[Diaphragmatic surgery in advanced ovarian cancer therapy]. / Chirurgie bránice v lécbe pokrocilého karcinomu ovaria.

OBJECTIVE: Advanced ovarian cancer is a lethal disease. More than 75% of women with ovarian cancer are diagnosed in advanced stage FIGO IIIC-IV. The combination of surgical cytoreduction without residual tumor, and chemotherapy is the only way to prolong overall survival of women with advanced ovarian cancer. DESIGN: Systematic review. SUBJECT AND METHODS: Current literature review. CONCLUSION: Due to frequent involvement of the diaphragm in women with advanced ovarian cancer and the effort of optimal debulking is the inclusion of diaphragmatic surgery necessary for so affected women. Diaphragmatic surgery increases the rates of optimal cytoreduction, improves survival of women with advanced ovarian cancer and has acceptable morbidity rate.

[Hyperechogenic fetal bowel as a marker of fetal cystic fibrosis]. / Hyperechogenita intestina jako marker cystické fibrózy u plodu.

INTRODUCTION: Hyperechogenic bowel (HB) occurs in 0.1 to 1.8% of normal pregnancies. In most cases it has no consequence for the foetus, but can be associated with cystic fibrosis (CF), chromosomal defects, genetic syndromes, viral infections, gastrointestinal pathology, missed gravidity, IUGR and preterm labour. OBJECTIVES: Assessment the risk of the foetus having CF or other abnormalities when HB was detected during ultrasound screening in the second trimester of pregnancy in our centre. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, Centre of Fetal Medicine and Genetics, KNTB a.s. Zlín. METHODS: Retrospective analysis of 149 cases of HB between 17 to 22 weeks of pregnancy detected from January 2008 to April 2012. HB was evaluated according to its degree of echogenicity (Slotnik/Abuhamed classification), presence or absence of other ultrasound markers and the result of first trimester combined screening result. When stage II or III HB and/or borderline risk in first trimester screening, and presence of other ultrasound markers was detected, amniocentesis (AMC) was performed to investigate the karyotype, mutations in the CFTR gene and presence of viral infections (cytomegalovirus and parvovirus B19). If stage I or II HB and/or negative I. trimester screening and no other ultrasound markers, viral infections and mutations in the CFTR gene were investigated form maternal blood. If positive, paternal blood sampling testing for mutation in the CFTR gene was performed. If a mutation was detected in both parents, AMC was performed. Mutations of the CFTR gene was investigated with a commercial panel of 33 to 50 most common mutations. Postnatally the outcome of neonatal screening for CF(IRT) and any newborns with congenital malformations were ascertained. RESULTS: HB was seen in 149 foetuses, AMC was performed in 94 (63%), and blood sampling in 55 (37%). Two mutations in the CFTR gene associated with a severe form of CF (deltaF508/3849 KBC +10 T) were found in one foetus from the AMC group with stage III HB. The parents decided to terminate the pregnancy. The incidence of HB in our group was 0.7%. In 4 foetuses (2.7%) with stage II HB heterozygous deltaF508 mutation was found, in the rest no mutations were detected. Parents of heterozygous carriers underwent genetic consultation. Postnatal CF screening (IRT level from a heel prick sample) was negative; therefore no further molecular genetic analysis was performed. Infection was detected in three foetuses; one case was managed with intrauterine transfusion and in the other two cases parents decided for termination. Four cases (2.7%) were terminated because of severe congenital anomalies. Minor congenital abnormalities were detected in seven (4.7%) cases. Intrauterine death was detected in three (2%) pregnancies. CONCLUSION: Based on our results, HB can be considered as a significant marker for the risk of CF, especially in HB stages II and III. It also demonstrates the importance of this marker for the risk of other foetal abnormalities.

[Hormonal replacement therapy by patientsafter treatment for gynecological cancer]. / Hormonálne substitucní lécbau pacientek po lécbe pro zhoubný gynekologický nádor.

OBJECTIVE: The most of gynecological cancers are diagnosed in postmenopausal period. There are, however, part of the premenopausal women which occurs to develop vegetative problems after medical procedures. The aim of the study is to provide an overview of the current status and views on hormone replacement therapy in women after treatment for gynecologic malignancy. SUBJECT: Systematic review. METHODS: Current literature review. CONCLUSION: The available literature sources don't show that hormone replacement therapy for premenopausal women worsens the prognosis of the underlying disease after treatment of gynecological cancer. The limiting factor in most of the works are small groups of patients and the low stage of disease at enrollment (especially for endometrial cancer). Even though no study has shown worsening prognosis or shorter disease free interval. However, it is necessary to proceed individually for each patient with an evaluation of the current status and potential benefits that this treatment can get.

[The surgical procedure of mini-sling antiincontinence procedure AJUST, recommendations and ways of solution of possible special situations]. / Operacní postup mini-páskové antiinkontinentní operace AJUST, doporucení a zpusoby resení mozných nestandardních situací

The objective of our work was to present and summarize the course of a joint meeting of surgeons with experience with AJUST in SUI anti-incontinence treatment. We would like to discuss the operation procedure and its individual steps. Further aim was to determine the optimal operation procedure, step by step, avoiding possible complications in the course of the procedure; simplifying the technique and publishing the recommendations how to solve possible complications in the course of, or after, the operation procedure, was important outcome of the meeting.

[Prolene mesh comparing with sacrospinal fixation in the treatment of genital prolapse in women. Prospective multicentre randomized study]. / Alogenni prolenové implantáty ve srovnání se sakrospinální fixací v lécbe prolapsu; randomizovaná multicentrická prospektivní srovnávací studie.

OBJECTIVE: Polypropylene mesh in the treatment of genital prolapse in women was introduced at the turn of the millennium with the rationale of decreasing surgical invasiveness, reinforcing weak tissues and to possibly complement insufficient surgical techniques. Prospective randomized studies comparing traditional and modern operations are lacking. SUBJECT: Prospective multicentre randomized study. SETTING: Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague. SUBJECT AND METHOD: A prospective multicentre trial was approved by the Ministry of Health of the Czech Republic and registered with the FDA planning to recruit 500 patients with vaginal prolapse, 18 years of age and over, undergoing surgery at 5 major urogynaecologic centres. The patients were divided into three groups according to prolapse predominance. The surgical techniques used were: anterior and posterior prolift, and randomly allocated total prolift or sacrospinous fixation. The examination setup included lower urinary tract ultrasound, MRI, POP-Q assessment and QoL questionnaires before surgery and six and 24 month after the surgery. CONCLUSION: Preliminary analysis of partial data of 225 women showed an acceptable rate of complications and a better success rate in the mesh groups, whereas operation time and blood loss was lower in the classical operation group. Quality of life questionnaires documented that all the methods used have comparably good results. The surgical techniques used are acceptable methods for pelvic organ prolapse repair with low complication rates and excellent impact on the subjective perception of the patient's quality of life.

[Using free mesh to prevent recurrence of cystocele]. / Pouzití volné sít'ky k prevenci recidiv cystokély.

OBJECTIVE: Assessment of the effect of utilisation of mesh in order to prevent recurrence of cystocele. SUBJECTIVE: Case study. SETTING: Department of Obstetrics and Gynaecology, Bata Hospital, Zlín. METHODS AND RESULTS: We evaluate the experience of using free mesh in the solution of cystocele. We implanted a total of 30 meshes. A free mesh is a preventive measure which only secondarily creates a suspension in the region of the anterior compartment of the vagina. Objective evaluation of the method requires a longer time interval.

[TVT (transvaginal mesh) surgical method for complex resolution of pelvic floor defects]. / Metoda TVM (transvaginální mesh) pro komplexní resení defektu pánevního dna.

OBJECTIVE: Assessment of the effects of a new surgical method for complex resolution of pelvic floor defects. SUBJECTIVE: Case study. SETTING: Department of Obstetrics and Gynaecology, Bata Hospital, Zlín. METHODS AND RESULTS: We evaluated the procedures and results of the new TVM (transvaginal mesh) surgical method which we used in a group of 12 patients. Ten patients had vaginal prolapse following vaginal hysterectomy and in two cases there was uterine prolapse and vaginal prolapse. Only in one case there was a small protrusion in the range of 0.5 cm which we resolved by removal of the penetrated section. The resulting anatomic effect was very good in all the cases.

[Posterior free tape for the reduction of enterocele]. / Posteriorní volná páska k resení enterorektokély.

OBJECTIVE: Evaluation of the effect of posterior free tape for the reduction of enterocele and rectocele. SUBJECTIVE: Case Study. SETTING: Department of Obstetrics and Gynaecology, Bata Hospital, Zlin. METHODS AND RESULTS: A very effective solution for the reduction of large enterocele and rectocele is the utilization of posterior free tape. At our workstation we use posterior TVTo, thus the "inside out" method when, after preparation of the ischiorectal space, the tape is stitched into the apex of the enterocele, and by tension balances, the posterior compartment. From November 2003 to January 2005 we carried out 20 operations. The anatomic effect in all on women operated was very good. In two cases we encountered haemorrhage with haematoma at the apex of the enterocele with the resulting protrusion of the tape. We resolved both cases by elimination of the slit tape.

[Treatment of insulin-dependent diabetics during delivery]. / Problematika péce o inzulindependentní diabeticku behem porodu.

The authors discuss the care of an insulin-dependent diabetic woman during delivery. Due to the introduction of modern procedures in diabetology, obstetrics and neonatology the perinatal mortality in diabetic pregnancies is close to that in healthy women. In the Zlín region there was in 1997 a total of 2301 deliveries, incl. 8 IDDM patients (0.34%) and 32 patients with gestational diabetes (0.72%). The perinatal mortality in diabetic pregnancies was 0 pro mille and in non-diabetic ones 5.14 pro mille.

Necrotizing crepitant cellulitis of the abdominal wall following a caesarean section and subsequent hysterectomy.

A case report of necrotizing crepitant cellulitis of abdominal wall following caesarean section is presented. Because of intense haemorrhage it was namely necessary to perform additional hysterectomy and bilateral hypogastric artery ligation. Serious wound infection and sepsis were successfully treated by administration of antibiotics and repeated deep incisions.