[Complete molar pregancy with development of non-metastatic persistent trophoblastic diseaseA case report, reflection of rules of care and decision-making processes Forensic responsibility and the position of doctor in the general gynecologic and obstetric outpatient practice]. / Mola hydatidosa completa s prechodem do nemetastázující perzistující trofoblastické nemociKazuistika, poucení a úvaha nad pravidly dispenzarizace a rozhodovacích mechanismu Forenzní zodpovednost a postavení spádového gynekologa.

OBJECTIVE: To define the forensic responsibility and the position of doctor in the general gynecologic and obstetric outpatient practice in care of the complete molar pregancy. DESIGN: Case report and review article. SETTING: General gynecologic and obstetric outpatient practice Velké Mezirící; Sanatorium REPROMEDA, Centre of reproductive medicine and preimplantation genetics, Brno; Histopatology department of Hospital Jihlava. CASE REPORT: The changing clinical presentation of complete molar pregnancy with development of non-metastatic gestational trophoblastic disease: management. Subsequent early pregnancies outcome following complete hydatiform molar pregnancy. DISCUSSION: Discussed are the forensic responsibility and the position of doctor in the general gynecologic and obstetric outpatient practice with the collaboration of Trophoblastic Disease Center based on the detail expert knowledges: rules of care and decision-making processes and potential controversies, the pitfalls of the histopathologic diagnosis, the genetics of complete hydatiform mole: new lights on a disease, outpatient follow-up and possibility and the risks of the subsequent pregnancy. CONCLUSION: The conclusion is trying to guide quickly a doctor in the general gynecologic and obstetric outpatient practice in the decision-making processes through the crossings of any situation of the complete molar pregnancy and outpatient follow-up, alternatively with the collaboration of Trophoblastic Disease Center.

[Status of bone mineral density after the long-standing application of contraception Depo-Provera]. / Stav kostní minerální denzity po mnohaleté aplikaci antikoncepce Depo-Provery.

OBJECTIVE: The objective of this study was to assess bone mineral density (BMD) on a cohort of women who used depot medroxyprogesterone acetate (DMPA) (Depo-Provera) contraception uninterruptedly between 3 and 10 years. DESIGN: Retrospective study with review of the literature. SETTINGS: Office gynecology Velké Mezirící; Osteocentrum Brno; Department of Obstetrics and Gynecology, Hospital Nové Mesto na Morave. METHODS: The study included 21 healthy women aged between 26 and 43 years (the mean age 31 years) who started long-term continual application of depot medroxyprogesterone acetate (DMPA) in contraception (Depo-Provera) (the mean time of using 7 years, range 3-10 years). The women underwent lumbar spine, hip, femoral neck and forearm BMC (g) (bone mass content), BMD (g/cm2)(bone mass density), T-score, PR (%) (peak reference), Z-score, AM (%)(age matched) evaluation using Hologic dual-energy X-ray absorptiometry. Age of women, time of application of Depo-Provera and body mass index (BMI) were collected. Randomly from this cohort of users DMPA (n = 11) were determined levels of serum folicle stimulating hormone (FSH) and estradiol (E2), mostly shortly before next application of DMPA. RESULTS: At average 7 years of treatment, as compared to baseline, the mean BMD of DMPA users was in total lumbar spine AM (age matched) 96.48%, total hip AM 100%, femoral neck AM 97.62%, total forearm (radius+ulna) AM 99.81%. Concentrations of serum estradiol varied from 94.3-294 pmol/l (25.7-80.1 pg/ml) with average level 190.3 pmol/l(51.9 pg/ml), seen in the early follicular phase. CONCLUSION: There are probably several reasons, but not at least, why mean bone loss even after long use of DMPA is low. The loss of BMD is more pronounced during the first 2 years of use DMPA and its fall subsequently gradually stabilises due to new balance between extrinsic and intrinsic factors that influence bone resorption and formation. After the two years bone loss in DMPA users nears under 1% per year and practically copies level of physiological bone loss. Another hypothetical compensation mechanisms of bone remodelling in the hypoestrogenic time during DMPA use may be reason of higher levels of BMD 4-5 years after discontinuing the use of contraceptive injections than that of nonusers (rebound phenomenon).

Regional changes of ciliary neurotrophic factor and nerve growth factor levels in post mortem spinal cord and cerebral cortex from patients with motor disease.

Ciliary neurotrophic factor (CNTF) rescues motor neurons in animal models of injury and neurodegeneration, and disruption of the mouse CNTF gene results in motor neuron degeneration in mature adults. Glial cells increase nerve growth factor (NGF) expression in neuropathological conditions, and the sensory system can be affected in the amyotrophic lateral sclerosis (ALS) type of motor neuronic disease. We therefore studied CNTF and NGF levels in post mortem spinal cord and cerebral cortex from patients with ALS and matched controls. We report a marked decrease of CNTF in the ventral horn of spinal cord in ALS, with no change in cerebral motor cortex. In contrast, NGF levels were decreased in ALS cerebral motor cortex, where the corticospinal tract originates, but increased in the lateral column of spinal cord, which includes the region of corticospinal tract degeneration in ALS. Both CNTF and NGF levels were decreased in ALS dorsal spinal cord.

Getting our house in order: an audit of the registration and publication of clinical trials supported by the National Institute for Health Research Oxford Biomedical Research Centre and the Musculoskeletal Biomedical Research Unit.

OBJECTIVES: To audit the proportion of clinical trials that had been publically registered and, of the completed trials, the proportion published. SETTING: 2 major research institutions supported by the National Institute of Health Research (NIHR). PRIMARY AND SECONDARY OUTCOME MEASURES: The proportion of trials reporting results within 12 months, 24 months and 'ever'. Factors associated with non-publication were analysed using logistic regression. INCLUSION CRITERIA: Phases 2-4 clinical trials identified from internal documents and publication lists. RESULTS: In total, 286 trials were identified. We could not find registration for 4 (1.4%) of these, all of which were completed and published. Of the trials with a registered completion date pre-January 2015, just over half (56%) were published, and half of these were published within 12 months (36/147, 25%). For some trials, information on the public registers was found to be out-of-date and/or inaccurate. No clinical trial characteristics were found to be significantly associated with non-publication. We have produced resources to facilitate similar audits elsewhere. CONCLUSIONS: It was feasible to conduct an internal audit of registration and publication in 2 major research institutions. Performance was similar to, or better than, comparable cohorts of trials sampled from registries. The major resource input required was manually seeking information: if all registry entries were maintained, then almost the entire process of audit could be automated--and routinely updated--for all research centres and funders.

Pharmacological characterization of non-NMDA subtypes of glutamate receptor in the neonatal rat hemisected spinal cord in vitro.

1. A grease-gap technique was used to record depolarizing responses to alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionate (AMPA), kainate and N-methyl-D-aspartate (NMDA) in the hemisected spinal cord of the neonatal rat. The pharmacology of non-NMDA subtypes of glutamate receptor was investigated with the novel quinoxalinedione, 2,3-dihydroxy-6-nitro-7-sulphamoyl-benzo (F)-quinoxaline (NBQX) and with a series of barbiturates. 2. NBQX antagonized AMPA- and kainate-, but not NMDA- induced depolarizations. The near parallel shifts of the major part of the dose-response curves for AMPA and kainate by NBQX gave pA2 values (+/- s.e.) of 6.7 +/- 0.2 and 6.8 +/- 0.2 respectively, consistent with a common site of action for these two agonists. 3. Below the 50% level at which these pA2 values were calculated, however, an NBQX-resistant plateau was seen within the kainate, but not the AMPA, dose-response curve. 4. In decreasing order of potency, methohexitone, secobarbitone, thiopentone, pentobarbitone and phenobarbitone preferentially reduced kainate-, rather than AMPA- and NMDA-, induced depolarizations. Methohexitone was also the most selective with IC50S against kainate, AMPA and NMDA of 31 +/- 7, 172 +/- 47 and greater than 200 microM respectively. 5. The NBQX-resistant plateau seen within the kainate dose-response curve was reduced by methohexitone. Kainate antagonism by methohexitone was not reduced by 50 microM picrotoxin. 6. We conclude that, while mixed agonist actions may hamper demonstration of antagonist selectivity, depolarizations induced by the non-NMDA ionotropic agonists, AMPA and kainate, are mediated in part via distinct receptors.

Methohexitone antagonises kainate and epileptiform activity in rat neocortical slices.

Using a grease-seal technique on cortical slices, methohexitone (10-316 microM) dose dependently and reversibly reduced depolarising responses to kainate more than those to alpha-amino-3-hydroxy-4-isoxazolepropionate (AMPA) and N-methyl-D-aspartate (NMDA). The respective pA2 values were 4.9 +/- 0.07, 3.6 +/- 0.03 and 4.0 +/- 0.05 whereas, for 6-nitro,7-sulphamoylbenz[F]quinoxalinedione (NBQX), they were 5.8 +/- 0.06, 6.7 +/- 0.05 and < 4.0. Methohexitone was also more effective than NBQX in reducing the spontaneous epileptiform activity occurring in these cortical slices. Thus 10 and 20 microM of this short-acting barbiturate reduced afterpotentials and burst frequencies respectively by about 50% whereas NBQX 10 microM only reduced burst frequency by some 15%. The results are discussed with respect to a putative methohexitone- and kainate-sensitive autoreceptor which facilitates presynaptic glutamate release.

Ketamine promotes hippocampal CA1 pyramidal neuron loss after a short-duration ischemic insult in rats.

The neuroprotective activity of the N-methyl-D-aspartate (NMDA) antagonist ketamine was examined in two groups of rats subjected to forebrain ischemia of differing durations. Ketamine provided a limited degree of protection against hippocampal CA1 pyramidal cell loss following a 10 min ischemic insult. In contrast after 6 min ischemia, which in non-treated control animals resulted in less CA1 neuron loss than was seen after 10 min ischemia, ketamine at the same dose worsened outcome. The data indicate that the possession by a drug of NMDA antagonist activity does not alone determine its neuroprotective activity in vivo.

Increased mitochondrial superoxide dismutase activity in Parkinson's disease but not amyotrophic lateral sclerosis motor cortex.

Oxidative stress may contribute to the neurodegenerative process in amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD). Motor cortex in PD is not affected and its inclusion in studies of free radical involvement in ALS pathogenesis could help elucidate whether oxidative stress is disease specific or a more widespread phenomenon present in the neurodegeneration. We have measured cytosolic and mitochondrial isoforms of superoxide dismutase (SOD), antioxidant enzymes involved in primary defence against free radical damage, in motor cortex of six patients with sporadic form of ALS (SALS), eight with PD and eight normal control subjects. We have found no difference in the activities of cytosolic and mitochondrial SOD between SALS and control motor cortex. Mitochondrial SOD activity in PD motor cortex was, however, significantly higher than in SALS and control motor cortex whereas activity of cytosolic SOD was lower than in two other groups although the differences were not statistically significant. Our findings indicate the presence of an altered antioxidant defence system in PD but not ALS upper motor neurons, suggesting that oxidative stress may be a widespread phenomenon in PD.

Ciliary neurotrophic factor receptor expression in spinal cord and motor cortex in amyotrophic lateral sclerosis.

Ciliary neurotrophic factor (CNTF) is known to rescue motor neurones in animal models of injury and neurodegeneration and we have recently described regional changes of CNTF protein levels in spinal cord from patients with sporadic motor neurone disease of the amyotrophic lateral sclerosis (ALS) type. However, information is lacking about the CNTF receptor in this condition. We have therefore studied mRNA levels for the alpha subunit of the CNTF receptor (CNTFR alpha) and for CNTF itself in postmortem spinal cord and cerebral cortex in patients with sporadic ALS and matched controls. We report that in the spinal cord of ALS patients there is a marked increase in the hybridisation signal for CNTFR alpha subunit mRNA overlying motor neurones. In contrast, very little mRNA for CNTFR alpha subunit was found in the motor cortex and no differences were seen between ALS and controls. We were unable to detect any hybridisation signal for CNTF mRNA. Our findings provide evidence for regional differences in CNTF receptor expression in upper- and lower-motor neurones in ALS.

Tears of the pectoralis major muscle.

Nine athletes (men, 22 to 40 years old) who sustained tears of the pectoralis major muscle are described. Four were treated by the authors and five patients' cases were reviewed from records of orthopaedic surgeons for the National Football League. Eight of the nine patients sustained tears from excessive tension; one was involved in an automobile accident and sustained a direct blow. Five patients were treated conservatively and obtained good results (normal range of motion, mild pain, and weakness). They agreed that they could not return to their previous athletic functional ability. The other four were treated surgically and obtained excellent results (normal range of motion, excellent strength). They were able to return to vigorous athletic performance.

Acute knee injury. How to determine if the knee is stable.

Knee injuries are common in patients of all ages. A detailed history concerning the mechanism of injury and symptoms is helpful in establishing a tentative diagnosis, and the physical examination can easily provide confirmation. X-ray films occasionally are helpful, but stress views and arthrograms should not be relied on for definitive diagnosis. Arthroscopy may be required for definitive evaluation of internal derangement of the knee and can be used therapeutically in meniscal injuries and other problems. Proper rehabilitation is mandatory for a good outcome; therefore, physical therapy is essential regardless of whether conservative or surgical treatment is required. Proper muscle conditioning and use of braces such as the one described here may aid long-term prevention of knee injury.

The Anderson Knee Stabler.

This double-hinged, single-sided knee brace allows full flexion and extension while it prevents any damaging valgus stress from being applied to the joint.

Self--administered cough cardiopulmonary resuscitation (c-CPR) in patients threatened by MAS events of cardiovascular origin.

Sudden cardiac death caused by cardiac arrhythmia's or asystolies in patients with coronary heart disease can often be avoided if resuscitation is administered immediately, preferably before the patient loses consciousness. In cases when rapid help is not available usually death occurs. We have studied a method of cardiopulmonary resuscitation (CPR) which can be self--administered by patients trained in recognizing imminent arrival of life-threatening Morgani Adams Stokes (MAS) events. The recent study comprised the three methods of investigation in three separate groups of patients: the first group underwent invasive procedures (20 pts), the second non invasive Doppler studies (31 pts) and the third in-and outhospital clinical observations (115 pts). The results indicate that evoked coughing can effectively prevent fainting and maintaining consciousness until conventional CPR help becomes available.