[Pregnancy in myelodysplastic syndrome]. / Gravidita pri myelodysplastickém syndromeu.

OBJECTIVE: Evaluation of the influence of myelodysplastic syndromee (MDS) on the course of pregnancy and delivery. DESIGN: Case report. SETTING: Gynecological and Obstetric Department 1st Medical Faculty Charles University and General Faculty Hospital, Prague. SUBJECTS AND METHODS: The authors analyze their experience with the course of pregnancy and delivery in a patient with MDS and refractory anaemia who was treated on account of the disease for several years before pregnancy in the Institute of Haematology and Blood Transfusion. Pregnancy was not associated with progression of the basic disease and complications which developed during pregnancy were not associated with MDS. Pregnancy was terminated in this patient on account of preeclampsia gravis per sectionem caesarean by delivery of a healthy foetus. CONCLUSION: The example draws attention to a serious haematological disease while during pregnancy and delivery deterioration of the basic disease was not observed.

[Psychological aspects of gynecologic operations]. / Psychologické aspekty gynekologických operací.

OBJECTIVE: To make the stress influence of the hospitalisation on patients objective, to determine the factors in the process of therapy, which negatively influence a patient, and to find the consequences between the intensity of anxiety and the occurrence of the post-operational complications followed by the lengths of hospitalisation. DESIGN: Prospective clinical study. SETTING: The Department of Gynecology-Obstetrics of the General Teaching Hospital and the 1 st. Medical Faculty of the Charles University in Prague. METHODS: 63 patients after the planned middle serious operation (abdominal or vaginal hysterectomy, Burche suspension and vaginal plastics) were included into the study. The women were not treated both because of oncological or psychiatric reasons and they did not suffer from some other serious illness. The mean age was 53, mean weight 72 kg and mean parity 1.7. Evaluation of the stress influence of the patients was performed by means of the questionnaires, which were devised by us (Questionnaire A and B), and by means of standard questionnaires (STAI, SCL-90) that were filled in by the patients on the day of their reception and on the day of their release from the hospital. RESULTS: By evaluation of the questionnaires we have received objective parameters of the measure of anxiety and stress the patient is entering the treatment process with, and also subjective evaluation of the concrete stress moments occurring during the hospitalisation. A hypotheses proving that the more the stress load experienced by a patient the higher the probability of the occurrence of complications in the post-operational period and consequently longer hospitalisation has been verified by the methods of the statistic analyses. For our clinical praxis, the results of the descriptive analyses, where our patients evaluated their fear concerning the illness, its operational resolution and particular stress situations during hospitalisation, are mainly important. CONCLUSION: Our results proved that for ensuring optimal course of operation and post-operational period it is most important to reduce stress influence on a patient, i.e. particularly by a personal discussion of a surgeon and a treating doctor with the patient, and by elimination of the negative factors during the period of hospitalisation. Last but not least the most important role plays the clinical psychologist because not only important is professional medical, but also psychological access to the patient.

[Psychology of urinary incontinence. I. Comparison of women with urgent and stress incontinence before initiation of therapy]. / Psychologie inkontinence moce. I. Srovnání zen s urgentní a stresovou inkontinencí pred zahájením terapie.

OBJECTIVE OF STUDY: Comparison of psychological characteristics of untreated female patients with urgent and stress urinary incontinence. DESIGN: First stage of a perspective comparative study. SETTING: Gynaecological and Obstetric Department of the Municipal Hospital Neratovice, Urogynaecological out-patient dept. of the Institute for Mother and Child in Prague-Podolí, the Urogynaecological out-patient dept. of the Gynaecological and Obstetric Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague. METHODS: The study compares a group of 54 patients with stress incontinence and a group of 16 patients with urgent incontinence. Before the onset of therapy the patients were examined by a series of psychodiagnostic tests: MMPI/100 (Minnesota Multiphasic Personality Inventory, abridged version), STAI (State-Trait Anxiety Inventory), SCL-90 (Symptom Check List), Lüscher's colour test, guided interview. For statistical evaluation the sign test and t-test were used. RESULTS: In the MMPI/100 and SCL-90 questionnaires a significant difference was found, i.e. a greater psychopathology in women with urgent incontinence (in both instances p < 0.01). The two groups did not differ in any single scale. STAI and the interview did not reveal any significant differences with the exception of greater importance of sexual contact in women with urgent incontinence (p < 0.05). CONCLUSION: In the group of women with urgent incontinence a higher non-specific psychopathology was proved as compared with women with stress incontinence.

[The HELLP syndrome]. / HELLP syndrom.

The HELLP syndrome is a serious complication of pregnancy, found most frequently in conjunction with severe preeclampsia. The incidence of this disease in preeclampsia is between 2 and 12%. The diagnosis is based on typical laboratory findings, i.e. haemolysis--H, elevated liver enzymes--EL and a low-platelet count--LP. Haemolysis is defined as microscopic finding of an abnormal peripheral blood smear, elevated total bilirubin above 1.2 mg/dl and elevated lactate dehydrogenase above 40 mukat/l. Transaminases (AST above 4.2 mukat/l) are also elevated. For HELLP a low platelet count is typical (number of thrombocytes less than 100,000 mm3). The symptoms include above all pain in the epigastrium, in the right subcostal area, nausea and vomiting. Non-specific symptoms resembling viroses are lassitude, general weakness, headache and fatigue. A correct differential diagnosis and early assessment of the diagnosis are decisive for starting treatment which can prevent the development of serious complications such as disseminated intravascular coagulopathies and hepatorenal failure. Treatment of the HELLP syndrome is symptomatic with the objective to stabilize the general condition of the mother, improved haemodynamic conditions and the impaired haemocoagulation. A very important therapeutic step is early termination of pregnancy which depends on ther mother's condition and the condition of the foetus with regard to gestational age.

Excitatory amino acid antagonists and pentylenetetrazol-induced seizures during ontogenesis. IV. Effects of CGP 39551.

We determined anticonvulsant effects of CGP 39551 [(E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid 1-ethylester] against pentylenetetrazol-induced seizures in developing, 7-90 day old, rats. The rats received CGP 39551 in doses of 10, 20 or 40 mg/kg IP 30 min prior to the pentylenetetrazol administration (100 mg/kg s.c.). In addition, the 20 mg/kg dose of CGP 39551 was injected 120 min prior to pentylenetetrazol. In adult rats, all doses of CGP 39551 blocked generalized tonic-clonic pentylenetetrazol-induced seizures. In younger rats, higher doses of CGP 39551 and/or a longer delay between the CGP 39551 pretreatment and pentylenetetrazol administration was necessary for similar anticonvulsant effects against tonic-clonic seizures. In contrast, there was no effect of CGP on pentylenetetrazol-induced clonic seizures. The results indicate that CGP 39551 has anticonvulsant features similar to other competitive NMDA receptor antagonists. High doses of CGP 39551 and long pretreatment latency which are necessary in young rats for anticonvulsant effects may reflect the overexpression of NMDA transmission during the second and third postnatal week of the rat. Alternatively in adult rats, we can speculate an anticonvulsant role of a CGP 39551 metabolite or maturation of brain uptake mechanism for CGP 39551.

Kainate/AMPA receptor antagonists are anticonvulsant against the tonic hindlimb component of pentylenetetrazol-induced seizures in developing rats.

Non-NMDA receptor antagonists CNQX, DNQX, and NBQX (10-40 mg/kg IP) were tested against pentylenetetrazol-induced (100 mg/kg SC) seizures in 7 to 90-day-old rats. All three drugs significantly decreased the incidence of tonic hindlimb component of tonic-clonic pentylenetetrazol seizures, often in favor of increased incidence of forelimb tonus throughout development. In addition, in 7 to 25-day-old rats, DNQX and NBQX decreased the severity of seizures due to a decrease in total incidence of the tonic component of tonic-clonic seizures compared to age-matched controls. However, neither drug was able to consistently suppress the incidence or increase latency to onset of clonic and tonic-clonic pentylenetetrazol seizures. The data suggest that, during development, non-NMDA receptor transmission may play a role in the generation of the tonic component, but not in the generation of other components of pentylenetetrazol-induced seizures.