[New diagnostic approach to different hydatidiform mole types, hydropic abortions and relevant clinical management]. / Nové diagnosticki prístupy k ruzným typum hydatidózních mol, hydropickým abortum a príslusné klinické postupy.

OBJECTIVE: To describe new diagnostic approach to complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. TYPE OF STUDY: Original research. SETTING: Trophoblastic Disease Center in the Czech Republic (TDC-CZ), Institute for the Care of Mother and Child, Prague. METHODS: Our study consists of 1321 partial hydatidiform moles, 805 complete hydatidiform moles, 524 proliferative moles, and over 2500 hydropic abortuses diagnosed and treated at theTDC-CZ, besides which 2896 of these lesions were examined at the TDC-CZ by referral. The material was examined by routine histopathological methods, which in selected cases was supplemented by immunohistological examination and correlated with cytogenetic and molecular genetic results and clinical features. RESULTS: The study describes the diagnostic procedures enabling the differential diagnosis between mature complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. Fourteen histological parameters have been defined which are most common, individually or in combination, in various types of hydatidiform moles and hydropic abortions. Warning is given to errors in histological diagnosis correlated with cytogenetic and molecular genetic results. Proposed reliable method of eliminating the influence of these errors on the possible development of trophoblastic disease. CONCLUSION: The study describes differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole, hydropic abortion and relevant clinical management.

[Current options of prenatal diagnosis in congential diaphragmatic hernia]. / Soucasné moznosti prenatální diagnostiky kongenitálni diafragmatické hernie.

OBJECTIVE: The aim of this article is to review the current options of prenatal diagnosis in congential diaphragmatic hernia (CDH). SUBJECT: Systematic review. SETTING: Institute for the Care of Mother and Child, 3rd Medical Faculty, Prague. SUBJECT AND METHOD: Review of recent published data. CONCLUSION: The basic method for prenatal diagnosis of congenital diaphragmatic hernia is 2D ultrasonography: measurement of lung-to-head ratio (LHR), observed to expected lung to head ratio (observed to expected LHR - O/E LHR), localization of diaphragmatic defect, assessment of liver position and presence of associated anomalies (negative prognostic factors). Prenatal diagnosis can be supplied with 3D ultrasonography and magnetic resonace (imaging methods for valid measurement of fetal lung volume and/or presence of associated congenital defects confirmation). The reactivity of intrapulmonary arteries are evaluated by hyperoxygenation test and measurement of arterial Doppler parameters. Isolated diaphragmatic hernia is not an indication for invasive prenatal diagnostic methods. Important part of succesful prenatal diagnosis and therapy of CDH is concentration of cases in specialized centre.

[Complications of the invasive prenatal diagnostic methods]. / Komplikace metod invazivní prenatální diagnostiky.

OBJECTIVE: To provide a literary overview of the complications associated with the invasive prenatal diagnostic methods in the 1st and 2nd trimester of pregnancy. DESIGN: A summarising article. SETTING: Mother and Child Care Institute, Prague. METHODS: Compilation of data from professional literature. RESULTS AND CONCLUSION: The global trend is characterised by the effort to move prenatal diagnostics into the period of the first trimester. The invasive diagnostic methods of this period - sampling of chorionic villi and timely amniocentesis are subjects of a number of discussions, which deal primarily with their reliability and safety. The main indicator is the evaluation of foetal losses occurring in connection with the action. So far, the safest method is second-trimester amniocentesis; for early diagnostics, the trans-abdominal sampling of chorionic villi is preferred to transcervical one and to early amniocentesis.

[Psychomotor development of children with signs of intrapartum hypoxia and monitored by intrapartum fetal pulse oxymetry]. / Psychomotoricky vývoj detí ohrozených intrapartální hypoxií a monitorovaných intrapartálním fetálním pulzním oxymetrem.

OBJECTIVE: The following questions were investigated: 1) the psychomotor development in newborns with pathological cardiotocographic recording (CTG), having been born spontaneously due to a normal oxygen saturation monitored by intrapartum pulse oxymetry (IFPO)(group I), 2) possible difference in development of children in group I in comparison with those with pathological CTG without IFPO monitoring delivered by cesarean section (group II), 3) possible differences in children in these two groups with signs of intrapartum hypoxia (groups I and II, respectively) from children delivered spontaneously during physiological delivery without signs of hypoxia (group III). DESIGN: A prospective clinical study SETTING: Institute for the Care of Mother and Child METHODS: There have been 88 children born in the years 2000-2001 from singleton pregnancies in gestational ages > 36 weeks. Three groups of children were established: 1) in the group I (IFPO, n=32) there were children born spontaneously having pathological CTG detected by cardiotocograph HP50A and simultaneously monitored by intrapartum fetal pulse oxymeter NELLCOR Puritan Benett A400 with the NELLCOR FE 14 sensor with normal values of oxygen saturation. The children of group II (CTG-SC, n=25) were born by cesarean section due to acute intrapartum fetal hypoxia (IH) indicated by CTG recording without IFPO. The group III (physiological, n=31) was formed by children from physiological deliveries without signs of IH. All children underwent psychological examination at the average age of 21.8 months by the Bayley Scales of Infant Development (BSID-II). The statistical analysis of data was performed according to the variables using t-test or chi-square test, respectively. RESULTS: Group I (IFPO) did not differ significantly from group II (CTG-SC) in any area of psychological evaluation. The prevention of cesarean section due to IFPO method in the group I therefore prevented a significant increase of psychological morbidity in children of this early age. In spite of that the children of the group I (IFPO) reached the lowest evaluation and differed significantly from the most favorably evaluated group III (physiological) in motor development, behavior, and in a total number of deviations. Group II (CTG-SC) was evaluated significantly worse in comparison with group III (physiological) only in behavior items. On the other hand the occurrence of children of above-average mental development in the groups I and II were the same as in group III. The results indicate complex character of the problem. CONCLUSION: The prevention of CS due to IFPO prevented a development of psychological morbidity in children. The increased occurrence of deviations in psychomotor development of children with signs of acute IH (groups I and II) in comparison with children of group III (physiological) will be analyzed in detail in relation to further data.

[Importance of ultrasonographic examinations in predicting abortion during the first trimester of gestation]. / Význam ultrasonografického vysetrení pro predikci potratu v I. trimestru gestace.

OBJECTIVE: Draw attention to the possibility to use ultrasonographic examination to predict abortion in the 1st trimester of gestation. DESIGN: Review. SETTING: Institute for the Care of Mother and Child, Prague. SUBJECT AND METHOD: Review article on possibilities of ultrasonographic examination to predict abortion during the first trimester of gestation. The article is divided according to the images of different extraembryonic and embryonic structures which may be important for prediction of abortion during the first trimester of gestation. Illustrations are from the author's own observations. CONCLUSION: The presented review draws attention to the possible use of transvaginal ultrasonography in prediction of gestational complications in early stages of the first trimester of gestation. Abnormalities in the size and shape of some embryonic and extraembryonic structures make it possible to detect early complications, still in the stages of embryogenesis, which may lead to early gestational loss.

[Separation of hematopoietic progenitor cells from peripheral blood in patients with hemato-oncologic malignancy]. / Separace hemopoetických progenitorových bunek z periferní krve (PBPC) u pacientu s hematoonkologickými malignitami.

BACKGROUND: Transplantations of haematopoietic progenitor cells from peripheral blood (PBPC) are able to ensure haematopoietic and immunological reconstitution as well as stable long term engraftment. Autologous PBPC are administered after previous myeloablative chemotherapy to patients with haematological and non-haematological malignancies. The objective of the submitted study was to follow-up the results of autologous separations of PBPC in patients with a good effect of mobilisation therapy. The authors evaluated in PBPC concentrates the content of cell parameters needed for transplantation. In the subsequent part of the trial they mention the times of engraftment after autologous transplantation. METHODS AND RESULTS: The authors evaluated parameters of 26 separations of PBPC in 11 haematooncological patients with a good effect of mobilisation therapy and with concentration of CD 34+ cells higher than 20 x 10(3)/ml of peripheral blood. The separations of PBPC were implemented on the Cobe Spectra and Baxter CS 3000 Plus equipment under a standard regime with processing of 12 l blood, i.e. 2.7 total blood volumes of the patients. In the mentioned group of patients already from one separation an adequate amount of CD 34+ cells for their transplantation was obtained. Transplantation doses were prepared on average from two separations and amounted as regards MNC/kg, CD 34+ cells/kg and CFU-GM/kg to 4.3 x 10(8), 17.1 x 10(6) and 2.5 x 10(4). The assembled parameters correspond to, or in some parameters exceed, recommended amounts for their transplantation. CONCLUSIONS: In well mobilised patients under the regime of standard separations adequate amounts of progenitor cells for their autologous transplantation were obtained. Transplantation doses were prepared from two collections. Investigation of pre-separation concentration of CD 34+ cells in the peripheral blood is a reliable indicator for starting PBPC separation. Early post-transplantation results indicate the time of engraftment 10 days on average and minor need of substitution therapy with blood products.