[Present position of the hormonal replacement therapy]. / Soucasné postavení hormonální substitucní terapie.

Hormone replacement therapy (HRT) is not a homogenous group of pharmacological agents. The dose and the way of application can influence the different effects of pure estrogens, combination of estrogens and gestagens and selective tissue estrogenic activity regulators (STEARs). This should be taken into account when results of clinical trials are applied in practice. Conclusions from observational studies demonstrated a positive effect of HRT in both the primary and secondary prevention of ischaemic heart disease. But all randomised trials (HERS, HERS II, WHI, PHOREA, PHASE, WAVE) failed to prove this positive effect; on the contrary, the cardiovascular risk was increased in the beginning of therapy. The ongoing arm of WHI with estrogens only and the EPAT trial indicate possible positive effects of some HRT regimens. There are no new contraindications to HRT after the new results of clinical trials were published. The new results only underline the necessity of clear indication to HRT and confirm already well known risks: increased incidence of breast cancer with long-term use of HRT, increased risk of tromboembolic disease and stroke. The prevention of ischaemic heart disease was excluded from the possible indications of HRT. Many questions regarding optimal choice in the individual treatment strategies have been raised. HRT in its individualised form remains the first choice therapy for the acute climacteric syndrome, for the prevention and the therapy of urogenital atrophy. HRT is highly effective way of the prevention of osteoporosis and as such can be considered as the second line choice if the calcium and vitamin D represent the first line. Other beneficial long-term effects of HRT cannot be considered as the indication but as a possible positive of the individually long usage.

[Changes in lipid profiles in women after surgical castration during the fertile age]. / Zmeny lipidového profilu u zen po chirurgické kastraci ve fertilním veku.

OBJECTIVE: The main known risk factors for coronary heart disease in women, other than age, which is the most important risk factor of all, are cigarette smoking, raised blood pressure, obesity, diabetes and premature menopause, especially after ovarectomy. DESIGN: Retrospective clinical study. SETTING: Medical building, Prague 7, Department of Obstetrics and Gynecology 3rd Medical Faculty Charles University and Faculty Hospital Vinohrady, Prague 10. METHODS: In 1995 and 1996 we investigated plasma lipid levels and bone density in 75 women, 3 to 5 years after ovarectomy without HRT (group A). The results were compared with a control group (group B) of women of the same age and BMI. This group of women had normal menstruation periods. We investigated age, body mass index, bone density, total cholesterol, HDL and LDL cholesterol, ateroghenic index and triglycerides. RESULTS: When we compared groups A and B, there was a better result in all serum lipid levels in group B, but not significantly. In group A was more women with patological level of HDL-cholesterol. In group A there was a significantly lower level of bone density than in group B and there was an increase in the number of patients with osteoporosis in this group. CONCLUSIONS: Castration in premenopause had no influence in mean levels of parameters of lipid metabolism, but bone density significantly decreased after castration in this period.

[Homocysteinemia--its significance in gynecology and obstetrics]. / Homocysteinemie--její význam v gynekologii a porodnictví.

OBJECTIVE: Metabolic study on plasmatic levels of homocysteine (Hcy) in healthy women during normal or pathological pregnancy accompanied with corresponding levels of Hcy in amniotic fluid and foetal sera. Increased levels of Hcy--hyperhomocysteinaemia is respected as an independent risk factor accelerating the early development of vessel damage and causing the neural tube defects (NTD). DESIGN: Basic study to get our own data about Hcy in Czech healthy and population at risk of pregnant and non-pregnant women. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague. METHODS: Total homocysteine in plasma, amniotic fluid and foetal sera was estimated by chromatographic method with use of fluorescence detection. RESULTS: Normal homocysteine in preclimacteric healthy nonpregnant women is: 9.7 +/- 1.6 mumol/l with evident age-dependence. In healthy climacteric women are higher levels of Hcy (corresponding to the men values): 11.8 +/- 2.6 mumol/l. After use of hormonal contraceptives the plasmatic levels of Hcy decrease: 7.2 +/- 2.0 mumol/l. In physiological pregnancies Hcy reachs the lowest values: 4.4 +/- 1.7 mumol/l with any evident oscillations during pregnancy. In women in childbed period was Hcy 8.4 +/- 2.1 mumol/l observed. In pathological pregnanciesare its levels slightly elevated: 6.3 +/- 2.1 mumol/l, most evident in placental abruptions: 7.5 +/- 1.7 mumol/l. In pregnant women with susp. results of screening on M. Down only unsignificant increase of Hcy was observed: 6.12 +/- 2.4 mumol/l. In amnial fluids of healthy pregnant women are levels of Hcy are quite low: 4.1 +/- 1.2 mumol/l with any oscillations during pregnancy. In foetal sera of pregnancies at risk (NTD, susp., trisomy, inborn errors of metabolism): 3.6 +/- 1.4 mumol/l of Hcy was detected. The foetoplacental quotient for Hcy is 0.62. CONCLUSION: Average values for Hcy were established in physiological as well as in pathological pregnancies and till now only limited diagnostic significance has been observed. The hyperhomocysteinaemia mentioned in previous papers was not in NTD observed because our pregnant patients were regularly supplemented with all critical vitamins (folate, B6, B12).

[Antibiotic prophylaxis of infectious complications in cesarean section--prospective study]. / Antibiotická profylaxe infekcních komplikací císarského rezu--prospektivní studie.

OBJECTIVE: To verify the significance of Cefazolin administration to women who were indicated for caesarean section. SETTING: Department of Obstetrics and Gynecology, First Faculty of Medicine, Prague, Czech republic. METHODS: Cefazolin was administered to 30 women with a patient history risk in a dose of 1 mg i.v. after ligation of the umbilical cord. The control group consisted of 30 women. Observed parameters: weight gain during pregnancy, indications for caesarean section, culture from the cervix and vagina prior to the caesarean section, culture from the amniotic fluid, culture from the 4th day lochia, temperature curve, leucocyte count before and 4 days after the operation, complications after the surgery, administration of antibiotics, and length of hospitalisation. RESULTS: In the group with antibiotic prophylaxis, we observed a more favourable course of the temperature curve and a smaller leucocyte count the fourth day after the surgery (p < 0.01), in comparison with the women without prophylaxis. The duration of hospitalisation in women with antibiotic prophylaxis was one day shorter and there was no occurrence of febrile complications requiring further antibiotic treatment. CONCLUSION: Cafazolin is advantageous antibiotic for prophylaxis in caesarean section in patients with risk.

Endotracheal tube safety during laser surgery.

The most morbid complication of laryngeal laser surgery is an endotracheal tube fire. The purposes of this study were to determine the efficiency of saline solution-soaked cottonoid pledgets in protecting endotracheal tube cuffs from the laser beam and to evaluate the safety of four commonly used endotracheal tubes. The method involved measurement of perforation times of saline-soaked cottonoid pledgets with controlled variables of air exposure times and laser energy. The second part evaluated the safety and ignition properties of the red rubber, silicone, polyvinyl chloride, and Xomed Laser-Shield tubes by studying their perforation times and ignition properties under controlled oxygen concentrations. The results revealed that saline-soaked pledgets are very efficient in protecting endotracheal tube cuffs. The Laser-Shield tube was the safest one studied. It had the highest ignition threshold of the four tubes tested.