[Enteral fistula as a postoperative complication--a case report]. / Enterální pístel jako pooperacní komplikace--kazuistika.

Enteral fistula is a serious postoperative complication. A therapeutical approach must be individual with regard to the character of the fistula and especially with regard to the entire state of the patient. With our patient the fistula occurred as a further complication after the reconstruction operation after the preceding Hartmann resection for the perforated diverticulitis. The serious catabolic state did not make possible an immediate operational revision. It was necessary to improve first the nutritional parameters by TPN and bring about anabolism. Only then the surgical intervention with the abolishment of the fistula was possible.

[Progress in surgical treatment may improve the quality of life in patients with breast surgery for malignant tumors]. / Pokroky v chirurgické lécbe mohou zlepsovat kvalitu zivota pacientek po operaci prsu pro zhoubný nádor.

Breast cancer surgery (BCS) is a common procedure performed in women. Chronic postmastectomy pain (PMP) has been reported in as many as 22-72 percent of patients. There are no published reports in Czech Republic. This study was performed to evaluate the prevalence and risk factors of PMP. An anonymous questionnaire was given to women after attending oncology departments in various hospitals during 3-month period. All 176 questionnaires have returned. The average age was 63.6 (SD 11.2) years, BMI 26.3 (SD 4.0). There was 23.6% of PMP prevalence in our group. The risk factors were younger age (below 60, p < 0.001, below 65, p < 0.01 resp.) and type of surgery (total mastectomy vs. tumour removal, p < 0.01). The prevalence of PMP in our study was significantly lower than in other studies. The age of our group was higher, than in other studies, but it does not explain the difference. We can hypothesise the reason is improved surgical technique.

[Laparoscopic surgery of gastric diverticula with secondary adhesiolysis]. / Laparoskopická divertikulektomie zaludku se sekundární adheziolýzou.

The authors present the case-history of a rare cause of gastric diverticulum. On account of a very painful symptomatology and X-ray evidence of a diverticulum the authors decided on laparoscopic excision of the diverticulum. The resection was made using a Endo GIA II stapler. The gradual, one-year development of adhesions and a new different algic symptomatology which impeded the subject's occupational activities led the authors to make another laparoscopic operation. After releasing the adhesion between the stomach and the collateral peritoneum the condition improved completely. The patient is now 16 months after re-operation completely free of complaints and performs his physically pretentious work and ingests food without dyspeptic phenomena.

[Squamous intraepithelial lesions in young female university students]. / Skvamózní intraepitelová léze u mladých zen, studujících vysokých skol.

The authors investigated the frequency of squamous intraepithelial lesions (SIL) in young women, in particular university students with special attention to morphological signs of the presence of human papilloma virus (HPV) in SIL low grade-SIL, LG-HPV. As compared with data in the world literature, they revealed a significantly lower rate of SIL LG, HPV-2.81% as compared with 5.5% reported in WHO studies of young women. The authors analyzed the biological behaviour of SIL, LG-HPV. As compared with data in the literature on known values of spontaneous regression which are 50-62% in the course of three years, they demonstrated during a time interval from 3 months to 2 years spontaneous regression in 39.1%. Further possibilities of regression in a longer time interval are expected in the group of clinically latent cytologically persistent LG lesions (18.1%) and in the group of patients which after termination of their studies were lost from the records (24.3%). During the investigated time interval no case of progression to a higher grade lesion was recorded. The authors reflect on diagnostic and therapeutic procedures with regard to the application of results of HPV typing.

[An unusual complication of establishing a capnoperiteoneum for laparoscopic cholecystectomy]. / Nezvyklá komplikace pri zakládání kapnoperitonea u laparoskopické cholecystektomie.

The authors describe the case history of a female patient indicated for laparoscopic cholecystectomy. In the patient with progressing muscular dystrophy and thickening of the peritoneum it did not prove possible to establish a capnoperitoneum at the onset of the operation.

[Cefoperazone in the treatment of infections of the gallbladder, biliary ducts and liver in surgical patients]. / Cefoperazon v lécbe infekcí zlucníku, zlucových cest a jater u chirurgických nemocných.

In 20 patients treated on account of advanced cholecystitis, inflammations of the biliary pathways and liver a cephalosporin of the third generation, cefoperazone, was administered within the framework of antimicrobial treatment after surgery or after endoscopic intervention. In the laboratory investigation of the study in isolated bacteria minimal inhibitory concentrations and serum, biliary and tissue levels of cefoperazone were assessed. The minimal inhibitory concentrations in the assessed bacteria were several times lower than the levels assessed in serum, bile and the wall of the gallbladder. The infection was eradicated in 20 patients. Seventeen patients were cured (85%).

[Iatrogenic pneumothorax]. / Iatrogenní pneumotorax.

The authors present a group of 22 patients with iatrogenic pneumothorax. They analyze the basic causes of development of iatrogenic pneumothorax, such as cannulation of the subclavicular vein thoracic puncture. They give an account of their experience with the therapeutic procedure which involves the insertion of a classical thoracic drain and several days of active exhausting. In the conclusion they discuss the possibility to use a new method-videothoracoscopy-in some indicated cases.

[New approaches in the use of antibiotics in the treatment of postoperative intra-abdominal infections]. / Nové postupy vyuzití antibiotik v terapii pooperacních nitrobrisních infekcí.

The authors present the results of a clinical investigation on the therapeutic use of carbapenem, imipenem/cilastatin in 20 patients operated on account of intraabdominal inflammatory affections, hospitalized at the intensive care unit of the Surgical Clinic of the Third Medical Faculty, Charles University, Prague in 1993. Imipenem/cilastatin was administered to patients during surgery--500 mg i.v.--and subsequently after 8--hour intervals for 5-8 days. During comprehensive treatment no superinfection developed and the patients recovered.

[Stab and gunshot thoracoabdominal injuries]. / Bodná a strelná poranení torakoabdominální.

The authors give an account of their experience with the treatment of punctures and gunshot injuries of the chest and abdomen in 43 patients hospitalized at the Surgical Clinic of the Third Medical Faculty, Charles University Prague 10 between 1989 and 1992. Injuries of the chest were recorded 15 times, abdominal injuries in 25 patients and concurrent injuries of the chest and abdomen in three patients. To ensure treatment of penetrating injuries the authors present an algorithm which comprises differentiated care as well as some non-interventional diagnostic methods (ultrasonography, computed tomography). Based on analysis of their own results and data in the literature, the authors recommend in casualties with penetrating chest injuries and abdominal injuries early indicated surgical revision which alone ensures adequate treatment with minimal diagnostic errors. They also draw attention to the necessity to ensure effective first aid and rapid transport of casualties to prevent the development of irreversible changes as a result of haemorrhage, as observed in a single patient who died after a piercing heart injury.

[Determination of the fertile period during the menstrual cycle in women by monitoring changes in crystallization of saliva with the PC2000 IMPCON minimicroscope]. / Urcení fertilního období v menstruacním cyklu zeny sledováním zmen krystalizace slin pomocí minimikroskopu PC 2000 IMPCON.

The authors tested the possibility of assessment of fertile and infertile days during the menstrual cycle by investigating the crystallization of saliva by means of a minimicroscope PC 2000 IMPCON. They followed up for five months a total of 58 women where they assessed by a combination of at least three classical examination methods ovulatory and anovulatory cycles. They monitored a total of 120 cycles and examined 1649 specimens of saliva. Some women had to be eliminated on account of virosis during a flu epidemic (a total of 11 cycles). During the periovulatory period the authors recorded in ovulatory cycles the foreseen crystalline structures in saliva in 78.57%. In anovulatory cycles agreement between the expected character of the saliva specimen and anovulation was found in 84% of the examined cycles. In addition to structures suggesting fertile or infertile days, the authors identified also intermediary types. In the discussion the authors analyze various aspects as regards evaluation of the correlation between salivary and serum levels of gonadotropins and ovarian steroids. They evaluate physical and chemical changes of saliva and vaginal secretion and discuss the problem of crystallization of the saliva during the menstrual cycle. Based on their findings, when testing the minimicroscope PC 2000, they supplement the list of factors with influence the results of examinations. They consider PC 2000 a suitable modern equipment which extends the range of contraceptives and at the same time helps to assess the optimal time for conception in planned pregnancies.

[Changes in the biochemical properties of cervical mucus occurring during the use of minitabled-based contraception (author's transl)]. / Zmeny biochemických vlastností cervikálního hlenu v prubehu uzívání minitabletové antikoncepce

PIP: 31 women were administered a modified mintablet contraceptive, consisting of .3 mg of norethisterone for an average of 10.6 months. During this period changes in the cervical mucus were analyzed. Changes in the protein fractions were revealed, which were characterized by a widening of the spectrum of albumins in the area of globulins and some special fractions. These changes, elicited by the contraceptive effect of the gestagen preparation, were confirmed in comparison to a control group through a permeation test.^ieng

[Ultrastructure of endometrium during low-dose gestagenic anticonception (author's transl)]. / Ultrastruktura endometria pri nízkodávkované gestagenní antikoncepci

PIP: 31 women (average age, 26 years) were administered a modified low dosage gestagen contraceptive, containing .3 of norethisterone for an average period of 10.6 months. Changes in the ultrastructure of the endometrium were studied throughout this period. Changes in both parts of the ultrastructure, the fibrose and epithelial parts, were revealed in comparison to material taken before use of the preparation. Changes in the stromata cells were particularly of a gestagenic character. Epithelial cells also demonstrated a particularly gestagenic stimulation.^ieng

[Personal experiences with Minitrol]. / Nase zkusenosti s Minitrolem.

PIP: Minitrol (.5 mg megestrol acetate) is an oral contraceptive preparation whose effect is directed toward a lower level than hypothalamic-hypophysial-ovarian preparations, and it does not affect the neurohormonal regulation of the cycle. 28 women participated in the experiment, taking Minitrol for 1-8 months. 122 cycles were examined. Acne and increased hair loss were experienced, believed to be due to relatively strong antiestrogen effects of the preparation. Of the 122 cycles, 68% fluctuated between 26-32 days, 6% were longer and 26% shorter. In 10% of the cases, intermenstrual bleeding occurred. In 1 woman whose cycle was irregular, an endometrial polyp was found. For a certain number of women, the .5 mg dosage is too strong, and its effect exceeds the desired contraceptive level as well as disturbs ovarian activity. For the group of women for which the preparation is too strong, a capsule with lesser content is recommended, as this contraceptive substance is highly suitable to young women.^ieng

[Choice of contraception in various periods of the woman's life]. / Volba antikoncepcní metody v ruzném obodobí zivota zeny.

PIP: All contraceptives must be considered not only for their effectiveness but for their side effects as well. The classical contraceptives such as the diaphragm and locally applied chemical preparations can only cause local irritations, but hormonal preparations and IUDs can have much more serious side effects. As long as the kind of complications that can result from a given contraceptive are known, the possibility of problems occurring each time a device is prescribed can be calculated. All complications considered, hormones and IUDs are not recommended. If there is a desire for more pregnancies later, discontinuance of the pill for a 3-month period after 1 year of use is recommended to allow the endometrium to regenerate. IUDs are recommended only for women who no longer wish to have children, and they are never to be used immediately after an abortion or bith. It is necessary to consider each patient individually and above all select the type of contraception that will least interfer with the successful planning of her parenthood.^ieng