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Disseminated intravascular coagulation (DIC) is characterized by systemic activation of the haemostasis. In many instances the release of inflammatory cytokines and tissue factor trigger the system in septic or traumatic conditions. Initially, the increased activation of haemostasis can be compensated by natural inhibitor systems. As release of the triggers persists, inhibitors (e.g. antithrombin and protein C) will be consumed leading to intravascular clotting. In this process many coagulation factors, most notably fibrinogen and platelets are consumed too, resulting in a failure of haemostasis system and in a diffuse bleeding (decompensated DIC). Fresh frozen plasma, blood transfusion, and fibrinogen concentrate correct the bleeding, if needed, in the case of traumatic (obstetric) DIC. Arrest of the activated haemostasis by heparin and natural anticoagulants (antithrombin or/and protein C) is recommended, mainly in septic conditions with systemic inflammatory reactions. A case of stercoral sepsis usefully treated by recombinant human activated protein C is reported.

Advanced glycation end products--AGEs take part in the pathogenesis of many diseases and their complications--e.g. diabetes mellitus, chronic renal failure, atherosclerosis, Alzheimer's disease. Their determination could be of importance for follow up of progression of these diseases. Determination of AGEs is very difficult due to the heterogeneity of this group of substances, lack of standards, long analytical procedures and necessity of equipment. There are several methods for determination of advanced glycation end products: immunochemical method--ELISA (enzyme linked immunosorbent assay) with the use of either polyclonal or monoclonal antibodies, fluorimetry using the characteristic fluorescence spectrum of AGEs, HPLC--high performance liquid chromatography, and MS--mass spectrometry. Mass spectrometry is the best and most precise method. When coupled with other methods, mass spectrometry is a unique research method, which can be used mainly for characterization of new AGEs. HPLC is very precise as well, but its drawback is time-consuming sample preparation. Fluorimetry and ELISA could be in the future used for the special diagnostic of complications of chronic diseases.

Leptin is a protein hormone produced by adipocytes. Its basic known function is its central hypothalamic action leading to reduction of food intake and augmentation of energy expenditure and thus to reduction of body weight. Various types of leptin receptors were found in other organs and tissues. The kidney is the main site, where leptin is eliminated from the body (probably by tubular degradation) under normal conditions and its blood concentrations increase significantly during renal failure. Leptin increases diuresis and natriuresis, increases sympathetic nerve activity in the kidney and participates in the elevation of blood pressure. It can also be involved in morphological changes in renal tissue, such as glomerulosclerosis, or stimulate growth and invasiveness of tumours.

Excessive daytime sleepiness arises frequently as a consequence of insufficient or shortened nocturnal sleep, or as a result of poor sleeps hygiene. One of the most common dyssomnias with imperative sleepiness is narcolepsy. Narcolepsy is a chronic disease that greatly affects quality of life. The present study of 57 patients shows that the negative assessment is partly due to the subjective views exhibited by the narcoleptic personality prone to underestimation, negative self-image and depressive disposition. The personality traits may be due to an adaptation reaction to the disease but also to the biological predisposition. Comparison with population data for our Republic brought no evidence of progress at education or family life being adversely affected by narcolepsy, however, decreased assertion in employment and limitation in self-realization in free time was an explicit consequence of the disease. All 57 patients reported excessive daytime sleepiness as the most discomforting symptom that in 40% of them was responsible for career curtailment in a productive age and for living on partial or full disability.

Authors refer the current level of diagnosis and therapy of sleep apnea syndrome in Germany. The sleep labs are perfectly equipped with recently developed diagnostic systems. Also the treatment of patients with CPAP system (continuous positive airways pressure) is very good organized.

Fasting plasma levels of both cortisol and sex hormone binding globulin (SHBG) in obese women were significantly inversely related to anthropometric characteristics of body fat distribution. It means that a central accumulation of body fat might be partly mediated by cortisol and SHBG levels. Significant within-pair resemblance observed in plasma cortisol level in obese female monozygotic twins suggests an important role of genetic factors in determination of cortisol secretion. However, no within-pair similarities revealed in plasma SHBG concentrations favour a major role of environmental factors in the regulation of plasma SHBG level. On the other hand the twin study supported the role of genetic determinants in changes of both cortisol and SHBG levels in response to energy deficit induced by very low calorie diet (VLCD). The mechanisms controlling baseline levels of cortisol and SHBG apparently differ from those controlling their responses to energy restriction.

At present, obesity is considered one of the major health problems. It is a predisposing factor of several chronic diseases including non-insulin dependent diabetes mellitus (NIDDM) and coronary heart disease (CHD). Leptin levels in humans have been found to be highly correlated with total adiposity. We performed statistic analysis in order to identify linkage between leptin levels and anthropometric parameters in a group of 285 Czech obese children (152 girls and 133 boys) aged 7 to 18 years. The children were measured using the standard anthropometric technique according to Martin and Saller [16] at the beginning and end of a five-week therapeutic weight reduction programme. The skin fold thickness at 14 sites was assessed by means of Best calliper. The body composition was evaluated using Matiegka's technique. The leptin levels were investigated on the beginning and end of the reduction programme by direct enzyme linked immunosorbent assay (ELISA). For the evaluation of the grade of obesity, body weight, BMI (body mass index), RI (Rohrer's index), FMI (fat mass index) and normalized body weight, normalized BMI and RI were plotted. Correlation analysis shows relation between leptin concentration and FMI to be the most significant. As to ponderal indexes, normalized RI shows the most significant positive correlation. Leptin concentrations are negatively correlated with the proportion of the weight of skeletal muscles by Matiegka both in girls and boys. Intersexual differences in correlations between leptin concentrations and normalized circumferences are observed, as well as in correlations between leptin and particular skin fold thickness. We also tested relations between the magnitude of leptin decreases and magnitude of decreases of anthropometric parameters. There is a strong endorsement both in girls and boys of positive correlation between decrease of leptin concentration and fat reduction. Interestingly, differences between boys and girls in relations between leptin decrease and change in lean body mass had been observed.

Introduction: Obesity and overweight correlate with endocrine disorders in women, polycystic ovary syndrome, there are more atretic follicles in the ovary of obese women, overweight affects ovulation, pregnancy rates and outcomes in natural as well as in treated cycles. Similarly starvation correlates with menstrual cycle disturbances with anovulation.

Material and methods: The study includes 309 IVF treatment cycles performed in our IVF centre between 1/1/97 and 30/6/99. The patients were divided into five groups according to nutrition evaluated by body mass index (BMI). The parameters of IVF treatment includes the number of follicles, the number of collected oocytes, the recovery rate, the number of fertilized oocytes, the fertilization rate, the number of cleaved embryos, the cleavage rate, the clinical pregnancy rate, the take home baby rate, the miscarriage rate. The unpaired t-test was used in statistical analysis.

Results: There were found statistically significant less number of cycles with more than 10% fertilized oocytes and lower recovery rate in the obese and overweight women.

Conclusions: Overweight and obesity significantly affect the parameters and outcomes of IVF treatment. The fertilization of the oocytes failed more often in the obese and overweight women. The lower pregnancy rates were achieved although the high oocytes recovery and high normal cleaved embryos were found in the obese women. The cause of the bad IVF treatment outcomes in the obese women seems to be probably the affected quality of the oocytes with lower fertilization and implantation potential eventually affected endometrium quality. The overweight reduction is the important part of infertility treatment in obese women.

The author presents a brief of the position of the surgery during centuries in Czech. He mentions the conditions for university education of the surgery since 1848. In 1860 the Czech Medical Society was founded and in 1862 the first issue of the Czech Medical Journal (Casopis lékarů ceských) was published. The first Czech lecture was made on 28th April 1882 on the Czech surgery clinic. The climax of Czech desires of revival was the separation of Czech and German clinics in 1882. The development of some medical disciplines, incl. surgical disciplines, made the surgeons abandon the Czech Medical Society and after the establishment of the committee of the Czechoslovak Republic they founded in 1920 the committee of the Czechoslovak Society for Surgery and Gynaecology. There is explained origin of title MUDr., so typical for graduated students on Prague Medical Faculty. The First Surgery Clinic (founded in 1920) of the Charles University and General Hospital in Prague is continuator of the Czech surgery clinic.

Unlabelled: The common basis of systemic inflammatory response to surgical trauma is the activation of cytokine cascade, accompanied by the release of soluble cytokine receptors. The main cytokine axis stimulates the release of acute phase proteins (APP) form liver, modulates metabolic pathways and hormonal responses. The aim of this study was to assess characteristic changes in levels of pro- and anti-inflammatory cytokines in early post-op stages after a major intraabdominal surgery and to compare the results with dynamic changes in APP levels. The results will form a basis of evaluation of diagnostic value of certain cytokines and APP in post-operative complications.

Subjects and methods: Subjects fell into three categories: 1--patients after colonic resection for colorectal carcinoma I. and II. grade (N = 20), 2--patients after hemipancreatoduodenectomia (N = 17) and 3--control group of 18 healthy subjects. The levels of following parameters were measured between from one day before to three days after surgery: tumour necrosis factor-alpha, interleukin (IL)-1 beta, IL-1ra, IL-2, IL-6, IL-8, IL-10, soluble IL-2 receptors, C reactive protein (CRP) and alpha1-antitrypsin (AAT).

Results: Measured parameters exhibited different dynamic changes in reaction to surgical trauma, according to their roles in immune reaction. Main pro-inflammatory cytokines culminated within 24 hours from the onset of surgery, marked elevations were noted in IL-1ra and the soluble IL-2 receptor. Both measured APP were rising until he 72nd hour post surgery, and their rise was markedly delayed compared to cytokines. The extent of immune reaction as measured by the amplitude of changes in both types of surgery was similar in most measured parameters, apart from marked difference in IL-2R. We also noted significant correlation of plasma levels of IL-6 and IL-1ra.

Conclusions: Surgical trauma as any other significant painful stimulus activates the pro-inflammatory cytokine axis with secondary response of APP. The release or pro-inflammatory cytokines, i.e. TNF-alpha, IL-1, IL-6 and IL-8 is synchronized with the release of antagonistic mediators (i.e. IL-1ra, IL-10, IL-2 and IL-6 soluble receptors), who precede the acceleration of APP production and thus modulate its extent. The evaluation of relationships between pro- and anti-inflammatory factors with regard to prognosis is confounded by unclear interpretation of their changes. The maximum effect of cytokines takes place at local autocrine and paracrine level and systemic levels do not reflect this. This is how we explain minimal changes in plasma levels of IL-1 beta and IL-2, despite their key role as initiators of cytokine cascade. In order to increase their diagnostic value the use a series of measurements is advocated in combination with other clinical and laboratory parameters of inflammation, such as the levels of acute phase prot