[Rare complication after stapled hemorrhoidectomy]. / Raritná komplikácia po staplerovej hemoroidektómii.

Statistics show that more than half of the population suffers from hemorrhoids at different clinical stages. Only a small percentage of them (5 to 10%) require surgical treatment. The gold standard is open hemorrhoidectomy (most commonly Milligan-Morgan operation). Circular stapled hemorrhoidopexy by Longo is an alternative to conventional hemorrhoidectomy. The main advantages of this procedure are: less postoperative pain, earlier return to work and to social life. The complication rate is similar to open hemorrhoidectomy. This method, however, also brings new kinds of complications, some of them potentially life-threatening. Our case report presents one of these rare complications.

Portomesenteric vein gas and pneumatosis intestinalis--a rare complication after neoadjuvant radiochemotherapy in oesophageal cancer.

Portomesenteric vein gas and pneumatosis intestinalis is most commonly caused by mesenteric ischemia and bowel necrosis but may have a variety of other causes. The etiology is multifactorial and the clinical presentation is variable. The diagnosis is based on a combination of clinical suspicion and radiographic findings. The finding of hepatic portal venous gas alone is not an indication for emergent exploration. We report portomesenteric venous gas as a rare complication after neoadjuvant radiochemotherapy of the oesophageal cancer (Fig. 3, Ref. 12).

Association of the leukemia inhibitory factor gene mutation and the antiphospholipid antibodies in the peripheral blood of infertile women.

To characterize the impact of the potentially functional mutation--the G to A transition at the position 3400 of the leukemia inhibitory factor (LIF; a pluripotent cytokine that plays a central role in the control of the embryo implantation) gene that leads to the exchange of valine with methionine at codon 64 we evaluated the association of the LIF gene mutation and the levels of antiphospolipid antibodies (aPLs) in the peripheral blood of infertile women (the aPLs examination was part of our routine immunological test during the infertility check-up). Eight infertile mutation-positive women were diagnosed with idiopathic infertility (n=5) and endometriosis (n=3) and their levels of aPLs in serum were compared with 115 infertile women without any LIF gene mutation. Enzyme-linked immunosorbent assay was used for the detection of seven antiphospholipid antibodies; the results were statistically assessed by the Fisher's 2 by 2 exact test to evaluate the association of the LIF gene mutations and aPLs in serum of infertile patients. The presence of aPLs was significantly higher in our study group (100%) than in 30% of aPLs-positives in control infertile patients (p = 0.0035) which indicates that the aPLs are elevated in women with LIF gene mutations.

[Vaginal delivery in primiparas and anal incontinence]. / Vaginální porod u primipar a anální inkontinence.

OBJECTIVE: An investigation of incidence and degree of anal incontinence after vaginal delivery among primiparas and characterizing of the risk factors. DESIGN: Prospective observational study. SETTING: Department of Gynecology and Obstetrics, Charles University and Faculty Hospital Pilsen. METHODS: 346 primiparas after consecutive vaginal delivery between May 2000 and February 2001 were included. All delivered in lithotomy position. Questionnaires were sent few days after delivery and then two and 6-9 months later. Analysis of the returned questionnaires. 28 obstetric parameters assessed. RESULTS: 46.5% women responded. 23 women registered leakage of flatus before delivery. Two months postpartum one (0.6%) patient reported fecal incontinence and 22 (14.3%) flatus incontinence de novo or impaired already present incontinence. 6-9 months after delivery the same patient (0.6%) reported fecal incontinence and 16 women (10.4%) incontinence of flatus. Ten of them felt impaired quality of life. Anal incontinence gradually improved during the time (in 76%). Risk factors of developing (worsening) of anal incontinence were antenatal anal incontinence (in two months period) and women weight (or BMI) measured at 6-9 months after birth. None of nine patients after forceps delivery (Breus traction forceps) which responded reported signs of anal incontinence. Neither the range of episiotomy nor the length of perineum had any relation to the development of anal incontinence. However episiotomy has been shown to be a protective factor of 3rd degree tear in primiparas (RR 0.24). Third degree tear was diagnosed in seven cases (2%), three out of 6 women reported anal incontinence postpartum. CONCLUSION: This study shows relatively frequent development of flatus incontinence after vaginal delivery in primiparas. These symptoms usually improve within the time. Only minimum of women after vaginal delivery suffers of fecal incontinence. 42% of women with anal incontinence feel impaired quality of life. At the first postpartum check every woman should be asked, whether she has any symptoms of anal or urine incontinence or impaired sexual health. If positive the answer, the woman should get information where to find a help.

[Analysis of the zona pellucida in human oocytes and embryos in an assisted reproduction program]. / Analýza zona pellucida lidských oocytu a embryí v programu asistované reprodukce.

OBJECTIVE: Our aim was to design simple method for quantitative evaluation of oocyte and embryo morphology in in vitro fertilization (IVF) programme efforting of embryo implantation prediction to be able to set the optimal number of embryos for transfer for given specific case. This study deals with zona pellucida (ZP)--the one interesting and for oocyte unique structure. The work is the part of comprehensive research of oocyte, zygote and embryo morphology. DESIGN: Prospective study. SETTING: Center of Assisted Reproduction, Department of Gynaecology and Obstetrics, Medical Faculty of Charles University, Pilsen. METHODS: The study includes analysis of 66 microphotography pictures of oocytes, zygotes and embryos of patients who were treated by IVF on our department between September and December 2000. The microphotographs were taken by digital microphotographic system. Analysis of zona pellucida parameters was conducted by image analysis software called AnalySIS, Soft Imaging System GmbH. RESULTS: It was found out the average width of the zona pellucida 18.4 microns +/- 2.1 microns, the minimum width was 12.3 microns a maximum 23.1 microns. CONCLUSION: There was found significant narrower zona pellucida in women who conceived in this IVF cycle then in the women who did not.

[Fructose and glucose in follicular fluid and serum of women undergoing stimulation in an in vitro fertilization program]. / Fruktóza a glukóza ve folikulární tekutine a séru stimulovaných zen v programu IVF.

OBJECTIVE: To find out if there is some amount of fructose in the follicular fluid of IVF stimulated patients. If so then to compare fructose and glucose levels with IVF outcome, type of stimulation and infertility factors. DESIGN: Retrospective study. SETTING: Department of Gynaecology and Obstetrics, Charles University, the Czech Republic. METHODS: 202 women undergoing IVF treatment since 11/1999 till 02/2001 were evaluated. We measured a level of fructose and glucose in a sample of serum and follicular fluid (FF) obtained at ovum pick-up. Then the results were compared with the IVF outcome, the length of stimulation and infertility factors. The control group consists of 23 women with a pure andrologic factor of infertility. RESULTS: At the day of pick-up the serum concentration of glucose and fructose taken on an empty stomach is on average 5.43 +/- 1.35 mmol/l and 25.05 +/- 9.26 micrograms/ml compared to 5.26 +/- 1.00 mmol/l and 23.69 +/- micrograms/ml in control group. The concentration of both glucose and fructose in FF correlates with their serum level. The FF concentration of glucose is on average 3.75 +/- 1.32 mmol/l (70% of serum concentration) and fructose 11.34 +/- 5.29 micrograms/ml (48% of serum concentration) by comparison with 3.78 +/- 0.91 mmol/l (73%) and 12.37 +/- 7.06 micrograms/ml (53%) in control group. CONCLUSION: There is a possible influence of follicular fluid saccharides like glucose and fructose in process of fertilization. We derived this hypothesis from studies evaluating the role of saccharides in endometrial secretion, cervical mucous and seminal plasma. We assumed that patients with a successful IVF cycle have a lower fructose concentration in FF. The clinical pregnancy is really mildly lower but this difference is not statistically significant. We confirmed FF fructose is in close correlation with its serum concentration. But we did not confirm the FF glucose and FF fructose concentration is related to the IVF outcome.