[Gallbladder volvulus]. / Volvulus zlucníku.

INTRODUCTION: Volvulus of the gallbladder is one of very rare diseases ranked among acute abdomen conditions. Only case reports are described in the literature. The disease presents with acute biliary ailments, often reminiscent of acute cholecystitis. It is more common in frail elderly women and its preoperative diagnosis is very difficult, and therefore this finding is encountered intraoperatively in most cases. CASE REPORT: In our case report we present the case of a female patient where the volvulus of the gallbladder was found as a surprising discovery during surgery. CONCLUSION: Gallbladder volvulus is a rare disease that presents as acute abdomen. It is most often diagnosed intraoperatively. Cholecystectomy is the most appropriate therapeutic method.Key words: gallbladder volvulus - acute abdomen - floating gallbladder.

[Postoperative administration of octreotide to reduce lymphorrhea, lymphocele, lymphedema and lymphatic ascites after lymphadenectomy in gynecological malignancies]. / Vliv pooperacního podání oktreotidu na redukci lymforey a následne vzniku lymfocyst, lymfedému a lymfatického ascitu po lymfadenektomii u gynekologických malignit.

INTRODUCTION: Octreotide is a synthetic analogue of natural somatostatin. Octreotide effect on lymphorrhea reduction in gynecological malignancies has only been assessed in case studies. DESIGN: Original work. SETTING: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno. METHODS: In 2014 there was a prospective, randomized, one-institution study. Patients underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy for cervical, uterine and ovarian cancer. The informed consent was signed. Octreotide was evaluated in relation to diagnosis, surgery (laparoscopy versus laparotomy), pelvic and/or paraaortic lymphadenectomy, number of removed lymph nodes and their positivity, neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy, albumin, BMI, number of days with drains postoperatively, number of days in hospital, blood loss during surgery, time of surgery, total number of drains placed into abdominal cavity. In follow up period, within 1 year after surgery, we searched for lymphocele, lymph-edema of lower extremities and lymphatic ascites in relation to lymphorrhea. RESULTS: 44 patients (9 cervical, 19 endometrial and 16 ovarian cancer) were enrolled in two statistically comparable randomized groups. "Octreotide group", which paradoxically showed lymphorrhea of 4082 ml on average, (without 1992 ml, p = 0.001), needed drainage for more days (p = 0.001). The diagnosis had no influence on lymphorrhea in both groups (p = 0.966). The neoadjuvant chemotherapy was administered (p = 0.026), the more lymph nodes were removed (p = 0.018), the more days the drainage was in place (p < 0.001), the bigger the lymphorrhea; no relationship between lymphorrhea and age (p = 0.631), albumin level (p = 0.584), BMI ( p= 0.966) or number of positive nodes (p = 0.259), length of surgery (p = 0.206), blood loss (p = 0.494). Nor lymphedema (p = 0.404), nor lymphocele (p = 0.086), correlated with postoperative lymphorrhea. Lymphatic ascites was associated with lymphorrhea (p = 0.048). CONCLUSION: Octreotide did not reduce lymphorrhea and the incidence of lymphocele, lymphedema of lower extremities and lymphatic ascites within one year of follow-up period after surgery. According to our results, we do not recommend to administer the octreotide in oncogynecological patients after pelvic and/or paraaortic lymphadenectomy.

[A point prevalence survey of healthcare-associated infections in the Slovak Republic - a part of the EU project]. / Bodové prevalencné sledovanie nozokomiálnych nákaz na Slovensku - súcast projektu Európskej únie.

AIM: The aim of this survey was to estimate the prevalence of healthcare-associated infections (HAI) in the Slovak Republic (SR), distribution of causative pathogens, and risk factors. METHODS: The point prevalence survey (PPS) of HAI in the SR was carried out in 40 acute care hospitals, according to a standardized methodology developed by the European Centre for Disease Prevention and Control (ECDC). Data were collected according to the standard protocol at the country, hospital, and patient levels. RESULTS: Of 8 397 patients included in the survey in the SR, 298 (3.5%) had HAI. The highest prevalence of HAI (12.4%) was found in the intensive care units (ICU) and Anaesthesiology and Intensive Care Medicine Units (AICMU). Nevertheless, intensive care medicine patients only represented 6.5% of all patients. The following six most common types of HAI accounted for 87.3% of all HAI: urinary tract infection (26.2%), pneumonia and other lower respiratory tract infections (22.0%), surgical site infection (15.7%), bloodstream infection (9.9%), infection of the eye, ear, and upper respiratory tract (8.3%), and skin and soft tissue infection (5.2%). The most often isolated pathogens were Escherichia coli (15.0%), Klebsiella spp. (12.5%), and Pseudomonas aeruginosa (10.8%). Of 8 397 surveyed patients, 60.5% had a medical device inserted: central vascular catheter (CVC)(3.4%), peripheral vascular catheter (PVC)(40.8%), urinary catheter (14.1%), or endotracheal tube (2.1%). The prevalence of HAI was higher in patients with than without a medical device inserted. CONCLUSION: By participating in the PPS, the SR has collected the most recent data on HAI and antimicrobial use in acute care hospitals. The adherence to the standard methods, standard definitions of HAI, and PPS protocol allows to repeat the survey, to analyse the HAI prevalence trend, and to take effective interventions.

[Exotic pets as a potential source of Salmonella]. / Exotickí domáci milácikovia ako potenciálny zdroj salmonel.

STUDY AIM: To clarify the source of infection with the exotic serovar Salmonella Urbana and the route of transmission in a 2-year-old child. MATERIAL AND METHODS: To identify the source of infection and the route of transmission, we used epidemiological investigation of the case of salmonellosis and microbiological methods for the detection of Salmonella from biological specimens, epidemiologically suspected food, turtle tank water and feed, and serotyping of isolated strains of Salmonella. RESULTS: Salmonella Urbana was confirmed in a rectal swab of the infected child and in a sample of turtle tank water. Laboratory analyses of farm eggs eaten by the investigated family, of rectal swabs of the other family members and of a turtle feed sample did not reveal the presence of salmonellae. CONCLUSION: The confirmed source of Salmonella infection caused by the exotic serovar Salmonella Urbana in a two-year-old child were pet water turtles. In the case of the isolation of exotic serovars of Salmonella, the epidemiological and laboratory investigation needs to be aimed at the contact with pet animals, especially reptiles. It is desirable to raise the awareness of both the public and health professionals of this issue.

Four years of monitoring antibiotic resistance in microorganisms from bacteremic patients.

From the second semester of 2002 to the end of the first semester of 2005, a total of 2544 bacterial strains were isolated from the blood stream of patients with clinical sepsis and bacteremia hospitalized in six University Hospitals in the Slovak Republic. Almost 30% of strains were coagulase-negative staphylococci (CONS), about 14% were Staphylococcus aureus and, of the Gram-negative bacteria, up to 9% were Klebsiella pneumoniae. All CONS, S. aureus and Enterococcus spp. strains were found to be still susceptible to vancomycin, but the resistance of CONS and/or S. aureus to macrolides and fluoroquinolones dramatically increased during the period of this study. Among Gram-negative bacteria, increasing levels of resistance to higher generation cephalosporins, to fluoroquinolones resistance in Pseudomonas aeruginosa and Acinetobacter spp. to meropenem was recorded, which is alarming. The results were periodically submitted to cooperating hospitals with proposals for rationalizing the prophylactic and general use of indicated antibiotics as well as for improving hospital hygiene measures and anti-epidemic practices.

Health status of the Slovakia population at its entry to the European Union.

The health status of the Slovak Republic (SR) population on the eve of its entry to the European Union (EU) was generally worse than the EU average. Life expectancy at birth was in SR for males 70 years, in EU 75.5 years and for females 78 in SR and 82 in EU. Premature mortality for the age interval 0-64 years (standardized death rates--SDR per 100,000) was mostly higher in SR; male mortality being almost twice as high as in EU. The reason was a significantly higher mortality caused by cardiovascular diseases, malignant neoplasms and mortality from external causes. Also mortality caused by diseases of respiratory and digestive system, by cirrhosis and diabetes is higher in SR both in male and female populations. However, there were some positive aspects in SR. Mortality caused by infectious and parasitic diseases was lower in SR for both males and females. The prevalence of HIV/AIDS in EU was five times higher than in SR. SR has one of the lowest concentrations of newly registered AIDS cases in all Europe. Immunization coverage in SR is higher than in many EU countries. The health status of children population in SR is not significantly worse than in EU. However, the global health status image seems worse due to values of the Gypsy minority. Trends of premature mortality are favourable in SR. Mortality from cardiovascular diseases, external causes of injury and poison and from diseases of respiratory system is falling. Infant mortality is falling while the average life expectancy of both men and women is rising. However, with health care improving constantly in EU countries in all these areas, it will not be easy for SR to catch up with EU. We estimate that this process might possibly take up to 20 years. (Tab. 5, Fig. 11, Ref. 26.)

Significance of a prolonged postoperative bowel paralysis in complete dehiscence of laparotomy wound.

We performed 910 laparotomies in the years 1998-1999. Complete dehiscence of a laparotomy wound was observed in 18 cases. We compare the duration of postoperative bowel paralysis in patients with and without eventration. The statistical comparison of the two groups was performed with the Wilcoxon test, the level of significance was set to 5%. We have found that the duration of postoperative bowel paralysis was significantly longer in the group of patients with eventration. (Tab. 4, Ref. 5.).