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Goal: So far there have been no data describing specialization education from the perspective of the trainee doctors in preparation for specialty examinations. The aim of the questionnaire study was to learn about the opinions and experience of trainee doctors with pre-exam education in the specialty of Anaesthesiology and Intensive Medicine. Type of study: Survey Materials and methods: The target group was AIM doctors in specialized training up to 35 years of age. They were addressed personally at educational events, electronically via Facebook or through their educational leads. Data collection took place between 09/2017 and 09/2018. The results were evaluated using descriptive statistics (MS Excel). Results: In the period of 09/2017–09/2018, a total of 244 physicians participated in the event. Nearly 90% of respondents knew the identity of their educational lead. 54% of the respondents admitted that they did not entirely complete the scope of the pre-exam preparation according to the educational program of Anaesthesiology and Intensive Medicine, breaking down as 50% of trainee doctors from university hospitals, 52% from regional hospitals, 60% from district hospitals and 67% of trainee doctors from municipal or other hospitals. Conclusion: Despite the limitations of the scope of the questionnaire, it is clear that the doctors in training are not indifferent to the conditions for obtaining the specialty examinations, and that the study can serve as a good stepping stone for further improvement of AIM training conditions. [ABSTRACT FROM AUTHOR]

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Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pregnancy adds challenges for healthcare professionals, regardless of gender. We investigated experiences during pregnancy, attitudes towards pregnant colleagues, family planning decisions, and awareness of regulations among European anaesthesiologists and intensivists., Methods: A cross-sectional online survey was conducted among 3590 anaesthesiologists and intensivists from 47 European countries. The survey, available for 12 weeks, collected data on demographics, working conditions, safety perceptions, and the impact of clinical practice and training demands on family planning. Quantitative data were analysed using descriptive statistics, whereas qualitative data underwent thematic content analysis., Results: Only 41.4% (n=678) of women were satisfied with their working conditions during pregnancy, and only 38.5% (n=602) considered their working environment safe. The proportion of women who changed their clinical practice during pregnancy and who took sick leave to avoid potentially harmful working conditions increased over time (P<0.001 for both). Men had children more often during residency than women (P<0.001). Pregnant colleagues' safety concerns influenced clinical practice, with women and men who had experience with their own and partner's pregnancy being more likely to modify their practices. Work and training demands discouraged plans to have children, particularly among women, leading to consideration of leaving training. Awareness of national regulations was limited, and respondents highlighted a need for better support and flexible working conditions., Conclusions: Improved support and working environments for pregnant colleagues and ability to express preferred clinical areas for work are needed. Department heads should commit to safety and family friendliness, and men transitioning to parenthood should not be neglected., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Malignant Hyperthermia (MH) is a rare, hereditary, life-threatening disease triggered by volatile anesthetics and succinylcholine. Rarely, MH can occur after non-pharmacological triggers too. MH was detected more often in children and young adults, which makes this topic very important for every pediatric specialist, both anesthesiologists and intensivists. MH crisis is a life-threatening severe hypermetabolic whole-body reaction. Triggers of MH are used in pediatric intensive care unit (PICU) as well, volatile anesthetics in difficult sedation, status asthmaticus or epilepticus, and succinylcholine still sometimes in airway management. Recrudescence or delayed onset of MH crisis hours after anesthesia was previously described. MH can also be a cause of rhabdomyolysis and hyperpyrexia in the PICU. In addition, patients with neuromuscular diseases are often admitted to PICU and they might be at risk for MH. The most typical symptoms of MH are hypercapnia, tachycardia, hyperthermia, and muscle rigidity. Thinking of the MH as the possible cause of deterioration of a patient's clinical condition is the key to early diagnosis and treatment. The sooner the correct treatment is commenced, the better patient´s outcome. This narrative review article aims to summarize current knowledge and guidelines about recognition, treatment, and further management of MH in PICU.

Histiocytic sarcoma is a neoplasm arising from the histiocytes. Histiocytic neoplasms are among the rarest malignancies of lymphatic tissues. Occurs in less than 1% of all malignancies affecting lymph nodes and soft tissues [1,2]. The exact incidence of histiocytic sarcoma has not been described so far. In this article, we report three patients with HS, who were treated at the departement of Internal medicine, haematology and oncology, Faculty Hospital Brno. Despite the fact that all these patients had the same disease, the treatment effects differ depending on the stage of the disease at the time of diagnosis.

Castleman disease is a rare idiopathic non-neoplastic lymphoproliferative disorder with 2 clinical (unicentric and multicentric) and 3 histomorphological (hyaline-vascular, plasma-cell and mixed) forms identified. The case report given here describes the 3-year experience with therapy in a patient, male born 1961, diagnosed with multicentric plasma-cell Castleman disease (HIV and HHV-8 negative) with the finding of generalized lymphadenopathy and splenomegaly. During first line treatment (R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone, 3 cycles in total, 12/2008-2/2009) the development of bilateral upper and lower limb edemas with clinical manifestation of vasculitis occurred and a restaging computed tomography (CT) examination revealed a stable finding of the lymphadenomegaly. Greater success was achieved with thalidomide regimen (CTD: cyclophosphamide, thalidomide, dexamethasone, 10 cycles, 3/2009-1/2010) leading to reduction in the size of the hypervascularized lymph nodes (almost by 50%) as well as their radiopharmaceutical (fluorodeoxyglucose) uptake as seen on a combined positron emission tomography and computed tomography (PET/CT) scan imaging. Thalidomide was given daily at doses between 100 and 200 mg. We returned to the CTD regimen again in April 2010 after a short period of monoclonal antibody tocilizumab treatment (400 mg intravenous in 2-week intervals with 50% dose reduction due to a limited supply of the drug, 5 doses in total) during which edemas reoccurred with a CT scan finding of stable lymphadenomegaly. However, the renewed regimen with thalidomide was stopped after 2.5 cycles due to adverse effects of thalidomide (neuropathy) and corticoids (Cushing syndrome). In September 2010, after enrollment in the Celgenes Compassionate Use Program we were able to start treating the patient with the derivative of thalidomide, lenalidomide, at a dosage of 25 mg on days 1-21 in a 28-day cycle, 15 cycles in total (10/2010-12/2011). The monotherapy with lenalidomide was very well tolerated by the patient without any effects of myelotoxicity, thromboembolism or relapses of edemas and vasculitis, additionally now with apparent improvement of fatic disorder and the patients motor abilities. Thus, lenalidomide represents an attractive alternative agent for patients with Castleman disease after rituximab and cytostatics failures. It has a favourable safety profile and could be therefore considered for administering in first line treatment.

Backgrounds: Osteolytic lesions are a common manifestation of multiple myeloma, though their healing is rare in these patients. Generally, during a complete remission, lesions only stop progressing; radiologically evident recalcification is exceptional., Case: Herein we report a case of a male patient born in 1941 and diagnosed in 2005 with IgA multiple myeloma presenting with multiple osteolytic bone lesions. Administration of 4 cycles of VAD chemotherapy (vincristine, adriamycin, dexamethasone) with subsequent autologous peripheral blood stem cell transplantation and maintenance treatment with interferon alpha had resulted into a very good partial remission. In 2009, the disease relapsed with enlargement of osteolytic lesions evident on skiagrams. The largest lesion, reaching 24 x 10 mm in size, was located in the left femur. A complete remission of the disease was achieved with CVD senior regimen (cyclophosphamide, bortezomib, dexamethasone, 8 cycles in total). Bisphosphonates (zoledronate, ibandronate and, from 2007, clodronate) were administered as a long-term supportive therapy. A one-year follow-up skiagram of the left femur revealed over 50% regression of the osteolytic lesion (10 x 5 mm) documented in a set of pictures herein., Conclusion: A complete remission of the disease after an administration of bortezomib (Velcade)-based regimen in a long-term clodronate (Bonefos)-treated patient with relapsed multiple myeloma is radiographically apparent by clear healing signs of the osteolytic bone lesion.

Monoclonal gammopathy of undetermined significance (MGUS) is a precancerosis comprising two different kinds of cancer: lymphoid/lymphoplasmocytoid MGUS and plasma cell MGUS that represents about 85% of all MGUS cases. This type of MGUS has low but persistent tendency to transform to malignant disease, mainly multiple myeloma (MM), with frequency of about 1% per year. Using known risk stratification models based on clinical parameters, it is possible to identify patients' groups with average rates of progression as low as 0.26% and as high as 12% per year. However, due to the lack of clear genetic and/or phenotypic markers distinguishing MGUS from MM, we are not able to predict if and when MGUS will progress to MM in individual patients. There are partially overlapping molecular pathogenic events shared by MGUS and MM. Better understanding of pathogenesis of MGUS and MM using molecular-genetic approaches will help disclose the mechanisms of myeloma genesis; it can be also useful for identification of novel molecular targets. The ultimate goal for the near future is to develop better markers for definition of high-risk MGUS patients who will be candidates for early treatment intervention.