[Vulvovaginitis. Occurrence and importance of mixed and unclassifiable pictures]. / Vulvovaginitida. Výskyt a význam smísených a "nezaraditelných" obrazu.

OBJECTIVE: To evaluate the occurrence of mixed and unclassifiable vulvovaginitis (i.e. those, which fulfill the diagnostic criteria of several diagnostic units or no diagnostic unit) in symptomatic and asymptomatic women. TYPE OF STUDY: Prospective study. METHODS: In 412 women (115 of them asymptomatic) the authors established the diagnosis of vulvovaginitis on the basis of gynecological examination, pH, the amine test and microscopic examination according to Giemsa and Gram. RESULTS: Mycosis was diagnosed in 15.5% women (in 9,6% of asymptomatic ones), lactobacillosis in u 5.6% (in 7.0% of asymptomatic), anaerobic vaginosis in 10.7% (8.7% of asymptomatic), aerobic vaginitis in 7.7% women (4.3% of asymptomatic). U 15.0% mixed infections were diagnosed (in 61% asymptomatic). U 29.4% symptomatic women the diagnostic criteria were not fulfilled for any nosological unit. CONCLUSION: Vulvovaginal mycosis, lactobacillosis, anaerobic vaginosis, aerobic vaginosis were considered as dysmicrobia conditions. The authors demonstrated a high occurrence of more units ("clear" diagnoses to "mixed" diagnoses being in the ratio of 1.62:1). The authors also demonstrated a high occurrence of mixed infections in asymptomatic women (36.0%). On the contrary, in 29.4% of symptomatic women the diagnosis could not be established, the findings being "normal" or "unclassifiable".

["Mixed" and "miscellaneous" vulvovaginitis: diagnostics and therapy of vaginal administration of nystatin and nifuratel]. / "Smísené" a "nezaraditelné" vulvovaginitidy. Diagnostika a terapie vaginální aplikací nystatinu + nifuratelu.

AIM OF THE STUDY: The evaluation of combined and miscellaneous vulvovaginal infections incidence and their treatment with combined vaginal products containing nifuratel and nystatin. DESIGN: Prospective study. SETTING: Gynecologic outpatient department LEVRET, Prague; Laboratories of Microbiology AescuLab, Prague. METHODS: 70 consecutive patients were examined with complaint of vaginal fluor and/or pruritus. We established macroscopic features of fluor, pH, amine test and mounts stained with Giemsa and Gram. We qualified the cases with more diagnostic criteria (mycosis, lactobacillosis, anaerobic vaginosis, aerobic vaginitis) as combined infection, those with no diagnostic criteria as miscellaneous. We treated all patients with vaginal tablets nystatin + nifuratel (Macmiror complex). We prescribed clotrimazol cream, if pruritus was present. We evaluated withdrawals of symptoms and relapses during 3 months after treatment. RESULTS: Combined infection was found in 21 patients from 70 (30%). The most frequent combination was that of mycosis and aerobic vaginitis (13/70, 18.6%) or mycosis and anaerobic vaginosis (4/70, 5.7%); 11 patients fulfilled criteria of no diagnosis. We concluded them as "miscelaneous". The treatment was successful in all cases, 10 women relapsed in 3 months. CONCLUSIONS: Combined vaginal infection findings are present very often (30%), likewise miscellaneous ones (15%) occur. The treatment of these women in successful with vaginal tablets with nystatin + nifuratel.

[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.