A randomized, controlled trial examining quarter-level somatic cell count and culture-based selective dry cow therapy against blanket dry cow therapy on early-lactation production outcomes.

The objective of this study was to determine quarters requiring antimicrobial treatment using either a benchtop somatic cell counter (S-SDCT) or culture with gram-positive selective media (C-SDCT) and compare outcomes in these cows to those receiving blanket dry cow therapy (BDCT) in a randomized, controlled trial. Two novel methods of identifying cows with intramammary infections followed by selective antimicrobial treatment were evaluated at a commercial dairy farm to determine their usefulness in decreasing antibiotic usage during the dry period without significant detrimental effects on milk quality and production. Cows (n = 840) were randomly allocated to one of 3 groups (BDCT, C-SDCT, S-SDCT) the day before dry-off and quarter-level milk samples (QLMS) were collected. The QLMS from cows in the S-SDCT group were evaluated using the cell counter and quarters were treated if somatic cell count (SCC) was ≥200,000 cells/mL, while QLMS from cows in the C-SDCT group were cultured and quarters were treated if the culture showed growth. All cows in the BDCT received antimicrobial therapy and all cows received an internal teat sealant regardless of treatment group. Outcomes measured were first and second DHIA test somatic cell count, milk production through 60 d in milk, cows leaving the farm, clinical mastitis, and bacteriologic new infections in a subset of quarters. Cows in both SDCT groups had fewer antimicrobial treatments than cows in the BDCT group as was expected, and cows in the C-SDCT group had fewer treatments than those in the S-SDCT group. Cows in both SDCT groups had higher linear score at the first DHIA test (BDCT: 1.8, S-SDCT: 2.2, C-SDCT: 2.2), however there were no other differences between groups regarding any other outcomes measured. While antimicrobial use was significantly reduced, farms should use caution in adopting the benchtop analyzer and the selective media described in this study as ways to identify infected cows for dry cow therapy as they may result in increased linear score early in lactation.

Thrombus or tumor? A case report of a rare sarcoma entity: intimal sarcoma of the pulmonary arteries.

BACKGROUND: Tumor embolism is a very rare primary manifestation of cancers and the diagnosis is challenging, especially if located in the pulmonary arteries, where it can mimic nonmalignant pulmonary embolism. Intimal sarcoma is one of the least commonly reported primary tumors of vessels with only a few cases reported worldwide. A typical location of this malignancy is the pulmonary artery. Herein, we present a case report of an intimal sarcoma with primary manifestation in the pulmonary arteries. A 53-year-old male initially presented with dyspnea. On imaging, a pulmonary artery embolism was detected and was followed by thrombectomy of the right ventricular outflow tract, main pulmonary artery trunk, and right pulmonary artery after ineffective lysis therapy. Complementary imaging of the chest and abdomen including a PET-CT scan demonstrated no evidence of a primary tumor. Subsequent pathology assessment suggested an intimal sarcoma further confirmed by DNA methylation based molecular analysis. We initiated adjuvant chemotherapy with doxorubicin. Four months after the completion of adjuvant therapy a follow-up scan revealed a local recurrence without distant metastases. DISCUSSION: Primary pulmonary artery intimal sarcoma (PAS) is an exceedingly rare entity and pathological diagnosis remains challenging. Therefore, the detection of entity-specific molecular alterations is a supporting argument in the diagnostic spectrum. Complete surgical resection is the prognostically most important treatment for intimal cardiac sarcomas. Despite adjuvant chemotherapy, the prognosis of cardiac sarcomas remains very poor. This case of a PAS highlights the difficulty in establishing a diagnosis and the aggressive natural course of the disease. CONCLUSION: In case of atypical presentation of a pulmonary embolism, a tumor originating from the great vessels should be considered. Molecular pathology techniques support in establishing a reliable diagnosis.

Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma - a single-centre retrospective analysis.

BACKGROUND: Soft tissue sarcomas (STS) account for less than 1% of all malignancies. Approximately 50% of the patients develop metastases with limited survival in the course of their disease. For those patients, palliative treatment aiming at symptom relief and improvement of quality of life is most important. However, data on symptom burden and palliative intervention are limited in STS patients. AIM: Our study evaluates the effectiveness of a palliative care intervention on symptom relief and quality of life in STS patients. DESIGN/SETTING: We retrospectively analysed 53 inpatient visits of 34 patients with advanced STS, admitted to our palliative care unit between 2012 and 2018. Symptom burden was measured with a standardised base assessment questionnaire at admission and discharge. RESULTS: Median disease duration before admission was 24 months, 85% of patients had metastases. The predominant indication for admission was pain, weakness and fatigue. Palliative care intervention led to a significant reduction of pain: median NRS for acute pain was reduced from 3 to 1 (p < 0.001), pain within the last 24 h from 5 to 2 (p < 0.001) and of the median MIDOS symptom score: 18 to 13 (p < 0.001). Also, the median stress level, according to the distress thermometer, was reduced significantly: 7.5 to 5 (p = 0.027). CONCLUSIONS: Our data underline that specialised palliative care intervention leads to significant symptom relief in patients with advanced STS. Further efforts should aim for an early integration of palliative care in these patients focusing primarily on the identification of subjects at high risk for severe symptomatic disease.

[Cerebral venous thrombosis during pregnancy]. / Mozková zilní trombóza v tehotenství.

OBJECTIVE: We present a case report of a patient with cerebral venous thrombosis during pregnancy. DESIGN: Case report. SETTING: Department of Gynaecology and Obstetrics at the Silesian Hospital. METHODS: Own observation, review of literature. CONCLUSION: In any tonic-clonic convulsions in pregnancy, we mainly think of an eclamptic attack and pregnancy must be ended. In case of persistent problems in the postpartum period after stabilization of the patients, differential etiology of convulsive states such as epileptic seizure, hypoglycemic spasms, CNS tumor, intracranial bleeding, cerebrovascular accident or cocaine overdose must be considered within the differential diagnosis.

[Two years of pharmacological termination of pregnancy in the Silesian hospital Opava, success and lessons]. / Dva roky metody medikamentózního ukoncení gravidity ve Slezské nemocnici v Opave, úspesnost a poznatky.

OBJECTIVE: The purpose of this study was to summarize our departments experience with pharmacological termination of pregnancy up to 49 days of amenorrhea, to assess the success, and especially, to offer a closer analysis of the complications of this method. DESIGN: Retrospective analysis. SETTING: Department of Gynaecology and Obstetrics at the Silesian Hospital. METHODS: The monitored sample consisted of 161 female patients who underwent pharmacological termination of pregnancy at our department from 1. 7. 2014 to 30. 6. 2016 being administered 600 mg of mifepristone (Mifegyne) and 400 µg of misoprostol (Mispregnol). Within the sample of patients we observed the objective process of pharmacological termination of pregnancy with special attention being payed to an analysis of complications. We compared the number of complications occurred under classic surgical intervention and those occurred under pharmacological termination of pregnancy. RESULTS: A complete abortion without the necessity of surgical intervention occurred with 151 patients (93.79%) of whom 15 patients with administering uterotonic medicaments. Ten patients (6.21%) required a consequent instrumental revision of the uterine cavity, seven of them (70%) had a history of surgical intervention in the uterine cavity. In case of one patient persisted vital pregnancy. Two patients underwent medical termination of pregnancy twice. In one case there were twins. CONCLUSION: The method of pharmacological pregnancy termination has a good efficiency, it is safe with minimal side effects.

[Heterotopic pregnancy after spontaneous conception]. / Heterotopická gravidita po spontánní koncepci.

DESIGN: Case report. SETTING: Departement of Obstetrics and Gyneacology, Silesian Hospital in Opava. METHODS: Case interpretation. CONCLUSION: Heterotopic pregnancy after spontaneous conception is diagnosed with a rare, often difficult to ascertain, however, the increasing incidence has justified its place in the differential diagnosis of acute abdominal not only for women enrolled in the program of assisted reproduction.

Platelets from flowing blood attach to the inflammatory chemokine CXCL16 expressed in the endothelium of the human vessel wall.

Endothelial chemokine CXC motif ligand 16 (CXCL16) expression is associated with atherosclerosis, while platelets, particularly those attaching to atherosclerotic plaque, contribute to all stages of atherosclerotic disease. This investigation was designed to examine the role of CXCL16 in capturing platelets from flowing blood. CXCL16 was expressed in human atherosclerotic plaques, and lesion severity in human carotid endarterectomy specimens was positively correlated with CXCL16 levels. CXCL16 expression in plaques was co-localised with platelets deposited to the endothelium. Immobilised CXCL16 promoted CXCR6-dependent platelet adhesion to the human vessel wall, endothelial cells and von Willebrand factor during physiologic flow. At low shear, immobilised CXCL16 captured platelets from flowing blood. It also induced irreversible platelet aggregation and a rise in intra-platelet calcium levels. These results demonstrate that endothelial CXCL16's action on platelets is not only limited to platelet activation, but that immobilised CXCL16 also acts as a potent novel platelet adhesion ligand, inducing platelet adhesion to the human vessel wall.

Safety and efficacy of periprocedural anticoagulation with enoxaparin in patients undergoing peripheral endovascular revascularization.

BACKGROUND: Periprocedural anticoagulation is primarily used in endovascular procedures to prevent acute reocclusion of the target vessel, but periprocedural anticoagulation might also have an impact on long-term outcome. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularizations (EVRs), the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR. MATERIALS AND METHODS: We performed a prospective, single-center, open-label phase III study comparing 2 different regimes of enoxaparin peri-interventional to peripheral EVR stratified into low- and high-risk groups according to the acute and long-term reocclusion risk due to their vessel morphology. In both groups, 0.5 mg/kg of enoxaparin as a bolus was administered intravenously 10 to 15 minutes before the start of the procedure. In the low-risk group, 40 mg of enoxaparin were administered once daily for 7 days; whereas in the high-risk group, 1 mg/kg of enoxaparin was administered subcutaneously (sc) 2 times a day for 48 hours after the procedure and afterward 40 mg of enoxaparin was administered sc once daily for 5 days. RESULTS: For the analysis of the per protocol population, 44 patients remained in the low-risk group and 140 in the high-risk group. Concerning the primary safety end point, a total of 25 (13.59%) bleeding events occurred until day 30; 5 (11.36%) of them in the low-risk group and 20 (14.29%) in the high-risk group (P = .809 for low vs high risk). None of the bleeding events observed were major according to Thrombolysis In Myocardial Infarction criteria. Concerning our primary efficacy end point, none of the patients showed an acute reocclusion classified as a significant decrease in ankle-brachial index (ABI) or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second end point of prevention of chronic reobstruction, at day 180 ABI has decreased in the low-risk group from mean 0.94 at day 30 to mean 0.89 and from 1.28 at day 30 to 0.85 after 6 months in the high-risk group. No significant reobstruction was found in the low-risk group, whereas 5 significant reobstruction events were objectified in the high-risk group, all of them in the femoropopliteal arterial segment at day 180. CONCLUSION: We conclude that low-molecular-weight heparin either in a low-dose or high-dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The long-term follow-up showed no significant difference between our high- and low-risk groups concerning reobstruction. The periprocedural anticoagulation seems to have no influence on the long-term patency rate after peripheral EVR.

Percutaneous transluminal angioplasty versus primary stenting in infrapopliteal arteries in critical limb ischemia.

BACKGROUND: In endovascular recanalisation of infrapopliteal arteries, studies have already pointed out the value of balloon angioplasty, but for stent implantation very few randomized controlled data exist so far. PATIENTS AND METHODS: We conducted a randomized controlled prospective trial in patients with critical limb ischemia (CLI) comparing the effect of percutaneous transluminal balloon angioplasty (PTA) versus primary stenting in infrapopliteal arteries, concerning 1-year clinical benefit and reobstruction rate. RESULTS: 54 patients were either randomized for primary stenting (balloon expandable stent) or PTA alone, 33 patients were assigned to the PTA group, 21 patients to the stent group. The whole follow up period of 12 months was completed by 46 patients. Improvement by at least one Rutherford classification was reached by a total of 33 (75.0 %) of patients at month 12, 22 (81.5 %) in the PTA group and 11 (64.7 %) in the stent group. A complete ulcer healing at month 12 showed 21 (63.6 %) of all patients, with a higher percentage in patients treated with PTA alone 16 (80.0 %) vs 5 (38.5 %). 50.0 % of all patients showed re-obstruction over the follow-up period, 39.4 % of the PTA and 66.7 % of the stent group. At month 3 primary patency rate was nearly equal in both groups (76.7 % PTA vs 75.0 % stent), but drifted apart with the duration of the follow-up period, with a primary patency at month 12 in the PTA group of 48,1 % vs 35,3 % in the stent group. As for secondary patency at month 12 the PTA group showed a patency rate of 70.4 %, vs 52.9 % in the stent group. CONCLUSIONS: Primary stenting with balloon expandable stents in the infrapopliteal arteries does not outway the benefit of PTA alone with the application of modern hydrophilic balloon catheters in patients with CLI.

Gemcitabine and carboplatin treatment in patients with relapsing ovarian cancer.

Despite progress in primary treatment of patients with advanced ovarian cancer, the majority develop recurrence of the disease. A platinum salt treatment, either as monotherapy or in combination with another cytostatic agent, is indicated for patients who have relapsed 6 or more months after primary treatment and thus have platinum-sensitive relapse. Because repeated use of paclitaxel treatment may lead to substantial neurotoxicity, the combination of gemcitabine with carboplatin represents a suitable treatment option, which is widely used in common clinical practice in the Czech Republic and Slovakia. This non-interventional, prospective study observed the effectiveness and tolerability of second-line treatment with gemcitabine and carboplatin in patients with platinum-sensitive relapse of ovarian cancer in routine clinical practice. The primary endpoint was to evaluate the survival and secondary endpoints were to evaluate time to disease progression, objective tumor response rate, and treatment toxicity. Patients were enrolled to planned second-line treatment with gemcitabine and carboplatin (gemcitabine 1000 mg/m2 and carboplatin AUC 5 on Day 1, and gemcitabine 1000 mg/m2 on Day 8 of a 21-day cycle) for platinum-sensitive relapse of ovarian cancer as a part of routine clinical practice and followed for 12 months. The events (death, tumor progression), tumor response, and maximal grades of toxicity were recorded according to common clinical practice. Survival time (using Kaplan-Meier analysis) and objective tumor response rate were calculated using data forms, and a subgroup analysis was performed using log rank tests for time-to-event endpoints; p-values were also calculated. Response rates were calculated for the whole population; for the subgroups, the Fisher's exact test was performed and only p-values were calculated. Between January 2004 and June 2005, 53 patients were enrolled in the study. The median age was 57 years and 96% of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0 and 1 at baseline. Approximately 91% of patients were originally diagnosed with stage III or IV; 60% of patients had disease free intervals (DFIs) of 12 or more months from previous therapy, and the additional 40% less than 12 months. The 1-year survival rate was 83%. Median survival time was not determined within the 12-month period following the start of the treatment study due to the limited duration of follow-up. Objective tumour response rate was 67.3%. Most common reasons for discontinuation of therapy were "Planned treatment completed" (53%) and "Tumor progression" (11%). Most common toxicities were leukopenia, anaemia, neutropenia, and thrombocytopenia; grades 3 and 4 of these toxicity types did not exceed 30%. Febrile neutropenia was recorded in two patients. Most common non-haematological toxicities were nausea and vomiting, fatigue, and neuropathy; grades 3 and 4 of these were below 6%. Results on time to disease progression are not published due to inconsistent statistical analysis of reported data. Based on this observation from routine clinical practice, which corresponds with previously published results from controlled clinical trials, the gemcitabine and carboplatin combination seems to be a suitable therapeutic option for patients with platinum-sensitive relapse of ovarian cancer.

Tongue necrosis as first symptom of giant cell arteritis (GCA).

Giant cell arteritis (GCA) is the most common systemic vasculitis affecting people over the age of 50 years, especially in the western world. Nevertheless, the initial diagnosis can be tricky, as some of the patients present at first time with a real unusual initial manifestation. One of these can be tongue necrosis, which is according to the literature in accordance with scalp necrosis, the rarest initial manifestation form of GCA. We describe two patients who presented with tongue necrosis as initial symptom of GCA. The diagnosis was made by the American College of Rheumatology criteria, biopsy and duplex sonography of their temporal arteries. A typical halo was seen as a sign of intimal edema. The patients were put on corticosteroids immediately after diagnosis was proven and their symptoms improved quickly.

High resolution three-dimensional brain atlas using an average magnetic resonance image of 40 adult C57Bl/6J mice.

Detailed anatomical atlases can provide considerable interpretive power in studies of both human and rodent neuroanatomy. Here we describe a three-dimensional atlas of the mouse brain, manually segmented into 62 structures, based on an average of 32 mum isotropic resolution T(2)-weighted, within skull images of forty 12 week old C57Bl/6J mice, scanned on a 7 T scanner. Individual scans were normalized, registered, and averaged into one volume. Structures within the cerebrum, cerebellum, and brainstem were painted on each slice of the average MR image while using simultaneous viewing of the coronal, sagittal and horizontal orientations. The final product, which will be freely available to the research community, provides the most detailed MR-based, three-dimensional neuroanatomical atlas of the whole brain yet created. The atlas is furthermore accompanied by ancillary detailed descriptions of boundaries for each structure and provides high quality neuroanatomical details pertinent to MR studies using mouse models in research.

Comparison of organochlorine pesticides, PCBs, and heavy metal contamination and of detoxifying response in tissues of Ameiurus melas from Corbara, Alviano, and Trasimeno Lakes, Italy.

Accumulation of cadmium (Cd), mercury (Hg), lead (Pb), chromium (Cr), hexachlorobenzene, gamma-HCH, DDTs, and PCBs has been investigated in the muscle of Ameiurus melas sampled during the same period from Lake Corbara, Alviano, and Trasimeno. Glutathione content and the enzymatic activities of glutathione reductase, glutathione peroxidase, catalase, glutathione S-transferase, and glyoxalase I were examined in gills, liver, and kidneys of each specimen. Catfish from Alviano, compared to those of Corbara and Trasimeno, showed the highest contamination of DDTs and PCBs and the lowest levels of biochemical parameters. Most likely, OCPs and PCBs content might be responsible for the compromised antioxidant status in these specimens.

Three-dimensional cerebral vasculature of the CBA mouse brain: a magnetic resonance imaging and micro computed tomography study.

Studies of mouse cerebral vasculature to date have focused on the circle of Willis without examining the morphological distribution of blood vessels through the rest of the brain. Since mouse models are frequently used in brain-related studies, there is a need for a comprehensive cerebral vasculature atlas for the mouse with an emphasis on the location of vessels with respect to neuroanatomical structures, the watershed regions associated with specific arteries, as well as a consistent nomenclature of the cerebral vessels. This article describes such an atlas, based on a combination of magnetic resonance and computed tomography technology to yield high-resolution volumetric and vasculature data on CBA mouse. This three-dimensional vasculature dataset provides an anatomical resource for future mouse studies.

La prueba de Rorschach y la personalidad antisocial

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Abstract: This paper is concerned with the análisis of the personality of eight subjects evaluated by the authors, using the Rorschach Test. Our purpose is to use this test to reflect on the psychic functioning of subjects for whom there is no agreement between clinical and legal and/or social criteria, in comparison to cases where there is a correlation between them. That is, to contrast the diagnostic criteria of the test with those criteria which actually lead to labella subject as "antisocial". Method: A descriptive study was used, whose sample was taken from an experiment involving cases examined over a period of ten years. The first group of subjects selected who confirm the sample meet the diagnostic criteria of the Rorschach Test for antisocial personality and also are in line with what society considers this to be. The second group includes those subjects who according to the test criteria evidence signs of being antisocial but are nonetheless not considered so by society. Finally, the third group is formed by those who do not fulfill any of the Rorschach Test criteria for antisocial personality, but socially and legally are considered to have it. Results: Significant differences were found between the three groups being studied. The first group shows signs or indications that are clearly associated with the antisocial personality. The case analysis revealed signs that had not previously been described as peculiar to the antisocial personality in the test but which nonetheless we consider essential to enable us to draw a diagnostic conclusion. In the other two groups, it was more difficult to reach a diagnostic agreement between the clinical and legal criteria. This illustrates the difficulty of making a categorical diagnosis of personality disorders, as other authors have already pointed out (Jaspers, Kernberg y Dórr). The other phenomena are not found in the literature relating to the Rorschach Test, and agree with the character traits described in classical psychopathological literature, such as the description by Schneider of the ruthless psychopath and the assertions made by Jaspers regarding the existence of an ideal type and numerous personalities between these two extremes. Moreover, Kernberg draws a distinction between "antisocial behavior" and "antisocial psychic functioning". Antisocial behavior may appear in different personality profiles, especially in Narcissistic personalities, while the psychic functioning of an antisocial personality is closer to that of Schneider"s ruthless psychopath. Other phenomena not described, but which we observed and consider important to point out in severe cases of psychopathic behavior were Presence of an aggressive tendency to lie and make up stories: This reveals a marked tendency to fantasize and even to lie, to embellish their surroundings and seek gratification more in fantasy than in reality. Such cases are disturbing because of the violent and excessive nature of the fantasies. Stimulus can cause them to lose control when evoking violent fantasies. Frequent defect responses: This is a disassociation index. The phrasings of "incompleteness" (broken, split, fragmented) could be linked to the existence of badly configured or conserved internal objects, in the sense that they are damaged, looked at in a warped or incomplete way. Suffered action responses: These are associated with the existence of sadomasochistic elements, with signs of aggressor to victim and victim to aggressor relationships in a context of very lurid and destructive persecution fantasies. Presence of thoughts that reveal persecution anxiety: It is possible to appreciate indicators of a paranoid type of anxiety, associated with borderline constructs. It also shows up in the attitude to-ward the exam, marked by a very defensive bearing, distant, cold, controlling and overly critical. Hiding responses: Many times the subjects perceive "covered" figures, "hidden", avoiding direct and frank contact. Reaction to plate IV (authority or paternal): Indicators abound in rejection of the authority figure, lack of appreciation of the other's power; avoid to recognize the superiority of the other, attempt to put them down and downplay their power or the threat they pose. Presence of antagonistic elements: It is worth noting the presence of very contradictory elements, revealing very violent images appearing alongside their opposites, in the sense of benevolent, peaceful, unthreatening images. Shock or failure inplate X: Another phenomenon not described and that surprise us, was the inability to give responses in Plate X. This fact strikes us as curious given that this plate is called the "forecaster". This plate requires a greater integration of the perceptive process. Discussion: As it is difficult to come up with a diagnosis for antisocial personality, let alone the contradictions and confusion that can arise in this field, we believe it is important to point out the benefits of psychodiagnosis through the Rorschach Test. This enables us to discriminate more accurately between some type of antisocial behavior and an antisocial personality per se. The possibility of narrowing down the criteria of the Rorschach Test associated with this disorder becomes a significant contribution to forensic psychiatry. The analysis of the above cases reveals to us the difficulty of carrying out a diagnosis by categories of Personality Disorders. This conclusion takes us to what Jaspers already proposed with his "Ideal Type", Kernberg with his classi-fication on gradients of the different types of borderline Personality, and O. Dórr, with his phenomenological perspective of the concepts of normality and abnormality. That is, whether a given number of symptoms or traits confirms the existence or nonex-istence of a disorder, without taking into account the transition to other clinical pathologies or the particular case in the context of the subjecfs family and social life. Although there are cases that do not involve major difficulties in reaching a diagnosis where the clinical impression agrees with the tests and the behavior, it also happens that in many others, the different indicators do not agree. This fact leads us to the following reflections: I) It is not only necessary to consider the difficulty of forming a diagnostic hypothesis in cases that are ethically so sensitive, but also the responsibility that this brings and the need to remain at the verge of the influence that social phenomena exercise, namely the pressure exerted by public opinion on what is "politically correct". With this we referred to certain cases in our sample, that were quite widely publicized (priest, doctor and agronomist), charged with pedophilia and murder, and for whom our diagnostic hypothesis didn't agree with either the way the media depicted them or the assessment of the judges. We think that in these situations the subjects were already condemned by society before their trials, to the point that not even the justice system remained immune from this influence. II) What is there to be done, given what is being decided with an assessment of this type is the future life of the subjects? On the one hand, from the point of view of the professionals in psycho-diagnosis, it is necessary to count on the evidence and have tests systematically checked independently by one or more specialists in the area. III) Another important aspect to consider is related to the diagnosis itself. It is here, as we already stated, where we found the biggest problem. The fact that our conclusions did not always agree with the judgment of other social organizations (judicial power, society and family) leads us to be very careful when stating a definitive conclusion. We already mentioned the problem with categorical diagnoses, such as DSM-IV, since they do not consider transitions and are based only on the presence or absence of symptoms to determine the type of disorder. We think that when dealing with personality disorders it is necessary to make use of dimensional diagnoses. It is also suggested to propose a Tentative Diagnostic Hypothesis, and not state cat-egorically that the subject pertains to such or other type. Finally, we wish to address the aspect related to the presentation of the report itself to professionals outside of the area of psycho-metrics although in charge of the case, that is, psychiatrists and legal professionals. Lately the Rorschach test has been questioned a lot particularly in the formulation of legal expert opinions. This criticism may be due mainly to three factors: 1) Use of very specialized and esoteric terminology that makes it incomprehensible to those who are not specialized in the Test. 2) Insufficient experience in the Test as it requires a lot of study and experience. 3) Individual marking of the test, that is, without contrasting the results with another specialist, a fact that does not help to reduce the subjective factor, which is impossible to avoid.

[Adjuvant radiotherapy in the therapy of uterine cancer in the first clinical stage]. / Adjuvantní radioterapie v lécbe karcinomu delozního tela 1. klinického stadia.

OBJECTIVE: The aim of our study was to find the influence of the postoperative radiotherapy on local control and overall survival in patients with carcinoma of the uterus. Endometrial carcinoma is the most frequent gynecologic malignity. Surgery, radiotherapy, chemotherapy and hormonal therapy are used in the treatment of this disease. The optimal cure strategy has not been established yet. DESIGN: Retrospective study. SETTING: Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno. METHODS: We followed up 246 patients with the diagnosis of endometrial carcinoma. All patients were in clinical stage 1. Median of the age was 60 years. Every patient underwent radical hysterectomy and adnexectomy. Most of them had adjuvant radiotherapy. Combined radiotherapy was used (external beam radiotherapy and brachyradiotherapy). Some of patients underwent only external beam radiotherapy, other had only brachytherapy. We used Kaplan-Meier survival function and methods of Statistica. RESULTS: The median of the follow up was 8.3 years. Local recurrence was proved in 16 cases. The time to the local relapse was 3.2 years. Dissemination occurred in 12 patients. The time to the progression was 5.9 years. Five-year DFS was 80.9%, five-year overall survival was 82.9%. Patients, who had risk factors, were proved to suffer from worse overall survival. The adjuvant radiotherapy improved the local, and the distant control in the group of patients with risk factors. CONCLUSION: The influence of the radiotherapy on the local control was proved in many studies, the influence on the overall survival was not statistically significant. Temporally there is the option not to apply adjuvant radiotherapy. Our study shows the important benefit of the adjuvant treatment in cases of endometrial carcinoma and risk factors.

Acerca de la comunicación médico-paciente desde una perspectiva histórica y antropológica / On doctor-patient communication from an anthropological and social point of view

This paper attempts to perform a historical anthropological analysis of the factors that currently either favor or obstruct the doctor-patient relationship. For this purpose, the main works of reference are the sociologist Gilles Lipovetsky and the Spanish author Pedro Laín Entralgo. The former, identified with the concept of Postmodernity and individual Hedonism, is crucial in understanding what are the main determinants in the most recent developments affecting the doctor-patient relationship. Since the technological revolution, advances in science have surpassed all imagination, information technology has worked its way into all types of relationship, and thus medical practice has been particularly affected. On the other hand, the work of Laín Entralgo enables us to perform a review of the history of the doctor-patient relationship in the Western world, which affords a more accurate view of the origins and evolution of the current situation.

Comet assay and micronucleus test in circulating erythrocytes of Cyprinus carpio specimens exposed in situ to lake waters treated with disinfectants for potabilization.

The detection of a possible genotoxic effect of surface water treated with disinfectants for potabilization is the aim of the present work. The Comet assay and the micronucleus test were applied in circulating erythrocytes of Cyprinus carpio. Young specimens (20-30 g) were exposed in experimental basins, built within the potabilization plant of Castiglione del Lago (Perugia, Italy). In this plant the water of the Trasimeno Lake is treated and disinfected for potabilization before it is distributed to the people in the net of drinkable water. A continuous flow of water at a constant rate was supplied to basins; the water was continuously treated at a constant concentration with one of the three tested disinfectants (sodium hypochlorite, peracetic acid and chloride dioxide), one control basin being supplied with untreated water. Three sampling campaigns were performed: October 2000, February 2001 and June 2001. Repeated blood samplings through intracardiac punctures allowed to follow the same fish populations after different exposure times: before introduction of the disinfectant, and 10 or 20 days afterwards. An additional blood sampling was performed 3 h after addition of the disinfectant in other, simultaneously exposed, fish populations. Genotoxic damage was shown in fish exposed to water disinfected with sodium hypochlorite and chloride dioxide. The Comet assay showed an immediate response, i.e. DNA damage that was induced directly in circulating erythrocytes, whereas micronuclei reached their highest frequencies at later sampling times, when a genotoxic damage in stem cells of the cephalic kidney is expressed in circulating erythrocytes. The quality of the untreated surface water seems to be the most important parameter for the long-term DNA damage in circulating erythrocytes.

[Guideline for gynecological malignant tumors 2004--primary complex therapy in operable stages of malignant tumors of vulva]. / Guideline gynekologických zhoubných nádoru 2004--Primární komplexní lécba operabilnich stadií zhoubných nádoru vulvy.

OBJECTIVE: Elaboration of guideline for primary treatment of operable vulvar cancer. DESIGN: Review, consensus between proposers and opponents. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Prague. METHOD: A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents. RESULTS: Guideline for the diagnosis remain the same as in the proposal from 1998. We elaborated practically new guideline for surgical treatment. Wide excision or simplex vulvectomy is adequate only for stage la without angioinvasion, free margins have to be 5 mm. Standard surgical procedure is radical vulvectomy with inquinofemoral lymphadenectomy in stage 1a with angioinvasion, 1b and 2. In laterally localised lesions it is possible to perform hemivulvectomy or radical excision with inquinofemoral lymphadenectomy. Free margins have to be more than 8 mm. An alternative procedure in internally high-risk patients is sentinel node detection with radical vulvectomy (hemivulvectomy). Sentinel node detection has to by performed by combined method of blue dye and radiocoloid Tc 99 simultaneously. Bilateral inquinofemoral lymphadenectomy is indicated in case of positive sentinel node. Primary radiotherapy is indicated in higher stages, in stage 3 we can perform an exenteration with the agreement of patient. CONCLUSION: Guideline for the treatment of vulva cancer should be directions for clinicians and others, who participate in the process of treatment of the vulva cancer. Guidelines include all parts of the process (from diagnosis to follow up). All topics of the guidelines were arise from a voting of the proposers and opponents.