[Endometriosis of the appendix presenting like acute appendicitis--a case report]. / Endometrióza apendixu s projevy akutní apendicitidy--kazuistika.

INTRODUCTION: In general, pain in the lower right abdomen is the most frequent reason for hospital surgical admissions, acute appendicitis representing the most common cause of operation for acute abdomen. Timely appendectomy remains the only treatment in the early stages of inflammation and is usually uncomplicated, requiring only a short hospital stay. A differential diagnostic analysis necessitates a search for other, particularly long-term symptoms that might be driven to the background in cases of acute exacerbation. CASE REPORT: The case report presents a 38-year-old female patient who was admitted for lower right abdominal pain. Clinical examination and a blood test both suggested typical acute uncomplicated appendicitis, and therefore the patient underwent appendectomy. Haemorrhagic peritoneal fluid and nodularity of the appendix not typical for appendicitis was found. Oedema of the terminal ileum and a right adnexal tumour were a surprising finding. A more extensive surgical procedure involving ileocaecal resection and right-side adnexectomy was finally performed with regard to the intraoperative finding. The definitive diagnosis of appendiceal endometriosis, endometrial mass in the terminal intestine and ovarian endometriosis was established by histological evaluation. Long-term follow-up revealed microadenocarcinoma of cervix uteri. CONCLUSION: It is generally very difficult to confirm appendiceal endometriosis before operation, and revealing primary appendiceal endometriosis is virtually impossible. It is advisable to consider endometriosis in fertile women with chronic abdominal pain of unclear aetiology and gynaecological symptoms in their personal history. The best diagnostic and therapeutic method, respectively, is laparoscopy enabling exploration of the entire peritoneal cavity including the minor pelvis, and performing appendectomy as well as excision of suspicious endometrial lesions. The definitive diagnosis is usually established by histopathological evaluation. Gynaecological assessment and follow-up is highly recommended after surgery.

[Gitelman syndrome in pregnancy--a severe hypokalemia with favorable perinatal prognosis]. / Gitelmanuv syndrom v tehotenství - tezká hypokalémie s príznivou perinatální prognózou.

Gitelman syndrom is a rare congenital tubulopathy characterized by hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. We report a case of a 32-year-old patient admitted for asymptomatic hypokalemia and hypomagnesemia in the 30th week of gestation. A diagnosis of Gitelman syndrom was made and intravenous administration of potassium chloride in high doses combined with spironolactone was started. Despite intensive potassium supplementation (8 g/day), the serum potassium levels remained at the lower limit of normality throughout the pregnancy. The patient delivered a healthy female 2670 g/48 cm after labor induction in the 39th week of gestation. A summary of 22 so far published cases of Gitelman syndrome in pregnancy is presented. The analysis of published case studies suggests a need for ion supplementation, reduction of urinary potassium wasting, monitoring of fetal well-being and amniotic fluid levels. Pregnancy has a very favorable perinatal prognosis despite critical serum levels of potassium and magnesium throughout the pregnancy.

[Meconium and postnatal neurologic handicaps]. / Mekonium a postnatální neurologický handicap.

OBJECTIVE: A review of meconium pathophysiology and its contribution to the incidence of postnatal neurological handicap. DESIGN: Reviewed article. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic. SUBJECT AND METHOD: Meconium can be a cause of infant neurological handicap. Two main pathogenetic pathways are mentioned. 1. Meconium (and its components: bile acids) may have a direct vasoconstrictive effect on umbilical and placental vessels. This way still remains controversial. 2. Meconium as a possible cause of intraamniotic infection results in a release of fetal cytokines (TNF alpha, IL-1 beta, IL-6), which can damage myelinogenesis in periventricular white matter. RESULTS: Meconium in premature labour is a higher risk factor compared to term delivery. 41% of premature infants were diagnosed as having CP when meconium was present compared to 10% in the same group with clear amniotic fluid. The incidence in term pregnancy with meconium present is 0.4% compared to 0.3% in a population without any obstetrical risk. CONCLUSION: Ultrasonographically found periventricular leukomalacia is the most reliable sign of subsequent cerebral palsy or other neurological sequelae.

[Meconium and its significance]. / Mekonium a jeho význam.

OBJECTIVE: A review of meconium patophysiology and its contribution to the incidence of perinatal infection. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic. METHOD: The reported incidence of meconium-stained amniotic fluid varies between 7 and 22%. The patophysiology of the presence of meconium in the amniotic fluid is not sufficiently explained. Meconium in fetal bowels is under hormonal and neurol control. The presence of the meconium-stained amniotic fluid was always considered to be a potential risk for the fetal and neonatal well-being. The review is further divided in to three chapters. (II. Meconium and meconium aspiration syndrome, III. Meconium and postnatal neurological handicap). RESULTS AND CONCLUSION: The first chapter on deals with meconium risk in the development of perinatal infection: intraamniotic infection/chorioamnionitis, postnatal endometritis, infection of the abdominal wound after Caesarean and neonatal infection. The incidence of clinical chorioamnionitis is 15% with the presence of meconium compared to 3% in controls. The incidence of puerperal endometritis is 10% in comparison to 3% under normal conditions. Two main mechanisms of development (or coincidence) of intraamniotic infection in the presence of meconium exist. 1) Infection may be a cause of meconium passage. 2A) Alteration of Zn/P ratio in the amniotic fluid can promote bacterial growth. 2B) Meconium attached to macrophages or absorbed by phagocytosis can impair cellular immune response. The antibiotic prophylaxis is discussed.

[Artificial lenses in surgery of traumatic cataracts due to perforating injuries of the eye]. / Artefakia v chirurgii traumatickej katarakty po perforacnom poranení oka.

In this work longdated anatomical and functional results of artificial lens implantation in traumatic cataracts after perforation of the eye in the group of 44 eyes (43 patients) aged between 3-54 years are evaluated (in the years 1985-89). Average period of observation was 6.3 years. Saving capsula, the artificial intraocular lens was implanted into the posterior eye chamber. In the years 1985-86 also the pupilar models (T03 Fyodorv-Zacharov) were used. In absent of capsular support, the artificial intraocular lens was implanted into the anterior eye chamber and also the posterior-chamber models with polypropylene haptics were successfully applicated (less number of negative changes was achieved). The visual acuity 6/36 and better was constated in 79.5% eyes (before operation only in 13.7%) during the last examination of the observed patients. Best results were achieved after implantation into the posterior eye chamber (90% of the eyes had visual acuity 6/6-6/12).