Recurrent miscarriage: aetiology, management and prognosis.

Recurrent miscarriage (RM) is a heterogeneous condition. A large number of studies has recently been published, yet many of them have conflicting conclusions. The various aetiological factors, management, prognostic features and outcomes of a subsequent pregnancy in women with RM are reviewed.

Embryo quality and IVF treatment outcomes may correlate with different sperm comet assay parameters.

BACKGROUND: Standard semen parameters have proven poor at predicting the outcomes of IVF treatment cycles. As recent studies suggest that the male genome may play an important role in early embryogenesis, this study attempts to correlate the level of sperm DNA damage in fresh semen and prepared sperm with the outcomes of conventional IVF treatment cycles. METHODS: Forty patients embarking on IVF treatment were recruited into this prospective observational study. Both fresh semen and PureSperm-prepared sperm were processed using a modified comet assay 3-6 months prior to the patients' IVF treatment cycles. Comet head DNA (mean and integrated head density) and tail DNA parameters (length and moment) were measured separately. RESULTS: Significant correlations between total sperm concentration and between comet length, moment, mean head density with embryo quality were detected in fresh semen and prepared sperm. Surprisingly, no significant correlations between head and tail parameters were detected. CONCLUSIONS: Comet head and tail DNA parameters appear to be potentially useful as predictors of embryo quality and IVF outcomes, especially in couples with unexplained subfertility. The lack of correlation between head and tail parameters may be due to a different mechanism of DNA damage within these two compartments.

Kidney transplantation and malignant diseases.

Basing on three types of questionnaires, the authors summarized the incidence of all malignant diseases in kidney transplant patients in CSFR. The total number of registered tumours was 34. Previously to the transplantation, two patients with malignancies were found, another one was transplanted for a kidney tumour and 31 patients manifested malignant diseases in various time intervals following the transplantation. This number is five times greater than the incidence of tumours in the standard population. At classical immunosuppression, the mean time interval between transplantation and tumour formation is 48 months; at cyclosporine application, it decreases to 19 months. The most frequent sites of tumour formation are the skin and the kidney. The early diagnosis of tumours and the surgical treatment will increase the survival period up to 58 months. The systematic oncologic follow-up and preventive controls of transplant patients represent one of the possibilities of the prolongation of the patient's life with the functional graft.

[Traumatic chylothorax and chyloperitoneum]. / Traumatický chylotorax a chyloperitoneum.

Traumatic chylothorax and chyloperitoneum are rare. Effusion of the chyle into the pleural cavity occurs after severe injuries of the chest wall after pretentious surgical operation in the posterior mediastinum and after operations of the cardiovascular system. The authors recorded one observation after operation of a patent ductus arteriosus and controlled the situation by a conservative procedure. A traumatic chyloperitoneum develops typically after a minor or obscure injury. The pathological picture usually develops slowly, in rare instances it imitates an acute abdomen. The condition calls for laparotomy. Only in rare instances a fissure is detected in the posterior peritoneum and it is very difficult to detect the sites of injuries of lymphatic vessels. The authors treated three patients. All were operated, two were subjected to laparotomy twice. A relapsing chyloperitoneum was brought under control by hitherto non published surgical procedures: in one instance by communication of the abdomen with the posterior mediastinum, in the second case by ligature of the lymphatic vessels close to the vasa mesenterica cran. All patients recovered.

[Indications for retrosternal esophagocoloplasty]. / Indikace k retrosternální ezofágokoloplastice.

The authors define, based on experience with 55 retrosternal oesophagocoloplasties, the indications for this operation. They divide the indications into three groups and describe them as 1. the most suitable operation, 2. as the only possible replacement of the oesophagus, 3. as a palliative operation in an otherwise insolvable disphagia due to an inoperable tumour. They emphasize the wide range of indications for the operation which can be implemented without influencing the basic disease of the oesophagus and which makes it possible to apply combined treatment. The operation, though pretentious and time consuming, has the advantage of an extrathoracic approach. As to technical aspects, the authors emphasize the importance to select a portion of the gut with an adequate blood supply. This demand is usually met by the transverse colon on a vascular pedicle of the vasa colica sin.; they also mention the conditions of safe deposition of the gut in the retrosternal tunnel. The paper is supplemented by several case-histories of particularly interesting and difficult situations. If the indication range of the operation and its technical principles are respected and the surgeon is experienced, the failures of the operation are proportional to the severity of the basic disease.