Study of awareness of tick-borne diseases among children and young people in the Czech Republic.

In the 2000 and 2001 years, there was performed a study which has given some insight on the knowledge of youths about ticks and tick-borne diseases. Two thousand seven hundred and sixty-three respondents from 6 to 26 years of age took part in this investigation. More than 98% of respondents knew about the existence of ticks. Almost 93% of children and 97% of adolescents reported that ticks feed on blood. Although the majority of respondents aged 10 to 26 years is convinced that ticks live on vegetation, 23% of them supposed that ticks jump on humans from trees. As many as 93.5% of youths knew that Lyme disease is transmitted by ticks. The main sources of information about Lyme disease for students and pupils older than 10 years of age are television and radio (40.9%) and the press (37.5%). The frequency of contact of young people with ticks is high--90.4% of children younger than 12 years, and 93.7% of youths from 10 to 26 years of age had at least once an attached tick. 56.1% of youths older than 10 years use oil to remove an attached tick. Almost 23.7% remove ticks with bare hands. People used those methods of tick removal although even children younger than 12 years of age knew that it was an incorrect habit. After removing, a tick is most frequently burned.

Molecular and microscopical evidence of Ehrlichia spp. and Borrelia burgdorferi sensu lato in patients, animals and ticks in the Czech Republic.

We report moderately severe cases of human ehrlichiosis and a lethal one caused by human granulocytic Ehrlichia, the HGE agent, closely related to Ehrlichia phagocytophila and Ehrlichia equi. Their vector is the Ixodes ricinus tick, which also transmits Borrelia burgorferi sensu lato in central, west and east regions of the Czech Republic. The diagnosis was established by PCR with sequence analysis of the genes encoding 16S rRNA of Ehrlichia and with reverse hybridization by using enzyme linked immunosorbent assay with different covalently coupled probes to the activated plate. Ten out of 47 patients and 10 huntsmen were PCR positive and 7 of them seroconverted to the HGE. Coinfection of Ehrlichia phagocytophila with Borrelia burgdorferi sensu lato was detected in 3 patients. Ehrlichia spp., the HGE agent, was isolated and propagated only from one patient in the HL-60 promyelocytic cell line. The maintenance of Ehrlichia in culture and in patients was assayed also by immunocytological staining and electron microscopy. Sequence or hybridization analysis of PCR results in different wild mammals and birds showed significant sources of Ehrlichia fagocytophila in nature. Three variants of E. phagocytophila in wild roe deer and boars, as well as for the first time in birds, have been described. Cultures from the blood of horses, and from the spleen and kidney specimens of roes and boars, PCR positive for Ehrlichia spp., displayed a disappearing level of the pathogen or contamination with other bacteria.

Incidence of Borrelia garinii and Borrelia afzelii in Ixodes ricinus ticks in an urban environment, Prague, Czech Republic, between 1995 and 1998.

The presence of Borrelia burgdorferi sensu lato and its individual genospecies was determined using a single-step polymerase chain reaction in a total of 779 Ixodes ricinus ticks collected from an urban park in Prague, Czech Republic. The incidence of Borrelia burgdorferi sensu lato was 9.2% in 1995, 3.4% in 1996, 4.5% in 1997 and 2.8% in 1998. The Borrelia garinii to Borrelia afzelii ratio was 1.4:1 and it did not differ significantly throughout the study period. Borrelia burgdorferi sensu stricto was not detected. Borrelia garinii/Borrelia afzelii coinfection was found in 5.7% of positive ticks. The results indicate it is possible for the urban population to come in contact with the causative agent of Lyme disease in an urban park.

Incidence of spirochetes (Borrelia sp.) in the tick Ixodes ricinus in the urban environment (capital of Prague) between 1994-1997.

A total of 12287 ticks were collected from 10 localities of the capital of Prague between 1994 and 1997 (2978 ticks in 1994, 5612 ticks in 1995-1996, 3686 ticks in 1997). The presence of Borrelia was investigated by the indirect immunofluorescence assay using hyperimmune rabbit sera. The tick infestation ranged between 3.8% and 9.7% (1994), 7.9% and 11.3% (1995), 3.6% and 6.2% (1996) and 4.8% and 9.2% (1997). The results obtained are indicative of a relatively high opportunity for exposure to the causative agent in Prague--the dynamics of the spirochete positivity rates in ticks in different years corresponds with the dynamics recorded in the incidence of Lyme borreliosis in the same region.

[Single-step polymerase chain reaction in the detection of Borrelia burgdorferi and the genome species in the Ixodes ricinus tick]. / Pouzití jednokrokové polymerázové retezové reakce k detekci Borrelia burgdorferi sensu lato a jejich genomospecies u klíst'at Ixodes ricinus.

The objective of the work to introduce screening PCR into the diagnosis of Borrelia burgdorferi sensu lato in the vector selection of the most suitable primer, derived from chromosomal DNA and detection of different genome species. The sensitivity of primers, described in the literature (LD, 16S, Wk, 5S-23S) was tested by different amounts of DNA strains of borrelias. The most sensitive primer--LD was used for detection of borrelias in the vector. Ticks were collected in municipal parks from 1995-1997. A total of 635 ticks were examined. The positivity of the group differs in individual years: 9.2% in 1995, 3.4% in 1996, and 4.5% in 1997. Adult ticks were markedly more infected than nymphs. Borrelia garinii prevails at the site, Borrelia burgdorferi sensu stricto was not detected so far. Mixed infection with Borrelia garinii/Borrelia afzelii was found in 1997 in one sample (female ticks). PCR is a sensitive and specific method suitable for assessment of the herd immunity of ticks with borrelias. It makes it possible to differentiate with a relatively high sensitivity individual genome species of Borrelia burgdorferi in the vector. Before its use the sensitivity of the reaction must be tested in the presence of tick DNA.

Long term follow-up study of laryngeal precancer.

The goal of this study was to determine subsequent malignancy on a discrete group of precancerous laryngeal lesions, and to assess the mortality. In a series of 227 patients, average age 51.8 years (ranging from 13 to 80 years). The changes were followed-up for 12.3 years (minimum of 5 years and maximum of 40 years). 58% are living without any sign of premalignant laryngeal mucosal disease, 13% with controlled precancer, and 3% in remission after surgery for carcinoma. 11% died (9% due to cause unrelated to the cancer) and 15% were lost for follow-up. 17% of the group with mucosal hyper- or metaplasia progressed to mild dysplasia, but none progressed to carcinoma. Reinke's oedema recurred in 4%, no malignancy was observed. Carcinoma developed in 16% of laryngeal papilloma (8% in situ and 8% invasive). 15% of mild dysplasia progressed in severity, but none transformed to malignancy. Moderate dysplasia progressed to severe dysplasia in 12%, carcinoma in situ in 4%. Of cases with severe dysplasia 13% developed in situ carcinoma while 43% progressed to invasive cancer. In the whole series progression to severe grade was seen in 7.1%, and malignant transformation in 4.4%. Three patients (1.3%) died due to subsequent carcinoma. Our results agree with some authors; but the majority of them reports higher incidence of malignant transformation. Invasive carcinoma was diagnosed in the follow-up in seven patients. Those represent only 3% of all laryngeal carcinomas diagnosed in our department in the same period of time. Based on the data we have evaluated the intensity of follow-up in patients with hyperplasia, metaplasia, keratosis and mild dysplasia.

[Endoscopic endonasal dacryocystorhinostomy: indications, technique and results]. / Endoskopická endonazální dakryocystorinostomie: indikace, technika, výsledky.

From 1996 till August 1998 the authors made 24 EDCRS in 23 patients aged 35 to 80 years, incl. 6 men and 17 women. All patients reported epiphora, in 19 cases a mucous purulent secretion from the lacrimal pathways was present and 9 had a history of phlegmon in the area of the lacrimal sac. Irrigation of the lacrimal pathways revealed occlusion which was confirmed also on dacryocystography. The cause of occlusion was in four instances iatrogenic (rhinosurgical operation), in another two post-traumatic and in six there were pathological findings in the nasal cavity. In two instances the authors detected a dacryolith and in 10 idiopathic stenosis was found. The operation was performed under general anaesthesia, using an endoscopic endonasal approach, without permanent or serious complications. On operation in 15 instances postsaccal stenosis was detected, in 7 instances intrasaccal stenosis and in two patients a dacryolith was present. A concurrent mild presaccal stenosis was present in three patients and was treated by insertion of a catheter into the lacrimal pathways for a period of several weeks (except these situations the authors do not indicate its use). After 24 EDCRS epiphora persists only in one patient (with a presaccal component of stenosis), in the remaining patients epiphora is no longer present and irrigation of the lacrimal pathways is free. Minor traumatization without injury of the medial palpebral ligament and normal function of the lacrimal pump are basic advantages of the endonasal approach. The majority of authors report patency of the lacrimal pathways which is achieved by the method of EDCRS in 83-86% of patients. The authors results are similar and justify the recommendation to consider EDCRS as the method of choice in the surgical treatment of intrasaccal and postsaccal stenoses of the lacrimal pathways.

Severe functional laryngeal stenoses treated by endoscopic arytenoidectomy.

During the 15-year period from 1978 to 1993 we treated 17 cannulated patients suffering from dyspnea caused by bilateral recurrent laryngeal nerve palsies. The causes of palsy were struma surgery (13 cases), prolonged intubation (3 cases) and unknown (1 case). All cases were operated on by the classical endolaryngeal arytenoidectomy technique developed by Kleinsasser. All patients were able to be decanulated after arytenoidectomy: 14 cases within 1 month of surgery and 3 delayed. Four patients required replacements of their tracheotomies during the follow-up period, but this proved to be only temporary in 3 cases. After excisions of polypoid tissues or enlargement of an ipsilateral partial cordectomy, definitive closure of the tracheostome was possible. Among the retracheotomized patients, only 1 patient with multilocular stenoses has remained under treatment for the past 2 years. In all, 16 of 17 patients (93%) have remained permanently decannulated.

A simple instrument for endoscopic laryngeal and pharyngeal surgery.

A simple suture instrument for endoscopic microlaryngeal surgery is presented. It is made from a common sewing machine needle that is soldered in a 25 cm pipe-like holder and is slightly bent near the point. The needle tip is so threaded that the thread can pierce through both edges of a wound following placement with an endoscopic tube. The thread is held by a forceps, the instrument withdrawn and the suture knotted. In practice, wounds can be sutured very quickly, easily and comfortable. An example of its application is use of the instrument to shorten significantly and simplify the performance of endoscopic arytenoidectomy.