Slovakia
online
Volume 97 / No. 3/ 1996
THE CHANGES IN HUMAN LEPTOSPIROSES EPIDEMIOLOGY IN THE SLOVAK REPUBLIC
BAKOSS P., MACHACOVA E., SLACIKOVA M.
Background. The epidemiologic patterns of infectiuos diseases
are liable to change in the course of time. References to such changes
in leptospirosis are very rare and of low systematic value.
Objectives. The study is aimed at the detection of changes in
the epidemiology of leptospirosis within the past 20 years in Slovakia.
Methods. Basic epidemiologic characteristics of leptospirosis
were compared within two chronological periods. 598 registered cases were
analysed during the first period (19701976), and 200 cases of leptospirosis
were analysed during the second period (19861991).
Main results. The second period yielded a decrease in total
incidence to approximately 50 % (yearly average was 0.9/10[^5] of the population).
At the same time the cyclic character of morbidity has almost entirely
disappeared. The incidence of leptospirosis has significantly decreased
in the group of population betweem 40 and 59 years of age, thus causing
a particular shift in morbidity towards the younger population. Cases of
leptospirosis caused by L. tarassovi and L. canicola ceased
to occur, however one case of infection caused by L. hardjo has
been registered in the Slovak population. A significant decrease in the
incidence of diseases caused by the Sejroe group serovars was detected,
especially in housewives, retired people, industrial and agricultural workers.
In contrast to the latter, the proportion of leptospirosis cases caused
by L. icterohaemorrhagiae/copenhageni increased particularly in
pupils and students, as well as those caused by L. pomona in slanghter-houses
workers. Consequently, the most dominating disease is represented by field
fever (L. gripotyphosa), the second highest incidence is ascribed
to Weil disease (L. icterohaemorrhagiae/copenhageni), while the
incidence of infections caused by the group of Sejroe serovars dropped
from the first to the fourth place. The possible reasons of these changes
are presented. No changes in the incidence of leptospirosis according to
sex and seasonal occurrence were registered.
Conclusion. The results of this study are in accordance with
the current knowledge of the development of epidemiologic signs of infectious
diseases, including leptospirosis. The results provide a pattern of the
current situation in the field of leptospirosis epidemiology in the territory
of Slovakia and emphasize the importance of systematic surveillance enabling
the assessment of appropriate measures suppressing these infections. (Fig.
7, Ref. 7.)
Key words: leptospirosis, Slovakia, changes in epidemiologic paterns.
Bratisl Lek Listy 1996; 97: 123130
TRIPLE ANTIMICROBIAL THERAPY IN HELICOBACTER PYLORI INFECTION AND BASAL LEVEL OF SERUM GASTRINE
JURGOS L., DURIS I., BATOVSKY M., SIMKOVICOVA M., PAUER M., DOROCIAK F., MAJERCIK M., KRATOCHVILOVA H., VALKO L., PAULEN P.
Background. The etiopathogenic relationship of Helicobacter pylori
(HP) infection to chronic active antrumgastritis and peptic ulcer disease
has been confirmed by a number of studies. The key role in the development
of peptic lesions belongs to hypergastrinemia. This is supposed to be related
to ammonium synthesis in the antral area influenced (promoted by HP and
resulting in interruption) weakening of the negative feedback mechanism
maintaining intraluminal acidity.
Objectives. In our present study we focus our attention to the
effectiveness of triple antimicrobial therapy in HP positive patients with
chronic active antrumgastritis residing in the lowering of the level of
serum gastrin.
Methods. There was a group of 15 patients in our current study
with HP positivity as well as chronic active antrumgastritis documented
by endoscopy, histology, microbiology and serology respectively. Endoscopical
and histological findings were classified according to The Sydney System".
The whole group was evaluated on an ambulatory basis, those with active
ulcer, endocrinopathy and biliary tract disorders were excluded. The basal
level of serum gastrin was evaluated by RIA-test-gastrin before and after
successful antimicrobial therapy.
Results. In our group of 15 patients with HP infection in coexistence
with chronic active antrumgastritis we have found a significant decrease
in the basal level of serum gastrin (p=0,01) after successful therapy.
Conclusion. The decrease in the basal level of serum gastrin
after eradication of HP confirms the importance of HP infection in the
pathogenesis of peptic lesions in stomach and duodenum. We consider the
antimicrobial therapy in chronic active antrumgastritis in HP positive
patients to be a fully indicated therapeutic approach. (Tab. 1, Fig.
1, Ref. 10.)
Key words: antimicrobial therapy, Helicobacter pylori infection.
Bratisl Lek Listy 1996; 97:131133
ANTIOXIDANT ENZYMES ACTIVITY IN HEALTHY PERSONS BLOOD
VOLKOVOVA K., BENO I., STARUCHOVA M., BOBEK P., MEKINOVA D., TATARA M.
Background. Under physiological conditions the dynamic balance
between the reactive oxygen production and detoxication is maintained.
Objectives. The study was aimed at the detection of the activity
of antioxidant enzymes: superoxide dismutase (SOD), catalase (CAT), glutathione
peroxidase (GPx) in erythrocytes and the level of malondialdehyde (MDA)
in the serum of healthy subjects, their relation to age, body weight, sex,
smoking, and the possible correlation between individual parameters.
Methods. The authors have examined 128 healthy volunteers (57
men and 71 women) from 20 to 72 years of age. The results were statistically
evaluated by means of the ANOVA programme.
Results. The group of healthy people had a large dispersion
of interindividual acitivities of antioxidant enzymes and MDA levels. Age
and weight were reversely correlated to the CAT activity in erythrocytes.
The CAT activity was significantly higher in women than in men, and the
GPx activity was lower in smokers than in non-smokers. The rest of investigated
parameters were not significantly influenced by sex of examined people
and smoking. Mutual correlation between individual enzymes were highly
significant.
Conclusions. A large dispersion of activities of the investigated
enzymes and MDA levels in healthy individuals do not allow to make a standard
use of these parametres in clinical practice. (Tab. 5, Fig. 2, Ref.
20.)
Key words: reactive oxygen, superoxide dismutase, catalase, glutathione
peroxidase, malondialdehyde.
Bratisl Lek Listy 1996; 97:134138
INTRACORONARY PRESSURE MEASUREMENTS AND ITS IMPORTANCE IN CLINICAL EVALUATION OF PATIENTS WITH ISCHAEMIC HEART DISEASE
BARTUNEK J., DE BRUYNE B., PIJLS N.H.J., HROMEC J., MALACKY T., CAGAN S.
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.)
Key words: coronary artery disease, coronary haemodynamic, transstenotic
pressure, atherosclerosclerotic lesion, cardiology, clinical practice.
Bratisl Lek Listy 1996; 97:139146
THE EXTRACRANIAL ANEURYSMS OF THE SUPRAAORTAL ARTERIES 8-YEARS EXPERIENCE
SEFRANEK V., TOMKA J., MOLCAN T., LESNY P., FISCHER V.
Background. There has been an obvious evidence of a rising incidence
of the supraaortic arteries aneurysms during the last 1015 years. It is
probably the consequence of both improved diagnostics and surgical technique.
Main purpose and starting points (objectives). Because of a
relatively high incidence of this group of aneurysms the authors of this
paper analyzed their own patients population.
Methods. From 1st Jan. 1987 to 31st Dec. 1994 10 patients were
admitted 10 patients with altogether 11 supraaortic trunk aneurysms. Last
year 5 patients with 5 aneurysms (45 per cent) were admitted. The mean
age of all patients was 57.5 (2088) years. The mean age in the group of
carotic artery aneurysms was 75.2 (7188) years, and 31 (2043) years in
the group of subclavian artery aneurysms, respectively. Both carotic and
subclavian arteries aneurysms were managed by the same technique aneurysm
resection and graft interposition. There were two exceptions. One of them
was a young woman with a small asymptomatic subclavian artery aneurysm
in connection with the thoracic outlet syndrome. The aneurysm has been
left in its place and followed up. The second exception was a young man
with a posttraumatic false aneurysm of the intrathoracic part of the right
subclavian artery. He died without surgery because of massive haemorrhage
due to the a false aneurysm rupture.
Main results. The hospital mortality of the group of operated
patients was zero. There has been one head nerve injury in this group and
100 per cent immediate patency, as well. All patients have been followed
up. There have been found an asymptomatic internal carotid artery occlusion,
the rest of reconstructions has been functioning.
Conclusions. The aneurysms of the extracranial supraaortic arteries
are rare vascular lesions. They have, however, a high incidence of unfavorable
sequelae, most of them of neurologic nature. The authors emphasize the
importance of proper diagnosis and early surgical intervention in selected
cases put into the hands of an experienced vascular surgeon. (Tab. 2,
Fig. 1, Ref. 17.)
Key words: aneurysms, extracranial supraaortal arteries, surgical
treatment.
Bratisl Lek Listy 1996; 97:147152
THE CHARACTERISTICS OF MULTIRESISTANT GRAM-NEGATIVE BACTERIA AND THEIR FREQUENCY IN THE FACULTY HOSPITAL IN OLOMOUC
KOLAR M., HEJNAR P., HAJEK V., KOUKALOVA D.
Currently, a persistant growth of bacterial resistance to antibiotics
takes place. Multiresistant bacterial strains thus represent a serious
danger for therapy in practice. The aim of the study was to characteristize
the multiresistant Gram-negative bacteria and to judge their antibiograms
by using the minimum inhibition concentrations (MIC). At the same time
the study evaluates the relations to the most frequent diagnoses and epidemiologic
data concerning the occurrence of these strains in different clinical cases
treated at individual departments of the Faculty Hospital in Olomouc. Out
of the total of 4.988 strains of Gram-negative rods, the number of isolated
multiresistant strains reached 316 (6.3 %). Individual bacterial species
were isolated in the following order: Pseudomonas aeruginosa (28.8 %),
Enterobacter cloacae (23.4 %) and Acinetobacter Baumannii complex (Acb
complex) (18.7 %). The most frequent occurrence of investigated bacteria
was registered at the departments in the following order: urology (45.9
%), internal medicine (18 %), paediatrics (13.6 %), and surgery (11.1 %).
The most frequent diagnoses based on positive cultivation of these bacteria
were the infections of the urogenital tract (53.8 %), postoperative infections
(16.8 %), and the infections of the upper respiratory ducts (7.3 %). 64.2
% of strains were cultivated from urine, 16.1% from pus, and 6.9 % from
swabs taken from the upper respiratory ducts. (Tab. 8, Ref. 18.)
Key words: Gram-negative bacteria, multiresistance to antibiotics,
minimal inhibition concentration.
Bratisl Lek Listy 1996; 97:153158
EPIDEMIOLOGICAL AND MICROBIOLOGICAL ASPECTS OF MYCOBACTERIOSES IN SLOVAKIA M. KANSASII
BADALIK L., SVEJNOCHOVA M., HONZATKOVA Z., KRISTUFEK P.
Mycobacterioses are diseases caused by mycobacteria other than those
that induce the classical tuberculosis: M. tbc (previously to as human"
type) and M. bovis (previously to as bovine" type of mycobacteria).
The purpose of this paper is to confront the limited knowledge about
the epidemiology of this disease abroad with the information obtained in
Slovakia. The methodology of this paper is based upon the surveillance
of tuberculosis as applied on mycobacterioses.
Pulmonary mycobacteriosis caused by M. kansasii was diagnosed in 51
subjects in Slovakia within the period 19791993: 47 men and 4 women. The
average age of men was 47 and of women 55 years. The highest incidence
of the disease was observed in Central Slovakia (25 subjects), followed
by Eastern Slovakia (18 subjects) and Western Slovakia (8 subjects). Geographic
distribution coincides with the profession of Slovak miners who work either
in the Slovak mining area or in Ostrava-Karvina mining complex. Miners
accounted for 20 out of 51 patients.
Apart from preventive measures applied in tuberculosis caused by M.
tbc, it is vitally important to pay great attention to the prevention and
treatment of pneumoconioses and chronic obstructive bronchitis. Both miners
and heavy smokers should avoid working in an environment where M. kansasii
is present. Examinations within the focus of the disease should be targeted
at the working environment (Ref. 13.)
Key words: epidemiology and microbiology, mycobacterioses, M. kansasii.
Bratisl Lek Listy 1996; 97:159161
ATYPICAL INFECTION CAUSED BY MICROSPORUM GYPSEUM, IMITATING A CIRCUMSCRIBED SCLERODERMA
VOLLEKOVA A., TOTHOVA I., KOLIBASOVA K., SEVCEKOVA A., BAUMGARTNER J.
The authors describe a case of a 31 year old woman who suffered from
sclerodermia circumscripta on her right leg. The diagnosis was hitopathologically
verified. Capillaroscopy and respiratory obstruction were positive. A new
lesion appeared on the right arm thus imitating morphea. However, by means
of mycological examinations Microsporum gypseum infection was recognized.
(Fig. 3, Ref. 13.)
Key words: morphea, tinea corporis, Microsporum gypseum.
Bratisl Lek Listy 1996; 97:162164
CHANGES IN THERMOREGULATION AND AGE HYPOTHERMIA AND HYPERTHERMIA
KOLESAR J.
The author presents a review of changes in thermoregulation in various
ages. The changes at infant and older ages are compared in contrast to
thermoregulation in healthy adults. Hypothermia occurs in all age groups,
especially in the aged. Then it is determined by both low temperature of
environment and impairment in production and expenditure of heat despite
the normal environment temperature. A special form of hypothermia is represented
by intraoperative hypothermia in the course of surgical performance under
general anaesthesia. Hyperthermia occurs most frequently as heatstroke
in consequence of high environmental temperature. The author presents etiopathogenesis
and pathomechanisms, possible treatment and prevention in thermoregulation
disturbances. (Tab. 6, Ref. 79.)
Key words: thermoregulation, thermogenesis, hypothermia, intraoperative
hypothermia, hyperthermia, critical temperature, heat generation.
Bratisl Lek Listy 1996; 97:165174