Accumulation of cadmium in potential hyperaccumulators Chlorophytum comosum and Callisia fragrans and role of organic acids under stress conditions.

Cadmium (Cd) accumulation, antioxidant activity (AOA), chlorophyll fluorescence (F) and organic acid distribution in Chlorophytum comosum and Callisia fragrans plants exposed to artificially added Cd (40, 160 and 320 mg kg-1) were examined in pot experiment. At the highest Cd concentration, C. comosum accumulated in roots and the aboveground parts up to 1331 and 1054 mg Cd kg-1 DW, and C. fragrans up to 1427 and 1263 mg Cd kg-1 DW, respectively, which are quite near at the level of hyperaccumulator. Cd accumulation in both plant species increased significantly with the increment of soil Cd dosage, and the distribution was roots > shoots > stolons. Values of BC showed rising trend indicating an accumulation potential of both species. The root AOA was positively correlated to Cd addition, especially in C. comosum. Higher values of free SA were found in roots with a significant enhancement at concentrations of 40 and 160 mg kg-1 Cd. It was observed that citric acid significantly reacted in both species, while fumaric acid only in C. comosum in response to Cd which may contribute to Cd chelation. Our data indicate that both species are suitable for phytoextraction of Cd from contaminated soils which increases their value as ornamentals.

Limited family members/staff communication in intensive care units in the Czech and Slovak Republics considerably increases anxiety in patients' relatives--the DEPRESS study.

BACKGROUND: Symptoms of anxiety and depression are common among family members of ICU patients and are culturally dependent. The aim of the study was to assess the prevalence of symptoms of anxiety and depression and associated factors in family members of ICU patients in two Central European countries. METHODS: We conducted a prospective multicenter study involving 22 ICUs (250 beds) in the Czech and Slovak Republics. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression in family members of ICU patients. Family member understanding of the patient's condition was assessed using a structured interview and a questionnaire was used to assess satisfaction with family member/ICU staff communication. RESULTS: Twenty two intensive care units (both adult and pediatric) in academic medical centers and community hospitals participated in the study. During a 6 month period, 405 family members of 293 patients were enrolled. We found a high prevalence of anxiety and depression symptoms - 78% and 54%, respectively. Information leaflets distributed to family members did not lower incidences of anxiety/depression. Family members with symptoms of depression reported higher levels of satisfaction according to the modified Critical Care Family Needs Inventory. Extended contact between staff and family members was the only related factor associated with anxiety reduction (p = 0.001). CONCLUSION: Family members of ICU patients in East European countries suffer from symptoms of anxiety and depression. We identified limited family member/ICU staff communication as an important health care professional-related factor associated with a higher incidence of symptoms of anxiety. This factor is potentially amenable to improvement and may serve as a target for proactive intervention proactive intervention.

Controlled hemostasis in thoracic surgery using drugs with oxidized cellulose.

The authors demonstrate the possibility of improving surgical results by the reduction of perioperative bleeding in thoracic surgery associated with extended resection procedures. We focused on patients in whom the expected perioperative blood loss was greater than 500 ml. The first group consisted of patients with lung cancer stage III A after neoadjuvant chemotherapy had been indicated to extend the resection procedure. The second group consisted of patients with chest wall and mediastinum tumors of various etiologies. The third group consisted of patients with post-inflammatory thoracic complications in whom combined decortication and pleurectomy was necessary. By the using the local hemostyptic Traumastem TAF on the basis of oxidized cellulose, it is possible to minimize the perioperative blood loss, thus sparing the blood derivative requirement and enabling surgeons to provide the desired treatment even to high-risk patients.

Ethics Committee or Community? Examining the identity of Czech Ethics Committees in the period of transition.

Reflecting on a three year long exploratory research of ethics committees in the Czech Republic authors discuss the current role and identity of research ethics committees. The research of Czech ethics committees focused on both self-presentation and self-understanding of ECs members, and how other stakeholders (representatives of the pharmaceutical industry) view them. The exploratory research was based on formal and informal communication with the members of the ethics committees. Members of the research team took part at six regular voluntary meetings of the ethics committees' members, organised by the Forum of Czech Ethics Committees, and at three summer schools of medical ethics. There were realised twenty-five semi-structured interviews as well as six focus group sessions and a participant observation of several regular meetings of three ethics committees. On the grounds of experience from the interviews a simple questionnaire survey was realised among the members of the ethics committees. The ethics committees comprise a community of members working voluntarily, without claims to remuneration or prestige; the unifying goal is protection of subjects of research. The principal working methods are dialogue and agreement. The members of the ethics committees thus, among other things, create an informal community, which can be to a certain extent seen as a Kantian ethical community in a weak sense. The phenomenon of ethics committees can also be described by terms of an epistemic community and a community of practice. These concepts, which are borrowed from other authors and areas, are used as a way how to think of ECs role and identity a bit differently and are meant as a contribution to the current international debate on the topic.

Saliva as a diagnostic medium.

BACKGROUND: This is a review of current knowledge on the use of saliva, gingival cervical fluid and mucosal transudate in the detection of some oral and systemic diseases as well as drugs. Oral fluid is a diagnostic medium that can be easily collected and with minimal invasion but it has been neglected in the past. Today, saliva is being used more often to diagnose: HIV virus, oro-facial and systemic tumors, cardiovascular disease and in detecting addictive substances. Neutropil levels in saliva may also indicate successful bone marrow transplant. Oral fluid is now systematically being researched and oral fluid analysis is being compared with the analysis of other diagnostic media such as blood and urine. A number of recent studies have focused on oncogenic marker detection and its monitoring in saliva. The latest clinical and laboratory findings on diagnostic markers of oropharyngeal carcinoma in oral fluid could be the beginning of their wider use as a diagnostic medium. Oral fluid can also be also used to diagnose other malignancies such as breast cancer which was one of the first malignant tumors to be detected using genetic protein biomarkers. Raised levels of CA15-3 and the epidermal growth factor (EGF) receptor have been found in patients with breast cancer and elevated levels of CA 125 and the glycoprotein complex in the saliva of ovarian cancer patients. CONCLUSION: Doubtless, the diagnostic value of saliva, aided by current technological development will increase rapidly in the near future.

Theory and practice of informed consent in the Czech Republic.

The large-scale change of Czech society since 1989 has involved the democratic transformation of the health system. To empower the patient was one important goal of the healthcare reform launched immediately after the Velvet Revolution. The process has been enhanced by the accession of the Czech Republic to the European Union and the adoption of important European conventions regulating the area. The concept of informed consent and a culture of negotiation are being inserted into a traditionally paternalistic culture. Our article describes the current situation on the issue of the communication of information on state of health and treatment, and on the question of the participation of the patient in decisions on treatment. We present empirical results of a public opinion survey on this issue. The results show a still prevailing submissive attitude towards the physicians, despite the fact that the concept of informed consent has become more and more publicly familiar (42% of respondents gave the completely correct answer regarding informed consent). The impact of age, education and sex on answers to the questionnaire was analysed. Men, younger and more educated respondents were more likely to show the autonomous attitude, whereas women, older and less educated people tended to show the traditional submissive attitude. Further, our article raises the question of the cultural and historical background within which the current ethically and legally binding norms (products of western democracies, in fact) are interpreted. The question is how far cultural modifications are tolerable in the practical implementation of universal ethical constructs (informed consent).

Intra-arterial chemotherapy and its significance in the treatment of oropharyngeal carcinoma.

BACKGROUND: In complex therapeutic algorithms for cancer, regional intra-arterial chemotherapy is usually used as an adjuvant and placed in the beginning of treatment. Clinical experience however shows that the achieved remission of malignant tumour illness after non-adjuvant chemotherapy is only temporary and short-lived. The illness progresses relatively quickly if the patient receives no further treatment and most clinical studies have not found any significant increase in life expectancy in oncological patients treated with this method. The question remains to what extent the poor results are due to the treatment method and its position in the therapeutic algorithm, and to what extent they are due to imperfect knowledge of molecular tumour genetics or inappropriate choice of the neoadjuvant intra-arterial chemotherapy METHODS: We compared preliminary results of immunohistochemical examinations (detection and analysis of expression of proteins Ku 70, STAT 1,3,5 which take part in the regulation of cell cycle apoptosis and repair of damaged DNA, carried out before and after chemotherapy, suggest that depending on the effects of neoadjuvant intra-arterial chemotherapy and patient's survivance. RESULTS AND CONCLUSION: An overview of intra-arterial neoadjuvant chemotherapy of head and neck is presented. Knowledge of cell cycle processes, especially apoptosis and repair of damaged DNA, could significantly influence the choice of the therapeutic algorithm and therapeutical effect.

Possibilities of combined surgical treatment of lung tumours and heart diseases.

The purpose of the study was a retrospective evaluation of the outcome of surgical therapy of lung cancer in patients where there was concomitant cardiac disease and who underwent a cardiac operation either because of ischemic heart disease or because of valvular disease. These patients were operated on at various time intervals (two to ten months) after their cardiac operation. Some patients had their lung cancer surgery after the cardiac operation because of the high risk of possible cardiac postoperative complications; in one patient the lung operation preceded the cardiac one.

[Surgical treatment of pneumothorax]. / Chirurgická lécba pneumotoraxu.

Complex therapy of pneumothorax is a multidisciplinary task. The point is: the etiology of pneumothorax is different but the resulting risk for the patient is always the same. Therefore, there is necessity of cooperation of several medical branches in causal therapy. The authors present experience with pneumothorax therapy in Cardiosurgical Department in 5-year interval in 101 patients, where they carried out surgical as well as conservative therapy approaches.

[Diagnosis and surgical treatment of bronchial carcinoid]. / Diagnostika a chirurgická lécba bronchiálního karcinoidu.

The purpose of this study was to look at the clinical behaviour of bronchial carcinoids and clarify a surgical approach. Over 30 years 61 patients with a final histological diagnosis of carcinoid tumours were assessed for surgery. All patients were retrospectively reviewed for clinicopathological variables, surgical management and outcome. Tumours were considered typical and atypical based on histological features. The mean age at presentation was 46 years (range 11-69). Overall survival in the group of typical carcinoids was 96%, and 67% in the group of atypical carcinoids.

[Extended lung resection]. / Rozsírené plicní resekce.

The history of surgical therapy for lung cancer has been dated since the beginning of the last century. There is a long experience of this type of surgical procedure in our cardiosurgical department. In our study there are included extended lung resections. The evaluation of these procedures is based on TNM classification. Extended resections are reserved for those in stage III. The diagnostic capabilities are improving and therefore there are more patients with more favourable stage and on the other hand there are smaller number of extensive operations. We carry out extended lung resections where we expect benefit for these patients. This is also backed up and influenced by improved postoperative care. In our paper there are patients operated in 1997-2002, which were in stage III. 30 days postoperative letality in this small group was 6%. It is certainly higher then in simple resections (0,5%). On the other hand we have to offer surgical treatement when it is feasible, despite of higher risk. Therefore we cannot expect the same results as in the group of patients operated in stage I and II.

[The two-stage surgical stabilization of the chest wall trauma with respiratory insufficiency -- a case report]. / Dvoudobá chirurgická stabilizace hrudní steny pro dechovou nedostatecnost -- kasuistika.

In this report there is described the case of 48-years-old women with nonpenetration chest trauma with respiratory insufficiency. The surgical strategy consisted of two-stage repair of surgical stabilization of the chest wall.

[Bronchopleural fistula after pneumonectomy]. / Bronchopleurální pístel po pneumonektomii.

We retrospectively reviewed the incidence of bronchopleural fistula after pneumonectomy. The records of 844 consecutive patients who underwent pneumonectomy within a period between the January 1962 and December 2000 either for the lung cancer or for benign diseases have been assessed. There were 12 cases of bronchopleural fistula representing an incidence of 1.42 %. All operations were performed using an uniform hand suture technique. Eight fistulas developed in patients who underwent pneumonectomy for lung cancer while four occurred in patients with benign diseases. Bronchial dehiscence was confirmed by bronchography or bronchoscopy in each patient. Resuturing of the stump and single completed muscle flap closure was performed in five patients. In three patients with very small fistulas we used the drainage of the pleural cavity and antibiotics only. Three other patients were treated by thoracoplasty. In one patient bronchoscopy closure by tissue adhesive and bone graft was done. The treatment was successful in nine patients from our set while the other three developed fatal complications.

[Unusual complication of osteosynthesis]. / Neobvyklá komplikace osteosyntézy.

Intrathoracic and intravascular migratory foreign bodies are a small but distinctive subgroup of injuries. The intravascular embolus can be treated like arterial or venous emboli of any other sort and removed as indicated. Wandering foreign bodies in the body cavities should be removed when they need to be, just like bodies imbedded in the body in a fixed position. Authors report an unusual case of migratory foreign body as a complication of osteosynthesis.