An entirely new method of optical microscopy in transmitted light “Relief Contrast after Hostounsk ̆” or RCH, Lambda Ltd. Praha, Czech Republic, was used to study of integument surface replicas of ...reptiles (microrelief adhesive method after Wolf) as well as reptilian sloughts. This equipment provides a three-dimensional image of high contrast and resolution. Compared to microscopy without phase or interference contrast, RCH-microscopy makes it possible to evaluate a three-dimensional organization of microrelief on reptilian scales. Results obtained from these microscopical observations can be used for both ecological and taxonomical studies on animals.
We investigated the frequency of pathology, especially intrauterine adhesions, after instrumental evacuation within 24 h of delivery in a prospective observational intervention study on 100 women ...where a ‘see and treat’ hysteroscopy was performed after three to four months. There were two possible etiology groups: intrauterine adhesions classified according by European Society for Gynaecological Endoscopy (ESGE) grades I–IV and residual tissue (classified as minimal and considerable). Adhesions were found in 18% of patients, as follows: ESGE I–II in 13% and ESGE III–IV in 5%. Residual tissue was present in 33%, as follows: minimal in 23% and considerable in 10%. There were 6% who had both mild adhesions and minimal residual tissue, while 43% of the women had normal intrauterine findings. Of the women, 32% were symptomatic (spotting, bleeding). Only residual tissue correlated with symptoms (r=0.376; p<0.001). There is a high prevalence of acquired intrauterine pathology (57%) in women who require early instrumental evacuation.
The objective of the study was to verify whether ultrasound vaginal cervicometry, performed in the 18th-20th week of gestation, can effectively predict preterm delivery.
279 singleton pregnancies ...were prospectively studied from the middle of gestation until delivery. In the 18th-20th week of gestation we performed ultrasound vaginal cervicometry, which we used to determine the length of the cervix, judge the shape of the internal os, and evaluate the cervicometry as normal or abnormal on the basis of these parameters. With the aid of one-dimensional and multi-dimensional analysis, we tested the dependence of completed weeks of gestation and preterm delivery on the results of ultrasound cervicometry.
247 women completed the study. Cervicometry was evaluated as abnormal in 53 women (21.46%). We proved a significant dependence of delivery prior to the 34th week of gestation on cervical length (p<0.01), abnormal shape of the internal os (p<0.0001; RR=10.35), and abnormal cervicometric result (p<0.0001; RR=29.28). Delivery prior to the 37th week was also significantly dependent on all observed parameters. Of the individual cervicometric parameters, cervical length had the most significant impact on the completed weeks of gestation.
The implementation of ultrasound vaginal cervicometry in the prenatal screening program can lead to effective and early selection of women with a significantly increased risk of preterm delivery.
Práce prezentuje prenatální diagnostiku, možnosti terapie a následnou péči u plodů a novorozenců s kongenitálním chylothoraxem na podkladě zhodnocení 14 případů na naší klinice v letech 1993 až 2012. ...Povšechný hydrops plodu byl popsán ve 4 případech (29 %), v 10 případech (71 %) byla provedena odlehčovací amniodrenáž a ve 3 případech (21 %) prenatální odlehčovací punkce hrudníku. Spontánně bylo porozeno 11 plodů (78 %), hrudní drenáž byla nezbytná v průměru 9 dnů po porodu. Mortalita dosáhla v souboru 29 % (4 případy). V článku popisujeme vyšetřovací algoritmy, terapeutické prenatální i postnatální postupy a je zdůrazněna nutnost mezioborové spolupráce.
The work presents prenatal diagnosis, treatment and care options in fetuses and neonates with congenital chylothorax based on a detailed evaluation of 14 cases recorded in our department between years 1993 and 2012. Generalized fetal hydrops was described in 29% of cases, therapeutic amnio drainage performed in 71% and prenatal thoracentesis in 21% of cases. 78% of fetuses were delivered spontaneously; thoracic drainage was necessary nine days after birth in average. Mortality reached 29%. The following text describes diagnostic algorithms, prenatal and postnatal therapeutic options with emphasis on the need for interdisciplinary cooperation.
Alena Malkovská, Zdeněk Žižka, Andrea Pašková, Václav Sebroň, Pavel Calda
Literatura
The purpose of this study was to determine the changes of biochemical risk factors for thromboembolisms using different administration routes of early estrogen replacement therapy.
In a 12-week ...prospective, randomized crossover trial, estradiol was administered orally (2 mg daily) or transdermally (0.05 mg daily). Forty-five healthy early postmenopausal women were included into the study within 12 weeks after hysterectomy and oophorectomy. Forty-one women (age 49 +/- 6 years) completed the study, and their data were analyzed. The hemocoagulation parameters were determined prior to beginning of the study and at the end of each treatment period, separated by a 1-week washout period.
After oral therapy, the average tissue factor pathway inhibitor levels decreased statistically significantly (p < 0.0001) from 87.5 +/- 39.1 to 68 +/- 37.49 ng/ml. The plaminogen activator inhibitor-1 levels also decreased statistically significantly (p = 0.001) after the oral estrogen therapy from 11.39 +/- 12.02 to 5.0 +/- 5.27 IU/l. These changes were also significant when compared with the nonsignificant changes after the transdermal therapy. No significant changes occurred in the levels of D-dimers. After both treatment methods, the antithrombin III and fibrinogen levels decreased, but within their physiological ranges.
Oral administration of estrogen statistically significantly reduced the tissue factor pathway inhibitor and plasminogen activator inhibitor-1 levels when compared with the transdermal route. These changes cannot be unambiguously considered risky, and the zero change of D-dimers suggests that there was no activation of the coagulation cascade. We consider the neutral effect of the transdermal therapy more beneficial.
