[Vesico-colonic fistulae in patients with chronic urinary tract infections]. / Kolovezikální pístel u nemocných s chronickou infekcí mocových cest.

The authors present their experience with diagnosis and treatment of colovesical fistula, which had been diagnosed due to chronic recurrent urinary tract infection. The underlying cause of the fistula was previously unrecognized diverticulosis with diverticulitis (3 out of 4 cases). The fistula was diagnosed primarily by a urologist, who performed cystoscopy, which proved to be the most contributing useful examination of all. On the other hand, coloscopy did not reveal the true diagnosis any time and its value is doubtful since insufflation of the inflamed bowel may be followed by intestinal rupture into the peritoneal cavity. Treatment of the fistulae was always surgical, during resection of the involved bowel and resection of the neighboring bladder was accomplished. In all cases one-staged procedure was done with restoration of bowel continuity and suturing of the bladder. Three patients were cured, one died on the 5th day due to complicated ischaemic heart disease.

[Prenatal induction of lung maturation in the fetus. Betamethasone versus betamethasone+thyrotropin-releasing hormone]. / Antenatální indukce plicní zralosti plodu. Betametazon versus betametazon+tyrotropin releasing hormon.

During the period from May 1, 1994 till December 31, 1997 at the First and Second Departments of Gynaecology and Obstetrics Masaryk University Brno 311 neonates with birthweights from 500 to 2000 g were born. A retrospective study was made comparing neonatal results of three methods of prenatal induction of maturing of surfactant in premature neonates. The first group was without treatment, in the second group only betamethasone was administered and in the third group betamethasone and thyrotropin releasing hormone (TRH). The neonates were divided into three body weight groups: 500-999 g, 1000-1499 g and 1500 g and more. The most favourable results with administration of betamethasone and TRH were obtained in the group weighing 500-999 g. This pertained to the smaller number of post-partum administration of surfactant, reduction of the oxygenation index and period of artificial pulmonary ventilation. IVth grade RDS and other complications in the child. In the group of neonates weighing 1000-1499 g administration of betamethasone and TRH had a positive effect only on the oxygenation index and grade of RDS. In the group of neonates with weights above 1500 there were no statistically significant differences between the described three groups. It may be concluded that the greatest effectiveness was achieved by a combination of betamethasone and TRH in neonates weighing 500-999 g, this combination was less effective in the group weighing 1000-1499 g and without effect in those weighing 1500 g or more.

[Kidney sparing surgery]. / Záchovné operace ledvin.

From 1988 to 1998 107 nephron sparing surgery have been done for localised renal cell tumor. The age was between 21 to 75. Nephron sparing surgery means removal of tumor consumed part of renal tissue with oncology clean border in healthy renal tissue. Elective indication for nephron sparing surgery is renal cell carcinoma on single kidney or on bilateral function disabled kidneys. In the last years indication for nephron sparing surgery have spread also to patients with both kidneys, who have single extrarenal growing renal cell carcinoma to the diameter 4.5 cm. In our group of follow up patients, within the interval 3 to 96 months from operation we have 96.26% survival without evidence of recurrent renal cell carcinoma.

[An active approach in membrane rupture before the 32nd week of pregnancy and perinatal results]. / Aktivní prístup pri odtoku plodové vody pred 32. týdnem gravidity a dosazené perinatální výsledky.

During the period from Jan. 1, 1991 to Dec. 31, 1994 at the Second Department of Gynaecology and Obstetrics in Brno 125 patients were delivered of babies after premature rupture of membranes (PROM) before the 32nd week of gestation. After verification of PROM the active approach involved the following steps administration of antibiotics, corticoids, tocolysis, monitoring of markers of inflammation, of the foetoplacental unit and side-effects of treatment. Unless the patient had a spontaneous delivery within three days, the pregnancy was terminated, if the portio uteri was mature, by induction, if it was not mature, by Caesarean section. The latter was performed in cases of a pathological position of the foetus, multiple pregnancy, foetal hypoxia, metrorrhagia or associated complications. The perinatal results were evaluated in four weight categories (500-749, 750-999, 1000-1249, 1250-1499). The early neonatal mortality rate in the different groups was 750/1000, 420/1000, 217/1000, and 90/1000, RDS IV 37%, 36%, 21%, 12% and adnatal infection 25%, 11%, 34% and 21%. According to the authors results an active approach in case of PROM before the 32nd week of gestation is another factor which reduces the perinatal mortality and morbidity.

[Evaluation of the functional status of the CNS using evoked potentials and EEG]. / Hodnocení funkcního stavu CNS pomocí evokovaných potenciálu a EEG.

The authors present an account on hitherto little used electrophysiological methods for the evaluation of the functional state of the brain and on the possibility to use the results of these examinations for prognostic purposes in therapeutic care of patients with impaired consciousness. They recommend the use of a mobile technique capable to ensure EEG monitoring, examination of the basic modalities of evoked potentials (visual, auditory and somatosensory) at the bedside. The practical results of these examinations are demonstrated on case-histories of patients treated at intensive care units for neonates. The asset is the relatively reliable evaluation of the actual condition of the brain and the possibility to assess the most probable development of the patient's clinical condition.

[Prophylactic administration of Claforan in patients with premature loss of amniotic fluid]. / Profylaktická aplikace Claforanu u pacientek s predcasným odtokem plodové vody.

The authors compared two groups of pregnant women with early loss of amniotic fluid. In the first group Claforan was administered, 3 x 1 g by the i.m. route, and in the second group Ampicillin, 3 x 1 g by the i.m. route. The data were recorded in a special protocol and were divided into three groups: 1. patient before delivery, 2. patient during puerperium, 3. neonate. From the results two conclusions were drawn: 1. The authors did not detect any reasons why antibiotics should not be administered prophylactically in case of premature loss of amniotic fluid. 2. The main differences between the compared groups were found in neonates where after administration of Claforan there was a substantially lower incidence of positive bacterial cultures than after Ampicillin and there was also a lower incidence of RDS II and adnatal infections.

[Delivery of neonates with a birth weight of less than 1500 grams. Perinatal results during a 6-year period and possibilities of affecting them]. / Porod novorozence s porodní hmotností pod 1500 gramu. Nase perinatální výsledky za sestileté období a moznosti jejich ovlivnení.

The authors evaluated the perinatal mortality and condition on delivery of 167 neonates with a birth weight under 1500 g who were delivered and hospitalized at the 2nd Department of Gynecology and Obstetrics in Brno between Jan. 1, 1985 and Dec. 31, 1990. The perinatal mortality of neonates with a birth weight below 1000 g was 73.1%, of those with a birth weight 1000 g-1500 g it was 25.9%. Early neonatal mortality was not influenced by the patient's age exceeding 30 years, occupation, environment, status, number of interrupted pregnancies, spontaneous abortions and previous spontaneous and induced deliveries, administration of tocolysis, corticoids, the position of the foetus, transport in utero, way of delivery, indication for Caesarean section and sex. Early neonatal mortality was influenced by the mother's age less than 20 years, administration of antibiotics, multiple pregnancy, grade of asphyxia, presence of RDS, necessity of respiratory support, incidence of intracerebral haemorrhage and birth trauma. In the discussion the authors mention possible ways of reducing the perinatal morbidity and early neonatal morbidity in the mentioned range of birth weights.