Search

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.

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.

The authors submit a model of the detection rate, monitoring and treatment of inborn defects of the locomotor system used in the Martin district. During the investigation period from 1972 - 1994 they examined and processed data from 41 281 neonates, i. e. 99,2 % of the total number of liveborn infants in the Martin district, focused specially on the hip joint and inborn defects of the foot. As to clinical symptoms of dysplasia coxae congenita they ascribe the greatest diagnostic value to Ortolani's phenomenon and abduction restricted to less than 60 degrees, which was recorded in 82 % and 52 % of the examined infants resp. As revealed by the incidence of dysplasia and dislocation in different periods, the introduction of preventive and therapeutic measures in the early neonatal stage had an unequivocal positive effect on the incidence of dysplasia and dislocation. The incidence of inborn defects of the foot was on a constant level during the investigation period. The authors did not record a significant coincidence of inborn defects of the foot and dysplasia of the hip joint in the investigated group, which is consistent with data in the literature. In the conclusion the authors emphasize the importance of prevention in the early neonatal age which leads to a reduction of the number of severe secondary coxarthroses. Key words: dysplasia coxae congenita, luxatio coxae congenita, inborn defects of the foot, prevention.

In the introduction of the paper the authors abalyze the problem of stable and long-term fixation of endoprostheses of the hip joint. They present statistics on the ratio of surgical revisions of endoprostheses of the hip joint in 1993-1996 which has a rising trend. In the subsequent part of the paper they deal with the problem of early diagnosis of loosening in the stage when only subjective data reported by the patient are available and the X-ray finding does not yet show signs of osteolysis and loosening of the TEP. Therefore they started to use in 1993 as a diagnostic aid three-phase all-skeletal scintigraphy. So far they used it in 18 patients with 100% reliability, as confirmed on operation. The authors describe in detail the method of three-phase scintigraphy with special emphasis on phase III. The results of scintigraphy are demonstrated on two patients. Key words: revision of endoprosthesis of the hip joint, radiopharmaceutical preparations, 99mTc-MDP, all-skeletal three-phase scintigraphy.

In the submitted paper the authors present a brief theoretical account and characteristics of sarcoidosis focused on its manifestations in the locomotor apparatus, found in 10 - 14 % of the patients. The course of this very rare form of sarcoidosis of the locomotor apparatus is demonstrated on a 50-year-old female patient with severe sarcoid arthropathy of the wrist. They draw special attention to diagnostic problems in extrapulmonary forms of sarcoidosis. Key words: sarcoidosis, arthropathy of the wrist, extrapulmonary sarcoidosis.

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 (≥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.

The knowledge on the functional structure of the spleen is gained from the analysis of diseases, and immunological studies. Significant information is gained from model tests and isolated cells. The latter is advantageous in coincidence with the studies of intercellular relations. The main function of the spleen resides in "purification" of the blood. The vascular system, white pulp, red pulp and the marginal zone participate in this process. T-dependent zones of the white pulp are restricted by the circumference reticulum (CR) of periarterial lymphatic sheaths. CR is a morphologic substrate of retro-directional flow of lymphocytes. In addition to T lymphocytes and a certain amount of B lymphocytes, the T-dependent zones contain interdigitizing cells. The B-dependent zones, in addition to lymphocytes, contain dendrite reticular cells. The cords are constituted by varied cellular and extracellular compartments, especially macrophages, fibroblastic reticular cells and various fibrous components. The latest filtration barrier is formed by the wall of sinuses of the red pulp. The achievement of new functional knowledge resides prospectively in the use of lectins, anti-collagen antibodies, fibronectins, proteoglycanes and other various molecules participating in intercellular relations, or morphometric studies, they can provide information on the newest subpopulations of cells in both red and white pulp, that are so far inaccurately defined.

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.).

Hereditary spherocytosis is the most common inherent, autosomal dominant hemolytic anemia. Mild splenomegaly, venostasis and common decrease of while pulp is characteristic for hereditary spherocytosis. Cords are filled with spherocytes, sinuses can be empty or squeezed. Both sinuses and veins include ghost erythrocytes that lost haemoglobin. They are seen light-microscopically in differential interferent contrast. Macrophages are numerous, sinus lining cells are hypertrophic. Erythrophagocytosis is hardly seen by electron microscope. Not all red blood cells are spherocytes. Spherocytes are seen well in electronmicroscopy. We did not observed transition of erythrocytes through sinus walls. In certain circumstances lots of ferritin is seen both intra and extracytoplasmically. Iron accumulation in cords can result in their fibrosis.

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.

Congenital atransferrinemia was first diagnosed at the age of 11 months in a now 27-year-old woman. Until she was aged 14 years treatment with human transferrin was irregular and, as it turned out, inadequate. But since then she has regularly received human transferrin (1 g monthly) and deferoxamine (500 mg twice weekly). Despite this she developed haemosiderosis affecting heart, liver, hypophysis, thyroid and the locomotor apparatus. This case report demonstrates the need of early diagnosis and treatment of congenital atransferrinemia to prevent the mentioned complications.

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.

The relationship between changes in blood coagulation, the occurrence and severity of risk factors of ischemic heart disease and the clinical condition of the patient was investigated. The at risk group of patients 42.2% had more than 3 pathological parameters. Intravascular blood coagulation was not activated in any of the patients. In patients with acute myocardial infarction (MI), 62.2% had more than 3 pathological parameters on the first day of MI development. Demonstrable activation of intravascular blood coagulation was found in 28.2% of these patients. On day 5 of MI, activation of intravascular blood coagulation was recorded in 57.7% of the patients treated by classical approach and in 15.4-30.8% of the patients on thrombolytic treatment. In the at risk group, primary hemostasis and the fibrinolytic system were more affected, in patients with MI the whole hemostatic mechanism was involved. On day 5 of MI, in patients with classical therapy pathological laboratory findings still persisted or were even more deteriorated, particularly increases in fibrinogen level. At that time, in patients on thrombolytic therapy no substantial changes of initial values were recorded. No correlation was found to exist between changes in hemostasis and the risk profile or between changes in hemostasis and the clinical severity of MI. The obtained results justify the administration of antithrombotic substances, especially in patients with unstable angina pectoris. On observing time constraints, administration of thrombolytics is justified in MI. (Fig. 9, Ref. 25.)

Authors deal with the classification of chondrodysplasia punctata, in detail they analyze the clinical and radiomorphological symptoms. From the diagnostic viewpoint it is important to evaluate typical X-ray epiphyseal changes in the first year of age of the affected child. Clinical symptoms vary and they are not typical only for this disease. They are often combined with various congenital developmental anomalies. The case study presents the correlation between X-ray epiphyseal changes in the knee and the arthroscopic findings.

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.

Derangements of hemostasis and hemocoagulation in patients with malignancies are known as paraneoplastic syndrome. Their origin, however, has not been unequivocally established and explained, and data on their occurrence are controversial. Examination of 157 patients with different malignant tumor diseases yielded pathological laboratory findings in 94.2%. The most frequent finding was the state of hypercoagulation in 41.0%; hypercompensated syndrome of disseminated intravascular blood clotting (DIC) was found in 10.9%, compensated DIC syndrome in 18.0%, consumptive coagulopathy in 3.8%, and in 19.2% hypocoagulation state caused by other abnormalities. The laboratory finding was normal only in 5.8% of the patients. In the light of the high occurrence rate of hemostatic and hemocoagulation changes in malignant diseases, established by laboratory analysis, the use of anticoagulants and antiaggregation substances appears to be justified in the majority of cases, both to prevent the development of these changes which may complicate the course of the malignant condition, and in preoperative care to reduce the rate of postoperative thromboses in patients with tumors.

Die Bestimmung der Grose und Funktion der Milz sowie anderer Laborparameter, die z. B. Anhalt fur das Vorliegen einer Leberfunktionsstorung oder einer Hamolyse liefern, erbrachten bei 29 Psoriatikern folgende Ergebnisse: Ein wesentlicher pathologischer Anstieg der untersuchten Leberfermente i. S., pathologische Blutbildungsveranderungen und Zeichen fur eine Hamolyse lagen nicht vor. In 50% waren die α-2-Globuline, in rund 75% das Haptoglobin und in gleichfalls 75% die Harnsaure i. S. erhoht. Die Milzgrose lag in 27 Fallen innerhalb des Normbereichs und 2mal geringfugig oberhalb der Normgrenze. Nur einmal war die Milz eindeutig vergrosert. Die auffalligsten Resultate erbrachte die funktionelle Analyse der Milz: So war unabhangig von Erscheinungsbild und Ausdehnung die Clearance der warmealterierten Erythrocyten aus dem Blut in der uberwiegenden Mehrzahl der Falle verzogert und der Sequestrationsindex bei fast allen Kranken stark reduziert. Diese Befunde weisen am ehesten auf eine reaktive Proliferation des Reticulums der roten Pulpa hin, wie man dies z. B. bei entzundlichen Vorgangen verschiedenster Genese und bei Stoffwechselerkrankungen vorfindet.

Eighteen tissue samples of human spleens obtained from patients suffering from hereditary sphaerocytosis, acquired haemolytic anaemia, hypersplenism, Banti's syndrome and extralienal neoplastic disease were subjected to electron microscopical examinations. Lesioned erythrocytes were removed with the aid of the macrophages of the red pulp and in cases of a high number of injured erythrocytes the cells lining the sinuses were also involved. The proliferation of collagen connective tissue was possibly also involved in injuring the blood cells. The spleens obtained from patients with neoplastic disease not affecting the spleen could not be regarded as normal.