Small-fibre involvement in diabetic patients with neuropathic foot pain.

AIMS: To assess small-fibre involvement in diabetic patients with neuropathic pain. METHODS: Peripheral nerve function was assessed in 30 patients with Type 2 diabetes mellitus (T2DM, n = 24) or impaired glucose tolerance (IGT, n = 6), and clinical symptoms of neuropathic pain in the feet, using nerve conduction studies, autonomic tests, thermal quantitative sensory testing (T-QST) and quantification of intra- and subepidermal nerve fibre densities in skin punch biopsies. RESULTS: Clinical signs of isolated small-fibre sensory involvement were present in 13 patients [pure small-fibre neuropathy (pSFN)], seven patients had isolated positive sensory symptoms without neurological deficits (pSFN-). Ten patients had concomitant electrophysiological and/or clinical signs of large-fibre sensory involvement [mixed-fibre neuropathy (MFN)]. Twenty-seven patients (90%) had both reduced skin innervation and abnormalities of the T-QST parameters. Two other patients displayed either abnormal skin innervation or T-QST, and only one patient had normal findings on both tests. The criteria of small-fibre neuropathy (SFN) were met in all 20 patients without large-fibre involvement. Small-fibre involvement was also present in the 10 MFN patients. Both T-QST and skin biopsy parameters revealed significant differences between these clinical subgroups, with increased severity of small-fibre involvement in the MFN group. Autonomic dysfunction was found in 43% of patients and did not correlate with either clinical, T-QST or skin biopsy data. CONCLUSIONS: Although the exact mechanism of neuropathic pain in diabetic patients is not known, pain is almost invariably accompanied by small-fibre dysfunction and pathology irrespective of autonomic or large-fibre involvement.

Risk factors for critical illness polyneuromyopathy.

Although numerous clinical, laboratory, and pharmacological variables have been reported as significant risk factors for critical illness polyneuromyopathy (CIPM), there is still no consensus on the aetiology of this condition. Objectives of the study were to assess the clinical and electrophysiological incidence and risk factors for CIPM.A cohort of critically ill patients was observed prospectively for a one-month period and the association between neuromuscular involvement and various potential risk factors was evaluated. Sixty one critically ill patients completed the follow-up (30 women, 31 men, median age 59 years).CIPM development was detected clinically in 17 patients (27.9 %) and electrophysiologically in 35 patients (57.4 %). CIPM was significantly associated with the presence and duration of systemic inflammatory response syndrome and the severity of multiple, respiratory, central nervous, and cardiovascular organ failures. The median duration of mechanical ventilation was significantly longer in patients with CIPM than in those without (16 vs 3 days, p<0.001). Independent predictors of CIPM obtainable within the 1(st) week of critical illness were the admission sequential organ failure assessment score (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.02-1.36), the 1(st) week total sequential organ failure assessment scores (OR, 1.14; 95 % CI, 1.06-1.46) and the 1(st) week duration of systemic inflammatory response syndrome (OR, 1.05; 95% CI, 1.01-1.15). They were able to correctly predict the development of CIPM at the end of the 1(st) week in about 80% of critically ill cases.In conclusion, the presence and duration of systemic inflammatory response syndrome and the severity of multiple and several organ failures are associated with increased risk of the development of CIPM.

[Comparison of diagnostic validity of carbohydrate-deficient transferrin and other laboratory markers in chronic ethanol abuse]. / Srovnání diagnostické validity karbohydrát deficientního transferinu a dalsích laboratorních markeru chronického abúzu etanolu.

BACKGROUND: Carbohydrate-deficient transferrin (CDT) has been reported to be the best laboratory marker of the chronic alcohol abuse, but there are conflicting data on its accuracy and sensitivity ranging from 19% to 96% in various studies. The aim of this study was to compare the diagnostic efficiency of CDT with the other markers of alcohol abuse used in clinical practice with respect to possible sex differences. METHODS AND RESULTS: The serum CDT (using the method of anion-exchange chromatography and TIA), mean corpuscular volume (MCV), gamma-glutamyl-transferase (GMT) values and platelet count were evaluated in 50 alcohol-dependent patients admitted to the Center of Detoxification and in the reference group of 85 healthy teetotallers. The cut-off values for %CDT where established in the level of 2.2% and 2.5% for men and women respectively. In men we proved a comparatively high diagnostic efficiency of CDT (AUC 0.94, sensitivity 82.6%, specificity 96.7%) and GMT, MCV seem to be less accurate marker of chronic alcohol abuse. In contrast there was a lower diagnostic validity of CDT in women in comparison with common markers (AUC 0.83, sensitivity 60%, specificity 88%). CONCLUSIONS: The laboratory diagnosis of chronic alcohol consumption can be improved by using a combination of several markers. The specificity and also the cumulative sensitivity of such a battery of laboratory markers can be elevated by CDT evaluation. In a part of patients, CDT can be the only detectable abnormality.

[Diagnostic value of carbohydrate-deficient transferrin, gamma-glutamyltransferase and mean erythrocyte volume as laboratory markers of chronic alcohol abuse]. / Diagnostická výteznost karbohydrát deficitního transferinu, gama-glutamyltransferázy a stredního objemu erytrocytu jako laboratorních markeru chronického abúzu alkoholu.

INTRODUCTION: Our research aimed at finding out values of carbohydrate-deficient transferin (CDT), gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV) for the purposes of future etiological diagnostics of alcohol neuropathy in thin fibres. METHODS: We examined the serum of 80 control subjects (50 women and 30 men), and the serum of 33 alcoholics (20 men and 13 women) with the daily consumption of more than 60 g alcohol in the course of the last four weeks. CDT was determined with the use of microcolumn separation after iron saturation followed by turbidimetric immunoassay (ChronoAlcoI. D., Sangui Biotech, Inc.) on Cobas-Mira analyser. CDT is expressed as a percentage of the total transferin. Senzitivity, specificity, positive likelihood ration (+LR), ROC and the area under the ROC curve were determined using statistical program MedCalc. RESULTS: The senzitivity, specificity and positive likelihood ratio (+LR) for CDT-%, respectively, were 82.6, 96.7 and 24.8 for men (cut off 2.2%), and 60.0, 88.0 and 5.0 for women (cut off 2.5%). The respective values for GMT were 95.7, 90.0 and 9.6 for men (cut off 0.64 mu kat/l), and 90.0, 80.0 and 4.5 for women (cut off 0.38 mu kat/l); for MCV 82.6, 96.7 and 24.8 for men (cut off 95.0 fL), and 80.0, 100.0 and 20.0 for women (cut off 97.2 fL). The area under the ROC curve for CDT-%, GMT and MCV, respectively, were 0.940, 0.964 and 0.896 for men, and 0.829, 0.917 and 0.906 for women. CONCLUSION: In men, CDT-% and MCV showed the same values of the statistical parameters studied. GGT was more sensitive and less specific. In women, all the parameters studied presented a lesser diagnostic value, except for MCV with 100% specificity and +LR 20.0.

[Lymphadenitis caused by toxoplasmosis during gravidity -- an aetiological factor in congenital damage to the child (author's transl)]. / Durch Toxoplasmose hervorgerufene Lymphadenitis während der Gravidität als ätiologische Ursache der kongenitalen Schädigung des Kindes.

Even simple lymphadenitis during pregnancy may possibly be an acquired lymphatic form of toxoplasmosis with all detrimental consequences to the foetus.

[Central european tick-borne encephalitis from 1969 to 1972 in central bohemia (author's transl)]. / Mitteleuropäische Zeckenenzephalitis in den Jahren 1969-1972 im Kreis Mittelböhmen

From 1969 to 1972 1,080 patients admitted with a diagnosis of viral meningoencephalitis were treated at the Hospital for Infectious Diseases in Prague-Bulovka. In 633 of these patients tick-borne encephalitis could be detected serologically. The epidemiological conditions and the clinical course of the disease are described. Paresis of the extremities and the cranial nerves occurred in 12.8% of the patients; the outcome was fatal in 0.8%. Treatment in hospital usually lasted 3 to 4 weeks and patients were unfit for work for a further 6 to 10 weeks after dismissal.