OBJECTIVE: Epilepsy surgery in the operculoinsular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of postoperative deficits. METHODS: Pre- and postsurgical data from 30 pediatric patients who underwent operculoinsular cortex surgery at the Motol Epilepsy Center Prague from 2010 to 2022 were analyzed. RESULTS: Focal cortical dysplasia (FCD; n = 15, 50%) was the predominant cause of epilepsy, followed by epilepsy-associated tumors (n = 5, 17%) and tuberous sclerosis complex (n = 2, 7%). In eight patients where FCD was the most likely etiology, the histology was negative. Seven patients (23%) displayed normal magnetic resonance imaging results. Seizures exhibited diverse semiology and propagation patterns (frontal, perisylvian, and temporal). The ictal and interictal electroencephalographic (EEG) findings were mostly extensive. Multimodal imaging and advanced postprocessing were frequently used. Stereo-EEG was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better neurosurgeon orientation. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the 2-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of >50% (International League Against Epilepsy class 3 and 4). Fourteen patients (47%) underwent antiseizure medication tapering; treatment was completely withdrawn in two (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median = 6 years 5 months, range = 2 years to 13 years 5 months postsurgery). Six patients (20%) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild and one (3%) to moderate hemiparesis. Two patients (7%) operated on in the anterior insula along with frontotemporal resection experienced major complications: pontine ischemia and postoperative brain edema. SIGNIFICANCE: Epilepsy surgery in the operculoinsular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. Rehabilitation brings a great chance for significant recovery of postoperative deficits.

• MeSH
• Child MeSH
• Electroencephalography * MeSH
• Epilepsy surgery   diagnostic imaging   MeSH
• Cohort Studies MeSH
• Infant MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Malformations of Cortical Development surgery   complications   diagnostic imaging   MeSH
• Adolescent MeSH
• Cerebral Cortex diagnostic imaging   surgery   MeSH
• Neurosurgical Procedures methods   MeSH
• Child, Preschool MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

AIMS: Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC. METHODS AND RESULTS: Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%). CONCLUSION: These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC.

• MeSH
• Catheter Ablation * methods   MeSH
• Tachycardia, Ventricular * surgery   physiopathology   MeSH
• Ventricular Premature Complexes * surgery   physiopathology   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Recurrence * MeSH
• Registries * MeSH
• Aged MeSH
• Feasibility Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

AIMS: Specific patterns in incidence may reveal environmental explanations for type 1 diabetes incidence. We aimed to study type 1 diabetes incidence in European childhood populations to assess whether an increase could be attributed to either period or cohort effects. METHODS: Nineteen EURODIAB centres provided single year incidence data for ages 0-14 in the 25-year period 1989-2013. Case counts and person years were classified by age, period and cohort (APC) in 1-year classes. APC Poisson regression models of rates were fitted using restricted cubic splines for age, period and cohort per centre and sex. Joint models were fitted for all centres and sexes, to find a parsimonious model. RESULTS: A total of 57,487 cases were included. In ten and seven of the 19 centres the APC models showed evidence of nonlinear cohort effects or period effects, respectively, in one or both sexes and indications of sex-specific age effects. Models showed a positive linear increase ranging from approximately 0.6 to 6.6%/year. Centres with low incidence rates showed the highest overall increase. A final joint model showed incidence peak at age 11.6 and 12.6 for girls and boys, respectively, and the rate-ratio was according to sex below 1 in ages 5-12. CONCLUSION: There was reasonable evidence for similar age-specific type 1 diabetes incidence rates across the EURODIAB population and peaks at a younger age for girls than boys. Cohort effects showed nonlinearity but varied between centres and the model did not contribute convincingly to identification of environmental causes of the increase.

• MeSH
• Diabetes Mellitus, Type 1 * epidemiology   MeSH
• Child MeSH
• Incidence MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Follow-Up Studies MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Registries MeSH
• Seizures MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECT: Epilepsy surgery is an effective treatment for selected patients with focal intractable epilepsy. Complete removal of the epileptogenic zone significantly increases the chances for postoperative seizure-freedom. In complex surgical candidates, delineation of the epileptogenic zone requires a long-term invasive video/EEG from intracranial electrodes. It is especially challenging to achieve a complete resection in deep brain structures such as opercular-insular cortex. We report a novel approach utilizing intraoperative visual detection of stereotactically implanted depth electrodes to inform and guide the extent of surgical resection. METHODS: We retrospectively reviewed data of pediatric patients operated in Motol Epilepsy Center between October 2010 and June 2020 who underwent resections guided by intraoperative visual detection of depth electrodes following SEEG. The outcome in terms of seizure- and AED-freedom was assessed individually in each patient. RESULTS: Nineteen patients (age at surgery 2.9-18.6 years, median 13 years) were included in the study. The epileptogenic zone involved opercular-insular cortex in eighteen patients. The intraoperative detection of the electrodes was successful in seventeen patients and the surgery was regarded complete in sixteen. Thirteen patients were seizure-free at final follow-up including six drug-free cases. The successful intraoperative detection of the electrodes was associated with favorable outcome in terms of achieving complete resection and seizure-freedom in most cases. On the contrary, the patients in whom the procedure failed had poor postsurgical outcome. CONCLUSION: The reported technique helps to achieve the complete resection in challenging patients with the epileptogenic zone in deep brain structures.

• MeSH
• Child MeSH
• Electroencephalography MeSH
• Epilepsy * surgery   MeSH
• Electrodes, Implanted MeSH
• Insular Cortex MeSH
• Humans MeSH
• Drug Resistant Epilepsy * surgery   MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

A series of nineteen novel ring-substituted N-arylcinnamanilides was synthesized and characterized. All investigated compounds were tested against Staphylococcus aureus as the reference strain, two clinical isolates of methicillin-resistant S. aureus (MRSA), and Mycobacterium tuberculosis. (2E)-N-[3-Fluoro-4-(trifluoromethyl)phenyl]-3-phenylprop-2-enamide showed even better activity (minimum inhibitory concentration (MIC) 25.9 and 12.9 μM) against MRSA isolates than the commonly used ampicillin (MIC 45.8 μM). The screening of the cell viability was performed using THP1-BlueTM NF-κB cells and, except for (2E)-N-(4-bromo-3-chlorophenyl)-3-phenylprop-2-enamide (IC50 6.5 μM), none of the discussed compounds showed any significant cytotoxic effect up to 20 μM. Moreover, all compounds were tested for their anti-inflammatory potential; several compounds attenuated the lipopolysaccharide-induced NF-κB activation and were more potent than the parental cinnamic acid. The lipophilicity values were specified experimentally as well. In addition, in silico approximation of the lipophilicity values was performed employing a set of free/commercial clogP estimators, corrected afterwards by the corresponding pKa calculated at physiological pH and subsequently cross-compared with the experimental parameters. The similarity-driven property space evaluation of structural analogs was carried out using the principal component analysis, Tanimoto metrics, and Kohonen mapping.

• MeSH
• Ampicillin pharmacology   MeSH
• Principal Component Analysis MeSH
• Anti-Inflammatory Agents pharmacology   MeSH
• Cinnamates chemical synthesis   MeSH
• Inhibitory Concentration 50 MeSH
• Hydrogen-Ion Concentration MeSH
• Humans MeSH
• Methicillin-Resistant Staphylococcus aureus drug effects   MeSH
• Microbial Sensitivity Tests MeSH
• Microwaves MeSH
• Models, Molecular MeSH
• Mycobacterium tuberculosis drug effects   MeSH
• NF-kappa B metabolism   MeSH
• Staphylococcus aureus drug effects   MeSH
• THP-1 Cells MeSH
• Cell Survival drug effects   MeSH
• Structure-Activity Relationship MeSH
• Inflammation MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Objective: The poor metabolic control in type 1 diabetes mellitus (T1D) has a negative impact on the developing brain. Hyperglycemia and glycemic fluctuations disrupt mainly executive functions. To assess a hypothesized deficit of the executive functions, we evaluated visual processing and reaction time in an oddball task. Methods: Oddball visual event-related potentials (ERPs), reaction time, and pattern-reversal visual evoked potentials (VEPs) were examined in a cohort of twenty-two 12- to 18-year-old T1D patients without diabetic retinopathy at normal glycemia and in nineteen 10- to 21-year-old healthy controls. Results: The P100 peak time of the VEPs was significantly prolonged in T1D patients compared with the control group (p < 0.017). In contrast to the deteriorated sensory response, the area under the curve of the P3b component of the ERPs was significantly larger (p = 0.035) in patients, while reaction time in the same task did not differ between groups (p = 0.713). Conclusions: The deterioration on a sensory level, enhanced activity during cognitive processing, and balanced behavioral response support the view that neuroplasticity counterbalances the neural impairment by enhanced cognitive processing to achieve normal behavioral performance in T1D adolescents.

• MeSH
• Diabetes Mellitus, Type 1 physiopathology   therapy   MeSH
• Diabetic Retinopathy metabolism   MeSH
• Evoked Potentials MeSH
• Glycated Hemoglobin analysis   MeSH
• Hyperglycemia physiopathology   MeSH
• Cognition MeSH
• Blood Glucose MeSH
• Humans MeSH
• Adolescent MeSH
• Brain physiopathology   MeSH
• Neuropsychological Tests MeSH
• Motion MeSH
• Reaction Time * MeSH
• Case-Control Studies MeSH
• Evoked Potentials, Visual * MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Splicing in S. cerevisiae has been shown to proceed cotranscriptionally, but the nature of the coupling remains a subject of debate. Here, we examine the effect of nineteen complex-related splicing factor Prp45 (a homolog of SNW1/SKIP) on cotranscriptional splicing. RNA-sequencing and RT-qPCR showed elevated pre-mRNA levels but only limited reduction of spliced mRNAs in cells expressing C-terminally truncated Prp45, Prp45(1-169). Assays with a series of reporters containing the AMA1 intron with regulatable splicing confirmed decreased splicing efficiency and showed the leakage of unspliced RNAs in prp45(1-169) cells. We also measured pre-mRNA accumulation of the meiotic MER2 gene, which depends on the expression of Mer1 factor for splicing. prp45(1-169) cells accumulated approximately threefold higher levels of MER2 pre-mRNA than WT cells only when splicing was induced. To monitor cotranscriptional splicing, we determined the presence of early spliceosome assembly factors and snRNP complexes along the ECM33 and ACT1 genes. We found that prp45(1-169) hampered the cotranscriptional recruitment of U2 and, to a larger extent, U5 and NTC, while the U1 profile was unaffected. The recruitment of Prp45(1-169) was impaired similarly to U5 snRNP and NTC. Our results imply that Prp45 is required for timely formation of complex A, prior to stable physical association of U5/NTC with the emerging pre-mRNA substrate. We suggest that Prp45 facilitates conformational rearrangements and/or contacts that couple U1 snRNP-recognition to downstream assembly events.

• MeSH
• Introns MeSH
• Ribonucleoprotein, U1 Small Nuclear metabolism   MeSH
• Ribonucleoprotein, U2 Small Nuclear metabolism   MeSH
• Saccharomyces cerevisiae Proteins genetics   metabolism   MeSH
• Saccharomyces cerevisiae genetics   metabolism   MeSH
• RNA Splicing * MeSH
• Spliceosomes metabolism   MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

The purpose of the study was to describe and compare normal and 5-fluorouracil (5-FU)-suppressed hematopoiesis in adenosine A(3) receptor knock-out (A(3)AR KO) mice and their wild-type (WT) counterparts. To meet the purpose, a complex hematological analysis comprising nineteen peripheral blood and bone marrow parameters was performed in the mice. Defects previously observed in the peripheral blood erythrocyte and thrombocyte parameters of the A(3)AR KO mice were confirmed. Compartments of the bone marrow progenitor cells for granulocytes/macrophages and erythrocytes were enhanced in the control, as well as in the 5-FU-administered A(3)AR KO mice. 5-FU-induced hematopoietic suppression, evaluated on day 2 after the administration of the cytotoxic drug, was found to be significantly deeper in the A(3)AR KO mice compared with their WT counterparts, as measured at the level of the bone marrow progenitor cells. The rate of regeneration, as assessed between days 2 and 7 after 5-FU administration, was observed in the population of the granulocyte/macrophage progenitor cells to be higher in the A(3)AR KO mice in comparison with the WT ones. The increased depth of 5-FU-induced suppression in the compartments of the hematopoietic progenitor cells in the A(3)AR KO mice represents probably a hitherto undescribed further consequence of the lack of adenosine A(3) receptors and indicates its synergism with the pharmacologically induced cytotoxic action of 5-FU.

• MeSH
• Blood Chemical Analysis MeSH
• Bone Marrow Cells drug effects   MeSH
• Fluorouracil pharmacology   MeSH
• Hematopoiesis drug effects   MeSH
• Mice, Inbred C57BL MeSH
• Mice, Knockout MeSH
• Mice MeSH
• Erythrocyte Count MeSH
• Leukocyte Count MeSH
• Antimetabolites, Antineoplastic pharmacology   MeSH
• Receptor, Adenosine A3 genetics   MeSH
• Animals MeSH
• Check Tag
• Male MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Úvod: Příčiny nestabilit můžeme rozdělit na stavy poúrazové, při kterých dochází k poškození vazů, a nestability v důsledku hypermobility kloubní na podkladě vrozené poruchy syntézy kolagenu typu I. V klinickém obrazu skafolunátní (SL) nestability bývá ve většině případů přítomná bolest zápěstí, zpočátku pozátěžová, v chronicitě pak klidová. Hlavním dynamickým stabilizátorem os scaphoideum radiální strany zápěstí je musculus flexor carpi radialis (FCR), který vzhledem k průběhu své šlachy používá tuto kůstku jako kladku k dosažení svého distálního úponu na II. metakarpu. Cílem pilotního projektu bylo zhodnotit míru benefitu posílení FCR v konzervativní terapii dynamických SL nestabilit. Pacienti a metody: V letech 2012–2014 bylo na našem pracovišti diagnostikováno a zařazeno do terapeutického programu 56 testovaných pacientů (49 žen, 7 mužů), věkového rozpětí 18–49 roků. Kritériem pro zařazení byla diagnóza predynamické nebo dynamické formy skafolunátní nestability s pozitivním Watsonovým testem. Třináct pacientů mělo diagnostikovánu nestabilitu SL po primární fraktuře distálního radia, u 11 probandů byla přítomna klidová bolest, u 45 pak pozátěžová, omezující aktivity denního života, a v 9 případech bylo současně verifikováno poškození triangulárního fibrokartilaginózního komplexu (TFCC). Hodnotili jsme míru bolesti prostřednictvím visual analog scale (VAS) u každého z probandů při první terapii a následně s odstupem 1,5 a 3 měsíců od začátku fyzioterapie. Byly vybrány 4 specifické cviky pro aktivitu musculus flexor carpi radialis. Výsledky: Při prvním vyšetření škály bolesti bylo její rozmezí u testovaných jedinců 5–8. Po prvním kontrolním měření změn s odstupem 1,5 měsíce od začátku terapie se intenzita bolestí zápěstí snížila do rozhraní 3–6 a po druhém kontrolním měření bylo subjektivní hodnocení bolesti od 2 do 7. S odstupem 3 měsíců byl z daných měření největší nárůst hodnot v intenzitě 3, tedy významné zklidnění obtíží. Pokud budeme brát hodnoty bolesti 5–8 VAS škály, pak u 19 probandů (33 %) z 56 nedošlo k výrazným změnám ve smyslu zmírnění obtíží, nicméně 5 probandů mělo současně poškozen komplex TFCC a 8 bylo po primární fraktuře distálního radia, zbylých 6 v tomto rozhraní mělo diagnostikovanou pouze dynamickou formu skafolunátní nestability. Osm pacientů vyžadovalo další chirurgickou intervenci pro neustupující bolesti zápěstí a značné limity denních činností – activity of daily living (ADL). Diskuze: V našem souboru 56 pacientů s diagnostikovanou dynamickou skafolunátní nestabilitou došlo k inhibici bolesti u 66 % testovaných v případě rozmezí škály VAS hodnot 0–4, nicméně u všech probandů došlo po 3 měsících k alespoň nějakému snížení intenzity bolesti po cílené rehabilitační intervenci. U 8 jedinců byly obtíže natolik limitující, že byl chirurgický zásah nezbytný. Potvrdilo se nám, že facilitace FCR má jednoznačný benefit pro pacienty s predynamickou a dynamickou formou a je schopna v určité míře zamezit předčasnému chirurgickému řešení. Nicméně můžeme usuzovat, že v případech, kdy je k samotné SL nestabilitě přidružena i jiná patologie (traumatizace TFCC, fraktura distálního radia), bude efekt samotné rehabilitace méně uspokojivý a následná chirurgická intervence více pravděpodobná. Závěr: Pohledem traumat měkkotkáňových struktur zápěstí řadíme SL disociace k frekventovaným obtížím v segmentu ruky. Jejich včasná a korektní diagnostika a následná cílená léčba může zajistit úspěšný výsledek na poli terapeutickém. Naší snahou je nejen rozšířit povědomí o specifičnosti dané problematiky a nutnosti komplexnosti léčby, ale také najít vzájemnou mezioborovou spolupráci, dál posunout vlastní zkušenosti a neomezit se jen na již zavedené a nekomplikované.

Introduction: The causes of instability may be classified as post-traumatic with ligament damage and those resulting from joint hypermobility due to congenital impairment of type 1 collagen synthesis. In most cases of scapholunate (SL) instability, the clinical picture includes wrist pain, initially post-exertional and later, in the chronic stage, resting. The main dynamic stabilizer of the scaphoid bone on the radial side of the wrist is the flexor carpi radialis (FCR) muscle. Along the course of its tendon, the muscle uses this bone as a pulley to reach its distal insertion at the second metacarpal bone. This pilot project aimed at assessing the benefit of FCR strengthening in conservative treatment for dynamic SL instabilities. Patients and methods: In 2012–2014, a total of 56 tested patients (49 males and 7 females) aged 18–49 years were diagnosed and enrolled in the therapeutic program at our center. The inclusion criterion was a diagnosis of pre-dynamic or dynamic SL instability made with Watson’s test. Thirteen patients were diagnosed with SL instability following a primary distal radius fracture. There was resting pain in 11 subjects and post-exertional pain limiting activities of daily living (ADL) in 45 persons. At the same time, a triangular fibrocartilage complex (TFCC) injury was confirmed in 9 cases. In each participant, pain intensity was measured using the Visual Analog Scale (VAS) during the first treatment session and at 1.5 and 3 months from the initiation of physiotherapy. Four specific types of exercise were selected for FCR muscle activity. Results: During the first measurement, the tested individuals had a pain intensity of 5–8. At 1.5 and 3 months from the initiation of therapy, the subjective pain intensity was reduced to 3–6 and 2–7, respectively. At 3 months, the largest increase was observed for a pain intensity of 3, suggesting a significant reduction of difficulties. When considering VAS pain intensity ranging from 5 to 8, nineteen out of the 56 subjects (33%) had no significant alleviation of problems. However, five individuals also had a TFCC injury and 8 had sustained a distal radius fracture; the remaining 6 patients with that range of pain intensity were only diagnosed with dynamic SF instability. Eight individuals required further surgical intervention for persistent wrist pain and severely limited ADLs. Discussion: In the group of 56 patients diagnosed with dynamic SL instability, pain was inhibited in 66% of the tested subjects with VAS pain intensity ranging from 0 to 4. In all patients, however, there was at least some reduction in pain intensity after three months of targeted rehabilitation intervention. In 8 patients, the difficulties were so limiting that they required surgical intervention. FCR facilitation has been confirmed to have a clear benefit to patients with pre-dynamic and dynamic SL instability and may, to a certain extent, prevent the need for early surgery. It may be assumed, however, that when SL instability is associated with another pathology (e.g. TFCC injury or distal radius fracture), the effect of rehabilitation alone would be less satisfactory and subsequent surgical intervention will be more likely needed. Conclusion: Among injuries to soft tissue structures of the wrist, SL dissociation is a common problem. Early and correct diagnosis as well as subsequent targeted therapy may guarantee successful results. It is our effort not only to extend the awareness of these issues and the need for comprehensive treatment but also to seek multidisciplinary cooperation and to extend our own experience without having to rely on the already established and uncomplicated approaches.

• Keywords
• skafolunátní nestabilita, musculus flexor carpi radialis,
• MeSH
• Scaphoid Bone MeSH
• Adult MeSH
• Muscle, Skeletal physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pain Measurement statistics & numerical data   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Joint Instability * therapy   MeSH
• Physical Therapy Modalities * MeSH
• Wrist Joint * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH

Cíl práce: Periprotetické infekce jsou závažnou komplikací totálních endoprotéz (TEP) kyčelního a kolenního kloubu. Součástí komplexního terapeutického přístupu v rámci dvojdobé reimplantace je použití spacerů (dočasné kloubní náhrady) s obsahem antibiotik. Cílem této práce bylo zhodnotit bakteriologické nálezy u vybraných pacientů s periprotetickou infekcí, u kterých byl použit komerčně připravený spacer s gentamicinem. Materiál a metodika: V letech 2008–2012 byl použit u 24 pacientů při ošetření infekce kloubní náhrady kyčelního nebo kolenního kloubu – v rámci dvojdobé reimplantace – ready-made cementový spacer s gentamicinem. K mikro­biologickému vyšetření byly z první revize odeslány všechny komponenty endoprotézy a vzorky periprotetické tkáně, v druhé době pak spacer a vzorky okolní tkáně. U šesti pacientů se zavedeným spacerem kolenního kloubu byla měřena hladinu gentamicinu v kloubní tekutině. Pacienti byli následně pravidelně sledováni. Výsledky: Výsledkem bakteriologického vyšetření byl kultivační průkaz agens v 22 případech z 24 (92 %). Nejčastěji byly vykultivovány koaguláza-negativní stafylokoky, dále byl izolován Staphylococcus aureus, korynebakteria, anaerobní bakterie a Salmonella Enteritidis, citlivých ke gentamicinu bylo 19 z 25 prokázaných agens (76 %). Kultivační vyšetření spacerů bylo pozitivní u dvou pacientů, vykultivovány byly koaguláza-negativní stafylokoky, v obou případech rezistentní ke gentamicinu. Po dobu sledování (minimálně 2 roky) pacientů nedošlo u žádného z nich k rozvoji další periprotetické infekce. Závěr: Úspěšnost reimplantací TEP kyčelního a kolenního kloubu ve dvojdobém rytmu s užitím ready-made spacerů s gentamicinem byla v našem souboru 100 %, po dobu minimálně dvou let nedošlo v našem souboru pacientů k zaznamenání dalšího periprotetického infektu. Z hodnocení nálezů bakteriologického vyšetření našeho souboru vyplývá, že ready-made spacer s gentamicinem pokrývá pouze 76 % spektra původců. Řešením by bylo použití spaceru nasyceného kombinací vankomycinu a gentamicinu, které by zajistilo antimikrobiální působení vůči všem vykultivovaným agens.

Background: Periprosthetic infection is a serious complication in total hip and knee arthroplasty. The complex therapeutic approach within two-stage reimplantation includes the use of antibiotic-impregnated spacers (temporary joint replacements). The aim of this paper was to evaluate bacteriological findings in selected patients with periprosthetic infection in whom a ready-made gentamicin-impregnated spacer was used to treat the infection. Materials and methods: Between 2008 and 2012, a ready-made, gentamicin-impregnated cement spacer was used in 24 patients to treat periprosthetic hip or knee infection within two-stage reimplantation. All components of the prosthesis and periprosthetic tissue samples were sent for microbiological examination at the first revision surgery, while at the second revision surgery, the spacer and surrounding tissue samples were sent in. In six patients with an inserted knee spacer, the level of gentamicin in the joint fluid was measured. Subsequently, the patients were regularly monitored. Results: Twenty-two (92%) of 24 patients were bacteriologically positive by culture. The most commonly detected causative agents were coagulase-negative staphylococci. Other isolates were Staphylococcus aureus, Corynebacterium, anaerobic bacteria, and Salmonella serotype Enteritidis. Nineteen (76%) of 25 primary pathogens were gentamicin sensitive. Spacers from two patients were culture positive for coagulase-negative staphylococci that tested resistant to gentamicin. During the follow-up of at least two years, none of the patients developed another periprosthetic infection. Conclusion: The success rate of two-stage-reimplantation total hip and knee arthroplasty using ready-made, gentamicin-impregnated spacers was 100 % in our cohort of patients; no other periprosthetic infection was reported during the follow-up of at least two years. From the bacteriological results, it appears that the ready-made, gentamicin-impregnated spacer only covers 76 % of the range of the causative agents. The solution would be to use a spacer impregnated with a combination of vancomycin and gentamicin that would be effective against all cultured species.

• MeSH
• Anti-Bacterial Agents * administration & dosage   therapeutic use   MeSH
• Arthroplasty, Replacement * MeSH
• Bacteriological Techniques methods   MeSH
• Chemoprevention methods   MeSH
• Surgical Procedures, Operative methods   MeSH
• Debridement MeSH
• DNA, Bacterial analysis   MeSH
• Prosthesis-Related Infections * diagnosis   microbiology   therapy   MeSH
• Protein Synthesis Inhibitors pharmacology   therapeutic use   MeSH
• Bone Cements MeSH
• Middle Aged MeSH
• Humans MeSH
• Microbial Sensitivity Tests MeSH
• Occult Blood MeSH
• Orthopedics MeSH
• Polymethyl Methacrylate chemistry   MeSH
• Postoperative Complications etiology   microbiology   therapy   MeSH
• Orthotic Devices MeSH
• Prosthesis Design MeSH
• Joint Prosthesis microbiology   MeSH
• Replantation MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Staphylococcal Infections diagnosis   therapy   MeSH
• Staphylococcus epidermidis isolation & purification   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH