Biomedical subjects
Publications and source records attributed to K Janků.
The authors analyze the diagnostic value of ECG examination in pulmonary thromboembolism which is a frequent complication in elderly women in postoperative gynaecological departments. They draw attention in particular to the importance of ECG in the differential diagnosis between cor pulmonale acutum and infarction of the inferior and anterior myocardial wall.
OBJECTIVE: To evaluate maternal morbidity and mortality of women suffering from coarctation of the aorta as well as the perinatal mortality of babies delivered by women with this anomaly of the aorta. According to our experience we recommend a suitable form of a follow up and suggest an optimal mode of delivery for these patients. DESIGN: Original paper. SETTING: 1st and 2nd Department of Gynecology and Obstetrics of the Masaryk University of Brno--Maternity Hospital, Obilní Trh 11, 602 00 Brno, Czech Republic. METHODS: Our set consists of 34 pregnant women with coarctation of the aorta. These patients were followed up during the pregnancy in the years 1964-1998 by the Centre for Cardiovascular Diseases in Pregnancy in the Maternity Hospital in Brno. Seven women who were not operated on for the coarctation of the aorta (group A) were pregnant 14 times. Twenty seven women who were operated on for the coarctation (group B) had 50 pregnancies. RESULTS: There were no maternal deaths in our set. From the 12 delivered babies of women with non operated coarctation of the aorta one child was SGA (small for gestational age). From 42 babies born by women who underwent an radical operation of the coarctation of the aorta previously we had to face one death of a newborn who was SGA as well. CONCLUSION: The radical operation of the aorta should be carried out during the first year of age if possible, between the 9th to 12th month, at best. With women who were not operated on there is a greater risk of rupture of the aneurysm of the aorta and aneurysm of the cerebral arteries in the 2nd and 3rd trimester, during the labor and in the early puerperium. We would advise therefore a through follow up during the whole pregnancy. The high BP should be lowered medicamentally. As to the mode of delivery Caesarean section is preferred. With women who were successfully operated on in their early infancy and whose BP is normal or the systolic BP does not exceed 160 mmHg the Caesarean section is not mandatory but elective. We would mostly advise a spontaneous delivery with shortening of the 2nd stage of the labor by forceps or vacuumextraction--the delivery by Caesarean section in accordance with usual obstetrical practice.
The authors submit an account of the terminology of toxemia of pregnancy and hypertension during pregnancy which are used in the world literature. They draw attention to the lack of uniformity which leads to a distortion of statistics. Differences in the nomenclature and incorrect enlistment of hypertension may lead also to an inadequate type of treatment and conduction of delivery. The authors recommend the use of nomenclature based on the pathogenesis and on their own experience. They emphasize the difference in the pathogenesis, therapy, prognosis and prevention of different types of hypertension.
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The authors revealed during dispensarization of pregnant women suffering from essential hypertension that the disease is relatively frequently associated with some metabolic disorders, i. e. obesity, gestational diabetes or impaired glucose tolerance. They draw attention to a similarity with Reaven's syndrome in non-pregnant women. The authors recommend to screen for diabetes all obese pregnant women and those with hypertension to detect an impaired glucose metabolism and prevent foetopathies in neonates of thus affected mothers. The authors consider obesity one of the subsidiary criteria in the differential diagnosis of essential hypertension and preeclampsia.
The authors compare perinatal results in insulin treated diabetic women who were followed up in the out-patient department of the Second Gynaecological and Obstetric Clinic of the Masaryk University in Brno. In 1980-1984 148 pregnant diabetic women were followed up and in 1985-1991 when self-monitoring has become part of comprehensive treatment of pregnant diabetics in our department, 279 women were followed up. The patients were monitored during pregnancy by a diabetologist and gynaecologist. Other members of the team are a paediatrician, geneticist, psychologist, dietitian, and educational nurse. As to laboratory parameters, short-term and long-term compensation of diabetes were monitored. Systematic preconception preparation of diabetic patients, with an attempt to achieve normal blood sugar levels and genetic examination of both partners from part of comprehensive care. The results achieved in our department revealed a statistically significant decline of the incidence of foetopathies in neonates at the 5% level of significance and a decline of hypoglycaemia in foetuses at the 0.1% level.
In the Second Gynaecological and Obstetric Clinic in Brno there has been for more than 15 years a specialized department for treatment of diabetes during pregnancy. The department monitors and treats pregnant diabetics from approximately two thirds of the former South Moravian region, i.e. patients with diabetes assessed before pregnancy as well as those where an impaired carbohydrate metabolism was detected during pregnancy. The authors submit an account of the organization of team work in their out-patient department.
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One case of adenocarcinoma of the kidney during pregnancy has been demonstrated.
Critical review of the classification of heart diseases in pregnancy of the New York Heart Association. A new classification of cardiovascular diseases in pregnancy is proposed mainly based on hemodynamic aspects.
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A centralization of the pregnant cardiacs within the districts of the GDR is discussed based upon an analysis of the centre for cardio-angiopathies during pregnancy in Brno and own experiences. A formerly demand for a high-specialised medical care and hospitalisation for pregnant women with cardio-angiopathies seems not to be necessary.
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