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BackgroundAgainst a background of rapid increase of β-lactamase-producing or multi-resistant pathogenic bacteria and the resulting lack of effective antibiotic treatment, some older antibiotics have been tested for new therapeutic uses. One of these is fosfomycin, to which according to studies these resistant bacteria are very sensitive. Our study was designed because there is no data on the fosfomycin susceptibility rate in the Czech Republic.MethodIn this study from January 2013 to June 2014 3295 unique isolates of Gram-negative bacteria which had caused urinary tract infections were examined. The antibiotic susceptibility was measured by disk diffusion test. Both EUCAST and CLSI guidelines criteria (for fosfomycin only) were used for the antibiotic susceptibility evaluation.ResultsThe most frequently tested bacterial isolates were Escherichia coli (51.3%, n = 1703), Klebsiella pneumoniae (19.4%, n = 643) and Proteus spp. (11.8%, n = 392). Among all isolates 29.0% (n = 963) were resistant to fluoroquinolones, 11.3% (n = 374) produced extended spectrum β-lactamase and 4.2% (n = 141) produced AmpC β-lactamase. The overall in vitro susceptibility was significantly higher for fosfomycin compared to the other tested per-oral antibiotics (nitrofurantoin, ampicillin, co-trimoxazole, ciprofloxacin and cefuroxime) against all tested Gram-negative rod isolates (excluding Morganella morgani and Acinetobacter spp. isolates). Fosfomycin also remained highly active against those isolates with extended spectrum β-lactamase (ESBL) production (95.8% in Escherichia coli isolates and 85.3% in Klebsiella pneumoniae isolates), unlike other tested per-oral antibiotics, which showed significant (p < 0.0001) susceptibility decrease.ConclusionWe have confirmed in the Czech Republic the very high susceptibility to fosfomycin trometamol of urinary tract infection pathogens, particularly Gram-negative rods including those producing β-lactamase.

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1 Klinika onkologie a radioterapie LF UK a FN Hradec Králové 2 Urologická klinika LF UK a FN Hradec Králové 3 Urologické oddělení, Oblastní nemocnice Náchod Souhrn Východiska: Intersticiální brachyterapie s nízkým dávkovým příkonem je ověřená orgán šetřící léčba T1-T2 karcinomu penisu. Zkušenosti s brachyterapií s vysokým dávkovým příkonem jsou v této indikaci limitované. Materiál a metody: V období 2002-2018 bylo na Klinice onkologie a radioterapie LF UK a FN Hradec Králové léčeno 26 pa cientů s časným stadiem karcinomu penisu brachyterapií s vysokým dávkovým příkonem dávkou 18 × 3 Gy aplikovanou 2× denně.Mammární intersticiální můstek byl použit k fixaci a precizní geometrii brachyterapeutických aplikačních jehel. Výsledky: Medián doby sledování byl 85 měsíců (7 vs. 200 měsíců). Akutní toxicita obvykle spočívala v mukozitidě stupně 2, která zpravidla odezněla do 8 týdnů po léčbě. Lokální recidiva se vyskytla u 6 pa cientů, u 5 z nich byla úspěšně léčena parciální amputací. Jeden pa cient měl uzlinový relaps úspěšně řešený lymfadenektomií. U jednoho pa cienta vznikla postradiační nekróza glandu vyžadující parciální amputaci. V současné době žije 24 pa cientů bez známek onemocnění. Jeden pa cient zemřel na kardiální komorbiditu, jeden na duplicitní karcinom plic. Celkem 19 pa cientů má zachovaný penis (73 %), z toho 18 sexuálně aktivních před léčbou udává plnohodnotný pohlavní styk. Závěr: Brachyterapie s vysokým dávkovým příkonem s dávkou 18 × 3 Gy aplikovaných 2× denně je slibná metoda orgán zachovávající léčby u vybraných pa cientů s karcinomem penisu a zaslouží si zhodnocení ve větší prospektivní studii. Klíčová slovanovotvary penisu -konzervativní léčba -brachyterapie Summary Background: Interstitial low dose rate brachyther apy is established organ spar ing treatment of T1-T2 penile carcinoma. Experience with high-dose rate brachyther apy is limited in this indication. Materials and methods: Twenty-six patients with early penile carcinoma were treated by high-dose rate brachyther apy at dose 18 × 3 Gy per fraction twice daily between 2002-2018 at the Department of Oncology and Radiother apy, University Hospital in Hradec Kralove. Breast interstitial brachyther apy template was used for fixation and precise geometry reconstruction of stainless hollow needles. Results: Median follow up was 85 months (range 7-200 months). Acute reaction usually consisted of grade 2 mucositis that dissolved dur ing 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed necrosis of the glans requir ing partial amputation. Currently, there are 24 patients alive without signs of dis ease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse. Conclusion: Hyperfractionated interstitial high--dose rate brachyther apy ...

Second aortic cross-clamp to start selective closed aortic arch perfusion provides excellent surgical control of the operative field over a liberal time interval during circulatory arrest under milder hypothermia.

Background : Recent studies have demonstrated the efficacy and favorable toxicity profile of chemotherapy regimens given at lower doses and frequent intervals. The aim of our study was to evaluate the efficacy and toxicity of a bi-weekly chemohormonal regimen consisting of epirubicin, etoposide, and low-dose dexamethasone (EED) in patients with hormone-refractory prostate cancer (HRPC). Methods : We treated a total of 32 patients who had failed hormonal therapy and antiandrogen withdrawal. Chemotherapy was given every 2weeks and consisted of epirubicin (30mg/m 2 intravenously, day 1) and etoposide (50mg/m 2 orally, days 1-7). Dexamethasone (1.5mg orally, every other day) was given continuously until disease progression. Twenty patients (63%) had received prior treatment with estramustine phosphate. Each patient's pain response was evaluated according to analgesic use. Toxicity was graded using the Common Toxicity Criteria (version 2.0). Results : Prostate-specific antigen (PSA) levels showed a decline of 50% or greater in 16 of 32 patients (50%, 95% confidence interval [CI], 32-68%) with a median time to biochemical progression of 5months (range, 4-9 months). The median survival for all patients was 10.5 months (range, 3-35 months). Four of 10 patients (40%) with measurable soft tissue lesions achieved partial response according to standard criteria. Eleven of 23 symptomatic patients (48%, 95% CI, 27-69%) experienced an improvement in pain with a median duration of 6months. The regimen was tolerated well by the patients, with only four patients (12%) having grade 3 leukopenia. Conclusion : Chemohormonal EED regimen proved to be active and well-tolerated in patients with HRPC.

Introduction: Prostate cancer with a Gleason score (GS) of 8–10 is linked to a higher risk of recurrence and progression. The aim of this paper is to evaluate treatment results of our high-risk patient cohort.Patients and Methods: The cohort of 42 patients with radical prostatectomy (RP) specimen histology GS 8–10 was assessed. The patients were followed up after RP and radiotherapy (RT) was delivered in case of a biochemical relapse. Adjuvant radiotherapy (aRT) was delivered only in case of a positive surgical margin (PSM). The following parameters were evaluated: biochemical progression-free survival (BPFS), overall survival (OS) and cancer-specific survival (CSS). The second objective was to evaluate adverse effects of RP and RT. Results: The median follow-up time was 88 months (18–168). RP led to BPFS in 16 patients (38%). Five patients with PSM underwent aRT and 20 underwent salvage radiotherapy (sRT). One patient died of myocardial infarction and 1 patient died of metastatic disease. Skeletal metastases were recorded in 2 patients. The BPFS in RP combinations with sRT or aRT was reached in 29 patients (69%). The OS and CSS in our cohort reached 95 and 98%, respectively. Conclusion: Management with aRT only in PSM was very effective, according to our retrospective study.