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Objective: To present a case of conservative - Fallopian tube preserving - surgical therapy of tubal pregnancy., Design: Case report., Setting: Department of Obstetrics and Gynecology, Strakonice Hospital., Case Description: Due to the desire to preserve the Fallopian tube in a hemodynamically stable primigravida, we decided for laparoscopic salpingostomy using hysteroscopy for assisted removal of pregnancy tissue from the oviduct., Conclusion: In well-selected cases, this treatment is an effective method of choice and can be performed even under conditions of a smaller hospital performing a common spectrum of laparoscopic surgery.

Objective: To report up-to date knowledge on laparoscopic, uterine sparing treatment of uterine fibroids., Study Design: Review., Setting: Uterine Fibroids Center, Department of Obstetrics and Gynecology, Charles University, Prague., Methods: Analysis of our clinical experience and available literature resources., Results: The management of uterine fibroids depends on the symptoms, location, and size of fibroids and on the reproductive plans of the patient. The surgical treatment has changed from laparotomy to minimally invasive surgery. In general, laparoscopic myomectomy (LM) is considered the best option in symptomatic patients with pregnancy plans. The laparoscopic approach is associated with lower postoperative morbidity as well as lower incidence of massive postoperative adhesion formation compared to laparotomy. The limitation of laparoscopic myomectomy is the size and the number of fibroids but also the location and the accessibility for the laparoscopic suturing. Laparoscopic uterine artery occlusion (LUAO) represents one of the alternatives to LM in patients with multiple small myomas or in patients with fibroids in unfavorable location. LUAO may be advantageously used prior to LM in order to reduce peroperative blood loss or to prevent the persisting fibroids from growing. However there is no universal treatment of uterine fibroids in fertile patients and in each single patient the indication and surgical method should be thoroughly considered. .

Uterine fibroids are the most common pelvic tumors in women of reproductive age. The cause of development of uterine fibroids is still unknown, however recent cytogenetic and genetic studies led to advancement in understanding of etiology of these tumors. In accordance with the latest findings up to 40% of uterine fibroids bear some chromosomal abnormalities. The most common are aberration of chromosomes 6, 7, 12 and 14. Uterine fibroids have been linked to mutations of fumarate hydratase (FH) gene. Germline mutations in FH gene cause autosomal dominant syndromes MCUL1 (multiple cutaneous and uterine leiomyomata) and HLRCC (hereditary leiomyomatosis and renal cell cancer), characterized by multiple uterine and cutaneous leiomyomata and renal cancer. This paper reviews recent findings in the role of genetic in etiology of uterine fibroids.

Objective: To compare principle, advantages, disadvantages, and risks of conservative (i.e. uterus saving) methods of treatment of uterine fibroids, which are focused on elimination or reduction of their perfusion. To contribute to better understanding of this dynamic topic between gynecologists, especially in the field of appropriate indication criteria., Design: Review article., Setting: Department of Obstetrics and Gynecology, Charles University and General Faculty Hospital, Prague., Methods: Analysis of literature and our clinical experience., Conclusions: Within the last decade the spectrum of treatment of uterine fibroids has broaden with methods causing ischemia of fibroids. These include the minimally invasive surgical therapy (laparoscopic occlusion of uterine arteries /LUAO/ and Doppler assisted laparoscopic myolysis) and radiological catheterization treatment (uterine artery embolization, UAE). Compared to foreign countries where UEA is mainly used in perimenopausal women, we focus on the group of patients with further fertility plans. It is necessary to stress that in spite of the number of affirmative experiences with the new techniques of uterine fibroid treatment in both the indication groups (women with or without further fertility plans) these methods still remain an alternative to standard surgical treatment, because both myomectomy and hysterectomy can be performed by minimally invasive techniques in the majority of women. This review is also focused on the specific risks of the particular methods as well as on their mechanism of action which may dramatically differ despite of some analogies.

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.

Uterine artery embolization (UAE) represents radiological treatment of uterine fibroids. It is highly effective and safe mainly in premenopausal patients with symptomatic fibroids and represents an alternative to hysterectomy in a group of women not suitable for minimally invasive surgical treatment (LAVH) and women desiring uterus sparing therapy. The future of UAE lies in optimal selection of patients based on volume-shrinkage prediction and fertility outcome. The second group is represented by methods based on direct fibroid tissue destruction using specific energy under MRI or UZ guidance. The common aim of these two groups is the volume shrinkage as well as the symptomatic relief. The second group is represented by radiofrequency ablation, focused ultrasound surgery, interstitial laser ablation and cryotherapy. Based on their non-surgical, percutaneous approach these can be classified as minimally-invasive methods. The second group of methods is suitable only for patients with the absence of any desire for child bearing due to the absence of their long-term outcome data.

Objective: The objective of this paper is give to guideline to the management of myoma, fertility and pregnancy., Design: Review., Setting: Czech Society Gynecological Endoscopy., Material and Method: The bibliographic data from Medline were reviewed from literature using the key words: fibroid - fertility - pregnancy., Conclusion: The clinical guidline was preparared after the aalysed data were supplied using the material of CSGE.

Objective: To sum up the knowledge of etiology and pathogenesis of uterine fibroids., Type of Study: Review., Setting: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague. SUBJECT OF STUDY: A summary of what is known about development of uterine fibroids., Conclusion: In this overview of etiology and pathogenesis of uterine fibroids we have attempted to ananlyze the literature and present prevailing evidence and opinions.

Objective: To evaluate bulk limits of intrauterine pathology for "see and treat" hysteroscopy., Type of Study: A retrospective observational study., Setting: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague., Methods: 200 mg of Indomethacin was administered to the patients by rectum 2 hours before procedure. "See and treat" procedures were performed with "Versascope" in awake patients without any peroperatively admistered analgesia or anaesthesia. As a "see and treat" were managed 796 endometrial polyps, 125 submucous myomas, as well as 62 cases of intrauterine synechias., Conclusions: endometrial polyps up to 1,5 cm, pedunculated submucous myomas up to 1,0 cm as well as fibroid adhesiones obliterated no more than 1/3 of uterine cavity can be managed as "see and treat" procedures with a high compliance of the patients.

Objective: To analyze clinical and reproductive outcomes of patients after laparoscopic (LM) or open (OM) myomectomy., Design: Prospective clinical trial., Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague., Methods: Women under the age of 40 with intramural fibroid larger than 4 cm were indicated for myomectomy. LM was performed when laparoscopy revealed solitary or 2 fibroids smaller than 8 cm; otherwise the OM was carried out. The patients were followed at 6 months intervals., Results: 80 myomectomies with extirpation of 121 myomas was performed from January 2002 to April 2005. The average age was 33.5 years, average size of dominant fibroid 56 mm. 38% of women suffered from infertility; the mean follow-up was 15.6 months. We performed LM in 56 cases (70%). From 24 open procedures 18 were elective and 6 converted from laparoscopy. In 18 patients some of the fibroid--ischemization procedures (uterine arteries embolization or laparoscopic dissection, or laparoscopic myolysis) preceded myomectomy. In the group with LM there was significantly lower peri-procedural blood loss, lower count of leucocytes and CRP concentration the 2nd day after surgery, shorter stay in the hospital, shorter interval between surgery and conception, and lower incidence of early complications than in women with OM. Fibroid related symptoms fully disappeared in 76% of patients. 20 women from 38 that have already tried to conceive have achieved 22 gestations so far: 9 deliveries (2 preterm; 3 vaginal, 6 Cesarean), 6 miscarriages, 1 ectopic and 6 ongoing pregnancies at the moment., Conclusion: In the hands of surgeons experienced in operative laparoscopy the enucleation of intramural uterine fibroids is safe, symptomatically effective, mostly low invasive procedure with good reproductive prognosis.

Objective: Twin pregnancy is perceived as a suboptimal result of an IVF/ICSI cycle. The most effective way to reduce the number of twins in IVF/ICSI program is a single embryo transfer. The aim of our study was to compare the efficiency of elective single embryo transfer (eSET) and double embryo transfer (DET) in the couples with a very good prognosis of IVF/ICSI., Design: Prospective case observational study., Settings: Department of Obstetrics and Gynecology, Charles University, 1nd Medical Faculty and General Teaching Hospital, Prague, Czech republic., Methods: A prospective study focused on eSET was performed between 1. 1. 2003 and 31. 12. 2004. We offered eSET or eDET to 331 IVF/ICSI couples who met the following inclusion criteria: age of the women < 35 years, 3 and more top quality embryos on day 4 after oocyte pick up. Fifty seven (17.2%) couples have chosen eSET and 274 (82.7%) couples preferred eDET. We compared clinical pregnancy rates in two groups of patients: In a group of patients who have chosen eSET versus patients who have preferred double embryo transfer (eDET). Student's t-test and F test were used to compare both groups., Results: Patients in both groups were not significantly different in age, number of oocytes retrieved and total number of quality embryos. In the eSET group, we achieved 30 clinical pregnancies and the pregnancy rate (PR) was 52.6%. In the eDET group, 151 clinical pregnancies were observed and the PR was 55.1%. Although the pregnancy rate in the eDET group was higher than in the eSET group, the difference between the two groups was not statistically significant. We have not observed any twin pregnancy (0.0%) in the eSET group while 57 (37.7%) twin pregnancies and 1 pregnancy with 3 embryos (0.4%) have been observed in the eDETgroup. This difference is statistically significant (P < 0.00001)., Conclusion: In the group with a very good IVF/ICSI prognosis (women < 35 years, 3 and more top quality embryos on day 4 after oocyte pick up), eSET did not significantly decrease the chance to achieve clinical pregnancy in comparison with DET. eSET seems to be a very efficient option to reduce the rate of twin pregnancy without compromising the pregnancy rate and should be recommended to these patients.

Objectives: To acquire information about the patient's follow-up evaluation of treating fibroids by uterine artery embolization (UAE)., Design: A retrospective multicenter clinical trial., Setting: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague., Methods: 45 women who underwent the UAE due to uterine fibroids from 1999 to 2003 were asked to complete a questionnaire. The questionnaire included 26 questions asking how the women had been informed and what they had expected. Further questions were focused on the course of embolization itself, early post-procedural difficulties (post-embolization syndrome) and patient's overall evaluation of treatment in a longer term. Those women who had completed the questionnaire and had been ready to co-operate were thereafter examined and included in the follow-up monitoring and, if necessary, further treatment was recommended., Results: Thirty one out of 45 patients from 26 to 48 years of age, who had been addressed (68.9%) answered the questionnaire. UAE was indicated 12 times (38.7%) on account of symptoms, 10 times (32.3%) because of sterility, 5 times (16.1%) as a preventive measure within the framework of family planning and 4 times (12.9%) for an asymptomatic but growing leiomyoma. Twenty seven (87.1%) women were also offered an alternative treatment, which they refused. As far as problems are concerned, 18 (58%) women described the course of treatment as corresponding with what they had expected, 5 times it was less painful, and 8 times it was worse than expected. The long-term results were considered as positive by 87.1% of responders, only 12.9% considered the treatment as failure. 5 in 11 women planning pregnancy became pregnant, 3 of them gave birth in term and 2 miscarried in the 1st trimester., Conclusion: From the point of view of the patients, the evaluated method proves highly successful, it is well tolerated and it involves a low risk of complications. It is not possible, at this point, however, to give an unequivocal answer to the question whether the method should also be routinely offered to women who are planning pregnancy.

Objective: The treatment of uterine myoma with pretreatment of uterine arteries embolization followed by laparoscopic myomectomy is presented., Design: Case report., Setting: Department of Obstetrics and Gynaecology 1st Medical Faculty of Charles University and General Faculty Hospital in Prague., Subject and Method: Forty two years old woman with uterine myoma was "pretreated" with uterine arteries embolization followed by laparoscopic myomectomy next day. The reason for this procedure was to improve in short period conditions for surgery and definitively solve uterine pathology., Conclusion: The "pretreatment" with uterine arteries embolization improves basically conditions and effect of uterine myoma surgery. This "two step procedure" could be recommended mainly for cases of large and vascularizated myomas.

Objective: To determine the incidence and the type thromboembolic complications in patients undergoing in vitro fertilization (IVF). To evaluate their clinical course, the influence on reproductive outcomes, and the prevalence of thrombophilia in these women., Design: Retrospective clinical study., Setting: Assisted Reproduction Center, Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague., Methods: The data, reflecting the diagnosis of thromboembolism (TE), were collected from all patients, who have undergone the IVF cycle in our clinic for the last 7 years. The following data were analyzed in these patients: medical history, type and course of TE, type and effect of ovarian stimulation, clinical pregnancy achievement, occurrence of ovarian hyperstimulation syndrome (OHSS), results of testing for thrombophilia, pregnancy course and outcome., Results: From 2748 IVF cycles 3 cases of TE were found (0.11%). In all cases the unilateral thrombosis of internal jugular vein associated with OHSS, manifesting in 1st trimester of pregnancy and not complicated with pulmonary embolism occurred. At least two thrombophilic markers have been detected in all these women. The clinical course of TE, as well as of the whole gestation was favorable. Prevalence of TE in patients with severe OHSS was 4.1% (2 women from 49)., Conclusion: The incidence of thromboembolism in women undergoing IVF is low. It appears almost exclusively in association with OHSS and the typical finding is deep venous thrombosis in the neck area. In our opinion, while screening of thrombophilia in all patients from IVF program is not indicated, the routine testing of most common thrombophilic markers in pregnant women with OHSS could decrease the risk of these serious complications.

Objective: Review of current knowledge about uterine fibroids management in young women. Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving., Design: Review article., Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague., Methods: Analysis of the facts in literature (texts in medical journals, monographies, textbooks, internet database Medline and Ovid) and authors' clinical experience., Conclusions: Alternatives of treatment of infertility in women with uterine fibroids have significantly enlarged in past 10 years. However none of the indicated methods is perfect. Expectation does not exclude the risk of growth of fibroids and abortion. The effect of pharmacological therapy is only temporary. Myomectomy is associated with the risk of surgical complications, fibroids' recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation (on an average) halves the fibroids volume, the long-term effect of the method on female fertility is still unknown. Nevertheless it seems convenient to advise the active approach to all women planning pregnancy and having significant (submucous or intramural) fibroid even before spontaneous or assisted conception. Most recent studies indicate significant improvement of reproduction outcomes after myomectomy, especially in young women with the absence of other factors of infertility. Only the results of randomized, controlled trials (that are still awaited) will inform us about comparison of the effects and risks of myomectomy and uterine artery embolization in management of infertility.

Objective: To evaluate, which of selected anamnestic, laboratory and ultrasonographic (USG) parameters could contribute to the prediction of prematurity., Design: Prospective, observational, clinical study., Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague., Methods: 349 women with the singleton pregnancy were followed from the half of the 2nd trimester until the end of gestation. At each woman the anamnestic (age, parity, pregravid BMI, weight gain until 20th week, significant risk from patient's history, cigarette smoking, risk pregnancy symptoms until 20th week), laboratory (maternal serum concentration of AFP, hCG, and uE3/triple test/at 16th week, the blood count and ferritin concentration at 18th-20th week, bacteriological cultivation of the smear from the cervix at 34th-36th week), and USG (transvaginal cervicometry and doppler flowmetry of the uterine arteries at 18th-20th week) data were established. With the aid of one-dimensional and multi-dimensional analysis the dependence of completed gestational age and preterm delivery (before completed 37th week) on above mentioned parameters was tested., Results: 314 women completed the study. We proved a significant dependence of prematurity on the following markers: risk pregnancy symptoms until 20th week (RR 2.94), abnormal triple test (RR 4.63), cultivation of pathogens from the cervix (RR 5.49), USG established cervical length (P < 0.0001), abnormal result of cervicometry (RR 19.02), both doppler parameters (RI of uterine arteries: P < 0.0001; presence of early diastolic notch: RR 2.84). The results of multi-dimensional analysis confirmed superiority of USG cervicometry in prediction of both measured outcomes., Conclusion: The predictive value of some of selected anamnestic, laboratory, and USG markers of premature delivery was proved at random population of women with singleton pregnancy. The abnormal result of transvaginal USG cervicometry was the most significant predictor of prematurity. We recommend a routine performing of cervicometry (as a part of USG screening at 18th-20th week) for early selection of women with significantly increased risk of prematurity.

Objectives: To analyze the laparoscopic findings in women with chronic pelvic pain (CPP). To verify the possible predictive value of the anamnestic factors for the laparoscopically established diagnosis., Design: A retrospective clinical trial., Setting: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague., Methods: We realized a detailed analysis of laparoscopies for CPP performed in our clinic in the last 5 years. With the help of statistical analysis (chi 2) the possible influence of age, previous surgical intervention, history of PID, dysmenorrhea, infertility, and some other factors on endoscopic finding was verified., Results: 480 laparoscopies for CPP were performed from the year 1995 to 1999. The most frequent findings were adhesions (22.3%), endometriosis (20.4%), PID (17.7%), and normal finding (17.7%). In 53% of all cases the operative laparoscopic procedure was done, most frequently the adhesiolysis (62.2%). Only one serious complication during laparoscopy was recorded (0.21%). In women younger than 30 years endometriosis was the most frequent finding (22.8%), in women older than 30 pelvic adhesions were the most often (31.9%). Diversity of findings between the groups was statistically significant (P < 0.0001). In patients with previous operation in pelvis the adhesions were found most frequently (46.2%). Diversity of findings in women with and without previous operation was also significant (P < 0.0001). In women treated for PID, pelvic inflammation was found in 25.8%, but in 22.5% the finding was negative and in 20.2% the endometriosis was diagnosed. In these subgroups (women after and without treatment of PID) the diversity of findings was not significant (P < 0.1). In infertile women, suffering from CPP, PID was found most frequently (41.2%). A suspicion of chronic appendicitis was verified in 64.3%. In patients with dysmenorrhea, as well as in women suffering from dyspareunia, endometriosis was dominant finding (30.4%, resp. 29.1%)., Conclusion: Laparoscopy for CPP is a safe and effective method for verifying and adequate therapy of as yet hidden pathological findings. With the help of anamnestic factors some laparoscopic findings are predictable; although the sensitivity and specificity is very poor.

Torsions are rare acute abdominal conditions and are mistaken for other more frequent diseases. The present work draws attention to the most frequent diagnostic errors. The authors present three cases of torsions of intraabdominal organs and two cases of testicular torsion. All patients attended their doctor because of abdominal pain. In four of five cases the patients were first treated for an erroneous diagnosis of acute abdomen. In the first case the torsion of the omentum was mistaken for diverticulitis of the sigmoid, later for an intraperitoneal lipoma, in he second case for cholecystitis, in the third case a patient with torsion of a myoma was indicated for surgery on account of acute appendicitis. In the fourth case incomplete torsion of the testis was mistaken for irritation of the appendix. In the fifth case where abdominal symptomatology dominated the correct diagnosis of testicular torsion was made and atypically spontaneous detorsion of the testis occurred.

Objective: To review the clinical risks of iron deficiency anemia (IDA) in pregnant women: a list of the possible disorders of the mother, fetus and the newborn. A discussion about the clinical value of iron administration in gestation., Design: Review article., Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. Apolinárská 18, Prague 2, 128,00., Methods: Analysis of the results in literature (texts in medical journals, monographies, textbooks, internet--"Medline") and authors' clinical experience., Conclusions: Routine iron supplementation in pregnancy is still a controversial issue. The key question is, whether improving the mother's laboratory parameters helps to improve her clinical status and the clinical outcome of pregnancy. There is no doubt that iron supplementation in pregnancy decreases the incidence of anemia and increases the level of iron stores in the 2nd and 3rd trimester of gestation as well as in the puerperium. Even with the presence of many recent studies there still exists a lack of proper evidence, that routine iron administration in pregnancy leads to improvement of the clinical status of the mother and fetus. Up to this time there is not sufficient proof either in favour of or against iron supplementation in pregnancy. In conclusion, there is a need for further research (randomized, controlled, clinical trials focused on the clinical outcomes of pregnancy, with a sufficient amount of pregnant women and with representative statistical evaluation; or careful metaanalysis of the existing studies) to reach definite results about the importance of iron administration and about the treatment of asymptomatic anemia in gestation.

The prevalence of anaemia during pregnancy and post partum is according to the literature and many years clinical experience high. In the submitted work we investigated the incidence of sideropenic anaemia in women during the first three months after a spontaneous delivery, changes of clinical and laboratory indicators of anaemia during this period and the possible effect exerted by administration of iron and iron plus folic acid resp. Ninety pregnant women in the 35th to 39th week of pregnancy were at random divided into three equally sized groups and the following were assessed: haemogram, indicators of iron reserves, serum concentrations of folic acid, vitamin B12, erythropoetin and soluble transferrin receptor, liver tests, total protein + electrophoresis, acute stage proteins. In the first group (T) the women were given, starting on the 4th day after delivery 1 tablet of Tardyferon per day for two months. To the second group (F) for an equal period 1 tablet of Tardyferon Fol per day was administered. Women in the control group (K) had no medication. In the investigation women with medium and severe pregnancy anaemia were not included nor women taking during pregnancy or previously iron preparations or those treated in the past by blood transfusion. After spontaneous delivery (women who had Caesarean section or forceps delivery were eliminated from the study) the women were subjected to the same examinations as before delivery. These examinations were made on the fourth day after delivery and then after monthly intervals for a period of three months. At the same time the subjective condition of the mothers was evaluated after delivery, focused on the development of symptoms typical for anaemia and the possible effect of administered treatment. The investigation was completed by 60 women. During treatment no allergic or other serious side-reactions to the administered drugs calling for discontinuation of treatment were recorded. The results of the investigation proved that laboratory and clinical indicators of post-partum anaemia reached more quickly normal values in women treated with iron preparations. The authors did not detect a single and supreme marker of sideropenic anaemia in the early post-partum period. This is one of the reasons why the authors recommend iron administration to all women after spontaneous delivery. In the authors' opinion examination of the blood count on the fourth day and assessment of the serum ferritin concentration one month after a spontaneous delivery in selected mothers (e.g. after an above average peripartal blood loss) is desirable. Addition of folic acid to iron is of no special value during the post-partum period. Iron substitution in women after spontaneous delivery should be, with regard to the long persisting sideropenia, administered at least for three months. The dose of 80 mg elemental iron per day is sufficient for mild or medium post-partum anaemia. Addition of mucoprotease and ascorbic acid to iron preparations is useful because it increases the compliance of the patients and thus also its effectiveness. The preparation Tardyferon meets the above criteria and is therefore a good choice for the treatment of post-partum anaemia.

Infections are still the most frequent postoperative complications and one of the limiting factors of successful gynaecological surgery. In recent years information on successful anti-microbial chemoprophylaxis is increasing and is associated with reduced postoperative inflammations, febrile morbidity and early complications. Views differ above all as regards indications for the use of antibiotic prophylaxis and the selection of a suitable antibiotic. Data in the literature differ also as regards achieved results. The submitted work had the objective to test on a representative group the success and rationality of medicamentous prophylaxis in gynaecological surgery and to contribute to a clearer view on controversial points. 203 women admitted to the Second Gynaecological and Obstetric Department of the First Medical Faculty Charles University and General Faculty Hospital Prague for elective abdominal or vaginal hysterectomy on account of a benign indication were divided into three groups which did not differ from the demographic or medical aspect. In group A (53 women) for prophylaxis two doses of Augmentin were used (combination of amoxycillin with clavulanic acid) i.v., patients in group M (50 women) had three doses of Mandol (Cefamandol) i.m., and in control group K (100 patients) no antibiotics were administered prophylactically. The authors investigated the postoperative course and evaluated some parameters in relation to possible postoperative infectious complications. The results proved unequivocally that prophylaxis with Augmentin reduces significantly the postoperative infectious morbidity (11.5%), febrile morbidity (5.6%) and the incidence of early infectious complications (3.8%) after abdominal or vaginal hysterectomy, as compared with the control group (35%, 31% and 11% resp.). Prophylaxis with Cefamandol reduced only in few parameters postoperative complications, but in general did not lead to a significant improvement of the postoperative course nor to a reduction of postoperative inflammatory complications. Similar results were obtained when only complications after abdominal hysterectomy were evaluated. The results of bacteriological examination confirmed the expected differences in the spectrum of efficacy of the two antibiotics on the most common microbial flora in the given area, i.e. a high sensitivity of Augmention to enterococci and bacterioids and resistance of these bacteria to Mandol. These results can be considered one of the reasons of different results of the two antibiotics. Prophylaxis with amoxycillin/clavulanic acid was found to be safe, very effective and financially feasible prevention of postoperative infectious complications after abdominal and vaginal hysterectomy. It led to a significant increase in the number of cases without any complications, when compared with the control group.

The investigation assessed, whether a nonspecific single and repeated immunization induced by Listeria monocytogenes Ei factor, BCG vaccine and their combination influences the growth of transplanted syngenic methylcholanthrene tumour depending on tumour graft cellularity. The cellularity of 10(4) and 10(5) were investigated. Tumour growth was examined 10 and 17 days after the inoculation. It has been found that single Ei factor administration did not influence the tumour growth. Single BCG vaccine favourably influenced the tumour growth, but in progressing time and cellularity the effect was failing. In combination of BCG vaccine and Listeria Ei factor the antitumour effect appeared to be most profound. In progressing time after the tumour grafting and graft cellularity the effect was disappearing. It was probably due to the fact that immunotherapy fails to control tumour mass with high cellularity. The antitumour effect potentiation by combination of BCG vaccine with Ei factor suggests a way to a possible combined antitumour immunotherapy.

The investigation assessed, whether a nonspecific single and repeated immunization induced by Listeria monocytogenes Ei factor, BCG vaccine and their combination influences the growth of transplanted syngenic methylcholanthrene tumour depending on tumor graft cellularity. The cellularity of 10(4) and 10(5) were investigated. Tumour growth was examined 10 and 17 days after the inoculation. It has been found that single Ei factor administration did not influence the tumour growth. Single BCG vaccine favourably influenced the tumour growth, but in progressing time and cellularity the effect was failing. In combination of BCG vaccine and Listeria Ei factor the antitumour effect appeared to be most profound. In progressing time after the tumour grafting and graft cellularity the effect was disappearing. It was probably due to the fact that immunotherapy fails to control tumour mass with high cellularity. The antitumour effect potentiation by combination of BCG vaccine with Ei factor suggests a way to a possible combined antitumour immunotherapy.