[Spontaneous preterm birth in mother in an artificial sleep on ECMO with severe form of H1N1 infection]. / Spontánní predcasný porod u rodicky v umelém spánku na ECMO pri závazné forme infekce H1N1.

OBJECTIVE: The authors demonstrate a premature birth of a pregnant woman, who was for heavy Respiratory Distress Syndrome (ARDS), on the basis of pulmonary infection H1N1, connected to venovenous extracorporeal membrane oxygenation (ECMO). Patient spontaneously delivered after being connected to the ECMO for 30 hours. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague. DESIGN: Case report. CONCLUSION: Preterm birth at 24 week of pregnancy. During pregnancy, the labor and postpartum was the pregnant woman connected to extracorporeal membrane oxygen therapy.

[Vulval oedema as the first sign of Crohn's disease--case reports]. / Edém vulvy jako první príznak Crohnovy choroby--kazuistiky.

OBJECTIVE: To show a rare reason of vulval oedema. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital, 1st Faculty of Medicine, Charles University Prague. SUBJECT AND METHOD: Oedema of vulva is presented in three case reports as form of cutaneous Crohn's disease. It causes mistakes of diagnosis and therapy. CONCLUSION: Oedema of vulva as a sign of vulval Crohn's disesase can appear even several years before intestinal problems.

[Benefits and risk of the modern combined hormonal contraception]. / Prínosy a rizika moderní kombinované hormonální antikoncepce.

The combined hormonal contraception is the most efficient reversible variety of family planning. The modern low doses combined hormonal contraception have a high efficacy with minimal risks. Users are still in risks of cardiovascular complications. The combined hormone contraception also has positive noncontraceptive effects on menstrual disorders, hyperandrogenism, cysts of ovary, pelipathy etc. The benefits are higher than the risks only when respecting the basic rules of the combined hormonal contraception prescription.

[Estradiol valerate/cyproterone acetate in the treatment of climacteric syndrome]. / Estradiolvalerát/cyproteronacetát v lécbe klimakterického syndromu.

In a prospective study 40 perimenopausal women with climacteric complaints between 45 to 52 years of age were examined. Twenty three (100%) were assigned to treatment with hormonal replacement therapy (Climen fy Schering-estradiol valerate cyproteron acetate) for 6 months. The therapy had to be stopped in 5 women (22%) for side effects. The drug was contraindicated in 17 patients because of non-treated hypertension, varices, hepatopathy and uterine fibroids with repeated metrorrhagia. In 18 patients (78%) Climax score, ALT, AST, bilirubin, total cholesterol, HDL-Chol, LDL-Chol, triglycerides, haemogram, fibrinogen, APTT, Quick test, serum Ca2+ and P2+ and urine C2+ and P2+/24 hours, weight and arterial blood pressure before and after the treatment were examined. The results confirm the benefical effect of Climen on the Climax score (p < 0.0001), total cholesterol (p < 0.01), HDL-Chol (p < 0.05) and LDL-Chol (p < 0.0001). After administration of Climen a significant decrease of P2+ serum concentration was demonstrated. Climen is suitable for treatment of acute climacteric complaints and has benefical effects on lipid metabolism.

[Prediction of increased levels of androgen in women with acne vulgaris using ultrasound and clinical parameters]. / Moznosti predikce zvýsené hladiny androgenu u zen s acne vulgaris pomocí ultrazvukových a klinických parametru.

OBJECTIVE: The aim of our study was to identify clinical parameters characterizing women with acne whose dermatological problems are due to increased androgen production. Identification of these parameters would allow to indicate endocrinological examination in only a proportion of women with acne vulgaris. PATIENTS AND METHODS: A total of 54 women with acne vulgaris resistant to local treatment were enrolled in the study. The following clinical parameters were monitored: hirsutism (Ferriman-Gallway score), severity of acne, association of the severity of acne with the menstrual cycle, beginning of manifestations of acne, regularity of the menstrual cycle, presence of alopecia, age at menarche, body weight, BMI and ultrasound investigation of the ovaries. In the standard phase of the cycle, blood was collected to determine the levels of the following hormones: LH, FSH, PRL, TSH, testosterone, androstenedione, DHEA, DHEAS, SHGB. Wilcoxon's robust non-parametric paired test was employed for statistical data analysis. RESULTS: Overall, 33 (61%) women showed increased levels of at least one androgen. An irregular cycle was found in 21 (39%) women, acne severity was associated with the menstrual cycle in 16 (30%) women, 48 (89%) women had acne from menarche, 19 (35%) women had hirsutism; an ultrasound finding of polycystic ovaries was revealed in 32 (59%) women. No significant differences were found between a sub-group of women with levels of at least one androgen above the upper reference limit and the other women in the following variables: age, weight, BMI, age at menarche, ultrasound finding of polycystic ovaries, manifestation of acne from menarche, irregular cycle, hirsutism. The two groups were not different in the severity of acne. Deterioration of acne depending on the menstrual cycle was more often present in women with normal androgen levels. By contrast, a regular menstrual cycle was found to be more frequent in women with raised androgen levels, although the difference was not statistically significant. CONCLUSIONS: Clinical parameters had no association with androgen overproduction. Evaluation of clinical parameters, including severity of acne, does not allow to refer only a proportion of women with acne resistant to local treatment for endocrinological examination.

The effect of combination therapy with metformin and combined oral contraceptives (COC) versus COC alone on insulin sensitivity, hyperandrogenaemia, SHBG and lipids in PCOS patients.

BACKGROUND: Neither oral contraceptives (COC) nor metformin are an optimal modality for the long-term treatment of polycystic ovary syndrome (PCOS). The aim of this study was to evaluate whether a combination of both is beneficial over COC monotherapy. METHODS: Altogether, 30 women were included in the study and 28 finished the protocol. The patients were randomly assigned to two groups treated with either COC (COC group) or COC and metformin (1500 mg/day) (METOC group) for 6 months. Anthropometric parameters, androgens, lipids, fasting insulin, glucose and sex hormone binding globulin (SHBG) concentrations were measured before and at the end of the sixth cycle of treatment. The insulin sensitivity index was evaluated using the euglycaemic clamp. RESULTS: There were no significant changes in anthropometric parameters, fasting glucose or insulin sensitivity in either group. Total testosterone, free androgen index, androstenedione and dehydroepiandrosterone decreased and SHBG increased significantly in both groups. When comparing the effect of both treatments, only a more pronounced decrease in free androgen index was found in the METOC group. CONCLUSIONS: Adding metformin slightly modified the treatment effect of COC, causing a more significant decrease in the free androgen index but having no additional positive impact on lipids, insulin sensitivity, SHBG or testosterone. The available data do not offer enough evidence to advocate the standard use of combined treatment in PCOS. Whether the combination might be beneficial for specific subgroups of patients is of further interest.