BACKGROUND: Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable. OBJECTIVE: This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters. STUDY DESIGN: From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated. RESULTS: Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight <10th percentile between 1.4 and 2.1. Birthweight <10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference ranges resulted in a far higher proportion identified as having fetal growth restriction compared with the Arduini Doppler reference ranges, whereas Delphi consensus definition with Ebbing Doppler reference ranges produced similar results to those of the Society for Maternal-Fetal Medicine definition. Application of Delphi consensus definition with Arduini Doppler reference ranges was significantly associated with adverse perinatal outcome, with any biometric standards/charts. The Society for Maternal-Fetal Medicine definition could not accurately detect adverse perinatal outcome irrespective of estimated fetal weight standard/chart used. CONCLUSION: Different combinations of fetal growth restriction definitions, biometry standards/charts, and Doppler reference ranges identify different proportions of fetuses with fetal growth restriction. The difference in adverse perinatal outcome may be modest, but can have a significant impact in terms of rate of intervention.

• MeSH
• Fetal Weight * MeSH
• Humans MeSH
• Birth Weight MeSH
• Fetal Growth Retardation * diagnosis   MeSH
• Pregnancy MeSH
• Ultrasonography, Doppler MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: To assess the association between newborn birth weight and the presence of intra-amniotic infection, presence of sterile intra-amniotic inflammation, and absence of intra-amniotic inflammation in pregnancies with preterm labor with intact membranes. METHODS: A total of 69 pregnancies with preterm labor with intact membranes between gestational ages 22 + 0 and 34 + 6 weeks who delivered within seven days of admission were included in this retrospective cohort study. Transabdominal amniocentesis to determine the presence of microorganisms and/or their nucleic acids in amniotic fluid (through culturing and molecular biology methods) and intra-amniotic inflammation (according to amniotic fluid interleukin-6 concentrations) were performed as part of standard clinical management. The participants were further divided into three subgroups: intra-amniotic infection (presence of microorganisms and/or nucleic acids along with intra-amniotic inflammation), sterile intra-amniotic inflammation (intra-amniotic inflammation alone), and without intra-amniotic inflammation. Birth weights of newborns were expressed as percentiles derived from the INTERGROWTH-21st standards for (i) estimated fetal weight and (ii) newborn birth weight. RESULTS: No difference in birth weights, expressed as percentiles derived from the standard for estimated fetal weight, was found among the women with intra-amniotic infection, with sterile intra-amniotic inflammation, and without intra-amniotic inflammation (with infection, median 29; with sterile inflammation, median 54; without inflammation, median 53; p = 0.06). Differences among the subgroups were identified in the birth weight rates, expressed as percentiles derived from the standard for estimated fetal weight, which were less than the 10th percentile (with infection: 20%, with inflammation: 13%, without inflammation: 0%; p = 0.04) and 25th percentile (with infection: 47%, with inflammation: 31%, without inflammation: 9%; p = 0.01). No differences among the subgroups were observed when percentiles of birth weight were derived from the birth weight standard. CONCLUSIONS: The presence of intra-amniotic inflammatory complications in pregnancies with preterm labor with intact membranes prior to the gestational age of 35 weeks was associated with a higher rate of newborns with birth weight less than the 10th and 25th percentile, when percentiles of birth weight were derived from the standard for estimated fetal weight.

• Publication type
• Journal Article MeSH

OBJECTIVE: To assess the association between the birth weight of newborns and microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation in pregnancies with preterm prelabor rupture of membranes. METHODS: A total of 528 pregnancies with preterm prelabor rupture of membranes were included in this retrospective cohort study. Transabdominal amniocentesis to determine the presence of MIAC (through culturing and molecular biology methods) and intra-amniotic inflammation (according to amniotic fluid interleukin-6 level) was performed as part of standard clinical management. Based on the presence of MIAC and/or intra-amniotic inflammation, the participants were divided into four subgroups: with intra-amniotic infection (presence of both), with sterile IAI (intra-amniotic inflammation alone), with colonization (MIAC alone), and with negative amniotic fluid (absence of both). Birth weights of newborns are expressed as percentiles derived from INTERGROWTH-21st standards for (i) newborn birth weight and (ii) estimated fetal weight. RESULTS: No differences in birth weights, expressed as percentiles derived from newborn weight standards (infection: median 52; sterile: median 54; colonization: median 50; negative amniotic fluid: median 51; p = .93) and estimated fetal weight standards (infection: median 47; sterile: median 51; colonization: median 47; negative amniotic fluid: median 53; p = .48) were found among the four subgroups. No differences in percentiles (derived from both standards) were found in the subset of participants who delivered within 72 h after rupture of membranes (newborn weight standard, p = .99; estimated fetal weight standard, p = .81). CONCLUSIONS: No association was identified between the birth weight of newborns and the presence of intra-amniotic inflammatory and infection-related complications in pregnancies with preterm prelabor rupture of membranes.

• MeSH
• Chorioamnionitis * etiology   MeSH
• Gestational Age MeSH
• Fetal Weight MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Amniotic Fluid MeSH
• Birth Weight MeSH
• Fetal Membranes, Premature Rupture * etiology   MeSH
• Retrospective Studies MeSH
• Pregnancy MeSH
• Inflammation complications   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Aim: To assess the association between the birth weight of newborns from pregnancies with preterm prelabor rupture of membranes (PPROM) and the presence of acute histological chorioamnionitis (HCA) with respect to the: i) fetal and maternal inflammatory responses and ii) acute inflammation of the amnion. Material and Methods: This retrospective cohort study included 818 women with PPROM. A histopathological examination of the placenta was performed. Fetal inflammatory response was defined as the presence of any neutrophils in umbilical cord (histological grades 1-4) and/or chorionic vasculitis (histological grade 4 for the chorionic plate). Maternal inflammatory response was defined as the presence of histological grade 3-4 for the chorion-decidua and/or grade 3 for the chorionic plate and/or grade 1-4 for the amnion. Acute inflammation of the amnion was defined as the presence of any neutrophils in the amnion (histological grade 1-4 for the amnion). Birth weights of newborns were expressed as percentiles derived from INTERGROWTH-21st standards for the i) estimated fetal weight and ii) newborn birth weight. Results: No difference in percentiles of birth weights of newborns was found among the women with the women with HCA with fetal inflammatory response, with HCA with maternal inflammatory response and those without HCA. Women with HCA with acute inflammation of the amnion had lower percentiles of birth weights of newborns, derived from the estimated fetal weight standards, than women with HCA without acute inflammation of the amnion and those with the absence of HCA in the crude (with acute inflammation: median 46, without acute inflammation: median 52, the absence of HCA: median 55; p = 0.004) and adjusted (p = 0.02) analyses. The same subset of pregnancies exhibited the highest rate of newborns with a birth weight of ≤25 percentile. When percentiles were derived from the newborn weight standards, no differences in birth weights were observed among the subgroups. Conclusion: Acute inflammation of the amnion was associated with a lower birth weight in PPROM pregnancies, expressed as percentiles derived from the estimated fetal weight standards.

• Publication type
• Journal Article MeSH

Text přímo navazuje na článek Tělesná kultura a životní prostředí, který byl publikován v minulém čísle časopisu. Článek z pozic evoluční ontologie Josefa Šmajse zdůvodňoval tvrzení, podle něhož tělesná kultura ani tělocvičná aktivita nejsou funkčně zapojené do vývoje a stability přírodního systému, ale jsou naopak součástí růstového „metabolismu“ protipřírodně orientované kultury. Cílem tohoto textu je z pohledu evoluční ontologie poukázat na různou míru i způsob protipřírodního působení tělocvičné aktivity, ale také načrtnout její „pro- -přírodní“ potenciál. Autor si pomocí běžných obecných metod fi losofi e (analýza, syntéza, zobecňování, konkretizace, abstrakce, komparace, explikace atd.) všímá spojení tělocvičných aktivit s kulturou. Tělocvičné aktivity se v tomto smyslu liší tím, v jaké míře jsou destruktivní vůči přírodě a rovněž tím, zda je problémem jejich přímé či zprostředkované působení. Zprostředkované negativní důsledky tělesného cvičení pro přírodní systém jsou výsledkem (různě těsného) spojení s ekonomickým subsystémem kultury, který je v současnosti silně orientován na zvyšování všeobecné spotřeby. Potenciální „pro-přírodní“ orientace tělesné kultury by se podle autora mohla uskutečnit prostřednictvím určitého příklonu k původní přirozené funkci pohybu, kterou je emoční, kognitivní a behaviorální vrůstání živých systémů do přírodního prostředí. Autor tak dospívá k závěru, že cestou „pro-přírodně“ orientované výchovy a vzdělání („naturalizace“) by se tělesná kultura mohla v budoucnu zapojit do potřebné „biofi lní“ rekonstrukce kultury.

This text extends the article Physical culture and environment which was recently published in this journal. That article gave reasons for physical culture and exercises (as well as all human cultural activities) which are not integrated functionally into the development and stability of nature, but they are integrated functionally into the growth of culture that is anti-natural. The aim of this text is to show a diff erent rate as well as a diff erent mode of anti-natural impact of physical culture. Another goal is to sketch a positive natural potential. The author’s concern is with the connection between physical exercises and culture by general philosophical methods (analysis, synthesis, generalization, specifi cation, abstraction, comparison, explication, etc.). Physical exercises diff er in degree of destructivity against nature and also by their diff erent mode of impact – direct or mediated. Mediated impact is given by the intensity of connection with an economical subsystem of the culture which is strongly focused on a general consumption today. The author also is concerned with the possibility of a “biophile” orientation of culture. This possibility is hidden in the “reversion” to a natural function of the movement that is emotional, cognitive and behavioural intergrowth living systems into a natural environment. Thus the author concludes that physical culture could join the intentional “biophile” reconstruction of the culture by its nature oriented enlightenment (“naturalization”).

• MeSH
• Philosophy * MeSH
• Humans MeSH
• Physical Education and Training * MeSH
• Environment * MeSH
• Check Tag
• Humans MeSH

Liečba rektálneho nádoru je multimodálna a výsledky liečby sú odrazom pokroku v zobrazovacej diagnostike, v chirurgických metódach resekcie a v neo a adjuvantnej liečbe. Cieľom práce bolo prezentovať prípad úspešne liečeného adenokarcinómu rekta a adenokarcinómu hepatálnej flexúry s recidivujúcimi metastázami a extrémne zriedkavým prerastením metastázy do venózneho systému pacienta. 61-ročný pacient podstúpil nízku resekciu rekta sec. Dixon pre stredne diferencovaný adenokarcinóm s klasifikáciou T3N0M0. Po absolvovaní chemoterapie (FUL -5-fluorouracyl) a ožiarení v dávke 50,4 Gy bol revidovaný pre metastázu adenokarcinómu do brušnej steny o veľkosti 16x15x20 cm. Po opätovnej adjuvantnej terapii FUL+Leukovorin bola exstirpovaná mestastáza opäť z brušnej steny. O 26 mesiacov od resekcie rekta sa objavil prisadlý nový polyp v hepatálnej flexúre s histologickým popisom dobre diferencovaného adenokarcinómu, ktorý bol odstránený pravostrannou hemikolektómiou. Vyšetrené lymfatické uzliny boli bez metastáz, pacient nebol indikovaný na adjuvantnú terapiu. O dva mesiace bol prijatý s flebotrombózou ľavej femorálnej vény a v priebehu nasledujúcich deviatich mesiacov bol trikrát reoperovaný a bolo aplikovaných 6 cyklov Xelody. Trikrát sa vykonala totálna exstirpácia metastázy do ľavého stehna, pričom sa histologicky potvrdilo prerastanie nádoru do vena saphena magna. Autori sa nestretli s prípadom prerastania metastázy adenokarcinómu do venózneho systému v literatúre, pri ktorom by bolo 5-ročné prežívanie pacienta. Pacient šesť rokov po prvej operácii nemá lokálnu recidívu ani metastázy.

Rectal cancer treatment has become multimodal as a result of significant advances in imaging diagnostic, in surgery technique of re section and in neo and adjuvant therapy. The aim of the case report was to present a successfully treated adenocarcinoma recti and adenocarcinoma of hepatal flexurae with recidivistic metastasis and an extremely rare intergrowth of the metastasis into venous system. A 61 year old patient underwent low resection of recti according to Dixon because of well differentiated adenocarcinoma with classification T3N0M0. The patient was reoperated because of metastasis of adenocarcinoma in the abdominal wall (16 x 15 x 20 cm) after chemotherapy (FUL-5-fluorouracyl) and radiation dose of 50.4 Gy. The metastasis of abdominal wall was extirpated after another cycle of adjuvant therapy of FUL+Leukovorin. 26 months after the first operation, a new sessile polyp was found in the hepatal flexurae with histological finding of well differentiated adenocarcinoma. The patient underwent right hemicolectomy. Since lymphatic nodes were without metastasis, the patient was not indicated for chemotherapy. Two months later, the patient was admitted because of phlebothrombosis of left femoral vein. The patient underwent three reoperations with total extirpation of recidivistic tumor located in left thigh and received six cycles of Xeloda. Histological examination proved an intergrowth into great saphenous vein. Authors did not come across a case in the literature with an intergrowth of metastasis into venous system with a five year survival of a patient. The patient from this case report has no local relapse and metastasis six years after the first operation.

• MeSH
• Adenocarcinoma secondary   MeSH
• Abdominal Wall MeSH
• Middle Aged MeSH
• Humans MeSH
• Abdominal Neoplasms secondary   MeSH
• Rectal Neoplasms pathology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Metastatické postižení plic je podle literárních údajů prokazatelné sekčně až u 20–54 % nemocných se solidním maligním nádorovým onemocněním. Sdělení dokumentuje případ nemocného s metastatickým postižením plic při generalizaci cholangiogenního karcinomu. Průběh onemocnění byl atypický, nemocný byl bez známek klinicky zřetelné cholestázy a většina symptomů vyplývala z plicního postižení, které imitovalo difuzní intersticiální plicní proces. Diagnóza byla u nemocného stanovena až sekčně. I při správném stanovení diagnózy jsou léčebné možnosti u nemocných s generalizovaným onemocněním omezené a prognóza těchto pacientů je v krátké době infaustní. Karcinomy rostou povětšinou pomalu, nicméně pokročilé onemocnění je charakterizováno lokální invazí s perineurálním a perivaskulárním šířením a prorůstáním do okolních tkání s následným metastatickým rozsevem. Za charakter metastatického šíření u různých nádorů nejspíše odpovídají růstové faktory, cytokiny, chemokiny a jejich receptory produkované nádorovými buňkami.

According to the literature, the metastatic affection of lungs can be proved by autopsy in up to 20–54 % of patients with a solid malignant tumorous disease. The report documents a case of a patient with the metastatic affection of lungs as generalization of cholangiogenic carcinoma. The course of the disease was atypical, the patient had no sings of a clinically obvious cholestasis, and most of his symptoms resulted from the pulmonary affection, which imitated an interstitial pulmonary disorder. The diagnosis was set only by the autopsy. Even in the case of a correctly set diagnosis, the therapeutical options in a generalized disease are limited and the patient’s prognosis is life limiting in short term. The carcinomas usually grow slowly; nevertheless the advanced disease is characterized by a local invasion with perineural and perivascular spread and intergrowth into surrounding tissues with subsequent metastatic dissemination. The growth factors, cytokines, chemokines and their receptors produced by cancer cells are most likely responsible for the nature of the metastatic dissemination.

• Keywords
• difuzní intersticiální plicní procesy, plicní metastázy, cholangiogenní karcinom,
• MeSH
• Cholangiocarcinoma diagnosis   complications   MeSH
• Lung Diseases, Interstitial diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Metastasis diagnosis   MeSH
• Lung Neoplasms diagnosis   complications   MeSH
• Bile Duct Neoplasms diagnosis   MeSH
• Disease Progression MeSH
• Bile Ducts, Intrahepatic MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH