Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report.

Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients' problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

[Occupational tuberculosis in Slovakia and in the Czech Republic]. / Profesionálna TBC na Slovensku a v Ceskej republike.

STUDY OBJECTIVE: To conduct a retrospective 15-year study to monitor trends in the number of employees at risk for occupational tuberculosis (TB) (levels III and IV) in the Slovak Republic, and in particular in the sector of economic activities Q (health care and social assistance). Furthermore, to analyze reported cases of occupational TB and to compare the incidence and sex-specific and age-specific prevalence with the data reported in the Czech Republic. MATERIAL AND METHODS: Data on the number of employees at risk of exposure to occupational TB were derived from the Automated Risk Classification System of the Slovak Republic. Data on cases of occupational TB were taken from health statistics (Institute of Health Information and Statistics/National Health Information Center in the Slovak Republic and the National Institute of Public Health in the Czech Republic). A retrospective analysis was conducted (for 1998-2012) of reported cases of occupational TB, selected from Article 24 of the List of occupational diseases (infectious and parasitic diseases except tropical infectious and parasitic diseases and diseases transmissible from animals to humans). The selection criterion was a TB diagnosis according to ICD-10. In the Czech Republic, the data were derived from Article 5.1.02 (tuberculosis), Chapter V. of the List of Occupational Diseases. The data obtained were analyzed by methods of descriptive statistics. RESULTS: The numbers of employees with a level III risk of exposure to occupational TB in the Slovak Republic declined by 30% over the 15 years of study and by 40% in category Q. In 2012, 2027 employees were classified in category III and 1442 of them belonged to group Q. Females accounted for 81-84% of employees at risk of exposure to occupational TB. Eighty-six and 181 cases of occupational TB were reported in the Slovak Republic and in the Czech Republic, respectively, in 1998-2012, with the incidence showing a downward trend in both countries. TB of the respiratory tract was reported most often (83.7% of the total of reported cases of occupational TB). As expected, more cases occurred in females than in males (1.9 times as many cases in females as in males in the Slovak Republic and three times as many cases in females as in males in the Czech Republic). The incidence of occupational TB was the highest in sector Q, with the highest absolute numbers reported in nurses. In 2012, the incidence rates of occupational TB were 0.22 cases per 100,000 sick benefit policy holders in the Slovak Republic and 0.13 cases per 100,000 sick benefit policy holders in the Czech Republic. CONCLUSION: The incidence of occupational TB has a downward trend in both countries, similarly to TB incidence in the general population. A negative aspect in both countries is the incidence of occupational TB at the middle productive age, in contrast to the population occupationally non-exposed to TB. Slovakia is surrounded by higher prevalence countries, with the exception of the Czech Republic. It cannot be ruled out that, in addition to the known factors influencing the prevalence of TB, including occupational TB, migration from eastern countries, including job search migration, can also play a role in increase in TB cases. It is vital to continue epidemiological surveillance and to reduce the risk of TB as much as possible also in healthcare settings by adhering to barrier nursing practices. Cases of active TB need early and adequately long, controlled treatment in order to reduce, among others, the incidence of multi-drug resistant TB.

Unusual clinical tumor development in axilla.

This work describes clinical development of a sarcoma in the left axilla of a 36-year-old woman. The macroscopic picture changed from the initial inflammatory reddening to globular resistance of 2.5 cm, suggestive of an enlarged lymph node. Mammography did not reveal any associated breast disease. Colliquation found on the ultrasound images led to a biopsy, the result of which indicated only an inflammation, without any malignancy. Rapid growth of the axillar tumor to 10 cm in size within 8 weeks prompted surgery allowing proper diagnosis of a small mature-to-immature sarcoma. Special examinations performed by a histopathologist (at the Institute for Histopathology) could not establish the precise histogenesis, i.e. the tissue origin. Therefore it was necessary to remove any clinically obscuring tumor for the final proper histological diagnosis and adequate treatment of the patient.

[Validity of the oncological cytodiagnostics and colposcopy examination versus biopsy in cervical carcinoma prevention]. / Validita onkologické cytodiagnostiky a kolposkopie versus biopsie v prevenci rakoviny cervixu.

THE AIM OF THE STUDY: The basic praebioptic methods detecting the precancerous lesions of the uterine cervix are oncologic cytology (PAP smears) and colposcopy. However in the Czech Republic the incidence of the invasive carcinomas during the last 10 years did not considerably decrease. Therefore the goal of our study is to estimate the validity of the prebioptic methods and compare the results of praebioptic methods (procedures) versus biopsy. TYPE OF THE STUDY: Analysis of the results of the oncologic cervical cytology comparing with the results of cervical biopsies performed during the years 2002-2003 were compared to those of the year 2009. THE SUBJECT AND METHODS OF THE STUDY: evaluation of the prebioptic methods (cytology, colposcopy) versus biopsy prior and during the start of the National Screening in the Czech Republic. SETTING: 1. Centre for Gynaecological Oncological prevention, 1st Faculty of Medicine, Charles University Prague, Department of Gynaecology and Obstetrics. 2. Institute of Physiology, Department of cybernetics, 1st Faculty of Medicine, Charles University, Prague. 3. Institute of Pathology, University of Ostrava. 4. Institue for Mother and Child Care, Prague. SUMMARY: We screened the documentation related to the treatment of 423 women with cervical lesions, examined at the Oncological prevention centre of the Obstetrical and Gynaecological Department of the 1st Faculty of Medicine Charles University Prague and the General Teaching Hospital in Prague 2. Results of the oncologic cytology, colposcopy and biopsy were compared. The comparison revealed differences related to the time of examinations. During the years 2002 and 2003 the agreement between cytologic diagnosis and biopsies in the group of HSIL was 40 %. In the year 2009 the agreement between HSIL and CIN was 68% the colposcopic diagnosis of precancerous lesions with those of bioptic specimens, during the years 2002 and 2003 was 90% while in the year 2009, during the National Screening, the agreement reached 98%.

[Optimized assessment of the outcome in patients with radicular back pain of the lumbar spine. The modified NASS questionnaire]. / Bessere Verlaufsdokumentation bei Patienten mit lumboradikulären Schmerzsyndromen. Der modifizierte NASS-Fragebogen.

BACKGROUND: The purpose of the study was to present a reliable instrument with easy application to assess the outcome and improvement of therapy in patients with radicular symptoms of the lumbar spine. METHODS: Data from patients who underwent microdiscectomy because of lumbar radicular symptoms were collected and analyzed and interviews were performed using the well-known North American Spine Society (NASS) lumbar spine questionnaire (17 items) before and after the intervention. In addition patient data including comorbidities were collected. By calculating effect size (ES) and standardized response mean (SRM) for each item of the questionnaire, the questions with the highest change before and after the intervention could be selected. RESULTS: A total of 139 patients undergoing microdiscectomy for lumbar radicular symptoms due to a disc herniation were included in the analysis. Concerning the three dimensions pain, neurological symptoms and impairment of activities in daily life, the questions with best predictive value (high ES and SRM) were selected. According to their clinical relevance eight questions of the NASS questionnaire were finally selected for the short form. CONCLUSION: This short, significant and easy to use questionnaire is in our opinion a useful instrument to assess the course of patients with radicular back pain and especially to measure and monitor the outcome of therapeutic interventions, in addition to conventional clinical diagnostics and examinations. This novel instrument could be a useful tool for improving quality assurance in conventional and interventional pain management of these patients.

Cell-mediated immunity in cervical cancer evolution.

Cell-mediated immunity (CMI) response to different antigens was examined in healthy women, in patients with cervical precancerous lesions, and in patients with cervical cancer. Cervical lesions were diagnosed by cytological (PAP) smears, from examination by colposcopy, and from "punch" biopsy material by histology. CMI response is related to specific processes in healthy and cancer cells. CMI was investigated by leukocyte adherence inhibition (LAI) assay using specific antigen (prepared from cervical carcinoma tissue) and non specific antigen (prepared from blood of mice infected by LDH--lactate dehydrogenase--virus). The CMI responses of healthy women and cancer patients to the antigens used are different: the majority of T lymphocytes display adherence and non adherence, respectively (but the CMI responses elicited by the antigens are not equal and small quantitative differences are observed). Regardless of the CIN (cervical intraepithelial neoplasia) grades, CMI responses correspond either to healthy women or to cervical carcinoma patients (at about similar ratio of cases in all the CIN groups). Effect of non specific antigen suggests that cervical carcinoma transformation may be connected with reduction of mitochondrial activity similar to processes in LDH virus infection.

[Molecular characterization of epithelial ovarian borderline tumors with respect to clinical management and prognosis]. / Molekulární charakteristiky borderline ovariálních tumoru ve vztahu k biologickému chování nádoru.

OBJECTIVE: To analyze up-to-data knowledge in the field of molecular characterization of epithelial ovarian borderline tumors with respect to clinical management and prognosis. DESIGN: Review. SETTING: Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine, and General Faculty Hospital, Prague. METHODS: Based on literature search and own experimental data in the field of molecular biology of ovarian cancer and borderline tumors of ovary, we summarize up-to-date knowledge of molecular differences and specific features of BTO with respect to implementation of these knowledge into the clinical management. RESULTS AND CONCLUSION: We suppose that spectrum of genomic changes (i.e. genetic and epigenetic) causing tumor transformation is limited and these changes take place in stem or progenitor cell. Analysis of genomic changes can help to define certain subtypes of BTO and, correlated to clinical characteristics, to identify subtypes with different biological behavior. Such molecular typing of BTO allows to individualize treatment.

[Detection of HPV DNA in lymph nodes in early stages cervical cancers]. / Stanovení DNA HPV v lymfatických uzlinách u casných stadií karcinomu delozního hrdla.

OBJECTIVE: Review recent knowledge concerning significance of detection of DNA HPV in regional lymph nodes in cervical cancer patients. TYPE OF THE STUDY: Literature review. SETTING: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague. RESULTS: Metastatic involvement of pelvic lymph nodes is the most important prognostic parameter in early stages cervical cancer. Still, almost 20% of patients with negative pelvic nodes experience recurrence. Detection of HPV DNA in lymph nodes might be a marker of occult metastatic involvement. However, published data are limited, mostly due to inconsistent methodology. Only 3 prospective studies evaluating HPV from fresh or frozen tissue were published till now, all other retrospective studies extracted HPV DNA from paraffin embedded samples. A few papers showed correlation between HPV DNA and metastatic involvement of pelvic lymph nodes. DNA HPV identification in histopatology-negative nodes was considered as a risk factor for recurrence. Presence of DNA HPV 18 in histopathology-negative pelvic nodes was described as a poor prognostic factor; however prognostic significance of individual genotype is still unclear. CONCLUSION: Detection of high risk HPV DNA in regional lymph nodes is a good candidate for prognostic parameter in early stages cervical cancers. The group of women with both absence of metastatic involvement and negative HPV DNA evaluation of regional lymph node should represent a cohort of patients with particularly good prognosis.

[Inactivation of BRCA1, BRCA2 and p53 genes in sporadic ovarian cancer]. / Inaktivace genu BRCA1, BRCA2 a p53 u sporadického karcinomu vajecníku.

OBJECTIVE: To analyze loss of heterozygosity (LOH), loss of expression and somatic mutations of BRCA1, BRCA2 and p53 genes in sporadic epithelial ovarian cancer samples. DESIGN: Original paper. SETTING: Oncogynecologic center, Clinic of Obstetrics and gynecology, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague. MATERIAL AND METHODS: We used genomic DNA and total RNA from peripheral blood and fresh frozen tumor as a template for LOH, loss-of-expression and mutation analyses. RESULTS: LOH in at least one region was found in 60% of tumors. Majority of these alterations occurred not solely, but in conjunction with other region deletions. CONCLUSION: Our study confirms high frequency of somatic alteration of BRCA1, BRCA2 and p53 genes in sporadic epithelial ovarian cancer.

Intermittent claudication caused by a hip joint ganglion.

A case report of a patient with unusual compressive syndrome is reported herein. A 27-year-old woman was referred to our hospital due to intermittent claudication in the left thigh and calf which gradually developed over the last five months. Angiography showed an atypical short occlusion of the external iliac artery. Only surgical revision made an exact diagnosis. The formation compressing the artery was a ganglion that originated from the hip joint and adhered to the artery. Resection of the ganglion was carried out. The adjacent segment of the artery was removed and replaced by end-to-end venous graft using vena saphena magna. From the operation until present (30 months) the patient remains symptom-free. To our knowledge a hip joint ganglion compressing the artery and causing symptoms of peripheral arterial disease has not been previously reported in medical literature.

[Ductal approaches in mammary diagnostics]. / Intraduktální prístupy v mamární diagnostice.

OBJECTIVE: Information about new possibilities of early diagnostics in mammary lesions. TYPE OF STUDY: Review. SETTING: Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Teaching Hospital, Prague. SUBJECT AND METHODS: Most malignant tumors of the breast originate from ductal epithelium. A direct examination of the ductal system, could significantly improve diagnostics of breast cancer as well as its preinvasive stages (DCIS) and to influence mortality. The concept of ductal approaches includes several techniques and ductal lavage and duscoscopy. CONCLUSIONS: Ductal approaches represent an attractive area for minimal load upon the patients. Specificity and sensitivity of these methods have some limits, which will be subject to change in relation to understanding of carcinogenesis and in a close relation to the knowledge of biomarkers, genomics and proteomics. Ductoscopy appears to be the ideal method for the future due to possibilities of direct visualization of epithelium in combination with biopsy and ductal lavage. It other advantages include minimal invasiveness, minimal risk and the origin of possible complications for the patient.

[Contribution of neoadjuvant chemotherapy for operability of cancers of the uterine cervix]. / Prínos neoadjuvantní chemoterapie pro operabilitu zhoubných nádoru delozního hrdla.

OBJECTIVE: To compare per-operative and post-operative morbidity in patients undergoing radical surgery for carcinoma of the uterine cervix after administration of a neoadjuvant chemotherapy, and for primarily small cervical tumour. TYPE OF THE STUDY: A retrospective case-control study. SETTING: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague. METHODS: The study included 24 patients with squamous cell carcinoma of the uterine cervix who underwent radical hysterectomy including systematic pelvic lymphadenectomy after previous administration of neoadjuvant chemotherapy (NACT) during the period between 1/2004 and 6/2006. The control group of 24 patients was selected retrospectively from the population of women after radical surgery carried out in the same period, nevertheless, the controls underwent the surgery for primarily small carcinoma of the uterine cervix, stages IA2 or IB1. The tumour size consistent with the reduced tumour after NACT administration was the criterion for selection of the control group. The following parameters were monitored in both groups--duration of the surgery, blood loss objectivised by a difference in pre-operative and post-operative haemoglobin and haematocrit values, the need of blood transfusion, per-operative complications, early post-operative complications (up to 6 weeks after the surgery), duration of hospitalization and retaining the inserted epicystotostomy due to hypotonic bladder after discharge. RESULTS: A therapeutic response allowing the radical surgery was achieved in 92% patients after NACT. After NACT the original tumour volume was reduced by 70% on the average (58% - 100%). No significant differences between the group of patients treated with NACT and undergoing subsequent radical hysterectomy and the control group were reported in terms of duration of the surgery (165 min. vs. 160 min.), blood loss (the difference in pre-operative and post-operative haemoglobin values 18 g/l vs. 19 g/l, the difference in pre-operative and post-operative haematocrit values 0.056 vs. 0.064), administration of blood transfusion (25% vs. 21%) and duration of hospitalization (9.5 days vs. 9.6 days). A significant difference was reported only in the need to retain the inserted epi-cystostomy after discharge (67% vs. 47%). CONCLUSION: There were no significant differences in the evaluated parameters of per-operative and postoperative morbidity in patients after NACT and in control patients, except for the necessary duration of artificial urine derivation in patients after NACT due to the fact that their surgery was more radical in the parametria. Administration of NACT regimen involving ifosfamide/cisplatin (IP) improved surgical conditions in the bulky squamous cell carcinoma of the uterine cervix.

[Glandular premalignant lesions of the uterine cervix]. / Adenoprekancerózy delozního hrdla.

OBJECTIVE: Review of diagnostical and therapeutical methods in glandular premalignant lesions of the uterine cervix. DESIGN: Review article. SETTING: Department of Obstetrics and Gyneacology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. RESULTS: The incidence of invasive adenocarcinomas of the uterine cervix is increasing. Incidence ratio between adenocarcinomas and spinocellular carcinomas is approximately 1:5; however ratio of premalignant lesions reaches only about 1:80. Glandular premalignant disease is usually found in the specimen taken for squamous disease. The coincidence of both types of premalignant lesions, so called "mixed lesion", is revealed in about 46-72%. PAP-smear of AGC-NOS/-NEO or adenocarcinoma in situ (AIS) in combination with typical colposcopic appearance raise a suspicion of glandular lesion. Direct biopsy must be always performed to get definite diagnosis. Optimum biopsy technique requires cylindrical excision. A woman can be carefully followed if desires pregnancy and specimen margins are negative. Hysterectomy is indicated if reproductive plans are completed. CONCLUSION: Diagnosis of glandular premalignat lesion of the uterine cervix is more complicated in comparison to spinocellular one, however it is getting more significant due to increasing incidence. Colposcopy and cytology are less reliable. Any suspicion on glandular premalignat leasion requires more active approach and radical procedure (hysterectomy) if possible.

[Radical parametrectomy in women with invasive cervix cancer after previous simple hysterectomy]. / Radikální parametrektomie u zen s invazivním karcinomem delozního hrdla po piredchozí prosté hysterektomii.

OBJECTIVE: Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy. DESIGN: Retrospective observational study, review of literature. SETTINGS: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic. METHODS: Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy. RESULTS: Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons. CONCLUSIONS: Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

[Isolated lymphadenopathy as the first presentation of systemic mastocytosis--description of two cases]. / Izolovaná lymfadenopatie jako první projev systémové mastocytózy--popis dvou prípadu.

Presented are two cases of systemic mastocytosis in 46- and 63-year-old women, where the correct diagnosis was established in randomly disclosed cervical respectively intraabdominal lymphadenopathy. Both cases lacked characteristic skin and systemic mast-cell mediator symptoms at the time of histologic diagnosis. The first case was classified as a indolent systemic mastocytosis without any proven genetic alteration, the second one met the criteria of aggressive systemic mastocytosis with eosinophilia, where the point mutation asp816val in c-kit gene was confirmed and the patient responded unexpectedly well to Gleevec. Discussed are both conventional morphological differential diagnosis of mastocytosis in lymph nodes and recent advances in genetics of these systemic clonal mast cell proliferations. The latter not only outlines the oncopathogenesis but, in particular, also provides important prognostic and biological implications of this peculiar disease.

[Metastasing and relapsing "low grade" adenosquamous metaplastic breast cancer--is there a really indolent lesion? A description of three cases and review of literature]. / Metastazující a recidivující "low grade" adenoskvamózní metaplastický karcinom prsu--jde skutecne o indolentní lezi? Popis trí prípadu a rozbor literatury.

OBJECTIVE: To describe personnel experience with three unusual cases of low-grade adenosquamous carcinoma of the breast. Due to the aggressive course in two cases, the review of the literature does not concentrate on morphology and differential diagnosis only, but discuss overall biology of this lesion too. DESIGN: Three case reports. SETTING: Biopsy Lab s.r.o. and Sikl's Department of Pathology, Charles University and Faculty Hospital, Pilsen. METHODS: Included are cases from mammary register of Biopsy Lab s.r.o. and from personnel consulting registry of Prof. Michal. In details are documented both clinical presentations, including follow up, and spectrum of histologic patterns of the lesion. Immunohistochemistry performed by streptavidin-biotin system (LSAB+, Dako) as detection system and diaminobenzidin tetrahydrochlorid as chromogen, employed standard myoepitelial markers (actin, CD10, calponin and p63), hormonal receptors, oncogen Her-2/neu, CK7, CAM5.2, CD34 and CD117. RESULTS: Partial mastectomy and segmentectomy were performed in three women 46, 72 and 74 years-old resp. for tumor, which size ranged from 20-35 mm in maximum diameter (mean 28 mm). Histology revealed low-grade adenosquamous metaplastic carcinoma displaying typical biphasic appearance combining regular tubular structures with surrounding storiform, sclerosing fibrous stroma. Variably present was characteristic squamous metaplasia of the gland forming either luminal morules or evident squamous pearls. Using immunohistochemistry, a total absence of myoepithelial layer in epithelial structures was confirmed. The stromal component expressed smooth muscle actin in two cases, one of which contained areas of heterologous chondrosseal differentiation. There were recognized metastases by one woman in two ipsilateral axillary lymph nodes mimicking benign breast heterotopia in one of them. One patient experienced recurrence in the scar 37 months after mastectomy where only mesenchymal heterologous component element was found. In two women with aggressive course the original biopsy was falsely interpreted, once as phyllodes tumor and secondly as benign sclerosing pseudotumor. CONCLUSION: low-grade adenosquamous carcinoma, despite its bland histology, should be understood as regular malignancy prone to frequent recurrences and recognized metastatic potential. It arises in the deep breast tissue and structurally resembles the microcystic adnexal carcinoma of the skin. Low-grade adenosquamous carcinoma, however, has nothing to do with syringomatous adenoma of the nipple, which is a benign tumor of the skin adnexa. Differential diagnosis includes spectrum of non-neoplastic slerosing lesions and above-mentioned phylloid tumor. The rarity of this neoplasm does not exclude deep knowledge.

Preservatives in insulin preparations impair leukocyte function. In vitro study.

m-Cresol and methyl p-hydroxybenzoate are preservatives in insulin preparations. As previously reported, in diabetic patients on continuous subcutaneous insulin infusion, users of insulin-containing m-cresol had significantly more inflamed infusion sites than users of insulin with methyl p-hydroxybenzoate. This study assessed the influence of insulin with and without these preservatives on leukocyte function. Leukocyte function was investigated in a killing experiment, expressed as the percentage of bacteria killed after 60 min incubation of bacteria (Staphylococcus aureus), polymorphonuclear leukocytes, serum, and insulin preparations. Because preservative is retained by the infusion device, insulin with preservative was tested before and after 1 and 4 days perfusion with a PVC pump catheter. After perfusion, the amount of preservative was reduced (percentage of original concentration after 1 and 4 days 8 and 30% m-cresol and 42 and 72% methyl p-hydroxybenzoate, respectively). The killing percentage in insulin with m-cresol reduced compared with insulin without preservative (mean +/- SE 95.4 +/- 0.8%) and the control without insulin (95.8 +/- 0.8%), both before and after 1 and 4 days perfusion (74.8 +/- 0.7, 80.2 +/- 2.8, and 80.6 +/- 1.6%, respectively; P less than 0.01). The same occurred in insulin with methyl p-hydroxybenzoate (85.0 +/- 0.9% before and 88.4 +/- 0.9 and 86.2 +/- 0.8% after 1 and 4 days perfusion; P less than 0.05). All insulin preparations with m-cresol caused lower killing percentages than corresponding insulin preparations with methyl p-hydroxybenzoate (P less than 0.05). These results demonstrate that both preservatives impaired leukocyte function, but m-cresol was the most noxious in this respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of collection and preprocessing methods on neutrophil elastase plasma concentrations.

OBJECTIVES: Elevated plasma levels of the elastase alpha 1-proteinase inhibitor complex (E-alpha 1 PI) have been proposed as a marker of bacterial infection and neutrophil activation. Liberation of elastase from neutrophils after collection of blood may cause falsely elevated results. Collection methods have not been validated for critically ill neonates and children. We evaluated the influence of preanalytical methods on E-alpha 1 PI results including the recommended collection into EDTA tubes. DESIGN AND METHODS: First, we compared varying acceleration speeds and centrifugation times. Centrifugation at 1550 g for 3 min resulted in reliable preparation of leukocyte free plasma. Second, we evaluated all collection tubes under consideration for absorption of E-alpha 1 PI. Finally, 12 sets of samples from healthy adults and 42 sets obtained from critically ill neonates and children were distributed into the various sampling tubes. Samples were centrifuged within 15 min of collection and analyzed with a new turbidimetric assay adapted to routine laboratory analyzers. RESULTS: One of the two tubes containing a plasma-cell separation gel absorbed 22.1% of the E-alpha 1 PI content. In the remaining tubes without absorption of E-alpha 1 PI no differences were observed for samples from healthy adult patients. However, in samples from critically ill neonates or children, significantly higher results were obtained for plain Li-heparin tubes (mean = 183 micrograms/L), EDTA tubes (mean = 93 micrograms/L), and citrate tubes (mean = 88.5 micrograms/L) than for the Li-hep tube with cell-plasma separation gel and no absorption of E-alpha 1 PI (mean = 62.4 micrograms/L, p < 0.01). CONCLUSION: Contrary to healthy adults, E-alpha 1 PI results in plasma samples from critically ill neonates and children depend on the type of collection tube.

Uterine necrosis after laparoscopic uterine vessel dissection for symptomatic fibroid--a case report.

Laparoscopic dissection of uterine vessels is a new minimally invasive method to treat symptomatic fibroids. A potential complication of uterine artery dissection is uterine necrosis. A woman with a large intramural fibroid underwent laparoscopic dissection of the uterine vessels using ultrasonic activated shears and three months later developed focal uterine necrosis requiring exploratory laparotomy and supracervical hysterectomy. Although uterine artery coagulation and dissection are procedures with a low reported rate of complications, uterine fibroid or focal uterine necrosis can occur.

[Cervical carcinoma during pregnancy]. / Cervikální karcinom v tehotenství.

OBJECTIVE: To evaluate management and outcome of pregnant women with cervical carcinoma. DESIGN: Retrospective clinical study. SETTING: Institute for Mother and Child Care, Prague, Czech Republic. METHODS: Clinical data of pregnant women suffering from cervical carcinoma were summarized and assessed. The primary treatment was radical hysterectomy and pelvic lymphadenectomy including the foetus in utero in the first and early second trimester and caesarean section and radical surgery after viability of the foetus has been reached. Patients were assessed with regard to the stage of the disease and the stage of pregnancy. RESULTS: In this retrospective study we discuss 8 cases of cervical cancer diagnosed during pregnancy. According to the TNM classification 3 patients were in stage Ib1, 3 patients in stage Ib2, one patient in stage IIa and one patient in stage IIb. With the exception of one patient in stage IIb all cases were operable with no complication after radical surgery. After a follow-up of at least 12 months we are convinced that pregnancy has no negative effect on the prognosis of cervical cancer.