1st Faculty Of Medicine Research Articles

Analysis of the Relationship between Psychiatric and Addiction-Related Disorders in Patients of an Outpatient Addiction Treatment Clinic for Children and Adolescents.

Dual diagnosis is used in addiction medicine to refer to the co-occurrence of an addiction-related disorder and another psychiatric disorder in the same individual. Adolescence is a key period for the development of both mental disorders and addictions. The aim of this study is to describe the relationships between psychiatric and addiction-related disorders in patients of the Outpatient Addiction Treatment Clinic for Children and Adolescents at the 1st Faculty of Medicine, Charles University in Prague in 2015-2022. Data were retrospectively analyzed from the hospital's medical system, which collects basic diagnostic data on patients. Descriptive statistics and cluster analysis were performed to identify relationships between psychiatric and addiction-related disorders. Of the 450 patients, 153 patients (34%) met the criteria for dual diagnosis. The most common addiction-related disorders were mental and behavioural disorders due to the use of cannabinoids (35%) and internet gaming disorder (35%). The most common psychiatric diagnoses were behavioural and emotional disorders with usual onset in childhood and adolescence (64%), with a lower prevalence in girls than in boys. These findings may be important for the diagnosis and treatment of risky behaviours and addictions in children and adolescents.

Robotic distal pancreatectomy - the first experience.

Minimally invasive distal pancreatectomy (MIDP) includes both laparoscopic and robotic distal pancreatectomy (RDP). MIDP is often adopted first due to the absence of the requirement of a complex reconstruction. In recent years, an increase in the use of robotic surgery has been noted. The authors present initial experience with RDP and retrospective analysis of data from prospectively collected database. Between September 2021 and October 2022 five patients undergoing RDP with splenectomy performed in the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital were included from a prospectively maintained database. The age was from 20 to 70 years. No conversion was required. One patient underwent reoperation due to staple-line hemorrhage. Postoperative hospital stay was from 4 to 14 days. The follow-up period was from 2 to 14 months. Our first experience demonstrates RDP is a safe and efficacious approach for tumors of pancreatic body and tail in selected patients. A larger number of patients is needed to obtain more accurate results.

Leber congenital amaurosis and early onset severe retinal dystrophy in the Czech Republic: Mutational spectrum and clinical findings

AbstractPurpose: Leber congenital amaurosis (LCA)/early onset severe retinal dystrophy (EOSRD) is a group of ultra‐rare retinal diseases with an estimated prevalence of 1/80 000. The aim of this study was to perform a detailed clinical characterization in patients with LCA/EOSRD confirmed at the DNA level.Materials and methods: 16 patients (eight females, eight males) from 16 families underwent ocular examination in the Department of Ophthalmology, 1st Faculty of Medicine and General University Hospital in Prague between the years 2010–2021. Pathogenic variants in genes associated with LCA/EOSRD were searched using targeted gene panels, exome and/or genome sequencing. Confirmation of the presence of causal variants and segregation within the families was performed by Sanger sequencing. Next we have performed review of available clinical documentation of five additional probands examined elsewhere in the Czech Republic.Results. The mean age at the first examination was 17.8 years (range 2–42 years). The mean age of symptoms onset was 1,99 years (range 6 weeks to 5 years). In five patients, the disease was caused by biallelic mutations in the RPE65 gene, in 4 patients in the CEP290 gene and in three patients in the CRB1 gene. Biallelic mutations in the GUCY2D, LCA5, RPGRIP1 and CLN3 genes were the cause of the disease in one patient each. As for probands suffering from LCA/EOSRD and examined elsewhere two were documented carriers for pathogenic variants in the CEP290 gene, two in the CRB1 gene and one in the GUCY2D gene.Conclusions: This is the first study presenting molecular genetic and clinical characteristics of patients with LCA/EOSRD from the Czech Republic. Biallelic mutations in the CEP290 gene are the most common genetic cause of LCA/EOSRD in our patient group.This work was supported by NU20‐07‐00182; EJPRD19‐234 Solve‐RET.

Snail track a in a case with anterior segment dysgenesis caused by a novel FOXC1 variant

AbstractPurpose: To identify disease‐causing mutation in one proband of Czech origin with anterior segment dysgenesis (ASD) and to describe the associated phenotype.Methods: After complex ophthalmic examination of 15‐year‐old female at the Department of Ophthalmology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, DNA extraction from blood was performed. Pathogenic variants in genes associated with ASD were searched using exome sequencing. Confirmation of the presence of causal variant and segregation within the family members was performed by Sanger sequencing. Standard paternity testing was performed to confirm de novo origin of the variant.Results: Except for common finding of ASD as mild iris hypoplasia, pupil deformation in both eyes, and unilateral iridocorneal adhesions, there was a snail track lesion of the right cornea at the level of the Descemet membrane. Molecular genetic analysis revealed that the proband was a carrier of a novel heterozygous frameshifting variant in the FOXC1 gene: NM_001453.3: c.605del, p.(Pro202Argfs*113). De novo origin was confirmed by the absence of the variant in healthy parents and sister of proband, and further by the paternity testing.Conclusions: Loss of visual functions in ASD is often very acute, therefore establishing molecular diagnosis highly impacts patient management and enabling prenatal diagnostics. Further studies need to be performed to verify if there is a true association of snail tracks and pathogenic variants in FOXC1.

Timing of caesarean section and its impact on levator ani musle avulsion at the first subsequent vaginal birth - a pilot study.

The aim of this multicentric observational study was to explore the impact of the timing of cesarean section (SC) on levator (MLA - levator ani musle) avulsion at the first subsequent vaginal birth. All women after term vaginal birth following a cesarean section (VBAC) for their second delivery at the Departments of Gynecology and Obstetrics, Faculty of Medicine, Charles University and University Hospital in Pilsen and the 1st Faculty of Medicine, Charles University and General Hospital in Prague, between 2012 and 2016 were identified. Hospital database and surgical notes were used to collect basic characteristics of the patients including the indication and course of their previous delivery. These women were divided into two groups according to indication of prior SC in the previous delivery to women with elective SC and acute SC. All participants were invited for a 4D pelvic floor ultrasound to assess levator trauma. Levator avulsion and the levator hiatus area were assessed off-line from the stored pelvic floor volumes. Data were statistically assessed. A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for 141 women for statistical analyses. These were further divided into 80 women after acute SC and 61 women after elective SC. The levator avulsion rate was higher in the elective SC subgroup, but the difference was not significant (26.3 vs. 41.0%, P = 0.0645). No statistical differences in urogenital hiatus enlargement and ballooning were observed. VBAC is associated with a significantly higher rate of levator ani avulsion compared to the first vaginal birth in nulliparous women. However, it seems that risk of levator ani avulsion doesnt depend on the timing of SC in previous labor. More studies are needed to confirm the results of this pilot study.

Stres i emocje studentów ostatniego roku Wydziału Lekarskiego. Znaczenie w zarządzaniu ochroną zdrowia

The subjects were 134 final-year students of Warsaw Medical University, 1st Faculty of Medicine. The purpose of the study was to measure the dominant coping strategy, moderated by positive and negative emotions, which can be important in management. The variance analysis showed that activation of negative emotions resulted in a significant rise in emotion-oriented and avoidance-oriented coping. At the same time, the level of a task-oriented strategy decreased significantly, which seems to be very important in healthcare management.

Vaginal birth after Cesarean section and levator ani avulsion: a case-control study.

The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section (VBAC) in comparison with vaginal delivery in primiparous women. In this two-center observational case-control study, we identified all women who had a term VBAC for their second delivery at the Departments of Obstetrics and Gynecology at the Faculty of Medicine in Pilsen and the 1st Faculty of Medicine in Prague, Charles University, Czech Republic, between 2012 and 2016. Women with a repeat VBAC, preterm birth or stillbirth were excluded from the study. As a control group, we enrolled a cohort of primiparous women who delivered vaginally during the study period. To increase our control sample, we also invited all primiparous women who delivered vaginally in both participating units between May and June 2019 to participate. All participants were invited for a four-dimensional pelvic floor ultrasound scan to assess LAM trauma. LAM avulsion and the area of the levator hiatus were assessed offline from the stored pelvic floor volumes obtained at rest, during maximum contraction and during Valsalva maneuver. The laterality of the avulsion was also noted. The cohorts were then compared using the χ2 test and Wilcoxon's two-sample test according to the normality of the distribution. P < 0.05 was considered statistically significant. Multivariate regression analysis, controlling for age and body mass index (BMI), was also performed. A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for statistical analysis for 141 women. The control group comprised 113 primiparous women. A significant difference was observed between the VBAC group and the control group in age (32.7 vs 30.1 years; P < 0.05), BMI (28.4 vs 27.4 kg/m2 ; P < 0.05) and duration of the first and second stages of labor (293.1 vs 345.9 min; P < 0.05 and 27.6 vs 35.3 min; P < 0.05, respectively) at the time of the index birth. The LAM avulsion rate was significantly higher in the VBAC compared with the control group (32.6% vs 18.6%; P = 0.01). The difference between the groups was observed predominantly in the rate of unilateral avulsion and remained significant after controlling for age and BMI (adjusted odds ratio 2.061 (95% CI, 1.103-3.852)). There was no statistically significant difference in the area of the levator hiatus at rest (12.0 vs 12.6 cm2 ; P = 0.28) or on maximum Valsalva maneuver (18.6 vs 18.7 cm2 ; P = 0.55) between the VBAC and control groups. The incidence of levator hiatal ballooning was comparable between the groups (17.7% and 18.6%; P = 0.86). VBAC is associated with a significantly higher rate of LAM avulsion than is vaginal birth in nulliparous women. The difference was significant even after controlling for age and BMI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Morbidity and mortality associated with thyroid surgery - retrospective analysis 19912010.

The incidence of thyroid disorders has been rising worldwide. Unlike the incidence, mortality associated with malignant thyroid cancer shows only amodest increase. Between 1979 and 2009, mortality in Czech women increased from 1.21 to 1.31 and in Czech men from 0.54 to 0.74 cases per 100,000 individuals. Methods: Aretrospective statistical analysis was performed in patients undergoing thyroid surgery at the Department of Otorhinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine, Charles University and University Hospital Motol, and at the Department of Otorhinolaryngology of the Institute for Postgraduate Medical Education in Prague from 1991 to 2010 (twenty years). In this period, 11,005 procedures were done for thyroid disease. The study analysed the incidence, morbidity, mortality, surgical complications and lethality. The study group included surgeries in 1588 male and 9417 female patients. The male/female ratio was 1:5.93. Benign thyroid tumours - mean patient age is 54.7 years; recurrent nerve morbidity is 1.37% (calculated from exposed nerves). Hypocalcaemia incidence is low, 5.4% of permanent hypocalcaemia or hypoparathyroidism, respectively, based on decreased serum parathyroid hormone (PTH) levels. Temporary hypocalcaemia is much more frequent, occurring in almost 15% cases depending on age, season of the year, and nutritional status. Hypoparathyroidism was demonstrated based on laboratory serum PTH levels only in 0.3% patients. In total, 442 patients were operated for the mechanic syndrome (alarge goitre). The mean thyroid volume was 493 ml±136 ml; however, the maximum volume was 980 ml and weight 1115 g. The incidence of recurrent nerve injury occurs in 4.5%, i.e. the morbidity is 2 times higher compared to surgeries for other diagnoses. The incidence of hypoparathyroidism is not higher compared to other surgeries. Revision surgeries were indicated more commonly in malignant thyroid diseases, particularly in papillary and follicular carcinomas. Cervical lymph nodes procedures comprise another large segment in tumour treatment. Our analysis supports selective neck dissections while preserving non-lymphatic structures. As arule, mortality associated with thyroid surgery is divided as mortality in the perioperative period (within 24 hours after the procedure) and early postoperative mortality (within 120 hours after the procedure). Surgery-related mortality was never classified as perioperative or within 24 hours after the procedure. Despite that, we believe that perioperative mortality within 120 hours after the procedure, which occurred in 7 cases, is very important. Mortality of the group was 0.007%. Each surgery procedure is associated with complications, morbidity and mortality. Experience of endocrine surgeons of all disciplines leads to avery low incidence of recurrent nerve and parathyroid gland injuries while at the same time achieving sufficient radicality. This, in cooperation with other medical fields such as endocrinologists, nuclear medicine specialists and oncologists, supports asafe and effective management of all thyroid disorders, including agood prognosis of patients with most types of cancer. Key word: thyroid surgery - complications recurrent nerve - hypoparathyroidism lethality.

Malignancy after lung transplantation

Lung transplantation has become asuccessful life-saving treatment for patients with end-stage pulmonary disorders. Long-term survival outcomes after lung transplantation have been improving with increasing experience. Malignancies occupy the third position among the causes of death, particularly between years 5 to 10 from lung transplantation. The risk factors include predominantly high doses of immunosuppressive therapy, older age, infections caused by oncogenic viruses and smoking history. We retrospectively evaluated all patients undergoing lung transplantation between 2010 and 2019. The aim of this study was to analyze the incidence, type and location of tumors, time from detection, survival time and cause of death in patients with malignant tumors after lung transplantation. In total, 308 lung transplantations were performed at the 3rd Department of Surgery of the 1st Faculty of Medicine, Charles University and University Faculty Hospital in Motol between 2010 and 2019. Posttransplant malignancy was diagnosed in 32 patients; atumor was detected in the explanted lung in 5 patients. Lung cancer was the most frequent tumor in our study and was found in 13 patients (37%); 6 patients (17%) had anonmelanoma skin cancer; and posttransplant proliferative disease developed in 4 patients (12.5%). The incidence rate of other types of malignancy was low. Mean of survival after diagnosis was 152 days. Life time administration of immunosuppressive therapy in lung transplanted patients plays akey role in the prevention of rejection but on the other hand it represents arisk factor for cancer development. Oncological management of posttransplant cancer is based on reduction of immunosuppressive therapy, combined with surgical resection of solid organ tumors and other types of cancer therapy. Oncology screening tests should be done regularly as amethod of prevention, and for an early detection of any tumor.

The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls.

The treatment strategy of parotid gland tumours depends mainly on the histopathological type of the lesion. Fine-needle aspiration biopsy (FNAB) is recommended in preoperative diagnostics. The aim of the study was to evaluate the FNAB standing in the diagnostic algorithm of parotid gland lesions and to correlate FNAB results in relation to the definitive histopathological diagnosis. The retrospective analyses of 651 examined and consequently surgically treated parotid gland lesions at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague between 2006 and 2016 were used. Preoperative cytological results were consequently evaluated in relation to the definitive histopathological diagnosis. The cohort consisted of 367 women and 284 men (average age 58years). FNAB was diagnostic in 604 (92.8%) patients and non-diagnostic in 47 (7.2%) patients. The result of FNAB was positive (suspicious for malignant tumour) in 89 (14.7%) patients and negative (benign) in 515 (85.3%) patients. Sensitivity of the examination was 80.00%, specificity was 93.82%, PPV 62.92%, NPV 97.28%, and LR + and LR- were 12.95 and 0.21, respectively, with an accuracy of 92.22%. Our results confirm the significant role of FNAB in the diagnostic algorithm of parotid gland lesions.

Prevalence of restless legs syndrome in functional movement disorders: a case–control study from the Czech Republic

ObjectivesThe prevalence of restless legs syndrome (RLS) in functional movement disorders (FMD) is not known. Patients with FMD often present with multiple motor and sensory symptoms. Some of these symptoms...

Anti-inflammatory therapy in the treatment of cardiovascular diseases.

Copyright © Polskie Towarzystwo Kardiologiczne Mariusz Tomaniak — cardiology resident and doctoral candidate in the 1st Department of Cardiology at Medical University of Warsaw, graduated with honours from the 1st Faculty of Medicine at Medical University of Warsaw in 2013, accepted for residency and PhD studies with the highest scores in 2014. Awarded with Ministry of Health (2010, 2011) and Ministry of Science and Higher Education Scholarships (2012) for scientific and experimental achievements. His current areas of research involve individualisation of cardiovascular pharmacotherapy with emphasis on antiplatelet and antithrombotic agents, novel technologies applied in the treatment of coronary artery disease, invasive cardiology, cardiac biomarkers and acute heart failure. His recent publications include papers on platelet function testing, non-vitamin K oral anticoagulants, bioresorbable vascular scaffolds, microRNAs and galectin-3 in acute decompensated heart failure and monographies on “Fondaparinux” and “Hypercholesterolaemias and dyslipidaemias”.

Abstracts from ATTD 20158th International Conference on Advanced Technologies &amp; Treatments for DiabetesParis, France—February 18–21, 2015

Abstracts from ATTD 20158th International Conference on Advanced Technologies &amp; Treatments for DiabetesParis, France—February 18–21, 2015

Transanal endoscopic microsurgery for rectal cancer at the 3rd Surgical Clinic of the 1st Faculty of Medicine, Charles University and the University Hospital in Motol in 2008–2013

Transanal endoscopic microsurgery for rectal cancer at the 3rd Surgical Clinic of the 1st Faculty of Medicine, Charles University and the University Hospital in Motol in 2008–2013

The impact of antinuclear antibodies on paternal lymphocyte immunization in women with recurrent miscarriage outcome

Karin Malickova1,∗, Michal Koucký2, Antonin Pařizek2, Květa Pelinkova1, Helena Brodska1, Zdeněk Hajek2, Anna Germanova2, Oto Mestek3, Tomas Zima1 1 Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and 1st Faculty of Medicine of Charles University in Prague, Czech Republic 2 Department of Gynecology and Obstetrics, General University Hospital and 1st Faculty of Medicine of Charles University in Prague, Czech Republic 3 Institute of Chemical Technology Prague, Czech Republic

Balance deficits and ADHD symptoms in medication-na&amp;iuml;ve school-aged boys

Background and objectivesFunctional disturbances developed early in life include balance deficits which are linked to dysfunctions of higher levels of cognitive and motor integration. According to our knowledge, there are only a few studies suggesting that balance deficits are related to behavioral disturbances in attention-deficit/hyperactivity disorder (ADHD).MethodsWe tested the extent to which balance deficits were related to ADHD symptoms in 35 medication-naïve boys of school age (8–11 years) and compared the results with a control group of 30 boys of the same age.ResultsADHD symptoms in medication-naïve boys had specific relationships to disturbances of postural and gait balance.ConclusionTo our knowledge, this study provides the first evidence in the medical literature for a direct relationship between ADHD symptoms and balance deficits, that cannot be attributed to medication and the presence of any neurological disease.

Case-report: Scleroderma with longitudinally extensive myelitis

WCN 2013 No: 2685 Topic: 6 — MS & Demyelinating Diseases Case-report: Scleroderma with longitudinally extensive myelitis J.P.R.P.T. de Azevedo, G.D.C. Ferreira, F.K.M.S. Pinto, L.A.A. Reis, L.V. de Oliveira, D.S. Diniz. Neuroscience Nucleus, Clinical Hospital of Goias Federal University, Goiânia, Brazil; Faculty of Medicine, Federal University of Goias, Goiania, Brazil Background: There is an intrinsic relationship between systemic autoimmune diseases and myelitis. Most of them are reported with acute transverse myelitis, some of them with longitudinally extensive myelitis (LTEM) and by now in the Neuromyelitis optica spectrum disorders (NOSD) Researching in major scientific directories there are no cases reporting the association between acute myelitis and Scleroderma. Objective: Describe an unreported association with Scleroderma and LTEM. Patients and methods: A 53 year old man was admitted with progressive weakness in the last 24 h. Symptoms began with sudden pain and leg paresthesia and evolved to a complete medullary syndrome with paraplegia, bladder dysfunction and a sensory impairment by the level of T8. He was previously diagnosed with Scleroderma four years ago. He presented by Raynoud fenomena, sclerodactyly and telangiectasia in the face, chest, and upper and lower limbs. He presented a positive nucleolar pattern ANA. Lab tests have shown elevated proteins in CSF and elevated CRP and ESR. A full spinal MRI has shown a contiguous T2 increased signal beginning from the bottom of the medulla oblongata to the level of T8 confirmed in the transactional view. Results: The patient was submitted to a five-day course of Methylprednisolone followed by a course of Intravenous Human Hyperimmune Gammaglobulin. The patientwas dischargedwith prednisone, colchicin and chloroquine. He returned 27 days later fully walking, without bladder or sensory dysfunctions. Antiaquaporin-4 IgG autoantibody was negative. Conclusion: This case reported the association between Scleroderma and LTEM in the NOSD. doi:10.1016/j.jns.2013.07.1348 Abstract — WCN 2013 No: 2707 Topic: 6 — MS & Demyelinating Diseases Neurological symptoms in demyelinating disease mimicking an acute ischaemic stroke—Case report WCN 2013 No: 2707 Topic: 6 — MS & Demyelinating Diseases Neurological symptoms in demyelinating disease mimicking an acute ischaemic stroke—Case report K. Majstorovic, A. Arsovska, M. Perovska. Institute of Nephrology, Struga, The Former Yugoslav Republic of Macedonia; University Clinic of Neurology, Skopje, The Former Yugoslav Republic of Macedonia Background: The case presented here emphasizes the role of an accurate diagnosis for proper targeting of therapy. Objective: Demyelinating disease should be considered even in older patients with focal and fluctuating neurological symptoms. Patients and methods: In March 2013, a 50-year-old woman was admitted with acute left hemiplegia and severe dysarthria, which occurred three days ago. Ten days earlier the patient had intense vertigo, nausea, vomiting, diplopiae, speech difficulty and unstable gait. Neurological status on admission showed severe dysarthria, bilateral rhythmic nystagmus, left hemiplegia, vivid generalized muscle tendon reflexes with asymmetry in the right and positive Babinski sign on the right. In the following days MRI of the brain and lumbal puncture were performed. MRI of the brain showed hypersignal changes in T2 and FLAIR images. CSF electrophoresis showed mild immune activity in the central nervous system.VEP showed a prolonged latency in P100 on the right eye. Results: Therefore, disseminated demyelinating process was diagnosed and intravenous methylprednisolone treatment was initiated (1 g/day for 5 days) with a subsequent progressive improvement of the neurological symptoms. Discussion: Our case has shown that sudden, rapid and unusual neurological deficits can be observed in multiple sclerosis (MS). In such cases, there is a wide range of diseases in the differential diagnosis, including ischemic cerebrovascular events. The presented case demonstrates rare Multiple Sclerosis cases with late onset of the disease by the age of 50.The correct diagnosis of these two entities is essential for proper treatment. doi:10.1016/j.jns.2013.07.1349 Abstract — WCN 2013 No: 2349 Topic: 6 — MS & Demyelinating Diseases Memory impairment in patients with clinically isolated syndrome WCN 2013 No: 2349 Topic: 6 — MS & Demyelinating Diseases Memory impairment in patients with clinically isolated syndrome E.Hyncicova, E.Meluzinova,M. Vyhnalek, J. Vecanova, J. Libertinova, I. Kovařova, T. Nikolai, J. Hort, J. Laczo. Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology, 1st Faculty ofMedicine, Charles University andGeneral UniversityHospital in Prague, Prague, Czech Republic Abstracts / Journal of the Neurological Sciences 333 (2013) e358–e421 e369

The Public Health Service in the Czech and Slovak Republics Celebrates its 60th Anniversary

Since the Age of Enlightenment, efforts to prevent disease in Europe have traditionally upheld an acceptably good standard. An implicit factor was the charitable attitude of many physicians and health workers as well as the drive to create the organizational and educational background necessary for the principles of primary prevention to be introduced into actual practice. The Institute of Hygiene of the Czech Faculty of Medicine, now known as the Institute of Hygiene and Epidemiology, 1st Faculty of Medicine at Charles University in Prague, was founded in 1 897. An analogical institute at the German Faculty of Medicine in Prague was founded at an earlier date, in 1 884.An important milestone in the development of regional efforts in the field of public health was the establishment of the National Institute of Public Health in 1925. The prominent figures in this process had largely acquired their expertise in the USA; hence a modern school of epidemiology was formed, among its leading lights the eminent Karel Raska, who became the Director of the Division of Communicable Diseases at the WHO Headquarters in Geneva and was one of the authors and managers of the smallpox eradication programme. During the post-war period, leading specialists from Czechoslovakia were trained in epidemiology at the London School of Hygiene and Tropical Medicine, a contact that has remained to this day.Anetwork of regional public health stations, based on the Soviet model, was set up in 1953. This was followed by the founding of Prague's 3rd Faculty of Medicine at Charles University in 1953.These days, what we miss most is an expert critical analysis of the successes, failures or potential errors of the public health service over the past six decades, and to even the score are some examples of the various practical applications of our preventive medicine, specifically in the field of epidemiology.The post-war period involved a campaign against venereal diseases, and decrease in incidence of tuberculosis and, with the much underestimated and close cooperation of the veterinary service, brucellosis.The former Czechoslovakia was the first country worldwide to start mass anti-polio vaccinations in the early 1960's, thus becoming a precedent for other states, and Czechoslovak doctors participated in the first ever eradication of smallpox; neither of these facts were ever fully appreciated both on the national and international level, although the eradication of smallpox as such was a global event that deserved the Nobel Prize Award.In the field of non-infectious diseases, there was an extensive epidemiological study of endemic goitre in the late 1 940's and early 1950's, performed by our clinical endocrinologists. The standards presented therein continue to mirror the relatively strict qualitative criteria of current epidemiological studies and have led to the systematic iodination of salt; likewise, this country was among the first to introduce fluoridation of drinking water to prevent caries, again on the basis of a thorough epidemiological study.Unfortunately, the frequent socio-political changes in this country throughout the last century undeniably disrupted the ongoing system of prevention. Accordingly, the present primary prevention system must adapt to existing social and economic change; much has been achieved, but a backup to the complex structure of existing primary prevention is urgently required.Czech public health is rooted in the German school founded by Max von Pettenkofer and Robert Koch. The Czech school enriched its predecessor with experimental aspects by providing safe drinking water via Kabrhel's Index and, later, through recognition of the pathophysiological factors expounded in the works of Teissinger, who by the mid-1 930's had laid the foundations of present-day biological exposure tests or biomarkers of exposure to environmental toxicants. Several years after the last London smog episode, when the best available health indicator was recorded mortality, Kapalin and Symon were demonstrating adverse environmental effects on growth changes and haematological parameters in exposed children; in this they contributed to the application of more sensitive and sophisticated indicators of health status. …

Chronic repetitive nonprogressive epilepsia partialis continua due to rheumatoid meningitis

David Krysl *, Josef Zamecnik , Ladislav Senolt , Petr Marusic a Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic c Institute of Rheumatology and 1st Faculty of Medicine, Charles University in Prague, Czech Republic

OC06.03: Shortening fraction of the right ventricle (SFRV)—a potential ultrasound marker of trisomy 21 between 11 and 13 + 6 weeks' gestation

P. Calda1, M. Brestak1, V. Tomek2, D. McKenna3, J. Sonek3 1Department of Obstetrics and Gynaecology, Charles University, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; 2Kardiocentrum and Centre for Cardiovascular Research, University Hospital Motol, Prague, Czech Republic; 3Department of OB/Gyn, Wright State University, Fetal Medicine Foundation USA, Dayton, OH, USA