[Legal requirements concerning textile medical products]. / Problematika legislativních pozadavku na textilní zdravotnické prostredky pouzívané v operacních sálech.

Presently, more and more often the medical public is concerned with questions regarding use of textile products intended for multiple application at operating theatres. Such questions have been evoked especially by spreading information on restrictions regarding purchase and us of health care products or medical means made from cotton of intended for multiple application. Based on this information preference is given to significantly more expensive products intended for single-use only. This decision is being reasoned by conditions given by European standard EN 13795 reportedly prohibiting the application of cotton within health care. Since this piece of information is not precise, we would like to sum-up legislative situation within this area.

[Caudal regression syndrome--two case reports]. / Syndrom kaudální regrese--dve kazuistiky.

OBJECTIVE: The authors demonstrate two cases of caudal regression syndrome (CRS), a rare malformative syndrom, seen mainly in cases of maternal diabetes with poor metabolic control. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Department of Medicine Regional Hospital Pardubice. CASES: The caudal regression syndrome (CRS) was revealed in two women with praegestational diabetes. The diagnosis was made at 18 and 20 weeks. The characteristic ultrasound findings include abrupt interruption of the spine and abnormal position of the lower limbs. The femur bones are fixed in a "V" pattern, giving a typical "Buddha's poise". A complete examination must be conducted for possible urinary and intestinal malformations. The mechanism leading to malformation is discussed in the article. To prevent pregnancy at the time of bad controlled diabetes is the only way to minimaze the risk of producing a congenitally malformed baby including caudal regression syndrom in the population of diabetic mothers. Family planning and supervision by the specialists is always advisable. CONCLUSION: Early diagnosis of CRS is possible using vaginal ultrasound. Emphasis is placed on the association of abrupt disruption of dorsal or lumbar spine and abnormal images of the lower limbs fixed in a,,V" formation, which is characteristic sign of CRS.

Regional anaesthesia for carotid endarterectomy: an audit over 10 years.

BACKGROUND: The aim of this retrospective study was to compare the failure rates and the frequency of anaesthesia-related complications of two different methods of regional anaesthesia used for carotid endarterectomy--cervical epidural (CE) anaesthesia and cervical plexus block (CPB). METHODS: The study included 1828 carotid endarterectomies performed in 1455 patients between 1996 and 2006. A combination of deep and superficial CPB was used for 1166 procedures, whereas in 662 cases surgery was performed under CE anaesthesia. RESULTS: The failure rate of CPB was 3% compared with 6.9% for CE anaesthesia (P < 0.0001). The reasons for failure of the anaesthetic techniques were (1) technical failure, (2) insufficient analgesia, (3) non-compliant patients, and (4) anaesthetic complications. The incidence of complications resulting from CE anaesthesia was significantly higher than with CPB; life-threatening complications--2% compared with 0.3% (P < 0.0001); other anaesthesia-related complications 5.7 vs 4.7%. Serious complications included inadvertant injection into the subarachnoid space or vertebral artery. The frequency of shunt insertion, perioperative stroke, and death from any cause was similar in both groups of patients. CONCLUSIONS: Both methods of regional anaesthesia are acceptable for carotid artery surgery. CPB is associated with a significantly lower frequency of anaesthesia-related complications and should therefore be considered the anaesthetic of choice. CE anaesthesia should not be performed except in extenuating circumstances such as variant anatomy or the requirement for more extensive surgery.

[Ischemic disease of the lower extremity and lumbar sympathectomy]. / Ischemická choroba dolních koncetin a lumbální sympatektomie.

We consider lumbar sympathectomy (LSE) to be the last attempt to improve the condition of the limb. Though being aware of inconsistent opinions on LSE, we are not opponents of this method, particularly if it is carried out in a selected group of patients, that is in case of: 1) treatment of frostbites, 2) treatment of patients at an early stage of advanced ischemia whose main symptom is moderate night pain at rest, 3) desiccation of chronically moist ulcerations between the toes, 4) treatment of patients with reflex symptomatic dystrophy (causalgia), 5) Buerger's disease.