Specialisation studies in medicine: formal or non-formal education?

The intention of authors of this article was not to interprete or even to criticise the official documents of the Europen Commission. We just want to put a flash onto unsolved problems in higher education which seem to hamper the ongoing process of harmonisation of higher education internal structure within the European Union leading to the European Higher Education Area. Bologna process as a backbone of this organism of knowledge might consider tertiary professional higher education in specialised medicine as part of its internal structure. It is just to hope that despite the critical distance and uniqueness of some policymakers in higher education, attention will be focused on this issue in thinking about a further progress in the preparation of a common European Qualification Framework (Ref 5). Full Text (Free, PDF) www.bmj.sk.

[Exchange amnioinfusion in conceptus with laparoschisis (first experience)]. / Výmenná amnioinfúzia u plodov s laparoschízou (Prvé skúsenosti).

OBJECTIVE: During amnioinfusion exchange (AE) a certain amount of amniotic fluid is repeatedly extracted and the same amount of physiological solution is consequently instilled into the amniotic fetal cavity. The aim of this procedure is to dilute the amniotic fluid that surrounds the eviscerated organs of fetuses with laparoschisis so as to avoid the genesis of fibrous coating on these organs. DESIGN: Prospective study. SETTING: Gynekologicko-pôrodnícka klinika SZU, FNsP akad. L. Dérera, Bratislava, Slovakia. METHODS: We have executed AE in five fetuses with laparoschisis since June 2002. Two patients underwent the treatment 2 times during the 32nd and 36th weeks of gestation. Two other patients were treated once during the 32nd week and one patient once during the 36th week. Under ultrasound control we used a spinal needle to extract 120-180 ml of dense, cloudy amniotic fluid. Consequently, we instilled the same amount of physiological solution warmed up to the temperature of 37 degrees C into the amniotic cavity through antibacterial filter. The fetuses were monitored cardiotocographically and with the help of ultrasound flowmetry in umbilical vessels, before and after the treatment. RESULTS: The AE were successful and without complications in all five cases. All patients delivered via elective caesarean section during the 36th - 37th gestation week. One patient delivered 24 hours after second AE due to the danger of intrauterine fetal hypoxia that was verified cardiotocographically. The other patients delivered 1-4 weeks after AE. CONCLUSION: The significance of AE lies primarily in the reduction of the occurrence of fibrous coating on eviscerated organs. It enables postnatal primary surgical closure of the defect in the front abdominal wall, an earlier onset of intestine peristalsis, transition from parenteral to peroral nutrition and shorter hospitalization.

Effect of starter culture, spice mix and storage time and temperature on biogenic amine content of dry fermented sausages.

Two types of dry fermented sausage differing in spicing mixture and the diameter (low content of red pepper+diameter 80 mm, H-sausage; high content of red pepper+diameter 55 mm, P-sausage, respectively) were produced in parallel with two different starter cultures (Pediococcus pentosaceus+Staphylococcus carnosus, B-samples and S. carnosus+Staphylococcus xylosus+Lactobacillus farciminis, F-samples, respectively). The sausages were ripened 21 days and subsequently stored 91 days at the room temperature. Concentration of both most abundant amines, putrescine and tyramine (y; mg/kg DM) increased significantly (P<0.01) in HB-sausage during ripening (x; days): y=2.5+18.13x-0.3144x(2) (R(2)=0.99) and y=0.7+8.17x-0.1130x(2) (R(2)=0.99), and also during storage: y=127.3+5.123x (R(2)=0.79) and y=26.0+3.211x (R(2)=0.74), respectively. At the end of ripening, putrescine (247 mg/kg DM) and tyramine (123 mg/kg DM) content in the HB-sausage was higher (P<0.05) than in the PB-sausage (12 and 9 mg/kg DM, respectively), concentration of either of these amines was negligible (1 mg/kg DM) in either type of F-inoculated sausage. Both starter culture and sausage type influenced significantly (P<0.001) both putrescine and tyramine content in the sausage; starter accounted for 57% and 55% of total variability in putrescine and tyramine content, respectively. Due to the significant (P<0.05) increase of total aerobic counts in the HB-sausage between the end of ripening and the 7th day of storage, followed by the significant (P<0.01) increase of the sum of total biogenic amines between the end of ripening (425 mg/kg DM) and the end of storage (1029 mg/kg DM), the storage of the dry fermented sausages at the room temperature should not be recommended.

[Laparoscopic fenestration of lymphoceles after kidney transplantation]. / Laparoskopická fenestrácia lymfokély po transplantácii oblicky.

Lymphocele is a relatively frequent complication after kidney transplantation, which impair the passage of urine from the kidney, cause emptying of bladder lymphoedemas of the lower limbs, etc. Percutaneous drainage of lymphocele is associated with a risk of infection and a high percentage of recurrence. Until recently, standard surgical treatment of this complication was open fenestration of the lymphocele into the peritoneal cavity. In their paper, the authors describe their first experience with laparoscopic fenestration of the lymphocele. From May 1998 till April 1999 the authors performed laparoscopic fenestration in 5 patients. In four patients the intervention was successful, in one female patient recurrence of lymphocele was observed, which was later resolved by an open operation. In none of the patients early or late surgical complications occurred, the use of analgetics during the postoperative period was minimal, the length of hospitalisation ranged from 2 to 4 days. The authors consider the discussed method a suitable alternative for treating lymphocele after renal transplantation thanks to its minimal invasivity. It involves practically no load of the sick patients after kidney transplantation.

["Non-cardiac" surgery in patients after heart transplantation]. / Nekardiálna chirurgia u pacientov po transplantácii srdca.

UNLABELLED: Aim of the study are description and analysis of the frequency, spectrum and results of "non cardiac" surgery after heart transplantation (HTx). PATIENTS: Up to December 1999, 74 patients (9 females) of age 18-65 years (median 49) were followed-up from 1 to 144 months (median 35) after heart transplantation (HTx). RESULTS: In 10 patients 12 symptomatic non cardiac diseases require surgical procedures. Four had cholecystolithiasis, one patient cholecystolithiasis with choledocholithiasis. The rest of them suffered from renal artery occlusion, carcinoma of the cervix uteri, umbilical hernia, ileus, sigmoidal carcinoma and two from benign prostatic hyperplasia. In all patients with cholecystolithiasis laparoscopic cholecystectomy was performed. In the case of concomitant choledocholithiasis endoscopic extraction of stones was carried out. In the other patients nephrectomy, cervix uteri conisation, hernioplasty, adhesiolysis, resection of sigma and transuretral resection of prostatae were carried out. All procedures were performed by standard methods and no major complications were noted. CONCLUSION: Non cardiac diseases requiring surgical management after HTx are common. By steady improvement of survival after HTx increasing incidence of these conditions has to be expected. The management of them is similar of those in "non transplant" patients. However the care should be paid to immunosuppressive state and therapy.

Ciprofloxacin in treatment of nosocomial meningitis in neonates and in infants: report of 12 cases and review.

Twelve cases of neonatal and infant nosocomial meningitis treated with intravenous ciprofloxacin in doses of 10 to 60 mg/kg/day are described. Four neonates were 21 to 28 days old and eight infants were 2 to 6 months old. Six presented with Gram-negative meningitis: Escherichia coli (2), Salmonella enteritidis (1), Acinetobacter calcoaceticus (1), two with two organisms, and (H. influenzae plus Staphylococcus epidermidis, Acinetobacter spp. plus S. epidermidis), and six were attributable to Gram-positive cocci (four S. aureus and two Enterococcus faecalis). Ten cases were cured. In two cases, reversible hydrocephalus appeared that responded to intraventricular punctures. In seven children, no neurologic sequellae appeared after a 2- to 4-year follow-up. One neonate had relapse of meningitis 3 months later and was ultimately cured, but developed a sequellae of psychomotoric retardation. Follow-up varied from 27 months to 10 years. Current published case reports from Medline on quinolone use in meningitis in neonates and infants are reviewed.

Laparoscopic cholecystectomy: an original three-trocar technique.

At present, laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. The operating technique reported by most authors includes the use of four trocars. We report a group of 710 consecutive patients treated by an original three-trocar technique. The use of the fourth trocar was necessary in only 55 cases (8%). However, among 56 cases of acute cholecystitis the use of the fourth trocar was necessary in 14 cases (25%) (p < 0.01). Twenty-six laparoscopies were converted to open procedures (3.6%). Four common bile duct injuries were observed (0.5%): two of them among the 655 operations with three trocars (0.3%) and two after application of the fourth trocar at the beginning of the procedure because of dissection difficulties. Our results are similar to those using the "classic" four-trocar technique. Moreover, this technique is less expensive and allows one less scar.

Prospective analysis of 40 initial laparoscopic colorectal resections: a plea for a randomized trial.

The experience reported herein is on our initial 40 cases of laparoscopic-assisted (LA) colorectal resection that were prospectively evaluated. The operations were performed for colonic tumors of the right segment (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 segmental left colectomies, 5 anterior resections, 2 abdominoperineal resections, and 1 total colectomy. Thirty-one patients (77.5%) had a successfully completed LA resection. The reasons for conversion in the majority of the cases (66.6%) were difficulties in dissection. In the entirely LA procedures, the mean flatus postoperative day was 3, the mean postoperative hospitalization was 10.7 days, and there were 8 complications (25%) in 7 patients. Two patients were reoperated 2 and 3 months later for adhesion and ischemic stenosis of the colon above the anastomosis. There was 1 death in the LA group (3.2%). The length of operative specimen was 19.6 cm, and the mean number of resected lymph node was six. In contrast to laparoscopic biliary surgery, the benefits of LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.

Prevention and treatment of prematurity in twin gestation.

Early prenatal diagnosis, intensive prenatal care, bed rest, cerclage, and preventive in-patient management are discussed. The authors present the management and outcome of 83 twin pregnancies in a 5-year retrospective study. The frequency of twin pregnancy wa 1.08%, the mean gestational age at the time of delivery was 37.5 weeks. Mean birth weight of the first fetus was 2453 grams, second 2406 grams. The incidence of preterm deliveries was 31.3% and perinatal mortality of twins came up to 54.2%. The early prenatal diagnosis of a twin pregnancy is the most important step in prenatal management. The centralization of prenatal care in the out-patient department designated for "high risk pregnancies" is recommended. Ultrasound scanning is recommended as a screening examination. Bed rest before the 25th gestational week is recommended on an individual basis though it is recommended in all cases after the 25th gestational week. Cerclage was indicated in 28.9% cases with unfavourable cervical findings. The mean gestational age of 38 weeks and the birth weight of 2659 grams found in the group who had in-patient management should be compared with 35.8 weeks and 2120.0 grams in the group managed on an out-patient basis. Perinatal mortality before 32nd week--300/1000, between 33-37th week--62.5/1000, and after 37th week--8.7/1000. The authors recommend in-patient management before the 32nd week of pregnancy in twins.

[Monitoring the effects of oxyphilline Spofa in the umbilical-placental circulation]. / Sledovanie úcinku oxyphyllinu Spofa na umbiliko-placentárnu cirkuláciu.

Vasodilatation treatment is an inevitable part of comprehensive therapy of intrauterine growth retardation of the foetus. The authors present the results of investigations of the effect of Oxyphylline on the umbilical and placental circulation of pregnant women with confirmed disorders of the flow parameters. Oxyphylline Spofa, 3 x 100 mg orally, is the drug of choice in treatment of foetal hypotrophy with a marked effect on the umbilical and placental circulation.

[Intersexual differences in the levels of trace elements in amniotic fluid in the 2d trimester of pregnancy]. / Intersexuálny rozdiel koncentrácie niektorých stopových prvkov v plodovej vode v II. trimestri tehotnosti.

The authors assessed during comprehensive examination of amniotic fluid obtained by transabdominal amniocentesis on account of genetic indication during the second trimester of normal pregnancy between the 15th and 22nd week of gestation four selected trace elements - Zn, Cu, Pb and Cd, using the method of atomic absorption spectrometry. One of the criteria for evaluation of the results was also the relationship of the concentration of the selected trace elements and sex of the foetus. In 157 amniotic fluids collected during the 16th-19th week of gestation they recorded a significantly elevated lead level in male foetuses. During the 17th week normal pregnancy they found also a significantly increased zinc concentration in amniotic fluid of female foetuses. The authors are so far unable to interpret these interesting results which will be the subject of future investigation.

[Functional reserve of umbilico-placental circulation]. / Vysetrenie funkcnej rezervy umbiliko-placentárnej cirkulácie.

The authors present the results of the action of 10% magnesium sulphate on the umbilico-placental circulation. They found that intravenous administration of magnesium sulphate reduces the vascular resistance in the umbilico-placental circulation and improves its parameters when a functional disorder is involved. The maximum effect was recorded during the 10th minute following administration. In case of absolute reduction of the placental circulation or in case of an obstruction in the umbilical artery the above parameters did not improve. Magnesium sulphate administration may serve as a loading test of the functional reserve of the umbilico-placental circulation.