[Primary omental torsion in preschool girls case report]. / Primární torze omenta u dívek predskolního veku kazuistika.

INTRODUCTION: Primary omental torsion is a rare finding in cases of suspected acute abdomen. It is more common in children. Secondary omental torsion is typical for adults. CASE REPORT: The authors describe two cases where pain in the right upper abdominal quadrant was caused by primary torsion of the omental corner due to increased intraabdominal pressure: after a strong cough in one girl and after a workout in the other. Primary omental torsion usually mimics acute appendicitis with clinical findings in the right lower abdominal quadrant, especially in obese children. However, our two cases describe normosthenic girls with pain in the right upper abdominal quadrant up to the mesogastrium. CONCLUSION: Primary torsion of the omentum is a very rare cause of acute abdomen, which is also confirmed by its incidence in our group of patients where only two cases were seen during a 15-year period, which corresponds to 0.17% of all appendectomies performed in our department. This value is comparable to data reported in the literature. KEY WORDS: acute abdomen omental torsion tenderness in right upper abdomen.

[Intestinal volvulus caused by the ingestion of magnet balls: unexpected risk in children]. / Strevní volvulus zpusobený pozitím magnetických kulicek: neocekávané riziko u detí.

INTRODUCTION: The occurrence of swallowed foreign bodies in the digestive system is a common problem in children with the highest incidence in children aged six months to five years. Most swallowed objects leave the human body per vias naturales while 10-20% of swallowed foreign bodies need to be removed with an endoscope. Serious and life-threatening situations are caused by the ingestion of foreign bodies in about 1% of all cases. CASE REPORT: The authors present a case of a two-year-old girl diagnosed with acute abdomen for which she was operated on. A small bowel volvulus and several intestinal fistulas were found intraoperatively. The cause of this finding was the ingestion of magnetic balls and a swallowed metal body drawn to them by magnetic force. CONCLUSION: If more than one magnetic body is ingested, it is necessary to admit the patient to hospital and to remove these foreign bodies using an endoscope. The position of the magnets which is not changing in a location inaccessible for an endoscope during 2448 hours is an indication for urgent operation.

Alkaline and alkaline/oxidation pre-treatments of spruce wood (Picea abies)--impact on the quality of kraft pulp.

A comparable series of specimens from spruce wood were pre-treated with sodium hydroxide, sodium hydroxide and hydrogen peroxide, or per-acetic acid sequences. The pre-treatments reduced the yield of pulps and their Kappa number noticeably, diminished the degree of polymerization moderately, and increased their brightness. One-step peroxide bleaching of pulps from the pre-treated spruce wood resulted in their higher brightness compared to bleached pulp from sound wood. From the viewpoint of improved properties of pulp, the most efficient were the sodium hydroxide/per-acetic acid and per-acetic acid/sodium hydroxide sequences. The pre-treatments did not influence mechanical strength of the obtained pulps significantly.

[Seat-belt syndrome in a pre-school child]. / Seat-belt syndrom u predskolního dítete.

The authors report on a pre-school child with a typical presentation of the trauma caused by a car safety belt and termed the seat-belt syndrome. The deceleration mechanism which throws the upper body forward in the presence of a rigid belt over the abdominal region results in large contusions of the abdominal wall and trauma to the spine, retroperitoneum, and intra-abdominal organs, or even the chest. In making the diagnosis a thorough examination of the spine is necessary as well as a repeated surgical examination of the abdomen, because seat-belt syndrome is often associated with small intestine rupture, a symptom which can remain unrecognised at the early stage. In the case of a four-year-old boy described here, two loops of the small intestine were resected for perforation; stabilization of the vertebral column was indicated on the 5th post-injury day because of decompensated diabetes and deteriorated health state following intra-abdominal surgery. In this boy, poor compensation of juvenile diabetes resulted in infectious complications requiring repeated drainage of an abscess of the abdominal wall injured by the seat belt.The abdominal wall healed within 2 months, diabetes was managed with insulin therapy and good spondylodesis was achieved at 9 months after the injury.

[Tracheobronchial injuries--experience with diagnosis and therapy]. / Tracheobronchiální poranení--zkusenosti s diagnostikou a lécbou.

The incidence of penetrating injuries of the respiratory pathways is permanently low and relatively stable, on the other hand, it may be assumed that there is an increasing rate of tracheobronchial injuries during blunt accidents of the chest in particular in conjunction with the increased rate of traffic injuries. Serious injuries are involved, in particular because of their high morbidity and mortality; frequently they are part of associated injuries and polytraumas. In 1999-2002 at the Surgical Clinic of the Plzen-Lochotín Faculty Hospital a penetrating stab wound of the cervical trachea was treated in an 11-year-old boy and injuries of the large bronchi of adult men resulting from blunt chest injuries during car accidents. All three injuries were associated with a typical symptomatology of pneumocolon and pneumomediastinum, or persistent pneumothorax and respiratory complaints resp. The definite diagnosis was established in two instances shortly after admission, based on results of CT and bronchoscopic examination, in the case of the injury of the middle bronchus only on the following day during surgical revision combined with preoperative bronchoscopy. Treatment was surgical in all instances. Twice the lesion was sutured, in one case pulmonary resection was performed. No significant postoperative complications were observed nor any deaths. The main factors which influence in a decisive way the prognosis of the casualty and the therapeutic result are in the authors' opinion, consistent with data in the literature, early assessment of the diagnosis of tracheobronchial injury and early adequate therapeutic action. In the diagnosis a dominant position is held in addition to CT in particular by treacheobronchoscopy. In case of surgical treatment reconstruction operations are preferred.

[Antibacterial chemotherapy--are we really at the end of the antibiotic era?]. / Antibakteriální chemoterapie--jsme skutecne na konci antibiotické éry?

Antimicrobial chemotherapy undergoes a global crisis. The nineties brought the unprecedented spread of resistance of main pathogenic bacteria to antibiotics, with an extent and intensity varying from negligible to threatening, depending largely on the local or regional or nationwide approach to prescribing antibiotics. In some reqions the microbial multiresistance led to various bacterial infections becoming untreatable, however, substantial increase of costs of antibacterial chemotherapy--somewhere even prohibitive--has been felt everywhere, depending on the necessity of using reserve drugs instead of basic ones. In he mid of nineties, the advent of a post-antibiotic era seemed almost inevitable. Concentrated efforts aimed at rationalizing the antibiotic usage, at decreasing the useless prescribing, at creating antibiotic policies as well as the development of new at the antibacterials have diminished the danger, at least for some time. Brief descriptions of new drugs (linezolide, quinupristine/dalfoprostine, new chinolones and naphythyridones and telithromycine) are given and some other, in the near future possibly useful antibacterials (daptomycine, glycycyclines, oral carbapenems and trinems) are mentioned as well as some new ways of antibacterial research. In a long-term view, however, rationalization of antibiotic prescribing is the only and irreplaceable mean of maintaining the efficacy of antibacterial chemotherapy at acceptable costs.

[Clinical experience with Timentin]. / Klinické zkusenosti s lécbou Timentinem.

BACKGROUND: A combination of ticarcillin with clavulanate has been used for more than 12 years in many countries in the treatment of infections caused by Gram-negative microorganisms and a mixed microbe flora, in particular where the presence of beta-lactamase producers can be anticipated. In the Czech Republic it is not very well known, probably more for commercial than medical reasons, and the objective of the present paper to draw attention to this old but still useful antibiotic. METHODS AND RESULTS: In a simple open trial the therapeutic results in a group of 15 patients treated by the above preparation in 1992-1995 at the unit for septic infections of the Clinic for Infectious Diseases in Prague were summarized and compared with the results of a previous trial conducted in the same department in 1987-91 and with results published in the literature. The mean success of treatment was about 90%. CONCLUSIONS: A combination of ticarcillin, a semisynthetic broad spectrum penicillin with clavulanic acid is an antibiotic which is still very valuable in the treatment of sepsis and other severe forms of bacterial infection, incl. patients with a significantly reduced immunity. The tolerance is very good and an important factor is also the relatively favourable price. The author's results are consistent with experience published by departments abroad.

[Contemporary views on the problem of sepsis]. / Soucasné pohledy na problematiku sepse.

Sepsis is due to its lethality, which varies round 25%, one of the major problems of contemporary clinical medicine. Classical therapeutic approaches, i.e. chemotherapy, surgical elimination of foci and intensive therapy focused on maintenance of vital functions have obviously reached the limit of effectiveness beyond which they are unable to advance any further. Therefore great efforts are devoted to research into pathogenetic mechanisms involved in sepsis with the aim to use their effect to improve therapeutic results. In the submitted paper the authors analyze the definition of sepsis, explain the concept of the syndrome of systemic inflammatory response and summarize the contemporary state of knowledge of the pathogenesis. A review of structures and mechanisms involved in the genesis and development of sepsis (complement, factor XII, macrophage, endothelial cell, polymorphonuclear leucocyte, thrombocyte etc.) is supplemented by a list of substances which act as mediators of inflammations. The conclusions for practice summarize contemporary therapeutic possibilities, i.e. classical means as well as more recent approaches (colony stimulating factors, haemodiafiltration, antithrombin III, monoclonal antibody against endotoxin). The authors review briefly therapeutic means which are developed at present and which should make it possible to interfere actively with the pathogenesis of the disease.

[Spiramycin]. / Spiramycin.

Spiramycin is a 16-membered ring macrolide (antibiotic). It was discovered in 1952 as a product of Streptomyces ambofaciens. As a preparation for oral administration it has been used since 1955, in 1987 also the parenteral form was introduced into practice. The antibacterial action involves inhibition of protein synthesis in the bacterial cell during translocation. Resistance to spiramycin can develop by several mechanisms and its prevalence is to a considerable extent proportional to the frequency of prescription in a given area. The antibacterial spectrum comprises Gram-positive cocci and rods, Gram-negative cocci and also Legionellae, mycoplasmas, chlamydiae, some types of spirochetes, Toxoplasma gondii and Cryptosporidium sp., Enterobacteria, pseudomonads and pathogenic moulds are resistant. Its action is mainly bacteriostatic, on highly sensitive strains it exerts a bactericide action. As compared with erythromycin, it is in vitro weight for weight 5 to 20 less effective, an equipotential therapeutic dose is, however, only double. This difference between the effectiveness in vitro and in vivo is explained above all by the great affinity of spiramycin to tissues where it achieves concentrations many times higher than serum levels. An important part is played also by the slow release of the antibiotic from the tissue compartment, the marked action on microbes in sub-inhibition concentrations and the relatively long persisting post-antibiotic effect. Its great advantage is the exceptionally favourable tolerance-gastrointestinal and general. It is available for parenteral and oral administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and pharmacologic review of antiviral agents]. / Klinický a farmakologický prehled virostatik.

The author presents a review if pharmacokinetics, undesirable effects, drug interactions, dosage, indications and drug forms of antiviral chemotherapeutic agents used for systemic treatment: amantadine and rimantadine (influenza virus A), acyclovir (HSV-1, HSV-2 and VZV), ganciclovir (CMV), zidovudine (HIV), ribavirine (broad spectrum) and fosfocarnet (herpes viruses and HIV), mentioning also vidarabine. All mentioned preparations are at least in some countries commercially available. The author does not mention virostatic agents used only locally and preparations which are at present in the stage of clinical tests.

[Lincosamide antibiotics]. / Linkosamidová antibiotika.

A survey of microbiological and pharmacological properties of, of clinical experience with and of untoward reactions of lincomycin and clindamycin has been presented. Both antibiotics are active against gram-positive aerobic and many anaerobic bacteria. As to anti-anaerobic activity, clindamycin is superior to lincomycin. Consequently, anaerobic infections are main indication for clindamycin in clinical practice. On the other hand, lincomycin shows excellent penetration into body fluids and tissues and its dosage can be adapted to actual clinical situation in a very wide range. Recently, combinations of clindamycin with other drugs have proved effective in the treatment of falciparum malaria as well as of acute toxoplasmosis and Pneumocystis pneumonia in AIDS patients. Both lincomycin and clindamycin play still an important role in chemotherapy of infections.

[Submicroscopic structure of amniotic fluid cells]. / Submikroskopická struktura bunek plodové vody.

Submicroscopic examination of amniotic fluid cells in the second trimester of pregnancy revealed that the cells are from the morphological aspect a very heterogeneous population, comprising vital and degenerated cells the ultrastructure of which rules out the possibility of cultivation of cells of foetal as well as of maternal origin. As to degenerated cells, the authors identified circular cells with a granular cytoplasm and nucleus originating from the urogenital or digestive tract of the foetus. Furthermore cells with a process and segmented or fragmented pycnotic nucleus derived from granulocytes and macrophages of maternal origin. Also circular cells of the periderm with short microvilli and advanced regressive changes of the nucleus and cytoplasm are degenerated. Among non-vital elements also anuclear completely keratinized cells of the stratum corneum originating from the skin of the maternal abdomen can be included. As to vital elements, the amniotic fluid contains cells of the amniotic ectoderm which are large, have numerous microvilli, a dense margin and a network of filaments in the cytoplasm. They are the most numerous cells. Other vital elements in amniotic fluid include granulocytes and macrophages with a typical ratio of lyzosomes. Both are considered elements of maternal origin. Maternal origin is assumed also in fibroblasts which along with collagen particles may penetrate into the aspirating needle. From the results ensues that the cells in amniotic fluid are not a homogeneous population of unequivocally foetal origin and that a better technique of collection of samples and cultivation must be developed.

Haemophilus aphrophilus isolated from blood.

H. aphrophilus was isolated from 11 successively cultivated blood samples of a male (72) with a fatal atypical endocarditis. Identification and differential diagnosis from Actinobacillus (Haemophilus) actinomycetemcomitans was done on the basis of phenotypic characters of the microorganism.

[Isolation of Haemophilus aphrophilus from a blood culture]. / Izolace kmene Haemophilus aphrophilus z hemokultury.

The authors describe the method of isolation and identification and differential diagnosis from a morphologically, cultivation and biochemically close species H. (A.) actinomycemcomitans. They discuss the problem of the taxonomic classification of the two species.

Dynamic pressure method for kla measurement in large-scale bioreactors.

A dynamic method is proposed for k(l)a measurement in aerated and agitated reactors, in which a change in the total pressure in the reactor by approximately 20% leads to a simultaneous change in the oxygen concentration in all the bubbles in the dispersion. This procedure suppresses the influence of nonideal mixing of the gas phase on the k(l)a value. Other dynamic methods so far used do not possess this advantage. They are based on a step change in oxygen concentration in the entering gas, where the interfacial nitrogen transport and the finite rate of the concentration change propagation into the individual bubbles in the dispersion can cause an error in the reported k(l)a values of more than hundreds of percent. The reliability of the pressure method is tested by comparison both with the standard dynamic method, in which pure oxygen is absorbed in a liquid from which all other gas components were previously removed, and with the steady-state sulphite method. The signal of the oxygen probe used in the experiments must be independent of the pressure. A test for this in dependence is described. The pressure method is also suitable for large-scale reactors since the necessary pressure changes are sufficiently small and, morever, air can be used.

Transient characteristics of oxygen probes with significant liquid film effects.

Various experimental procedures for the determination of transient characteristics with significant liquid film effects were tested. A comparison between transient characteristics obtained experimentally and those calculated from rational models indicates that all procedures but one give highly inconsistent results. Recalculation of transient characteristics with no liquid film (easily measured in the gas phase) to that with liquid film (occurring in viscous liquids) is recommended as well as the selected experimental procedure which yields consistent results in the situations where the steady-state probe reading is decreased up to one-half due to the liquid film.