[Torsion of the omentum - an unexpected cause of acute surgical abdomen in a pregnant woman -case report]. / Torze omenta - prekvapivá prícina náhlé príhody brisní v gravidite - kazuistika.

OBJECTIVE: Torsion of the omentum is a rare cause of acute surgical abdomen. Here we describe a case of a pregnant woman with acute abdominal pain and a perioperative diagnosis of necrosis of torted omentum was made. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Masaryks Hospital, Jilemnice. CASE REPORT: Thirty year old female patient, who was 38 weeks pregnant, presented to our department with acute surgical abdomen. Acute appendicitis was suspected and an urgent caesarean section followed by appendectomy was scheduled. However, perioperatively a necrotic part of torted omentum was identified and resected. CONCLUSION: Torsion of the omentum is a rare cause of acute abdominal pain which is usually diagnosed only perioperatively. This condition usually presents with nonspecific symptoms and most commonly mimics acute appendicitis. Owing to, inexplicit symptoms and wide range of differential diagnoses it is important to think of this entity as a possible cause of acute abdominal pain. Clear indication for abdominal surgery, especially in pregnant patients is essential and requires efficient team working between gynaecologists, abdominal surgeons and radiologists.

Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease: retrospective analysis of 9095 patients.

BACKGROUND: Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). AIM: To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. METHODS: We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn's disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. RESULTS: A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The per cent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15% and 0.18% (RR = 0.83, 95% CI: 0.28-2.42; P = 0.729); CD: 0.19% and 0.22% (RR = 0.89, 95% CI: 0.24-3.31; P = 0.863); UC: 0.07% and 0.15% (RR = 0.49, 95% CI: 0.06-4.22; P = 0.510). CONCLUSION: Anti-TNFα biologics do not appear to impact the risk of developing clinical idiopathic inflammatory demyelinating disease in patients with inflammatory bowel disease.

[Laparoscopic uterus sparing treatment of uterine fibroids]. / Laparoskopická konzervativní lécba delozních myomu

OBJECTIVE: To report up-to date knowledge on laparoscopic, uterine sparing treatment of uterine fibroids. STUDY DESIGN: Review. SETTING: Uterine Fibroids Center, Department of Obstetrics and Gynecology, Charles University, Prague. METHODS: Analysis of our clinical experience and available literature resources. RESULTS: The management of uterine fibroids depends on the symptoms, location, and size of fibroids and on the reproductive plans of the patient. The surgical treatment has changed from laparotomy to minimally invasive surgery. In general, laparoscopic myomectomy (LM) is considered the best option in symptomatic patients with pregnancy plans. The laparoscopic approach is associated with lower postoperative morbidity as well as lower incidence of massive postoperative adhesion formation compared to laparotomy. The limitation of laparoscopic myomectomy is the size and the number of fibroids but also the location and the accessibility for the laparoscopic suturing. Laparoscopic uterine artery occlusion (LUAO) represents one of the alternatives to LM in patients with multiple small myomas or in patients with fibroids in unfavorable location. LUAO may be advantageously used prior to LM in order to reduce peroperative blood loss or to prevent the persisting fibroids from growing. However there is no universal treatment of uterine fibroids in fertile patients and in each single patient the indication and surgical method should be thoroughly considered. .

Detection of fetal major structural anomalies at the 11-14 ultrasound scan in an unselected population.

OBJECTIVE: The aim of the study was to determine the efficacy of the 11-14 week scan in detecting fetuses with structural anomalies. STUDY DESIGN AND METHODS: Prospective interventional study in an unselected population of pregnant women in a 5-year period (2003-2008) in a single ultrasound unit. 8889 fetuses with median CRL 65mm (45-84mm) were examined. Continuing pregnancies were rescanned at 20-22 weeks. Actual structural anomalies among newborns from the studied group were obtained from our computerized database. RESULTS: The median maternal age was 30 years (14-50 years). The incidence of anomalies was 16.08 per 1000 (143/8889). Of these, 99 of the 143 were detected with prenatal sonography. 46.9% (67/143) of all anomalies were detected at the 11-14 week scan. Later in pregnancy, another 22.3% (32/143) of structural anomalies were detected. CONCLUSIONS: 67.7% of all antenatally detected malformations by ultrasound were recognized in the 11 14 week scan. Obviously, the second trimester scan cannot be abandoned, as it provides effective detection of other anomalies.

Toxoplasma and reaction time: role of toxoplasmosis in the origin, preservation and geographical distribution of Rh blood group polymorphism.

The RhD protein which is the RHD gene product and a major component of the Rh blood group system carries the strongest blood group immunogen, the D-antigen. This antigen is absent in a significant minority of the human population (RhD-negatives) due to RHD deletion or alternation. The origin and persistence of this RhD polymorphism is an old evolutionary enigma. Before the advent of modern medicine, the carriers of the rarer allele (e.g. RhD-negative women in the population of RhD-positives or RhD-positive men in the population of RhD-negatives) were at a disadvantage as some of their children (RhD-positive children born to pre-immunized RhD-negative mothers) were at a higher risk of foetal or newborn death or health impairment from haemolytic disease. Therefore, the RhD-polymorphism should be unstable, unless the disadvantage of carriers of the locally less abundant allele is counterbalanced by, for example, higher viability of the heterozygotes. Here we demonstrated for the first time that among Toxoplasma-free subjects the RhD-negative men had faster reaction times than Rh-positive subjects and showed that heterozygous men with both the RhD plus and RhD minus alleles were protected against prolongation of reaction times caused by infection with the common protozoan parasite Toxoplasma gondii. Our results suggest that the balancing selection favouring heterozygotes could explain the origin and stability of the RhD polymorphism. Moreover, an unequal prevalence of toxoplasmosis in different countries could explain pronounced differences in frequencies of RhD-negative phenotype in geographically distinct populations.

New and old risk-factors for Toxoplasma gondii infection: prospective cross-sectional study among military personnel in the Czech Republic.

The aims of this study were to evaluate seroprevalence and the importance of various risk-factors for Toxoplasma infection in the Czech Republic. A prospective cross-sectional survey was conducted among military personnel in Prague. Consenting subjects (n = 3250) completed a questionnaire concerning demographics and risk-factors, and blood samples were taken to determine anti-Toxoplasma antibody titres according to complement fixation and ELISA IgG and IgM tests. The seroprevalence of toxoplasmosis was 23%. In multivariate analysis, independent predictors of Toxoplasma seropositivity were age (OR 1.03 / year), consumption of raw meat (OR 1.35), owning a cat (OR 1.25), owning rabbits (OR 1.47), childhood residence in a town with a population of <10 000 inhabitants (OR 1.63) vs. location of the childhood residence in a town with population of >100 000 inhabitants, and blood group type A (OR 1.28), B (OR 1.33) or AB (OR 1.43) vs. O. These results suggested that horizontal toxoplasmosis transmission in the Czech Republic may occur through consumption of raw meat, contact with cat faeces and farming.

Body height, body mass index, waist-hip ratio, fluctuating asymmetry and second to fourth digit ratio in subjects with latent toxoplasmosis.

Between 20% and 60% of the population of most countries are infected with the protozoan Toxoplasma gondii. Subjects with clinically asymptomatic life-long latent toxoplasmosis differ from those who are Toxoplasma free in several behavioural parameters. Case-control studies cannot decide whether these differences already existed before infection or whether they were induced by the presence of Toxoplasma in the brain of infected hosts. Here we searched for such morphological differences between Toxoplasma-infected and Toxoplasma-free subjects that could be induced by the parasite (body weight, body height, body mass index, waist-hip ratio), or could rather correlate with their natural resistance to parasitic infection (fluctuating asymmetry, 2D : 4D ratio). We found Toxoplasma-infected men to be taller and Toxoplasma-infected men and women to have lower 2D : 4D ratios previously reported to be associated with higher pre-natal testosterone levels. The 2D : 4D ratio negatively correlated with the level of specific anti-Toxoplasma antibodies in Toxoplasma-free subjects. These results suggest that some of the observed differences between infected and non-infected subjects may have existed before infection and could be caused by the lower natural resistance to Toxoplasma infection in subjects with higher pre-natal testosterone levels.

Complete DNA sequence of the linear mitochondrial genome of the pathogenic yeast Candida parapsilosis.

The complete sequence of the mitochondrial DNA of the opportunistic yeast pathogen Candida parapsilosis was determined. The mitochondrial genome is represented by linear DNA molecules terminating with tandem repeats of a 738-bp unit. The number of repeats varies, thus generating a population of linear DNA molecules that are heterogeneous in size. The length of the shortest molecules is 30,922 bp, whereas the longer molecules have expanded terminal tandem arrays (nx738 bp). The mitochondrial genome is highly compact, with less than 8% of the sequence corresponding to non-coding intergenic spacers. In silico analysis predicted genes encoding fourteen protein subunits of complexes of the respiratory chain and ATP synthase, rRNAs of the large and small subunits of the mitochondrial ribosome, and twenty-four transfer RNAs. These genes are organized into two transcription units. In addition, six intronic ORFs coding for homologues of RNA maturase, reverse transcriptase and DNA endonucleases were identified. In contrast to its overall molecular architecture, the coding sequences of the linear mitochondrial DNA of C. parapsilosis are highly similar to their counterparts in the circular mitochondrial genome of its close relative C. albicans. The complete sequence has implications for both mitochondrial DNA replication and the evolution of linear DNA genomes.

Telomerase as a diagnostic and predictive marker in colorectal carcinoma.

In a search for molecular markers providing both informative diagnostics of malignant disease, and rational stratification of a therapeutic strategy to achieve optimal response in a given patient, we examined the possibility of using telomerase for this purpose in colorectal cancer. Telomerase, a ribonucleoprotein enzyme complex catalysing synthesis of chromosome ends (telomeres), has been known as an almost universal tumor marker but its predictive value has been found in only a limited number of malignant tumor types. Telomerase activity and expression of its catalytic subunit hTERT was determined in 82 surgical specimens from 41 patients (a sample of tumor tissue and of adjacent morphologically normal tissue was obtained from each patient). Telomerase activity was present in tumor samples from 34 (83%) patients, reaching an average value of 47.6 telomerase units (T.U.), while adjacent tissue specimens were either negative (in 25 (61%) patients), or slightly positive (in 16 (39%) patients) showing 1.5 T.U. on average. In tumor samples from patients without lymphatic node metastases (pN0), an average of 37.1 T.U was found. In contrast, in tumor samples from patients with lymphatic node involvement (pN1 or pN2) the average activity was significantly higher (60.2 T.U., p<0.05). In patients with distant metastases a tendency towards higher telomerase activity, although lacking statistical significance, could be observed. Among patients that obtained chemotherapy with 5-fluoruracil, those with low telomerase activity showed a tendency to chemosensitivity. Expression of hTERT was detected not only in samples showing telomerase activity, but also in a considerable portion of telomerase-negative samples either from the tumor or the adjacent normal tissue. We demonstrate that some of these apparent discrepancies may be attributed to differential splicing of hTERT mRNA. We conclude that TRAP assay for telomerase activity is more informative than the common testing for hTERT expression. Telomerase activity is useful both as a diagnostic as well as a predictive factor in colorectal cancer.

[Long-term use of combined hormonal contraception--myths and reality]. / Dlouhodobé uzívání kombinované hormonální kontracepce--mýty a realita.

OBJECTIVE: To assess relationship of long-term use of combined oral contraception (COC) and women health, discussion about myths connected with use of COC. DESIGN: Review of literature. SETTING: Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, Czech Republic. METHODS: Identification of studies able to address the topic using Medline database search. RESULTS: Besides reliable control of fertility COC protect women against dysmenorrhea, iron deficiency anemia, ovarian cysts and uterine fibroids. COC plays very important role in gynecologic endocrinology suppressing effectively hyperandrogenism, which has not only cosmetic effect but brings also improvement in cardiovascular health of affected perimenopausal women. Premenopausal using of COC could help preserve bone mineral density and can reduce the risk of developing Alzheimer's disease. The most important feature is protective effect against endometrial (by 70%) and ovarian (by 50%) cancer which increases with duration of COC use and is long lasting and may be observed 15 to 20 years after stopping use. Association of use COC with increased risk neither of cervical cancer nor breast cancer has not been confirmed. Controversy still persists over the association of long-term (longer than 8 years) COC use by young nulliparas and breast cancer. The risk in this group of users is probably slightly increased. But no authorities recommended any restriction of COC's prescription. Some studies have suggested an inverse relationship between use of COC and risk of colorectal cancer. The only established evidence of direct association between OC use and cancer risk is the increased risk for hepatocellular carcinoma in the absence of hepatitis B (but maximum by 4 cases per 1,000,000 users per year). CONCLUSION: Most non-contraceptive health benefits of COC are still not widely appreciated in spite of much evidence. The final decision of contraception method is upon well and adequate informed user by well educated doctor.

[Comparison of the risk of fetal hypoxia in active and expectant management of post-term delivery]. / Srovnání rizika hypoxie plodu u aktivního a expektativního prístupu po termínu porodu.

OBJECTIVE: Evaluation and comparison of risk of intrapartum foetal hypoxia in expectative and active approach after term of delivery. DESIGN: Retrospective analysis. SETTING: Gynaecological and Obstetric Clinic Medical Faculty, Masaryk University Brno. METHODS: The authors compared retrospectively two groups. Group A comprised 1906 deliveries in 1996, group B 2008 deliveries in 1999. In group A 194 deliveries after the 41st week term was applied. In group B there were 373 deliveries with an expectative approach, with inductions after the 42nd week of pregnancy. The authors evaluated the number of surgical and induced deliveries in after-term pregnancy in both groups and analyzed in indications. The post-delivery condition of neonates was evaluated in both groups according to the Apgar score during the 1st, 5th and 10th minute, In group B the authors had for the blood from the umbilical artery. The condition of neonates delivered by a surgical approach in group B was made more accurate by the base excess (BE) blood from the umbilical artery. The statistical significance of results was evaluated by the U-test and chi 2 test. RESULTS: The differences in the condition of neonates after delivery between the two groups are insignificant. In the expectative approach in 1999 there was a significant decline of the total number of induced deliveries and the total number of surgical deliveries. The difference in the number of surgical deliveries on account of imminent foetal hypoxia in group A and B are statistically insignificant. The number of hypoxic neonates is the same in both groups. CONCLUSION: Based on the results of comparison of the two groups it is obvious that the expectative approach is safe and medically justified. It is not associated with a greater risk of intrauterine foetal hypoxia. It does not lead to deterioration of perinatal results and leads to a marked reduction of induced deliveries.

[Arterial diseases in women using combined hormonal contraceptives]. / Arteriální cévní onemocnení u uzivatelek kombinované hormonální kontracepce.

OBJECTIVE: To determine the association between myocardial infarction and cerebral stroke and use of combined oral contraceptives. DESIGN: Review of literature. SETTING: Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, Czech Republic. METHODS: Identification of methodologically sound studies able to address the topic. Studies were identified by Medline database search. RESULTS: Five the most recent and important studies were the main source of information (Oxford Family Planning Association Contraception Study 1984, Royal College of General Practitioners' Study 1994, WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception 1996, 1997, Transnational Study on Oral Contraceptives and the Health of Young Women 1997, Myocardial Infarction and Oral Contraceptives Study, 1997). Generally there was no evidence of a significantly increased risk of arterial wall disease in healthy non smoked users younger than 35 years. No difference between second and third generation oral contraceptives on risk of arterial wall disease were found. In the most of cases of myocardial infarction or stroke one or more risk factor were identified. Two of the most relevant risk factors are smoking and the absence of blood pressure control. CONCLUSION: The risk of arterial cardiovascular system diseases seems not to be increased at no-risk users (healthy non-smoker younger than 35 years).

[An active approach in membrane rupture before the 32nd week of pregnancy and perinatal results]. / Aktivní prístup pri odtoku plodové vody pred 32. týdnem gravidity a dosazené perinatální výsledky.

During the period from Jan. 1, 1991 to Dec. 31, 1994 at the Second Department of Gynaecology and Obstetrics in Brno 125 patients were delivered of babies after premature rupture of membranes (PROM) before the 32nd week of gestation. After verification of PROM the active approach involved the following steps administration of antibiotics, corticoids, tocolysis, monitoring of markers of inflammation, of the foetoplacental unit and side-effects of treatment. Unless the patient had a spontaneous delivery within three days, the pregnancy was terminated, if the portio uteri was mature, by induction, if it was not mature, by Caesarean section. The latter was performed in cases of a pathological position of the foetus, multiple pregnancy, foetal hypoxia, metrorrhagia or associated complications. The perinatal results were evaluated in four weight categories (500-749, 750-999, 1000-1249, 1250-1499). The early neonatal mortality rate in the different groups was 750/1000, 420/1000, 217/1000, and 90/1000, RDS IV 37%, 36%, 21%, 12% and adnatal infection 25%, 11%, 34% and 21%. According to the authors results an active approach in case of PROM before the 32nd week of gestation is another factor which reduces the perinatal mortality and morbidity.

Evaluation of methods for the determination of chlorophenols in surface water.

Three methods for the determination of chlorophenols in surface water have been evaluated. Two of them utilize solid phase extraction followed by derivatization either in aqueous phase or in organic solvent. The third method is based on liquid-liquid extraction with simultaneous in-situ derivatization. This method was found to be not applicable for samples of surface water. The surfactants present in the samples prevent the separation of the hexane layer at a ratio of 1 : 20 or higher. Both methods using solid phase extraction gave acceptable results; however, the derivatization in aqueous phase proved its priority.

[Induction of cervical maturation using vaginal administration of estrogens]. / Indukce zrání cípku pomocí vaginálne aplikovaného estrogenu.

During the period between September 1, 1993 and September 1, 1994 the authors preinduced 38 pregnant women in term by oestrogen administered by the vaginal route. The group comprised patients with a single pregnancy, PPH, CS 5n and reactive NST. For preinduction 150 mg oestradiol in a viscous gel were used which along with a pessary was inserted 24 hours before the planned induction of delivery by the vaginal route on the portio uteri. After removal of the pessary the CS was evaluated and then delivery was induced by intracervically administered prostaglandin. The preinduction was successful in 32 patients (84.3%), in 6 patients uterine contractions started during preinduction, delivery by forceps was used twice (5.3%) and Caesarean section six time (15.8%). In the course of preinduction there were no side-effects, no irregularities in the course of parturition were observed. The described method can be recommended as the method of choice for the treatment of an immature portio uteri before planned induction of delivery.

Branching of the coeliac artery in some domestic birds. iii. A comparison of the pattern of the coeliac artery in three breeds of the domestic fowl (Gallus gallus f. domestica).

The authors examined the pattern of the coeliac artery and its branches in 100 females of the domestic fowl of three breeds: White Leghorn (33 females), Brown Leghorn (34 females) and White Plymouth (33 females). The arterial pattern was injected by red-dyed latex. An exact analysis of the pattern of branches of the coeliac artery in the individual breeds was made, the individual signs were compared and the level of statistical significance in the differen breed-related findings was determined. On the basis of study of the material it is possible to state that: a) There exist certain differences in the pattern of branches of the coeliac artery in various breeds of the domestic fowl. b) These differences comprise especially the way of origin of the A. proventricularis dorsalis, the origin of spleen arteries, the existence of the accessory arteries for the gall bladder, bile ducts and the duodenum, the origin of the Aa. ileocaecales and the way of branching of the A. gastrica sin. c) It will be possible to compare the pattern of the coeliac artery in various species of birds no sooner than the breed-related differences are determined.