[Use of recombinant activated factor VII (NovoSeven) in the treatment of a patient with idiopathic thrombocytopenic purpura complicated with subarachnoid and parenchimatous hemorrhage]. / Zastosuvannia rekombinantnoho aktyvovanoho faktora VII (NovoSeven) u khvoroho z idiopatychnoiu trombotsytopenichnoiu purpuroiu, uskladnenoiu subarakhnoïdal'no-parenkhimatoznym krovovylyvom.

Efficiency of recombinant activated factor VII (rFVIIa) (NovoSeven) in treatment of patients with idiopathic thrombocytopenic purpura (ITP) complicated with subarachnoid and parenchimatous hemorrhage was shown in the article. The action of NovoSeven in patients with an affected megakaryocytic system depends on the binding of rFVIIa with activated thrombocites and on their surface rFVIIa provides the activation of X factor and thrombin formation. NovoSeven proved to be called a universal hemostatic medication for the idiopathic thrombocytopenic purpura treatment. Taking into account that transfusion of thrombocites concentrate is not recommended for patients with thrombocytopenia of immune origin and after immunoglobulin infusion we need time to see thrombocites number grow so in urgent NovoSeven is a medication of choice to stop bleeding in patients with ITP.

Obstetric anaesthesia in Hungary.

A nation-wide survey of pain relief in childbirth in Hungary was carried out in 1993. Information was provided on 104 137 deliveries in 98 units. The frequencies of different methods of pain relief for vaginal delivery were as follows: systemic opiates in 7387 cases (8.3%), epidural analgesia in 4611 cases (5.2%) and inhalational analgesia (nitrous oxide) in 4470 cases (5%). Epidural analgesia was available in 36 units (36.7%). For 71 744 vaginal deliveries (80.5%) no pain relief was provided at all. For caesarean section (n = 13240) the rate of spinal or epidural anaesthesia was 36.7%. It was concluded that despite an increasing rate of pain relief in labour elsewhere, the numbers of epidurals are still rather low in Hungary.

[Gynecologic and obstetric anesthesia in Hungary 1993]. / A szülészeti és nögyógyászati anesztézia helyzete Magyarországon 1993-ban.

Authors publish findings of a nationwide survey of pain relief in childbirth in Hungary carried out during the year of 1993. Informations were provided on 104,137 deliveries in 98 units. At 71,744 vaginal deliveries (81%) not any types of pain relief were used. The frequency ot different types of pain reliefs at vaginal deliveries were as follows: systemic opioids at 7387 cases (8.3%), epidural analgesia at 4611 cases (5.2%) and inhalational analgesia (nitrous oxide) at 4470 cases (5.0%). The availability of epidural analgesia at 62 units was absent. The rate of spinal--epidural analgesia at Cesarean sections was 37% (n = 13,240). At gynaecological laparotomies (n = 18,219) the rate of general anaesthesia was 98%, this rate at vaginal hysterectomies was 56.8% (n = 1568). Authors conclude that the rate of pain relief in labour in Hungary is unreasonably low. The reason of it is the lack of anaesthetists and also the traditional view, which does not recognize the importance of the pain relief in labour.

[Changes in the serum level of methohexital (Brietal) in mothers and newborn infants during anesthesia and cesarean section]. / Die Veränderungen der Serumspiegel von Methohexital (Brietal) bei Mutter und Neugeborenen während der Narkose bei Kaiserschnitt.

On the occasion of cesarean sections the concentration of Brietal was investigated in maternal and umbilical vein blood after administration of 1 mg/kg body weight to the mother. The mean serum level in the newborns 5 minutes after injection was 0,02 micrograms/ml. No side effects were observed.

Ovarian actinomycosis developed during the use of a plastic intrauterine contraceptive device.

The case of a primary ovarian actinomycosis developed during the use of a Szontágh--Szereday type plastic IUD is presented. After a radical operation the patient was discharged in a good condition but 40 days later had to be readmitted because of a pelvic and abdominal wall abscess. After local surgery and massive penicillin treatment she is free of complaints. It is assumed that the IUD had a pathomechanical role.

PIP: A case report of ovarian actinomycosis developed during the use of a plastic IUD describes diagnosis and treatment. After 7 months use of the Szontagh-Szereday IUD, a 33-year-old patient was admitted with fever and a flat tender mass of apple size, reaching to the right pelvic wall. The patient was treated with chloramphenicol, phenylbutazone, trimethoprim and sulphadimidine, erythromycin, neomycin, colistin, and methicillin which were administered in courses of 4-5 days to treat the septic fever and repeated, but negative punctures of the pelvic mass were made. The patient was transfused and then treated with carbenicillin and penicillin and a few complaint-free days followed. On the 65th day of clinical treatment laparoscopy was performed and a mass was found adhering to the pelvic wall and coecum and enclosing the Fallopian tube and ovary. Chronic inflammation with multiple abscesses were seen histologically and total hysterectomy and bilateral adnexectomy were performed. 1 section of the ovary showed a structure suggesting actinomycosis. The patient was discharged and then readmitted on the 40th postoperative day. Culture of an abscess in the right side of the pelvis revealed macrophages, granulocytes, and typical "sulphur" granules. Actinomycosis was diagnosed and treated with penicillin and methicillin.