5 microM), the cells grew much more slowly, but produced 20-40% more toxin. This is in agreement with the hypothesis that production of microcystins may be a response to specific environmental stress conditions.

Influence of direct and cross-relaxation pumping processes on the output energy and thermal load of an Er:YAG laser.

The dependence of the output-energy efficiency and thermal load of an Er:YAG laser on the spectrum of exciting flash-lamp light has been measured. In particular, the influence of the direct and crossrelaxation pumping process has been studied. For pump pulses of 400 µs cross-relaxation pumping processes provide four times the efficiency and 1.5 times less thermal load normalized to fixed output energy.

Transient population dynamics in flashlamp pumped sensitized erbium glass lasers.

Erbium population dynamics in ytterbium sensitized phosphate glass is studied by measuring transient changes in laser probe transmission during flashlamp pumping. The influence of energy loss channels such as excitation cumulation and nonlinear fluorescence quenching on the flashlamp pumping efficiency is observed to be relatively small. The decrease of the pumping efficiency at high input energies can be attributed mostly to the blue shift in the flashlamp output radiation spectrum.

[The role of internal medicine and hospitals in preventive services]. / Podiel vnútorného lekárstva a nemocnice na prevencii.

Preventive care is an integral part of the integrated, differentiated, modern therapeutic and preventive doctrine which in the present period of ideas on health and disease holds the most important position in ensuring active health, so-called superhealth. The effectiveness of a wide complex of preventive measures can be ensured only if the entire society participates. Health workers whose profession it is to protect health must all participate in prevention at all work places incl. hospitals. Without the participation of in-patient departments the health services cannot fulfill their preventive role in the health protection of individuals and society. The tasks of internal medicine, incl. internal in-patient departments, ensue from the contemporary main tasks of this basic medical discipline. The authors give an account of the main forms of preventive activities in hospitals and draw attention to the complexity of implementation of clinical prevention at the present time. The implementation of preventive activities in clinical departments and the participation of hospital staff in prevention should not be impeded by any administrative or conceptual barriers or regulations for the activities of health institutions.