[Reducing of cesarean section rate in Krajská nemocnice Liberec - Robson classification]. / Snizování poctu císarských rezu v Krajské nemocnici Liberec - hodnocení podle Robsona.

OBJECTIVE: A retrospective analysis of caesarean section rates using modified Robson classification in years 2013-2016. Discussion of factors influencing the decrease of caesarean section rate. DESIGN: Restrospective data analysis. SETTING: Gynecology and obstetrics department Krajská nemocnice Liberec. METHODS: We compared the caesarean section rates at our department between years 2013-2016 using the modified Robson classification system. The groups were analysed both separately and mutually to identify the factors contributing to the decrease of caesarean section rate in concrete subgroups. RESULTS: We experienced a remarkable reduce in caesaren section rate from 24.6% in 2013 to 14.5% in 2016. CONCLUSION: The Robson classification provides objective caesarean section rates comparisons. This method enables further interpretation of outcomes and policy assessment to reach the optimal caesarean section rate.

Transformation of blood monocytes to multinucleated giant cells in vitro: are there any differences between malignant and nonmalignant states?

Blood monocytes (BMs) from 139 subjects (70 malignant melanoma patients, 31 breast cancer patients, 38 healthy controls) were cultured for at least 7 days. The formation of multinucleated giant cells (MGCs), which was checked during the whole time of culture, was observed in all cases. By the seventh day MGCs represented 25-50% and during the second and third month more than 90% of all cells. Lymphokines and/or concanavalin A stimulation (16-34 cases respectively) of BMs was performed as well. This stimulation greatly accelerated MGC formation. There were no differences either in spontaneous or in stimulated fusion between the different groups compared.

HLA-DR antigen expression on melanoma metastases and the course of the disease.

Melanoma cells freshly isolated from regional lymph node metastases of 59 stage II malignant melanoma patients were analyzed by indirect immunofluorescence staining with monoclonal antibody TAL 1B5, detecting the HLA-DR alpha chain. The expression of HLA-A,B,C antigens, using antibody W6/32, was also investigated in 45 of these cases. There were no substantial differences in the course of the disease with respect to the percentage of positive cells. In 13 malignant melanoma patients two to four simultaneous and/or successive metastases (both locoregional and distant-subcutaneous) were analysed for HLA-DR. With simultaneous metastases (7 cases) the percentage of HLA-DR-positive cells was mostly very similar, and in no case was there more than 25% variation. As to successive metastases (9 cases) the percentage of HLA-DR-positive cells remained practically unchanged or decreased during the course of the disease.

Expression of HLA-DR antigens on tumour cells does not contribute to skin reactivity to autologous cholesteryl hemisuccinate (CHS)-treated tumour cells in patients with metastatic melanoma.

Skin tests with autologous cholesteryl hemisuccinate (CHS)-treated and untreated cells were performed in ten metastatic melanoma patients. In the majority of cases evident reaction was noted with CHS-treated cells (9/10) while the reaction with untreated cells was mostly negative (7/10). Tumour cell suspensions used for skin tests were characterized for reactivity with monoclonal antibody TAL 1B5 detecting the HLA-DR alpha chain. There were no differences between CHS-treated and untreated cells with respect to HLA-DR expression and no correlation was found between grade of skin reaction to CHS-treated cells and the proportion of HLA-DR positive cells in the injected cell sample.

[Acid-base equilibrium in the blood in cattle in relation to the incidence of DFD (dark, firm, dry) meat]. / Acidobazická rovnováha krve skotu ve vztahu k výskytu DFD masa.

We studied changes in the parameters of the acid-base balance of the blood in cattle before animal transport to the slaughterhouses, after transport, after stunning and before bleeding. At the same time we studied the occurrence of DFD meat by measuring the pH value of the muscle and by determining the meat color. We found out that the disorder of acid-base balance was less manifest, with respect to the large capacity of the buffer systems of the blood, than the changes caused by glycogenolysis in the muscle.

Skin tests with autologous cholesteryl hemisuccinate treated tumour cells in cancer patients.

Skin tests with autologous irradiated tumour cells were performed in 20 malignant melanoma, 7 breast and 6 ovarian cancer patients. In the majority of cases evident reaction was noted with cholesteryl hemisuccinate (CHS)-treated cells while the reaction with untreated cells was mostly negative. No correlation was found between this reactivity and the ability of patients to be sensitized to DNCB and to their reactivity to PPD. No correlation was found between reactivity to CHS-treated tumour cells and the stage and course of the disease.

Leukocyte adherence inhibition responses obtained with various tumor extracts in breast cancer patients.

Leukocyte adherence inhibition (LAI) assay was employed to detect cell-mediated immune response in breast cancer patients of clinical stages I and II. Twenty-one breast cancer extracts were screened in 232 breast cancer patients and 343 healthy persons. The activity of individual extracts differed remarkably. Overall, LAI response was 58.6% (136/232) correct and 18.9% (65/343) false positive. Fifteen extracts were not suitable from the clinical point of view. Only two extracts gave a constantly high rate of tumor-specific LAI-positive values in breast cancer patients, ie, 83.3% (25/30) and low percentage of false positive results in controls, ie, 4% (2/50). A further study dealt with the possible relation between the activity of extracts (expressed in percentage of positive LAI results in the tumor group) and histology of primary tumor of patients whose tumor tissue was used for extraction. This relationship could not be proven statistically. We investigated also whether the percentage of correct LAI responses in breast cancer patients could be affected by histological agreement or disagreement (grading and node involvement) between primary tumor of extract donor and primary tumor of patients tested. No significant relationship was found in this respect.

Evaluation of the LAI test in patients with benign and malignant breast diseases.

Tumor "specific" immune recognition was assayed in 125 patients with various breast diseases including breast cancer of clinical stage I and II, 22 patients with other malignancies and 64 healthy persons employing leukocyte adherence inhibition test (LAI). In the group of breast cancer patients (BC) there were 81% of positive responders (52/65) with a mean nonadherence index (NAI) value 67.4. Sensitization to extract derived from breast cancer was detected in 38.3% (23/60) of patients with benign breast diseases (BBD). The mean NAI value was significantly lower comparing to NAI value of BC patients (34.8 vs. 67.4) but exceeded the upper limit of normal values. The most frequent positive responders of BBD group were found in patients with proliferative mastopathy (11/17). Our study brought further evidence that BC patients and in a lesser degree BBD patients are sensitized to some antigen(s) contained in selected breast tumor extracts. However, high proportion of false positive results in healthy persons (14.1%) and mainly considerable number of positive responders in BBD patients represent a major limitation for clinical diagnostic usefulness of the LAI assay.

DNCB and PPD skin testing in breast cancer.

DNCB and PPD skin testing was performed in 152 breast cancer patients. Bates' instruction with a plea for uniformity was used (Cancer, 43, 1979, 2306). Majority of patients were tested while being diagnosed and prior to the treatment. There were no differences in the reactivity within early operable breast cancer patients (Stage I and II) with respect to nodal involvement. Patients with N1 reacted in the same manner as those with N0. The reactivity of patients with locoregionally advanced disease (Stage III) was similar to that of Stage I and II patients. Significantly lower responsiveness was found in Stage IV patients, the depressed response to DNCB being more pronounced than to PPD.

A prospective study of lymphocyte responses to phytohemagglutinin in melanoma patients. (lack o prognostic value of correlation with minimal tumor burden).

Clinical findings in 63 patients with malignant melanoma were compared with the results of PHA-induced lymphocyte transformation tests. The patients had been followed up for 1 to 60 months (average 16 months) and repeatedly tested at regular intervals. Reactivity of lymphocytes in stage I patients was not altered if compared with that of controls. The frequency of lowered values increased in more advanced stages. Only in stage II patients a significantly impaired PHA-lymphocyte transformation was demonstrated in comparison with controls. In stage I and II patients, there was no significant difference in lymphocyte transformation between those with the presence of tumor and those without clinically evident tumor. Prognostic value of PHA transformation tests as regards the appearance of distant metastases within two years after the first examination, could not be proven in patients at initial stages of melanoma.

Humoral and cellular immunity in long-term surviving patients with malignant lymphoma.

Humoral and cellular immunity was followed in a group of long-term surviving patients with malignant lymphoma, viz. serum immunoglobulins quantitatively, T lymphocytes by the E rosette and B lymphocytes by the EAC rosette methods. A single examination of this group was compared with data from a control group of normal humans and a smaller group of patients with malignant lymphoma at an advanced stage. A significant increase of IgA (3.73 g/l onthe average) was noted in the surviving group as against both the controls (mean 2.31 g/l in the healthy and 1.23 g/l in the patients with advanced disease). IgM values were found to be significantly decreased in the latter patients (mean 0.85 g/l) in comparison with both the other groups. The rosette tests yielded lower absolute values of E rosettes in the same patients with advanced lymphoma (mean 725/ml) as against the healthy subjects (mean 1525/ml) and the long surviving patients (mean 1277/ml). The absolute value of active E rosettes in the two groups of patients was lower (741 and 580/ml) than that in the healthy group (mean 1067/ml). A percentage determination of rosette values proved to be of low statistical significance.

Establishment of cell line derived from human malignant melanoma.

A new human cell line of malignant melanoma (MJM) was established with the use of the in vitro fragment technique. It has been maintained over 34 months of continuous cultivation. Three types of cells can be recognized by light microscope. The epitheloid elements predominate, less frequent are fibroblastoid and giant multinuclear cells. The pigment production is not macroscopically visible. Over 60 per cent of analyzed metabphases showed hyperdiploid number of chromosomes, the rest was mostly tetra and hexaploid. No marker chromosomes were detected. The growth studies indicate the MJM cells have 63-hr doubling time. Cytochemistry revealed positive pigment or propigment granules in 36 per cent of cells. Ultrastructural studies did not detect melanin granules but some particles resembling atypical premelanosomes and melanosomes were recognized in some sections.

Experimental chemotherapy of rat leukemia RBA-Le with cis-diamminedichloroplatinum.

The antileukemic activity of cis-diamminedichloroplatinum (PDD) was studied in rats bearing myelogenous leukemia RBA-Le. Clinical picture, changes in life-span, hematological indices and weight changes were used to assess the effectiveness of the therapy. Maximum effectiveness was noted when PDD was given in combination with Methotrexate (MTX) and Poly I:C, respectively. The mean life-span of the rats treated with PDD and MTX was prolonged to 37 days that is an increase of 147 percent of the control level. Furthermore 20 percent of the treated animals survived symptom-free for more than 60 days. Out of 20 animals receiving PDD in combination with Poly I:C 6 rats survived 60 days symptom-free. In remaining 14 animals who finally died on leukemia an 85 percent increase in life-span was noted. Only slight increase in life-span was recorded in those groups treated with PDD alone and in combination with Cyclophosphamide regardless of dosage schedule. The general toxicity of PDD therapy is discussed.