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Biomedical subjects

T Binder

Publications and source records attributed to T Binder.

At least 19 recordsLinked to original sources
PubMed2006

[Antithrombotic prophylaxis and treatment in thrombophilic disorders in gynaecology and obstetrics].

Pregnancy and puerperium are physiological thrombophilic condition and risk of venous thromboembolism in pregnancy is 4 - 6 fold higher. This risk is further increased in the presence of the additional risk factors. Inherited thrombophilia is well-defined risk factor for VTE in pregnancy and also can be the risk for obstetrics complications. So that early diagnostic of inherited thrombophilia can result in the decrease of risk of VTE and the obstetrics complications.

Anticoagulants↗
PubMed2006

[Ursodeoxycholic acid, S-adenosyl-L-methionine and their combinations in the treatment of gestational intrahepatic cholestasis (ICP)].

UNLABELLED: SEATING: Department of Obstet. Gynecol., 2nd Medical School Charles University and Teaching Hospital Motol, Prague, Institute of Haematology and Blood Transfusion Prague, Department of Clin. Bioch. General Teaching Hospital and 1st Medical School, Charles University Prague, Czech Republic. AIM OF THE STUDY: To compare the efficacy of the monotherapy with ursodeoxycholic acid and S- adenosyl-L-methione with combined effect of both drugs in the treatment in pregnant women with intrahepatic cholestasis of pregnancy. METHODOLOGY: All women with singleton pregnancy at <36 weeks of gestation with moderate or severe form of ICP during January 1999 to June 2005 were enrolled. All were randomly assigned oral ursodeoxycholic acid (UDCA) 3 x 250 mg daily or 500mg S-adenosyl-L-methione (SAMe) twice daily in slow running infusion for twelve days ongoing oral 500 mg twice daily until delivery. Haematological and biochemical parameters were evaluated every week. Intensive monitoring of the fetus with cardiotocography and utrasound were accompanied. RESULTS: Of the 78 women enrolled, 25 received SAMe and 26 UDCA monotherapy. 27 women received combined therapy with both drugs. At enrolment, gestational age, duration of therapy, parity and biochemical characteristics were similar in the groups. All types of therapy improve the pruritus. The combined therapy and the monotherapy with UDCA led to improving of the serum concentrations of bile acids, asparate aminotranspherase, alanine aminotranspherase compared with monotherapy with SAMe. The differencies were statisticaly significant (p>0.01). The combined therapy led to quicker decrease of serum concentrations of bile acids and transaminases compared with UDCA monotherapy, however the results are only of borderline statistical significance. Gestational age at the time of labor and rate of prematurity were similar in all groups. No adverse effects were noted on the fetuses or neonates with either therapy. CONCLUSIONS: Ursodeoxycholic acid is effective in improving the biochemical parametres during the treatment of ICP. There is probably the synergistic effect with S adenosyl-L-methione. Whether the successful treatment influence the conditions of the fetus is not clear. The good perinatal outocome is probably more due to the precise monitoring of the intrauterine well-being of the fetus.

Adult↗
PubMed2006

[Hematological aspects of gestational cholestatic hepatosis (ICP)].

AIM OF THE STUDY: To assess the changes of hemocoagulative parametres induced by ICP from the view of posssible affection of the hemostasis. SEATING: Department of Obstet. Gynecol. 2nd Medical School Charles University and Teaching Hospital Motol, Prague, Institute of Haematology and Blood Transfusion Prague. METHODOLOGY: 20 blood samples of the pregnant with severe signs of ICP underwent the precise hemocoagulative analysis. The control group was composed from 12 women with physiological course of pregnancy comparable in terms of gestational week, age and parity. RESULTS: The routine hemocoagulative tests did show any statistical significant difference between both groups of examined women. The statisticaly significant elevation was found in women with ICP in factor VIII (fVIII:C), vWf and in the serum levels of fibrinogen. The elevated levels of fibrinogen did not influence the function of platelets and even the analysis of fibrinogen itself did not show any significant differences. Clinically assessed peripartal blood loss did not deviate from average of loss during the spontaneous labor of healthy women. CONCLUSIONS: The changes in hemocoagulative parametres in patients with ICP do not increase the risk of thromboembolic events during pregnancy and labor. We also did not approve the risk of the higher peripartal blood loss in these patinets.

Antithrombins↗
PubMed2005

[Nalbuphine in obstetrical analgesia].

OBJECTIVE: Comparison between particular methods of obstetrics analgesia, their analgetic efects and influence on the progress of delivery and postpartum adaptation of fetus. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: A prospective study of 92 patients who received intravenous infusion nalbuphine (28 women) or epidural analgesia (31 women) or pethidin (33 women). Assessment of maternal analgesia, satisaction was carried out. Apgar scores and resuscitative measures required for the neonate were note at delivery. RESULTS: The best analgesic effect was in the group with using peridural analgesia, where max. score was 3. The highest value was in the group of women who received pethidin. The most significant decrease of score after application of analgesia was in group with epidural analgesia, the least decrease of score was in the group with pethidin. The Apgar score at 1. minute was the lowest in the group with epidural analgesia, the highest score was in the group with nalbuphine. CONCLUSION: The mixed agonist/antagonist narcotic analgesic like nalbuphine have the place in clinical practice. The obstetric analgesia is very common in obstetrics practice. The epidural analgesia is very popular but not always accessible. Nalbuphine is the option which is effective in analgesia and have minimal side-effects.

Analgesia, Epidural↗
PubMed2005

[Reimplantation of heart valve prosthesis at the 25th week of gestation].

OBJECTIVE: Pregnancy in a woman with thrombosis of heart valve prosthesis at the 25th week of gestation and fetal death during reimplantation of prosthesis with the use of extracorporeal circulation. SUBJECT: Case report. SETTING: Department of Gynecology and Obstetrics, 2nd Medical Faculty of Charles University, Motol Hospital, Prague. SUBJECT AND METHOD: Patient L. S., 24 years old, first pregnancy, admitted to coronary heart unit at the 25th week of gestation with a blocked heart valve prosthesis, NYHA IV, left heart failure, and pulmonary edema. There was an insufficient anticoagulation therapy during pregnancy and a thrombosis of the prosthetic heart valve was suspected from that reason. Reimplantation of a prosthetic heart valve with the use of extracorporeal circulation was indicated in spite of a possible risk for the fetus. The thrombosis was confirmed during cardio surgical operation and a change of the prosthesis was successfully performed. After the patient was converted to extracorporeal circulation, bradycardia and intrauterine fetal death occurred. With regard to the patient's coagulation and circulatory instability, further management was necessary because of fetal death--termination of pregnancy by minor caesarean section was the only alternative. Six hours later an 850 g weight dead fetus was delivered. There were no serious complications during the postoperative period. CONCLUSION: Reimplantation of a prosthetic heart valve from vital indication was performed at the 25th week of gestation. After conversion of mother to extracorporeal circulation, fetal death occurred. The patients was released with satisfactory cardiopulmonal compensation.

Adult↗
PubMed2004

[Development of the pregnancy and labor in patient with systemic lupus erythematosus].

OBJECTIVE: Pregnancy and its outcome in a woman with systemic lupus erythematosus. SUBJECT: Case report. SETTING: Obstetrics and Gynecology Department, Charles University, 2nd Medical Faculty and Faculty Hospital Motol, Prague, Cardiocentrum, University Hospital Motol, Prague. SUBJECT: Patient with systemic lupus erythematosus (SLE) was admitted to our department at 31 weeks of gestation with diagnosed fetal bradycardia. Detailed prenatal echocardiography revealed complete atrioventricular block (AVB III) with atrial rate of 140 b.p.m. and ventricular rate of 70 b.p.m., fetoplacental failure was not present at initial examination. Patient was hospitalised for the remainder of the pregnancy, which continued to full-term without complications. During delivery, fetal pulse oxymetry was utilized to monitor fetal state saturation levels. Labour proceeded without complications with an Apgar score of 9-9-9. The newborn was observed at the ICU and the Cardiac center and deemed to be in stable condition with AVB III without any signs of heart failure and without the necessity for pacemaker implantation. CONCLUSION: In cases of diagnosed fetal bradycardia, it is beneficial to expand the methods of fetal monitoring during labour. Pre-, peri-, and postnatal observation of pregnant women diagnosed with SLE and fetal bradycardia should be done in specialised facilities that are able to provide the appropriate level of care for mother and infant.

Adult↗
PubMed2003

[Left ventricular dysfunction in Churg-Strauss syndrome].

Churg-Strauss syndrome is a rare disorder characterized by hypereosinophilia and a systemic vasculitis occurring inpatients with asthma and allergic rhinitis. Vasculitis commonly affects the lungs, the heart, the skin, and the peripheral nervous system. Cardiac involvement is characterized by acute and constrictive pericarditis, myocarditis and endocarditis, as well as ischemic cardiomyopathy. Endomyocardial fibrosis similar to Loeffler's syndrome has been rarely described. In the presented case, a 43 year old man with a history of allergy and asthma suffered from increasing dyspnea, fever, pulmonary infiltates and cardiomyopathy. Laboratory studies were notable for marked hypereosinophilia. In a bronchoscopic lavage and transbronchial biopsy eosinophilic infiltrates accompanied by vasculitis were found, Churg-Strauss syndrome was diagnosed. Echocardiogram showed endomyocardial deposits in the apex of the right ventricle, right ventricular function was normal particular in the basal segments. The left ventricle was slightly enlarged and left ventricular function was impaired. The diastolic mitral in-flow showed a restrictive pattern. Additionally, a pericardial effusion was observed without signs of tamponade. The patient received corticosteroids, cyclophosphamide and cardiomyopathy-specific therapy and showed a marked improvement after 4 months.

Adult↗
PubMed2003

[Obstetrical aspects of peripartum cardiomyopathy].

OBJECTIVE: The authors demonstrate a case report of the peripartum cardiomyopathy that occurred at a so far healthy woman after the delivery by the caesarean section. SUBJECT: Case report. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: The gravidity of a 28-year old primipara, gemini, was finished by the caesarean section because of cardiologic (benign cardiac extrasystoles) and obstetric (gemini clashing position) indication. After the delivery a heart failure started to develop. The diagnosis was closed as peripartum cardiomyopathy. The clinical state of patient stabilized after initiating adequate therapy, the follow up has been still going on. RESULTS: Peripartum cardiomyopathy is a rare disease that occurs as a left ventricular cardiac failure in pregnant women or in woman in childbed. Etiology of the disease is unknown, the disease management requires collaboration among obstetricians, cardiologists, anesthesiologists and neonatologists. Prognosis is uncertain.

Adult↗
PubMed2003

[Pregnancy in myelodysplastic syndrome].

OBJECTIVE: Evaluation of the influence of myelodysplastic syndromee (MDS) on the course of pregnancy and delivery. DESIGN: Case report. SETTING: Gynecological and Obstetric Department 1st Medical Faculty Charles University and General Faculty Hospital, Prague. SUBJECTS AND METHODS: The authors analyze their experience with the course of pregnancy and delivery in a patient with MDS and refractory anaemia who was treated on account of the disease for several years before pregnancy in the Institute of Haematology and Blood Transfusion. Pregnancy was not associated with progression of the basic disease and complications which developed during pregnancy were not associated with MDS. Pregnancy was terminated in this patient on account of preeclampsia gravis per sectionem caesarean by delivery of a healthy foetus. CONCLUSION: The example draws attention to a serious haematological disease while during pregnancy and delivery deterioration of the basic disease was not observed.

Adult↗
PubMed2003

[The May-Hegglin anomaly in pregnancy. 2 case reports].

TYPE OF STUDY: Case report. SETTING: Obstetrics and Gynecology Department, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Department of Hematology and blood transfusion, Obstetrics and Gynecology Department, 1st Medical Faculty Charles University and General Faculty Hospital, Prague. METHODS: The authors present two cases of pregnant women with May-Hegglin anomaly. This rare hereditary trombocytopenia is characterized with the presence of megathrombocytes and typical basophilie inclusions (Dahli's inclusions) in granulocyte cytoplasma in blood count. Clinically, there are possible haemmorrhagic manifestations in this anomaly [13]. The course of pregnancy was uncomplicated in both cases. The values of thrombocytes fluctuated between 22-34 x 10(9)/l and 17-27 x 10(9)/l respectively. The response on the corticosteroid administration was minimal. The pregnancy was terminated with caesarean section in general anesthesia in both cases. The indication in the first case was, after the neonatologist consultation with hematologist on duty, the anomaly itself. In the second case it was primarily decided to conduct the labor vaginally. It was necessary to start the induction of labor for the development preeclamptic signs. This prostaglandin induction was unsuccessful and therefor was the labor also terminated with s.c. Both delivered neonates were in good condition without clinical or lab signs of the disease. The neonate in the second case was of borderline trophicity. The s.c. were secured with transfusions of thrombocytes and carried out without any complications in both cases. The blood losses were 400 and 700 ml without necessity of erythrocyte transfusions. The postoperative course was also uncomplicated in both cases. Both women with their children were released from hospital on the 6th postoperative day. CONCLUSION: There are about 20 published papers of authors describing pregnancy with this rare anomaly. The efforts of haemmorrhage are very rare, the course of pregnancy is usually not disturbed [7, 8, 9, 11]. Some authors alert on possible higher risk intrauterine growth restriction [4]. The risk of fetal hemorrhage is from all available, data also small and there is no need of prenatal invasive investigation (cordocentesis) [11]. The mode of delivery depends only on the obstetrics and indications, vaginal labor is not associated with higher risk for the fetus [2, 3, 5, 6, 10]. The treatment with corticosteroids or immunoglobulins in cases when the clinical symptomatology appear is only little effective, administration of thrombocytes transfusions are useful [8, 9]. When the anesthesia is necessary, general anesthesia is preferred because of higher risk of local haemmorrhage complications in cases of epidural or spinal analgesia [10, 14].

Adult↗
PubMed2003

[Successful postponement of delivery in twin pregnancy].

OBJECTIVE: Description of twin pregnancy after IVF preterm rupture of membranes of fetus A in 22nd gestational week. Abortion of fetus A and successful delayed delivery of twin B. DESIGN: Case report. SETTING: Obstetrics and Gynecology Department, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Obstetrics and Gynecology Department, 1st Medical Faculty Charles University and General Faculty Hospital, Prague. METHODS: Patient A. S. 34 years old, admitted to the hospital in 23rd gestational week with preterm rupture of membranes of fetus A, after appearing spontaneous uterine contractions terminated the abortion of fetus A. The uterine contractions stopped with toxolytics and after one week of expectation interval the cerclage suture of cervix was performed. The following course of pregnancy was protected with antibiotics and 48 hours toxolysis with beta mimetics. The pregnancy continued without any serious complications till 37th gestational week, when infectious markers elevated. Cerclage suture was taken away and after 12 hours interval the labor started. The labor was terminated with s.c. because of imminent fetal hypoxia. CONCLUSION: After the abortion of twin A we succeeded to delay delivery interval for 4 months. The borderline mature neonate was born in good clinical condition and survived without any serious complications.

Abortion, Spontaneous↗
PubMed2001

[Characteristics of a population of drug dependent pregnant women in the Czech Republic].

OBJECTIVE: The aim of the study was to characterise the population of drug abused pregnant women in Czech republic and chart their socioeconomic situation. DESIGN: Prospective study. SETTING: The Department of Gynaecology and Obstetrics of the General Teaching Hospital and the 1st Medical Faculty of Charles University in Prague. METHODS: This prospective study coursed since January 1998 till the end of the year 2000. This study covered a group of pregnant women addict on illegal drugs (heroin, pervitin). The group was set in close cooperation with Prague's contact anti-drugs centers (DROP-IN, K-centrum, Sanopin), Dependence therapy department and Department for genetics Teaching hospital Prague and of course in cooperation with the district gynaecologists. During 3 years we succeeded in gathering 41 addict women for prenatal care. Twenty of them were heroin and 18 pervitin addict. The control groups were selected by method of accidental choice. We compared each group with its control and both groups of addicted mutually. We focused mainly on characteristics which could have a negative impact on the course of pregnancy, labour and lying-in period and the health condition of the foetus and the neonate (age, status, employment, parity, length of drug abuse, mode of application, attempt of therapy or abstinence, STD, hepatitis B and C, quality of prenatal care). RESULTS: We proved, that drug abused pregnant women are statistically significantly younger than pregnant women from control groups (by equal parity), mostly single and unemployed. The majority of them prefer intravenous way of drug application. The heroin--addict choose this type of application statistically significantly more often (94.4%) and also more often they report efforts at abstinence or therapy. A big part of drug abused pregnant women has insufficient prenatal care. 33% of heroin-addict and 25% of pervitin-addict never attended the obstetrician during their pregnancy. We revealed a significantly higher incidence of HBsAg a mainly anti HCV and active hepatitis C among women from both "drugs" groups compared to their controls. We did not encounter any HIV positive case among the Czech addict pregnant. CONCLUSION: The population of drugs-addict pregnant women may be characterised as a high risk group from the view of prenatal care. The pregnancy is not a sufficient impulse for the majority of drugs-addict women to change their life stereotypes.

Adult↗
PubMed2001

[Placental and umbilical cord changes in drug-addicted women].

OBJECTIVE: The aim of the study was to gauge the impact of drugs on placental changes in heroin and pervitin addict pregnant women as one of the influence factors supporting the lower birth-weight of the neonate. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynaecology and Obstetrics and the Department of Pathology of the General Teaching Hospital and the 1st Medical Faculty of Charles University in Prague. METHODS: The drugs-addict pregnant women were included in the study in the period between January 1998 till the end of the year 2000. We succeeded to concentrate in total 39 drug abused pregnant women and 39 their placentas and umbilical cords were examined (19 heroin and 20 pervitin addict). The placentas were sent for the histological examination in total without the chemical fixation. There were 3 placental samples, 2 cord and 2 membranes samples examined. The controls groups were formed by non-abused pregnant women and their placentas by method of accidental choice. RESULTS: We found the statistically significant higher incidence of placental and cords abnormalities in among the addict women compared to their non abused controls (P < 0.05). In heroin addict group in 16 from 19 cases were the abnormalities present. We registrated increased intervillous and perivillous microfibrin deposits (6 times), an increased number of trophoblastic proliferation buds (7 times) increased vascularization of the villi (7 times) mikrovilli (6 times) and their necrosis (5 times). In umbilical cord we enregistered in 3 cases the only one artery, in two case the thrombosis of the vein. In 5 cases we also found the signs of infection. In pervitin addict group we registered placental changes in 9 from 20 cases. The majority of them presented as increased microfibrin deposits on the surface and also in the choriotic board (9 times), in five cases we enregistered the intervillous haemorrhage manifested in 2 cases clinically as abruption of placenta. The placental changes participate in low birth weight of neonates, IUGR and the abbreviation of the gestational duration. CONCLUSION: The microscopic changes in placenta is the expression of the circulatory disorder during the attack of the drug. They are not four-square specific, rather quantitatively expressed. In heroin abused women is the incidence of placental changes much more higher comparing to pervitin-addict. Heroin led more frequently to preterm labour, lower birth-weight and IUGR. The pervitin-addict mothers are higher risk of placental abruption.

Amphetamine-Related Disorders↗
PubMed2000

Predictors of outcome in severe, asymptomatic aortic stenosis.

BACKGROUND: Whether to perform valve replacement in patients with asymptomatic but severe aortic stenosis is controversial. Therefore, we studied the natural history of this condition to identify predictors of outcome. METHODS: During 1994, we identified 128 consecutive patients with asymptomatic, severe aortic stenosis (59 women and 69 men; mean [+/-SD] age, 60+/-18 years; aortic-jet velocity, 5.0+/-0.6 m per second). The patients were prospectively followed until 1998. RESULTS: Follow-up information was available for 126 patients (98 percent) for a mean of 22+/-18 months. Event-free survival, with the end point defined as death (8 patients) or valve replacement necessitated by the development of symptoms (59 patients), was 67+/-5 percent at one year, 56+/-5 percent at two years, and 33+/-5 percent at four years. Five of the six deaths from cardiac disease were preceded by symptoms. According to multivariate analysis, only the extent of aortic-valve calcification was an independent predictor of outcome, whereas age, sex, and the presence or absence of coronary artery disease, hypertension, diabetes, and hypercholesterolemia were not. Event-free survival for patients with no or mild valvular calcification was 92+/-5 percent at one year, 84+/-8 percent at two years, and 75+/-9 percent at four years, as compared with 60+/-6 percent, 47+/-6 percent, and 20+/-5 percent, respectively, for those with moderate or severe calcification. The rate of progression of stenosis, as reflected by the aortic-jet velocity, was significantly higher in patients who had cardiac events (0.45+/-0.38 m per second per year) than those who did not have cardiac events (0.14+/-0.18 m per second per year, P<0.001), and the rate of progression of stenosis provided useful prognostic information. Of the patients with moderately or severely calcified aortic valves whose aortic-jet velocity increased by 0.3 m per second or more within one year, 79 percent underwent surgery or died within two years of the observed increase. CONCLUSIONS: In asymptomatic patients with aortic stenosis, it appears to be relatively safe to delay surgery until symptoms develop. However, outcomes vary widely. The presence of moderate or severe valvular calcification, together with a rapid increase in aortic-jet velocity, identifies patients with a very poor prognosis. These patients should be considered for early valve replacement rather than have surgery delayed until symptoms develop.

Adult↗
PubMed2000

Presence of human beta- and gamma-herpes virus DNA in Hodgkin's disease.

Herpes viruses have been implicated in the etiology of Hodgkin's disease (HD). We studied the prevalence of human cytomegalovirus (CMV), human herpes viruses type-6 (HHV-6), type-7 (HHV-7) and type 8 (HHV-8) DNA in up to 88 Hodgkin's disease biopsies in comparison to Epstein-Barr virus (EBV) DNA by polymerase chain reaction (PCR). Non-Hodgkin lymphomas (NHL) and reactive lesions served as controls. CMV and HHV-6 were found in 8/86 (9%) and 11/88 (13%) HD cases, respectively, by nested primer PCR. Except for three cases harbouring HHV-6 type-B, only HHV-6 type-A was detected in HD. HHV-7 was observed by nested PCR in 33/88 (38%) HD cases and was already detectable in 15/88 (17%) HD cases by a single-round PCR indicating elevated virus copy numbers. Seven of these cases showed co-infection with HHV-6, and 11 cases were found to contain EBV DNA. 7/8 CMV-positive HD cases also harboured EBV DNA. HHV-8 DNA was not detected by single round or nested PCR in any HD case investigated. Thus, CMV, HHV-6, and HHV-7 were present in small proportions of HD cases, with frequent co-infection of HHV-6 and HHV-7, and frequent association with EBV. In contrast to EBV, beta-herpes viruses are therefore unlikely to have a role in the aetiology of HD. Rather, the presence of these viruses seems to reflect impaired immunological surveillance.

Betaherpesvirinae↗
PubMed2000

HLA-A*2416: a new allele of the HLA-A19 lineage.

We here report on a new HLA-A19 allele (A*2416) found in a German kidney recipient. Serological class I typing revealed HLA-A11,19 without clear definition of the A19 split antigen. As with serology, polymerase chain reaction (PCR)-based typing also revealed inconclusive results. We therefore sequenced the gene from the 5' flanking region through the 3'-end of exon 4 of this allele after haplotype-specific PCR amplification. The sequence analysis revealed a new HLA-A allele which is identical to A*3101 with the exception of the 3' half of exon 2 which is identical to the common A9 alleles. The phylogenetic analysis constructed with the nearest-neighbor algorithm and based on exons 1-4 or introns 1-3 clearly indicated, that A*2416 belongs unequivocally to the A19 lineage.

Alleles↗