[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.

[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.

[Hemostatic effects of oxidized cellulose]. / Hemostatické úcinky oxidované celulosy.

Oxidized cellulose ranks among nontoxic and biocompatible biopolymers. Oxidized regenerated cellulose (ORC) is manufactured from regenerated cellulose derived from wood pulp containing about 50% of cellulose. To obtain purified cellulose, it is necessary to decompose it in a chemical way and subsequently put it together to make "regenerated" cellulose. Thanks to its good hemostatic effects, high biosolubility and biodegradability, antioxidant and wound-healing properties, oxidized cellulose represents a suitable means for the therapy of bleeding conditions in various fields of medicine. In addition, the confirmed bactericidal effects of oxidized cellulose towards a wide spectrum of aerobic and anaerobic pathogens increase the therapeutic potential of this agent for use in clinical practice. At present there is a renewed interest in its wider use in clinical practice and in an improvement of the knowledge of its mechanisms of effects, which are tested in vitro, on animal models as well as in clinical studies. The present paper attempts to summarize the hitherto knowledge of hemostatic properties of oxidized cellulose and also to characterize other possible biological effects.

Endometrial expression of the estrogen-sensitive genes MMP-26 and TIMP-4 is altered by a substitution protocol without down-regulation in IVF patients.

BACKGROUND: The aim of this study was to analyse the effects of an estradiol (E(2))-progesterone substitution protocol on the endometrial expression of estrogen-sensitive genes during the peri-implantation period. METHODS: Peripheral blood and endometrial biopsies were obtained from 13 infertile women both in a natural cycle (NC), on days 5 and 7 after ovulation (NC5, NC7), and in an artificial (substituted) cycle (AC), on days 5 and 7 of progesterone addition (AC5, AC7). Estrogen receptor-alpha (ERalpha) and progesterone receptor (PR) were assayed by immunohistochemistry. Matrix metalloproteinase-26 (MMP-26) mRNA and tissue inhibitor of metalloproteinase-4 (TIMP-4) mRNA were semiquantitatively assessed in tissue sections using in situ hybridization (ISH) and quantified in tissue extracts using real-time PCR. RESULTS: Levels of both E(2) and progesterone were higher in the peripheral blood in AC than in NC. Also on day AC5, expressions of ERalpha, PR and MMP-26 mRNA (focally) were increased in the epithelium and TIMP-4 mRNA in the stroma. Expression levels of these genes dropped significantly between AC5 and AC7, but not between NC5 and NC7. Abnormally high levels in AC5 samples suggest overstimulation with E(2), and the rapid decrease between AC5 and AC7 suggests overstimulation with progesterone. CONCLUSIONS: In ACs, increased levels of E(2) in the blood exaggerate the endometrial expression of estrogen-sensitive genes, whereas higher levels of progesterone in the blood in the secretory phase exaggerate the drop in expression of these genes. Dramatic variations in the gene expression may not be optimal for the implantation process.

[Protein bcl-2 expression in the secretory endometrium after oral estrogen-progesterone replacement]. / Exprese proteinu bcl-2 v sekrecním endometriu po perorální estrogen-progesteronové substituci.

OBJECTIVE: To compare the changes of the protein bcl-2 expression, regulatory mechanism in the process of apoptosis, in the secretory endometrium throughout natural and artificial (estrogen-progesterone substitution) cycles in the same group of patients. DESIGN: A prospective study. SETTING: Dept. of Obstetrics and Gynecology, University Hospital Olomouc, Dept. of Histology and Embryology, Faculty of Medicine, Palacký University in Olomouc, Dept. of Obstetrics and Gynecology, Bata Hospital, Zlín. METHODS: Endometrial samples (n=56) were obtained on days 5 and 7 after ovulation, progesterone addition, resp. Patients (n=14) included in the study had regular menstrual cycle, age under 40, BMI range 20-32 and basal FSH level range 5-9 IU/l. The collected samples were processed routinely and bcl-2 was estimated by indirect three level imunohistochemic method. RESULTS: We demonstrated the bcl-2 expression in all evaluated layers (epithelial surface, stroma, glands) of the mid-secretory endometrium in both cycles. No difference was found in bcl-2 expression between days 5 and 7 in the secretory phase of the natural cycle. In artificial cycles higher bcl-2 expression was found only in epithelial surface (p<0.05) between days 5 and 7. On day 7 higher bcl-2 expression was found in the artificial cycle in the endometrial epithelial surface (p<0.001) as well as in spongy layer (p<0.01) and compact layer (p<0.05) comparing to day 7 of the natural cycle. CONCLUSION: The bcl-2 expression in the mid-secretory endometrium is significantly higher in the cycle with estrogen-progesterone substitution comparing to the natural cycle. These changes were more significant in endometrial and glandular epithelium than in stromal cells.

[Comparison of apoptosis expression in the secretory endometrium during a normal menstrual cycle]. / Porovnání exprese apoptózy v sekrecním endometriu prirozeného menstruacního cyklu.

OBJECTIVE: Comparison of level of apoptosis in the mid-secretory human endometrium. DESIGN: Clinical-laboratory trial. SETTING: Department of Gynecology and Obstetrics, Medical Faculty, Palacký University, Faculty Hospital, Olomouc, Department of Gynecology and Obstetrics, Bata Hospital, Zlín. METHODS: Samples of secretory endometrium were obtained from 14 women. The women included in the study had the next criteria: a history of infertility of more than 12 months, regular menstrual cycles, age below 40 and FSH basal level range 5-9 IU/L. Sampling of tissue was performed after confirmed ovulation by LH surge and repeated ultrasound examinations. Patterns were processed by routine methods and apoptosis was detected using TUNEL assay. RESULTS: The level of apoptosis in the endometrial epithelial surface was significantly higher on day +7 compared to day after ovulation (P < 0.02). Apoptotic cells were seen only sporadically in endometrial stromal cells. The level of apoptosis in endometrial stroma was also higher (but not statistically significant) on day +7 compared to day The level of apoptosis was markedly higher in spongy layer on day +7 (P < 0.01) compared to day There were no significant differences between day and +7 in compact layers of the glands.

Apoptosis and expression of proliferative proteins in the developing nervous system and orofacial region of human embryos.

We have studied expression of PCNA and Ki-67 in the developing nervous system, sensory organs and orofacial regions in human embryos and fetuses, using monoclonal antibodies PC-10 and MIB-1 in three-step immunohistochemical method and apoptosis performed by TUNEL technique. Expression of PCNA and Ki-67 increased with the age. Apoptosis was rare in above mentioned regions.