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Apropos the major methanol poisoning outbreak that occurred in the Czech Republic recently, though there is no evidence that fomepizole is a more efficient antidote than ethanol, the study showed the rate of mortality in the most severely poisoned patients treated with fomepizole was no higher than the total hospital mortality rate at the time. The benefits of fomepizole were the indirect : no need to thoroughly monitor serum ethanol levels during hemodialysis in severely poisoned patients and less working overload on ICU doctors treating several poisoned patients simultaneously. This allowed for managing the most severely poisoned patients through the most critical phases, including the dialysis sessions where ethanol dosing is especially difficult. The authorsfound no adverse effects attributable to fomepizole but the possibility of delirium tremens in patients with a history of chronic alcohol abuse has to be considered. The prevalence of visual and CNS sequelae of methanol poisonings can be underestimated due to the absence of follow-up prospective studies in patients who survive acute poisoning.

A simple method of pleural effusion volume quantification based on a single planar measurement on CT scan is devised. The described method is widely applicable in adult patients with free pleural effusion, easy to perform and appropriately accurate.

This article covers key information on the use of amino acids including how much in the context of nutritional support for ICU patients. It is a summary of the vital role of nutritional support. The research shows that inappropriate composition of amino acids and/or insufficient amounts contributes to malnutrition which may cause increased risk of morbidity and mortality in ICU settings.

In patients with proven unilateral overproduction of aldosterone, adrenalectomy can cure the hyperaldosteronism with a high probability and a positive effect on hypertension. The main aim of this retrospective study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters in a cohort of 51 patients. Unilateral adrenalectomy had a positive effect in 82% of the patients and led to either blood pressure normalization or reduction of the antihypertensive medication. This study demonstrated a better effect of surgery on blood pressure in younger patiens.

The role of zinc-finger transcription factor Crz1 in hypoxic adaptation and cell wall integrity is described in the human pathogenic strictly aerobic basidiomycetous yeast Cryptococcus neoformans. Whereas the role of various Crz1 homologues in cell wall integrity is well- known in other fungal species, this is the first time that its role in hypoxic adaptation has been documented, indicating a tight link between cell wall integrity, hypoxia and cell cycle slowdown/arrest in G2.

Hematopoietic stem cells in combination with portal vein embolization provides new insight into the solution of primary unresectable colorectal liver metastases. The authors present a case report describing successful use of a novel method.

Background: Renal cell carcinoma (RCC) is a urologic malignancy with a steady rise in incidence and high mortality rate. Between 60 to 70% of patients with renal cell carcinoma can only be cured with surgery but despite advances in early diagnostis, in around 20-30% of cases there is metastasis. For these patients, chemotherapy and radiotherapy are ineffective and hence the prognosis is poor. Retinoids are biologically active compounds of either natural or synthetic origin that are involved in complex physiological and developmental processes in many tissues including cell proliferation and activation of tumour suppression genes. This article reviews the role of retinoids and their cognate nuclear retinoid/rexinoid receptors in relation to renal cell carcinoma. Methods: A literature search using ScienceDirect and Medline with a focus on the relationship between renal cell carcinoma and nuclear retinoid/rexinoid receptors. Results: Use of retinoids/rexinoids in the treatment of locally advanced and metastatic RCC significantly prolongs median time of tumour progression and overall survival of patients. Combination therapy with other preparations has greater efficacy than treatment with retinoids alone. Patient survival can be predicted on the basis of the expression of different all-trans retinoic acid receptor (RAR) and 9-cis retinoic acid receptor (RXR) subtypes. Conclusions: Since nuclear retinoid receptors play a crucial role as ligand-activated, DNA binding, trans-acting, transcription-modulating proteins involved in a general molecular mechanism responsible for transcriptional responses in target genes, retinoids might be an alternative approach for the treatment of renal cell carcinoma.

The article deals with peripartum cardiomyopathy, a relatively rare disease, which is very likely in our region underdiagnosed. Increased awareness of the disease should contribute to its detection. The authors describe their own experience with the diverse clinical course of the disease. When properly diagnosed and treated it has a very good prognosis, and vice versa unrecognized or improperly treated can have fatal consequences.

A unique clinical study investigating the effects of preferential COX-2 in the treatment of exudative age-related macular degeneration. The results suggest a possible neuroprotective effect of COX-2

Iterative reconstruction of cerebral CT examinations enables reduction of both effective and organ eye lens dose by one third compared to the standard filtered back projection, without signficant loss of image quality.

BACKGROUND: Bacterial strains that are oxacillin and methicillin-resistant, historically termed methicillin-resistant Staphylococcus aureus (MRSA) are resistant to all β-lactam agents, including cephalosporins and carbapenems. MRSA are pathogenic and have a number of virulence factors that enable them to result in disease. They are transmissible and important causes of nosocomial infections worldwide. An MRSA outbreak can occur when one strain is transmitted to other patients or through close contacts of infected persons in the community. Hospital-associated MRSA (HA-MRSA) isolates are also frequent causes of healthcare-associated bloodstream and catheter-related infections. Community-associated MRSA (CA-MRSA) isolates are often only resistant to beta-lactam agents and erythromycin but they are an emerging cause of community-associated infections, ecpecially skin and soft tissue infections (SSTI) and necrotizing pneumonia. METHODS: Current possibilities for detecting MRSA strains in the laboratory are reviewed and discussed in the context of the recent literature. RESULTS AND CONCLUSION: The active surveillance and prevention of MRSA occurence and spreading in hospitals are discussed in the context of recent literature.

The technique of iterative CT image reconstruction is capable of a substantial reduction in both breast radiation dose and effective dose in pulmonary CT angiography. When compared to the standard filtered back projection, the lower radiation dose achieved with iterative image reconstruction was also associated with a significantly better objective and subjective image quality.

This is the first study to describe the high prevalence of isolated exercise-only induced heart failure with normal ejection fraction (HFNEF) reaching 58% in a cohort of 81 post-heart transplant patients with normal left ventricular ejection fraction. This finding explains their low exercise tolerance due to exertional dyspnea and/or fatigue. Of the noninvasive parameters obtained at rest, multivariate regression analysis identified left ventricular mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF.

This is a review of recent data on the most widely-spread chromosomal rearrangements in human prostate carcinomas with focus on on the diagnostic, prognostic and therapeutic implications of the TMPRSS2-ERG gene fusion.

Aim: We present a case report of a female patient with metastasis of breast carcinoma to the medullary conus and cauda equina. Methods: A 48-year-old woman with a history of breast tumor, suddenly felt severe weakness and numbness of the lower extremities. MRI of the spine disclosed a mass lesion within the medullary conus, with leptomeningeal involvement of cauda equina at the spinal level L1. Laminectomy was performed and partial resection of the medullary conus tumor and especially release of nerve roots of cauda equina was achieved using microsurgical techniques. Results: Her clinical status, especially right leg weakness and sensory loss in the lower extremities have immediately improved but bladder dysfunction remained and she was unable to walk. The histological picture and immunophenotype indicates the presence of metastatic ductal adenocarcinoma of the mammary gland. Patient died 4 months after the spinal cord and cauda equina surgery. Conclusion: To our knowledge, this is the first report of successful surgical treatment of metastatic leptomeningeal infiltration of breast carcinoma.

Background: Variants of the immune response genes (IRG) are considered a potential source of interindividual differences in both innate and adaptive immune responses. A large number of gene polymorphisms have been reported as alternative forms of the IRG nucleotide sequence with important functional consequences for the structure/expression of immune response molecules. Accordingly, IRG polymorphisms are considered responsible for various monogenic diseases. They may also affect individual predisposition to complex diseases or modify their clinical course. Methods and Results: In this review we define IRG polymorphism including its potential functionality. Common approaches used for the investigation of IRG polymorphisms are next briefly described. We then review current approaches (including genome - wide studies) for assessing the importance of particular IRG variants in the susceptibility to and clinical course of complex diseases. Finally, based on our own experience and on the literature, we illustrate current knowledge of the genetic component of two selected complex diseases (sarcoidosis and coronary artery disease). Conclusions: Despite major advances in genotyping technology and general knowledge of the implications of IRG in the susceptibility to complex diseases, the potential clinical application of these approaches still faces major challenges.

Background: For more than 20 years, infection with the human papillomavirus (HPV) has been of a matter of interest not only to gynecologists but also to maxillofacial surgeons and othorhinolaryngologists. HPV is generally known to be involved in cervical cancer. Recently, there are many clinical studies pointed out the potentially dangerous connection between HPV infection and head and neck carcinomas (HNC). HPV infection was identified as a possible etiological factor in 15-30% of HNC. Methods: Aim of this article is to summarize the recent knowledge about the HPV infection with regards to etiology of head and neck cancer. Results: It has been proven that HPV infection is related to development of head and neck cancer and that the sexual behavior has played an important role in the viral transmission. HNC of viral etiology have been observed mostly in younger people; their curability is difficult and prognosis serious. Conclusion: Beside the well known correlation between developing of new head and neck cancer and bad habits (smoking, alcohol abuse, poor oral hygiene etc.) we should take into consideration the sexual promiscuity and alternative sexual practices. Vaccination against cervical cancer, recommended to young women, should be extended to their male partners to prevent the virus transmission and decrease the HNC incidence.

Background: This is a review of current knowledge on the use of saliva, gingival cervical fluid and mucosal transudate in the detection of some oral and systemic diseases as well as drugs. Oral fluid is a diagnostic medium that can be easily collected and with minimal invasion but it has been neglected in the past. Today, saliva is being used more often to diagnose: HIV virus, oro-facial and systemic tumors, cardiovascular disease and in detecting addictive substances. Neutropil levels in saliva may also indicate successful bone marrow transplant. Oral fluid is now systematically being researched and oral fluid analysis is being compared with the analysis of other diagnostic media such as blood and urine . A number of recent studies have focused on oncogenic marker detection and its monitoring in saliva. The latest clinical and laboratory findings on diagnostic markers of oropharyngeal carcinoma in oral fluid could be the beginning of their wider use as a diagnostic medium. Oral fluid can also be also used to diagnose other malignancies such as breast cancer which was one of the first malignant tumors to be detected using genetic protein biomarkers. Raised levels of CA15-3 and the epidermal growth factor (EGF) receptor have been found in patients with breast cancer and elevated levels of CA 125 and the glycoprotein complex in the saliva of ovarian cancer patients. Conclusion: Doubtless, the diagnostic value of saliva, aided by current technological development will increase rapidly in the near future.

Background: A cross-sectional study has been designed and the study observes the prevalence of polymorbidity in senior inpatients suffering from psychiatric morbidity hospitalized in gerontopsychiatric ward in one of the biggest psychiatric hospitals in the Czech Republic. The aim of the study is to prove that gerontopsychiatry is a comprehensive specialization for both doctors and nurses and should not be viewed as a low-status medical specialization. Methods and results: A cross-sectional study comprising of 304 patients was designed and a simple descriptive analysis of the patients' medical records was carried out. Polymorbidity and serious somatic conditions were present in senior patients hospitalized in gerontopsychiatric ward. Polypharmacy is a widespread phenomenon and has hazardous side effects for the treatment of patients. Last but not the least it also makes the treatment more expensive. Conclusion: Both doctors and nurses working in gerontopsychiatry should have a comprehensive interdisciplinary knowledge that would help in both early detection of many serious somatic conditions and in the improvement of the reputation of gerontopsychatry.

Backround. Ischemic mitral regurgitation (IMR) is a consequence of coronary artery disease and the main underlying mechanism is augmented leaflet tethering due to outward displacement of the papillary muscles. Although mitral annuloplasty combined with coronary revascularization is usually effective in the treatment of IMR, occasionally the regurgitation can persist or recur and this can affect patient prognosis. Methods: We searched Medline and Google scholar database for articles published since 1996 to June 2009. Search terms included ischemic mitral regurgitation, recurrent mitral regurgitation, persistent mitral regurgitation and annuloplasty failure. Conclusion: This article reviews current knowledge about IMR, the reasons and mechanisms of persistent and recurrent mitral regurgitation. We review clinic and echocardiographic predictive factors associated with persistence a recurrence of mitral regurgitation after annuloplasty.

Background: Insufficient venous vasculature disallows autologous arteriovenous fistula creation. In this case an arteriovenous conduit of expanded polytetrafluoroethylene (ePTFE) interponed between artery and vein is used for hemodialysis. Although arteriovenous graft infection is an infrequent complication, infected grafts cannot be used for hemodialysis and can cause infection, sepsis and bleeding. Treatment options remain limited but the general approach is to maintain functional angioaccess and to eradicate infection. Aim: to summarize current knowledge of the prevention and treatment of arteriovenous graft infection. Methods: literature review Conclusions. ePTFE graft present an unreplaceable material used for angioaccess in patients with an insufficient venous vasculature. A number of risk factors causing graft infection is known. Since hemodialysis patients are a highrisk group, an effective strategies for graft infection prevention and early diagnosis should be determined. Among the most important risk factors belong surgical procedure, recurrent venipuncture and other infection disease. The prostheses should be removed when infected, especially in the presence of sepsis. In case of "localized infection", the prostheses can be removed partially only under the condition of careful patient selection and subsequent follow-up.

Background: Increasing evidence from numerous research studies in internal medicine shows that adipocytes and adipokines are involved in primary inflammatory processes and disease. CORS-26 (collagenous repeat- containing sequence of 26 kDa protein) is a newly discovered adipokine of the C1q/TNF molecular superfamily C1q/TNF-related protein-3 (CTRP-3) secreted, inter alia in murine monocytes and adipocytes and in human adipocytes. Reported recently as a gene product of adipocyte differentiation, it shares structural similarity with the adipocyte, adiponectin. CORS-26 is much less known than other adipocytes such as leptin and resistin. Knowledge of its various functions has clinical and therapeutic implications especially in relation to obesity and the metabolic syndrome. Aims: This review aims to provide current knowledge of this adipokine. Methods: Review; sources were scientific biomedical databases Medline/PubMed, BioMedCentral, Google Scholar, Ovid, ProQuest from to 1998 to 2009. Conclusion: CORS-26 is an adipokine that regulates the secretion of other adipokines. Its effects on adipokine secretion are most probably independent of PPAR-γ. As CORS-26 up-regulates adiponectin secretion, it may be involved in metabolic and immunologic pathways. The effect of recombinant CORS-26 on insulin signaling in the presence of the metabolic syndrome needs to be investigated to further evaluate the physiological and pathophysiological role of this protein.

Background: Hemolytic disease in the newborn with its typical signs and poor prognosis has been known for centuries. Historically it can be divided into three pathological states which are fetal hydrops (hydrops fetus universalis), neonatal jaundice (icterus neonati gravis familiaris) and fetal anemia (anemia neonati). Almost 70 reports with quite accurate descriptions were found up to the end of 19th century. The patho physiological basis of the condition began to be studied at the beginning of the last century and the development of our knowledge is an example of the cooperation between pathologists, pediatricians, hematologists and later, obstetricians, immunologists and geneticists. Despite all the advances in this field it remains a serious disease up to this time. It is not managed successfully in all cases and despite successful immunological prophylaxis there are cases when we need to administer intrauterine transfusion based on the information received by dopplerometric measurement of arteria cerebri perfusion and fetal blood sampling. Methods: Review of lover cited literature. Conclusion: The history of the hemolytic disease in the newborn, its condition and approaches to it has not been recently compiled in the Czech Republic.

Background: Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. Materials and Methods: An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Results: Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. Conclusion: The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

Background: Plasma N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) concentration is elevated in cardiovascular diseases such as congestive heart failure, where increased levels of NT-proBNP indicate cardiac dysfunction, hypervolemia, and higher risk of hospitalization and death. These associations apply also to patients with severe impairment of kidney function. Little is known about diferences in plasma level of NT-proBNP in patients receiving hemodialysis (HD) versus those receiving continuous ambulatory peritoneal dialysis (CAPD). Aim: To evaluate differences in plasma NT-proBNP concentration between HD and CAPD patients. Methods: Plasma NT-proBNP concentration was prospectively measured in consecutive patients receiving either HD or CAPD at our hospital center. All other standard clinical parameters were recorded. The correlation between plasma NT-proBNP concentration and the type of dialysis was then examined. Results: We studied 99 consecutive patients on HD (age 62 ± 15 years, 66% male) and 18 consecutive patients on CAPD (age 56 ± 18 years, 67% male). Both groups had similar baseline characteristics including duration of dialysis, left ventricular function and mass, and cardiothoracic ratio. Significantly more patients on HD had abnormal NT-proBNP levels compared to patients on CAPD (97% vs 44%; P<0.0001), and this difference remained highly significant when using various NT-proBNP cut off values. A subgroup analysis revealed that the lower NT-proBNP levels of CAPD patients are most pronounced in patients with preserved left ventricular ejection function. As expected, NT-proBNP levels correlated negatively with left ventricular function and positively with cardiothoracic ratio, and this applied to both HD and CAPD groups. Conclusion: The lower concentration of NT-proBNP in patients on CAPD compared to those on HD suggests that CAPD produces lesser hemodynamic stress, especially in patients with preserved left ventricular systolic function. Even though increased NT-proBNP levels have been shown to predict increased morbidity and mortality, further studies are necessary to assess the long term benefit of CAPD compared to HD.

Aims: Evaluation of serum levels of 17 cytokines and 5 adhesion molecules in patients treated for acute myeloid leukemia (AML) using biochip array technology. This approach allows multi-analytical determination from a single sample. Methods: A total of 15 AML patients were studied. Blood samples were taken at the diagnosis (active leukemia) and at circa 6 months after completion of last chemotherapy (durable complete remission in all patients). Results: Comparing cytokine and adhesion molecule levels in active leukemia and in durable complete remission, we found significant increase (P<0.01) in serum interleukin-7 (IL-7), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and significant decrease (P<0.01) in serum E-selectin. Discussion: Our results indicate that serum levels of specific cytokines and adhesion molecules (IL-7, EGF, VEGF, E-selectin) are significantly altered in patients treated for AML, reflecting activity of the disease. Further investigation is needed to establish if the changes observed in the levels of these molecules could be used as a prognostic indicator of AML.

Introduction: ADAM33 is the candidate gene most commonly associated with asthma and airway hyperreactivity (AHR). Aim: The aim of this study was to determine whether level of AHR is associated with certain alleles or haplotypes of the ADAM33 gene in asthmatic children. Methods: One hundred and nine asthmatic children and 46 controls from the general population were examined with spirometry before and after histamine and methacholine inhalation. All subjects were genotyped for single-nucleotide polymorphisms (SNPs) of the ADAM33 gene. Haplotypes were determined according to genotypes of the patient's parents. Results: We found the three most frequent ADAM33 haplotypes (a1-3) were associated with the highest level of AHR to methacholine and histamine in 66% of asthmatic children. The paternally transmitted GGGCTTTCGCA haplotype was seen in 73.3% asthmatic children with serious AHR to methacholine challenge (paternal and maternal origin of haplotype 73.3% to 37.5, P=0.046) Significant differences in the relative frequency of paternal haplotypes with high levels of AHR to histamine were found (P=0.013). Conclusion: ADAM33 haplotypes (a1, a2, a3) are associated with severity of AHR and are significantly more often transmitted in the paternal line.

Aims: The non-invasive ¹³C-methacetin (¹³C-MBT) breath test has been proposed as a measure of metabolic liver function that improves the diagnostic efficacy of serologic and biochemical tests in assessing hepatic functional capacity and liver disease severity, The goal of this study was to establish the clinical utility of this test in quantifying hepatic metabolic function in patients with liver cirrhosis of varying severity and to compare ¹³C-MBT measurements with the AST/ALT ratio, APRI score, and other routine liver tests. Methods: Routine liver function tests including serum bilirubin, aspartate aminotransferase activity (AST), alanine aminotransferase (ALT), AST/ALT ratio, the APRI score, the percentage of dose rate (PDR) and cumulative percentage of dose rate (CPDR) of the ¹³C-MBT were evaluated in 52 cirrhotic patients of alcohol etiology (Child-Pugh A/B/C 10/28/14) and 37 healthy controls. Results: The ¹³C-MBT differed significantly between healthy controls and cirrhotic patients at all time intervals measured. It also proved the ability to differentiate patients with liver cirrhosis based on severity of hepatic impairment corresponding to the Child-Pugh classification A vs. B vs. C. The ROC curve analysis suggested that the best prediction is provided by time intervals between the 10^th - 20^th or 10^th - 40^th minute of PDR. Conclusions: The ¹³C-MBT offers a reliable means for quantification of hepatic metabolic function over the complete range of functional liver impairment. It is non-invasive, easy to perform and completely safe.

Background: The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL_Smax) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q_REST), and to define the optimal cut-offs for SL_Smax to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). Methods and Results: In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL_Smax (r=-0.59, P<0.0001) and DE on ceCMR. The SL_Smax optimal cut-off -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL_Smax for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL_Smax resp. Q_REST, p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL_Smax than Q_REST in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SL_Smax resp. Q_REST, P=0.001). Conclusions: STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.