[Two years of pharmacological termination of pregnancy in the Silesian hospital Opava, success and lessons]. / Dva roky metody medikamentózního ukoncení gravidity ve Slezské nemocnici v Opave, úspesnost a poznatky.

OBJECTIVE: The purpose of this study was to summarize our departments experience with pharmacological termination of pregnancy up to 49 days of amenorrhea, to assess the success, and especially, to offer a closer analysis of the complications of this method. DESIGN: Retrospective analysis. SETTING: Department of Gynaecology and Obstetrics at the Silesian Hospital. METHODS: The monitored sample consisted of 161 female patients who underwent pharmacological termination of pregnancy at our department from 1. 7. 2014 to 30. 6. 2016 being administered 600 mg of mifepristone (Mifegyne) and 400 µg of misoprostol (Mispregnol). Within the sample of patients we observed the objective process of pharmacological termination of pregnancy with special attention being payed to an analysis of complications. We compared the number of complications occurred under classic surgical intervention and those occurred under pharmacological termination of pregnancy. RESULTS: A complete abortion without the necessity of surgical intervention occurred with 151 patients (93.79%) of whom 15 patients with administering uterotonic medicaments. Ten patients (6.21%) required a consequent instrumental revision of the uterine cavity, seven of them (70%) had a history of surgical intervention in the uterine cavity. In case of one patient persisted vital pregnancy. Two patients underwent medical termination of pregnancy twice. In one case there were twins. CONCLUSION: The method of pharmacological pregnancy termination has a good efficiency, it is safe with minimal side effects.

[Heterotopic pregnancy after spontaneous conception]. / Heterotopická gravidita po spontánní koncepci.

DESIGN: Case report. SETTING: Departement of Obstetrics and Gyneacology, Silesian Hospital in Opava. METHODS: Case interpretation. CONCLUSION: Heterotopic pregnancy after spontaneous conception is diagnosed with a rare, often difficult to ascertain, however, the increasing incidence has justified its place in the differential diagnosis of acute abdominal not only for women enrolled in the program of assisted reproduction.

Cochlear implantation in malformed inner ear.

OBJECTIVES: Authors evaluate diagnosis, surgery and results in the implantees with malformed inner ear. METHODS: Four children with the inner ear malformations were included in this series (one child with common cavity, two children with narrow internal auditory meatus and one child with lateral semicircular canal aplasia). CT and MRI were used for the imaging of inner ear malformations. Different types of implants (Medel Combi 40+, Nucleus Freedom) with different types of electrodes were used. The average time of being the cochlear implant user in the time of evaluation was 3 years. RESULTS: Pure tone audiometry (PTA), Category of Auditory Performances (CAP), Evaluation of spontaneous speech and Evaluation of speech understanding were used to evaluate of the CI outcome. CONCLUSIONS: Malformation of inner ear with the developed cochlear nerve nowadays is the indication for CI. Councelling with parents must be open and detailed to inform them on realistic expectations and different ways of deaf child education (Tab. 4, Fig. 4, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

[Granulomatous myopathy in patients with sarcoidosis and myasthenia gravis]. / Granulomatózní myopatie u pacientu se sarkoidózou a myasthenia gravis.

Granulomatous myopathies are extremely rare. The finding of epithelioid granulomas in muscle biopsy indicates mostly an involvement of the skeletal muscle in systemic sarcoidosis. In this report we provide description of five patients with previously diagnosed sarcoidosis (pulmonary or cutaneous), in which a clinically significant muscle weakness developed. We aim at demonstrating the value of muscle biopsy for further treatment of the patients, since clinically indistinguishable myopathies can arise not due to the involvement of muscles in the granulomatous process, but due to the corticosteroid-induced changes (chronic steroid myopathy). The demonstration of a selective atrophy of type II muscle fibers can provide the clue for distinguishing the patients, in which the corticosteroid treatment should continue, from those, in which the treatment should be modified. Further, we discuss a rare finding of granulomas in muscle biopsies of two patients with myasthenia gravis (MG) associated with thymoma. Although it is difficult to explain the pathogenesis of this event, MG should be considered in the differential diagnosis of granulomatous myopathies. Moreover, the finding of granulomas along with lymphocytic infiltration in MG muscle should lead to a search for an underlying thymic neoplasm.

MESAM4 evaluated nocturnal respiration disturbances in myasthenia gravis.

Twenty-eight treated patients with myasthenia gravis (MG) (Osserman's scale: ocular form-12 cases, mild generalized form-5 cases, medium generalized form-10 cases, free of symptoms after thymectomy-1 case) were examined with MESAM4. Typical sleep apnea syndrome (SAS) patterns were observed in 12 subjects, mild saturation undulation without respiratory noises and without heart rate changes in 7 (3 of them also produced the SAS pattern) and irregular nonspecific changes in 3. The average vital capacity in SAS patients was 2556 (SD = 1166) ml, and in patients without MESAM4 abnormality 1629 (559) ml, P < 0.05. The average of oxygen saturation minima in SAS patients was 87.6 (3.6) %, in patients without MESAM4 abnormality 91.5 (1.8), P < 0.01. We conclude that there is no relation between any clinical parameter of MG and the occurrence of nocturnal respiratory disturbances. The risk factors of the occurrence of sleep respiratory disturbances in MG are similar to those of the non-myasthenia population although the incidence of this condition in MG is higher.