Acta medica (Hradec Kralove)最新文献

Chronic diarrhea is a significant challenge in clinical practice because of its high prevalence and various causes. Comprehensive clinical assessment and stepwise laboratory approach are crucial for an accurate diagnosis. This report presents a case of an adult woman who experienced chronic watery diarrhea, complicated by renal impairment and multiple electrolyte imbalances, including hypokalemia, hypophosphatemia, and metabolic acidosis. The diagnosis of a vasoactive intestinal polypeptide-secreting tumor (VIPoma) with liver metastases was confirmed by elevated serum levels of a vasoactive intestinal polypeptide (VIP) and imaging findings of a pancreatic mass with multiple hepatic lesions. Preoperative management, including fluid rehydration, electrolyte correction, and somatostatin analog therapy, significantly improved her clinical symptoms. Subsequent surgical tumor removal and radiofrequency ablation of the hepatic lesions resulted in complete resolution of symptoms and normalized VIP levels. This case emphasizes the importance of early recognition of this rare tumor in patients with chronic diarrhea to improve clinical outcomes.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is frequently associated with syndromes, such as those within the PAPA spectrum. Syndromic HS presents unique management challenges, as it often shows resistance to conventional therapies. Pyoderma gangrenosum is a rare inflammatory neutrophilic dermatosis that is often seen in association within the spectrum of autoinflammatory diseases. The PAPA spectrum disorders include a group of autoinflammatory diseases characterized by mutations in the PSTPIP1 gene or by clinical manifestations that closely resemble or overlap with those of PAPA syndrome. Each syndrome (PASH, PAPASH, PsAPASH, PASS, PAC, and PAMI syndrome) in this spectrum highlights specific inflammatory pathways and symptoms, providing insight into targeted therapeutic approaches. Here, we present a rare case of incomplete PASH (pyoderma gangrenosum and hidradenitis suppurativa) syndrome successfully managed with a standard combination of antibiotics (ceftriaxone and metronidazole) and corticosteroids (methylprednisolone), followed by immunosuppressant (azathioprine) and corticosteroids (dexamethasone). We review both novel and established/standard treatment options, with an emphasis on treatment outcomes. Conventional therapies remain both effective and affordable, providing valuable alternatives for patients.

Solitary Fibrous Tumor (SFT) is a rare mesenchymal tumor with a higher incidence of benign than malignant, most common location in the pleura. Although this tumor has been found in other locations in the body such as the head and neck region, retroperitoneal space, and intra-abdominal omentum, SFT of the gallbladder remains extremely rare in the medical literature. In this article, we present the imaging characteristics of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of gallbladder SFT, thereby contributing to providing information in the study of this rare pathology.

The advent and dominance of social media in our daily lives is not a matter of discussion, and very few minimalistic individuals have tried to decrease this technological dependency, which can become toxic and noxious for the development of an autonomous personality and free thinking. Academic faculties claim a depauperation in terms of their freedom but are also not free from duties, responsibilities, and obligations. Here, duties, responsibilities, obligations, and freedom are addressed in historical terms as the university as an institution developed over the centuries after its founding in the 11th century is currently under attack. We premonish that these concepts must still be reiterated and divulgated to students and fellows in academia. Galilei's "Eppur si muove" ("and yet it moves") are the words pronounced by the Italian mathematician, physicist, and philosopher Galileo Galilei that should resonate in censorship bodies now and in the future.

Purpose: To screen visual acuity in two refugee camps in Greece and explore the feasibility of replicating these methods on a nationwide scale.

Methods: Visual acuity was assessed in all participants using web-based Democritus Digital Acuity & Reading Test (DDART). Furthermore, the immigrants responded to a structured questionnaire regarding their demographics and medical history.

Results: A total of 330 adult refugees and immigrants were recruited. A total of 47.3% of the patients had never undergone ophthalmological examination. A significant negative correlation was detected between age (r = -0.207, p < 0.001) and educational background (r = -0.135, p = 0.014), suggesting that younger immigrants who had attended compulsory education were more likely to have their eyes checked in their home country. A total of 6.97% of patients presented with impaired vision and were referred for further care. All remote DDART measurements presented no differences from the corresponding hospital-based data in the referred cases.

Conclusions: Visual acuity screening using DDART provides valuable information regarding the visual capacity of refugees. The study outcomes suggest that pilot methods can be replicated on a nationwide scale.

Clinical trials: Gov number NCT05209581; date of registration: January 13, 2022. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no funding or conflicts of interest to disclose. Patients Consent Statement: The patients sign written consent form.

X-linked agammaglobulinemia (XLA) was one of the first inborn errors of immunity to be described. It is caused by pathogenic variants in the gene for Bruton tyrosine kinase (BTK), which has important functions in B cell development and maturation. Recurrent bacterial infections in the first two years of life and hypogammaglobulinemia with absent B cells in male patients are the most common symptoms. A four-month-old male patient underwent surgical removal of urachus persistens complicated with recurrent scar abscesses. Hypogammaglobulinemia (IgG, IgA, and IgM), low phagocytic activity, mild neutropenia, and a normal percentage of B cells were observed in the patient's immune laboratory profile. Over time, he suffered recurrent respiratory infections (otitis media and rhinosinusitis) and developed B cell depletion, but interestingly, this was with a normalisation of IgG and IgA levels along with undetectable IgM. Molecular-genetic testing confirmed the presence of the pathogenic variant c.1843C>T in the BTK gene, which is associated with a milder phenotype of XLA. Molecular-genetic testing uncovers the variability of clinical and laboratory features of apparently well-known inherited disorders. Patients with mild "leaky" XLA may have normal levels of non-functional or oligoclonal immunoglobulins.

Zirconia ceramics have become popular among other dental ceramics thanks to their biological, mechanical, optical, and aesthetic properties. CAD/CAM (computer-aided design/ computer-aided manufacturing) technology improvement has played a vital role in the increased popularity of zirconia ceramics; easy computer manipulation significantly expanded the possibility of using different types of restorations. Zirconia ceramics have a broad spectrum of indications in prosthetic dentistry, from simple restorations to complex structures supported by dental implants. A good orientation in the classification, features, and manipulation of zirconia ceramics is the main key to success.

Background: During otosclerosis surgery, operative trauma can lead to decreased bone conduction.

Aims: The study aims to observe the bone conduction changes after otosclerosis operations and analyse possible factors affecting the postoperative decrease in bone conduction.

Material and methods: Authors retrospectively processed the data of 109 patients and evaluated pure tone audiometry before surgery and consequently 2 days, 1 month and 1 year after surgery.

Results: We noted a deterioration of bone conduction >5 dB on the second postoperative day in 28% (30/109) of patients, which persisted one year after the surgery in 9% (10/109) cases. Analysis of individual factors affecting bone conduction loss revealed a higher risk of permanent loss of bone conduction in patients with early postoperative loss in higher frequencies, in older patients and patients with a preoperative threshold of bone conduction >20 dB. Revision surgery was not a statistically significant factor.

Conclusion and significance: The bone conduction decrease after otosclerosis surgery is usually temporary. The recovery of bone conduction is influenced by the age of patients and the level of bone conduction before the surgery. The early postoperative decrease of bone conduction in higher frequencies is a negative predictive factor for permanent hearing loss.

Colloid cyst of the third ventricle (CC) represents approximately 1% of intracranial tumours and 20% of intraventricular tumours. CC usually occurs between 20 and 50 years of age. During the first decade of life, it is diagnosed very rarely (1-2%). It can be most commonly found in the anterior part of the third ventricle at the foramen of Monro (1). It is often visualised during the computed tomography (CT) examination as a hyperdense focal lesion, it has variable change of the signal during magnetic resonance imaging (MRI) (2). CC has a benign character, however, a strategic position which may lead to acute hydrocephalus, intracranial hypertension syndrome, consciousness disorder, and even sudden death. This peracute hydrocephalus is an indication to an acute neurosurgical procedure (3).

Introduction: The sex ratio at birth (male/total births, M/T) is expected to approximate 0.515. M/T is influenced by many factors including stress. Both World Wars have been implicated as influencing birth rates and M/T. This study was carried out to analyse the effects of two World Wars on Belgium vis-à-vis missing births as well as M/T changes.

Methods: Belgian male and female births were available for 1830-2019 and annual population was available from Statista. ARIMA models were used to estimate and project birth losses. The effect of wars was assumed to begin in the years following the commencement of each war and extend to the year after cessation of hostilities i.e., 1915-1919 and 1940-1946 for the First and Second World Wars respectively.

Results: This study included 27,346,178 live births for 1830-2019, M/T 0.5124. There was a decreasing trend in births for 1830-2019, significant for 1950-2019. There were dips in births in association with both Wars resulting in over 440,000 missing births, 3.80% of the Belgian population for the First World War and 1.91% for the Second World War. M/T rose non-significantly for the First World War and significantly for the Second World War.

Discussion: The declining birth rate and M/T in developed countries is a recognised phenomenon. The missing births in relation to wars are of demographic importance but are often overlooked with emphasis usually on casualties and deaths. M/T may rise in wars, possibly due to increased coital activity as well as other factors.