Alveolar Echinococcosis of the Liver with a Rare Infiltration of the Adrenal Gland.

Human alveolar echinococcosis (AE) is a silently-progressing disorder that has become a threat in many countries. Since 2000, when the first case was recorded, the number of human AE patients in Slovakia is on continuous raise. The article presents a rare case of alveolar echinococcosis with infiltration in the adrenal gland and discusses the problems associated with differential diagnosis of the disease. In 2016, abdominal ultrasound performed due abdominal pain complaint showed the presence of cystic lesions in the right liver lobe of 54-year old female patient. During surgery, another lesion in the right adrenal gland was found, and neoplastic processes or echinococcosis were considered in the differential diagnosis. Due to unclear correlation between radiology, serology and histopathology results and endemic situation in Slovakia, molecular examination was recommended. Subsequently E. multilocularis was confirmed as etiological agent of infection. Alveolar echinococcosis is considered as a rare disease, with very few patients referred to clinicians or hospitals that sometimes have almost none existing experience with the diagnosis and treatment of the disease. Therefore, the establishment of networks or reference centres specialized on management of the disease would be suitable way to provide the patients with the best care and improve the disease diagnosis, treatment and prognosis.

Importance of GOLD Guidelines for Chronic Obstructive Pulmonary Disease.

In December 2011, a major revision of GOLD 2011 guidelines was published based on the evidence-based medicine. The goal of GOLD 2011 is to determine the severity of the disease, its impact on the patient's health, and the risk of future events; all of which eventually guide therapy. A combined COPD assessment according to GOLD 2011 considers the patient's level of symptoms, spirometry abnormalities, risk of exacerbation, and the presence of comorbidities. GOLD 2011 stratifies patients into four basic groups labeled A, B, C, and D. The aim of the present study was to assess the importance of updated GOLD guidelines for the diagnosis, treatment, and prevention of COPD. We found that the multicomponent 2011 guidelines offer a significant advantage over the previous mono-component COPD assessment according to GOLD 2006 in terms of disease control and therapy management, with patients enjoying better spirometry values and a higher arterial oxygen content considered the primary outcomes of interest.

Hypoglycemia associated with non-islet cell tumors.

UNLABELLED: Tumor hypoglycemia is rare but life-threatening medical condition which may be associated with insulinoma and non-islet cell tumors (mainly of mesenchymal origin). The pathogenesis is connected with abnormal processing of insulin-like growth factor-2 (IGF-2) precursor and production of pathognomic "big" IGF-2 - incompletely processed posttranslational precursor of IGF-2, which is responsible for hypoglycemia. Other typical laboratory features include low level of fasting glucose and C-peptide, low IGF-1 and increased IGF-2 : IGF-1 ratio. Although paraneoplastic hypoglycemia is often present in patients with already diagnosed malignancy, it is necessary to consider this possibility in patients having unclear and inexplicable hypoglycemia. The adequate treatment can significantly reduce the symptoms and improve the quality of life.    KEYWORDS: tumor hypoglycemia, non-islet cell tumor, insulin-like growth factor.

[Paraneoplastic hypoglyacemia]. / Paraneoplastická hypoglykémia -  popis prípadu a prehlad problematiky.

Paraneoplastic hypoglyacemia (PH) is a relatively rare phenomenon, which may be caused by insulinomas or nonislet cell tumours (NICT). Both types are among the major "fasting" hypoglyacemia as opposed to reactive postprandial hypoglyacemia. The most common group of nonislet cell tumours causing hypoaglycemia are large mesenchymal tumours, which account for over 50 % of all neoplasms associated with hypoglyacemia. Neuroglycopenic symptoms in patients with NICT may be present for months or years before the actual diagnosis of the underlying disease. Differentiation and correct diagnosis of this type of disease leads to significant improvement in the quality of life of these patients.

[Hyponatremia - carbamazepine medication complications]. / Hyponatrémia - komplikácia liecby karbamazepínom.

Hyponatremia can be defined like the low sodium concentration, lower that 135 mmol/l. It becomes really serious when the concentration is lower than 120 mmol/l. The most frequent causes of hyponatremia are: the extrarenal loss (GIT, skin, bleeding, sequestration), the renal loss (diuretics, nephritis with the salt loss, osmotical diuresis, the Addison disease), hypothyroidism, the lack of glucocorticoids, emotional stress, pain, pseudohyponatremia (incorrect taking, dyslipoproteinemia). There is fatigue, exhaustion, headache and vertigoes dominating in the clinical record file. By the deficit increasing a patient becomes delirious, comatose even with the shock development. It is necessary to separate sufficient supply of sodium from much more often reason, which is loss of sodium which can be caused by: excessive sweating, vomitting with the metabolical alkalosis development, diarrhoea with the metabolical acidosis development, renal losses (a phase of renal failure). Treatment of hyponatremia: intensive treatment starts at the level of plasmatic concentration of sodium under 120 mmol/l or when neurological symptoms of brain oedema are present. In the therapy it is necessary to avoid fast infusions of hypertonic saline solutions (3-5% NaCl solutions) because of the danger of the development of serious CNS complications (intracranial bleeding, etc.). It is recommended to adjust the plasmatic concentration of sodium up to 120 mmol/l during the first four hours and a subsequent correction should not be higher than 2 mmol per an hour. Treatment of the basic illness is very important. We present 2 case histories: a 74-year old female patient and a 69-year old female patient both with the hyponatremia caused by taking of carbamazepine. We want to inform and warn about not only a well known side effect during long-term treatment but about hyponatremia that arose within 48 hours after the start of taking medicine as well.

Consideration of endoscopic retrograde cholangiopancreatography in cases of acute biliary pancreatitis.

AIM: The important question to be answered in all cases of ABP is whether or not a calculous biliary obstruction is still present. Answering this question conditions subsequent management, including the need for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the relationship between persistent common bile duct stone (CBDS) and laboratory values, and dilation of bile duct in order to find possible significant associations in patients with acute biliary pancreatitis (ABP). METHODS: Retrospectively, statistical evaluation of a group of 76 patients with ABP who had received early ERCP. RESULTS: The prevalence of choledocholithiasis in patients > 70 years old was 54.2%, in patients < or = 70 years old it was 36.5%. Following cholecystectomy, CBDS was present in 81.8% of patients, p = 0.005. The probability of CBDS occurrence in patients > 70 years old with bile duct dilation was 81.3%; in the absence of bile duct dilation CBDS was not present, p < 0.001. The probability of CBDS occurrence in patients 70 years old with bile duct dilation was 57.7%, in the absence of bile duct dilation CBDS was present in 15.4%, p = 0.002. In patients with bile duct dilation predictive factors are as follows: bilirubin (Bi), after excluding patients with acute cholecystitis and cholangitis, p = 0.05; alanine aminotransferase (ALT) in patients 70 years old, p = 0.004; gamma-glutamyl transferase (GMT) in patients > 70 years old, p = 0.02. CONCLUSIONS: ERCP is indicated in patients with ABP if biliary obstruction is present and the presence of a ductal stone is suspected. From our results it is clear that the predictive parameter for choledocholithiasis is the dilation of the bile duct and previous cholecystectomy. In patients with bile duct dilation possible predictive factors are Bi, ALT, and GMT (Tab. 1, Fig. 8, Ref. 20).

[Options of hormonal contraceptives and substitution in female diabetic patients]. / Moznosti hormonální antikoncepce a substituce u diabeticek.

The pregnancy planning is extremely important for women with diabetes mellitus and therefore, reliable contraceptives are indispensable for such women. Generally, female diabetic patients can use the same forms of contraceptives as healthy women, however, in their case many specific circumstances must be considered, which are addressed in the first part of the overview. In particular, the selection of hormonal contraceptives for type I female diabetic patients with late complications and type II female diabetic patients is problematic as in this area very few studies are available. The other part of the overview is dedicated to hormonal substitution therapy. The author discusses its metabolic effects and possible administration to female diabetic patients. Menopause and diabetes mellitus are associated with a high risk of cardiovascular complications. Both pharmacologic and non-pharmacologic control of risk factors may reduce the risk of the disease. However, a definite recommendation of hormonal substitution therapy is not possible; both the benefits and risks for a particular female patient need to be considered.

Side effects of anastrozole in the experimental pre-menopausal mammary carcinogenesis.

UNLABELLED: The aim of this study was to assess side effects of aromatase inhibitor anastrozole in the prevention of N-methyl-N-nitrosourea - induced pre-menopausal mammary carcinogenesis in female Sprague-Dawley rats. This model mimicked situation in healthy, but from the point of view of the development of breast cancer, high-risk pre-menopausal women.

Aromatase inhibitor anastrozole was used as a chemopreventive agent taken by the animals in the food during the whole period of time of the experiment. Group 1 - the control group had taken food without anastrozole, the groups 2 and 3 with anastrozole in various concentrations - 0.05 mg/1 kg of food (ANA 0.05) and 0.5 mg/1 kg of food (ANA 0.5).

In anastrozole-treated animals in comparison with untreated animals, macroscopic changes of uterus and vagina were not found. The values of absolute and relative wet weight of uterus and vagina in the groups ANA 0.05 and ANA 0.5 were comparable with the control. Histological examination did not show atrophic changes in endometrium of uterus and in epithelium of vagina in anastrozole-treated animals. In the group ANA 0.5 myometrium was significantly grosser than in the group ANA 0.05 (P<0.05). Anastrozole neither affects parameters of plasma lipid metabolism (triacylglycerols, total cholesterol, low - density lipoprotein cholesterol and high - density lipoprotein cholesterol) nor serum levels of sex hormones (estradiol, testosterone, dehydroepiandrosterone). Compact bone thickness in the groups with anastrozole was significantly increased in comparison with untreated animals (P<0.001). A significant increase in body weight was found in the group ANA 0.5 compared with the control group (P<0.01). The significant increase in body weight gain was not attended by the significant increase in food intake.

The side effects of aromatase inhibitor anastrozole in the prevention of N-methyl-N-nitrosourea - induced pre-menopausal mammary carcinogenesis in female Sprague-Dawley rats on myometrium, compact bone thickness and body weight gain were observed.

Aromatase inhibitors in the breast cancer therapy and their potential using in the prevention setting.

Long term exposure to estradiol is associated with an increased risk of breast cancer. Aromatase inhibitors, suppressing tumour and plasma estrogen levels by blocking conversion of testosteron to estrogen, have been proven to provide the most effective endocrine therapy in metastatic and adjuvant setting in postmenopausal women. Questions remains about the long term side effects and safety profile of aromatase inhibitors. The effectiveness and safety of aromatase inhibitors therapy in premenopausal breast cancer patients is unknown, this needs to be further investigated. Although tamoxifen represents the gold standard for prevention therapy at present, results of ongoing studies may indicate a role of aromatase inhibitors in prevention of breast cancer (Tab. 2, Ref. 22).

Analysis of the cough sound frequency in adults and children with bronchial asthma.

It is well known that the frequency distribution of cough sound varies in different pathological conditions. Its identification could have diagnostic value. In this study the cough sound frequency in adults (n=20, 51.7 +/- 11 yrs), children (n=21, 11.8 +/- 0.4 yrs) asthmatics and healthy volunteers (n=25, 21 yrs) was explored. All patients were suffering from bronchial asthma. They were on a stable therapeutic regime and in a quiet status. Voluntary cough sound was recorded by a microphone and a tape recorder an ddigitally processed. Overlapping technique and Fast Fourier Transform were used to estimate the sound spectra. The records were smoothed by the method of Pascal triangle. They demonstrate the mean values of cough sound spectra. The registered pseudo three-dimensional plots of cough sound frequency (1 K spectra as function in time) of adults showed that the intensity of frequencies increased from 100 to 900 Hz in 3-4 waves. These frequencies afterwards decreased and between 1 to 2 kHz a smaller elevation was present. The spectra of children resembled to the spectrum of adults but had a smoother course. The spectra of asthmatics had some specificity and differed from the spectrum of healthy volunteers.

The effect of the pulsatile electromagnetic field in children suffering from bronchial asthma.

From the bibliography it is well known that pulsatile electromagnetic field has an anti-inflammatory and analgesic effect. It causes vasodilatation, myorelaxation, hyper-production of connective tissue and activation of the cell membrane. Therefore our aim was to study the possible therapeutic effect of pulsatile electromagnetic field in asthmatic children. Forty-two children participating in this study were divided in two groups. The 1st group consisting of 21 children (11 females, 10 males, aged 11.8 +/- 0.4 yr) was treated by pulsatile electromagnetic field and pharmacologically. The 2nd group served as control, consisting also of 21 children (11 females, 10 males, aged 11.7 +/- 0.3 yr) and was treated only pharmacologically. Therapeutic effect of the pulsatile electromagnetic field was assessed on the basis of pulmonary tests performed by means of a Spirometer 100 Handi (Germany). The indexes FVC, IVC, ERV, IRV, FEV1, FEV1/FVC%, MEF75,50,25, PEF, PIF and the changes of the flow-volume loop were also registered. The pulsatile electromagnetic field was applied by means of the device MTU 500H, Therapy System (Brno, Czech Republic) for 5 days, two times daily for 30 minutes (magnetic induction: 3 mT, frequency: 4 Hz as recommended by the manufacturer). The results in children of the 1st group showed an improvement of FVC of about 70 ml, IVC of about 110 ml, FEV1 of about 80 ml, MEF75 of about 30 ml, PEF of about 480 ml, PIF of about 550 ml. The increases of ERV, IRV and FEV1/FVC and decreases of MEF25,50 were statistically insignificant. The results in the 2nd group were less clear. The flow-volume loop showed a mild improvement in 14 children. This improvement in the 2nd group was less significant. The clinical status of children and their mood became better. We believe that the pulsatile electro-magnetotherapy in children suffering from asthma is effective. On the basis of our results we can recommend it as a complementary therapy.

The effect of the pulsatile electromagnetic field in patients suffering from chronic obstructive pulmonary disease and bronchial asthma.

Pulsatile electromagnetotherapy (PETh) stimulates biological tissues and processes; it modulates ion exchange across cell membranes and thus regulates the tone of smooth muscles. On the basis of these effects we hypothetized that PETh might treat COPD and bronchial asthma. We examined 117 (61 females, 56 males) adult patients who were decided in 4 groups. The 1st consisted of 16 patients with COPD who were treated by PETh and pharmacologically. The 2nd group (control) consisted of 24 patients with COPD who were treated only with medicaments. The 3rd group consisted of 37 asthmatics, treated by PETh and medicaments. The 4th group (control) consisted of 40 asthmatics treated only with medicaments. The effectiveness of PETh was assessed by lung function tests, which were performed using a Spirometer 100 Handi (Germany). We measured FVCex, FEV1, percentage of FEV1/FVCex, MEF25, 50, 75, PEF and registered the flow-volume loops. PETh was applied by apparatus MTU 500H (Therapy System, Czech Republic). It was administered 10 doses; once daily for 20 min, with a frequency of 4.5 Hz and a magnetic induction 3 T. The initial 3 doses were about 25% lower then the later doses. PETh was very effective in patients with COPD. The measured indexes improved about 200-660 ml or ml x s(-1), except FVC. PETh was less effective in asthmatics. Most indices improved without statistical significance, about 50-620 ml or ml x s(-1). The indices of FEV1/FVC and MEF25 deteriorated. The changes in controls without PETh were very small. (Tab. 2, Fig. 1, Ref. 19.)

The sensitivity of tussiphonography for assessing the effectiveness of treatment.

Our previous studies have demonstrated that tussiphonogram is suitable not only for the detection of pathological condition in the respiratory tract but also for treatment effectiveness assessment. The purpose of this study was to evaluate the possibilities of tussiphonography in detection of already little pathological changes in the airways and lungs. Therefore the changes of voluntary cough sound indexes were compared with pulmonary function tests in selected group of asthmatics before and after a pulsatile electromagnetic therapy in which the effect of therapy on pulmonary function tests was minimal. After magnetotherapy in 18 patients with increased expiratory forced lung capacity by 7.3% and increased peak inspiratory flow by 31.7% in average the voluntary cough sound intensity decreased by 37.8%, the sound duration shortened by 11% and the sound pattern showed the tendency to normalization. The improvement of mentioned cough indexes was absent in 17 patients who were treated by magnetotherapy too, but at the same time suffered from respiratory viral infection and in 22 patients treated only with climatotherapy and antiasthmatics. Changes of flow-volume loops in patients were not in the close relation to other followed indices. The correlation analysis showed a functional connection in relative differences of cough sound indices and some pulmonary function tests. The results confirmed the suitability of tussiphonography to indicate even mild pathological changes in respiratory tract. (Fig. 4, Ref. 21.)

[Personal experience in the use of magnetotherapy in diseases of the musculoskeletal system]. / Vlastné poznatky o pouzití magnetoterapie pri niektorých chorobách pohybového ústrojenstva.

Therapeutic application of pulsatile electromagnetic field in disorders of motility is recently becoming more frequent. Despite this fact information about the effectiveness of this therapy in the literature are rare. The aim of this study was therefore the treatment of 576 patients who suffered from vertebral syndrome, gonarthritis and coxarthritis. For application of pulsatile electromagnetic field MTU 500H Therapy System was used. Pulsatile electromagnetic field had a frequency valve of 4.5 mT in all studied groups and magnetic induction valve 12.5-18.75 mT in the 1st group. In the 2nd group the intensity was 5.8-7.3 mT and in the 3rd group it was 7.6-11.4 mT. The time of inclination/declination in the 1st group was 20/60 ms, in the 2nd group 40/80 ms and in the 3rd group 40/90 ms. The electromagnetic field was applied during 10 days. In the 1st-3rd day during 20 minutes and in the 4th-10th day during 30 minutes. The therapy was repeated in every patient after 3 months with values of intensity higher by 50%. In the time of pulsatile electro-magnetotherapy the patients were without pharmacotherapy or other physiotherapy. The application of pulsatile electromagnetic field is a very effective therapy of vertebral syndrome, gonarthritis and coxarthritis. The results have shown that the therapy was more effective in patients suffering from gonarthrosis, than in patients with vertebral syndrome and least effective in patients with coxarthosis. Owing to regression of oedema and pain relieve the motility of patients improved. (Tab. 3, Ref. 19.)

Analysis of the cough sound: an overview.

Coughing is presented by a sudden air expulsion from the airways which is characterized by a typical sound. This sound is so characteristic that it allows identification of the cough and its distinction from other vocal manifestations. The cough sound is a very important symptom of well over 100 diseases and other conditions of medical significance. Changes in its character may have a considerable value in identifying the mechanisms of airway pathology present in respiratory diseases. The cough sound gives information about the pathophysiological mechanisms of coughing by indicating the structural nature of the tissue during therapy that leads to certain patterns of cough. Similarly the character of the cough sound gives information about the behaviour of the glottis and whether the glottis behaves differently in different pathological conditions. Analysis of the cough sound record has significant value in prognosis because its changes may indicate the effectiveness of therapy or the progress of disease. Despite recent progress in cough sound research the attention paid to this interesting physiological and clinical problem is still not sufficient to solve completely various open questions, including our correct knowledge of the mechanism of creation of cough sounds.

The origin of cough sounds.

We have analyzed the origin of the first and second cough sounds recorded by tussiphonography. About 10,000 tussiphonograms were performed in about 1,000 healthy and diseased subjects. Changes in the first cough sound are due to pathological processes in the airways, for example, the presence of mucus or acute inflammatory disease. The first cough sound may then become divided. In bronchial asthma the first sound is also abnormal because of the narrowed airways. The origin of the second sound becomes clear by its absence in patients after laryngectomy or in those with paralysis of the vocal folds. The reappearance of the second cough sound may indicate rehabilitation of the vocal folds. With laryngotracheitis there is a pattern of multiple sounds. In patients with cough of psychogenic origin, the second sound is absent and cough sounds "bovine". Treatment of patients with bronchodilating drugs did not improve their pathological cough sounds in spite of improvement in airway obstruction.

Tussiphonogram in probands with chronic obstructive bronchitis.

Tussiphonographic examinations were conducted in 21 probands admitted to hospital with chronic bronchitis, diagnosed by spirometry. Voluntary cough registered in subjects with obstructive chronic bronchitis appeared in the recordings as a marked multifarious sound, an increased mono-sound or a connected double-sound. The average value of cough sound intensity was increased to 244%, and the duration of cough was delayed to 77% when compared to normal values. No correlation was found between the changes observed in spirometric values, and values indicated by the tussiphonogram.

The tussiphonogram during asthmatic attack.

By tussiphonography the voluntarily induced cough sound was registered in the course of asthmatic attacks and in the state of quinescence. Evaluation of the recordings revealed that in the course of the asthmatic attack, the intensity of voluntarily induced cough sound was significantly decreased.