Application of three different methods to determine the prevalence, the abundance and the environmental drivers of culturable Vibrio cholerae in fresh and brackish bathing waters.

AIMS: Three cultivation methods were used to study the prevalence and abundance of Vibrio cholerae in Eastern Austrian bathing waters and to elucidate the main factors controlling their distribution. METHODS AND RESULTS: Vibrio cholerae abundance was monitored at 36 inland bathing sites with membrane filtration (MF), a standard most probable number (MPN) approach and direct plating (DP). Membrane filtration yielded the most reliable and sensitive results and allowed V. cholerae detection at 22 sites with concentrations up to 39 000 CFU per 100 ml, all belonging to serogroups other than O1 and O139 and not coding for cholera toxin and toxin coregulated pilus. Direct plating turned out as an easy method for environments with high V. cholerae abundances, conductivity was the only significant predictor of V. cholerae abundance in the bathing waters at warm water temperatures. CONCLUSIONS: Vibrio cholerae nonO1/nonO139 are widely prevalent in Eastern Austrian bathing waters. Instead of the standard MPN approach, MF and DP are recommended for V. cholerae monitoring. Conductivity can be used as a first easy-to-measure parameter to identify potential bathing waters at risk. SIGNIFICANCE AND IMPACT OF THE STUDY: Vibrio cholerae nonO1/nonO139 infections associated with bathing activities are an increasing public health issue in many countries of the northern hemisphere. However, there are only limited data available on the prevalence and abundance of V. cholerae in coastal and inland bathing waters. For monitoring V. cholerae prevalence and abundance, reliable and simple quantification methods are needed. Moreover, prediction of V. cholerae abundance from environmental parameters would be a helpful tool for risk assessment. This study identified the best culture-based quantification methods and a first quick surrogate parameter to attain these aims.

Malignant schwannoma of the obturator nerve.

Lesions of obturator nerve are rare. Tumours and mainly malignant schwannoma of this nerve are extremely rare. The authors describe an unusual case of a gigantic schwannoma of the obturator nerve in 69 year old woman. Due to tumour expansion in the proximal part of the thigh MRI was performed and demonstrated extensive tumour originating most probably from the obturator nerve. The patient had no neurological symptoms. Biopsy from the lesion was taken at the Department of Orthopaedics with the following conclusion: malignant schwannoma. The patient received neoadjuvant chemotherapy due to diffuse metastatic spread on the chest X ray, after which metastatic spread subsided. The main lesion reduced its size by 1 cm. In 4 months after biopsy the patient was referred for operation to neurosurgery. The tumour was removed along its borders and except of minimal weakness of adduction of the right thigh there was no neurological deterioration. She was subsequently referred for further care to oncology and radiotherapy.The goal of this work is to emphasize the extremely rare occurrence of tumours of this nerve and suggest therapeutic options (Fig. 4, Ref. 11).

Diagnosis and surgical therapy of plasma cell neoplasia of the spine.

Presented is a retrospective analysis of 27 patients with plasma cell neoplasms of the spine treated by surgery. Multiple myeloma was confirmed in 22 (81%) and solitary plasmacytoma in 5 patients (19%), assessed at the time of surgery. Nineteen patients (70%) with the preliminary diagnosis of malignancy of unknown etiology were admitted for surgery. In 23 patients (85%) the essential symptom was back pain, which preceded surgery by an average of 4 months. Thirteen patients (48%) were bedridden due to tumor spinal cord compression, on average for 7 days before undergoing surgery. Only 5 out of 13 bedridden patients (38%) regained the ability to walk after surgery and 8 patients (62%) remained bedridden despite successful surgical decompression of the spinal cord. The difference of survival of the patients between bedridden and able to walk prior to surgery was statistically significant (Cox's F-Test = 0.005). Key words: plasma cell neoplasia, spinal cord compression, late diagnosis, outcome.

[Compressive syndromes of the suprascapular nerve--experience with surgery]. / Kompresivní syndromy n. suprascapularis--zkusenosti s chirurgickou lécbou.

Compression of suprascapular nerve at the suprascapular notch or spinoglenoid notch can be a cause of a rare mononeuropathy. Patients complain of pain in scapula and shoulder, and selective wasting and weakness of the supraspinatus and infraspinatus muscles. Tenderness at the suprascapular notch and pain by forced abduction of arm are typical and useful signs. Electromyographic signs of various grade denervation are regularly found in both muscles. Development of entrapment syndromes is associated with chronic overload, shoulder injuries, with surgical procedures, or with shoulder-arm fixation. The authors present their own group of 10 patients, who were operated on for entrapment syndrome of suprascapular nerve during 7 year period. Direct or indirect traumatic mechanisms of development of nerve compression were disclosed in most patients. During postoperative period there was not only substantial decrease of pain, but also regression of weakness and wasting of both muscles. In discussion, necessity of differential diagnostic procedures in case of pain and muscle wasting, use of appropriate imaging techniques, demand of purposeful EMG examination, and postoperative follow-ups are emphasized.

The role of embolization in radical surgery of renal cell carcinoma spinal metastases.

BACKGROUND: Radical surgery of renal cell carcinoma spinal metastases carries a high risk due to potentially life-threatening extreme blood loss. Radical preoperative embolization of renal cell carcinoma metastases alone is not necessarily a guarantee of extreme blood loss not occurring during operation. METHODS: A retrospective analysis of 15 patients following radical surgery for a spinal metastases of a renal cell carcinoma was performed. Eight patients were embolized preoperatively and 7 were not. We analysed features influencing peroperative blood loss: size and extent of tumour, complexity of surgical approaches and radicality of embolization. RESULTS: The embolized and non embolized groups were not comparable before treatment. They differed markedly in size of tumour as well as the complexity of approach. In the embolized group the size of the tumour was, on average, twice as large as that in non embolized patients and more complex approaches were used twice as frequently. Despite findings suggesting that embolization was effective, blood loss was greater in the embolized group of 8 patients (4750 ml), compared to the non-embolized group of 7 patients (1786 ml). CONCLUSION: Metastasis size, extent of tumour, technical complexity of surgery and the completeness of preoperative embolization had an important effect on the amount of peroperative blood loss. The evaluation of the benefits of preoperative embolization only on the basis of blood loss is not an adequate method.

Meningeal carcinomatosis as a late complication of brain metastases of epithelial ovarian carcinoma.

The brain represents a rare site of metastasis in patients with epithelial ovarian carcinoma (EOC). In recent decades there has been an apparent increase in the number of EOC patients diagnosed with brain metastases, probably as a result of improved prognosis of patients with advanced tumors, but cases of meningeal carcinomatosis complicating EOC remain rare. A patient with Stage III EOC had brain metastases diagnosed 31 months after primary surgery. The isolated brain metastases were controlled with radiosurgery, surgery and chemotherapy. Forty-five months after the diagnosis of brain metastases, meningeal carcinomatosis was diagnosed which led, despite intrathecal therapy, to a fatal outcome. At autopsy, the disease was limited to the central nervous system. Meningeal carcinomatosis may represent a late fatal complication of brain metastases of EOC.

[Present view on the spinal haemangioma]. / Soucasný pohled na problematiku páterního hemangiomu.

Ethiopathogenesis, diagnostic and treatment of spinal haemangioma remains suggestive topic not only for surgeons. The development of diagnostic imaging methods allows more precise evaluation of the pathology and optimal therapeutic planning. We have many therapeutic modalities: selective embolisation, radiotherapy, vertebroplasty, alcohol ablation and surgery. It depends on radiologic findings and clinical status which of them is used. The treatment of emergent compression is still the domain of surgeon. In the therapy of haemangiomas causing local pain, we prefer less invasive procedures. The interdisciplinary cooperation is required for the successful treatment.

[The usefulness of carpal tunnel pressure measurement during endoscopic surgery of carpal tunnel syndrome]. / Vyuzití merení tlaku v karpálním tunelu behem operace syndromu karpálního tunelu.

The usefulness of carpal tunnel pressures measurement during surgery of carpal tunnel syndrome is documented by the authors. 31 patients underwent endoscopic uniportal approach, the pressure in different positions (neutral position, flexion and extension in wrist, grip of the fingers) and in different levels (distal forearm, proximal, central and distal part of carpal tunnel, palm) was measured. The significant drop of pressure was observed after dissection of ligament in all levels. The results are presented in the form of several graphs.

[Role of percutaneous vertebroplasty and kyphoplasty in the treatment of oncology disorders of the spine]. / Postavení perkutánní vertebroplastiky a kyfoplastiky v lécbe onkologického onemocnení pátere.

BACKGROUND: The aim of the study is to present results of a prospective uncontrolled clinical study. Percutaneous vertebroplasty or kyphoplasty are minimally invasive methods based on polymethylmethacrylate (PMMA) bone cement application into the damaged vertebra. This leads to decrease of the pain and vertebral body stabilisation. Oncology disorders of the spine are relatively common, having a wide alternative of various methods of treatment. Patients, according to their findings and indication criteria, are treated surgically or conservatively, oncological treatment is usually based on radiotherapy. Authors discuss the role of these invasive procedures in the treating algorithm of patients with spinal metasthases and multiple myeloma. METHODS AND RESULTS: From September 2003 to December 2005, 21 percutaneous vertebroplasties in 14 patients, mean age 68.7 (47-80) year, were performed in our department. During one treatment session 1-2 vertebrae (total of 21 vertebrae) in level Th9 - L5 were treated. Vertebroplasties and kyphoplasty were performed under fluoroscopy guidance. Transpedicular acces was used. Totally, 3 asymptomatic complications were proved. As first, a bone cement leaked paravertebrally during L5 body treatment, as second, a bone cement leaked into paravertebral veins, and as third, a bone cement leaked into the intervertebral space. Visual analog scale (VAS) was 8.9 points before procedure, 1.9 point 3 months after procedure and 2.6 points 6 months after procedure. We did not prove a symptomatic or total complication. CONCLUSIONS: According to our experience, percutaneous vertebroplasty is an effective alternative treatment of painful oncologic spine disease.

[Percutaneous sacroplasty in sacral insufficiency fracture treatment]. / Perkutánní sakroplastika v lécbe insuficientní fraktury krizové kosti.

Stress (insufficient) sacral bone fracture is a seriously painful disease with discussed and disunited therapy. Older women sufferig from osteoporosis create the main group in which this fracture occurs. Clinically, serious pain in sacral area is the most common symptome. This pain may last for a long time when treated conservatively and it can lead to pacient's immobilization with related comorbidity. In 2% of patients, neurological complications can be observed. Authors present summary of published studies and demonstrate an own case treated using percutaneous sacroplasty.

[Percutaneous vertebroplasty]. / Perkutánní vertebroplastiky.

Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure originally developed in France by Galibert, Deramond et al. (1987). The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of bone cement into a vertebral body for the relief of pain, and the strengthening of the bone. The procedure was used initially to treat aggressive hemangiomas, but it then was extended to the treatment of osteolytic metastases, multiple myeloma and osteoporotic compression fractures refractory to medical therapy. In this article we review the current techniques, indications for this procedure, preoperative and postoperative evaluations.

[Measurement of carpal tunnel pressure during surgery of carpal tunnel syndrome]. / Merení tlaku v karpálním tunelu pri operacích syndromu karpálního tunelu.

A significance of carpal tunnel pressure measurement during surgery of carpal tunnel syndrome (endoscopic and twin incision technique) was evaluated. The pressure in different levels of palm and in different positions of the hand was measured by ICP sensor Codman during operation of 10 patient. The results are presented in the form of several graphs. In all 10 cases excellent results were obtained.

Clinical results of intensity-modulated radiation therapy (IMRT) for tumors of the head and neck region.

Intensity-modulated radiation therapy (IMRT) is an advanced form of the three-dimensional conformal radiation therapy (3D-CRT). Highly conformal dose distribution is the basic feature of IMRT. The head and neck region is suitable for this new technology since the primary tumor is often surrounded by several critical structures. IMRT offers the ability of dose escalation due to steep dose gradient towards healthy tissues. In this review, clinical results of IMRT in several head and neck sites are presented, including intracranial tumors. Parotid-sparing strategies and patterns of local-regional failures are analyzed. The possibilities of irradiation of recurrent malignancies are mentioned. In perspective, the potential of IMRT should be explored in conjunction with altered fractionation regimens, including simultaneous integrated boost (SIB). Particularly, studies with dose escalation are desirable.

[Dr. Jan Vanysek: founder of the ophthalmology clinic in Hradec Kralove. A distinguished personality in Czechoslovak ophthalmology]. / Prof. MUDr. Jan Vanýsek, DrSc.: Zakladatel ocní kliniky v Hradci Králové. Významná osobnost ceskoslovenské oftalmologie.

Professor Vanýsek was the first Czechoslovak ophthalmologist who overstepped the boundaries of the Republic and became one of the foremost scientist in ophthalmology. He was head of a department, consistent more with ideas of the 21st than 20th century. He founded two important ophthalmological school--in Hradec Králové and Brno. He laid the foundations for an experimental institute in Brno which would have become one of the foremost European institutions if Vanýsek had not been condemned by the totalitarian regime in the seventies.

[Professor Václav Vejdovský--the man and his work]. / Profesor Václav Vejdovský--osobnost a dílo.

Professor Václav Vejdovský, for many years head of the Olomouc Clinic, is a distinguished personality of Czechoslovak ophthalmology. He was head of the department for 42 years and created an important school of ophthalmology. He was one of the founding members of the Czechoslovak Ophthalmological Society and for many years its vie-chairman, in 1967-1970 its chairman. He represented Czechoslovakia in the committee of the European Ophthalmological Society. Professor Vejdovský has special merits as regards introduction of Czech nomencalture into previous almost exclusively German ophthalmology in Moravia.

Scleroplasty in progressive myopia--selection of materials.

Scleroplastic surgery is known to encounter the pathogenetical agent when the progressive myopia develops. In the first part, the implemented surgical approaches as well as up-to-date surgical techniques are presented. The experimental part is reserved for the selection of material which is necessary to perform scleroplasties. Both the allogenic and xenogenic grafts have been studied for histocompatibility on 20 rabbits. Following materials were used: 2 types of collagenic sponge, native and deproteinated human sclera, modified dura mater as well as both the native and devitalized sclera from rabbits. The best results were obtained with allogenic sclera, deproteinated xenogenic sclera and collagenic sponge. The application of other materials is discussed.

[Spectrum and dynamics of free amino acids in bovine ocular tissue and their interaction with pilocarpine. IV. The sclera]. / Spektrum a dynamika vol'ných amínokyselín tkanív hovädzieho oka a ich interakcia s pilokarpínom. IV. Sklera.

Two-dimensional ascending chromatographic analysis revealed that a 3% aqueous pilocarpine solution dropped into the conjunctival sac of cattle 2.5 hours after the last instillation shifts in a specific qualitative and quantitative way the levels of different free amino acids in the anterior, equatorial and posterior portion of the sclera. This alkaloid in the anterior and posterior part reduces and in the equatorial part of the sclera increases the total levels of free amino acids. The greatest drop in the anterior portion occurred in leucine + isoleucine methionine + valine and glutamine, in the posterior part threonine and leucine + isoleucine. The greatest rise in the equatorial part was observed in glutamine, leucine + isoleucine and taurine.

[Prostanoids and leukotrienes in ophthalmology. I. Basic biochemistry and physiology of prostanoids and leukotrienes]. / Prostanoidy a leukotrieny v ocním lékarství. I. Základy biochemie a fyziologie prostanoidu a leukotrienu.

The authors give a brief account of hitherto assembled knowledge on the biochemistry and physiology of prostanoids and leucotrienes. They describe the history of investigations of these substances, their properties and patterns of synthesis. The authors evaluate possibilities of the pharmacotherapeutic use of inhibitors of prostanoid and leucotriene synthesis.

[Prostanoids and leukotrienes in ophthalmology. II. Role of prostanoids and leukotrienes in the physiology and pathophysiology of the eye]. / Prostanoidy a leukotrieny v ocním lékarství. II. Ucast prostanoidu a leukotrienu ve fyziologii a patofyziologii oka.

The authors give an account on the development and contemporary knowledge regarding the participation of prostanoids and leukotrienes in physiological and pathophysiological processes of the eye. According to many data in the literature of all intraocular tissues of the human eye the greatest prostaglandin production was found in the anterior segment of the choroid. The authors describe the role played by these substances in the pathogenesis of inflammations, their importance in the regulation of intraocular pressure and in the development of cystoid macular oedema.

[Prostanoids and leukotrienes in ophthalmology. III. Results of a clinical study of local administration of indomethacin in preoperative and postoperative care]. / Prostanoidy a leukotrieny v ocním lékarství. III. Výsledky klinického sledování lokálního podávání indometacinu v predoperacní a pooperacní péci.

The authors submit results of the clinical investigation involving indomethacin administration during preoperative and postoperative care of patients with primary glaucoma who were submitted to trabeculectomy. The investigation was made by the method of a double blind trial. Indomethacin 0.5% eye drops or placebo were administered on the day prior to operation to the 10th day after operation, three times a day. During the final comparison of the two groups after indomethacin a reduction of the number of postoperative complications was observed, as well as a shorter hospitalization period, and the result of the filtering operation was not affected.