A rare clinical presentation of human Dirofilaria repens infection as a pseudo-tumour of the epididymis - Case Report.

Introduction. Epididymal dirofilariasis is one of the unusual manifestations of this zoonosis. In Slovakia, this is the third case out of 20 Dirofilaria repens infected patients in whom the worm (the parasite) was identified in the epididymis. The patient felt a painless tumour about 2 cm in size on the left testicle. During ultrasound examination, the radiologist observed a cyst containing a live worm within the epididymis. After mechanical stimulation, the movement characteristic for filarial worms (´filarial dance sign´) appeared. An orchiectomy was performed at the Department of Urology in the University Hospital in Kosice. Histopathology confirmed a parasitic cyst with a worm, and based on characteristic morphological features, the parasite was identified as Dirofilaria repens. Objective. The aim of case report is to alert physicians to the possibility dirofilarial infection of the epididymis, where tumors and cystic structures often occur and to present clinical signs of the disease.

Sophisticated self-circumcision: Case report.

In this case report, we describe a unique case of a highly motivated patient who tried to solve his problem with a redundant foreskin by a sophisticated, thoughtful method. Dissatisfaction with the foreskin made it difficult for him to establish intimate contact. After studying the operation on the Internet, he performed self-circumcision.

Foamy cell (hibernoma-like) change is a rare histopathological feature in renal cell carcinoma.

We report nine patients (seven males and two females, median age 64 years (range 51-79 years)) with a renal cell carcinoma, each of which contained a significant component of neoplastic epithelial cells with a striking microvacuolated (hibernoma-like) cytoplasmic appearance. Tumor sizes ranged from 1.5 to 8.0 cm (mean 4.2 cm, median 4.3 cm). The basic architecture of the tumors was solid-alveolar in two cases (classified as renal cell carcinoma-not otherwise specified (NOS)) and papillary in seven cases (classified as papillary renal cell carcinoma NOS). The nuclear grade according to the Fuhrman grading system was three in all cases. By immunohistochemistry, the cells with microvacuolated cytopasm and significantly expressed adipophilin and anti-mitochondrial antigen in a similar cytoplasmic pattern. On ultrastructural examination, the cytoplasm of the neoplastic epithelial cells was packed with distended mitochondria, most of which displayed lamellated cristae. Numerous microvesicles were dispersed between the mitochondria. No mutations in the succinate dehydrogenase B gene were identified. Based on our findings, we propose that the mechanism behind this phenomenon is an abnormal intracellular processing of lipids. No aggressive behavior was observed in six out of nine patients with available follow-up information.

Acute bacterial prostatitis in humans: current microbiological spectrum, sensitivity to antibiotics and clinical findings.

OBJECTIVE: To assess the current microbiological profile and sensitivity to antibiotics in patients with acute bacterial prostatitis (ABP). PATIENTS AND METHODS: In the period 2003-2010, we treated 192 ABP patients, aged from 18 to 85 years (average 56.3 years). We performed a biochemical examination including a microbiological urine examination. After admission, we immediately began the empirical antibacterial treatment. RESULTS: The clinical picture was dominated by pain, prostate enlargement and failure of micturition in 185 (96.4%) patients; 14 (7.3%) patients had acute urinary retention where epicystostomy was necessary. Fever occurred in 177 (92.2%) patients and Escherichia coli was the most frequent etiological agent detected in 103 (53.7%) patients followed by Pseudomonas aeruginosa and Klebsiella species. In 16 (8.3%) patients we found 2 bacteriological strains. Sterile urine was found in 65 (33.8%) patients. Fluoroquinolones, aminoglycosides and cephalosporins were used most frequently. 147 (76.6%) patients were treated according to the microbiological results. Overview of resistance shows an increase in resistance to fluoroquinolones. In 14 (7.3%) patients there was progression to urosepsis. CONCLUSION: Clinicians should consider local drug-resistance patterns when choosing antibiotics and should adjust the therapy on the basis of bacterial cultures and local sensitivity to antibiotics.

The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients.

OBJECTIVES: Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation. METHODS: One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium. RESULTS: Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ≤0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ≤0.001, P ≤0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed. CONCLUSIONS: The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response.

Unusual presentation of the urogenital myiasis caused by Luciliasericata (Diptera: Calliphoridae).

INTRODUCTION AND OBJECTIVE: The case report describes the unusual presentation of the urogenital myiasis caused by Luciliasericata in two Slovakian men. MATERIAL AND METHODS: The first patient, aged 66, who suffered from a locally advanced and inoperable urinary bladder dedifferentiated TCC with bilateral ureteral obstruction, chronic renal insufficiency and non-functioning left kidney. After surgical exploration the patient developed a malignant vesico-intestino-cutaneous fistula with stool leakage through the open wound. Because of very poor hygiene, and unsatisfactory attendance by staff, a fly deposited ova in the patient's necrotic wound. The patient died three months later of metastatic cancer disease. The second patient, a 43-year old homeless alcoholic male had gangrene of the scrotum and penis, urethro-cutaneous urinary fistula with numerous live and motile larvae on the surfaces. In both patients, some larvae were removed and sent to the lab for identification. The larvae were identified as maggots of the fly Luciliasericata. Antibiotic therapy, disinfection and debridement with sterile covering of the wound were used. RESULTS: For both patients, complex treatment of myiasis was successful and patient recovered without parasitic consequences. CONCLUSIONS: To our knowledge, this is the first report of the unusual presentation of the urogenital myiasis in Slovakian men with poor social habits and hygiene.

Effect of NAT2 gene polymorphism on bladder cancer risk in Slovak population.

N-acetyltransferase 2 (NAT2) is phase II enzyme with major roles in catalyzing the detoxification of aromatic amines, which are known risk factors for bladder cancer, and are ubiquitously present in the environment. We assessed the association between common polymorphisms in NAT2 gene and the risk of bladder cancer in 90 Slovak patients and 274 ethnicity-matched healthy controls. Effect modifications by smoking, age and gender were also evaluated. Overall, NAT2 slow acetylation was associated with significantly increased risk of bladder cancer (OR = 1.90; 95% CI, 1.15-3.16). In stratified analyses by age and gender, the elevated risk conferred by slow acetylator genotype was evident in older individuals (OR = 3.55; 95% CI, 1.77-7.35) and males (OR = 4.65; 95% CI, 1.68-16.10), with further increasing in NAT2*5B/*6A genotype carriers. Smoking was confirmed to be important risk factor, moreover, the risk was markedly increased in smokers with NAT2 slow acetylator genotype, and NAT2*5B/*6A carriers especially. In summary, these findings are consistent with previous literature suggesting that individual susceptibility to bladder cancer may be modulated by NAT2 polymorphisms, particularly in interaction with relevant environmental exposures such as smoking.

Juxtaglomerular cell tumor, causing fetal demise.

AIMS: This case report describes juxtaglomerular cell tumor-a rare renin-producing tumor of the kidney, complicating pregnancy. CLINICAL CASE: A previously healthy 24-year-old primigravid woman developed hypertension in the 20th week of pregnancy, leading to a miscarriage in the 28th week. However, hypertension continued after the miscarriage. A more complete examination revealed a solid tumor in the lower pole of the right kidney. The patient underwent a partial right nephrectomy. A histological examination and electron microscopy confirmed the diagnosis of JGCT. The patient's blood pressure was normalized within 2 weeks. CONCLUSIONS: JGCT can lead to miscarriage if undiscovered during pregnancy. A kidney ultrasound should be performed on pregnant women with newly detected hypertension. No staining in early phase of contrast CT is the feature that differentiates JGCT from renal cell carcinoma. These tumors are benign, with only one reported exception, and nephron-sparing surgery is preferable.