[Current issues of assisted reproduction in the Czech Republic]. / Aktuální otázky asistované reprodukce v Ceské republice.

INTRODUCTION: Participants of the lunch table discussion held during the 22nd symposium of assisted reproduction in Brno discussed some current topics of assisted reproduction. DISCUSSED TOPICS: More than 150 participants at round tables discussed 10 topics: 1. IVF in native AR cycle,2. observation of the embryo development dynamics, 3. evaluation and support of endometrial receptivity,4. increased number of elective single embryo transfers (eSET), 5. transport of gametes and embryos in the Czech Republic and between the Czech Republic and abroad, 6. National registry of assisted reproduction,7. new view on sperm pathology, 8. problems with the SAR membership records, 9. surogacy motherhood and 10. preimplantation genetic diagnosis and preimplantation genetic screening. CONCLUSIONS: All findings were presented in the afternoon session. Some of the topics brought concrete results. Some topics could not be clearly concluded and will be the subject of further discussions. A brief summary of those discussion conclusions presents this paper.

["Tension Free" method in inguinal hernioplasty using CHS 100 mesh--our experience]. / Plastika tríselné kýly "tension free" metodou s vyuzitím sít'ky CHS 100--nase zkusenosti.

The authors present their experience with "Tension Free" method for hernia surgery, using a CGS 100 mesh. They highlight pros and cons of the described method.

Tackling corruption in the pharmaceutical systems worldwide with courage and conviction.

Poor drug access continues to be one of the main global health problems. Global inequalities in access to pharmaceuticals are caused by a number of variables including poverty, high drug prices, poor health infrastructure, and fraud and corruption--the latter being the subject of this article. There is growing recognition among policy makers that corruption in the pharmaceutical system can waste valuable resources allocated to pharmaceutical products and services. This, in turn, denies those most in need from life-saving or life-enhancing medicines. As a result, international organizations, including the World Health Organization and the World Bank are beginning to address the issue of corruption in the health sector broadly and the pharmaceutical system specifically. This is encouraging news for improving drug access for the global poor who are most harmed by corruption as they tend to purchase less expensive drugs from unqualified or illegal drug sellers selling counterfeit or sub-standard drugs. In our paper, we illuminate what are the core issues that relate to corruption in the pharmaceutical sector. We argue that corruption in the pharmaceutical system can be detrimental to a country's ability to improve the health of its population. Moreover, unless policy makers deal with the issue of corruption, funding allocated to the pharmaceutical system to treat health conditions may simply be wasted and the inequality between rich and poor in access to health and pharmaceutical products will be aggravated.

[Incisional hernias--the Ramireze corrective procedure]. / Incizionální hernie--plastika podle Ramireze.

The authors describe surgical management of extensive abdominal hernias using the Ramireze procedure. They present their results on a small patient group.

Mammalian oocyte therapies.

In assisted human reproduction, the cytoplasm of oocytes recovered from follicles is often abnormal. Its lower quality, especially in older patients, may be responsible for certain chromosomal abnormalities or developmental arrest. Thus, the deficiency of some vital molecules, which are necessary for oocyte maturation, can be the cause of infertility in women. Moreover, mutated mitochondrial DNA (mtDNA) that is located in the oocyte cytoplasm might be transmitted to offspring. With the advance of new micromanipulation techniques like the oocyte nucleus replacement or cytoplasmic transfer, some of these abnormalities could be theoretically eliminated. In this review, we briefly discuss some of these approaches and their potential use in assisted human reproduction.

[Relapsing gastrocolic fistula--a case review]. / Recidivující gastrokolická pístel--kazuistika.

In this study the authors present a case review of the patient suffering from the relapsing gastrocolic fistule. They point out some problems in its diagnostics and therapy, which may occur in conjuction with this ulcerative disorder complication.

[Psychological condition of children from pregnancies after assisted reproduction in the third year of life]. / Psychický stav detí z tehotenství po asistované reprodukci ve tretím roce zivota.

OBJECTIVE: To analyse psychological development of children born after assisted reproductive technology. DESIGN: Psychological analysis of the child's development related to the technology of assisted reproduction, length of pregnancy and multiple birth was performed and compared with the control group. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Out of the total number of 123 children born after assisted reproductive technology during the 1st half of the year 1998 in the Center ISCARE IVF, psychological development was evaluated in 109 children (88.6%). Ninety four children from this sample were assessed using mental, motor and behavior scales of the Bayley Scales of Infant Development II. RESULTS: Mental and motor development of infants born after intracytoplasmatic injection (ICSI) and after in-vitro-fertilisation (IVF) was not significantly different. Fullterm singletons born after assisted reproductive technology did not differ from control fullterm children. There was a developmental delay in both fullterm and preterm children from multiple pregnancies in comparison to control children. No child had serious impairment of psychic functions (developmental index <50). There were no significant differences in behavior records between children born after assisted reproductive technology and control children, but some parents had problems in educational care of their children born after assisted reproductive technology. CONCLUSION: From children born after assisted reproductive technology, those from multiple pregnancies may be at risk for later psychological development. The occurrence of educational problems in assisted reproductive families indicates a need of accessible professional care in this field.

[Cloning of mammals--biological aspects]. / Klonování savcu--biologické aspekty.

Cloning by somatic cell nucleus transfer into enucleated oocytes represents a very straightforward approach. The nucleus is simply transferred into the oocyte from which its nuclear genetic material (chromosomes) has been earlier removed. By using this approach clones of sheep, cattle, horse, rabbit, goat, rat, mule, pig, cat and interspecies-specific clone mouflon x sheep were obtained. The success of cloning is, however, disappointingly low and only 1-3% of reconstructed embryos develop to term. Some cloned animals are abnormal and die prematurely. This clearly speaks against the use of cloning in humans. On the other hand, so called therapeutic cloning, when the nucleus is transferred into an oocyte and the developing embryo is then used for the production of embryonic stem cells is generally well accepted. This promising technique may be probably used in some as yet untreatable diseases and in certain serious injuries.

[Intraoperative enteroscopy in the diagnosis of recurrent gastrointestinal tract hemorrhage--case report]. / Vyuzití intraoperacní enteroskopie pri diagnostice opakovaného krvácení do trávicího ústrojí--kazuistika.

The authors of this article point out the diagnostic scopes and advantages of the intraoperative endoscopy as one of the many diagnostic means, which may be employed to determine the cause of recurrent attacks of bleeding to the gastrointestinal tract. As an example demonstrating the scope of use of this relatively simple device, they present a case of examining a female patient with the recurrent attacks of bleeding to the gastrointestinal tract. Should other common diagnostic methods be employed, the case of the bleeding was impossible to discover.

[Sacral pilonidal sinus--the Limberg operation]. / Sinus pilonidalis sacralis--operace sec. Limberg.

The authors describe the operation on coccygeal fistule by a less usually applied plasty using a transposition lobe according to Limberg. Advantages of this solution are documented in a small group of patients.

[Successful treatment of azoospermia diagnosed as "Sertoli cells only syndrome with maturation arrest"--developing a quality embryo]. / Uspesné resení azoospermie s diagnózou "Sertolli cells only syndrome" (SCO sy.) a Maturation Arrest (MA)--získání kvalitního embrya.

OBJECTIVE: The transfer of good quality embryo in the program of assisted reproduction in the case of azoospermia, dg. Sertolli cells only syndrome (SCO sy) + maturation arrest (MA). Testes were assessed and found to have a high occurrence of Sertolli cells and very low occurrence of germinal cells, which were arrested at the round spermatid level. The histological evaluation was hypospermatogenesis gr. 3 (minimum 1 spermatid/sample). DESIGN: Case report. SETTING: Laboratory IVF, Iscare, a. s., Department of Biology and Biochemistry of Fertilization, Institute of Molecular Genetics, Czech Academy of Sciences, Prague. SUBJECT AND METHOD: The successful integration of three methods provides a solution for this case of azoospermia. Immunology and histology can more exactly diagnose the degree of azoospermia. Detection and visualisation of spermatids using monoclonal antibodies against sperm proteins predicts the eventual occurrence of spermatogenesis, and histological evaluation confirms these immunological findings. Using the information of both methods it is possible to use special in vitro cultivation of testicular cells and so obtain injectable spermatozoa, or precursors of sperm, for the ICSI method. CONCLUSION: The probability of acquisition of good-quality embryo in the program of assisted reproduction is higher when these three methods are applied in combination.

Nucleus replacement in Mammalian oocytes.

Our contribution discusses the potential use of cell therapies (nucleus replacement) in mammalian oocytes. It is assumed that these approaches may be used, for example, for the elimination of mutated maternally transmitted mitochondrial DNA (mtDNA) as well as for the reconstruction of normal oocytes from oocytes that are developmentally compromised. Moreover, it is speculated that the replacement of germinal vesicles by somatic cells may result in cells of the haploid genome: the production of germ cells from somatic cells. The preliminary results obtained in our laboratories are discussed in this article.

Somatic and embryonic cell nucleus transfer into intact and enucleated immature mouse oocytes.

BACKGROUND: The aim of our study was to evaluate the possibility of embryonic or somatic cell haploidization after fusion with intact or enucleated immature oocytes which were subsequently cultured in vitro. Embryonic or somatic cell nuclei do not undergo premature chromosome condensation when fused to intact or enucleated immature oocytes whose maturation is prevented by dibutyryl cyclic AMP (dbcAMP). The presence of dbcAMP permits, however, the completion of DNA replication in somatic cell nuclei. METHODS AND RESULTS: The chromosomes condensed when the reconstructed cells were released from the dbcAMP block. When somatic or embryonic nuclei were introduced into intact immature meiotically competent oocytes and subsequently cultured their chromosomes assembled on a common spindle with meiotic chromosomes and proceeded through the meiotic-like division, judged according to the presence of the first polar body extruded. When embryonic cell nuclei were introduced into cytoplasts obtained from immature meiotically competent oocytes, polar bodies were extruded in about 75% of reconstructed cells but the metaphase plates were abnormal in almost all cases. When somatic cell nuclei were inserted into the above cytoplasts, polar bodies were extruded only very exceptionally and in these cells chromosomes were arranged in abortive metaphase plates. CONCLUSIONS: Our results suggest that somatic cell nuclei are unable to proceed through the reduction division (haploidization) when introduced into an immature oocyte meiotic cytoplasm.

[Surgical treatment of male infertility]. / Taktika chirurgické lécby muzské infertility.

OBJECTIVE: In the Czech Republic in the treatment of male infertility the most up-to-date technologies of assisted reproduction have also become the methods of choice: MESA--microsurgical epididymal sperm aspiration, TESE--testicular sperm extraction and ICSI--intracytoplasmic sperm injection. The objective of the present study was an attempt to find a reliable predictor of results of planned TESE as prediction of possible successful sperm extraction can prevent unnecessary ovarian stimulation. DESIGN: Retrospective analysis of a group of 202 men operated in the authors centre on account of azoospermia--65 patients with obstructive azoospermia and 137 patients with testicular azoospermia. SETTING: Andromeda, Biolab, Iscare IVF, Prague. METHOD: The following parameters were evaluated: testicular volume, FSH serum level and histological finding and their values were compared with results of TESE. RESULTS: Elevated FSH levels and low testicular volume do not rule out a positive result of TESE. The most accurate predictor is histological examination. Elongated spermatids were found in the histological material in 59.3% of the examined cases which correlates significantly with the 60.2% TESE yield in the evaluated group. CONCLUSION: The material assembled on operation was divided into three parts. One serves preparation of the perIerative native preparation, the second one is dispatched for histological examination and the largest part is frozen. Simultaneous collection of oocytes and sperm cells is done only in selected cases. The histological finding of elongated spermatids indicates a positive finding of sperm during TESE with an accuracy of 91%. Assessment of the causes of azoospermia, evaluation of the state of spermatogenesis and treatment are thus implemented by a single operation.

[Therapeutic experiences with alcohol-related Korsakoff syndrome]. / Therapeutische Erfahrungen beim alkoholbedingten Korsakow-Syndrom.

Korsakoff's psychosis (Wernicke-Korsakoff-Syndrome) following severe, long-term alcoholism is considered to be widely resistant to treatment. We report two cases with beneficial effects of treatment by a combination of clonidine and fluvoxamine.

Prevalence of lower urinary tract symptoms and self-reported diagnosed 'benign prostatic hyperplasia', and their effect on quality of life in a community-based survey of men in the UK.

OBJECTIVES: To assess the prevalence of lower urinary tract symptoms (LUTS) in a community-based population in the UK, to measure the impact of these symptoms on quality of life and health status in men with self-reported 'benign prostatic hyperplasia' ('BPH'), and to evaluate health-seeking behaviour in this population. SUBJECTS AND METHODS: A postal survey was distributed to an age-stratified random sample of 1500 men aged 50 years or older from throughout England, Scotland and Wales. The self-administered survey included: demographic questions; the EuroQoL (EQ-5D) instrument, consisting of a health-status index questionnaire and a visual analogue scale (VAS) on which participants rated their current health status; the International Prostate Symptom Score (IPSS) questionnaire; and a questionnaire assessing the participants' health-seeking behaviour and awareness of BPH. RESULTS: Responses to the survey were received from 1115 (74%) of the 1500 men. Overall, 41% (450/ 088) had an IPSS of > or =8, indicating moderate-to-severe LUTS, yet only 196 men (18%) reported that they had been diagnosed with 'BPH'. Both quality of life (as measured by the EQ-5D) and general health status (as measured by the VAS) decreased as urinary symptom severity increased, and the greater the severity, the more men who reported a problem with mobility, self-care, usual activity, pain/discomfort, and anxiety/depression (the five domains of the EQ-5D). The possibility of symptoms worsening appeared to be the key determinant in the respondents' decisions to consult a medical professional for their LUTS. Less than 11% of the respondents were aware of the availability of specific prescription drug therapies or surgical options for the treatment of 'BPH'. The most common first treatment strategy for those consulting for symptoms was watchful waiting (34%), followed by surgery (30%) and prescription drugs (21%). CONCLUSIONS: Moderate-to-severe LUTS were relatively common in this UK population of men over the age of 50, yet relatively few had been diagnosed with 'BPH'. As LUTS adversely affect quality of life, improved treatment options and increased public awareness of BPH and LUTS are needed to combat a problem facing the growing number of elderly men in the population.

[MESA, TESA, TESE + ICSI: results of the first 50 cases]. / MESA, TESA, TESE + ICSI: výsledky u prvních 50 prípadu.

During the period between February 1996 and August 1997 51 infertile men were operated. The authors evaluate the results from 47 couples--25 cases of testicular azoospermia and 22 cases of obstructive azoospermia. The mean age of the men in the group was 33 years (22-48 years). The follow-up period is 1-18 months. In 17 cases, microsurgical epididymal sperm aspiration (MESA) was made, in five cases testicular sperm aspiration (TESA) and in 25 men, testicular sperm extraction (TESE) was performed. In the group with testicular azoospermia it proved possible to obtain sperm in 12 of 25 cases, i.e. in 48%. In men with obstructive azoospermia all aspirations were successful, i.e. the yield was 100%. In this group five children were born, seven pregnancies are under way. Thus regardless of the etiology of male infertility 12 of 47 cases, i.e. 25.5% were resolved successfully. When the results of the two groups are differentiated, the outcome is as follows: in the group with testicular azoospermia one child was born and two pregnancies are under way, i.e. 12%, in the group with obstructive azoospermia four children were born and five pregnancies are under way, i.e. 40.9%.