[Sexual functions after laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) in preoperatively asymptomatic women]. / Sexuální funkce po laparoskopicky asistované vaginální es gynek. hysterektomii (LAVH) a totální laparoskopické hysterektomii (TLH) u predoperacne asymptomatických zen.

OBJECTIVE: To find the consequences of laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for sexual functions in preoperatively asymptomatic women. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Teaching Hospital in Prague. MATERIAL AND METHODS: In 100 women without subjective complaints hysterectomy was performed for benign uterine pathology. In all the women the uterus weighted less than 250 g, there were no salpingooophorectomies and no perioperative complications. Women were alternativelly assigned for LAVH (n = 50) or TLH (n = 50). Clinical documentation and questionnaires about sexual functions were evaluated in 87 women (in 40 women after LAVH and in 47 after TLH) 18 months after surgery or later. RESULTS: According to our findings the type of surgery did not influence the frequency of sexual activity after surgery, there was no change in sexual manners using during coitus as well as no change in preferred way how to reach the sexual arousal (clitoridally, vaginally or combined). The type of surgery did not influence frequency, quality and duration of orgasm. From all the evaluated parameters there were only two significantly different: the presence of postoperative sexual activity (positive answer in all women from LAVH group and only in 85% women from TLH group, F test, p = 0.009) and the frequency of sexual satisfaction (in terms of both increase and also decrease in TLH group chi2 8,376, p = 0.015). CONCLUSION: The type of laparoscopic hysterectomy (LAVH or TLH) does not significantly affect the sexual functions (frequency of sexual satisfaction, type of sexual arousability, intensity and duration of orgasm) in preoperatively asymptomatic women.

Arthropods in a hospital and their potential significance in the epidemiology of hospital infections.

Synanthropic and other arthropods were collected and examined for microbes in the summer seasons of 1988 and 1990. The collection was performed in a Prague hospital with departments situated in separate buildings, each surrounded by a park. In 1988, the most attention was given to flies (35 species collected) found outside between the buildings. In 1990, all arthropods found inside the buildings (particularly in the departments of dermatology and urology) were studied. A total of 30 taxons were identified. The microbes found on the bodies of arthropods were isolated in both seasons. In 1990, the hospital environment and biological material from patients (urine, pus) were also examined for the presence of microbes. Altogether 108 strains (21 species) and 116 strains (25 species) were isolated from the arthropods' bodies in 1988 and 1990, respectively. The ecological characterization of the arthropods and results of microbiological studies show that synanthropic arthropods play a significant role in the epidemiology of hospital infections.

[The production of toxic shock syndrome toxins and enterotoxins by Staphylococcus aureus]. / Produktsiia toksinov sindroma toksicheskogo shoka i énterotoksinov Staphlyococcus aureus.

The production of toxins of the toxic shock syndrome and enterotoxins by S. aureus of clinical origin was studied by means of commercial standard antisera and standard toxins. The study revealed that among 511 strains isolated in Russia toxigenic ones constituted 41%, and among 592 strains isolated in Czechia toxigenic ones constituted 63%. The capacity for producing toxins may be used as an epidemiological marker.

Detection of staphylococcal enterotoxigenicity IV. Strains isolated in 1981 and 1982.

Enterotoxin A, B, C, D and E detection and typing was undertaken in 807 staphylococcal strains isolated from food, breast milk, clinical material, diarrhoeal stools and hospital-collected swabs in 1981 and 1982. One hundred and sixty-six of the strains produced enterotoxin, most frequently type A or C, less so type D or B. There were single instances of strains with double toxin production: AB, AC or AD. Nine hundred and ten supernatants collected in 1972-1973 were additionally tested (after a lapse of 8 years) for type D enterotoxin; there were 152 positive specimens, predominantly relating to strains isolated from tinned cocoa and delicatessen, with 26 of the supernatants containing AD and BD enterotoxin combinations. For the first time the authors' laboratory detected strains producing enterotoxin F and the combination.

Detection of staphylococcal enterotoxigenicity. III. Strains isolated in 1979-1980.

During 1979-1980, the enterotoxin production was studied in 1426 strains of staphylococci isolated from food, veterinary and clinical material, and from some other sources. Using the microprecipitation test, the authors identified 514 enterotoxigenic strains that produced most frequently enterotoxins A and D, but also the types C, B and E of enterotoxins; 39 strains were found to produce two types of enterotoxin, specifically in AB, AD, AC and BD combinations. Some conditions of the microprecipitation test used in this study for the typing of staphylococcal enterotoxigenicity are also discussed.

Detection of staphylococcal enterotoxigenicity. II. Field strains.

The immunodiffusion micromethod was used to detect enterotoxin production in 5974 staphylococcal strains isolated during 1972-1978 from food, human milk and various specimens of clincial material. Of a total number of examined strain there were identified 3001 staphylococcal strains that produced the following enterotoxins or enterotoxin combinations: A, B, C, D, E, A + B, A + C, A + D, A + E, B + D, C + E and A + C + E.

Staphylococcus aureus at a maternity ward. II. Characterization of isolates by enterotoxigenicity and toxic shock syndrome toxin (TSST-1) production.

Tests for enterotoxins A, B, C, D, E and TSST-1 production were carried out on 775 S. aureus strains isolated from various sources (50 mothers and neonates studied periodically, mothers and infants treated for various acute inflammatory conditions, members of hospital staff, environmental swabs) during the period 1981-1983 at a maternity ward chosen for a 3-year systematic study and on additional 97 isolates obtained in 1985 from another maternity ward. This had contributed to a better classification of strains within certain phage type groups. It was found that the distribution of S. aureus types in the particular sub-sets varied, depending on the source of isolates. At the maternity ward followed for 3 years there was a clear-cut trend towards the spread of phage-untypable isolates producing enterotoxin C whereas at ward examined for comparative purposes B enterotoxin producers of phage type 95 were predominant. The tests for enterotoxigenicity has also proved to be useful as the epidemiological marker characterizing the predominantly circulating S. aureus strain. It has been confirmed that the majority role in the spread of maternity-ward-staphylococci is played by the neonates and the factors of hospital environment.

Staphylococcus aureus at a maternity ward. I. Colonization of mothers and neonates and survival of various S. aureus types in colonized individuals.

Colonization by Staphylococcus aureus, characterized by phage type or production of enterotoxins and toxic-shock-syndrome-toxin, was followed in 50 mothers and their babies. Types or groups of staphylococci predominating during the particular period at the maternity department were evaluated according to survival rates in the colonized subjects. S. aureus frequently colonized nipples at the start of lactation and was found regularly on umbilical stump and in eye and mouth corners of the babies. During the second stage of the study phage untypable staphylococci producing enterotoxin C (NT/C) strongly predominated. These microorganisms colonized in the greatest extent both mothers and neonates. The majority of NT/C complex originated probably from one or two clones characterized, among others, by high biological activity.

Drug resistance and pathogenicity of S. aureus isolated from patients.

Over the period 1983-1985, investigators from the Institute of Hygiene and Epidemiology, Prague, and the Central Research Institute of Epidemiology, USSR Ministry of Public Health, Moscow, carried out a joint study of drug resistance in S. aureus strains in relation to their enterotoxigenic properties and phage group specificity. Altogether 277 strains were explored which had been isolated at random from the clinical material from infant and adult inpatients. Most of the isolated strains featured multiple resistance to antibiotics: PNC (77.9%), CMP (52.7%), TET (21.6%), ERY (17.6%) and LIN (11.9%). The strains isolated from infants were most frequently resistant to TET and ERY. No correlation was found between the incidence of antimicrobial drugs resistance and toxigenic properties of the isolated strains.