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Constipation is a syndrome on which approximately 20% of the population complains. There are three main causes of constipation: slow transit, anismus and obstructive defecation syndrome. Outlet obstruction (= ODS syndrome or anismus) can be successfully treated by physiotherapy or surgery. In patients with severe slow transit constipation, there is often need for long term treatment with laxatives. There are several types of laxatives: volume, osmotic, stimulative and others. Laxatives can be also used for bowel cleansing before colonoscopy or surgery. There are several myths about laxatives and many doctors as well as patients believe in. For example, it is believed that laxatives are harmful, people can develop a dependence and that they can worsen constipation once already present. No such myth has ever been confirmed and evidence based medicine rather shows that even long-term laxative treatment is safe and effective. Of course, high quality data definitely confirming the long term safety are lacking but there are no valid data showing that treatment with laxatives is risky. Doctors should not discourage patients with laxative to take them if they help and are indicated. A new product on the Czech market represent bisacodyl suppository. [ABSTRACT FROM AUTHOR]

Background: A safe technique is essential for successful access site closure in Natural Orifice Translumenal Endoscopic Surgery (NOTES) and for closures of iatrogenic perforations. Aim: To compare an over-the-scope clip (OTSC) versus an endoloop + endoclips closure technique (KING closure). Methods: 40 minipigs underwent NOTES peritoneoscopy with liver biopsy. Gastrotomies and rectotomies were closed with OTSC ( n = 20; 10× stomach, 10× rectum) or KING closure ( n = 20; 10× stomach, 10× rectum). The animals were euthanized 28 days after the procedure. The main outcome variables were technical feasibility, effectiveness, and healing. Results: Stomach: All but one closure (KING) was successfully completed. The times of closure were similar between the techniques. At necropsy, all access sites were healed. In two animals (1× KING, 1× OTSC), an abscess, probably related to the closure technique, was found. Histologically, transmural healing with muscular bridging was observable in nine pigs for KING versus two pigs for OTSC closure ( p = 0.003). Inflammation was present in three pigs for KING versus seven pigs for OTSC closure ( p = 0.08). Rectum: All closures were successfully completed. The times of closure were similar between the techniques. At necropsy, all closure sites had healed. Transmural healing with muscular bridging was present in nine pigs for KING versus two pigs for OTSC closure ( p = 0.003). Inflammation was present in two pigs for KING versus seven pigs for OTSC closure ( p = 0.03). In one animal (OTSC), an enterocolic fistula developed in the proximity of the closure site. Conclusions: OTSC and KING closure are comparable closure techniques in terms of technical feasibility and effectiveness. KING closure provides a superior histological outcome compared with OTSC closure. [ABSTRACT FROM AUTHOR]

Corticosteroids were once considered highly ulcerogenic drugs. Despite the fact that many studies have not confirmed this fact, a large percentage of doctors still consider them as ulcerogenic. Even the renowned textbooks from various disciplines do not consider corticosteroids ulcerogenic except when administered with Non-Steroidal Anti-Rheumatic Agents (Non-steroidal anti-inflammatory drugs -- NSAIDs). We ourselves have conducted a study in which we investigated the views of Czech doctors from various specialties and medical students on the ulcerogenicity of steroids. Not surprisingly, we have confirmed the expected -- more than 80 % of the responding doctors and students consider corticosteroids to be highly ulcerogenic. The only exception is in the field of Gastroenterology where 30 % of respondents did not consider the steroids ulcerogenic. When comparing ulcerogenic potential of -- ibuprofen, -- diclofenac, and -- prednisone, total of 40 % of respondents consider prednisone the most ulcerogenic. It is obvious that despite the fact that no data prove the ulcerogenity of steroids and most modern textbooks and articles do not consider these drugs ulcerogenic, there is still a myth of the ulcerogenity of steroids in the minds of Czech doctors and students. This has undoubtedly not only important economic consequences when prescribing concomitant antisecretory prophylaxis. [ABSTRACT FROM AUTHOR]

The relationship between gastro-oesophageal reflux disease (GERD) and Helicobacter pylori is unclear. Recent data indicate that H. pylori probably exerts a protective effect against GERD. In recent years, the interaction between H. pylori, proton pump inhibitors and GERD has been widely studied. Currently available proton pump inhibitors produce significantly higher intragastric pH in H. pylori-positive patients than in those who are H. pylori negative, and this phenomenon may be clinically relevant. The mechanisms responsible for this difference in efficacy are not fully understood, although there are two major theories. Ammonia, produced by H. pylori, is able to neutralize gastric acid, and thus apparently increase the effect of acid suppressive agents (the ‘ammonia theory’). The other theory is that decrease in acid output is due to the development of corpus gastritis during treatment with a proton pump inhibitor (the ‘gastritis theory’). Treatment strategies to overcome this lowered sensitivity to acid suppression are to increase the frequency/dose of a proton pump inhibitor or to add an H2-receptor antagonist in the evening—but both have pharmaco-economic implications. An agent that could provide adequate pH control regardless of H. pylori status would be highly beneficial in the treatment of GERD, and may also lower treatment costs. [ABSTRACT FROM AUTHOR]

Background: Penetration of antibiotics into the pancreas is considered to be an important criterion in determining the most appropriate antibiotic treatment during severe acute pancreatitis. Our study investigated pancreatic penetration of five antibiotics in rats with and without acute necrotizing pancreatitis (ANP) (non-pancreatitis rats (NR), pancreatitis rats (AP)). Methods: ANP was induced by intraductal bile acid injection, and 3 h later the antibiotic was administered. In both NR and AP the antibiotic concentrations were evaluated in blood and pancreatic tissue 90 min after antibiotic administration. Results: The tissue/serum (T/S) ratios for NR were 16% with amikacin, 24% with amoxycillin/clavulanic acid, 27% with piperacillin, 59% with ofloxacin, and 108% with cefoperazone. The ratios for AP were 7%, 23%, 26%, 52%, and 70%, respectively. T/S ratios were similar for NR and AP except for amikacin, for which the T/S ratio was lower in AP than in NR (P = 0.02). Pancreatic tissue concentrations of antibiotics with high penetration rates (cefoperazone and ofloxacin) were sufficient to inhibit most of the pathogens expected during acute pancreatitis. The concentrations of the other antibiotics were less than the minimal inhibitory concentrations (MIC) for common potential pathogens in pancreatic infection. Conclusions: Cefoperazone and ofloxacin showed the best pancreatic penetration of the five antibiotics tested. The high concentrations of these antibiotics in the pancreatic tissue would have enabled efficient antibacterial activity against most of the potential pathogens causing pancreatic infection. An early stage of acute necrotizing pancreatitis did not have a major effect on the pancreatic concentrations of the antibiotics. [ABSTRACT FROM AUTHOR]

We present the results of a pilot study concerning the interlaboratory variability of CD34+ enumeration. Three surveys, each including a set of samples, were sent to participating Czech flow cytometry laboratories. The efficacy of this exercise was determined by the reduction in interlaboratory variation and the influence of method used on assay outcome. The variability in results of CD34+ enumeration declined with time. The mean coefficient of variation (CV) of measurement among laboratories dropped, from 58% in first survey to 32% in last survey. All tested variables (gating strategy, platform methodology, sample preparation) affected the variability of the assay. Sample preparation method was associated with a significant bias of absolute CD34+ cell counts. Initially, the outcome of the measurement was also affected by the participating laboratory (identified by a unique laboratory number; ULN). However, laboratories with poorer performance modified their protocols during the study, and the ULN ceased to influence the variability. This study was successful in reducing the interinstitutional variability of CD34+ enumeration. It was shown that the implementation of a standardized protocol does not guarantee accurate measurement. Our research design represents a useful tool, which allows verification of the proper use of a standardized method, the training of operators and feedback in response to the survey results. [ABSTRACT FROM AUTHOR]

Objective: Descendent necrotizing mediastinitis (DNM) results from infection in the orofacial region. A serious septic state requires an early surgical intervention. Methods: The retrospective evaluation of a cohort of patients who underwent surgery for DNM at our workplace in 2017. Results: The surgery of 122 paratonsillar abscesses and 9 parapharyngeal abscesses was performed at the ORL Clinic of Faculty Hospital in Plzen in 2017. The surgery for DNM concerned four patients, two women and two men of the average age of 53 years. The introductory anaerobic cultivation was always Fusobacterium and the aerobic one revealed Streptococcus anginosus in three cases. All patients initially underwent tonsillectomy and external cervical drainage. All patients subsequently needed transthoracic revision and lavage unilaterally (twice), bilaterally (twice) and repeatedly (three times). The mean duration of hospitalization was 36 days, and there was no 30-day mortality. C-reactive protein (CRP) values were in the range of 295-392 mg/l, mean 336,5 mg/l. Leukocytosis was in the range of 16.2-40.7, mean 24.8x109/l. Conclusion: Tonsillectomy and sufficient external cervical drainage prevents the development of mediastinitis, which in the advanced stage mostly requires transthoracic approach, regular redressement and long-term intensive care. [ABSTRACT FROM AUTHOR]

Mitochondrial morphology was studied in cultivated myoblasts obtained from patients with mitochondrial disorders, including CPEO, MELAS and TMEM70 deficiency. Mitochondrial networks and ultrastructure were visualized by fluorescence microscopy and transmission electron microscopy, respectively. A heterogeneous picture of abnormally sized and shaped mitochondria with fragmentation, shortening, and aberrant cristae, lower density of mitochondria and an increased number of “megamitochondria” were found in patient myoblasts. Morphometric Fiji analyses revealed different mitochondrial network properties in myoblasts from patients and controls. The small number of cultivated myoblasts required for semiautomatic morphometric image analysis makes this tool useful for estimating mitochondrial disturbances in patients with mitochondrial disorders. [ABSTRACT FROM PUBLISHER]