Wunderlichs syndrome in patient with sporadic bilateral angiomyolipomas - case report.

We present the case report of bilateral renal angiomyolipomas in a 70-year-old patient. Spontaneous bleeding into the retroperitoneum and hemodynamic instability required an acute surgical revision with a left-sided nephrectomy. The contralateral angiomyolipoma was selectively embolized in the second period and subsequently resected.

[Pregnant women and mothers using alcohol, tobacco and illegal drugs]. / Rodicky uzívající alkohol, tabák a nelegální drogy.

UNLABELLED: This analysis is focused on use of addictive substances among women hospitalised during delivery or puerperium. Analysed data come from National Registry of Mothers at Childbirth and from National Registry of Newborns, which are managed by the Institute of Health Information and Statistics. GOAL: To describe the prevalence of addictive substances use among women during gestation and to study its relation to health complications during pregnancy, delivery or puerperium and to health status of foetus and newborns. METHODS AND MATERIALS: The reporting to registries is provided in the Report on mother at childbirth and in the Report on newborn. Both registers provide basic socio-demographic information about mother, information about previous pregnancies and abortions, about current pregnancy, course of delivery, birth and neonatal treatment and health of newborn during hospitalization of mother during delivery or puerperium. Use of addictive substances is monitored in the National Registry of Mothers at Childbirth since 2000. Addictive substances are divided to tobacco, alcohol and drugs. Descriptive analysis of data was performed and binary logistic regression was used to test association of substance use with education and marital status (adjusted for age), analysis of variance was used to test association of substance use with selected health complications of pregnancy, delivery or puerperium and with health status of foetus/newborns (adjusted for age, education, marital status and interaction between addictive substances). RESULTS: In 2000-2009, 1,008,821 mothers were reported of whom 60,502 women were registered as cigarette smokers, 1,528 used alcohol and 1,836 used other (illegal) drugs. Total of 1,027,200 newborns were reported. The average age of mothers using addictive substances were about 0.5-3 years lower in comparison with nonusers, in average mothers using illegal drugs were the youngest. Mothers using addictive substances were more often unmarried and had lower education than nonusers - almost 2/3 of mothers using addictive substances were unmarried or didn't live in permanent partnership and more than 82% of mothers-users have lower education (primary or secondary school without a diploma). The association between substance use and induced and spontaneous abortions was observed only in smokers. Serious complications of pregnancy were associated with all monitored addictive substances - in mothers-smokers, a probability of serious complications were about 40 %, in users of illicit drugs about 13 % and in alcohol users about 5 % higher as compared to nonusers. Substance use showed almost no association with problems during childbirth. Alcohol and illegal drugs use increased probability of complications in puerperium. Health status of foetus/newborn was negatively significantly altered mainly in those born to mothers-smokers in almost all observed characteristics. Mothers alcohol use during pregnancy was associated primarily with the overall health status of foetus immediately after delivery, congenital anomalies, stillbirth or need for treatment of newborn in the theatre. Infants of mothers using addictive substances had higher probability of consequent hospitalization after discharge from the neonatal department, transfer to infant home and death of infant. CONCLUSION: Association between complications during pregnancy, delivery and puerperium and health status of newborns and substance use of mothers during pregnancy was found mainly in cigarette smoking. Alcohol use was found significant in some (but serious) health problems of mothers and newborns. The association between illegal drugs and monitored indicators wasn't found. Following the results of this work, criteria for reporting of illegal drug use in mothers during pregnancy should be improved.

[Outpatient care for substance users and addicts in the Czech Republic in Health Statistics since 1963]. / Ambulantní péce o uzivatele a závislé na návykových látkách v CR ve zdravotnické statistice od roku 1963.

UNLABELLED: Outpatient care for alcohol and other addictive substances users in the Czech Republic has a 100-year-old history, with the last 50 years covered in health statistics. GOAL: To perform descriptive analysis of the historical data gathered, analysed and published by the Institute for Health Information and Statistics on the network of outpatient psychiatric facilities in 1963-2008 (particularly those specialising in the treatment of addictive disorders, e.g. alcohol counselling centres and later AT centres where AT stands for alcoholism and other toxicomanias) as well as on the numbers and characteristics of their patients--users of addictive substances. RESULTS: The number of visits to alcohol counselling and AT centres showed an upward trend in 1963-1991, mainly from 1970 to 1988 when a historical peak of 387 thousand visits was recorded. This trend was primarily due to males who constituted the majority of the reported patients and their proportion gradually decreased from 95% in 1963 to 79% to 1991. The reporting from the specialised AT centres ended in 1992 to be replaced by the reporting of addictive substances users from all psychiatric outpatient centres. In the period 1993-2008, for which the data by group of addictive substances are available, alcohol users constituted 3/4 of the treated addicts and their annual number decreased by half (from 49 to 25 thousand)--this decrease was also influenced primarily by men, with the male to female ratio declining from approx. 4:1 to 2:1. Since 1995 when age-specific data started to be reported, the age of substance users was increasing, with the exception of non-alcohol drugs users where the proportion of 15-19-year-olds rose in 1995-1997. In 2008, the highest proportion (about two thirds) of alcohol users were aged 40 years and more, while most (nearly 70%) users of non-alcohol drugs were from the age-group 20-39. The number of treated non-alcohol drug users increased more than 3 times between 1993 and 2008. Higher proportions of males were noticed among the users of all non-alcohol drugs but sedatives and hypnotics preferred more often by females (58%). An increase in the number of users was reported for all groups of non-alcohol drugs except volatile substances in 1993-2008: the most common were users of opiates (26%), followed by users of stimulants other than cocaine (23%) and poly-drug users (14%). In 1993-2008, the proportion of injecting drug users decreased from 75% to 50% for opiates and from 70% to 60% for stimulants other than cocaine; however, injecting drug use increased in poly-drug users. The trend in the number of clients of sobering-up stations (short-term detoxification from alcohol and other drugs) follows the trend in the number and capacity of these stations, although a downward trend in their capacity coupled with an upward trend in the number of clients have been observed since 2005. CONCLUSION: Information from the outpatient health care psychiatric facilities is relevant to drug use epidemiology in the Czech Republic, despite the fact that the network of specialised AT centres has not been monitored separately any longer since the early 1990s. Data on drug users in outpatient treatment are in line with the inpatient treatment data and both data sources show some congruent trends. Health statistics remains practically the only data source on the outpatient treatment of alcohol users.

[Residential care for substance users and addicts in the Czech Republic according to the health statistics since 1959]. / Luzková péce o uzivatele a závislé na návykových látkách v CR ve zdravotnické statistice od r. 1959.

UNLABELLED: Similarly to the prevalence of disorders related to the use of addictive substance, the system of medical care for patients with addictive disorders, including the residential treatment, has changed dramatically in the Czech Republic in the last 50 years. GOAL: To perform descriptive analysis of historical data gathered, analysed and published by the Institute for Health Information and Statistics since 1959 on the inpatient psychiatric facilities, and numbers and characteristics of patients hospitalised due to addictive disorders in 1959-2008. RESULTS: The number of episodes of hospitalisation due to alcohol-related conditions was increasing throughout the whole monitored period since the end of the 1950s. After a short decrease at the turn of the 1980s and 1990s, the alcohol-related hospitalisations increased again to the historical peak of 11,691 episodes in 2005. As compared to alcohol-related admissions, the number of hospitalisations due to other (non-alcoholic) addictive disorders was 5-10 times lower until 1993 (60-1,000 episodes annually); however, a sharp increase was observed since 1994, to 5,264 episodes in 2008. The proportion of males among hospitalised alcohol users is currently about 70% in comparison with approximately 95 % at the very beginning of the study period, with most hospitalised persons being aged 40-49 years. Users of sedatives and hypnotics are more often females (approximately 65%), with the highest proportion of them being also aged 40-49 years. From 70 to 90% of hospitalised users of other addictive substances, i. e. illicit drugs and volatile substances, the percentage varying with the substance, are males and the highest proportion of cases is reported in the age group 20-29 years. In the last 15 years, the highest relative rates of hospitalisations for alcohol-related conditions were recorded in the Zlin, Olomouc and Moravian-Silesian Regions and for non-alcohol substance abuse in Prague and the Ustí Region. The inpatient psychiatric bed capacity considerably decreased after 1989, which contrasts with the increasing number of alcohol-related and particularly non-alcohol substance-related hospitalisations since the 1990s. CONCLUSION: The data on hospitalised users of addictive substances are a valuable contribution to the body of information about drug use and its consequences in the Czech Republic and are complementary to the description of the epidemiological situation and trends seen in other data sources. They are of crucial relevance to the study of alcohol abuse due to the scarcity of other data sources in the Czech Republic.