[Czech model for decrease of maternal mortality in Uganda]. / Ceský model pro snízení materské úmrtnosti v Ugande.

High maternal and perinatal mortality is the leading problem of the health care in developing countries of Sub-Saharan Africa, including Uganda. The main condition for decrease of maternal mortality is availability of an emergency obstetrical care in hospital accompanied by skilled team of specialists (gynaecologist, anaesthesiologist, paediatrician), which are able to treat all obstetrical complications and provide an intensive care to risk newborns. The Czech Hospital and School for midwives in Uganda was founded and build with the aim to accomplish a grant project for the decrease of maternal, perinatal and child mortality. Our project to connect emergency obstetrical care in hospital to villages and traditional delivery attendants by mobile phones shows a simple and original model, which can help to decrease maternal mortality in Uganda and in the other countries of Sub-Saharan Africa as well. The Czech-Uganda Hospital started its work on 19th February 2007 with a team of Slovak doctors; however, till now, after 2 years of work, it doesn't fulfil its role of a specialised obstetrical department, which would be able to join its partners in villages and start the grant project for decrease of maternal and perinatal mortality.

Long-term results of high-dose chemotherapy and autologous stem cell rescue for high-risk neuroblastoma patients: a report of the Spanish working party for BMT in children (Getmon).

The authors retrospectively analyzed the long-term outcome of 67 patients over 1 year of age at diagnosis with high-risk neuroblastoma (stage 4 or stage 3 with N-myc amplification) who were treated with megatherapy and stem cell rescue from 1984 to 1998. Median age at transplant was 4 years (range 1.6-15 years). The source of cells was peripheral stem cells in 29 and bone marrow in 38 patients. In 12 patients, an in vitro purging of bone marrow harvest was performed. Most patients were conditioned with melphalan, BCNU, and VM-26. After transplant 19 patients received complementary treatment with IL-2 (16) or 13-cis-retinoic acid (3). Six patients (8%) died from transplant-related toxicity and 39 from disease progression. Three patients were alive with active disease at the time of analysis. Nineteen patients are alive and disease-free at a median follow-up of 104 months. Five-year event-free survival is 0.30. Survival of patients who received a purged graft was not significantly better than the rest. Post-transplant complementary treatment significantly improved overall and event-free survival (p = .01 and p = .04, respectively).

Charcot-Marie-Tooth disease.

OBJECTIVE: To discuss the similarities and differences in the clinical presentation of Charcot-Marie-Tooth Disease, an inherited peripheral neuropathy, and acquired lumbar spinal stenosis. CLINICAL FEATURES: Patients with lumbar spinal stenosis causing nerve root entrapment often have leg pain and weakness during such activities as walking or standing. Additional symptoms of poor balance, foot deformity and signs of cerebellar and sensory ataxia suggest a diagnosis of peripheral neuropathy rather than nerve root entrapment. INTERVENTION: Electrodiagnostic testing and nerve conduction studies reveal abnormal conduction velocities in cases of peripheral neuropathy such as Charcot-Marie-Tooth Disease. CONCLUSION: Sciatica and leg weakness may be due to a variety of causes, including nerve root entrapment and peripheral neuropathy. A diagnosis of Charcot-Marie-Tooth Disease should be considered in a case of progressive lower limb weakness associated with loss of balance and sensory ataxia. This diagnosis can be confirmed using nerve conduction studies.

Neuropharmacological evaluation of movement disorders that are adverse reactions to specific foods.

Three cases are reported of patients who had episodic movement disorders triggered by foods or components of the diet. In the first patient, the movement consisted of shaking the head from side to side that was triggered by milk and a number of other foods. In the second patient, the movement consisted of a repeated shrugging of the shoulders that was triggered by egg and coffee. In the third, the movement consisted of rhythmic contractions of the arms and legs that were triggered by aspartame. The first patient agreed to participate in a study in which she drank 250 ml of skim milk, an amount sufficient to trigger head shaking, after pretreatment with drugs known to alter neurotransmission across beta-adrenergic, dopaminergic, GABAergic or purinergic synapses. At the doses used, propranolol and diazepam had no effect on the milk evoked movement disorder. Levodopa (plus carbidopa) blocked the reaction to milk. Haloperidol, salbutamol and theophylline by themselves triggered a reaction similar to that evoked by milk. These observations suggest that, in susceptible individuals, foods can trigger movement disorders through an action on dopamine and other neurotransmitter pathways in the brain. A videotape of the reactions of the first two patients is available.

[Electroanalgesia in programmed delivery]. / Elektroanalgézie v programovaném porodnictví.

The influence of electroanalgesia on the uterus activity, delivery duration, pH, P02, PCO2, Hb02, BE, sodium and potassium values in venous and arterial umbilical blood as well as in venous mother's blood has been evaluated. The investigated total was composed of 31 pregnancies, in 18 of them the delivery was backed with electroanalgesia, and the remainder of 13 represented a control group. No statistical significance has been evaluated as to the duration of delivery in both groups. The positive finding resides in significantly higher Hb02 and lower Be umbilical blood values in a group with applied electroanalgesia. No significant differences were found out in the rest of either the indices of respiratory foetal metabolism or sodium and potassium values in contrast of control group.

Anticoagulant therapy and subdural hematoma formation.

Subdural hematoma formation should be considered as a diagnosis in the patient who complains of headache and is on long-term anticoagulant therapy. Three such cases are described and the proper medical management is discussed.

Unilateral asterixis due to thalamic hemorrhage.

Unilateral asterixis involving the face, hand, and foot was caused by a contralateral hypertensive thalamic hemorrhage, confirmed by computerized tomography. In addition to the asterixis, loss of upward gaze and pupillary abnormalities suggested secondary midbrain compression. These findings raise the possibility that asterixis may be due to mesodiencephalic dysfunction, and suggest that unilateral asterixis can be used to localize focal lesions of this region of the brain.