[Vulvodynia and the possibility of its management]. / Nový pohled na problematiku vulvodynie.

OBJECTIVE: A study of vulvodynia and the possibility of its management. SUBJECT: Original study. SETTING: Department of Obstetrics and Gynecology, Teaching Hospital and Medical Faculty Hradec Králové, Charles University, Prague. Department of Neurology, Teaching Hospital and Medical Faculty Hradec Králové, Charles University, Prague. Outpatient psychiatric department Galenus, Hradec Králové. Department of Clinical Microbiology, Teaching Hospital and Medical Faculty Hradec Králové, Charles University, Prague. Department of Biological and Medical Sciences, Faculty of Pharmacy Hradec Králové, Charles University, Prague. METHODS: Analysis and discussion focused on our experience in a long time follow-up of patients with chronic vulvovaginal discomfort and vulvodynia. CONCLUSION: Especially the management of indolent form of vulvodynia would be taken into consideration of idiopathic origin and problematic management. Our study emphasizes the necessity of individual approach. The goal of therapy in this most problematic form is the improving of the actual quality of life. In the case of idiopathic forms of vulvodynia.

Diagnosis and surgical therapy of plasma cell neoplasia of the spine.

Presented is a retrospective analysis of 27 patients with plasma cell neoplasms of the spine treated by surgery. Multiple myeloma was confirmed in 22 (81%) and solitary plasmacytoma in 5 patients (19%), assessed at the time of surgery. Nineteen patients (70%) with the preliminary diagnosis of malignancy of unknown etiology were admitted for surgery. In 23 patients (85%) the essential symptom was back pain, which preceded surgery by an average of 4 months. Thirteen patients (48%) were bedridden due to tumor spinal cord compression, on average for 7 days before undergoing surgery. Only 5 out of 13 bedridden patients (38%) regained the ability to walk after surgery and 8 patients (62%) remained bedridden despite successful surgical decompression of the spinal cord. The difference of survival of the patients between bedridden and able to walk prior to surgery was statistically significant (Cox's F-Test = 0.005). Key words: plasma cell neoplasia, spinal cord compression, late diagnosis, outcome.

The role of embolization in radical surgery of renal cell carcinoma spinal metastases.

BACKGROUND: Radical surgery of renal cell carcinoma spinal metastases carries a high risk due to potentially life-threatening extreme blood loss. Radical preoperative embolization of renal cell carcinoma metastases alone is not necessarily a guarantee of extreme blood loss not occurring during operation. METHODS: A retrospective analysis of 15 patients following radical surgery for a spinal metastases of a renal cell carcinoma was performed. Eight patients were embolized preoperatively and 7 were not. We analysed features influencing peroperative blood loss: size and extent of tumour, complexity of surgical approaches and radicality of embolization. RESULTS: The embolized and non embolized groups were not comparable before treatment. They differed markedly in size of tumour as well as the complexity of approach. In the embolized group the size of the tumour was, on average, twice as large as that in non embolized patients and more complex approaches were used twice as frequently. Despite findings suggesting that embolization was effective, blood loss was greater in the embolized group of 8 patients (4750 ml), compared to the non-embolized group of 7 patients (1786 ml). CONCLUSION: Metastasis size, extent of tumour, technical complexity of surgery and the completeness of preoperative embolization had an important effect on the amount of peroperative blood loss. The evaluation of the benefits of preoperative embolization only on the basis of blood loss is not an adequate method.

Less frequent neurologic complications of anticoagulant therapy.

One of the less frequent complications of anticoagulant therapy is damage to the femoral and sciatic nerves due to bleeding. This report presents two cases and discusses the pathogenetic mechanism and treatment of this medical problem.

[Proportion of tau protein to phosphorylated tau protein CSF levels in differential diagnosis of dementia]. / Bedeutung der Gesamt-tau- und Phospho-tau-Protein-Liquorspiegel in der Demenzdiagnostik.

BACKGROUND: The diagnosis of Creutzfeldt-Jakob disease (CJD) is based on typical clinical features and can be supported by detection of 14-3-3 protein in the CSF. The present study suggests the importance of investigating this ratio of total tau protein to phosphorylated tau protein in differentiating CJD from other dementias. Thirty-one patients with Alzheimer's disease (AD) or frontotemporal dementia and four with definitive diagnoses of CJD were included in the study. METHODS AND MATERIAL: Results from baseline investigations were compared with those from an age-matched cognitively controlled group with Bell's palsy. Tau protein, phosphorylated tau protein, and beta amyloid were analyzed using a commercially available enzyme-linked immunosorbent assay; 14-3-3 protein was assessed by Western blotting. RESULTS AND CONCLUSION: A distinctly high proportion of total tau protein to phosphorylated tau protein in CSF was found in all patients diagnosed with CJD, even in those with negative 14-3-3 protein blot results. In contrast, marker analysis in patients with Alzheimer's dementia revealed the highest CSF ratio of beta amyloid to phosphorylated tau protein levels. These proteins are important diagnostic biomarkers for CJD, especially in patients with negative 14-3-3 protein findings.

[Contribution of spectrophotometry of the cerebrospinal fluid in the rational treatment of subarachnoid hemorrhage]. / Prínos spektrofotometrie likvoru pro racionální lécbu subarachnoidálního krvácení.

In connection with antifibrinolytic therapy of subarachnoid hemorrhage which reduces, especially at the acute stage, the risk of repeated bleeding, more frequent incidence of other serious complications was observed, i.e. late ischemic neurological deficiency. As this complication is prognostically serious and therapeutical effects are not satisfactory its prevention is necessary, which includes administration of antifibrinolytic drugs for a limited time period. Such period may be determined by means of dynamic study of hemoglobin degradation products in the liquor using liquor spectrophotometry.