[Immunotherapy and long-term chemoprophylaxis in prevention of recurrent urinary infections in women]. / Imunoterapia a dlhodobá chemoprofylaxia v prevencii recidivujaticich uroinfekcii u zien.

In clinical practice, management of urinary infections is a frequent task. Long-term prophylactic administration of small-dose chemotherapy had been shown to prevent recurrent urinary infections. Recently, an interest increases in applying immunotherapy in this indication. The authors compare immunomodulators Urovaxom and Luivac as part ofa combined immunotherapy and chemoprophylaxis regimens with small doses of fluorochinolones over 12 months in women with recurrent urinary infections. This treatment statistically significantly decreases occurrence of relapses and has been relatively well-tolerated. Unlike previous studies, we managed to isolate resistant strains producing the so-called extended-spectrum beta-lactamases (ESBL) and this may provide a signal for revision of some therapeutic approaches. In line with international recommendations, we prefer immunotherapy as comparably effective but safer treatment modality than the long-term chemoprophylaxis with fluorochinolones.

STK11/LKB1 germline mutations in the first Peutz-Jeghers syndrome patients identified in Slovakia.

Peutz-Jeghers syndrome (PJS) is characterized by number of hamartomatous polyps in the gastrointestinal tract and by mucocutaneous hypermelanocytic lesions at different sites. Older patients have an increased risk of the cancers of small intestine, stomach, pancreas, colon, esophagus, ovary, testis, uterus, breast and lung. In majority of PJS cases, the germline mutations in serine/threonine kinase STK11/LKB1 gene were found to be associated with disease. Here we report the results of a first mutational screen of STK11/LKB1 in PJS patients characterized in Slovak population. The first patient with unusual carcinoma of duodenum was a sporadic case and carried c.842delC change residing in a mutational C6 repeat hotspot. Neither the polyp nor the tumor of the patient displayed the loss of heterozygosity at the site of mutation suggesting different mechanism involved in the formation of polyp and tumor in this case. The second patient belonged to a three-generation family with typical PJS features but not cancers. Interestingly, the patient displayed concomitant occurrence of adenomatous and hamartomatous polyps. Molecular analysis revealed an IVS2+1A>G mutation that alters the second intron 5' splice site and was shown to lead to aberrant splicing mediated by the U12-dependent spliceosome. The same mutation was present in the 9 affected members of the family but in none of their normal relatives. We also observed novel c. IVS2+61G>A unclassified variant, and recurrent IVS2+24G>T and 3UTR+129C>T polymorphisms. Based on the achieved results, we could offer predictive genetic testing and counseling to other members of the patient's families.

Treatment of lower urinary tract infection in pregnancy.

Urinary tract infection (UTI) is a common complication of pregnancy. Approximately 20--40% of women with asymptomatic bacteriuria will develop pyelonephritis during pregnancy. All pregnant women, therefore, should have their urine cultured at their first visit to the clinic. In a clinical study comparing single-dose treatment with 3 g fosfomycin trometamol versus a 3-day course of 400 mg ceftibuten orally, the inclusion criteria were acute symptomatic lower UTI (acute cystitis), significant bacteriuria (> or =10(3) CFU/ml), pyuria and confirmed pregnancy. Excluded were patients with asymptomatic bacteriuria or acute pyelonephritis. Predisposing factors comprised a history of recurrent UTI, diabetes mellitus, analgesic nephropathy, hyperuricaemia or Fanconi's syndrome. Escherichia coli was the most frequently isolated pathogen in both groups. Therapeutic success (clinical cure and bacteriological eradication of uropathogens) was achieved in 95.2% of the patients treated with fosfomycin-trometamol versus 90.0% of those treated with ceftibuten (P, non-significant). The treatment of acute cystitis in pregnant women using a single-dose of fosfomycin trometamol was equally effective as the 3-day course of oral ceftibuten. Both regimens were well tolerated with only minor adverse effects. Long-term chemoprophylaxis should be suggested in patients with recurrent UTI or following acute pyelonephritis during pregnancy.

Newer quinolones in the long term prophylaxis of recurrent urinary tract infections (UTI).

Up to 10% of premenopausal women experience recurrent symptomatic urinary tract infection (UTI), mainly due to reinfection from the faecal flora. The recently introduced fluoroquinolones possess a wide spectrum of activity against most uropathogens and achieve high urinary concentrations for extended time periods. Our initial study, conducted between 1993 and 1995, was designed to compare the efficacy and safety of oral pefloxacin 800mg once weekly with oral ciprofloxacin 125mg once daily, over a 12-month prophylactic course in women with recurrent UTI. A 12-month reinfection-free period was achieved in 83.3% of pefloxacin patients and in 78.9% of ciprofloxacin patients. The present study, which commenced in 1996, was designed to compare pefloxacin 400mg with oral fleroxacin 400mg once weekly. Prophylaxis was maintained for 12 months. There are no statistically significant differences between the 2 regimens in terms of efficacy and safety. The most frequently isolated pathogens causing breakthrough reinfections were Escherichia coli and Enterococcus spp. Adverse effects observed were mostly neuropsychic (insomnia) and gastrointestinal. In both studies, there was no evidence of emergence of quinolone-resistant organisms in the urine or rectal flora, even after 12 months of chemoprophylaxis.

[Intracoronary pressure and its significance in the clinical evaluation of patients with ischemic heart disease]. / Intrakoronárne tlaky a ich význam pre klinické hodnotenie pacientov s ischemickou chorobou srdca.

Assessment of coronary artery disease is a highly relevant problem in current cardiology. Although, coronary angiography still remains the ultimate diagnostic test to prove the presence of coronary narrowings, it is increasingly becoming obvious that a refine understanding of the atherosclerosclerotic lesions and its consequences on perfusion of the underlying myocardium requires much more than just the silhouette of the arterial lumen provided by contrast angiography. This knowledge together with the current therapeutic invasive approaches has led to the introduction of new invasive methods to demonstrate the haemodynamic significance of a given lesion. In this brief review we describe the importance, feasibility and usefulness of transstenotic pressure gradient measurements. Furthermore, we provide the description of myocardial fractional flow reserve as a new functional index for the assessment of the coronary stenosis severity and its effects on maximal myocardial perfusion. This index, by interpreting the transstenotic pressure gradient in combination with mean aortic and central venous pressure offers a complex and easy assessment of coronary haemodynamics. On the basis of our recent experience we discuss the applications of the presented concept in daily clinical practice. (Tab. 3, Fig. 4, Ref. 25.).

[Single-dose therapy of infections of the lower urinary tract]. / Jednorazová liecba infekcií dolných mocových ciest.

The authors analyze two clinical studies in the frame of single-dose treatment of uncomplicated infection of the lower urinary tract. The first study deals with comparison of the effect of netilmicin, ciprofloxacine and aztreonam. The second study deals with pefloxacine and cefuroxim-axetil. As the results implied, both long-term and short-term effectiveness of therapy comparable with other verified regimes was accomplished in female patients who were not pregnant and irrespective of their age. It is necessary to respect the contraindications of therapy. Chemotherapeutics which are appropriate for single-dose therapy of uncomplicated infections of the lower urinary duct include quinolones (pefloxacine, ciprofloxacine), phosphomycin-trometamol, co-trimoxozole a netilmicin. The majority of oral beta-lactam antibiotics cannot be recommended for a single-dose therapy of uroinfections. The authors summarize the advantages of a single-dose therapy of uroinfections and analyze the criteria of significant bacteriuria.

[Endoscopic ultrasonography in the gastrointestinal tract]. / Endoskopická ultrasonografia v gastrointestinálnom trakte.

Endoscopic ultrasonography is a combination of endoscopy and ultrasonography. This method facilitates an accurate evaluation of singular layers of the gut-walls and adjacent structures. Great gain is represented by the possibility to analyze submucosal tumors, to diagnose vascular anomalies and especially the staging of both gastrointestinal malignancies and tumors in the pancreato-biliary area. The method is also suitable for the monitoring of treatment of these malignancies (chemotherapy, radiotherapy and laser therapy) as well as for an early diagnosis of tumor recurrences. The paper enumerates the possibilities, limits, some differential-diagnostic problems, complications, as well as perspectives of this modern method.

[New examining technics and approaches in ultrasonography]. / Novsie vysetrovacie techniky a postupy v ultrasonografii.

The new examination technique and methods are causing a fundamental development in ultrasonic diagnostics. The author describes the characteristic features of new technique and methods, e.g. endosonography, peroperative sonography, computer processing of ultrasonographic images of the liver, coloured picturing of abdominal vessels by the 2-D-Doppler method in real-time, 3-D ultrasonic diagnostic and application of contrast agents in ultrasonography. All said methods require adequate erudition of the examiners and high standard instrumental equipment. They indicate wide prospects of development in ultrasonographic diagnostics in the nineties.

[Single dose administration of netilmicin in the treatment of urinary tract infections]. / Jednorazové podanie netilmicínu v liecbe infekcií mocových ciest.

The authors submit the results of treatment of non-complicated urinary tract infections by a single dose of netilmicin. They treated 23 patients to whom they administered a single dose of 200 mg netilmicin by the i.m. route. A positive short-term effect was recorded in 82.8%. Cases of failure of this treatment indicate the necessity of careful indication of a single dose of netilmicin only to patients with non-complicated infections of the urinary pathways.