[Pre-eclampsia from the perspective of inter-professional collaboration]. / Preeklampsie z hlediska mezioborové spolupráce.

Preeclampsia-eclampsia is a syndrome which covers the area of influence belonging to gynecologists-obstetricians. However the internists, especially those who work as consultants in obstetric departments, are interested in diagnostics and therapy of this problem as well. Though internists working in the outdoor-departments do not face the problems of preeclampsia so often, it will be usefull to inform them about the latest trends in diagnostics and therapy ofthis syndrome, which may be very risky in pregnancy. The physicians in general (except the gynecologists) consider preeclampsia mostely as one form of hypertension that appears sometimes during gravidity and they do not realy appreciate the complex danger ofthis illness for the both, mother and child. The objective ofthis paper is to inform the general medical public, especially the internists and general practitioners about the modern view ofthe main problems of preeclampsia e.g. the pathogenesis, diagnostics and the up to day therapy of this high risky syndrome joined with pregnancy.

[Effects of mental stress on the health status of the accused during a criminal trial]. / Vliv psychického stresu na zdravotni stav obvineného v prubehu trestního rízení.

A court-sworn medical expert is sometimes authorized to pass a medical judgement, whether an older, from serious diseases suffering accused is able to take part in the criminal trial proceedings. The court-sworn medical expert is required to consider the accused's fitness, his mental and physical ability to appear in court, to understand the trial, to answer the questions of the judge, to defend himself, to put questions and objections against the witness's testimony, etc. Such medical expert's opinion is usually a task for a psychiatrist. Judgement of the ability of the accused to take part in the main court trial is of another character, especially when the accused is suffering from a serious disease, e.g. cardiovascular, pulmonary, gastrointestinal, haematological, tumorous or other. In this case the medical judgement is usually required from a doctor of internal medicine. Nevertheless, this is not an easy task for him. As far as these problems are concerned, the expert gathers only little experience of his own during his juridical practice. Similar cases have been extremely sporadically published in medical or juridical literature and if, then in common sense only. It is evident that the expert must face any possible aggravation of the accused's difficulties. At the same time the expert ought to take care lest the court trial should be inadequately extended and even should prevent the accused's avoidance in the main court trial. This paper tries to determine the basic rules for the court-sworn experts in the branch of internal medicine and would like to facilitate them to judge under which circumstances a seriously ill accused may appear in trial proceedings without exposing him to a serious damage of his health or even endangerment of his life.

[Postoperative pulmonary thromboembolism and nosocomial pneumonias: differential diagnosis]. / Pooperacní plicní tromboembolie a nozokomiální (tzv. pooperacní) pneumonie: diferenciální diagnóza.

After a surgical intervention patient can face pulmonary complication that was formerly recognised as postoperative pneumonia. This term described the clinical picture which was diagnosed after abdominal or thoracic operations, after polytraumatic lesions, especially with elderly patients that were for a longer time confined to bed rest. The clinical symptoms incl. the X ray picture were consistent with those of pneumonia - such pneumonias are nowadays classified as nosocomial infections. These complications sometimes ended fatally. The post-mortem examination revealed either pneumonia or often pulmonary thromboembolism (PTE). Occasionally it happened that PTE was incorrectly clinically diagnosed as pneumonia and the patient was treated with antibiotics instead of with heparin. The present paper brings discussion on the differential diagnosis between postoperative nosocomial pneumonia and PTE. Clinical casuistic is also added.

[Importance of the ECG in pulmonary thromboembolisms in gynecology]. / Význam EKG u plicní tromboembolie v gynekologii.

The authors analyze the diagnostic value of ECG examination in pulmonary thromboembolism which is a frequent complication in elderly women in postoperative gynaecological departments. They draw attention in particular to the importance of ECG in the differential diagnosis between cor pulmonale acutum and infarction of the inferior and anterior myocardial wall.

[Management and methods of delivery in women with aortic coarctation--results of 64 pregnancies in 41 women]. / Dispenzarizace a zpusob vedení porodu u zen s koarktací aorty--výsledky 64 tehotenství u 41 zen.

OBJECTIVE: To evaluate maternal morbidity and mortality of women suffering from coarctation of the aorta as well as the perinatal mortality of babies delivered by women with this anomaly of the aorta. According to our experience we recommend a suitable form of a follow up and suggest an optimal mode of delivery for these patients. DESIGN: Original paper. SETTING: 1st and 2nd Department of Gynecology and Obstetrics of the Masaryk University of Brno--Maternity Hospital, Obilní Trh 11, 602 00 Brno, Czech Republic. METHODS: Our set consists of 34 pregnant women with coarctation of the aorta. These patients were followed up during the pregnancy in the years 1964-1998 by the Centre for Cardiovascular Diseases in Pregnancy in the Maternity Hospital in Brno. Seven women who were not operated on for the coarctation of the aorta (group A) were pregnant 14 times. Twenty seven women who were operated on for the coarctation (group B) had 50 pregnancies. RESULTS: There were no maternal deaths in our set. From the 12 delivered babies of women with non operated coarctation of the aorta one child was SGA (small for gestational age). From 42 babies born by women who underwent an radical operation of the coarctation of the aorta previously we had to face one death of a newborn who was SGA as well. CONCLUSION: The radical operation of the aorta should be carried out during the first year of age if possible, between the 9th to 12th month, at best. With women who were not operated on there is a greater risk of rupture of the aneurysm of the aorta and aneurysm of the cerebral arteries in the 2nd and 3rd trimester, during the labor and in the early puerperium. We would advise therefore a through follow up during the whole pregnancy. The high BP should be lowered medicamentally. As to the mode of delivery Caesarean section is preferred. With women who were successfully operated on in their early infancy and whose BP is normal or the systolic BP does not exceed 160 mmHg the Caesarean section is not mandatory but elective. We would mostly advise a spontaneous delivery with shortening of the 2nd stage of the labor by forceps or vacuumextraction--the delivery by Caesarean section in accordance with usual obstetrical practice.

[Hypertension in pregnancy--chaos in terminology of literature world-wide]. / Hypertenze v tehotenství--chaos v názvosloví ve svetové literature.

The authors submit an account of the terminology of toxemia of pregnancy and hypertension during pregnancy which are used in the world literature. They draw attention to the lack of uniformity which leads to a distortion of statistics. Differences in the nomenclature and incorrect enlistment of hypertension may lead also to an inadequate type of treatment and conduction of delivery. The authors recommend the use of nomenclature based on the pathogenesis and on their own experience. They emphasize the difference in the pathogenesis, therapy, prognosis and prevention of different types of hypertension.

[Gestational diabetes mellitus and disorders of glucose tolerance in pregnant women with essential hypertension]. / Gestacní diabetes mellitus a porucha tolerance glukózy u tehotných trpících esenciální hypertenzí.

The authors revealed during dispensarization of pregnant women suffering from essential hypertension that the disease is relatively frequently associated with some metabolic disorders, i. e. obesity, gestational diabetes or impaired glucose tolerance. They draw attention to a similarity with Reaven's syndrome in non-pregnant women. The authors recommend to screen for diabetes all obese pregnant women and those with hypertension to detect an impaired glucose metabolism and prevent foetopathies in neonates of thus affected mothers. The authors consider obesity one of the subsidiary criteria in the differential diagnosis of essential hypertension and preeclampsia.

[The effect of self-monitoring on perinatal outcome in insulin therapy of diabetic women during pregnancy]. / Vliv selfmonitoringu na perinatální výsledky u inzulínem lécených diabeticek v tehotenství.

The authors compare perinatal results in insulin treated diabetic women who were followed up in the out-patient department of the Second Gynaecological and Obstetric Clinic of the Masaryk University in Brno. In 1980-1984 148 pregnant diabetic women were followed up and in 1985-1991 when self-monitoring has become part of comprehensive treatment of pregnant diabetics in our department, 279 women were followed up. The patients were monitored during pregnancy by a diabetologist and gynaecologist. Other members of the team are a paediatrician, geneticist, psychologist, dietitian, and educational nurse. As to laboratory parameters, short-term and long-term compensation of diabetes were monitored. Systematic preconception preparation of diabetic patients, with an attempt to achieve normal blood sugar levels and genetic examination of both partners from part of comprehensive care. The results achieved in our department revealed a statistically significant decline of the incidence of foetopathies in neonates at the 5% level of significance and a decline of hypoglycaemia in foetuses at the 0.1% level.

[Prenatal preparation--a part of the care of young female diabetic patients]. / Prekoncepcní príprava--soucást péce o mladou diabeticku.

In the Second Gynaecological and Obstetric Clinic in Brno there has been for more than 15 years a specialized department for treatment of diabetes during pregnancy. The department monitors and treats pregnant diabetics from approximately two thirds of the former South Moravian region, i.e. patients with diabetes assessed before pregnancy as well as those where an impaired carbohydrate metabolism was detected during pregnancy. The authors submit an account of the organization of team work in their out-patient department.

[Grawitz tumor in pregnancy]. / Grawitz-Tumor in der Schwangerschaft.

One case of adenocarcinoma of the kidney during pregnancy has been demonstrated.

[Classification of patients with heart diseases]. / Beitrag zur Klassifikation herzkranker Schwangerer.

Critical review of the classification of heart diseases in pregnancy of the New York Heart Association. A new classification of cardiovascular diseases in pregnancy is proposed mainly based on hemodynamic aspects.

[Remarks and indications for the continuous monitoring of females and pregnant patients with cardiovascular diseases]. / Bemerkungen und Hinweise zur kontinuierlichen Betreuung von herzkreislaufkranken Frauen und Schwangeren.

A centralization of the pregnant cardiacs within the districts of the GDR is discussed based upon an analysis of the centre for cardio-angiopathies during pregnancy in Brno and own experiences. A formerly demand for a high-specialised medical care and hospitalisation for pregnant women with cardio-angiopathies seems not to be necessary.