[Neurogenic bladder therapy in patients with spinal dysraphism. Actual strategy]. / Soucasná strategie 1écby neurogenního mocového mechýre u pacientu s mísními dysrafismy.

PURPOSE: Retrospective evaluation of conservative and surgical treatment of detrusor hyperactivity in patients with spinal dysraphisms having been observed in our clinic during the last 20 years. MATERIAL AND METHOD: In the period 1989/2009, 87 patients in the age between 0 and 35 years suffering from the above disease were monitored. The period was divided into three terms. Term I: 1989/1995, Term II: 1996/2005, Term III: 2006/2009. 28 patients were followed-up in the Term I, 58 patients in the Term II and 69 patients in the Term III. The applied types of therapy (conservative, surgical, mini-invasive methods) were specified within the mentioned patients' groups and substitution alterations were monitored. RESULTS: 54 patients were treated conservatively, 33 patients underwent an operation. During the Term I, 23 of the total 28 patients were treated conservatively, 5 (17.9%) patients were operated (3x ileocecal replacement, 2x ileocystoplasty). In Term II, 58 patients were treated, 23 (39.7%) thereof were operated (18x ileocystoplasty, 4x gastrocystoplasty, 1x sigmoideocystoplasty). In the Term III, 69 patients were followed-up and treated, 5 (7.2%) of them were operated (3x ileocystoplasty, 1x gastrocystoplasty, 1x sigmoideocystoplasty), and other 5 (7.2%) underwent a mini-invasive procedure by Botulinumtoxin A application.

[Malone antegrade continence enema stoma in children with dysfunctions of pelvic organs]. / Kontinentní nálevové stoma u detí s dysfunkcí pánevních orgánu.

INTRODUCTION: Regular large intestine cleansing using rectal enemas in patients with impairment of pelvic organs is technically demanding and, frequently insufficient. Defecation is made easier using Malone antegrade continence enema (MACE), which is based on the same principles as continent vesicostomy. AIM: Assessment of up-to-date experience with the MACE in children. MATERIAL AND METHODOLOGY: During 2004-2007, the MACE stoma was completed in 7 child patients with spinal dysraphia and severe intestinal dysfunction (meningomyelocele 4x, cerebral palsy 1x, rectal atresia 2x) aged 2-15 y.o.a. In all the subjects, in situ adjusted appendix was used for the construction and, furthermore, continent vesicostomy was performed in two children. RESULTS: Seven children were followed up for a period of 10-48 months. The enema volume ranged from 100 to 600 ml and it was administered for 20-30 min. The intestine is cleansed within 20-40 minutes. Frequency of the enemas was once daily in 6 patients and every other day in one girl. Complete continence was achieved and obstipation resolved in 5 children, negligible soiling of a diaper lining persisted in 2 subjects. Stenosis of the appendix stoma in two children was managed by its dilation 3 and 5 months postoperatively. CONCLUSION: MACE stoma facilitates regular cleansing of the large intestine and subsequent establishment of stool continence in patients with spinal dysraphia, as well as in patients with any intestinal dysfunction, requiring regular administration of enemas. It is safe to be used in patients with concomittant continent stoma of the urinary tract.

[Priapism in childhood--case report of 14-year-old boy]. / Priapismus v detském veku--kazuistika 14letého chlapce.

In this article, a 14-year-old boy with priapism is presented. A secondary low-flow type of priapism, persisting 11 hours, as a result of olanzapine and methylphenidate therapy was diagnosted. There was a good response to conservative treatment (diazepam, metamisolum), detumescence appeared in 3 hours. No recurrence of priapism was observed, after the olanzapine and methylphenidate therapy was stopped.

[Mucus production consequences in cystoplasties and continent urinary diversions in children--long term experiences]. / Následky produkce hlenu u cystoplastik a náhrad mocového mechýre u detí--dlouhodobé zkusenosti.

INTRODUCTION: Following transposition into the urinary tract, intestinal segments continue to produce mucus and problems related to excessive production do not to diminish with time. The aim of the study is to assess complications connected with excessive mucous production in unsatisfactory cooperative patients with various types of cystoplasties and urinary bladder replacements. PATIENTS AND METHODS: 45 children aged 2-18 years underwent surgery between 1991 and 2005 in our department. Ileocecal urinary reservoir (13), ileocystoplasty (25), sigmoideocystoplasty (2), gastroileocystoplasty (1) and gastrocystoplasty (4) with continent appendicovesicostomy (25) and ileovesicostomy (5) were created. Surgical results with a particular attention to the complications of mucous retention, calculus formation and ruptures of the neobladder were assessed on the basis of data from questionnaires mailed to relevant patients and from their medical documents. RESULTS: Full continence was achieved in 97% patients with catheterizable stoma and 81% children with patent urethra. Excessive mucous production occured in 13 (29%) children, reservoir calculi and neobladder rupture in 2 (4%) patients. In this time, 26 (58%) children practise regular irrigation. CONCLUSION: Although continent urinary diversion using intestinal or gastric segments may improve the quality of life in severely affected patients, it remains an imperfect solution requiring significant cooperation from patients. Many problems may be prevented by the use of suitable surgical techniques, the mucus production and lithiasis by regular catheterization and lavages of the urinary bladder only. The recommended procedures are, however, sometimes neglected even by properly instructed patients or their parents.

[Laparoscopic surgery varicocele in the childhood and adolescent--our experience with 202 patients]. / Laparoskopické operace varikokély v detském a adolescentním veku--nase zkusenosti s 202 pacienty.

UNLABELLED: The aim of this work was to assess benefits and complications of laparoscopic procedures of varicocoelas in children and adolescents, conducted in our clinic. MATERIAL AND METHODOLOGY: From 2000 to 2004, 202 patients (198 with leftsided, 2 with rightsided and 2 with bilateral varicocoelas) underwent laparoscopic procedures in our clinic. Patients with stage II and III varicocoelas were operated. The median age of the operated patients was 15 years (range 11-18 years). The procedures saved arteries and lymphatics maximally. RESULTS: During a two-year follow up period, 8 patients (3.96%) relapsed, 21 patients (10.39 %) presented with hydroceolas. No testical hypotrophy was recorded in our patient group. Also, no peroperative complications were recorded during the laparoscopic procedures. The procedures lasted 20.4 min, on average, hospitalization lasted 4.2 days, on average (range 4-6 days). CONCLUSION: Laparoscopic varicocolectomy, maximally saving arteries and lymphatics, proved a safe method. The rate of complications is similar to that of other treatment procedures of childhood varicocoelas. Rather long term effects considering a quality of hormonal production of testes and seminal counts, than postoperative complications rates, are the main parametres for choice of a treatment method.

CD24 is a marker for human breast carcinoma.

CD24 is a small, mucin-type glycosylphosphatidylinositol-linked cell surface molecule expressed by neutrophils, pre B lymphocytes and certain human tumor cell lines. CD24 has been identified as a ligand for P-selectin in both mouse and human cells. We previously reported that the P-selectin-CD24 binding pathway is important for the binding of the breast carcinoma cell line KS to platelets and the rolling of these cells on endothelial P-selectin. In the present study we have analyzed the expression of CD24 on human breast carcinoma cell lines and on fresh breast carcinoma specimens using the CD24-specific antibody ML-5. Our study clearly demonstrates that CD24 is abundantly expressed on cell lines and fresh tissues of breast carcinomas. We find a differential expression of CD24 in breast carcinomas (cytoplasmic pattern) versus benign breast lesions (apical pattern). Moreover, the intensity of CD24 expression increases with the histological grade of the tumor. Thus, CD24 expression might be a useful marker for human breast carcinoma and play a role in facilitating metastasis by the interaction between tumor cells and platelets or endothelial cells.

Segmental dilatation of the ileum: an uncommon cause of neonatal intestinal obstruction.

Two cases of congenital segmental dilatation of the ileum are reported. In both cases additional abnormal segments of bowel were not diagnosed during the initial laparotomy, and further surgical exploration was required. Consideration of this entity in the differential diagnosis of neonatal intestinal obstruction may enable definition of the optimal site for bowel resection and anastomosis.

Intracardiac primary fibrosarcoma. Case report and literature review.

A 58-year-old woman was hospitalized because of shortness of breath, cough, weakness, and physical signs suggestive of mitral stenosis. Echo-Doppler examination revealed a left atrial mass. This was removed and turned out to be a fibrosarcoma. Recurrence of the tumor with metastases into the pericardium, thyroid goiter, and left kidney led to the patient's death 6 months later. The clinical and pathological features of our rare case are compared with those in the literature.

[Regulation of fertility in Belgrade]. / Regulisanje fertiliteta u Beogradu.

PIP: The authors analyze problems related to fertility control and reproduction in the Belgrade area over the 1976-83 period. The specific social and demographic development of the town is reflected in the regulation of fertility in the population. The authors established that abortion was the most frequent method of birth control, although this method was not held in high regard. The number of abortions was twice that of the number of live deliveries and this had a direct effect on fertility rate. Thus, the end result of this is that the population has been growing old and there has been a low natural increase in the population in relation to its mechanical increase. In this way, the health of the female reproductive population has been endangered. A high frequency of abortion in adolescents is a serious problem facing the Belgrade area because of a high risk of complications. In this population, all forms of birth control were utilized but only in 10% of the population. The authors conclude that all relevant factors must be considered in trying to reach as many women as possible in the different contraceptive centers. (author's modified)^ieng

[Study of pH values of uterine fluid in users of medicated intrauterine devices]. / Ispitivanje pH vrednosti uterinog fluida u korisnica mediciranih intrauterinih ulozaka.

A study was made of the pH value of uterine secretion in 100 women at the age of 18-50 years and with a normal menstrual cycle (28 +/- 2 days). Fifty women had inserted medicated IUDs (Copper T and Multiload Cu 250) and 50 women served as a control group. In the proliferation phase of menstrual cycle 22 women were with the IUDs (of whom 14 had group II and 8 women group III vaginal secretion) and 21 women without any IUD of whom 8 had group II and 13 women group III vaginal secretion. In the secretion phase 28 women were with IUDs, (8 had group II and 20 women group III vaginal secretion) and 29 women from the control group, of whom 17 had group II and 12 women had group III. For the sampling of the intrauterine fluid the aspiration method and for the pH determination the colorimetric method were used. It can be seen that there is no correlation between the group of vaginal secretion and the pH of the uterine fluid, that the presence of a medicated IUD induced an insignificant change in the intrauterine pH, and that the pH value of the uterine fluid ranges from 3.0-9.0 which may be an important factor in the elucidation of certain mechanisms that occur in the uterus in the presence of intrauterine devices.

[Study of the pH values of uterine secretions in women with and without intrauterine devices]. / Ispitivanje pH vrednosti uterinog sekreta zena sa intrauterinim uloskom i bez njega.

A study was performed of the pH value of uterine secretion in 250 women at the age of 18-50 years and with a normal menstrual cycle (28 +/- 2 days). Two hundred out of the total number of the women observed had an inserted nonmedicated IUD (Beospir), whereas the remaining 50 women served as the control group. In the study the phase of the menstrual cycle and the group of vaginal secretion were considered. For the sampling of the intrauterine fluid from the uterine cavity the aspiration method was used and for the determination of pH, the colorimetric method. On the basis of the present study it can be seen that there is no correlation between the group of vaginal secretion and the pH of the uterine fluid, that the presence of a nonmedicated IUD induces an insignificant change in the intrauterine pH, and that the pH value of the uterine fluid ranges from 3,0-9,0 which may be an important factor in elucidating certain mechanisms that occur in the uterus in the presence of intrauterine devices.

[Health needs of adolescent girls in the area of reproductive behavior]. / Zdravstvene potrebe adolescentkinja u oblasti reproduktivnog ponasanja.

Most users (64.1%) of the Counseling Unit for the Young are unmarried girls aged 17 to 24, predominantly students and secondary pupils. Although more frequent in older girls (21-24 years old), pregnancy is highly undesirable both in younger (22.2%) and older (57.1%) ones. Since they are most often nulliparae, the underlying health problems are significant. The girls are considered to be pregnant before their coming to the Counselling Unit, because afterwards 83.0% of them start using contraceptives. The health service for adolescents is encountered with two tasks: (1) to get adolescent girls coming to the Counselling Unit before they experience pregnancy in a negative sense, and (2) to observe and analyse the efficacy and side-effects of contraceptives.

[The status of sterilization in proposed legislation in Serbia]. / Stavovi o sterilizaciji u nacrtu zakona SR Srbije.

According to the draft to for the respective law in Serbia, sterilization is meant to be allowed only on the basis of medical indications determined by a consilium of physicians and with the consent of the person in question. Only exceptionally, for persons incapable of reasoning, can be the consent to sterilization be given by their guardian with the preceding agreement of the guardianship office. In other words, the law on sterilization in Serbia does not accept sterilization as a method for birth control planning.