[Malignant mucosal melanoma of the head and neck]. / Maligní melanom sliznic hlavy a krku.

Mucosal melanoma comparison to cutaneous melanoma of the head and neck are rare and do poorly. Approximately 0.5-2% of all melanomas occur from the mucous membranes of aerodigestive tract. Most common site of the tumor are the nasal cavity and paranasal sinuses but melanoma of the oral cavity are described too. Therapy usually consists of surgical resection with or without postoperative radiotherapy and immunochemotherapy eventually. The definite role of a kind of therapy in the treatment of mucosal melanoma is not remains to be defined as the small number of cases make prospective study challenging. This article reviews 19 patients with mucosal melanoma of the head and neck treated at the Department of ENT and Head and Neck Surgery Charles University of Prague since 1980 to 1999. Clinical data were obtained from the patient's charts. Analysis of the metastatic disease, type of therapy and follow-up was retrospectively reviewed. The site of the tumor was the lateral wall of the nasal cavity (five cases), nasal septum (four cases), maxilar cavity (two cases), and ethmoidal cavity, orbitoethmoidal complex, nasopharynx, saccus lacrimalis to ethmoidal sinuses diffused, tonsilla (one case each) and hypopharynx (two cases). Primary treatment was surgical resection in ten cases, in one case with radiation therapy, and in seven cases chemotherapy. In three cases were diagnostic surgery only and one patient was without therapy. Three patients received radical neck dissection more. Four patients were treated radiation therapy and three chemotherapy after surgery. In two cases were surgery after primary radiotherapy. For nine cases of recurrence of the disease were surgery (in five cases) and chemotherapy (in four cases). Overal and disease free interval was from 2 to 22 month, approximately 9.3 month and 3-year survival was 41.18%.

Green fluorescent protein as a detection marker for Coxiella burnetii transformation.

The molecular biological study of the obligate intracellular bacterium Coxiella burnetii is hampered because of the lack of an efficient DNA transformation system. We used expression of the green fluorescent protein (GFP) in addition to ampicillin resistance as a selection marker for detection of transformed C. burnetii cells. Fluorescent microscopy studies revealed that transformed C. burnetii cells can be detected easily inside the host cell line. A high level of GFP expression was reached with the strong Escherichia coli trc (trp/lac) promoter. The use of GFP not only provides a convenient marker for transformation of C. burnetii, but also allows detection of this obligate intracellular pathogen inside host eukaryotic cells. Possible applications for GFP in the study of host-pathogen interactions are discussed.

Q fever in pregnancy: case report after a 2-year follow-up.

We report an acute Q fever case, a febrile syndrome, in the 14th week of pregnancy. Placental infection was documented by Coxiella burnetii culture. Newborn infection was ruled out on the basis of the absence of serological evidence after 2 years and on clinical normality. Serological diagnosis is reviewed here, as maternal serology was suggestive of chronic Q fever. The clinical progress, following extended observation, was consistent with acute infection. A QpDV plasmid, already described as being common to acute and chronic European cases, was detected.

Immunogenicity and protective ability of corpuscular and soluble vaccines prepared from different Coxiella burnetii phase I strains.

BALB/c mice immunized intraperitoneally (ip) with killed purified Coxiella burnetii phase I corpuscular vaccines or trichloroacetic acid (TCA) extracts from phase I corpuscles (soluble vaccines) were protected against ip challenge with both homologous and heterologous C. burnetii phase I strains. Though the degree of protection, namely the inhibition of C. burnetii multiplication in the mouse spleen slightly varied, in general, corpuscular vaccines provided better protection than soluble ones. Cross-protection was accompanied by comparable levels of cell-mediated immune response as evaluated by lymphocyte transformation test (LTT). However, higher stimulation indices of LTT were obtained with homologous than with heterologous strains. The values of antibody response as determined by enzyme-linked immunosorbent assay (ELISA) were higher with homologous strains too. On average, both antibody-inducing and antibody-binding capabilities of the strains Priscilla and S were lower than those of the Nine Mile and Luga strains, except for values obtained with the antigens from homologous strains.

A new plasmid (QpDV) common to Coxiella burnetii isolates associated with acute and chronic Q fever.

Genetic studies of Coxiella burnetii strains suggested the possibility of differentiating new isolates according to their plasmid DNA content. Virulence and/or clinical manifestations ('chronic' and 'acute' Q fever) had been claimed to correlate with this plasmid typing. A new plasmid, named QpDV, was found to be common to C. burnetii isolates obtained from acute and chronic Q fever. According to the results obtained, plasmid usage for detection and differentiation of respective pathovars of C. burnetii and the correlation between gene specificity and pathovar has to be revised. Closer studies suggested a common origin of C. burnetii plasmids, but also showed some differences characteristic for each plasmid, probably reflecting divergent evolution.

Comparison of virulence for guinea pigs and mice of different Coxiella burnetii phase I strains.

Virulence of four Coxiella burnettii phase I strains associated with acute (Nine Mile and Luga strains) and chronic (S and Priscilla strains) forms of Q fever, respectively, for outbred guinea pigs and inbred BALB/c mice was compared. In guinea pigs exposed to infectious aerosol, virulence of the strains Nine Mile, Luga and S was similar, because they all caused lethal infection and high febrile reaction (FR). By contrast, exposure to similar doses of the strain Priscilla resulted in the non-lethal infection manifested only by low, dispersed and protracted FR during a 20 day-period of observation. Lower virulence of the strain Priscilla than of the strains Nine Mile and S was observed also in guinea pigs infected intraperitoneally (ip). In mice, comparable degree of multiplication in the spleen on day 6 post ip infection was observed with the strains Nine Mile, Luga and S, but not with the strain Priscilla, namely when lower infectious doses were used. Whereas the highest doses (10(7) EID50) of the strains Nine Mile and S were lethal for mice during the second week post infection (p.i.), the strains Luga and Priscilla did not kill mice with 10-times lower (10(6) EID50) doses. At the same time agglutination antibody response detected 4 weeks p.i. was very similar in guinea pigs with all strains under study and in mice it did not differ markedly, reflecting the infectious dose used.

Concentration of plasma middle molecular weight substances and clinical condition of patients undergoing short-time regular dialysis treatment.

Forty patients were dialysed 12 hours weekly for three years by 1 sq.m. Cuprophane coil dialyser. Clinical features, conventional laboratory data, concentration of middle molecular weight substances, and metabolic state were studied. No difference was found in the clinical picture during the short time dialysis schedule. Neither did the plasma concentration of middle molecular weight substances change substantially during this period. The metabolic state after three years of short time dialyses was good. The elimination of middle molecular weight substances by 1 sq.m. Cuprophane coil was sufficiently effective to prevent an excessive increase of their plasma level.

[Short-term dialyses using a conventional hemodialyzer]. / Kurzzeitdialysen mit dem konventionellen Hämodialysator.

1. Twelve patients who were treated twice eight hours a week for at least one year were admitted to a dialysis plan of twice seven hours a week and fourteen patients who were dialysed twice eight hours a week for at least one year were dialysed thrice four hours a week. The patients were dialysed with a spool dialysator with cuprophan membrane of a surface of 1 m2. Blood flow was 200--250 ml/min., dialysate flow 500 ml/min. After 3, 6, 10, and 12 months the clinical picture, hydratation, protein katabolism, degree of anaemia and renal osteodystrophy as well as number of complications, degree of rehabilitation, concentration of the medium-molecular substances and of phenylalanine and the glucose tolerance were compared and the opinion of the patients concerning different types of the plan of dialysis was inquired. 2. The plan of dialysis of thrice four hours a week with a conventional dialysator is sufficient for a good state of the most patients. In none of the parameters investigated by us we could establish noticeable differences between the dialysis plan twice eight hours and twice seven hours and thrice four hours a week. The patients themselves clearly preferred a plan of dialysis of thrice four hours a week. 3. The concentration of medium-molecular substances in the blood is no sufficiently sensitive indicator for the determination of the quality of a permanent dialysis treatment in a good clinical state of the patient.