Risk of anal incontinence in women with inflammatory bowel diseases after delivery.

AIM: The aim of our prospective study was to evaluate the development of postpartum anal incontinence in patients with inflammatory bowel disease (IBD) compared to healthy women. MATERIAL AND METHODS: Patients with IBD and healthy controls enrolled in the study from January 1st 2013 to November 30th 2016 and filled in the anal incontinence questionnaire in the beginning of pregnancy and after vaginal delivery. The results were statistically processed using suitable tests. RESULTS: A total of 57 women were enrolled, 17 (29.8 %) with ulcerative colitis, 23 (40.4 %) with Crohn's disease, and 17 (29.8 %) healthy controls. Incidence of postpartum anal incontinence is comparable across all groups; there was no statistically significant difference between the IBD and control groups (Kruskal-Wallis test by ranks with Dunn correction, non-significant). Postpartum anal incontinence was strongly correlated with the extent of perineal injury (r = 0.80; p < 0.0001; Pearson's linear correlation). CONCLUSIONS: Women with inflammatory bowel disease in remission do not exhibit higher incidence of postpartum anal incontinence (PPAI) compared to healthy controls; the key correlate of PPAI appears to be the extent of obstetric injury, consistently across all study groups. These results suggest that concerns about postpartum anal incontinence development should not be an indication for Caesarean section in IBD patients (Tab. 6, Fig. 1, Ref. 34).

[Non-tumor bile duct strictures]. / Nenádorové stenózy zlucových cest.

The authors rectrospectively evaluate the possibilities of the solutions and the complications regarding benign stenoses of the biliary tract in 10 patients, who were treated within the years 2008 - 4/2011 at the Surgical Clinic of Medical Faculty of Charles University and the Faculty Hospital in Plzen. The injury of the biliary tree at cholecystectomy - 6 cases - was the most often cause of the benign stenosis of the biliary tree development in our collection. Once it was the case of a rare incidence of M. Crohn's disease of the biliary tract, once it was the case of stenosis in Mirrizi syndrome and two times it was the case of stenosis after the repeated instrumental procedures at ERCP after choledocholithiasis. Three times stenosis was solved by help of the repeated dilations of stenosis in the way of ERCP procedure. In other 7 cases stenosis was solved surgically by help of hepaticojejunalanastomosis to the excluded Roux-en-Y gastric bypass. The dilation of stenosis of the biliary tree requested two sessions on average, the surgical solution had a minimal peri-operative morbidity - 0% and within a 30-day peri-operative period there was noted 1 death in connection with the solution of stenosis of the biliary tract with the massive bleeding at decubitus of the stent of the left biliary duct into hepatic artery. Long-term results with respect to a short-time period were not evaluated.

[Feedings of critical care patients by endoscopic three-luminal tube--a retrospective analysis]. / Výziva kriticky nemocných endoskopicky zavádenou trojluminální sondou--retrospektivní analýza.

BACKGROUND: Enteral nutrition (EN) represents a preferred type of nutritional support in critical care patients, in spite of the high incidence of intolerance. One of the methods which can speed up the delivery of adequate amounts of food is to switch from the gastric to post-pyloric feeding. A three-luminal tube (TLT) enables post-pyloric enteral feeding with accompanying gastric decompression. The aim of our study was to evaluate effectiveness and safety of the endoscopically introduced TLT along with the estimation of the adequate dose of enteral nutrition. METHODS AND RESULTS: Retrospective analysis of 111 critical care patients with 140 introduced TLT during 2003 to 2006 in two intensive care units (UIC) in the Teaching hospital in Plzen included patients of average age 54 years (+/- 15), APACHE II score 26 (+/- 10) and UIC mortality was 24%. Eight introductions were technically not successful (6%). Reintroduction of the tube was necessary in 21 patients (19%). The average time of tube introduction was 6 minutes (+/- 3). In direct relation to endoscopy no serious complication was observed. In our cohort, 34 ventilator-associated pneumonias developed (31%). Average time interval since the admission to the hospital till TLT introduction was 7 days (+/- 6). Evaluation of a subgroup of 77 patients from one UIC has shown that the adequate amount of EN was achieved in 82% of patients in 4 days (+/- 3) after the TLT introduction. In average, TLT was introduced for 11 days (+/- 7). CONCLUSIONS: Endoscopic TLT introduction represents a safe and reliable method which can ensure adequate amount of enteral nutrition in majority of critical care patients with gastrointestinal dysfunction. In our conditions, TLT is probably not sufficiently used.

[Carcinoid of the ileocecal junction with symptoms of acute abdomen]. / Karcinoid ileocékálního prechodu s príznaky NPB.

The authors describe a group of six patients (two men and four women) operated at the Surgical Clinic in Plzen during 1995-2000 on account of a carcinoid of the GIT. The mean age of the patients was 48.6 years, the range 14-77 years. In five instances a carcinoid of the appendix was detected. In a separate case-record they evaluate a carcinoid of the ileocaecal transition with symptoms of acute abdomen, early surgery, its extent incl. the postoperative procedure.

[A vasoactive-intestinal-polypeptide producing tumor (VIPoma) as an uncommon cause of life-threatening hypokalemia]. / Nádor z bunek produkujících vazoaktivní intestinální polypeptid (VIPom) jako vzácná prícina zivot ohrozující hypokalémie.

The authors present a case of a 40-year-old female patient examined repeatedly in the course of 11 years and hospitalized on account of pain in the hypogastrium, subfebrile temperatures, watery diarrhoea, hypokaliaemic alkalosis, weakness, fatigue and loss of body weight. As to laboratory examinations hypokaliaemia, hyponatraemia, metabolic alkalosis, irregularly elevated CRP values and minor leucocytosis predominated. A weight loss of cca 8 kg along with a severe mineral deficiency and clinical symptomatology called for parenteral nutrition with a mean daily substitution of 240 mmol K and 200 mmol Na. Due to the clinical condition and non-specific results of graphic and histological examinations the possibility of a VIPoma was considered. This diagnosis was confirmed by laboratory examinations and clinically--after the onset of corticoid treatment marked improvement of the general condition occurred. Finally the authors discuss diagnostic and in particular therapeutic possibilities in this disease.