Risk of anal incontinence in women with inflammatory bowel diseases after delivery.

AIM: The aim of our prospective study was to evaluate the development of postpartum anal incontinence in patients with inflammatory bowel disease (IBD) compared to healthy women. MATERIAL AND METHODS: Patients with IBD and healthy controls enrolled in the study from January 1st 2013 to November 30th 2016 and filled in the anal incontinence questionnaire in the beginning of pregnancy and after vaginal delivery. The results were statistically processed using suitable tests. RESULTS: A total of 57 women were enrolled, 17 (29.8 %) with ulcerative colitis, 23 (40.4 %) with Crohn's disease, and 17 (29.8 %) healthy controls. Incidence of postpartum anal incontinence is comparable across all groups; there was no statistically significant difference between the IBD and control groups (Kruskal-Wallis test by ranks with Dunn correction, non-significant). Postpartum anal incontinence was strongly correlated with the extent of perineal injury (r = 0.80; p < 0.0001; Pearson's linear correlation). CONCLUSIONS: Women with inflammatory bowel disease in remission do not exhibit higher incidence of postpartum anal incontinence (PPAI) compared to healthy controls; the key correlate of PPAI appears to be the extent of obstetric injury, consistently across all study groups. These results suggest that concerns about postpartum anal incontinence development should not be an indication for Caesarean section in IBD patients (Tab. 6, Fig. 1, Ref. 34).

[Feedings of critical care patients by endoscopic three-luminal tube--a retrospective analysis]. / Výziva kriticky nemocných endoskopicky zavádenou trojluminální sondou--retrospektivní analýza.

BACKGROUND: Enteral nutrition (EN) represents a preferred type of nutritional support in critical care patients, in spite of the high incidence of intolerance. One of the methods which can speed up the delivery of adequate amounts of food is to switch from the gastric to post-pyloric feeding. A three-luminal tube (TLT) enables post-pyloric enteral feeding with accompanying gastric decompression. The aim of our study was to evaluate effectiveness and safety of the endoscopically introduced TLT along with the estimation of the adequate dose of enteral nutrition. METHODS AND RESULTS: Retrospective analysis of 111 critical care patients with 140 introduced TLT during 2003 to 2006 in two intensive care units (UIC) in the Teaching hospital in Plzen included patients of average age 54 years (+/- 15), APACHE II score 26 (+/- 10) and UIC mortality was 24%. Eight introductions were technically not successful (6%). Reintroduction of the tube was necessary in 21 patients (19%). The average time of tube introduction was 6 minutes (+/- 3). In direct relation to endoscopy no serious complication was observed. In our cohort, 34 ventilator-associated pneumonias developed (31%). Average time interval since the admission to the hospital till TLT introduction was 7 days (+/- 6). Evaluation of a subgroup of 77 patients from one UIC has shown that the adequate amount of EN was achieved in 82% of patients in 4 days (+/- 3) after the TLT introduction. In average, TLT was introduced for 11 days (+/- 7). CONCLUSIONS: Endoscopic TLT introduction represents a safe and reliable method which can ensure adequate amount of enteral nutrition in majority of critical care patients with gastrointestinal dysfunction. In our conditions, TLT is probably not sufficiently used.

[Diagnostics and therapy of hepatorenal syndrome. Recommendations of of the working group on portal hypertension of the Czech Hepatology Society and the J. E. Purkinje Czech Medical Society]. / Doporuceny postup pro diagnostiku a lécbu hepatorenálního syndromu. Doporucený postup vypracovaný skupinou pro portální hypertenzi pri Ceské hepatologické spolecnosti Ceské lékarské spolecnosti J. E. Purkyne a schválený výborem Ceské hepatologické spolecnosti Ceské lékarské spolecnosti J. E. Purkyne.

Hepatorenal syndrome is a functional renal failure in patients with advanced cirrhosis and portal hypertension or acute liver failure. It is caused by extreme vasoconstriction in renal arterial bed. Type I HRS presents as an acute renal failure, while type II HRS is chronic alteration of renal function in patients with refractory ascites. Prognosis of HRS is very poor with survival reaching several weeks in patients with HRS type I. Causal treatment is liver transplantation, other treatment options include use of splanchnic vasoconstrictors (terlipressin) together with plasmaexpansion (albumin) and TIPS. It is important to exclude nephrotoxic medication (non-steroid anti inflammatory drugs, aminoglycosides) and properly treat all infective complications in prevention of HRS.