Acta medica (Hradec Kralove)最新文献

Addison's disease (AD) is characterized by non-specific symptoms and electrolyte disorders, namely hyponatraemia and hyperkalaemia; rhabdomyolysis is uncommon. AD may manifest at onset with a life-threatening adrenal crisis which is triggered by stressful events. We describe the case of a young man who was hospitalized for severe myalgia and fatigue. Severe hypotonic hyponatraemia, rhabdomyolysis and hypotension were found; hormonal assessment unexpectedly revealed primary adrenal insufficiency. Saline infusion and intravenous hydrocortisone significantly improved the patient's condition and normalized sodium and muscle enzyme levels; thereafter, he was switched to oral steroid therapy. The autoimmune origin of AD was ascertained by the positivity of adrenal cortex autoantibodies and 21b-hydroxylase autoantibodies. The association of hyponatraemia and rhabdomyolysis may be the initial finding of an as yet unknown AD, which requires proper investigation and treatment.

Introduction: This case report aims to showcase the successful application of electron hypofractionated radiotherapy in the treatment of eyelid basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Cases presentation: Two cases are presented involving a 91-year-old Greek female with nodular BCC and an 88-year-old Greek male with ulcerative SCC. Both cases were treated with electron 10MeV irradiation using an ELEKTA 5-15MV linear accelerator. In the first case, a patient with advanced dementia presented with left-upper-eyelid nodular BCC. Following confirmation through biopsy and imaging, hypofractionated electron-beam radiotherapy was chosen, leading to gradual recession of the lesion and no recurrence at the one-year follow-up. In the second case, an elderly male with comorbidities had right-upper-eyelid ulcerative SCC. After systemic evaluation ruled out metastasis, the patient underwent hypofractionated radiotherapy, resulting in unexpected lesion shrinkage, resolution, and absence of recurrence at the 6-month and one-year follow-ups.

Conclusions: Hypofractionated electron-beam radiotherapy emerges as an effective and well-tolerated alternative for eyelid tumors, particularly in cases where surgical excision is challenging or contraindicated.

Henipaviruses, including Hendra and Nipah viruses, represent significant zoonotic threats with higher mortality rates. Due to limited therapeutic interventions, poses substantial challenges. These bat-borne pathogens were first identified in Australia (Hendra, 1994) and Malaysia (Nipah, 1998-1999), with subsequent multiple outbreaks. The recent discovery of Camp Hill virus in North American shrews, suggest broader geographic distribution than previously recognized. Transmission occurs primarily through contact with reservoir hosts, though human-to-human spread has been documented in Nipah outbreaks. Initial non-specific febrile symptoms can progress to fatal encephalitis with distinctive pathological findings including syncytia formation and vasculitis. A concerning feature is the potential for relapsing encephalitis months or years after initial infection. Management remains predominantly supportive, highlighting the urgent need for effective antivirals, vaccines, and enhanced surveillance. Expanded research into therapeutic countermeasures is essential to address this emerging global public health threat.

Background: To this date, the impact of body weight on total hip arthroplasty is still debated. The literature lacks evidence on the impact of body weight on surgical times and complications.

Methods: We retrospectively evaluated all the patients who underwent primary total hip arthroplasty (THA), collecting patients' pre-operative BMI before surgery. We recorded the surgical approach performed (anterior or posterolateral), and their duration. All the major complications were recorded.

Results: Seven-hundred-thirty-two cases were included (627 posterolateral and 105 anterior approach). The mean BMI was 27.3. The mean surgical time was 90.8 minutes (104.9 for anterior and 88.5 for posterolateral approach). We found a significant positive relationship between BMI and surgical times for both cases treated with a posterolateral approach, and (even more remarked) in case anterior approach. Thirty-nine cases (5.3%) had major complications; 27 of them (69.2%) were overweight or obese. The surgical times of those who had complications were significantly higher compared to others.

Conclusions: Patients' body weight, and in particular their Body Mass index, has a direct impact on the duration of THA surgical procedures, particularly if performed using an anterior approach, and an indirect effect on complication rates.

Cartilage damage is caused by degenerative process and also by trauma, microtrauma or as a consequence of avascular necrosis. The damage may be focal or diffuse over a larger area. Because of the limited healing potential, treatment of articular cartilage injuries is problematic. The choice of surgical treatment depends on several factors: the size, depth and location of the defect, the age of the patient, the desired activity, associated changes and the possibility of postoperative rehabilitation. Finding an appropriate method of treatment for chondral defects with a reliable long-term outcome is difficult. The most common, clinically proven and used surgical techniques include abrasive chondroplasty, marrow stimulating techniques, transplantation procedures or a combination of methods. The possibility of introducing new methods in the form of the application of cultured mesenchymal stem cells represents a significant advance in the field of regenerative medicine. Their use is safe and effective.

Purpose: Oxidized cellulose-based haemostatic agents are widely used for managing bleeding in various surgical procedures. This study evaluates the efficacy and safety of oxidized cellulose powder and an endoscopic applicator across a broad spectrum of surgical settings.

Methods: This was a prospective, multicentre study involving 99 evaluable patients undergoing surgeries with varying bleeding severities and surgical approaches (open, laparoscopic, or thoracoscopic). The primary endpoint was achieving haemostasis within 3 minutes and avoiding revision surgery within 12 hours. The time to haemostasis (TTH) and complications were recorded, and statistical comparisons were made using a paired and unpaired t-test, with a significance threshold of P < 0.05. Data from this study were compared to historical results from fibrillar haemostats.

Results: Haemostasis was achieved within 3 minutes in 61.6% (95% CI [52.0, 71.2]) of patients and within 5 minutes in 99.0% (95% CI [97.0, 100.0]) of patients. The overall mean TTH was 153.8 seconds (95% CI: 141.5-166.1), with shorter TTH observed in minimally invasive procedures using the endoscopic applicator. Subgroup analysis revealed higher success rates for patients with mild bleeding (78%) compared to moderate bleeding (50%).

Conclusion: Oxidized cellulose powder demonstrates reliable haemostatic performance across diverse surgical applications. The endoscopic applicator enhances precision and applicability, particularly in minimally invasive settings, making it a valuable tool in modern surgical practice.

Anomalous extensor indicis proprius (EIP) tendons are rare anatomical variations that can cause wrist pain and dysfunction due to tendon compression and inflammation. These variations, though often asymptomatic, are implicated in conditions such as fourth extensor compartment peritendinitis, requiring accurate diagnosis and tailored treatment. We report the case of a 56-year-old man with chronic right wrist pain lasting eight months, primarily aggravated by finger extension. Physical examination revealed a tender nodule on the dorsum of the wrist and pain elicited by the Spinner test, indicating involvement of the fourth dorsal compartment. Magnetic resonance imaging (MRI) showed an anomalous, thickened EIP tendon with peritendinitis. The patient opted for conservative management, including nonsteroidal anti-inflammatory drugs (NSAIDs) and activity modification, which led to complete symptom resolution within two weeks. This case highlights the clinical relevance of EIP tendon anomalies, which can mimic other wrist pathologies. The Spinner test and imaging modalities such as MRI are essential for diagnosis. While conservative treatment is often sufficient, surgical decompression may be necessary in refractory cases. Awareness of these rare anatomical variations is crucial for accurate diagnosis and effective management, ensuring better outcomes for patients with wrist pain.

Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNAC) with the employment of cell block preparations and intraoperative squash smear cytology upgrade the interpretation accuracy and typing of common malignant lesions. Yet, their capacity in the diagnostic workup of less familiar neoplastic entities is not clearly determined and this analysis was designed towards this direction. We describe four cases of patients with uncommon malignancies and evaluate EUS-FNA cell block cytology and intraoperative squash smear cytology as a necessary (important) step in rendering the diagnosis. All cases enhance the diagnostic role of cytology in a wide variety of neoplastic disorders including lymphoproliferative conditions and rare carcinomas.

Objective: The objective of this study is to assess the expression levels of different immaturity CD markers in diverse subtypes of Acute Lymphoblastic Leukemia (ALL) among children and adults, and determine any statistically significant variations in marker expression between these two groups.

Methods: This dataset included CD marker expressions (CD34, HLA-DR, TdT, and CD38) for 130 ALL patients (51 pediatric B-ALL, 16 pediatric T-ALL, 44 adult B-ALL, and 19 adult T-ALL patients). The Shapiro-Wilk test analysis was conducted to check for normality distribution in all data points before proceeding with the statistical analysis test. As a result for each marker within these subtypes, descriptive statistics were calculated. Independent samples t-tests were initially conducted to compare mean expression levels of CD markers between groups. Moreover, since non-normal distributions are likely to occur, Mann-Whitney U tests were used for Pediatric T-ALL and Adult T-ALL.

Results: Descriptive analysis indicated variability in CD marker expression levels among the different subtypes of ALL. Both t-tests and Mann-Whitney U tests revealed statistically significant differences (p < 0.05) in the expression levels of CD markers between pediatric and adult groups, or between B-ALL and T-ALL groups.

Conclusion: Significant differences have been identified using different analysis methods across the studied groups. The investigation analyzes the expression levels of CD34, HLA-DR CD38, and TdT within pediatric B-ALL patients and pediatric T-ALL patients along with adult B-ALL patients and adult T-ALL patients. The patterns need appreciation because they might reveal biological differences at their base which influence disease development and both treatment results and patient survival outcomes.

Arginine vasopressin (AVP) is a key regulator of fluid balance and vascular tone. Its diagnostic utility in various disorders is limited by its short half-life, pulsatile secretion, and preanalytical instability. Copeptin, the C-terminal fragment of preprovasopressin, is secreted in equimolar amounts with AVP and offers a stable, easily measurable surrogate marker. This review highlights the clinical relevance of copeptin in the differential diagnosis of polyuria-polydipsia syndrome, hyponatraemia, critical illness, cardiovascular disease and diabetes mellitus. Copeptin improves diagnostic accuracy, particularly in differentiating types of diabetes insipidus and in the early exclusion of acute myocardial infarction. It also shows prognostic value in heart failure, stroke, and diabetic complications. Given its broad diagnostic potential and analytical advantages, copeptin represents a valuable biomarker for AVP-related pathologies.