High and dry: integrative taxonomy of the Andean spider genus Nerudia (Araneae: Pholcidae)

Ninetinae are a group of poorly known spiders that do not fit the image of ‘daddy long-legs spiders’ (Pholcidae), the family to which they belong. They are mostly short-legged, tiny and live in arid environments. The previously monotypic Andean genus Nerudia exemplifies our poor knowledge of Ninetinae: only seven adult specimens from two localities in Chile and Argentina have been reported in the literature. We found representatives of Nerudia at 24 of 52 localities visited in 2019, mostly under rocks in arid habitats, up to 4450 m a.s.l., the highest known record for Pholcidae. With now more than 400 adult specimens, we revise the genus, describing ten new species based on morphology (including SEM) and COI barcodes. We present the first karyotype data for Nerudia and for its putative sister-genus Gertschiola. These two southern South American genera share a X1X2X3Y sex chromosome system. We model the distribution of Nerudia, showing that the genus is expected to occur in the Atacama biogeographic province (no record so far) and that its environmental niche is phylogenetically conserved. This is the first comprehensive revision of any Ninetinae genus. It suggests that focused collecting may uncover a considerable diversity of these enigmatic spiders.

Karyotype differentiation and male meiosis in European clades of the spider genus Pholcus (Araneae, Pholcidae)

Haplogyne araneomorphs are a diverse spider clade. Their karyotypes are usually predominated by biarmed (i.e., metacentric and submetacentric) chromosomes and have a specific sex chromosome system, X₁X₂Y. These features are probably ancestral for haplogynes. Nucleolus organizer regions (NORs) spread frequently from autosomes to sex chromosomes in these spiders. This study focuses on pholcids (Pholcidae), a highly diverse haplogyne family. Despite considerable recent progress in pholcid cytogenetics, knowledge on many clades remains insufficient including the most species-rich pholcid genus, Pholcus Walckenaer, 1805. To characterize the karyotype differentiation of Pholcus in Europe, we compared karyotypes, sex chromosomes, NORs, and male meiosis of seven species [P.alticeps Spassky, 1932; P.creticus Senglet, 1971; P.dentatus Wunderlich, 1995; P.fuerteventurensis Wunderlich, 1992; P.phalangioides (Fuesslin, 1775); P.opilionoides (Schrank, 1781); P.silvai Wunderlich, 1995] representing the dominant species groups in this region. The species studied show several features ancestral for Pholcus, namely the 2n♂ = 25, the X₁X₂Y system, and a karyotype predominated by biarmed chromosomes. Most taxa have a large acrocentric NOR-bearing pair, which evolved from a biarmed pair by a pericentric inversion. In some lineages, the acrocentric pair reverted to biarmed. Closely related species often differ in the morphology of some chromosome pairs, probably resulting from pericentric inversions and/or translocations. Such rearrangements have been implicated in the formation of reproductive barriers. While the X₁ and Y chromosomes retain their ancestral metacentric morphology, the X₂ chromosome shows a derived (acrocentric or subtelocentric) morphology. Pairing of this element is usually modified during male meiosis. NOR patterns are very diverse. The ancestral karyotype of Pholcus contained five or six terminal NORs including three X chromosome-linked loci. The number of NORs has been frequently reduced during evolution. In the Macaronesian clade, there is only a single NOR-bearing pair. Sex chromosome-linked NORs are lost in Madeiran species and in P.creticus. Our study revealed two cytotypes in the synanthropic species P.phalangioides (Madeiran and Czech), which differ by their NOR pattern and chromosome morphology. In the Czech cytotype, the large acrocentric pair was transformed into a biarmed pair by pericentric inversion.

Atypus karschi Dönitz, 1887 (Araneae: Atypidae): An Asian purse-web spider established in Pennsylvania, USA

The mygalomorph spiders of the family Atypidae are among the most archaic spiders. The genus Atypus Latreille, 1804 occurs in Eurasia and northern Africa, with a single enigmatic species, Atypus snetsingeri Sarno, 1973, known only from a small area in southeastern Pennsylvania in eastern USA. A close relationship to European species could be assumed based on geographic proximity, but A. snetsingeri more closely resembled Asian species. This study was undertaken to learn more about the genetics of A. snetsingeri, its habitat requirements and natural history. Molecular markers (CO1 sequences) were compared to available data for other atypids and showed that A. snetsingeri is identical with A. karschi Dönitz, 1887 native to East Asia. Natural history parameters in Pennsylvania were also similar in every respect to A. karschi in Japan, therefore, we propose that the spider is an introduced species and the specific epithet snetsingeri is relegated to a junior synonym of A. karschi. Cytogenetic analysis showed an X0 sex chromosome system (42 chromosomes in females, 41 in males) and we also detected nucleolus organizing regions and heterochromatin, the latter for the first time in the Atypoidea. In Pennsylvania the spider is found in a variety of habitats, from forests to suburban shrubbery, where the above-ground webs are usually attached vertically to trees, shrubs, or walls, although other webs are oriented horizontally near the ground. Prey include millipedes, snails, woodlice, carabid beetles and earthworms. Atypus karschi is the first known case of an introduced purse-web spider. It is rarely noticed but well-established within its range in southeastern Pennsylvania.

Insights into the Karyotype Evolution of Charinidae, the Early-Diverging Clade of Whip Spiders (Arachnida: Amblypygi)

Whip spiders (Amblypygi) represent an ancient order of tetrapulmonate arachnids with a low diversity. Their cytogenetic data are confined to only a few reports. Here, we analyzed the family Charinidae, a lineage almost at the base of the amblypygids, providing an insight into the ancestral traits and basic trajectories of amblypygid karyotype evolution. We performed Giemsa staining, selected banding techniques, and detected 18S ribosomal DNA and telomeric repeats by fluorescence in situ hybridization in four Charinus and five Sarax species. Both genera exhibit a wide range of diploid chromosome numbers (2n = 42-76 and 22-74 for Charinus and Sarax, respectively). The 2n reduction was accompanied by an increase of proportion of biarmed elements. We further revealed a single NOR site (probably an ancestral condition for charinids), the presence of a (TTAGG)n telomeric motif localized mostly at the chromosome ends, and an absence of heteromorphic sex chromosomes. Our data collectively suggest a high pace of karyotype repatterning in amblypygids, with probably a high ancestral 2n and its subsequent gradual reduction by fusions, and the action of pericentric inversions, similarly to what has been proposed for neoamblypygids. The possible contribution of fissions to charinid karyotype repatterning, however, cannot be fully ruled out.

Evolutionary pattern of karyotypes and meiosis in pholcid spiders (Araneae: Pholcidae): implications for reconstructing chromosome evolution of araneomorph spiders

BACKGROUND

Despite progress in genomic analysis of spiders, their chromosome evolution is not satisfactorily understood. Most information on spider chromosomes concerns the most diversified clade, entelegyne araneomorphs. Other clades are far less studied. Our study focused on haplogyne araneomorphs, which are remarkable for their unusual sex chromosome systems and for the co-evolution of sex chromosomes and nucleolus organizer regions (NORs); some haplogynes exhibit holokinetic chromosomes. To trace the karyotype evolution of haplogynes on the family level, we analysed the number and morphology of chromosomes, sex chromosomes, NORs, and meiosis in pholcids, which are among the most diverse haplogyne families. The evolution of spider NORs is largely unknown.

RESULTS

Our study is based on an extensive set of species representing all major pholcid clades. Pholcids exhibit a low 2n and predominance of biarmed chromosomes, which are typical haplogyne features. Sex chromosomes and NOR patterns of pholcids are diversified. We revealed six sex chromosome systems in pholcids (X0, XY, X1X20, X1X2X30, X1X2Y, and X1X2X3X4Y). The number of NOR loci ranges from one to nine. In some clades, NORs are also found on sex chromosomes.

CONCLUSIONS

The evolution of cytogenetic characters was largely derived from character mapping on a recently published molecular phylogeny of the family. Based on an extensive set of species and mapping of their characters, numerous conclusions regarding the karyotype evolution of pholcids and spiders can be drawn. Our results suggest frequent autosome-autosome and autosome-sex chromosome rearrangements during pholcid evolution. Such events have previously been attributed to the reproductive isolation of species. The peculiar X1X2Y system is probably ancestral for haplogynes. Chromosomes of the X1X2Y system differ considerably in their pattern of evolution. In some pholcid clades, the X1X2Y system has transformed into the X1X20 or XY systems, and subsequently into the X0 system. The X1X2X30 system of Smeringopus pallidus probably arose from the X1X20 system by an X chromosome fission. The X1X2X3X4Y system of Kambiwa probably evolved from the X1X2Y system by integration of a chromosome pair. Nucleolus organizer regions have frequently expanded on sex chromosomes, most probably by ectopic recombination. Our data suggest the involvement of sex chromosome-linked NORs in achiasmatic pairing.

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

We aimed was to assess the factors influencing therapy choice and clinical outcome after 3-4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3-4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0-1). Multivariate logistic regression analysis was used for statistical evaluation. After 3-4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.

Patterns of Sex Chromosome Differentiation in Spiders: Insights from Comparative Genomic Hybridisation

Spiders are an intriguing model to analyse sex chromosome evolution because of their peculiar multiple X chromosome systems. Y chromosomes were considered rare in this group, arising after neo-sex chromosome formation by X chromosome-autosome rearrangements. However, recent findings suggest that Y chromosomes are more common in spiders than previously thought. Besides neo-sex chromosomes, they are also involved in the ancient X1X2Y system of haplogyne spiders, whose origin is unknown. Furthermore, spiders seem to exhibit obligatorily one or two pairs of cryptic homomorphic XY chromosomes (further cryptic sex chromosome pairs, CSCPs), which could represent the ancestral spider sex chromosomes. Here, we analyse the molecular differentiation of particular types of spider Y chromosomes in a representative set of ten species by comparative genomic hybridisation (CGH). We found a high Y chromosome differentiation in haplogyne species with X1X2Y system except for Loxosceles spp. CSCP chromosomes exhibited generally low differentiation. Possible mechanisms and factors behind the observed patterns are discussed. The presence of autosomal regions marked predominantly or exclusively with the male or female probe was also recorded. We attribute this pattern to intraspecific variability in the copy number and distribution of certain repetitive DNAs in spider genomes, pointing thus to the limits of CGH in this arachnid group. In addition, we confirmed nonrandom association of chromosomes belonging to particular CSCPs at spermatogonial mitosis and spermatocyte meiosis and their association with multiple Xs throughout meiosis. Taken together, our data suggest diverse evolutionary pathways of molecular differentiation in different types of spider Y chromosomes.

Cytological-energy analysis of pleural effusions

Background

Simultaneous cytological and metabolic investigation of the pleural effusion provides clinically relevant information about the type and intensity of immune response in the pleural cavity.

Methods

We investigated 1329 pleural effusions from patients with different pathological changes in the pleural cavity. Evaluated parameters were differential cell count of neutrophils, eosinophils, lymphocytes and monocytes, and values of the coefficient of energy balance.

Results

We found the lowest numbers of cells and the highest coefficient of energy balance values in patients with heart failure and sepsis; relatively high frequency of eosinophils and slightly decreased coefficient of energy balance values in patients with pneumothorax and haemothorax; the predominance of lymphocytes and low coefficient of energy balance values in patients with tuberculous pleuritis; the predominance of neutrophils and variable coefficient of energy balance values in patients after chest surgery; the highest presence of neutrophils and very low coefficient of energy balance values in patients with chest empyema and the predominance of lymphocytes and normal to low coefficient of energy balance values in patients with pleural malignancy.

Conclusions

Our findings in patients with heart failure and sepsis suggest the absence of inflammation in the pleural cavity. We observed the manifestation of tissue repair in patients with pneumothorax and haemothorax. Patients with tuberculous pleuritis were predominantly characterized by T cell-driven immune response and oxidative burst of macrophages. We found different intensities of immune responses to the chest surgery. The typical finding in patients with empyema was oxidative burst of neutrophils. In patients with pleural malignancy, weak cytotoxic inflammation predominates together with the intensive inflammation characterized by oxidative burst of macrophages.

Insights into the karyotype and genome evolution of haplogyne spiders indicate a polyploid origin of lineage with holokinetic chromosomes

Spiders are an ancient and extremely diverse animal order. They show a considerable diversity of genome sizes, karyotypes and sex chromosomes, which makes them promising models to analyse the evolution of these traits. Our study is focused on the evolution of the genome and chromosomes in haplogyne spiders with holokinetic chromosomes. Although holokinetic chromosomes in spiders were discovered a long time ago, information on their distribution and evolution in these arthropods is very limited. Here we show that holokinetic chromosomes are an autapomorphy of the superfamily Dysderoidea. According to our hypothesis, the karyotype of ancestral Dysderoidea comprised three autosome pairs and a single X chromosome. The subsequent evolution has frequently included inverted meiosis of the sex chromosome and an increase of 2n. We demonstrate that caponiids, a sister clade to Dysderoidea, have enormous genomes and high diploid and sex chromosome numbers. This pattern suggests a polyploid event in the ancestors of caponiids. Holokinetic chromosomes could have arisen by subsequent multiple chromosome fusions and a considerable reduction of the genome size. We propose that spider sex chromosomes probably do not pose a major barrier to polyploidy due to specific mechanisms that promote the integration of sex chromosome copies into the genome.

Taxonomic revision and insights into the speciation mode of the spider Dysdera erythrina species-complex (Araneae : Dysderidae): sibling species with sympatric distributions

The genus Dysdera Latreille, 1804, a species-rich group of spiders that includes specialised predators of woodlice, contains several complexes of morphologically similar sibling species. Here we investigate species limits in the D. erythrina (Walckenaer, 1802) complex by integrating phenotypic, cytogenetic and molecular data, and use this information to gain further knowledge on its origin and evolution. We describe 16 new species and redescribe four poorly known species belonging to this clade. The distribution of most of the species in the complex is limited to southern France and the north-eastern Iberian Peninsula. The species studied do not show any obvious differences in habitat preference, and some of them even occur sympatrically at certain sites. They probably feed on the same type of prey as they readily capture woodlice. On the other hand, they differ in body size, mouthparts shape, sculpturing of carapace, morphology of the copulatory organs, karyotype and DNA sequences. Experimental interspecific mating showed a partial precopulatory behavioural barrier between D. erythrina and D. cechica, sp. nov. Our data suggest that karyotype evolution of the complex included chromosome fusions and fissions as well as translocations (between autosomes as well as autosomes and sex chromosomes). We hypothesise that chromosome rearrangements generating reproductive incompatibility played a primary role in speciation within Dysdera complexes. Dysdera spiders are poor dispersers, and their original distribution areas (forested areas in the Mediterranean) were repeatedly fragmented during Quarternary climatic oscillations, facilitating integration of chromosome rearrangements into karyotypes by genetic drift. Sympatric occurrence of closely related species may have been promoted by prey segregation as suggested by differentiation in body size in co-occurring species. The following new species are described: D. catalonica, sp. nov., D. cechica, D. dolanskyi, sp. nov., D. fabrorum, sp. nov., D. garrafensis, sp. nov., D. graia, sp. nov., D. kropfi, sp. nov., D. minairo, sp. nov., D. portsensis, sp. nov., D. pradesensis, sp. nov., D. pyrenaica, sp. nov., D. quindecima, sp. nov., D. septima, sp. nov., D. stahlavskyi, sp. nov., D. tredecima, sp. nov. and D. undecima, sp. nov.

Fixation of biomaterial to metallic stent and fixation of stents after circular endoscopic dissection in the esophagus on an animal model

INTRODUCTION

Complete circular endoscopic (submucosal) resection (CER) performed using the endoscopic submucosal dissection (ESD) technique is burdened with a high incidence of post-operative strictures in the esophagus. The most effective method of preventing them is not known so far; one of the possible methods is to prevent these strictures directly at the site of their formation by covering the defect with a stent. The aim of the study was to find a way to fix a selected biomaterial to a stent, and subsequently, to fix the stent at the CER site to prevent esophageal strictures in an animal model.

METHOD

Miniature piglets from the Czech Academy of Sciences breeding unit in Libechov (N=10) were used. Endoscopy was performed using a single-channel endoscope. First, we made two circular mucosal cuts spaced 5 cm apart in the middle esophagus and we performed the CER between them using the endoscopic submucosal dissection technique. After that, we covered the defect with a stent coated with biomaterial (Xe-Derma®) while we tried to prevent stent migration into the stomach. For stent fixation, we tested endo-clips (N=3), the Apollo endoscopic system (N=1) and the suspension technique using two polyamide threads (N=6) anchored in the nasal septum. We performed a control endoscopy, stent removal and subsequent autopsy after 12 weeks.

RESULTS

All procedures were completed successfully without serious complications or deaths. Although stents covered with Xe-Derma® were applied to the entire resection area, one case of mediastinitis and one paraesophageal abscess were found during autopsy, most likely due to microperforations caused during the procedure. Histological analysis showed that after contact with the biomaterial, re-epithelisation took place within one week of application to the resection area. Stent migration occurred in each case when the stent was attached to the esophageal wall by endo-clips or with the endoscopic suture system (Apollo). There was no stent dislocation in the cases where the stent was suspended by two polyamide threads.

CONCLUSION

We developed a technique of fixing biomaterial to the surface of metallic stents which we used to prevent the formation of esophageal strictures after CER. Distal suspension fixation of the stent with a polyamide thread proved to be the most effective, while fixations by endo-clips or with the endoscopic suture system were ineffective.Key words: benign esophageal strictures circular endoscopic resection endoscopic submucosal dissection complication prevention.

[Molecular Pathogenesis of Colorectal Cancer]

BACKGROUND

Colorectal cancer (CRC) remains a major health burden with an incidence of 1.3 million new cases worldwide and a mortality of almost 8.5%. It is the 2nd most common cancer in women (1st breast carcinoma) and 3rd most common in men (1st lung carcinoma, 2nd prostate carcinoma). CRC alongside breast, lung, prostate and stomach cancer is in the top five most common cancers in men and women worldwide. There are still more than 50% of CRC patients diagnosed with advanced disease (stage III and IV) in the Czech Republic. Genetically, CRC is a very heterogeneous disease with many factors playing key roles in pathogenesis. There are two types of CRC, hereditary with an incidence of between 5% and 10% with APC (FAP, aFAP) or MMR (HNPCC) genes affected, and sporadic colorectal cancer with an incidence of 90-95% with a lot of mutations in variable genes that accumulate during pathogenesis (APC, KRAS, MMR, microRNA, CIMP etc.). Knowledge of the molecular pathogenesis of CRC (hereditary, sporadic) is crucial for treatment, assessment of risk, prognosis, and patient follow-up.

CONCLUSION

This article summarizes the molecular pathogenesis of sporadic and hereditary CRC.

Sex chromosome pairing and extensive NOR polymorphism in Wadicosa fidelis (Araneae: Lycosidae)

In terms of cytogenetics, entelegyne araneomorphs are the best studied clade of spiders. The typical karyotype of entelegyne males consists of acrocentric chromosomes, including 2 non-homologous X chromosomes. The present study is focused on the karyotype, nucleolus organising regions (NORs) and sex chromosome behaviour during meiosis of the entelegyne Wadicosa fidelis (Lycosidae). Preparations stained by Giemsa were used to study karyotype and meiosis. NORs were visualised by silver staining and fluorescence in situ hybridisation with 18S rDNA probe. The male karyotype consists of 28 acrocentric elements, including 2 X chromosomes. In contrast to the majority of other spiders, the male sex chromosomes pair during the major part of meiosis. Following an initial period of parallel pairing, the attachment of male sex chromosomes is restricted to centromeric areas and continues until metaphase II. Our study revealed an enormous number of NORs in the population from Galilee and indicates a considerable variability of NOR numbers in this population. The distal regions of 9 or 10 autosomal pairs contain NORs. The obtained data indicate the rapid spread of NORs in the karyotype of W. fidelis, which was presumably caused by ectopic recombinations and subsequent hybridisations of individuals with different NOR genotypes that produced heterozygotes.

The first cytogenetic characterization of atemnids: pseudoscorpions with the highest chromosome numbers (Arachnida: Pseudoscorpiones)

The karyotypes of pseudoscorpions of the family Atemnidae (Arachnida: Pseudoscorpiones) were studied for the first time. Karyotype data for 7 species have been obtained. The diploid chromosome numbers of most species considerably exceed the numbers reported in pseudoscorpions so far, with males ranging between 65 and 143. In spite of this, the sex chromosome system of atemnids is characterized by the same features that are found in the majority of other pseudoscorpions with an X0 system; the X chromosome is metacentric and is the largest chromosome or one of the largest chromosomes of the karyotype. Male meiotic cells of Atemnus politus contain 1 or 2 autosome multivalents; most specimens had 2 multivalents. The multivalents were composed of 4, 6, 8 or 10 chromosomes. Multivalent number and structure was consistent within each of the studied individuals. The same number of chromosomes in all of the males examined suggests that multivalents are generated by reciprocal translocations. The high diversity of multivalents suggests considerable range of translocation heterozygosity in the studied population.

[750 satisfied patients? Stapled haemorrhoidopexy (Longo procedure) for the treatment of haemorrhoids and anal canal prolapse: a review of our 10-year experience]

INTRODUCTION

Haemorrhoid disease in a common ailment, which constitues a serious clinical and social problems, especially in countries having a significant level of development. There have been a great number of articles published on the method of treatment for haemorrhoid disease and anal canal prolapse with circular stapler introduced to clinical practise by Longo in the year 1993. However, there are very few studies devoted to assessment of this procedure in the Czech medical literature.

AIM

Summary our 10 year experience--to perform a retrospective evaluation of early and long-term results of surgical treatment with a Longo procedure.

PATIENTS AND METHODS

We evaluated retrospectively 750 patients, submitted in our hospital to Longo procedure since January 2000 until December 2009, considering results and complications of this procedure. 435 (58%) were women and 315 (42%) men, aged from 17 to 83 (46.2 years old on overall). Mean follow up was 5.5 months (ranged from 3 months to 3.5 years).

RESULTS

Complications occurred in 76 patients (10.1%). In 24 patients (3.2%) during the early post-operative period. Late complications developed in 52 patients (6.9%). 34 patients (4.5%) required reoperation. Duration of hospitalisation after the procedure ranged from 2 to 8 days, an overage of 3.2 days.

CONCLUSION

Longo procedure in indicated cases--treatment of the 3rd and 4th stage of haemorrhoid disease and anal canal prolapse, is an advisable alternative to other surgical methods. Has satisfactory short and long-term effects, lower postoperative pains, shortening of the patient's hospital stay. Longo's method is safe and suitable for the haemorrhoid therapy, can be recommended in selective patients for a one-day surgery scheme.

[The role of echocardiography in cardiovascular diseases assessment during pregnancy]

Maternal heart disease complicates at least 1% of pregnancies and is one of the most important causes of maternal death. Echocardiographic examination provides valuable information about the size and function of cardiac chambers, valve morphology and function, hemodynamic consequences of various cardiac pathologies. It is particularly important during pregnancy when the complaints and physical signs may be misleading. Echocardiography is well suited to rapid diagnosis in pregnant women with known or suspected cardiac disorders. This review article deals with the contribution of echocardiography to precise diagnosis and management of cardiovascular diseases in pregnancy.

[Stapled hemorrhoidopexy (Long method)--procedure for prolapsing hemorrhoids (PPH)--eight-year experience with the method]

Based on the author's long-term experience with stapled hemorrhoidopexy (procedure for prolapsing hemorrhoids-PPH), principal pros and cons of the procedure are presented in the article. Stapled hemorrhoidopexy is considered an option for radical and safe management of advanced hemorrhoid disorders.

[Recurrent peripheral arterial embolism from metastatic lung choriocarcinoma]

A case of patient with choriocarcinoma, most likely of ovarian origin, with lung metastasis is presented. The disease manifested by recurrent embolism into peripheral arteries. Publications on this topic are reviewed.

[Mycotic aneurysm of the coronary artery]

Mycotic aneurysm of the coronary artery occurs in less than 1% of patients with infective endocarditis and only few cases of successful treatment has been described in the literature. The paper presents a case of 64 years old man with infective endocarditis of the mitral valve, complicated with a development of mycotic aneurysm of the right coronary artery, who was successfully surgically treated.

Heart disease in acromegaly

Evidence has accumulated regarding acromegalic heart muscle disease which existence now appears to be unequivocal. We took an advantage of a large group of acromegalic patients being followed-up at our institution for a long time and have studied pattern, nature and reversibility of acromegalic heart disease. Its major manifestation is cardiac hypertrophy expressed especially as left ventricular hypertrophy. The cardiac hypertrophy is slowly reversible after normalization of plasma growth hormone levels due to successful treatment. This we have first suggested on the basis of a retrospective analysis of clinical and echocardiographic data in 78 patients with acromegaly and subsequently confirmed by a 10-year prospective follow-up of the original patient cohort. We have also showed that effective treatment of acromegaly with a new slow release somatostatine analogue lanreotide leads to regression of cardiac hypertrophy.

[Stress echocardiography in the selection of patients for coronarography]

Exercise echocardiography has in recent years become the best non-invasive method for detection of IHD. The authors made an investigation with the objective to test the feasibility of exercise echocardiography, under our technically imperfect but generally available conditions, for the selection of patients for coronarography. In 44 consecutive patients (30 men, 14 women, mean age 50 years) the authors used before planned coronarography exercise echocardiography and 24-hour monitoring of ECG according to Holter with evaluation of ST segments. The results of all three non-invasive methods were compared with the coronarographic findings. The criterium of positivity of coronarographies was 75% stenosis. Such a stenosis is an unequivocal indication for cardiosurgery or percutaneous angioplasty. On comparison of results of non-invasive examination methods with coronarographic findings the best indicators as regards reliability were obtained with exercise echocardiography. Its sensitivity was 71%, specificity 69%, positive predictive value 77% and negative predictive value 61%. The sensitivity of exercise echocardiography increased, depending on the number of affected arteries (50, 71 and 100%). On isolated evaluation of findings in individual main coronary arteries the sensitivity was highest in the area supplied from the ramus interventricularis anterior (67%), the specificity was 77%. For the ramus circumflexus the sensitivity was 50% and the specificity 96%. For the right coronary artery the sensitivity was 25% and the specificity 96%. The sensitivity of exercise ECG (44%) was even lower than Holter sensitivity (57%). The specificity, on the other hand, was lower in Holter (47%) than in exercise ECG (61%). Electrocardiographic methods were not, contrary to echocardiography, usable for evaluation fo the extent of damage.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiovascular changes in Turner's syndrome]

25 adult asymptomatic patients with Turner's syndrome were evaluated by clinical examination, ECG, M-mode and two-dimensional echocardiography and 24 h Holter monitoring. Patients with Turner's syndrome had a significantly higher resting heart rate (83.3 versus 73.7/min in controls, p < 0.01) and a shorter PQ interval (122.3 ms versus 147.1 in controls, p < 0.01). The short PQ interval was not associated with the karyotype (45,X vs. mosaic karyotypes and structural abnormalities of X and Y chromosome), hypertension, estrogen treatment, or congenital valvular abnormalities. No significant arrhythmias were present. On 24 hours ambulatory ECG monitoring the frequency of ectopic supraventricular and ventricular activity was identical as in published controls. The congenital heart abnormalities were detected in 8 (32%) women with T.sy, however, during the follow-up they became significant in only two (8%) of them.

[Incidence and changes in mitral regurgitation in balloon valvotomy of the mitral valve. A color Doppler study]

The objective of the work was a detailed examination of the incidence and changes of mitral regurgitation (MR) in conjunction with percutaneous transluminal valvotomy of the mitral valve (VMCH). Using coloured Doppler mapping, the authors examined a total of 40 patients before and in the course of one week after VMCH. They assessed the number of regurgitation jets the site of their development, the timing and haemodynamic impact of MR. Knowing the site of development of MR, the authors were able to assess whether the regurgitation after VMCH persisted, developed de novo or disappeared. The total number of mitral regurgitation increased after VMCH from 38 to 51 (increase by 34%, p < 0.05) with a significant rise of the number of double regurgitation jets (4 before as compared with 12 after VMCH, p < 0.05). Before VMCH the authors recorded a holocystic MR in 53%, after VMCH in 86% of the patients (p < 0.01). While before VMCH almost half the regurgitation jets originated in the central portion of the valve, after VMCH MR originated mainly from the area of commissures (48% regurgitation jets before, 79% after VMCH, p < 0.01). Only in 33% of MR after VMCH persisting regurgitation was involved, almost half (47%) of 38 regurgitation jets present before VMCH, disappeared after valvulotomy. MR displays a considerable variability. This may be one of the reasons why prediction of the development and severity of MR after PTMV is difficult.

[Pregnancy and labor in women with mitral valve prolapse]

In a prospective study the authors investigated 30 pregnant women (mean age 27 +/- 5.5 years) with prolapse of the mitral valve confirmed on echocardiography, without significant mitral regurgitation, in order to assess whether mitral valve prolapse is a risk factor for the development of complications during gestation and childbirth. As control served a group of 30 healthy pregnant women of corresponding age and number of previous pregnancies, incidence of complications during pregnancy, the type of delivery, sex, length, weight and maturity of the neonates. In women with mitral valve prolapse the authors recorded a significantly higher incidence of subjective complaints such as palpitations associated in 7 of 8 cases with sinus tachycardia 110-140/min. at rest and with vasovagal syncopes. The palpitations were always favourably influenced by beta-blocker therapy or by calcium antagonists. Mitral valve prolapse without haemodynamically significant mitral regurgitation during pregnancy is not a significant risk factor for the development of complications.

[Noninvasive quantification of the severity of aortic defects using the Doppler method]

Using Doppler method (HPRF and CW regime), the authors assessed the peak velocity of flow in an aortal spurt in 41 patients with aortal stenosis. For calculation of the transaortal pressure gradient they used a modified Bernoulli equation. The values of the calculated gradients were compared with those obtained by direct manometric assessment during catheterization of the heart after an interval of several hours to five days. Combination of two Doppler techniques correlated closely with direct assessment (r = 0.811; p less than 0.001). By application of the continuity equation in the best records of spectral analysis of velocity curves the authors calculated in 8 patients the area of the reduced aortal orifice which was very close to the area calculated by means of Hakki's formula from direct haemodynamic indicators (r = 0.948; p less than 0.001). In 33 patients the authors quantified by Doppler method the severity of aortal regurgitation from the ratio of forward and backward flow in the descending portion of the aortal arch (expressed as the % regurgitation fraction--RF). The RF values correlated well with the angiographic semiquantitative scale of severity of aortal insufficiency (r = 0.805; p less than 0.001), although they enabled the authors only to make a partial differentiation of haemodynamically severe regurgitations and mild or insignificant ones. The authors conclude that the Doppler approach makes it possible to evaluate sufficiently accurately the severity of aortic valve disease (in insufficiencies the authors recommend a more comprehensive approach), which when correctly applied and interpreted, can make non-invasive clinical diagnosis more accurate and thus permits also more accurate indication of surgical treatment of these patients.

[Disorders of the cardiovascular system in Turner's syndrome]

A group of 22 adults with Turner's syndrome, mean age 29.6 years, was subjected to a careful examination by one-dimensional, two-dimensional, pulsed and coloured Doppler echocardiography. The purpose was to assess the incidence and character of congenital and acquired abnormalities of the cardiovascular system which occur within the framework of this defined genetic syndrome. A quite normal echocardiographic finding was recorded in 13 patients, i. e. in 59.1%. In the remainder a wide spectrum of abnormalities was found such as prolapse of the mitral valve (in 13.6%), bicuspid aortal valve with a medium regurgitation (4.5%), hypoplasia of the coronary cusp of the aortal valve (4.5%), dilatation of the ascending aorta with a residual significant stenosis at the site after operation of coarctation of the thoracic aorta (4.5%), subaortal defect of the interventricular septum (4.5%) and slight left ventricular hypertrophy in patients with arterial hypertension (9.1%). Echocardiographic examination in Turner's syndrome makes early diagnosis of abnormalities of the cardiovascular system possible, incl. quantification of the haemodynamic impact. Some of these pathological changes (bicuspid aortal valve, dilatation of the root of the aorta) are for a long time clinically silent but may be nevertheless associated with serious complications. An echographic diagnosis made in time may be of decisive importance for the prevention of complications.

[The effect of OROS metoprolol in mild and moderately severe essential hypertension]

The authors tested in an open, uncontrolled trial in a group of 23 patients with essential hypertension grade I-II (WHO classification) the effect of Metoprolol OROS. The OROS system is a new form of Metoprolol administration which makes it possible to maintain by a single dose per day a steady plasma concentration, while preserving the cardioselectivity and total 24-hour effectiveness during treatment of hypertension and angina pectoris. After eight weeks of Metoprolol OROS administration, in doses gradually adjusted to the therapeutic action, gradually a significant decrease of the heart rate (HR) occurred, of the systolic blood pressure (BPs) and diastolic blood pressure (BPd) (p less than 0.01 for all values) in a recumbent as well as upright position. A reduction of the BPd in an upright position by greater than or equal to 10 mm Hg was achieved in 85% of the patients, in 73.9% of the patients the BPd in an upright position dropped below 95 mm Hg. Four patients developed side-effects which were mild to medium severe (vertigo, palpitations, fatigue, sensation of tremor, tension in the lower extremities). Two patients discontinued treatment early, the main reason in both being palpitations which were under better conversely, in two patients palpitations which were not adequately controlled by previous metoprolol treatment, disappeared completely during Metoprolol OROS treatment. During the trial no significant changes in the investigated laboratory values incl. total cholesterol were recorded, Metoprolol OROS administered once per day is an effective, safe and well tolerated preparation in treatment of mild to medium severe essential hypertension.

[Is it possible to treat cardiac hypertrophy?]

Cardiac hypertrophy in heart disease is associated with a deterioration of the patient's prognosis. From experimental work it is known that hypertrophy can recede, sometimes it is, however, associated with an undesirable increase of fibrous tissue in the heart muscle. In clinical practice we can reduce cardiac hypertrophy (assessed mainly by echocardiography), at least in some patients, by reducing or eliminating the evoking cause (e.g. in sportsmen terminate training, in aortic valve disease by replacement of the valve, in hypertonic patients we reduce the pressure by drugs). After regression of hypertrophy later also the amount of fibrous tissue recedes and as a rule the function does not deteriorate. Lately we are trying to influence factors which directly participate in the hypertrophy of the myocytes, in particular in hypertonic subjects by preferential action on the adrenergic system and the renin angiotensin system.

[Reoperation for recurrent carcinoma of the large intestine and rectum]

Based on their own experience with reoperations of relapses of colorectal carcinoma the authors draw attention to the very poor results of these operations; even in case of early detection of a relapse of the tumour in the majority only a palliative operation could be performed and only in 10% patients a radical operation. Therefore the authors emphasize prevention of relapses.

[Use of bone plates in external osteosynthesis]

The author applied the bone plate for external osteosynthesis in 6 patients. Three of them had open fractures of 2nd grade in the area of shin, one patient in the area of forearm. In 2 patients there occurred unstable pseudoarthrosis of shin with significantly trophically changed soft tissue covering. On the shin he always two broad bone plates on the anteromedial aspect of the shin, and namely in the V-configuration. For the increase of the stability of the assemblage he used the interconnection of two broad plates by one or two narrow moulded plates the subsequent modification of which allowed to apply the rubber traction for the training of the sole. He had not met with any reaction to the inserted screws. In unstable pseudoarthrosis he used the combination of the clamp telescopic fixator and a broad bone plate and namely on the anteromedial aspect of the shin. He considers the combination of these methods perspective for the application of clamp fixators in unstable fractures and pseudoarthrosis of tibia. By means of the application of bone plates for external fixation we can achieve adequate fixation also in case of short fragments in both the proximal and distal parts of tibia and thus avoid the application of a fixator over the adjacent joint. In 3 patients he has succeeded in ensuring full healing with full range of mation in the adjacent joints, in 2 patients the bone consolidation is proceeding successfully and in a short time it will be possible to remove the fixators. The application of this method on the forearm had not ensured the healing. It was necessary to remove the fixator due to the intermittent inflammatory reaction around the screws. The bone consolidation was then achieved by spongioplasty. The method presented does not allow secondary correction of fragments, its application is limited.

[Vaginal electrostimulation with the CONTERG apparatus in the treatment of urinary incontinence]

The authors submit their initial clinical experience with vaginal electrostimulation in the treatment of urinary incontinence, using a CONTERG apparatus made in Czechoslovakia. Treatment was applied in 26 women with stress incontinence, incl. 8 (31%) who had moreover symptoms of sensory urgent micturition. A favourable clinical effect was recorded in 11 patients (42%), a partial effect in 9 (34%), treatment failed in six patients (24%). The direct effect of stimulation of the pelvic diaphragm was verified by profilometric examination which proved a rise of the maximum and clossure pressure of the urethra (P less than 0.05) and values of the transmissive factor (P less than 0.01). The indirect inhibitory effect on the detrusor was confirmed by cystometric examination which indicated a rise of values of the volume of the first desire to void (P less than 0.01) and higher values of the detrusor coefficient--compliance (P less than 0.01) in the investigated group.

[Our 2-year experience with diagnostic arthroscopy of the knee joint]

The authors performed 200 arthroscopic examinations of the knee joint from April 1986 through March 1988. A suspected lesion of medial meniscus (in 52.5%) was the most frequent indication for the examination. Chondromalatia of patella was the most frequent arthroscopic finding (in 50.5% of examinations), two thirds of these findings were clinically inapparent. The ratio of arthroscopic findings of damage on the medial and lateral meniscus was 1.5:1. The lesions of medial meniscus were more frequently erroneously diagnosed clinically (32.4%), than the lateral meniscus lesions (25%), whereas the rupture of lateral meniscus was a more frequent accidental finding (19%) as compared with medial meniscus (11%). In 35% of cases the diagnostic arthroscopy saved the patient a useless revision of the joint. Reliability of the arthroscopic findings evaluated according to subsequent revisions proved to be 90.7%.

Puromycin aminonucleoside nephropathy: ultrastructure, glomerular polyanion, and cell surface markers

Puromycin aminonucleoside nephropathy with heavy proteinuria and oedema was induced in rats by 10 consecutive daily subcutaneous injections of aminonucleoside (1.67 mg/100 g of body weight). The main ultrastructural lesions were vacuolation of podocytes and total fusion of foot processes with loss of colloidal iron-reactive polyanion layer on the epithelial surface adjacent to the basement membrane. On the other hand the outer surface of podocytes and intravacuolar granular substance stained with colloidal iron. In scanning electron microscopy of freeze-fractured tissue the swollen podocytes and the urinary spaces displayed granular and filamentous precipitates. Seven cell surface antigens were examined by indirect enzyme immunohistochemistry with a series of MRC OX monoclonal antibodies. Glomeruli of control rats exhibited rare isolated Ia- positive endocapillary cells, possibly monocytes; these elements were significantly reduced in puromycin aminonucleoside nephropathy but there was an increase in Ia- positive cells in the cortical interstitium. Control kidneys harboured scanty interstitial T lymphocytes. These latter, especially the T8- positive cytotoxic/suppressor subpopulation, were markedly augmented in puromycin aminonucleoside nephropathy. The expression of class I histocompatibility antigens and of differentiation antigens (Thy 1) was not altered by aminonucleoside.